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HomeMy WebLinkAboutTR-8322A James F. King, President O~e~yfFO( rc Town Hall, 53095 Main Rd. ~P.O. Box 1179 Bob Ghosio, Jr., Vice-President Dave Bergen °w Southold, NY 11971 W John Bredemeyer oy~ Telephone (631) 765-1892 Michael J. Domino 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 1" day of construction % constructed Project complete, compliance inspection • 0 James F. King, President QF so~ryol 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 • a0 Telephone (631) 765-1892 Michael J. Domino O OOUNf'1 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8322A Date of Receipt of Application: November 1; 2013 Applicant: Fishers Island Development Corp. C/O Fishers Island Yacht Club SCTM#: 10-1-9 Project Location: Central Avenue, Fishers Island Date of Resolution/Issuance: November 13, 2013 Date of Expiration: November 13, 2015 Reviewed by: Board of Trustees Project Description: For a Sea Stretcher gurney ramp by installing two 6"x6"x12' timber piles, fasten hinge mount to existing dock, and install a 42"x8' ramp, lifting cables and counterweights Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Gary Vollinger, received on November 1, 2013, and stamped approved on November 13, 2013. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. King, President Board of Trustees • James F. King, President guf FD(,r A~ C P.O. Box 1179 Bob Ghosio, Jr.- Vice-President Southold, NY 11971 Dave Bergen Telephone (631 765-1892 John Bredemeyer Fax(631)765-6641 Michael J. Domino col ~ ,~aa. Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: k 111 6 J.M.O. Environmental Consulting on behalf of FISHERS ISLAND DEVELOPMENT CORP. c/o FISHERS ISLAND YACHT CLUB requests an Administrative Permit for a Sea Stretcher gurney ramp by installing two 6"x6"x12' timber piles, fasten hinge mount to existing dock, and install a 42"x8' ramp, lifting cables and counterweights. Located: Central Avenue, Fishers Island. SCTM# 10-1-9 Type of area to be impacted: -Saltwater Wetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of wetland PqXof Town Code proposed work falls under: _Chapt.275 Chapt. 111 -other Type of Application: Wetland -Coastal Erosion -Amendment _?Administrative_Emerge ncy -Pre-Submission Violation Info needed: Modifications: z c Conditions: n> c Present Were: J. King __:~'B. Ghosio 1-I'D. Bergen, J. Bredemeyer ~ Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: EDGE OF RO. APPROA,A E LJ TF OF r ,$.a Bn SPKE(CPX} RSHE?515CAN®YACHT jCLUB 5ET W GROINJD B 8.596;'K.W «5A EDGE OF N ao G GA PAP-I4NG AREA .63 I~`NY _ COCK RAM WIDE +63 t. SEAWALL F1OllSE o e o / NON VEGE7A7E[7 pp C 's ~S Q / 6UFfER < ,4 g FPGE / ,SASee sheet ~4~~ '^4.,.,,`'••.. 5 / IAVJV Z-9 O-A, y cx~M0.~e Ii -2 Seca s~kchec t iAF2E3taR 45 r' FUND FINGER PER ClJNG'!,'E7E FLOAT r a Ja PL_AhJ `a/IJ=W u WIP J(L^..E V.SO' .5 2 so 25 0 f • a ....»o~ ? N r~ F4 \ _Y_ ~ 16E« J. ~ aN a N O IL I i / aQa 12 11 _ ~ _ .n7 ~ - liar ~'~mP w L.w FDO' / « Woe L, A . H I R^- I i I al o. I ~ ~ - xPnv COUM OFSUFFOLK ® w w+,a.o arnwxo SavkN RppC/ 10 L - - L' ~ ~Ma, r~-- ~ ® • mismau w aROKRM1wa OFFICE LOCATION: OF SOUjho MAILING ADDRESS: Town Hall Annex ~0 l0 P.O. Box 1179 54375 State Route 25 # * Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 47e,p Nip Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM flD To: Jim King, President r[[N:OV- Town of Southold Board of Trustees 2013 From: Mark Terry,Principal Planner LWRP Coordinator : Date: November 6, 2013 Re: LWRP Coastal Consistency Review for FISHERS ISLAND DEVELOPMENT CORP. c/o FISHERS ISLAND YACHT CLUB SCTM#1000-10-1-9 J.M.O. Environmental Consulting on behalf of FISHERS ISLAND DEVELOPMENT CORP. c/o FISHERS ISLAND YACHT CLUB requests an Administrative Permit for a Sea Stretcher gurney ramp by installing two 6"x6"x12' timber piles, fasten hinge mount to existing dock, and install a 42"x8' ramp, lifting cables and counterweights. Located: Central Avenue, Fishers Island. SCTM# 10-1-9 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 C James F. King, President of SOTown Hall Annex Bob Ghosio, Jr., Vice-President 54978 Main Road Dave Bergen