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HomeMy WebLinkAboutTR-8296 James F. King, President so~ryo Town Hall Annex Bob Ghosio, Jr., Vice-President ~O 54375 Main Road yy P.O. Box 1179 Dave Bergen T Southold, New York 11971-0959 John Bredemeyer G Michael J. Domino ~O • Telephone (631) 765-1892 Fax (631) 765-6641 O BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0930C Date: November 20, 2013 THIS CERTIFIES that the removal of existing retaining _wall and installation of a 280' Redi-Rock block retaining wall, add +/-300 cubic yards fill; and install two drywells to be connected to the gutters of the dwelling. At 2175 Bayshore Road, Greeneort, New York Suffolk County Tax Map # 53-4-14 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 23, 2013 pursuant to which Trustees Wetland Permit #8296 Dated September 18, 2013 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of existing retaining wall and installation of a +/-280' Redi- Rock block retaining wall-, add +/-300 cubic yards fill, and install two drywells to be connected to the gutters of the dwelling. The certificate is issued to ROBERT RENGIFO owner of the aforesaid property. pr"" Authorized Signature James F. King, President o~gufFQ(..t Town Hall, 53095 Main Rd. Bob Ghosio, Jr., vice-President a~ Gy P.O. Box 1179 Dave Bergen Southold NY 11971 John Bredemeyer Telephone (631) 765-1892 Michael J. Domino j~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: /h Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boomtsilt curtain 1st day of construction % constructed roject complete, compliance inspection. 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Cak i ! rr. by #.P xj~, if •1 •,-i Ail ? l t .K i -ir. it ! f t7,~j ~ ' -t+.''~"~~ ~ .I f i -•f ~ r.'r, r'.~f ~ ?~,s.... r~_' ~ ~ ~ ~,1 +'t ~ r . */~h iL iF - z a. -s' t f + ~Y ? e , 'Ls • Az, • _ ~~~"to, , 1 or, V V. ~4, Art t1 1 YiiJf J ON* r ~i: j L 7 a te} r l Y Vi -1 _ KI"F.. ~,r~y~,~t f', to 3A'~' S'~ ry~ ~ !1(D~ = ~ Sr~n;r, 's~ p'•c(• ~ ~ •y .fY ~T1#s~ a f'!~$~i;+ ~-~'~~i_ ''~Jt'~,. i ~'.SF:t, ~";~~ia? k '*`s P iiCf''••i~ _F'$ ? i+ . i ` . * sue. 1.~y~~ N 5 f, .q•iM4' ~ ~ Y ! ~~~4• , y '-l~.ak-~i~~! ~t'~'~ ~ ''~y~eD ••7 l' v -011 i: I.A All: • • James F. King, President ~OgOffOL¢~, Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President h~0 filly P.O. Box l 179 Dave Bergen Southold NY 11971 W John Bredemeyer ~y Telephone (631) 765-1892 Michael J. Domino ~Ol 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 Abigail BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8296 DATE: SEPTEMBER 18, 2013 ISSUED TO: ROBERT RENGIFO PROPERTY ADDRESS: 2175 BAYSHORE ROAD. GREENPORT SCTM# 53-4-14 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 Member 18. 2013, and in consideration of application fees in the sum of $350.00 paid by Creative Environmental Design 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 for the removal of existing wooden retaining wall; install a 280' Redi-Rock retaining wall block; install 250-300 cubic yards clean fill material; install two drywells for house gutters; and as depicted on the site plan prepared by Creative Environmental Design, last dated August 23, 2013 and stamped approved on September 18, 2013. A Ten (10) Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to no less than 12" in height by hand on an as needed basis; for a 4' wide access path to the water; and as depicted on the project plan submitted by Creative Environmental Design, received on August 30, 2013 and stamp approved on September 18, 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. a*rU4 eel,, ~p~g11fF0(/( 05 ichael J. D ino TERMS AND CONDITIONS The Permittee, Robert RenAifo residing at 2175 Bavshore Road Greenport 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 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. James F. King, President o~~oF souryol Town Hall Annex Bob Ghosio, Jr., Vice-President 54375 Main Road P.O. Box 1179 