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Home My WebLink AboutTR-8277 �� , V vujy�l0 Michael J.Domino, President Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders G Southold,New York 11971 Glenn Goldsmith O �O Telephone(631) 765-1892 A.Nicholas Krupski �lycoum Fax(631) 765-6641 BOARD OF TOWN TRUSTEES July 19, 2017 TOWN OF SOUTHOLD Michael A. Kimack P.O. Box 1047 Southold, NY 11971 RE: PAUL GROBEN 3705 WELLS ROAD, PECONIC SCTM#: 1000-86-2-13 Dear Mr. Kimack: ;. The following action was taken by the Southold Town Board of Trustees at their Reguldr;. Meeting held on Wednesday, July 19, 2016: ; RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative- Amendment to Wetland Permit#8277 to install a 6'x20'floating dock secured by four(4) 8" diameter piles set in an "I" configuration in lieu of a 4'x16' floating dock; and as depicted on the project plan prepared by M.A. Kimack, dated June 18, 2017, and stamped approved on July 19, 2017. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Au Michael J. Domino President, Board of Trustees MJD/dd BOARD OF ]i�UST ES ,. T®VO/%1-O F OUT I.O JUN 2 0 20Tj DATE — 460 R 07MI`I Southold Town — oard of Trustees = 1� oPo�' Gro'��a.4l elzV 61ftf11,,PX4 CE 2?)l InZ,104�91) _tea_ ��°,�� ,�.a�•�,� ; ri 14-OASE If 6 56 qzIA 76 - -SC, flv-,cL4S RD f P,COA1/C', AI.Y Michael J. Domino, Presi( OS0F01 CO ) Town Hall Annex John M. Bredeineyer III,Vice-Pretaen_t ��O G�� 4# 54375 Route 25 Charles J. Sanders z P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski �O �O� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: I/JI7 P1,00 Completed in field by: Michael Kimack on behalf of PAUL GROBEN requests an Administrative Amendment to Wetland Permit#8277 to install a 6'x20' floating dock secured by four (4) 8" diameter piles set in an "I" configuration in lieu of a_4'xl6' floating dock. Located: 3705 Wells Road, Peconic. SCTM# 1000-86- 2-13 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of 'a-ring Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line a Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: 017 1�,, I�d2 �k vabil d ? Present were: k_�J. B edemeyer _;Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino,Presk }; r( �O5V�Fat/(0 a' Town Hall Annex John M. Bredemeyer III,Vice-President ,�,Z ��, 54375 Route 25 Charles J. Sanders P.O.Box 1179 Glenn Goldsmith 1�_ Southold,NY 11971 A.Nicholas Krupski p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Michael Kimack on behalf of PAUL GROBEN requests an Administrative Amendment to Wetland Permit#8277 to install a 6'x20' floating dock secured by four (4) 8" diameter piles set in an "I" configuration in lieu of a 4'x16' floating dock. Located: 3705 Wells Road, Peconic. SCTM# 1000-86- 2-13 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources:, D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Ned Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 MAP OF DESCRIBED PROPERTY LOCATED AT PECONIC, \ WILLIAM&ANGELA WEISSERT TOWN OF SOUTHOLD, \ 3440 WELLS ROAD CO. OF SUFFOLK, ST. OF N.Y. \ PECONIC, N.Y. 11958 SCTM NO. 1000-86-02-13 \ 86-01- 13 E r E SKWARA \ �n✓ l� 1 S ROAD \ PECO C, J.Y. 11958 — — 14 6.71 FOCMON SCALE: 11=30' 3 2017 101.0560D outhold Town • 6g5��F10 Board f T u RS''" O -p° i tp WELLS rj,\ < 755FDCMON R=256.60 0 2`CI�� CONC MON. N •L �®y a. TAX LOT 13 co Q a •825 FD8013 629 yO� OJ m SLATE WALK- may m moo 0) Z r ? 34.3 GAR. i , r I � = 30.0 26.2 N < to N 1 STORY FRAME 6 { Z y w BRICK N0.3705 Cil � � pNo No 39.0 7 / \ 15.6 5.6 n c w � r o SLATE DECK A I31.0 e. /`A' 26tz 0.51 T E SINE 0 80D3 1-1 0 1'20" 3.0 .499 0 MON. 468CP FDBOD/ S 71 1 OUSTING FD(ED RAMP \ o • ORDIN'gRY 1 HIGHo OBSF Y 20 3 C�8 M 2951+/ STATIONARY PORTION OF DOCK&PILES I. I i-16 MA -SON SURREY 30 dUN SEVERELY DAMAGED BY SUPERSTORM SANDY---, I 112 WATER MARK PER VAN TUYL ` vE I to LT-0 18 EXISTING FWED DOCK BUTT_111, LTCL-022 -07B CLPOSTB RICHMOND CREEK NOTES: BOTTENDFIXDOCK-1.11 ?O� AC:ASPHALT BUTT-1 61• 3,-0 00 LT BOTT.:BOTTOM \ PROPOSED REMOVABLE RAMP ALUM.:I2.OX3.0 10.0 CB:COBBLESTONE BRICK te6cLBOTT `�° EX. EXISTING BUTT-261• PILE-1 93 A� EX.SS.LAT.:EXIST SEWER LAT. 150 eon FF:FINISH FLOOR PROPOSED FLOATING DOCK ,20,0 LT:LOW TIDE BOT7.918 PILE-269, -206BOTT NG:NATURAL GROUND PCC:CONCRETE BOTTa71• BOT 276 (=PROPOSED) •v z 62 BOTT SRF:SPLIT RAIL FENCE 6.0 SSMH:SEWER MANHOLE TC:TOP OF CURB TD:TOP DECK TG:TOP GRATE TH:TEST HOLE -3 53 Kon TW:TOP OF WALL SURVEYED:20 AUGUST 2012 TX:TOP OF DRIVEWAY"X" UPDATE:STORM DAMAGE 07 APRIL 2013 WD UPDATE:PROPOSED REPLACEMENT DOCK 03 AUG 2013 OFW REVISION:PROPOSED FLOATING DOCK 21 JUN 2017 PROPERTY OF: �P� �� A• G,1 e0 0 PAUL &ANNE GROBENUj Q`� 2 3705 WELLS ROAD THE OFFSETS OR DIMENSIONS SHOWN HERON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE&USE.THEREFORE,THEY ARE PECONIC,N.Y. 11958 NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION n e OF FENCES,ADDITIONAL STRUCTURES OR ANY OTHER IMPROVEMENT. S/ PROPOSED REPLACEMENT ' UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THIS SURVEY IS A VIOLATION OF SECTION 7209 SUBDIVISON 20 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF FIXED DOCK W1 PILINGS, OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR REMOVABLE RAMP&FLOATING DOCK LANDS LY N�?` C. 50869 EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. P.O. BOX , NY 11961 CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM 631.849.4750 THE SURVEY IS PREPARED, AND ON THEIR BEHALF TO THE TITLE COMPANY,GOV- ERNMENT AGENCY AND LENDING INSTITUTION LISTED HEREON CERTIFICATIONS MEASURMENTS HEREON WERE TAKEN WITH A TOPCON GTS3B TOTAL STATION ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. NO RESPONSIBILITY IS ASSUMED BY THE UNDERSIGNED FOR ANY SURFACE, UTILIZING AN HP 48GX DATA COLLECTOR WITH TDS SURVEY-PRO SOFTWARE. SUB-SURFACE,AERIAL EASEMENTS,SUB-SURFACE UTILITIES AND/OR ELEVATIONS SHOWN HEREON ARE REFERENCED TO MLLW DATUM STRUCTURES IN OR OUT OF EASEMENTS IF SO PROVIDED. SCTM 1000-86-02-13 John M. Bredemeyer 111, President 'Town Hall Annex 54375 Main Road Michael J. Domino,Vice-President ,_' I7, i P.O. Rol 1179 James F. lKiing, Trustee 4 ,w Southold, New York 11971-0959 Dave Bergen,Trustee t jl yr Telephone (631) 765-189`2 Charles J. Sanders,s, I rustee �, `y1 UNC, yj\a��' tl Fax (631) 765-6641 iC1,*M 1` 330ARD OF TOWN TRUSTEES TOWN DFSOUTHOLD Off ce Use Only __Coastal Erosion Permit Application __Wetland Permit Application Administrative Permit / Amendment/Transf r/Extension 1Received Application: x,1 7 XReceived Fee:$ %!50&00 Completed Application: _ �• '�_-(T_ _Incomplete: SEQRA Classification: C E � V E Type I _ Type II _ Unlisted . /coordination:(date sent): -7a 7.17 V- LWRI'Consistency Assessment Form: _ _ JUN 2 0 2017 CAC Referral Sent: Date of Inspection: 7 11.1-1 _Receipt of CAC,Report: _T Southold sown Lead Agency Determination: rd of Trustees Technical Review: _ Public Hearing Held: 7s 1-",1 Resolution: Name of Applicant: D ^® Mailing Address: . 12---6 � .f�,� 1i�_��JI� g� Phone Number: �) _ �7, Suffolk County Tax Map Number: 1000 - -,� _ q Property Location:_ �� a P (provide LILCO Pole#, distance to cross streets, and location) AGENT: . (If applicable) Address: � �� Ly� / R ,oard of Trustees Appl.i.cat a GENERAL DATA Land Area(in square feet): Area Zoning: 40 Previous use of property: Intended use of property: A�„_77 o 0 6&7_®o#,1_44 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 the 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 _ -.