P.O. Box 1179 33#rr Southold, New York 11971-0959 John Bredemeyer Telephone (631) 765-1892 j Michael J. Domino ly ice' Fax (631) 7656841 j BOARD OF TOWN TRUSTEES RD TOWN OF SOUTHOLD OIHce use only NOV - 1 2 13 -Coastal Erosion Permit Applicafi n ~ -Wetland Permit Applicati on Administrative Permit _AmendmenNrrawf xtensron Received Application: i -31 Received Fee:$ Nj_ Completed Applicatioh 1 1 -Incomplete j _SEQRA Classification: Type I_Type Il_Unlisted_ Coordmation:(date sent) gLWRP Consistency Assessment Form I I J' -CAC Referral Sent: TDate of Inspection: Receipt of CAC Report'' - ~ --Lead Agency Determination:- Technical Review: .,.~_Pubfic Hearing Held: I 1 j -Resolution: j I I NameofApplicani Fishers Island Yacht Club I` Mailing Address P.O. Rox 141 r Fishers Island, NY Phone Number:( ) 631-788-7035 06290 0141 Suffolk County Tax Map Number: 1000 - 010 - 1 - 9 Property Location: Central AVenue, no 0 Fish>rs Tsl nd Location map enclosed (provide LILCO Pole distance to cross streets, and location) AGENT: Glenn E. Just-JMO Fnv'r,,nmtaxtha1 r!F§Rst1}ti,1q- (If applicable) Address: P.O. Rom 447 QuOgue,NY 11959-0447 Phone: 663 acn:; Board of Trustees APplioatioa GENERAL DATA Land Area (in square feet): 26,140 I. R-80 & M-II Area Zoning: Previous use of property: Yacht club l Yacht club Intended use of property: Covenants and Restrictions on property? Yes X No If "Yes", please provide a copy. I~ Will this project require a Building Permit as per Town Code? yes ° Na a Board of Trustee review If "Yes", be advised this application will be reviewed by the Building Dept. prior and Elevation Plans will be required- Does this project require a variance from the Zoning Board of Appeals? Yes No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept ? Yes x No i Does the structure (s) on property have a valid Certificate of Occupancy? Zyes No i prior pennits/approvals for site improvements: Agency Date I Y I Town Trustees 2/13 No prior permits/apProvals for site improvements. x No Yes ~ Has any permit/approval ever been revoked or suspended by a governmental agency? If yes, provide explanation: Project Description (use attachments if necessary): Applicant proposes to install two 6"x6"Xt2' timber piles, fasten hinge mount to exist_!2" Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA ! I Purpose of the proposed operations: t xr Nat ~T r ,n~a ; hpj ; Ts l rt rr1 ~~~FT~(L=l N~N.;'~ j i i.. i I Area of wetlands on lot 1 )~nQ square feet i Percent coverage of lot. Closest distance between nearest existing structure and upland edge of wetlands:~ feet Closest distance between nearest proposed structure and upland edge of wetlands: 3G~ feet Does the project involve excavation or filling? f I No Yes i If yes, how much material will be excavated? cubic yards j, How much. material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 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): 6Sil_ al ~ T i a 617.20 Appendix B Short Environmental Assessment Form Instructions for Comaletina 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 1 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 Part 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 Lion (de ,and attach ocation map J 1, QC, G Brief Description of Proposed Action kt~w\~C~'~`~~ nrl`)F~Q:3Se=S~ try 1 r~ +.-1-fir'-}-~~' c~'~"~`Q i \..~~'SS~' c.-c1~i~~ ctu~ C;)~t~"~c~.~ vs r?~ti'iS Telephone: Name of Applicant or Sponsor. 1 f. ! E-Mail: , Address: State: Zip Code: city/PO: ` ti~ t Q q ~ .1. oe~? ~S\ l 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 54- may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 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 acres or controlled by the applicant or project sponsor? 4. Check all land uses that occur on, adjoining and near the proposed action. ? Urban ? Rural (non-agriculture) ? Industrial ? Commercial d Residential (suburban) Other (specify): ? Forest ? Agriculture ? Aquatic T ? Parkland Page 1 of 4 NO YES N/A 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES 6. is the proposed action consistent with the predominant character of the existing built or natural ES landscape? 