Dave Bergen * Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino '.20 i0 Telephone (631) 765-1892 (~~vurm, Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 18, 2013 Mr. David Cichanowicz Creative Environmental Design PO Box 160 Peconic, NY 11958 RE: ROBERT RENGIFO 2175 BAYSHORE ROAD, GREENPORT SCTM# 53-4-14 Dear Mr. Cichanowicz: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 18, 2013 regarding the above matter: WHEREAS, Creative Environmental Design on behalf of ROBERT RENGIFO 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, applications dated August 23, 2013 and August 30, 2013, and, WHEREAS, said application, dated August 23, 2013, 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 applications 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, dated August 23, 2013, on September 18, 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, z ~ • WHEREAS, the Board has considered all the testimony and documentation submitted concerning these applications, 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 applications to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the applications of ROBERT RENGIFO for a Wetland Permit for the removal of existing wooden retaining wall; install a +/-280' Redi-Rock retaining wall block; install 250-300 cubic yards clean fill material; install two drywells for house gutters; and as depicted on the site plan prepared by Creative Environmental Design, last dated August 23, 2013 and stamped approved on September 18, 2013. A Ten (10) Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to no less than 12" in height by hand on an as needed basis; for a 4' wide access path to the water; and as depicted on the project plan submitted by Creative Environmental Design, received on August 30, 2013 and stamp approved on September 18, 2013. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, /N,-" CZ -,5r James F. King President, Board of Trustees JFK/amn James F. King, President y0g~1fF0( tc Town Hall Annex Bob Ghosio, Jr., Vice-President ~~O 0 54375 Route 25, P.O. Box 1179 a Dave Bergen Southold, NY 11971 John Bredemeyer Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Creative Environmental Design for Robert Rengifo Please be advised that your applications dated 8/23/13 & 8/30/13 have been reviewed by this Board at the regular meeting of 9/18/13 and your applications have been approved pending the completion of the following items checked off below. XX Affidavit of Posting Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) '/2 Constructed ($50.00) XX Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50.00 BY: James F. King, President Board of Trustees t t yry _ ' l ,y'. i ati ...'f vs~.t tt -~-:`"i~r 1 wr ~ .r t _ ':'~er" 1• ~ _ -:~h C fI ...~/tlfV' - 1 Y "''V r t'°4 ~ r ~ j~J }j w! f e Y~s, ~i _ !~S ~ 'C s t ~ ~ < np ' . ~ ~ 'ti , y~~lN?~ r - A.n ~4 ?~'~7ia '.ct r ' r J M #M^.`~ w ~.a ? ~y }a~" + ~S34Y i ?~•rsk i,p w 3 *~.x "-~'+y', A''.'. 7 ' ti S.,ti. 4 via i''? • 4 1,,pw •r c LSati.u •s°•:w4- 4,, a . h• - ~1 ~t 4 1~.A~ lh.. te~a • a~~ ~ Zyfn Vti 'q1 ;,1, h ~ r• Vv 4, 41 s Robert Rengifo 175 eayshore Road, Greenport CTM# 53-4-14 /11/13 0 Jamul I- king. Pre,;dent CpP.O_ Box 1179 Bob Ghosln. Ir.- Vice-President N 4y Southold. NY 11971 Dave Bereen & l elephone 1631 765-1892 John Bredeme)cr P Fax (631) 765-6641 Michael 1. Domino Southold Town Board of Trustees Field InspectionMork Session Report Date/Time: ~P / i 2,'t 3 /c : y Creative Environmental Design on behalf of ROBERT RENGIFO requests a Wetland Permit for the removal of existing wooden retaining wall; install a +/-280' Redi-Rock retaining wall block; install 250-300 cubic yards clean fill material; install two drywells for house gutters. Located: 2175 Bayshore Road, Greenport. SCTM# 53-4-14 Type of area to be impacted: Saltwater Wetland Freshwater Wetland -Sound vBay 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: Top F gfr2r-41Ct~ /f 7- EAST CpQtiJL2 U Sf- c,F_ eel - ,EYz Present Were: J. King _B. Ghosio D. Bergen, -~'J. Bredemeyer -Michael Domino D. Dzenkowski other Form filled out in the field by j, k ? Mailed/Faxed to: Date: 7r ~ p', t ~h~.ir"W :A `say SryAVT¢~ f~l r`~V~,. 