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James F. King, President gU y p~ C~ P.O. Box 1179
Bob Ghosio, Jr.. Vice-President y d Southold, NY 11971
Dave Bergen ? Telephone (631 765-1892
John Bredemeyer G ~ Fax (631) 765-6641
Michael .I. Domino
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time:
DANA & MICHAEL SAVINO request and Administrative Permit to repair and
replace the existing bulkhead, dock with a 4'x16' hinged ramp, 6'x50' float,
and (2) 6'x31' floats; and deck damaged from Hurricane Sandy. Located:
1945 Bayview Avenue, Mattituck. SCTM# 106-6-37
Ty4a.-of area to be impacted:
-Saltwater Wetland -Freshwater Wetland -Sound -Bay
Distance of proposed work to edge of wetland
Payt-ef 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:
v
C,ondit ons: ax q l ' f~N ~X / ,;L' A OW Wry
r(+A~11~i1/nr.L~
Q G 17 icon
C- Pa,
Pre 'it Were: '1Xj. Ki - B. Ghosio / D. Bergen,
J. Bredemeyer Michael Domino D. Dzenkowski other
Form filled out in the eld by C
~I re 'n2'~
Mailed/Faxed to:
Date:
TOWN OF SOUTHOLD.
BOARD OF,SOUTHOLD TOWN,TRUSTEES.
'OUTHOLO, NEW YORK ~ . ,
1 ' WETLANDS PMOT
y TRUSTEE PERMIT NO.: 2303
Tba Wetlands Petlmt Na 467 has}seatt granted by the TowD ,Tlry:stees according to
' s r EdoneviC n}e Inc for
-:nfmmation furnW"in 7slipptlop,No. filed by~Applicant :
: Philip sahce^, . on ruae_25 _,,,3b.,.., 1g.67 A map of -tlta'propoeed work 541 be kept
on tile in:theTrustee`Offtce under theapplicationnumbeggl4in
granted to clo the following work To. conatruet a tfml;e~ d¢ak S sieting of a„ ..T. 35!
Parma
. , an.existixlg: bullcepdj ;4' x 16': hingg5j,xj,
fixed. elevated walk extending from
6' x' 50! float and (2) 6' x 31' floats and a Gasebo
Location of property on wh:ch work to be done 8aY`1ew ,....Aveau M@ttMJX
.
Creek, Bay or Harbor fronting property Mattftuck Creek
"
Size of work. Length (3gq walk 16' ramps. 50!. float and (2) 31' f14}fg„egs}„~ r~g)ZA.. ,
Width _ 4' .:walk, 4' ramp, 6' float and (2) 6' floats
_
Height Above High Water ....n/a
Depth Below Low Water ........n/a Yards to be Excavated nla
Yards to be Filled n/a
Manner in which material is to be removed or deposited
Intended use of property Residential
-
Conditions if any
.
_
bx.,sa'&J.. rjxgr;,,,,,,,,,,,,,,,,;,,,
.wor.k..has. not commenced....
. if..
Expiration Date June 25..,...1989..
..;Trustees are to be notified upon the completion.. of. the
Number of l nspections Required
work.
Inspection Fees _..$1m. t
.
Liability Policies. in the Amount of
The validity. of this permit is or may be subject to theapproval of other governmental or municipal .
authorities. The Town accepts no responsibility in applying for or obtaining.. such approval. In the
event that such approval is necessary, the holder of this permit shall not commence operations here-
- under until such approval has been obtained in writing. The failure to obtain such other approval when
required shall subject this permit to immediate revocation by the Trustees upon receipt by the
Trustees • of written notice from such other governmental or municipal authorities of its refusal. or
disapproval.
FRANK A. KUJAWSKI, JR., President - TELEPHONE
ALBERT J. KRUPSKI, JR., Vice President Ln - (516) 76&1692
JOHN. N..BREDEMEYER,. HI O
JOHN L.rBEDNOSKI,JR•
HENRY P. sM1TH
i
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
November 22, 1988
Philip Salice
ayview Ave.
i~attituck, N.Y. 11952
e: Conditional amendment of permit No. 2303
ear Mr. Salice:
The following action was taken by the Board of Town Trustees
curing their regular meeting held on November 17, 1988 regarding your
zequest to amend the above permit.