—No Does the structure(s) on property have a valid Certificate of Occupancy? Y Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has,any permit/approval ever been revoked or suspended by a governmental agency? No Yes. If yes,provide explanation: Project Description (use attachments if necessary): _ (� �' —77- C P 61) �C X46 A�T A�Co rlm6 P®Gx:�, oasd of Trustees Applicat ra WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: dQ square feet Percent coverage of lot: zz % Closest distance between nearest existing structure and upland edge of wetlands: ® feet Closest distance between nearest proposed structure and upland edge of wetlands: — feet j",-L 0,471-1V& A62®CL- e/I Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: A//W feet Proposed slope throughout the area of operations: A&— Manner in which material will be removed or deposited: 1W 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): 617.20 Appendix B Short Environmental Assessment Fornt Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Past 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item, Part I -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action. fl✓� /rr� 6 f� �o Fr. ��o,��.�(� �a Cie -fA�W&',C-P ey o0/4 � �,�M ��ciivGs w� a� GUS 12/a 4 Cr' X /d tel" CL 9'077ivG ®Q C/-e Name of Applicant or Sponsor: Telephoner/A AQ_ —1 Address: City/PO: State: Zip Code: 10 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. l� 2, Does the proposed action require a permit,approval or funding from any other governmental Agency? NO_ YES_ If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? _� —acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): _ ❑Parkland Page I of 4 5. Is the proposed action, - — NO YES N/A .. _._. a. A permitted use under the coning regulations? b.Consistent with the adopted comprehensive plan? __...__ ___-- _ _—. 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape!? ```� 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NOYES If Yes, identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action'? (-`l c. Are any pedestrian accommodations or bicycle routes available on or near site of tite proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES if the proposed action will exceed requirements,describe design features and technologies- 10.Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: �_......� . ._.__ _ EJ 11.Will the proposed action connect to existing wastewater utilities? NO YES 1 f No,describe method for providing wastewater treatments ^�� El �� 12 a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? EL 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? (� If Yes,identify the wetland or waterbod and extent of alterations in square feet or acres: t._ l 14. I dtify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: - ❑Forest ❑Agricultural/grasslands ❑Early mid-successional Wetland ❑Urban XSuburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will storm water discharges flow to adjacent properties? 14 NO F_JYGS b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: NO AYES Page 2 of 4 18, Does the proposed action include construction of other activities that result in the Impoundment of _ NO YES water or other liquids(e.g retention pond,waste lagoon,dam)? If Yes,explain purpose and size: _ 19.Has the site of the proposed action or an adjoining property been the location of an act ive or closed NO YES solid waste management facility? If Yes,describe: _ _ R�1 ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE �® Applicant/sponsor name:_ Alf/C �/�i�C C Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions in Part 2 using the information contained in Pail 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or Toning D regulations? [A — L2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? - uEL 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? (� 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ( ❑ reasonably available energy conservation or renewable energy opportunities? U 7. Will the proposed action impact existing: a. public/private water supplies? t I b.public/private wastewater treatment utilities? LJ 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,_ watcrbodies,groundwater,air quality,flora and fauna)? `--t Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action resuIt in an increase in the potential for erosion,flooding or drainage ( problems? F) 11. W ill the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. ( j Check this box if you have determined,based on the information and analysis above,and any supporting documentation, tt�,Il that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impact Town of Southold-Board of Trustees r^ Name of Lead Agency Da e 'Do ft()i;b President Pi int or Type Ne of Res ons'ble Officer in Lead Agency Title of Responsible Officer Signature of Resp n ible Officer in Lead Agency _ Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 L-;.-rd of Trustees Applicatia.. s County of Suffolk State of New York AA41,L ,��, O� i+ 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. &3 Signature of Property Owner SWORN TO BEFORE ME THIS DAY O 5204-�_ Notary Public KAREN COSTA No.01 C06165801 Notary Public,State of New Yor Qualified in Suffolk County < My Commission Expires 05114/ L,.,-rd of Trustees Applicatio=i- AUTHORIZATION (where the applicant is not the owner) I, P &/— Ovg? per_residing at Z'6 4 o'rn k1,4"Z Al, (print owner of property) (mailing address) S7`®N 9' �4(.��,��1 uX /1736 do hereby authorize (Agent) ASB ,� � , s�//'�✓ ��to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) ' ' TRANSACTIONAL DISCLOSURF,FORM thi,g form is to-provide wrormation..which can qlg!rt.t1rq town or nossihic conflic6 of interestand allow it to take-Mia(ever action L� necosaa to avoid same. TODRNAMG (List name,first name,-irliddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicatelthe other person's or company's name.) NAME 0yAPPLICATION: (Check all that oyyly.) Tax grievance Building Variance Trustee Chuogeo[Zon* Coastal Erosion Approval vfplat Mooring Exemption from plat orofficial map Y>uouing Other (|["Othnr'`omnnthe ucbvityJDo you personally(or through your company,spouse,sibling,parent,or child)havea__ ( with any officeremployee of the Town of Southold? "Relationship" includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which(fie town officer or employee has even a partial owne:N-lip of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO 1 �___ ' <fyou answered~YES'.complete tile balance of this form and domundsign where indicated, Name ofperson employed hytile Town nfSouthold ________ -- ?h|oorposition o[that pccmn__________ Describe the relationship between yourself(tile applicaiiVtigetit/represciitative)and die town officer or employee.Either check the aypmyrlon line A)through\qand/or describe inthe space pmvidod. ' The town officer oremployee orhis orher spouse,sibling,parent,orchild(s(check all that apply): tire owner oygreater than 5Y6o[the shares of the corporate stock o[the uyp|ie*m| . (when tko applicant is ucorporation); the legal orbeneficial owner ofany interest bounon-corporate entity(when the applicant ionot uoorponatioo); uoofficer,director,partner,oremployee o[tire applicant;nr _____1D)the actual upy|iouot, --- -- — ----- ' ' - - ----' - DESCRIPTION OFRELATIONSHIP - Submitted this of moe 4-A a. Ole, 11-7 Print Name Form TQ1 Town of Southold rt LWRP CONSISTENCY ASSESSMENT FORINT 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 infonnation 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 preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area-(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" 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 Doth supporting and Hou supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork,net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office, B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME .S'U�� ,?'