1'.. ~ ~ tyre r~ ar ~ry a w~ ~ J ` ~ f4 + w r ~ z ~ r ` _ ( t yr r . k 4S~,r.r c / /,fit+>* .~~py f K i ~y , t t. ~i 41 ~ v{ WYY 'l h~ `A-~.F .4' GSVa l _s+~1, `~r ~77a _b fa t> el '7 w 14 7 t ~ ~ ! 4 ~ ~ `9•,+~ ''M`iA W' F" y~y~,~~' - ~p ~~aYW Arm - ;~i._.L ~ ~ , `wr ~ 4~.?" . y't ~L:r1 ~JMiQ w ~ t•. r 4. ^y' j - ~ - (p 4`~ s '/',t- _jS"1?1'~ f'r` aywa to, ~J fci°~S tc ` sue. 'C'. < 'fg{rs,t, r ` ,,t, - 1(/~ 404 `y 4 y aQ a ~1 k. Y yYJ,: -WA ~ 11 a r ~ - ~ =``c ^ ~.`°4a~,' - fir' . ,.fit '.':~~°YES f ~ a{• i low y ¦ a yL?~~'t. I ~ , .f ~n / ~FyR.i, A f ~k`~'I _ !Gq ~ \ 1 Q . f- i ~ y 4~ ! ~:.F~ ~a, 'r ~ ~F f to ;.act 'l,, r e~ ? { 77 ~ MS'S" , ~ ..~r ~ - ' r i . =l^~~ _ F y~ - 41 a~ off; m' era d a9 d r - t Q2 ~ ~ a' ~ P ^y~ •wa prt[e F ~r J "'Y` \ ry R AI \I °li I 2 rwn ,V ~ ~xI~III o / Z e V y f f I., IIIV//I/ y h (y ta- , ~ 'Iff O V V Vtr ~ 4'0 ~ 'Y q 1. f Vb V" V Yr Y ~ a Ftr \ r VdOrd V £:'~fir ~3 4d IrE r a r d < a ° .wa ~ ~ r ra° ? P il a tytr or `e° ,i 4d P, 0.c Vi Pq° 4 yb ~ I J .y tt 8 P~., xf 1 ~Wa ,y ~ ~w ~ S~ ~ J_p , P v 0 ~ ~ m maw S .QJ ~ s e P 9 - ~.=^rwm s[[PC.rnmr w,cx YHB[Cw P, ~ a` Y a/P nox gWP.pay TUU U. Ap m 53 0 OFFICE LOCATION: ~~Of so~jyo MAILING ADDRESS: Town Hall Annex lQ P.O. Box 1179 54375 State Route 25 # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 Q Telephone: 631 765-1938 Fax: 631765-3136 com, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM l~ To: Jim King, President Town of Southold Board of Trustees - B0~" ~rr~~-~~es From: Mark Terry, Principal Planner LWRP Coordinator Date: September 13, 2013 Re: LWRP Coastal Consistency Review for ROBERT RENGIFO SCTM#1000-53-4-14 Creative Environmental Design on behalf of ROBERT RENGIFO requests a Wetland Permit for the removal of existing wooden retaining wall; install a +/-280' Redi-Rock retaining wall block; install 250- 300 cubic yards clean fill material; install two drywells for house gutters. Located: 2175 Bayshore Road, Greenport. SCTM# 53-4-14 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 actions are CONSISTENT with the LWRP. 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 ~~gpfFO(~.c • Peter Young, Chairman C Town Hall, 53095 Main Rd. Lauren Standish, Secretary P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 1 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., September 11, 2013 the following recommendation was made: Moved by William McDermott, seconded by Doug Hardy, it was RESOLVED to SUPPORT the application of ROBERT RENGIFO to remove existing wooden retaining wall. Install 280' Redi-Rock retaining wall block, approx. 250-300 cy. clean fill material and install two (2) drywells for house gutters. Located: 2175 Bayshore Rd., Greenport. SCTM#53-4-14 Inspected by: William McDermott The CAC Supports the application, however, questions what potential impacts this project will have on the surrounding property owners. Vote of Council: Ayes: All Motion Carried James F. King, President ~OF SO(/jy Town Hall Annex O~ 54375 Main Road Bob Ghosio, Jr., Vice-President O P-O- Box 1179 Dave Bergen a w Southold, New York 11971-0959 John Bredemeyer G Q p Telephone (631) 765-1892 Michael J. Domino Fax (631) 765.6641 OOUNTI, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application 2 Wetland Permit Application Administrative Permit 6 D Q E p V E / _Amendment/Transf dExt nsion L~ eceived Application: 1113 D V completed Fee:S L AUG 2 3 2r'3 Completed Application Z 13 --Incomplete-.. SEQRA Classification: Sae'( _ . ' - Type I_ Type ll_ -Unlisted- r Coordination: (date sent) 3 _ y~WRP Consistency Ass ssme t Form _iztAC Referral Sent Z 3 _I, bate of Inspection:-- Receipt of CAC Repo-r: Lead Agency Determination:- - echnical Review:__. 