RESOLVED that the Town Trustees Approve the. request of Philip
alice to amend, with the condition of boat size restriction,,
ermit number 2303 to reflect 101 extensions to existing floating
ocks, no vessel shall exceed size of dock or extend past eastern end
f dock so as to cause navigational problems in the channel.
This letter is to notify you that we will amend permit on.
ayment of fees for work to be done and the amended permit shall take
ffect as soon as payment is received. All other terms and
onditions in the original permit granted shall remain.
Very truly yours,
Frank A. Kujawski, Jr., President
Board of Trustees
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P?RPOSS: PRIVATE bw<<~ane
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el. ST~ViA SA~vOi R$ j
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G/i1®), G/n/eo
HENRY P. SMITH, President
JOHN M. BREDEMEYER, Vice-Pres. TELEPHONE
(516) 765-1892
PHILLIP J. GOUBEAUD t)>Y
ALERT KRUPSKI, JR.
ELLEN M. LARSEN 't( 7.
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
May 29, 1987
Mr. Roy L. Raja, President
En-Consultants, Inc.
1329 North Sea Road
I. Southampton, New York 11968 -
j
Re: Philip Salice - Application No. 506
i
I Dear Mr. Haje:
The following action was taken by the Board of Trustees during their
regular meeting held on May 28, 1987 regarding the above matter.
WHEREAS, En-Consultants, Inc. on behalf of Philip Salice applied to the Southold
Town Trustees for a permit -
under the provisions of the Wetland Ordinance of the Town of
Southold,. application dated February 18, 1987 and -
WHEREAS said application was referred to the Southold Town
Conservation Advisory Council for their findings and
recommendations, and
i WHEREAS, a:public hearing was held by the Town Trustees with
respect to,'said application on May 28, 1987 at which time all interested
j persons wem.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
WHEREAS; the Board has considered all the testimony and documentation
sub*itted concerning this application, and -
WHEREAS, the Board has determined that the project as proposed will
notaffectthe health, safety and general welfare of the people of
the.-.town,
NOW, THEREFORE, BE IT
VOLVED that En-Consultants, Inc. on behalf of Philip Salice BE AND HEREBY IS GRANTS
PFRMY:SS.IOl,.LINDER THE
PROVIS,IONS;: WETLAND ORDINANCE OF THE TOWN OF SOUTHOLD TO:
Construct.a timber
dagk consisting of a 4' x 40'(with additional 4'x.41 off set at the outer end)
fixed elevated walk extending from existing bulkhead; 41 x 16' hinged ramp; 6'
x 501 float oriented N-S and (2) 6' x 30' floats oriented E-W to form "V":
Doak over area behind existing bulkheaded (301x99.5') and construct a 12' 15'
Gaz bo. Ptoperty is located on Bay-view Avenue, Mattituck. APPROAAL IS WITH THE
PR(SVISION'THAT 'THE DOCK IS SHORTENED 10'. -
gy5s
w
y, Page 2.
Philip Salice - Approval
This permit will expire on May 28, 1988 if work has
not commenced by said date. There are two inspections required and
the Trustees are to be notified upon the completion of the work.
Prior to the issuance of said permit by the Clerk, the applicant
shall file with the Clerk a certificate that he has public liability
insurance policies "insuring against any liability which may arise
in the performance of the operations pursuant to such
permit in.such
amount as shall be-,fixed by the Trustees, which said`poii6les shall
name the Town as -a name insured. Please take further notice that
this declaration should not be considered a' determination: made for
any other department or agency which may also have an application
pending for the same or similar project.
THE FOLLOWING FEES ARE NOW DUE AND PAYABLE:
(2) 30' x 6' floats= 360 sq. ft. @ $1.00 $360.00
(1) 50' x 6' float - 300 sq. ft. @ $1.00 300.00
(1) 4' x 16' hinged ramp - 64 sq. ft. @ $1.00 64.00
(1) 4' x 40' dock - 160 sq. ft. @ $1.00 - 160.00
(1) 4' x 4' off set - 16 sq. ft. @ $1.00 = 16.00
8 pilings @ $25.00 200.00
$25.00 Trustee application fee 25.00
$10.00 Wetland Inspection Fee 10.00
Total Amount due $1,135.00
Very truly yours,
P.