� " s ti fL izL 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: l�J Nature and extent of action: N � Location of action: 3!1�.5� &ZZe-F A9A�� GPOA& C Site acreage: Present land Present zoning classification: S'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: _ (b) Mailing address: (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 EI 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, snakes efficient use of infrastructure, snakes beneficial use of a coastal location, and minimizes adverse effects of development. See I.` RP Section IIT—Policies; Page 2 for evaluation criteria. Yes [:] leo 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 El No J� 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 0 No [:j Not Applicable if ZAP 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 A through 16 for evaluation criteria Yes ❑ No ID651 Not Applicable 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 1:1 No 50 Not A plicable QA1 gg v Z 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 LVVRP Section III—Policies; Pages 22 through 32 for evaluation criteria. E] E Yes No Not A,,,,--cable 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 X 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 LVVRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 21 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❑ NoX Not Applicable Attach additional sheets if necessary WORKING COAST POLICI�,� Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent rases in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No XT 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 J9 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 W 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 0 Not Applicable PREPARED BY TITLE- ,, �'� DATE r aul Groben - 705 Wells Road,Peconic CTM#: 1000-86-2-13 /11/17 'y y f _ _ �1 . Am. .�.:.: e n,..- " pk !r = � ��". _._: __ '� ,k !�� i:.k^{wry ..:��, 7i �°b��,'�- d�-'dFc+J Y- ..�' 1 _ - � = ' ____ _=a. —_—_-___ ....,. _.; �. . �,.: -�, r - -- --- � . - �- - - - - : .: �yr«., _l �_' = i *rjf SO John M. Bredemeyer III, President �Vv Ol Town Hall Annex 54375 Main Road Michael J. Domino,Vice-President P.O. Box 1179 James F. King,Trustee C Southold, New York 11971-0959 Dave Bergen,Trustee • y0� � Charles J Sanders,Trustee � Telephone (631) 765-1892 COMM Fax(631) 765-6641 BOARD OF TOWN_TRUSTEES TOWN OF SOUTHOLD August 19, 2015 Paul Groben 26 Lotowana Lane Stony Brook, NY 11796 RE: PAUL GROBEN 3705 WELLS ROAD, PECONIC, SCTM# 86-2-13 Dear Mr. Groben: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 19, 2015: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit#8277, as issued on August 21, 2013. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. incerely, = -M7- John M. Bredemeyer III President, Board of Trustees JMB:dd IUo g -7 -7 OL NP CL-I-S Sjo JUL 2 8 241 John Bredemeyer, President �OSUFF91.t Town Hall Annex Michael J. Domino, Vice-President °° °°y 54375 Route 25 James F. King ti $ P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen oi ,� �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: fl /1 PAUL GROBEN requests a One-Year Extension to Wetland Permit#8277, as issued on August 21, 2013. Located: 3705 Wells Road, Peconic. SCTM# 86-2-13 Type'Qfarea 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 Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed- Modifications: Conditions: Present Were: J. Bredemeyer M. Domino J. King /D. Bergen C. Sanders Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: James F. King,Presidente�fFO( Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President ao� x�l6y P.O.Box 1179 Dave Bergen w Southold NY 11971 W John Bredemeyer may. Telephone(631)765-1892 Michael J. Domino 1 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 %z constructed Project complete, compliance inspection I BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8277 DATE: AUGUST 21,2013 ISSUED TO: PAUL GROBEN PROPERTY ADDRESS: 3705 WELLS ROAD, PECONIC SCTM# 86-2-13 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 Aueust 21,2013,and in consideration of application fee in the sum of$250.00 paid by Michael A. Kimack 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 replace in the same location a 41x50' fixed dock; a 3'x28' fixed ramp; a 3'x12' removable aluminum ramp; and a 4'x16' floating dock secured by two sets of mooring pilings; decking to be Thru-Flow and railings to be a composite material; with the condition 6" pilings be used through wetlands and 8" pilings be used in the creek; and as depicted on the site plan prepared by Michael Kimack, last dated May 20, 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. TERMS AND CONDITIONS The Permittee, Paul Groben residing at 3705 Wells Road, Peconic,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: I. 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 he 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. James F. King, President ��Of SO!/jyo Town Hall Annex Bob Ghosio,Jr.,Vice-President h� 54 Main Road P..O.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino 0 �O Telephone(631) 765-1892 UPR(,� ► Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 21, 2013 Mr. Michael Kimack 321 Riverside Drive Riverhead, NY 11901 RE: PAUL GROBEN 3706 WELLS ROAD, PECONIC SCTM# 86-2-13 Dear Mr. Kimack: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 21, 2013 regarding the above matter: WHEREAS, Michael Kimack on behalf of PAUL GROBEN 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 3, 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, in accordance with Chapter 268, said application was found to be Exempt from 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 0 0 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 approve the application of PAUL GROBEN to replace in the same location a 4'x50' fixed dock; a 3'x28' fixed ramp; a 3'x12' removable aluminum ramp; and a 4'x16' floating dock secured by two sets of mooring pilings; decking to be Thru-Flow and railings to be a composite material; with the condition 6" pilings be used through wetlands and 8" pilings be used in the creek; and as depicted on the site plan prepared by Michael Kimack, last dated May 20, 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: $986.00 Very truly yours, James F. King President, Board of Trustees JFK/amn 0 0 James F. King, President g0fF0(p C Town Hall Annex Bob Ghosio,Jr., Vice-President �� G 54375 Route 25,P.O. Box 1179 0 Dave Bergen ; Southold,NY 11971 John Bredemeyer �� a Telephone(631)765-1892 Michael J. Domino �O! * Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Michael Kimack for Paul Groben Please be advised that your application dated 6/3/13 has been reviewed by this Board at the regular meeting of 8/21/13 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) % Constructed ($50.00) XX Final Inspection Fee ($50.00) XX 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: Final Inspection- $50.00 Dock Fees- 4'x32' fixed dock (128 sq. ft.)x $3.00 per sq. ft.