3 Public Hearing Held: _ _ _ Resolution: tom' Name of Applicant _~5~__QJjY~cLZ - Address (Lee +V'\~q lq~/ Phone Number.(9n) I44, Suffolk County Tax Map Number: 1000 - 5 3 _ 1 ~i Property Location:g1TJ 1J fg- Cee4\ (provide LI CO Pole distance to cross streets, and location) AGENT: May,, LILV'd- ~ k~ C? (If applicable) PO Box 160 Address: FOWWG, NY 119% Phone: (~'~I - 1311-r79a Se~~ rd of Trustees Application GENERAL DATA Land Area (in square feet): q3.0 t l. S , V- 5 a I t Area Zoning: ^a~ Previous use of property: n~,Aef\V;eL \ Intended use of property: Covenants and Restrictions: Yes LI 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 de lition as per Town Code or as determined by the Building Dept. Yes =0 Does the structure (s) on property have a valid Certificate of Occupancy Yes No Prior permits/approvals for site improvements: Agency Date k/ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended y a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): 1'~ZC2VCi \ r' ~K\~~l l1`-1 1 ~fJD~~ (,d,)Q x\ Tjf \1 ye-yo n~ u0eA1 b\rt~ a~s -a~-t31 ,nS~n\1 A!Qy u a5o 3CD LLL44S CV6LO ww\ a. ~ SUS ~rc \r~vl ~tc BIf d of Trustees Application* WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: `"'-O ~cC ~1Gyl ~~CVOX +J 4 C )C- 1 &U-\L \I Ce~L Area of wetlands on lot:a~ , square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: _4 eL' feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve e/xcavation or filling? No ? Yes If yes, how much material will be excavated? cubic yards How much material will be filled? o.&-SOD cubic yards u Depth of which material will be removed or deposited: - 2 i feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: LGYtG'1~ 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): 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) 1. APPLICANT/ SPONSOR 2. PROJECT NAME ?c, E iwa'rAVV4"w ice' 3.PROJECT LOCATION: Municipality (Y!{~1 County fJ~r \ 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map j an s 5. IS PROPOSED ACTION : ? New 11 Expansion 61 odifcation /alteration 6. DESCRIBE PROJECT BRIEFLY: ~cIL, n~tA, W~ l~ b\a~K as 7. AMOUNT OF LAND AFFECTED: Initially kL{a> acres ALA()h- Ultimately acres .1,14 =rk~ 8. WILL P POSED 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.) esidential ? Industrial D Commercial Agriculture ? Park / Forest / Open Space Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL ! AGENCY (Federal State or Local) ?Yes I If yes, list agency name and permit / approval: 11. DOES Ill vvvANIIIYY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ?Yes ~~~1~~ I, ,Irv'. If yes, list agency name and permit / approval 11l22.~. LL'~AS A REII15 OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Des o I CERTIFY THAT THE INFO ~ PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Name J Date: Signature If the ac a Costal Area, and you are a state agency, \J complete the Coastal Assessment Form before proceeding with this assessment PART 11- IMPACT ASSESSMENT o be Co feted b Lead Agency~ A. DO~-E7~S ACTION EKCEED ANY TYPE f THRESHOLD IN 6 NYCRR, PART 617, If yes, coordinate the re%iew IJ Yes Q process and use the FULL F.AF. 8. V&i- ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 61 7.6? If No, a negative dedaralat may be superseded by another kniolved agency. - Yes es © No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if I"Ible) Cl. Eds*V air quafdy, surface or groundwater quality or quandly, noise Levels, existing traffic pattem, sold waste production or disposal, potential for erosion, drainage or flooding problems? 6cplain briefly: C2. Aeshedo, agdaAtural, ardmeowgical, tktonlo, of other natural or cultural resources. Of COMMIally of m4hbahood charader? EVI* bdaly: C3. Vegetation a fauna, lsk shellls "or species, sigdficanl habitats. or ttxeatened or endangered spedes? Ergrlaln Ixiefly: C4. A community's existing plans w goals as ofridafly adopted, ore change.in use or intensity of use of Wnd "other natural resources? Explain briefly: C5. Growth, subsequent devebpmenl, or related activities likely b be induced by the proposed action? Explain briefly: 06. Long term, star term, oumulalive, Of other effects not identified in C1 E5? Explain briefly: C7-- Other impacts (Including changes in use of either uantit or t 0. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT MT OF A CRITICAL ENVIRONMENTAL AREA 7 Of brie . yes. explain Yes Q No E. IS TV43;W, OR IS THERE LIKELY To RHATEO TO POTENTIAL M_ IMP If -0 Yes no, No - PART W - OEDSR104AT1ON OF SKi OIcANCE (to be aaflpleted by Agency) IDISiiplCilOliB: Foreach"Woliedfea MmWedabo" deleRnirlewhellwitilsubst~gel lafge,kiWalt>mtofgh~w~eslgRiflfrent Each ertod should be astcetlsea wt owxlafdell um its (W tml&Ig (Le- urban or lutap ro) loo xllril~ (ra aaadofC cm imavelsafrity (e) 90WePl90 SWIM Aural M rtregnitude If III'aoes18aay, add 8*KWltettts Or reterslloe atlpplfgng makrials. C- mm UW 00aatatiotl5 rwa,.b - . : . afAfidafrtdatA4odawtlletdlrelevantad iIMaoiallawbeen idiliffrOdWill 8de y,add S dofpaftAwasdNidged yet lhedetanrlklaSonafLeignifatarloemustevAuft#WPOtatrdalknradofthepteposWOCOonanpLewAxm~draradefb OftheCrA Check llsboxIfpoutlsveldenfdedoosarmerePatertgal WWorst nl=KadverseNpac7the ooaeddlectlyMthe W aad/ur prepare a posiBvo dedawlor, Check 16 bum If you have delermined, based on the hdormalon and analysis MV documenbrior the Mcilmsed Will NOT result In any slgntiluxnt adverse environmental hnpadsAN rovide, ana determination. f~eadetermination. Board of Trustees ssety Name of LeadAgenccy Vl,f Print or Type Name of Res President yPe Responsible Offigerm lead A9en ~ ?~~/°y Title e( Responsible Offrcer quo (/!7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK Creative En - 'ronmental Design COUNTY OF SUFFOLK PO Box 160 Peconic, NY 11958 residing at being duly sworn, deposes and says that on the 3 ` day of 20JI, deponent mailed a true copy of the Notice set forth in the Board o 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 Ii of the Town of Southold; that said Notices were mailed at the united States Post OffceatLLp yx; L I that said Notices were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. Sworn to before me this & 10) Day of -~p nL 20 Notary Public • ~$UFFO,',~c • James F. King, President Town Hall, 53095 Main Rd. Bob Ghosio, Jr. Vice-President P.O. Box 1179 Dave Bergen Gy Southold, NY 11971 John Bredemeyer Telephone(631)765-1892 Michael J. Domino ~j 41 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ROBERT RENGIFO COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS 1, Cic t+4aJw is 2 residing at/dba ''~l1be~ 2~ t N~ being duly sworn, depose and say: That on the ` 6 day of 'Z V+ . , 2013, 1 personally posted the property known as TOF~E:zs i2F,~ 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, September 18, 2013. Dated: (signature) Sworn to before me this day of 6~-2013 ~r1 fr P L C l ~l Notary Public i`i Ot:ab' C-u(d3C. SRS+..^ U, DuE:.q, Yv:,ti. optic _ Lf 1 _ NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held b the SOUTHOLD BOARD OF TRUSTEES at he Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RE ~ CORD. Robec+ Tan qo g SUBJECT OF PUBLIC HEARING: The removal of existing wooden retaining wall; install a +/_280' Redi-Rock retaining wall block; install 250-300 cubic yards clean fill material; install two drywells for house gutters. TIME & DATE OF PUBLIC HEARING: GJednesday, S r 18,' A01 3 - 04-Or 04>0 3d P yp}~e~ If you have an interest in this be project, 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 Board of Trustees Application County of Suffolk State of New York RUIOe-rI- I BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SIIE 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 TIIAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUfHOLD 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 COMPLETINGTTHIS APPLICATION, I HEREBY AUTHORIZE THE. TRITSTEES, THEIR AGFNT(S) OR