Henry P. math, President
Board of Town Trustees
HPS:ip
cc: Robert A. Greene, D.E.C., Stony Brook
Commissioner Henry G. Williams, D.E.C., Albany
Stephen Mars, Army Corps of Engineers
Thomas Hart, Coastal Management
Conservation Advisory Council
Bldg. De
Board7ppeals
File
PLEASE RETURN TO THE BUILDING DEPT. FOR A DETERMINATION ON THE NEED OF ANY
OTHER TOWN PERMITS THAT MAY BE REQUIRED FOR THIS PROJECT.
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SURVEYED FOR.- ~N/Ur0 ?/1U~=E , TOk V OF .'S4U7'H0L0 SUFFOLK COUNTY N.Y.
LOCATED AT 1117.4 7- T/T/uG,C_
LOT /.5 /Oq.2r OF GOT co ax NO. 41 FILED- 4/
• MAP OF Sf/0,2E a~ES
SCALE 1"
SUFFOLK CO. TAX MAP DATA:- '1/.~C Z/Ecs e-
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DIST. /OOO .SEC. /OGj .OO „ "`CCC 1
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WILLIAM R. SIMMONS JR.
4-- PIQ Box 1"
IPAOk 03 OFU0 3G,
-.n F tit) i L _
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FRANK A. KUJAWSKI, JR.. Aesideat ~
TELEPHONE
ALBERT J. KRUPSM, JR., Vtc -Pmidelt (515) 7WI892
JOHN M. BREDEMBYER, M
JOHN 4. BEONOSM, JR.
NEMR P. SWrH .
BOARD OF TOWN TRUSTEES
I TOWN OF SOLMHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
1 I
i December 13, 1988
on-Consultants, Inc
1329 North Sea Road
Southampton, N.Y. 11968
f
e: Conditional Amendment of permit No. 2303- Philip Salice
ear Mr. Salice:
I I The following action was taken by the Board of Town Trustees
uring "their regular meeting held on Nov. 17,1988 regarding your
~equest to amend the above permit.
RESOLVED that the Town Trustees Approve the request of Philip
slice to amend, with the condition that no vessel exceed size of
Bock or extend past east end of dock, permit number 2303.
This letter is to be an amendment to the original permit and as
uch shall be attached herewith.
All other terms and conditions remain as written in the original
ermit.
Very truly yours,
?idVte'rt
Frank A. Kujawski, Jr., reBoard of Trustees
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Albert J. Krupski, President • ~QS0 F04 •
-James King, Vice-President ti,\y~ OGy Town Hall
53095 Route 25
Artie Foster P.O. Box 1179
Ken Poliwoda ti 2
Southold, New York 11971-0959
Peggy A. Dickerson
y~1f0 aQ`' Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 23, 2003
Cdr & y1rs. Savino
15 Maria Court
Wading River, NY 11792
RE: 1945 Bayv iew Avenue
Mattiuick, NY
SCT.\1 it 106-6-37
Dear Mr.& :Mrs. Savino:
The following action was taken at the Southold Town Board of Trustees Regular Meeting on
Julv 23. 2003.
RESOLVED, that the Southold Town Board of Trustees Approve the request for a Transfer of
Pcyu i1__?' ; construct a limber dock of a 4'x35' fixed elevated walk extending from an
<~__Cxismni z bulkhead'`4'x 16' hinged ramp, 6'x50' float and (2) 6'x30' floats and a Gazebo and deck.
cham~e ofname lion) PHILIP SALICE to MICHAEL & DANA SAVINO
If you have any questions, please contact our office at 765-1892.
i ere) - o
Albert J Krupski, Jr.
President, Board of Trustees
\JK:cjc
Aber[ J. 1U"upski, President ~O%VF0jf
'J 0
annes King, Vice-President Town
Arne Foster y
Hall
Ken PDli"oda y < 53095 Route 25
Peggy A_ Dickerson Z P.O. Box 1179
p • Southold, New York 11971-0959
y~41 ~a0~ Telephone (631) 765-1892
Fax(631)765.1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 23, 2003
\11 & ::\]Is. Savino
15 Maria Court
\\'ading River. NY 1 1 792
RE: 1945 Bayview' Avenue
Nlattituck, NY
SCTM I (J6-6-37
Dcar \9r.& :\1rs. Savino:
The following action was taken at the Southold Town Board of Trustees Regular Meeting on
July 23-2003.