= $384.00 3'x28' fixed ramp (84 sq. ft.)x $3.00 per sq. ft.= $252.00 3'x12' aluminum ramp (36 sq. ft.)x $3.00 per sq. ft.= $108.00 4'x16' float (64 sq. ft.)x $3.00 per sq. ft.= $192.00 TOTAL FEES DUE: $ 986.00 BY: James F. King, President Board of Trustees mA « , e 'z�'+ ._ate •"`,< ' " y ,r " ,L - - - .. -_. "r • 4 As ��...�� . Wi T. r _ JW LC 14 lo i y � l��`+µ �-1 � ;: 7•.;' , � �-';� ��'`' ` `l, �� '�''� .fir= Tom, �� " �,• . 7 ter• .. �� `t'�1 ��t t.� Y'•� I:. a t� •i /r• y -� ^ —�I �s gUFFO(�- James F.King.President ¢�p� C P.O. Box 1179 Bob Ohosio..Ir.. Vice-PresidentVj Southold.NY 11971 Dave Bergen Telephone(631 765-1892 John Bredemcyer � T � Fax(63 1)765-6641 Michael I Dmnino Southold Town Board of Trustees Field I 7nspection/Work Session Report Date/Time: �`� 1 Michael Kimack on behalf of PAUL GROBEN requests a Wetland Permit to replace in the same location a 4'x50' fixed dock; a 3'x28' fixed ramp; a 3'x12' removable aluminum ramp; and a 4'x16' floating dock secured by two sets of 8"- 9" diameter mooring pilings; decking to be Thru-Flow and railings to be a composite material. Located: 3705 Wells Road, Peconic. SCTM# 86-2-13 Type of area to be impacted: saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland U� Part of Town Code proposed work falls under: —Ofiapt.275 Chapt. 111 _other Type of Application: —Wetland _Coastal Erosion _Amendment —Administrative—Emergency _Pre-Submission Violation Info needed: Modifications: Conditions: 6 X11 F s I�1riet Present-Were: King B Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by )-- Afe-d ola" Mailed/Faxed to: Date: �i Ilk" N PaulGroben 13705 Wells Road, Peconic : • K f __ _ \ b 7/10/13 AI � . S I .�y � . , '1 fir. � � ._`. � � . '♦ '� i .lames F.King,Presidentrp� C P.O. Box 1179 Bob Ghosio,.Ir..Vice-President , vs Southold,NY 11971 Dave Bergen Felephone(631 765-1892 John Bredemeyer � T� Fax(631)765-6641 Michael I. Domino Southold Town Board of Trustees Field InspectionlWork Session Report Date/Time: JV L / 4 ?o ) I /art L/ S Michael Kimack on behalf of PAUL GROBEN requests a Wetland Permit to replace in the same location a 4'x50' fixed dock; a 3'x28' fixed ramp; a 3'x12' removable aluminum ramp; and a 4'x16' floating dock secured by two sets of 8% 9" diameter mooring pilings; decking to be Thru-Flow and railings to be a composite material. Located: 3705 Wells Road, Peconic. SCTM# 86-2-13 Type of area to be impacted: lr `� C�E'�r Af _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: Presy�nt Were: ✓ J. King _B. Ghosio Ve D. Bergen, ✓J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: l is <. Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. _._1062._ ....... DATE: APri1...7.........1975 :. `.< ISSUED TO ........_.......................Pa.u.1....Groben ........I........._......I............................... .......................a ,. �l1ltl�Dl'iMft�n Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS ROM LANDS UNDER TOWN WATERS;" and in accordance wi h the Resolution of The Board adopted at a meeting held on ..Apr.i.l....7.. 19.7...., and in of the sum of $22 .71 paid by ii Paul Groben........... of Wells Road, Peconic N. Y. and subject to the H Terms and Conditions listed on the reverse side hereof, a of S9uthold Town Trustees authorizes and permit the followin Builda 60 ft. by 3 ft. catwalk', 0 ft. by ft. 10 in. ramp, 6 ft. by 16 £t. floating dock and two 16 £t. byp 8. in. mooringg piles at his property ou Richmond 8reek, off Ml ls Road, Peconic. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and fh'ase presents to `! be subscribed by a majority of the said Board as of this date. j ✓tom Y�.. 1. ..jt��YIG4.(�n 4 CK Trustees 1 � � m ) -. 1V�L.L,5 .:LOM{ O pea a: oft uwa� r > Y, 0la Y f ' Z 10 a € sga _2 �. -O ate. ., 24c''- _ QRO7Nggy WAT61t ..r y1GL1 n a � f seer ev x c R MAP 'F ROP mascnt ER i Y suRvsy_ A c'pFOR c °e �„ r. o S(rUATC AT .us w.w f`C t!rw3suia T c'YN OF: N SOUr401q °. .Y. a � rum = O.E. ORDINARY N;taN WATER M °� - Cr. R1 A7,g ^HL yNM'ONO CREEK G11+IRANTEED TO TkE A e'' •- 5CALE . 40'= z , INSY¢ANCE COIdnANY O n. MONUYtENT ! `gp$vEYftL` C _. .p •xo CL VA Cic VAbI ?(h^L C Eiv JUN 3 2013 4 �, "mow,•. `�� _ ~w► �� - - _..�-. �,ter '""'•-� - at:` � a�-� � -, .i, ,� ,. 9 1.7111+' '1' ►t `�y 1 , "�•Z.: l': _-� - �+t - i `,\ �.'•�/,�- �►A'+i4 , 1 �'t�� '�'X 7� � -�� v.� •\ ,' � '�� 1r ( 1� 1''•/ J t•.`: 'v 1 � _f _ • �" .�` � 1 f �1�` � �. _ � .. � � 4'11� � �_ w ! w� I .�� 'l ems' ,;��'•�.� 4V, w 1 4;r Alp `M !R' \�_ - .• ; �•' °`� `••. y+�j1�'��..� •lid h f mom 4 , ko �_ �� "AJ �Ili' � .'i 1 y 1 •\ �1.• , `\\\�� `�`` �tir\�� \��t�• �1• `� \\ JOINT APPLICATION FORM For Permits/Determinations to undertake activities affecting streams, waterways, A" waterbodies, wetlands, coastal areas and sources of water supply. New York You must separately apply for and obtain separate Permits/Determinations from US Army Corps of State each Involved agency prior to proceeding with work. Please read all Instructions. Engineers (USAGE) APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart- Check all permits that apply: Check all permits that apply: General Services ment of State ❑ Stream Disturbance ❑ Coastal Erosion ❑ Section 404 Clean Water Act Check all permits that Check'If this ❑ Excavation and FIII In Management ❑ Sapply applies: ❑ Section 10 Rivers and Harbors tate Owned Lands ❑ Coastal ?�Navigable Waters ❑ Wild,Scenic and Act Under Water Consistent ICL Docks, Moorings or Recreational Rivers ❑ Nationwide Permit(s) - Identify y ❑UtilityConcurrence Platforms ❑ Water Supply Number(s): Easement ❑ Dams and Impoundment ❑ Long Island Well Structures (pipelines, ❑ Aquatic Vegetation Control conduits, ❑ 401 Water Quality ❑ Aquatic Insect Control cables, etc.) Certification Preconstruction Notification - ❑Docks, ❑ Freshwater Wetlands ❑ Fish Control ❑ Y / ❑ N Moorings or ❑Tidal Wetlands ❑ Incidental Take of Endan- Platforms gered/Threatened Species lid"I am sending this application to this agency. �"J I am sending this application ❑ I am sending this ❑ lam sending to this agency. application to this this application a enc to this a enc . 5. Name of Applicant(use full name) ApD7l.,ic�alit must be: 6. Name of Facility or Property Owner(If different than L♦ ?wner Applicant) Gjv ❑Operator Mailing Address ❑ Lessee Mailing Address (check all that apply) Post Office City Taxpayer ID(If applicant Post Office City xmw.v B�OOYL is NOT an Individual): State Zip Code/ State Zip Code Telephone(daytime) all Telephone(daytime) Email 7147— -79-4,1 . I 1 1 7. 7- 7. Contact/Agent Name 8. Project/ Facility Name Property Tax Map Section/Block/Lot Number R��L/�� DAHFlG.E� DOC/c- Company Name Project Location- Provide directions and distances to roads, bridges and bodies of waters: OFic W,.6U,9 R440 0' R/C111y4Noo eJW..EIG rO HOG NEC1f BA Mailing Address Street Address, if applicable Post Office Clty State Zip Code zz 370'V WELL3 RR "y 1193'/ Post Office City Town/Village/City County lv v State Zip Code Name of USGS Quadrangle Map Stream/Water Body Name Telephone( ) _ Locatlon Coordinates: Enter NYiMs in kilometers, OR Latitude/Longitude Email NYTM-E NYTM-N Latitude Longitude MIl�M.4�'/CZ@OW17e . 