RF.PRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature tt C~ SWORN TO BEFORE ME THIS 1 ~_DAY OF_i IA f o S '-201-1 r• ~ Notary Public DIANA LENZ Notety pdk, Stets of New York No. 01LE49173M QMftd in Weateleger CoonnJJ,,yy cm *ft apkes Japery 19, 20,1.E - Board of Trustees Application AUMORIZATION (where the applicant is not the owner) I. e I /~eL,9 y residing at P d. Bc ,~v b `f / e v1po~ (1 ~(4 ¢ (print owner of property) (mailing address) do hereby authorize David Cichanowicz, Pres. (Agent) Creative Environmental Design__ _ to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The twmose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is i necessary to avoid same. - YOUR NAME: `6 `!3W - (Last name, first name, Middle initia , 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 t~ 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 ares. 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 non-corporate entity (when the applicant is not a corporation); C) an officer, director, parmer, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP I Submitte e~ da 20,2L Signature Print Name wrc z Form TS 1 ear Town of Sou hold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM 0 PROPERTY LOCATION: s.c 7.M. s: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Ol STORM-WA TERr GRADINGr DRAINAGE AND EROSION CONTROL PLAN rs-D lr c ee3 bon '~Tx rV- - ot- CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? I Will this Project Retain All Storm-Water Run-Off (include Total Area of all Parcels located within the Scope Q I S~ the Scope of Work for Proposed Construction) 931 Generated by a Two (2") Inch Rainfall on Site? ~x r (Sr. / Acres) (This item will include all run-off created by site It. What Is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed - C Site Improvements and the construction activiry' r t (S.F./Ac.cme) ) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT' DESCRIPTION (Pmma. Atlditlond Papea a, Needed) Drainage Structures Indicating Size 8 Location? ion? This is Item shall include all Proposed Grade Changes and ZEI y.L\ X; LjcrO~''~ 1 e. Slopes Controlling Surface Water Flow. ,tom ` p r- 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to 1rL/ control site erosion and storm water discharges. This a`~7L^- Gam, \ / U\ 11 item must be maintained throughout the Entire Construction Period. T_`mb-~, ^e)- ckv V t 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural V A - ~ I4 Ti~t~r Existing Grade Involving more than 200 Cubic Yards I t of Material within any Parcel? `J 5 Will this Application Require Land Disturbing Activities ~y - Encompassing an Area in Excess of Five Thousand 11~]~L/JII (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 Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (t) or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ? are 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 involving soil disturbances of less than one (t) acre where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. I SWPPP's Shall meet the Minimum Requirements 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 Storrs-Water Run-Off 1. The SWPPP shall 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, postconstruction 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 assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit. In addition, the SWPPP shall Area? (this use will NOT moI.de we mau radon of onveway A nsi identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Man, 3. All SWPPPs that require the postconstruction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F. d 1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New yw, a storm-Water, Grading, Drainage & Erosion Control Plan Is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check M.A (4) and/or Answer for cam Question is Required for a complete AppbraWn) STATE OF NEW YORK, ~C~OUN `TY OF SS 't'hat I, LjOPL:..