RESOLVED, that the Southold Town Board of Trustees Approve the request for a Transfer of
Permit 2303 consu'ucl a limber dock ofa 4'x35' fixed elevated walk extending from an
c istin bulkhead 1', 16' hinged ramp, 6'x50' float and (2) 6'x30' floats and a Gazebo and deck.
of name I-'om PHILIP SALICE to MICHAEL & DANA SAVINO
11 `ou have any questions, please contact our office at 765-1892.
i errl
Albert J Krupski, it..
President. Board of-Frustees
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COUNT'/ OF SUFFOLK ® • o c^°"
_ wl 0 ~ _ _ FIUI PIapeRy TeISEMmlpncy v
OFFICE LOCATION: • ~~OF SO(/jyO • MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 y Southold, NY 11971
(cor. Main Rd. & Youngs Ave.) T
Southold, NY 11971 013 Q Telephone: 631 765-1935
• ~O Fax: 631765-3136
~~OOUNi'1,~~
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
pEQEIVE~
To: Jim King, President JAN 2 2 2013
Town of Southold Board of Trustees
outhold Town
From: Mark Terry, Principal Planner Board ot e
LWRP Coordinator
Date: January 18, 2013
Re: Proposed Wetland Permit for DANA & MICHAEL SAVINO
SCTM# 1000-106-6-37
The dock and bulkhead were endorsed by the Board of Trustees under permit 407 and 2303.
DANA & MICHAEL SAVINO request and Administrative Permit to repair and replace the existing
bulkhead, dock with a 4'x16' hinged ramp, 6'x50' float, and (2) 6'x31' floats; and deck damaged from
Hurricane Sandy. Located: 1945 Bayview Avenue, Mattituck. SCTM# 106-6-37
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 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). The proposed structures are not located within the CEHA.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
James F. King, President O~ ~~~F soUjy~ Town Hall Annex
Bob Ghosio, Jr., Vice-President ~O 6 54375 Main Road
Dave Bergen P.O. Box 1179
Southold, New York 11971-0959
John Bredemeyer ca *0
' Telephone (631) 765-1892
Michael J. Domino Fax (631) 765641
~~~Vu0i
r.
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
-Coastal Erosion Permit Application _
-Wetland Permit Application Administrative Permit
_AmendmentfrransferBx nsion _ D2 C Z&P 20 I2-
Received Application
-Received Fee:$ 2SOlk~sn 2blZ-~
_),/Completed Application Z /Z i
-Incomplete '
_,SEQRA Classification:
Type 1_Type II-Unlisted
Coordination:(date sent) / f..
~LWRP Consistenc As semen[ Form 3
CAC Referral Senty: A/
Y Date of Inspection: t - j
-Receipt of CAC Report:
_Lead Agency Determination:
Technical Review:
-7 u;lic Hearing Held: 3
-Resolution:
Name of Applicant -ba n o, °H M; L h e4 e. L SGLU N O
Mailing Address ~ 1^(1 Ot (L i C. OU (Z-: aj i n V` \ ? Q 2
I I -Y1 m~ Z Phone Numbe~3) - q"2`1 OQ
Suffolk County Tax Map Number: 1000- 1 o (D " fQ 3-1
Property Location:- S-_e Su 2 y 2~6 1 q \~OLu 0\ t.J Q
G~+t k~c ~y s Z
(provide LILCO Pole distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Board of Trustees Application
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GENERAL DATA
Land Area (in square feet): See 'So U e ~
Area Zoning: tjAr
Previous use of property: _ReS
nn t A e o r, A L
Intended use of property: 1G ,Ps 1 (Y e o -b 61 r1
Covenants and Restrictions on property? Yes No d 5, 2 e 0
If "Yes", please provide a copy. St ea 4 -Ic NO J eS Se PX (e e
Will this project require a Building Permit as per Town Code? Yes No I '
If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review 4
I
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 y demolition as per Town Code or as determined by the Building Dept?
Yes No
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Does the structure (s) on property have a valid Certificate of Occupancy`? Ve"Yes No
Prior permits/approvals for site improvements:
Agency Date
,
Or #Z3D3 l~~5-1 I
Pe(2 n,%A--~.
W C~ 160a
No prior permi lts/approvals for site improvements.