419 41-az-, Al W JOINT APPLICATION FORM 09/10 This Is a 2 Page Application Application Form Page 1 of 2 Both Pages Must be Completed r 0 • JOINT APPLICATION FORM - PAGE 2 OF 2 Submit this completed page as part of your Application. 9. Project Description and Purpose: Provide a complete narrative description of the proposed work and Its purpose. Attach additional page(s) if necessary. Include: description of current site conditions and how the site will be modified by the proposed project; structures and fill materials to be installed; type and quantity of materials to be used (I.e., square ft of coverage and cubic yds of FlII material and/or structures below ordinary/mean high water) area of excavation or dredging, volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource Impacts; and where applicable, the phasing of activities. ATTACH PLANS ON SEPARATE PACES REP4,4cz �/MS'Ai-/,E/-a •4IION) 5-,Q FEFT G5rDOC.e ,1904 /p��>N VV�,OTN, 28 FST of f7X44D RA AIR A9P AN13 Wl,mr%ly A 3 Fr X i2 '.pZvriNUF1 REHGI/.q � RA 1 s.€TS A /6 FTX 4 ' ,FL oT/NG paGl:f 1'ECUR,eO �Y pG FAIL/NGS 5 -r/r,6 PLAAVI. Proposed Use: DrPrJvate ❑ Public ❑Commercial Proposed .r Estimated State: om letion Date: Has Work Begun on Project? ❑ Yes No If Yes, explain. Will Project Occupy Federal, State or Municipal Land? ❑ Yes No If Yes, please specify. 10. List Previous Permit/Application Numbers(if any)and Dates: XtW 47ZP 1OWN TRbsTfE y5yi7- Am 106 2 /-rJVEP APRIZ 7, /97S 11. WIII this project require additional Federal, State, or Local Permits Including zoning changes? XYes ❑ No If yes, please list: ,NEGlU 7-eW,,Y 0FJ27j(1 '6`1-4) rRUs'Z,E PERH/7� 12. Signatures.If applicant Is not the owner, both must sign the application. I hereby affirm that Information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45.of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or Indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said project. In addition, Federal Lave, 18 U.S.C., Section 1001 provides for a fine of not more than $10,000 or Imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies, conceals, or covers up a material fact; or knowingly makes or uses a false, fictitious or fraudulent statement. Signature of Applicant Printed Name Title Date PAC /L GRB �� OWNEiP z5 /3 Signature of Owner Printed Name Title Date Za Signature of Agent Printed Name Title Date JOINT APPLICATION FORM 09/10 Application Form Page 2 of 2 31 wr � 3�0 ell �. i a .ara f f �14e1J• �a COUN OFSUFFOLK © e secmxrw _—_�_ Q-_ �•� _ _ �•�••� -- Rxi PR TaServim Agem.Y _ s OFFICE LOCATION: OOF SO(/lyOl MAILING ADDRESS: Town Hall Annex h O P.O. Box 1179 54375 State Route 25 11 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 O Telephone: 631 765-1938 Fax: 631 765-3136 D�yCOU ' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President D Town of Southold Board of Trustees JUL 1 1 2013 From: Mark Terry, Principal Planner LWRP Coordinator Southold Town Board of Trustees Date: July 10, 2013 Re: LWRP Coastal Consistency Review for PAUL GROBEN SCTM#1000-86-2-13 A permit (1062) was issued for the dock in 1975. Note that the fixed ramp was not included in the original permit. Michael Kimack on behalf of PAUL GROBEN requests a Wetland Permit to replace in the same location a 4'x50' fixed dock; a 3'x28' fixed ramp; a 3'x12' removable aluminum ramp; and a 4'x16' floating dock secured by two sets of 8"-9" diameter mooring pilings; decking to be Thru-Flow and railings to be a composite material. Located: 3705 Wells Road, Peconic. SCTM#86-2-13 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 determination that the action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins, jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); 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 �gpFF04 0 Peter Young,Chairman Town Hall, 53095 Main Rd. Lauren Standish, Secretary T 11.0. Box 1179 Southold,NY 11971 Telephone(63 1)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, it was RESOLVED to SUPPORT the application of PAUL GROBEN to replace in same location 50' of fixed dock @ 4' wide, 28' of fixed ramp @ 3' wide, a 3' wide aluminum removable ramp @ 12' in length, a 4' wide X 16' long floating dock secured by 2 sets of mooring pilings. All lumber treated except railings and decking. Located: 3705 Wells Rd., Peconic. SCTM#86-2-13 Inspected by: Audrey Horton, Jack McGreevy The CAC Supports the application with the Condition treated lumber is not used on the decking. Vote of Council: Ayes: All Motion Carried James F. King,President ��a SoU)yO Town Hall Annex Bob Ghosio,Jr.,Vice-President 54 Main Road P.O.. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer i5 C Michael J. Domino %�'' Telephone(631) 765-1892 �y cOUNfY, Fax(631) 765-6641 N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application Wetland Permit Application _ Administrative Permit Amendment/Transf /E tension �}e� ceived Application: eceivedFee:$ Z_`i0 Completed Application D E C E I V E _Incomplete D SEQRA Classification: Type ( Type II Unlisted u u Coordination:(date sent) �ry JUN - 3 2013 , 'LWRP Consistency Asse smen Form 9 ci LZC'AC Referral Sent 7777�� LZ6ate of Inspection s onfl - Receipt of CAC Report:_ Lead Agency Determination: peclmiical Review: ublic Hearing Held: Resolution: Name of Applicant Poeta- CZ4096V Mailing Address / /'4'p W-4,VW ZX AAE, ST74-NyB,[PA7O/C� N.Y /I 7944 Phone Number:( ) 631 757- 7:F, Suffolk County Tax Map Number: 1000 - 8% 2- /.3 Property Location: 37QS kl/ELLS 'eQAd 476CJWrG . Al Y // 9S-9 (provide LILCO Pole#, dist ce t�streets, and location) AGENT: (If applicable) Address: 3Vn/vze 'OV' . y', Z: ; AZ), -- Phone: 777- 1/03 �fT �, t Ord of Trustees Applicatice GENERAL DATA Land Area (in square feet): ,3 9. 6OD t Area Zoning: Previous use of property: Intended use of property:_ Covenants and Restrictions on property? Yes X'No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes _X No If"Yes", be advised this application will be reviewed by the 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 No Does the structure(s) on property have a valid Certificate of Occupancy? Yes aX No Prior permits/approvals for site improvements: Agency Date —P4U —" MWAIES 4/?//9�.57 psc1ZA'1/T y0. / G 6 Z 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 A � necessary):Rfp[ACE moo410� 1GT /,tt/fT¢HD R�A�H�P CPEjJQ3/f/./o ' 11w/D� VMIAVH RC-n0VV 86k RAHP /Z N 9 � By z jrJS Dor 8-9 �• x oVA16 PALINGS'. ALL 1,0119,e5R 7%84Y25D €x C4P2-, R,01"'O'00'65; T/ 15/c Olt AMD p,6 C elV6 YHMUAL o W 0 1r-- / XX J77AE� I-OW) Bco of Trustees Application• WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: q'a B5o��[',5 .l*MCW ,DAh� D &,9W Al CIC d X/; ,P.rHffVt7d a -VLUH/ti/UH &V kZ6.