-~ L.1 L.VYRM.Mlld9 ~.4Z.......... being duly swoon, deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) l And that he/she is the t?YS! tS~ r.....................................................etc................................................................... (Owner, Contractor, Agent, Corporate Olacer, ) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have perfomled the said work and to make and file this application; that all statements contained in this application are true to die best of his knowledge and belief; and that the work will be performed in the manner set fords in die application filed herewith. Swom to before me this, aaa.... .r...- f da of 1:1.. J..X ~a'.................. , 20.1..3 III Notary Public:... ~~.:i........._....... t ..:.7f lyy;_ _ . . 6UN ( I,c 11 ^H s ureo ) FORM - 06/10 "'In N"' 9IM-c0prim. Yelk ttrn _''";DI 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: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees O ^ 1 local libraries and the Town Clerk's office. E Q E E B. DESCRIPTION OF SITE AND PROPOSED ACTION D D SCTM# 53 AUG 2 3 2013 uthna; Tom PROJECT NAME , The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees I 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: P,kvr\nk_ \ . l ~doc~yA .a c y~11 k~- Z8D` Location of action: ~L~~Of~~ ~C~i~R9P} Site acreage: Sat~s__ Present land use: 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: (a) Name of applicant: p\dQtTV (b) Mailing address: p • 1 k { i ~rTr~C~L (c) Telephone number: Area Code ( 1 1-~ - ~1 (d) Application number, if any: Will the action 7eire ly undertaken, require funding, or approval by a state or federal agency? Yes ? No f yes, w hich 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 criteri . Yes ? No ? Not Applicable I; Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See j L 7ction III - Polici s Pages 3 through 6 for evaluation criteria Yes El No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Se on III - Policies Pages 6 through 7 for evaluation criteria Yes ? No ? Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Seeti 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 - Poli es Pages 16 through 21 for evaluation criteria Yes ? No ? Not Applicable 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 throu 32 for evaluation criteria. ? ? Yes No Not Apple • 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 ev luation criteria. ? Yes ? No Not Applicable i Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous subst ces and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Yes ? No ? Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ? YeSEI No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES • Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L P Section III - Policies; Pages 47 through 56 for evaluation criteria. ? Yes ? No of Applicable i Attach additional sheets if necessary Policy 1. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estu ry and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes ? No 0 Not Applicable Attach additional sheets if necessary Policy 12. Protect agri ultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for eval anon criteria. ? Yes ? No Not Applicable i Attach additional sheets if necessary Policy 13. Promote ppropriate use and development of energy and mineral resources. See LWRP Section III -Policies- Pages 65 through 68 for evaluation criteria. ? Yes ? No Not Applicable i PREPARED BY TITLE:_Ra j ~ DATE c~" D EVE AUG 3 0 201 D 3 cid o E S G O V C I+"P o iz-- C T,4T G ENaeRA(-0) cil ; 10 r co r r +J J tJ~c ~ f; l~ r i ~ c { 4 of 4 f!s~ b4 T, ~ ~arir ~ - r 3 8 ~ f f £ 6 , t MG' _ A C7 F-~ I E S C O V C L7 E C~ ~ I C E)Ay r~_s57A_T- E G Erv ERA oFZT ~~wN c~ r-- S/z, ?9g7 `/o«K - 000 53- 4-i4 E C- RLNCri P- C> - I~ rGE C02P. 61 s o c 1 ,4~., -r- E_-G] J N c. ! iu 4 -r oC) Q N r m 1Q s. co. 0 00 a ~EC~~IED 's Ij 7.D AUG 23 y jf - (L S 4 i i B c a I~jLK li - MCOU I L K I N ; c 'Yy SU RV CSI 1 /,3G ; -OM) ST ~bsE r -1 i ^Q ~ 4 N ~i ° z J a J