Has any permittapproval ever been revoked or suspended by a governmental agency? V No Yes
If yes, provide explanation:
Project Description (use attachments if necessary): Q ~Gt i IZ lG C
1 S ~ir\ 6L) IL I-4rc G` 4 tpc ~c _ (y 'f c 4 S~ `V
yxly hiW,04 l1Grn, 1®XSV Flom (2> C~~31 /ms' s
Dr
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA .
Purpose of the proposed operations: p a i l 4 ~G
Area of wetlands on lot: I t qq.~ square feet (y~ 1~ 3Q
a~,s
Percent coverage of lot: -4o1? % i
Closest distance between nearest existing structure and upland
edge of wetlands: e," SoUL4 1µs feet
Closest distance between nearest proposed structure and upland
edge of wetlands C)Q4 L feet
Does the project involve excavation fillin
I.
No ? Yes
if yes, how much material will be excavated?__0_cubic yards
How much material will be filled? R P Par 10 cubic yards
Depth of which material will be removed or deposited: a I ' feet
Proposed slope throughout the area of operations: PIP
Manner in which material will be removed or deposited: i mtS RA
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):
NIP-
PROJECT ID NUMBER 817'20 SEQR I
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
BART 1 -PROJECT INFORMATION (To De wmpleted by plicant or Project Sponsor) j
1. APPLICANT/SPONSOR 2. PROJECT NAME
p,?IIL~1l (+Z
Q a- I C eL SSGO.N ith-Q 12E41 n 6w,40 UOclc jc ~r s&vv!r j
3.PROJECT LOCATION: ~Municipality >O 04)0 1 County sU "t-t d 1 I
i
4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map
C) c4 f ~I , e w 4 u 2 (Y) -J 441 Svc lc I I a~ Z
B N YY1 t4 f" I c. tr P IL
5. IS PROPOSED ACTION : New Expansion fill Modification I alteration
L. q zP-024 jewear
6. DESCRIBE PROJECT BRIEFLY:
R,0pa,z- RPPIac e Irn~ 10t 111/~~~'
Gl~ nJP2 KaN,p ~k s o Floe,-~ 2 L.t 31 )F jg. Jec%
r<-4M NU Q e i c Gln ,e_ Sp
f:
7. AMOUNT OF LAND AFFECTED:
Initial ras Ultimately acres
8. WILL PROPO ED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
b Yes ? No if no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as marry as apply.)
Residential ?Industrial Commercial Agriculture ?Park/Forest/Open Space ?Other (describe)
10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
[2Yes ? No If yes, list agency name and permit / approval:
+ e z¢ e r» 'A---
ggrfes ?No If yes, list agency name and permit / approval:
12 AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
ea No ~
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I Sponsor a Dat
signature -
L-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 completed b Lead Agency).
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 N yes, coordinate the review process and use the FULL EAF.
0 Yes Q No
B. W LL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative
declaration nay be superseded by another knelved agency.
Yes No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. N legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patem, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
C2. Aesthetic, agriaAtmai, archeological, historic, or other natural or cultural resources: or = W or neighborhood character? Fxpialn briefly:
I
C3. Vegetation or fauna, fish, shellfish 'or wgdgfe species, significant habitats, or threatened or endangered species? Explain briefly:
1 71
C4. A community's existing plans or goals as officially adopted, or a change -in use or intensity of use of land or other natural resources? Explain briefly:
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
C6. Long term, shad term, mmulafive, or other effects not Identified in Cl-C5? Explain briefly:
C7: Other Impacts (Including changes in use of either quantity or type of energy? Explain briefl ; - - - - -
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL `
ENVIRONMENTAL AREA CEA 7 It s, explain briefl :
0 Yes Q No
E IS[3 ERE, OR IS THERE LIKELY TO B CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMP If Yes ain: .
_ Yes Q No
PART IN - DETERMINATION OF SIGNIFICANCE (To be o mpleted by Agency)
11111STRUCTIONB: Foreachadverse effort Mwefiedabove, determine whetheritissubstantial. large, imporfantorotherwisesignificant Each
effect should be assessed In connection with its (a) selling (Le. urban or rural): (b) Probablrny, of occurring; (c) duration; (d) imevers6lt(y; (e)
geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain.. -
su(Bdentdefal to show that all relevant adverse hnpacts have been identified and adequately addressed. If question d of pant was checked
ys,this determina lonMaignilkanoe mustevaluate the Potential kneadoftheproposed action on theernircrimm alcrersidwistIce of the CEA
CfadX/his boxNyou have Wangled one ormore porentiakywile orslgNflcartahorse imparts which MAY occur. Thenpooeed diredlylo the FULI
EAF and/or prepare a positive declaration.