#jyA/G VIQCLV 1N gaRi5 LCC4IUN/ Area of wetlands on lot: 8 Fe o square feet Percent coverage of lot: ZZ-% f Closest distance between nearest existing structure and upland edge of wetlands: 4 n feet Closest distance between nearest proposed structure and upland edge of wetlands: feet (DOUG /N WRTG 16L7� Does the project involve excavation or filling? ( No Yes If yes, how much material will be excavated? MIR cubic yards How much material will be filled? yards Depth of which material will be removed or deposited: k4 feet Proposed slope throughout the area of operations: 4"k—'r- j5,X Zz7'/J✓& G12AVZ S Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): rA&E Paoly&-F R&4215 aT .925 RA er- JXI Mi 1014EVMVcY P),�/-V wry Bc& of Trustees Application• COASTAL EROSION APPLICATION DATA Purposes of proposed activity: &/S Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) James F.King,President �QF so Town Hall Annex Bob Ghosio,Jr.,Vice-President ,�0� Ol0 54375 Main Road y P.O.Box 1179 Dave Bergen T 41 Southold, New York 11971-0959 John Bredemeyer rn ac Michael J. Domino �O Telephone(631) 765-1592 2121 ' Fax(631) 765-6641 OR BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE I (We) The owners of record of property at: SCTM#1000- in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or important natural resource features. Notarized signature of owner of record Notary Public This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. PROJECT ID NUMBER 617.20 SEQR 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) t 1.APPLICANT/SPONSOR 2.PROJECT NAME .4L�� ,f rfJ/Tj J AW,0W6A6 C L Ck /C 3.13ROJECT LOCATION: /+ - Municipality C County L/L 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 3745" wF[Ls OrCF A4075 Z-6- 5. s5. IS PROPOSED ACTION: ❑ New El Expansion ❑Modification/alteration gerlo-ACE ME.v7- 6.DESCRIBE PROJECT BRIEFLY:q,�5A�4Cr65 /!t,JX/Me L 6 C IMNJ 5-6 /-7 Or DOCle & 41 eu 10VIAE, -?0',4r Af'Rg4oR1`o11)'V1Aq5 1* l�w�X!6 a oNG JC/2�ALU/IH/NLµ1 R�NOVABI� aA/`1�j A 4 04rLd1W-V6 ,D6 C14 J) C0 /Z trY 2 .JETS' Or f1W R/.vG Pel--V65 X O/ a ,¢ G l , , U % D,,5e/ AA& `,VWQercow 0/5) 7.AMOUNT OF LAND AFFECTED: Initially o4ocres Ultimately u. acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ®Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 6NResidential 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) MYes No If yes, list agency name and permit / approval: ,c% Y,5* DEe Q' 0-04 05 ho;Pf X65V AgHl 77A�p 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑No If yes, list agency name and permit / approval:�C _. • �� TOIUN O > JJ JJ1J / S A RESULT OF PROPOSED ACTT N WILL EXISTING PERMIT/ ALPP'ROVA REQUIRE MODIFICATION?es El Q / Cn N ;f-4 RjE,67-AIA54V CAPE I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant 1 Sponsor Name /C�,/� �, ,�../'O�*clf Date: 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 11- IMPACT ASSESSMENT o be com feted by Lead Agency). A. DOES ACTION EXCEED ANY TYPE t THRESHOLD IN 6 NYCRR,PART 617.47 If yes,coordinate the review process andusethe FULL EAF. - 0 Yes Q Na 8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negatve declaration may be superseded by another Involved agency. Yes a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:IMawers may be harWwMea.K legtfle) Ct. E)WM air Quality,surface or groundwater quality or quare ty.noise levels.eWsting traffic paten;sold waste production or disposa(, umtial for emsbn,drainage or boding problems? F)plaki briefly: (x. Aesthetic,agdaAbaal,;ZtIdagical,Iislaft or otlher natural orad oind resbrxces;or or thbodlood dharadef?Ehplskh briefly: C3. Vegetation or fauna,fish,shetitis or wildlife species,sigolfloed habitats.or threatened or,endangered;pedes?Esplain briefly. C4. A comm irdWs existing plans or goals as officlaay adopted,or a change in use or rn ensay of use o(land or other natural resources?IYrplaln briefly: C6. Growth,gubsequent development,or related activities likely to be induced by(he proposed adion7 Fxplain briefly: C6. Long term,strort lercn,cumulative,or other eget;not identified in C7 LS? Explain briefly: C7:Other Impacts Qncluding changes in use of ether quantity y or type of energy? Explain briefly.—- -- — - - -- - O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHA ENVIRONMENTAL AREA CFA 7 f n briefly,: THAT CAUSED THE ESTABLISHMENT OF A CRITICAL s, ' . . Q Yes Q No E 1S THERE.OR IS THERE UKELY TO RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL ffVfCTS7 t --0 Yes ONO PART W-OET13ilAINATIOft OF GMNIFICANCE(To be aompleled by Aeanty) . kISiRUCTWN8: Forsechadverse elfedlderifiedabove de6 mdmwhetherltlshibstaaffattwgeimpetlantorOOMV&esignificatlL Eadr stied slhoatd be assetaed In connedidn wwh is(a)seting(Le.urban or run*(b)probef ft deoolinklg;(a)"atom(d)inavelslbtiq;(e) 0e09MPMC li WW M mag NW& If trepull add atadsflerds Or reference stppoftlfg alalledals. Enslala that wola efta t Contatf aumotef4deta116tahowtl8tdMW4v tadversokftpadatrovebeenIdertifiedendadeqlaideyraddaaased. Ifgnstondefpertiwasdledaed yas,ihedeWmbatonofalgnttmfloemuctevduaWftpotentalimpa"gmpmposedaodon ontrew*ommftldlaradwMmoftheCEA. ChecktisboxtyoutlahteldNWOoneormorepdartiatylargeors4m'c twtWU%Wacs%iftMAYo=ir.Then EAF andfor prepare a positive dedaralah, prooaeddkeatif tothe p Check this boa tYOU t4as9 deletllhkxK based on tie Infam coon and anelysis above and any slpponfatg documentall that the proposed acu WILL NOT result in arty significant adverse emhonmental impacts AND pmvWe, on attadmherds as necessary, the reasons supportrit IN determination. Board of Trustees Name of Lead Agency Date President U Print or Type Naof Responsible Officer m Lead Agenq idle of Responsible Officer D ECEIV`� PROOF OF MAILING OF NOTICE JUL 1 2 2013 ATTACH CERTIFIED MAIL RECEIPTS o ho own Name: Address: Rb&�Rl��!✓ BE7�/ -'C,S/!/�t4e 9695 W,5&5,r0. fe-"" Ro"452?7- N1rC1,,rG1- 3905 WIZZIA IANc1-44 wEls�-V,91' 3440 00p,�PZrON/C, NY 95 Cy7Z o W,�LIS RD., PFco�//C, N Y STATE OF NEW YORK COUNTY OF SUFFOLK ii�1/_CE1.9E1- !1. 6H.4CW residing at 32/ iQlYEif'/7 C' �, /1/.Y !/90/ , being duly sworn, deposes and says that on the 2k° day of yLY 2p[ , deponent mailed a true copy of the Notice set forth in the Boar of Trustees Application, directed to each of the above named _ persons at the addresses set opposite there respective names; that the addresses set F opposite the names of said persons are the address of said persons as shown on the current assessment mll of the Town of Southold; that said Notices were mailed at the United States Post Office at p NOZQ that said Notices were mailed to each of said persons by CERTIFIED MAHJRE RN RECEIPT. &Zel , �. Sworn to befoe gee this Day of C t 2� Notary P lie JEAN CHAMBART Eym tary Public- State of New York NO. 01CH6087101 oualified in Suffolk only ommission Expires i x • . Postal (DomesticCERTIFIED MAIL,,, RECEIPT CERTIFIED MAIL,,, RECEIPT t` (Domestic M M Er �. 0 M CO Postage $ $0. 1 to Postage $ $o. I. .. m—� certified Fee �1O 06 � CedHied Fee \ $1610 06 0 Return Receipt Fee O 2 24113 Postmark (Endorsement Required) „gj H 0 Retum Receipt Fee 0 UL (Fstlorsement Require d) ,� ,. O Restricted Delivery Fee E3L 0 2 "P013 (Endorsement Required) 00 (Endorsement Del Fee E3M C3 (EntlorsemeM Required) 00 E3 Total Postage&Fees $6.1�� c Lr) $ To al Postage&Feea $ $6. /02/201 �� s�a�n/t Ta m 4 kVet. t No-1 �NtY(r76dG!'�__ r� sent o p/� Stieei.Apt No.; ___ __ __ _ __ ____ _ ___ __ __________. r-1 S r�-+/ _ ._sr[_L[_..-_ __- ____-__-_-__.__-__, - POC3No. �j��J/�/�/y� _- ----- - �1�1----- -/� �.. _-,_.__ I_,_kM4 hf� _______________-_- City,State.ZIP+4 W/Y� A (� C _.---_--___-4 _______________ W State 95�----------------------- r0August U.S. Postal Serviceir, U.S. Postal Service: CERTIFIED MAIL,., RECEIPT CERTIFIED MAIL,. RECEIPT m (Domestic Mail . m (Domestic Mail Only; O M RIV 1199MIMIFIRRIM - PEIWN t1� 1 Er m I * ' M co Postage $ $O 'aPostage $ $O. 0971 r=1 certified Certified Fee �1 06 r--1 CaNgetl Fee �p� a Postmark � ° jj �an�1113 0 Return Receipt Fee Return Receipt Fee Here (Endorsement Required) $2.55 O Fstlorsement Required) 0 2 X13 0 ( red, $z. 0 Restricted Delivery Fee IL O Reskisem ntDeliveryRequired)Fee (Endorsement Required) $0.00 0 (Endorsement Required) In On Total Postage&Fees $ 07/02/20 �,� C3 Total Postage&Fees ant To m Via, t. e.: �' z .