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NO YES If Yes, identify: SIt~Pa 1 `"RCN as~6 LLrt 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?~ c. Are any pedestrian accommodations or bicycle routes available on or near site of the 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 Yes, does the existing system have capacity to provide services? \ 14-NO ? YES] If No, describe method for providing potable water: NO YES 11. Will the proposed action connect to existing wastewater utilities? [If Yes, does the existing system have capacity to provide service? NO ? YES] If No, describe method for providing wastewater treatment: u\A e- 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? 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 waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: Shoreline ? Forest ? Agricultural/grasslands ? Early mid-successional F~Weiland ? Urban ? Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed ZYE by the State or Federal government as threatened or endangered? 16. Is the project site located in the 100 year flood plain? 7theproposeedd d action create storm water discharge, either from point or non-point sources. er discharges flow to adjacent properties? ? NO ? YES er discharges be directed to established conveyance systems (u offOan?d ss drains)? ribe: Page 2 of 4 18. Does the proposed action include construction or 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 active or closed NO YES solid waste management facility? If Yes, describe: 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 FO ION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponso ame; _ ~1'xis;;i, [?S ~t ( bi Date: yVj Signature: Part 2 - Impact Viintbnmation d Agency is responsible for the completion of Part 2. Answer all of the following questions in Part contained in Part I 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. 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? 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? 7. Will the proposed action impact existing: a. public / private water supplies? b. public / private wastewater treatment utilities? 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, waterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 No, or Moderate small to large impact impact may may occur occur [;problems? roposed action result in a;incr;easein h e potential for erosion, flooding or drainage 11. Will the p roposed action create a hazard to environmental resources or human health? -71 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. o Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ? Check 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 impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from Responsible Officer) Page 4 of 4 i i Town of Southold Erosion, Sedimentation A Storm-Water Run-off ASSESSMENT FORM 75 PROPEM LOCATION: SP-TALn: THE FOLLOi11N0 ACMUS MAY MOMM TM SW/15f1pN OF A s MUD PLAN -L IFFATE OF FORM TOM I SCOPE OF WORK - PROPOSED CONSMUCPION ITEM # / WORK ASSESSMENT Yes No a. What Is Be Total Area of the Project Parcels? I Will this Project Retain Ad Storm-Wabr Run-Off (Include Total Nee of all Parcels boded withhm '1 V Generated by a Two (2") Mall Rahtall on Sib? the Scope of Work for Proposed Construction) J ~F. / 1 ry~ will Include all run-off created by ass b. Whist is the Total Area of Land geadrg clearing andhr construction aclivides as wed as all a and/or Ground Disturbance for the proposed She Improvements and the permanent creation of construction activay? y.mAwaa) Impervious surfaces.) 2 Does the Site Plan and/or Survey Stow AN Proposed PROVIDE RRw PRO=r DicxairnoN alowsAaamrPw®n..a.o Drainage Structures Indicating Size & Location? This - / Ibull shall Include all Proposed Grade Charges and 11 I al ! ~j ~'TS! i Y C}~: I [ Slopes Controlling Surface Water Flow. 6 3 Does the She Plan and/or Survey describe she emslon 4g,}: S (0`4 (P(( 5L %,I' !A%yinii~t .L i~(LC and sediment control practices that will be. used to 1 7 control ode erosion and storm waer discharges. This An ~JV'~n k~(1f3 ! t. (L\ `f~j_ Item must be maintained throtgiout the Entire ConshuNonn Period. ? k.,-1 1+r n l~C = r (mot? 2~ 4 WIII Oils Project Require any Land Filling. Grading or ? Excavation where there Is a charge to the Natural t Existing Grade Involving mom than 20o Cubic Yards c of Material within any Part:st7 5 Will Oils Application Require Land Disturbing ActlNtles Encompassing an Area in Excess of Five Thousand ? (5,000 S.F.) Square Feet of Ground Surface? 