Check this box KYW have determined, based on to Infomation and anatysis above and any supporting doasneMaton, that tine proposed editor
WILL NOT result In any significant adverse ervkonmenlal Impacts AND provide, on atadarertis as necessary. the reasons suppodkg
determination.
Board of Trustees n 15 Z a i Z
Name of Lead Agency / / Date
~ ~ / • IZIN President El
Prbd or Type ame o Responsible Officer ` Lead Agency Title of Responsible Officer
S hire of Responsible Officer Lea ency Signature of Preparer (If different from responsible officer)
Town of Southold
r~ erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
yt' PROPaMY LOCATION: 5,CNA. a: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
S RI&WATEP GRADI;p DRAINAGE AND M=MrdURFP-.OL-P-ak
j
G 10 IO IN T V NM
i
SCOPE OF WORK - PROPOSED coNST umoN TrEM # / WORK ASSESS1 mT Yes No
a. What Is the Total Area of the Project Parcels? I NAIL this Project Retain All Storm-Water Run-Off
(include Total Area of el Parcels located within V('1 I( J. Generated by a Two (2-) Inch RaiMel on she?
the Scope of Work for Proposed Construction) ) ~3 C - ?
(aF. rAaes) (This Item will Include all mnoH seated by site
b. What Is the Total Area of Land Clearing clearing and/or construction activities as wel as all
and/or Ground Disturbance for the proposed Site Improvements and the permanent creation or
construollon aotNRy? Impervious surfaces.)
(e.F.lAUesI 2 Does the Site Plan and/or Survey Show AN Proposed
PROVIDE BRIEF PROJECT' DESCRHMON Wcweee AUwrv.aea-Hesse Drainage Structures Indicating Size & Location? This
- a
Item shall Include all Proposed Grade Changes and
E' pas / d R e P I Gc e ez, 1 S-40 Slopes Controlling Surface Water Flow.
1 T 1 It ~1f Q C a- p C~I<- r r 3 Does the She Plan and/or survey will describe the erosion ?
rj y'J~ I and sediment control practices that t will be,use sed to
_ control alto erosion and storm water dlschergels. This
1 R ft .Q ck e C(l-t V, ~r.,j Item must be maintained throughout the Entire
a Construction Period.
`Z 2 3' f-LI IS A -b-C S 4 WWI this Project Require any Land Filling, Grading or
Excavation where there is a change in the Natural
EAstbrg Grade Involving more than 200 Cubic Yards
df Material within any Parcel?
5 NAIL this Application Require Lard Disturbing Activities / .
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.) Square Feet of Ground Surface? L=J
6 Is there a Natural Water Course Running through the
Site? Is this Project within the Trustees jurisdiction V CA
General DEC SWPPP stmt nnents: or within One Hundred (100') feet of s Wetland or
SuMdeebn de SWPPP b required oral Conakidw adMfts nvoNbg soli Beach?
dbhrba m. done (1)a Ines saes irdWng disturbances crime than one acre Met 7 WIII there be Site preparation on ExlsUng Grade Slopes C
am partofa rgeroommon plan that will uftmaly, dbhub arm ormore aces of [arid; which Exceed Fifteen (15) feet of Vertical Rise to Q -
ntludagConalmallmactivities; involving act disturbances of loss than ona(1)aee wham One Hundred (100') of Horizontal Distance?
tie DEC hm determined Mate SPOES permit Is required for atom wehrdtswgmm.
(SWPPPY shell meet the Mlnlmum Requimmuds of the SPOES General Parm t 8 WIII Driveways, Parking Areas or other Impervious /
for Sturm Weser Discharges from Oce struceon audvib.-Permit Nee OP-04e.0e1.) Surfaces be Sloped to Direct Storm-Water Run-0R V
1. The SWPPP shell be prepared pdw to the subtotal crew NOT. The Not shat be Into and/or In the direction of a Town rightoRwayt
submitted to the DepeMwd Prior tu the ComMnterrmre of conabuctbn actk*.