� Un Sent To r = ----F------ ma r.r7-1 .1��--------------------- 0 or PC Box No. . - - ��-_�� __R,a 0 a PoBoxNa . _��tr�cs.RP, cry,ware.zi - r ----- o CON G N Y CRY,b m, /C N 2/ /I9SB PS For. :rr ��o�QgpFFd(,�coGZ James F. King. President Town Hall.53095 Main Rd. Bob Ghosio.Jr. .Vice-President y. P.O. Box 1179 Dave Bergen r !'�` Southold,NY 11971 John Bredemeyer7/ Telephone(63 1)765-1892 Michael T. Domino �'� Fax(631)765-6641 BOARD OF TOWN TRUSTEE TOWN OF SOUTHOLD "ECUM BOARD OF TRUSTEES: TOWN OF SOUTHOLD ---------------------------------------------------------------In the Matter of the Application of PAUL GROBEN COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, 1ZZC1A&4W d, /0,, residing at /dba �.Z/ I��YLG�Wd2. P-11ACAM690, Al- , 11Y01 being duly sworn, de ose and say: That on the-P60day of fVL V 201, 1 personallyosted the pro erty known as X74 (trL�s' 121)4) e'6212(1 01/1/. P, 1/ -' 9 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,July 17, 2013. Dated: ,TULy /2� 2D1)3 (signature) Sworn to before me this /qrAfday of >'/ 13 o ry ublic L EAN CHAMBART blic- slate of New York0. 01CH6087101ied in Suffolk ountysion Expires ,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) OF RECORD: I��%.1 G ro6et, SUBJECT OF PUBLIC HEARING: Replace in the same location a 4'x50' fixed dock; a 3'x28' fixed ramp; a 3'x12' removable aluminum ramp; and a 4'x16' fkoat ft dock secured by two sets of 8"-9" diameter mooring pilings; decking to be Thru-Flow and railings to be a composke material. TIME & DATE OF PUBLIC HEARING: • A)eanesc1lay, Sint / 7 .2c)13 - e&or oboLA}'S*30 PM Ifou have an interest in this s protect, you are invited to view the Town file(s) which are available for inspection rior to the day of the hearing during normal business days between the hours ofp8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 Bod of Trustees Applicatio>� County of Suffolk State of New York PAyL �jPL7$ N 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. .pP Signature of Property Owner SWORN TO BEFORE ME THIS DAY O 20 Notary Public KARENCOSTA No.01 006165801 Notary Public.State of New Yor Qualified in SuffobC County (� My Commission EzOves 05114/ *d of Trustees Applicatio* AUTHORIZATION (where the applicant is not the owner) I, F14UL Ga 292's" residing at 26 407MV-41y t7 Z AI, (print owner of property) (mailing address) S'TGN Y FKR( k0,kTAdY J179h do hereby authorize (Agent) 14,1CAI. �L /a KW�1G'K to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Sot hold Code of Ethics prohibits conflicts of intim*on the part of town officers and emnlovees.The nuroose of this forms to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action necessary to avoid same. YOUR NAME: (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If0ther name the activity.) eyg�i0,C 2Z5 w�reAN,ns ri�aUN�s Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO _ X,_ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant _ (when the applicant is a corporation); _B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); - C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 20! ,l Signature Print Name Form TS I ear Town of Southold ®� Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: s.C.T.M.g: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A TSTORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN -A.— ot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCIYO ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? IffyAr (Include Total Area of all Parcels located within Will this Project Retain All Storm-Water Run-Off QQGenerated by a Two(2')Inch Rainfall on Site? L ❑ the Scope of Work for Proposed Construction) (This Item will include all runoff created by site S. ./Awes b. What is the Total Area of Land Clean _ clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Zn D/� — Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F./Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION IPmvide Mdimn.iPsea a.Nsedadl Drainage Structures Indicating Size BLocation?This Item shall include all Proposed Grade Changes and ,06AiY-M� �W 2&9 LO Q97760 Slopes Controlling Surface Water Flow. GrG3 Does the Site Plan and/or Survey describe the erosion Fj OF�fX_P DOC�yl i a7yt0 iywm�� and sediment control practices that will be used to �w,p� control site erosion and storm water discharges. This 4 Pt CIF�JXAO RAHP 3-O ! item must be maintained throughout the Entire ,4 f l></2 14,J.4114VA1 aFMQV�� Construction Period. 4 Will this Project Require any Land Filling,Grading or F]0I;a Excavation where there is a change to the Natural �E &w 0Y ,� w �f I"lW'VwCy Existing Grade Involving more than 200 Cubic Yards �� P �1�� ,* ��Q� �asr� circ. G�n� of Material within any Parcel? / 6::6k6—r 41Z L a�cSrd.>li._/L�C[7/f-��--'�`r-.-per 5 Will this Application Require Land Disturbing Activities ❑ R,41406.9trRXA 014)M10 DSICkJNG Encompassing an Area in Excess of Five Thousand i(M�/ r (5,000 S.F.)Square Feet of Ground Surface? �v/�d W F 6 Is there a Natural Water Course Running through the ❑ Site? Is this Project within the Trustees jurisdiction X General DEC SWPPP Requirements: or within One Hundred(10(y)feet of a Wetland or — Submission of a SWPPP is required for all Construction activities involving soil Beac0 disturbances of one(1)or more acres; including disturbances of less than one ace that 7 Will there be Site preparation on Existing Grade Slopes [:] X are pad 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 involving sou disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? — the DEC has deterruned that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requlrements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP.0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off X 1.The SWPPP shah be prepared prior to the submittal of the Not.The Not shall 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,postconswclion storm water management prectmes that will be used and/or Removal of Vegetation andlor the Construction of any constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder — compliance with the tern and conditions of this permit.In addition,the SWPPP shah Area?(tale lam wr NOT missile the mwmseuen w ori way AP,nm.) identify potential sources of pollution which may reasonably be expected b affect the quality of storm water discharges. NOTE: If Any An w b Ouestions Ona through Nim b Answered witha Cheek Mark 3.At SWPPPs,that require the postconslmctbn storm water management precllce in a Box and the construction sib disturbance is between 5,000 S.F.a/Acre in ares, component shall be prepared by a qualified Design Professorial Licensed in New York a Stonn-Weter,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knoaAedgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any guiding Permt. (NOTE: A Check Mark(�)and/or Mswwfor eadt Ouevion is Required Ma Cgmpbte Applicator) S7-A17E OF NEW YORK, �y COUNTY OF.......�F4.o AS That I, ........i../1...�. �.., '1'...L�1.�r._.-being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual signing"Dorvmenq ^, And that he/she is the .......................................................... 