8 Is there a Natural Water Course Running through fin Site? IsMls Proactwdhin the TnmOassjwiedktion ! SanerU ! SWPPP IbmllamreniU: or within One Hundred (1007 test of a Wetland or 19 1 srt rkolon d s awpPP b rearxea kr B camtrudb eWvl6es bvoldng ad Beach? mea.asawwadam (Acanore seas: YmWtllrW db6a6ammawdlaea >>men one ace Ind 7 Will tea ha She preparation on Existing Bred t slopes em pion of a Naga coma, pan ow ws mmdamuymaws one or rrow eau dbm which Exceed Fften (15) feet of Vertical Rise to ? ~ l t Including he DEC Cionshuclon sclivillas lnmbspacldgabemu of less Ascaae wtmpae One ne Hundred (1001 1007 of Horizontal Distance? the DEChaadabrararad Mae SPDEa llamas aegmaad lorabm xara maedaemgee. (SWPPPh Blue ortthe YlaMma Raqulra mmb of the aPOEa General Permit Will 8 dve ceding Nees or a ter Run-Off Impervious tarStorm WfaUr maU egu flown Censtruetianneedyfb •Pamlg No. (1134-10,0011.) Surfaces be be Sloped ,o Direct Slam-taster WM 1. The awPPP dog be Waapsed Prior to ft u6nitlot die NO]. The Not Met are Into and/or in the direction da Town right-of-way? I M*FWADd bee Department gbrto do com enmemmddmxnunndbn adidy. 22ThaSWPPPahati aanaoka araeN/namceamaamNrd gadkas and whets 9 wnl this Project Regular the PlacemeraofMabdal, a mm quftA PSamneawmmsbm waermmayammupm mores Me WE be and NOW Removal of vegetation ad/or Me Construction day wroaucrad to mdum Me Pdkdmft b$WewatrAtdw~eand a.seas, hem Within the Town Ri hFof-Way or Reed Shedder cummpeeeewRnlmlm udmuabmdMbpunkin em rd .1w SWRW6h8a S tda®ypabMbl as ofook*mwtdchawren A*becpecbdt*OM Ma Nee?In+rw.warmrumrmma.m.srpeam.awmr.avMwel mwallydabmweKdbtlMpes. NOTi: If AryAamnace QuaatlmsQrMrtugh am Is Aea smi yin schUkaa, a: A1sWPPPadWmglietlmp nsbrmwatedaemgmmapadke In a9ma and au combustion all didaftwee Is basses SAWAP.at Aare auk mhwauaa'dmlbuwepamdbyegreMaaDwWPmkubWLtwmdinNmYwk aabm.WUV,Wamnabndm .a Emalmoamd Pbnkfl a- abyaaTOVmd tlelbbnaYtlpw6bbtlp pkepbssrd PUdkmdaumWUaYomegunant. Dammamedmd Mm betobnabaferRrA mPdorftWa dAmy806dkaP- W l>rdTe AOwG Nwa(~f rmao NrmwbearAQuafamb RaVAad WeeamWbAppWnq STATE OF NEW YORK, COUNTY OF ..-J..~~1..~..j..~'~ SS That t ..101n~n_.. w; a ~ ~ being duly swom, deposes and says that he/she is the applicant for Permit, And Ihat he/she is the lf'~~'.a.:........................................... . I. 1-1 (amwen a;mtrador, Agent, capaaoeor~Ce ..ek.~ Owner and/or tepresenbGve of the Owner or Owners, and is drily authorized to perform or have performed the said work and to make and file this application; that all statements contained m this appliaiion are are to the best of his knowledge and belief and that the work will be performed in the manner set forth in the application filed herewith. Swom to before me this; day of , 20..... Notary Public (Slgeaee dApplmsa) FORM - 06/10 MAR-9-2012 04:32 FROM: 0 TD:iB607550'563 P.414 J.M.O. Environmental Consulting Services o whom it may cwncen: Please be advised dtet we have aut adnd the firm of Mo Pnvirawwwal Conanlting Services to act as err agent on our behalf in applying for certain approvals d wougo your agency and odrers involved with this project, J.M.O. Envirwatc rW Coowl6ng SeMew bas been retained to coordinate all approvals necessary duough your and other involved agencies, es well as arcidtaia, cogiaoer and camftactam We request dW ail Sena, awropondenoes, notices, approvals and cells be addressed dbm* to dw offices of J.M.O. Envba =enW Comutting Services. 