2. The SWPPP shall describe the aroNon and sedi nent ombal practices and wham 9 Will this Project Require the Placement of Materiel,
mclubed, postcomeruttlan he wdwffm genmd VackN set wa be wed wdlor Removal of Vegetation and/or do Construction of any
caubrlchd o reduce ire pollutants in dorm water discharges and to assure Item Within the Town Rlghtof•Way or Road Shoulder a -
compliance with tit hems and oordaom of eb permt. In ed0on, the SWPPP Ones Area?
(mrnsn mo xorseeas m.ewaaa.rariwaq ppena)
Identify pomSat steams of pot Wan which may masornby be aWchd to affect t the
grWp~d atolls watsrdbdLmteq. NOTE: If AnyAnswer to Questions Oneemugh Mne Is Answered wish a Chu* Mud/
&At 8WPPPs that require the ppetsomWgbn strmm watamanapameM prattle Ica Dmandthemnsauc§m NbdbWrb n Wbawes'nf WD$Y.a/A=Inaree,
co potent shat be Papered bye qudW Design Pmhssknel Licensed In Nwwyok astamwa .Gredag, Dmhtw&Emlon CoWol PlantsRegdmdbytire Towed
that is lawwledgeable n the prinDism and preolkes of Storm Water Manepenpnl. Southold Wd Must be Submitted rm"Am Prbrh issuers of Any Bending Pamk
prrars Ache* link(#)eriaa.NUwer far esdr Ou-tlan bRWAW tors CrophasPppenden)
STATE OF NEW YORK,
COUNTY OF SS
That 1... ~ f be' dui swum, deposes and says at he/she is the
Y th applicant for Permit,
( medindMdwlsi^pn~hp~D,oonwnt) ~ / J ,~T
And that he/she is the ...........,ba..aA...~...M..t..f..A...dyl-- v..F-...... A?:. ?
(Owner, Canlreda, Agent. copor ~
ea)
Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to
make and file this application; that all statements contained in this application are true to the best of his 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:
(SlpmWe dApplkenq
FORM - 06110
i
Board of Trustees Application
i
County of Suffolk
State of New York
I;
I.
i
I:
J,)01)6 Sao, l7 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 THIS APPLICATION.
S e of Property Owner
SWORN TO BEFORE ME THIS DAY 019 ,20-L):1
Notary Public
CONNIE D. BUNCH
Notary Public, State of New York
No. 01BU6185050
Qualified in Suffolk County
Commission Expires April 14, 2-nj
Boar Trnstaee Application •
AUTHORIZATION
(where the applicant is not the owner) L
I, nO\ S (%1 d 1) D residing at I Im Q i G r w` (Cl v 1~ \1
(print owner of property) (mailing address) r'j\~ -A Z
do hereby authorize
(Agent)
I
to apply for permit(s) from the
Southold Bo Town Trustees on my behalf.
(O signature)
CONNIE D. BUNCH
Notary Public, State of New York
No.01BU6185050
Qualified in Suffolk County
Commission Expires April 14, 2 Cam) to
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM ~
Ttu T °C Id s Code of Ethics erohibits conflicts of Interest on the ad of town officers and emolovoes The Ramose of
this form i to Wylde Inforinarion whica ~n alert the town of possible conflicts of htinrssY and allow it to take whatever action Is I..
naxssane to avoid same.
1 N
YOUR NAME:
(Last name, first name, tpfddle initial, unless you am 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 Tutee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
of"OthcC, name the activity.) ~~ryp,S he, 14/ Q• `f" q PY I_ c G' .
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town ofsouthold? "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 shams.
YES NO
If you answered "YES", complete the balance of this forth and data 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 applicantlagenVrepresentative) 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);
_Q an officer, director, partner, or employee of the applicant; or
_A) the actual applicant.
DESCRIP'1710N OF ]RELATIONSHIP
Submitted this `day of 200 _
Signature.
Print Name
Form TS I
• •
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS j
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. M .