1 ..... (Owner,Con c, gent Coporete Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed die said work and to make and file this application;that all statements contained in this application are true to die kNTHONYGFaRG��ORBERPfeand that the work will be performed in the manner set forth in die application filed herewith. Notary Public,State of New York Sworn to before me this; L/ I Qualified in Suffolk County 93 if...... .. .................. . . 20.`3 My omm ss onSE 6 ies311-01-2014 ....................... .. .. ... Notary Public: ......... ....I4L!7-,-,,.,. .'L ....... / (Signature of Applicant) FORM - 06/10 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. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" 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 supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: onlitlgd website (southoldtown.northfork.net), the Board of Trustees all local libraries and the Town Clerk's office. JUN — 3 2013 B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM#��- j -�_ rd at Trustees awn PROJECT NAME Asi:� sjD� n42At2EgO paces sXJEM The Application has been submitted to(check appropriate response): �� Town Board EJ Planning Board❑ Building Dept. El Board of Trustees EK 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: R,6�PL,4C,6MWIVl`//V pmo,E Z.0,W 60 OF s'o��X9 '�txFo o�r�i�, T�,cr x 3 FT Glx�R,4� 3�T'X,dZ PT' XPHINUM � .&MVA5445- �QA1�1P, 4�T. K161 AZd%071 /SOClz'- Location of action: 8 72�5 14/64LS )W Ar66rV/ C4 NY /l 95-�p Site acreage: Q, 9 Present land use: ZEUPA!5N719L. Present zoning classification: 17E179.ZJ!/ /- 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: PAOL ry1fog'EAJ (b) Mailing address: ,z46 L Or ►n/ANA LANA (c) Telephone number: Area Code 7.0/- 73,i5rl (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 F] 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 0 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 M No ❑ Not Applicable LIA112 /t gA?N2 a ? a l� �J /F/ZOVT CONI'/ rVG°Y ,QEV/EV1l Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III— Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ® Not Applicable 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 toNot Applicable 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 Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes [:] No Y 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. 1:1Yes ❑ No VJ 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. ❑ YeF-1 No ErNot 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 X 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 tz 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. El Yes ElNolte evpNot 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 N I Not Applicable PREPARED BY A. /ejj%4Ck' TITLE 46-GENT DATE Z / Board of Town Trustees Town of Southold Application for permit under Chapter 275 —Wetlands and Shorelines For: Groben property: 3705 Wells Road, Peconic, N.Y.11968 275-6 Application responses as numbered: (1) See authorization form attached (2) Schedule: Replacement of dock system would take approximately 3 weeks after receipt of the permit to proceed (3) Purpose: to replace in kind (with modifications to meet the new code)the Dock system which was damaged by hurricane Sandy (4) Removal of existing dock material, and debris that has accumulated on property from the storm (5) Standing on east side of damaged dock near water line in photo #1 and looking westerly. Standing on the east side of damaged dock in photo # 2 and looking westerly. Standing with back to house near high water mark in photo #3 and looking southerly. (6) The proposed project does not require the removal of any soils. The material to be removed includes the existing dock structures and miscellaneous debris that was depoited on the property from hurricane Sandy. (7) Material will be moved to the site and deposited using a rubber tracked front end loader traveling on preplaced plywood to protect the existing vegetation from further damage. (8) Survey: See new survey attached. (9) See wetlands application data sheet (10) No prior operations conducted on the property. (11) There had been no permits previously issued for the proposed work. (12) The site has not sustained significant erosion damage. There is no planned restoration or replanting required (13) See current photos attached t (14) N/A (15) See owner affidavit (16) See ethical disclosure statement (17) See false information statement (18) See Local waterfront revitalization program consistency assessment A. See filing fee attached MAP OF DESCRIBED PROPERTY \��O LOCATED AT PECONIC, / TOWN OF SOUTHOLD, CO. OF SUFFOLK, ST. OF N.Y. 69y0/ SCTM NO. 1000-86-02-13lb WELLS ROAD / 00 SCALE: 1'=90' JUN - 3 2013CONC,,x,, j R=256.60 Southold Town Od)$ / oar f Trustees . / •Q p � a0 TAX LOT 15 TAX LOT 13 TAX LOT 11 NOTES: r AC:ASPHALT CB:COBBLESTONE BRICK EX.-EXISTING m EX SS.LAT.:EXIST SEWER LAT. Z m SLATE WALK . FF:FINISH FLOOR O PE NG:NATURAL GROUND ,Zl g 34.3 GAR. \ I-P OCOD) = 30.0 25.2IPOSEN SRF:SPLIT RAIL FENCE SSMH:SEWER MANHOLE 1 STORY FRAME& w TO:TOP OF CURB j BRICK NO.3705 TD:TOP DECK -4 TG.TOP GRATE p N N / TH:TEST HOLE C A 15.5 5b 38.0 TW:TOP OF WALL W m TX:TOP OF DRNEWAY W WD:WOOD DECK 8 SLATE DECK I / 31.0 T►E►-INE SURVEYED:20 AUGUST 2012 /4i,20AN1 UPDATE:STORM DAWGE 07APRIL 2013 1 CONC MON. / / $li ED TO:PAUL&ANNE GROBEN / \ 1 / / OF NEW THE OFF:BEI ORDREN¢pNS SHO1MI.HFAON F7iGIA 7}E PROP.ETY DIES TO TIE ?ORA BPEgRC RN MUSE n160.EFD UNB ARE NOTs _ - OW6410=11M ORTOGUMETHEERECTION O\ of 81R11CfUREBORMYOnMIVRMBIENT. GH�� 2g5'+1' �e7z ALIETATONB ORMMTTONS TOTNIS BURVEYB AVIOLA710N OF Hr •VAN SURLY lDOFTEt6Y YORKBTATE EOlIC11TK1N UW. COPIES L WATER IAARK peR YL SC11NE1'IPP NOT BEAMIB TIE IND eURVEYOIiS N®BFAL OR j ), D N ;T.. BEAL SNALL NOT BE CONSOER®TD BEAVN.D11aUE COPY. STA770NARYPDRTION OF DOCK6 PILES I y ELEVATIONS SHOWN HEREON ARE REFERENCED SEVERELY DAMAGED BY SUPERSTORM SANDY- I 11T1DNBRdGiED HEREON SHAM RIM OILYTn TIE PERSON FORM" T TO VERTICAL DATUM:NAVD38 LAND SU LIC. 50869 THESURYEY 6 WEPARED. MD ON TBR BE1MIF TO THE TTE COMWANY,OOV- T TWMerrAGENCY AIS)UNXW WSTIVNDN USTEDMRS OM.CBMWATTDNS P.O. BOX 704 RIDGE, NY 11961 ANNOT ""asFERAeLETOADDnX ALWa"'m"NS ORSUBSEQUMTOwNERS � � ' t RICHMOND CREEK 951.640.4899 NO 'EASffiBA®BY THE UIPERSWal)FOR MY SURFACE. I SUB-SURFACE AERIAL EASEMENTS.SUBSURFACE UTILITIES MRD/OR L-1 STRUCTURES M OR OUT OF EASEMENTS IF$O PROVIDED. 1�_/_, ..✓•�,ti._i.J SCTM 1000-86-02-13 rAuM, Pla4o, She 86y- 6La:'K7, GGTNo. /3 i p ECEIVEit 2 APPROLDB F �BOARD OESJUN - 3 2013TOWN OF outhold Town EL t I/.4T/O/V __-____- O O p D+ g 3 scams : ,•,-2orET s t� rlof; .yavB�zot,3�B: a ..x © r1v�' N1py�9,?oJd(% l;3o RM, th�d?UfLory o�� -- +1 =0~ �'�6"P_OS'7 8/rp.C, s�✓c._p111NG t I " F<xED Rs�MP - I j �I I �ED�ClG+/6 P/SlMG9 S'oc.� 11 -� X[a,BEidh7 Ic L �S/1 .� R X57-7' aO 1540.4 CDHMO/V L//bN WATBR M.bl' g a Lf- ![t�j 1r�G�ocK F1EU - (A(U/�//i(i/i�1� c / .PBOae,YTy �� e -- K�LEI/AZIG+N Fr NO?P�-��rI�NG_-Eo/p,pQee =37c2� W,E.GLS RGL4G GECKINC,A'Oif'K/X 1� Lam: /"� 9 FSEFT Ib C�iliL^�._Al, l/s4S (6ui AW-P P) P�ZM-I&G/./`BC,- VdA/- Tit"Pi2tFt��1.4? `L P/eoPOs.0D REf�[.9oMENrGf� / aTr-. xZeF0,01U" 0e1,WP 10<=i(e*✓//�/[tNG S RICNMONA CA7&zk _ I�uar�/�-o�prH/�i �af7l.PtY9�rvrs -?r&/LioR4 401VA-YP 0(, Z0Arlv6 04Z& ;%A4AiVC&H/Gk 77p,5 D.4r f.I`1Av 2o,201? 53/,H-4. 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