4sigosuffe --Dated 3 / 2 ~t 5~ ¢ 3 S te` Y, CO, Phone (631) 653-0607 • Fort (631) 653-3348 121 Jessup Ave a 2nd Roor • P.O. Box 447 QLx)gue, New York 119594)447 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Tie T>Zt~tt of SoutMld's Code of Eih prohibits caufficts; interest Qu - of tomm officers and emoloveac" Th Yf Shrs form rs to movrde nfmmatim which M alert tovm of t esible conflicts of interest and n r whatever necessary to avoid same. YOUR NAME: j u&4 , O~ (Last omne, rmC t name, midave 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 Plannin Other g (if "Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO If you answered "YES", complete the balance of this face 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 applicantlagent/rWresentative) 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 thi day o r 204 Signature Print Nam Form TS I FW: Sea Stretcher Ramp . • Page I of 2 From: Richard Strouse <rstrouse@cmeengineering.com> To: gjust10215 <gjust10215Qaol.com> Subject: FW: Sea Stretcher Ramp Date: Wed, Oct 30, 2013 1:41 pm Dick Richard H. Strouse, P.E., L.S. Vice President-Resource Management Group CME Associates, Inc. 32 Crabtree Lane P. O. Box 849 Woodstock, CT 06281 Tel: 860-928-7848 Fax: 860-928-7846 rstrouse(u),cmeeni,yineering.com From: gary [mailto:createlearningCalaol.com] Sent: Tuesday, October 29, 2013 2:50 PM To: Richard Strouse; areoorythibodeauOhotmail.com Subject: Fwd: Sea Stretcher Ramp Second approval from FIDCO, Please let me know if you need and further information, or have any questions Gary Vollinger Original Message— From: Chris Finan <jcfinan@fishersisland.net> To: createleaming <createlearninp(caol.com> Sent: Tue, Oct 29, 2013 1:13 pm Subject: FW: Sea Stretcher Ramp http://mail.aol.com/38135-111/aol-6/en-us/mail/PrintMessage.aspx 10/30/2013 FW: Sea Stretcher Ramp 40 0 Page 2 of 2 From: Chris Finan [mailt07icfinan@fishersisland nett Sent: Tuesday, July 02, 2013 5:49 PM To: createlearningO),aol com Cc: Mark Gaumond; Scott Reid Subject: Sea Stretcher Ramp Dear Gary, If you comply with the following conditions before work starts Fishers Island Development Corporation is not opposed to your plans: 1. Request to name Fishers Island Development Corporation additionally insured. 2. Statement to hold the Fishers Island Development Corporation harmless of any liability. 3. The Fl Yacht Club agrees in writing with the proposed construction plans and start date for work. Best, Chris Finan Fishers Island Development Corp. Manager 161 Oriental Ave Drawer E Fishers Island, NY 06390 631-788-7251 httr)://WWW.FIUC.net http://mail.aol.com/38135-111/aol-6/en-us/mail/PrintMessage.aspx 10/30/2013 Town of Southold LOVRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I 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 j malting a determination of consistency. *Except minor exempt actions including Budding 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 to its iMificant j beneficial and adverse effects upon the coastal area (which includes all of Southold Town) i 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 snuuortina and non- sunaortine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken f A copy of the LWRP is available in the following places: online at the Town of Southold's j. website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all j local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# co. - :1~ 10 PROJECT The Application has been submitted to (check appropriate response): Town Board ? Planning Board El 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: r 6~t~ C r C4'.Es 1n~ Location of action: ~i? n. (1ti_ k~_~1(J ; ~C Ctv Site acreage: C . tG~ 1 tt I Present land use: j f l~fi t b Present zoning classification: - cyJ \ 1 Yl : ~t7Z- i 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: 1 . (a) Name of applicant: X~~a ai8 ~A CI ('J C) address: (b) Mailing C! :`~,~9.r ) ( j (c) Telephone number: Area Code (r I -~G31~ (d) Application number, if any: Q vt r ;c. oL1 Will the action b, directly undertaken, require funding, or approval by a state or federal agency? Yes ? No 124 If yes, which state or federal agency? f i 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. Q Yes ? No ? Not Applicable t i It i olP ! i La c Aii Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LW-R}P Section M - Policies Pages 3 through 6 for evaluation criteria LEA Yes ? No ? Not Applicable .Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria Yes © No [3 Not Applicable The-nroiar} will not n t t the visual quality of he Tnwn It 'g felt that- this projeri- is consistant with this policy 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 lil Yes 13 No G Not Applicable The project will not cause the accelerated erosion of adjacent properties, will not create any aesthetic impairments, the shall be no oss o a i a marine or wetlands) an there s al be no loss o pu is ecrea_iona resources_ is e a is project wi is po-icy 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 2 Yes D No © Not Applicable The project W111 have no impact upon the n,li y nr quantity of potable water in the Town of Southold 'Elie-rct shvm}d irsp*;erve the wa!er quel-6 y of--reissue xa-i~_ Tt is felt that this project is consistant with this policy 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. a Yes ©No 0 Not Applicable The project shall have no ne ative impacts upon the qua lit or function o any wet ands, ecosystems or areas of Significant Coas a is an wildlife Ha i a s an s ou improve the water qua i y o es ar or. is e a is pralec is consIstant i is po icy 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. Lfg, Yes ? NOD Not Applicable The project will have no impact upon air quality. It is e a is pro~ec is conics ant wi this policy 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. li~Yes ? NOD Not Applicable The project does not involve the use or di posal of solid waste or hazardous substances and wastes. It is felt that this p project is consistant with this policy 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. nn lb Yes[] No ? Not Applicable The project will have no impact upon public access to, and the recreational use of coastal wa u t public resources of the Town It is felt that this roiect is consistant with this policy 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. F 77 1 LI Yes ? No ? Not Applicable The project will have no impact upon Southold's water-aepennent uses or the siting of new water-dependent uses 1n 2 u1 a e ovations. It is elt that this project is consls an with is Policy Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes ? No[:] Not Applicable The project will have no impacts upon the substainable use of living marine resources. It is felt that this project is consistan wiUIL L 11-L6 po icy 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 li~' Not Applicable The project does not involve agricultural lands It is felt that this policy is not a plicahle to this project Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. -Yes ? No ? Not Applicable The project does not involve the use of or development of energy or mineral resources. rt is felt that this project is consistan it. t is po icy Created on 5125105 11:20 AM NOV - 1 ar of ins APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE 3 13 j 5Sq ~ Y ~ t ~ T , A fi ~ Y { x I ' s Ape ice 6k (3y y~GlF 0, LPC a2di m l ?e/1e, Nav t ry . ' <y J NOV - 1 2013 Ily r IP { ~A tea I ; j i ~jrr~"rrJC D~"k r a - r 1 ` /r. rat 73 KS F*-' , ---.L1 to L~ • ~ "T x 9V NOV - 1 2013 Ssutlwll'I~uwn ~ Ac cat ~1L r t 1 • U~~w ~kG PIPI C'C,JNeC+iON Cl � Sc a (Gam LNOV' - 1 ^Ol Hinge mount to 2 Pylons to support dock and mount lift Hinge mount fastened to and dock Lifting cables and counterweights V4 'a ock approx , 42 inch wide _ -411{vith railings Ramp extension 8 ft long, slides over the NOV - i 2-0 t upper section for storage, hinges in extended position to Board of Trus upper section IG Nylon wheels allow extension Position at low tide to roll on deck and over upper ramp Support roposa or ea tretcher gurney amp contractor Installation of ramp : p • Provide pylons 6x6 pt bracing and support framing to existing dock, pulleys of ss or galvanized steel mounted to top of pylons. Pylons must be bolted to framing and capable of sustaining high wind loads. • Provide ss cables and counterweights (weight determined at assembly) -- to allow ramp to lift up off the boat. • Complete entire assembly of ramp and rub rail on boat, and step approx 18 inches wide to cabin (teak or mahogany). • Please provide quote for parts and assembly to Gary Vollinger by March 3. • Questions call Gary 7029 PNOV 1 ?013 Board Fri