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 PwWjed action will be evaluated as to its si iigrr ficant
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 mast be Mlabred in detail. listing both suonortin¢ 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 To+N2 pf SvathoTd's
website (southoldtown.northfork.net), the Board of Trustees Office, the p , Ji uimg Department, all ' '
local libraries and the Town Clerk's office. L.i Dec. 21p, Z-
61 Z
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM#)00l? i
PROJECT NAME fIwai e (A:. ODODrr ' <L nYl ' ~ o ~,R .r r + 9-P,21&
The Application has been submitted to (check appropriate response): A am i N S h a 4~ ?R__
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:
Nature and extent of action:
RPp~, e .~pla~P fx /Shy c
- Ire) l ~v~?. Ccrn -e Salldk VY /('e h vt~c?/~~i~/~
~'D Floe f .2 (g~' 3lJ F/vA s Dec ts. 6el Mc ~tp
purf
Location of action: /Xl C,-1'~, vC K C' (22
Site acreage: y,,( A ?c_
Present land use: e S, ~n t°n i, a I
Present zoning classification: P S i d r/1 I C L
2. If an application for the proposed action has been filed with the Town of Southold agency, the following i
information shall be provided:
(a) Name of applicant:
(b) Mailing address: m A 2 16
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(c) Telephone number: Area Code 9/2 C-) (0)
o -2 I w `1
(d) Application number, if any: :11 7,":>03
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes ? No D 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.
i
? Yes ? No UNot Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III - P icies Pages 3 through 6 for evaluation criteria
? Yes ? No Not Applicable
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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 ? NoPlot Applicable
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Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of fife, structures, and natural resources from flooding and erosion. See LWRP
Section III - Policies Pages 8 through 16 for evaluation criteria
1:1 Yes 1:1 NoEJgeNot Applicable
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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 VNot Applicable
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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.
? ? R
Yes No /Not Applicable
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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.
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? Yes ? No [D"Not Applicable
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Attach additional sheets if necessary
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Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous f
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
? Yes -1 No VNOt Applicable
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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.
? YeJ[] No RfNot 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 WRP Section III-Policies; Pages 47 through 56 for evaluation criteria.
Yes ? No Not Applicable
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Attach additional sheets if necessary
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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 u Not Applicable j
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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 I=Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section M - Policies; Pages 65 through 68 for evaluation criteria.
? Yes ? No Not Applicable
PREPARED BY J~UII~G; (Ad 1 V TITLE D DATE ) 2 -2 I
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TROPICAL STORM SANDY EMERGENCY APPLICATION
Valid thru June 1, 2013 Il
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Property Owner Name: 1 1 i, C h e, ti. L rY'~ l N
Permanent Mailing Address: S 01 el 4--- Uv Cry ~ o Q Q. m v F 2 t
T I l~f Z. i
Phone Number(s): _ r 7 ifl
Property Address: I I ~f S~~. e c A Lt ~VI 1~1c i i 1 I~- j
Suffolk County Tax Map Number: 1006 - f (o - (a -31
Agent (If applicable) Nf /
Address:
Phone Number(s): IV M t
Board of Trustee Permit Number(s):
Will any part of this project require a Building Permll? 05 Me-Oj4PnG~ i
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How much fill will be required? L2 L(~ JOe S- '
Project Description: EmUV + i2 e p In c Q CY r S~r rlC. Rre1Le h-)
1001 kh~gc' !n x1nd p J P 5 C~ r v.r\
T! IS E 1[' l` -'nl(f~L7 11.}i 17 LX.•~~~
IW,
IGi ;'Y1C~~r I
County of Suffolk
State ofNaw York
r (LDBEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE I
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
REPRFSENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW F THIS APPLICATION.
i
I
i of Property Owner I
SWORN TO BEFORE ME TM D Y OF a44~20_4kl
is
j.
PAMELA S. DONOFRIO
Notary Public;Stafa cf New York
h~. Olli060?0599
Ova!!fie: in Suffolk County
Commission Espires Sept l )j)/~
Dec, 26, z~{z
SURVEYED FOR. PH/rJ0 `~iAU':B , SUFFOLK COUNTY N.Y. j
LOCATED AT MATT/«• v OF .'J`'-OUTHOLO '
LOT J5 /Oq.Ef' OF CoT y" , CO CLK. NU. FILED-/4U 3 10161 r
MAP Of S"f/0.2E
SCALEV =30' ~
SUFFOLK CO. TAX MAP DATA: 'V/F Gy/EGG E~ j f
DST.,LJOO SEC./pH.pp 57"5.430E 175.1¢ Ike
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