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TR-8385
®� soar Town Hall Annex John M.Bredemeyer III, PresidentyOlO Michael J.Domino,Vice-President 54375 Main Road� � P.O. Box 1179 James F.King,TrusteeCIO -luc Southold,New York 11971-0959 Dave Bergen,Trustee Charles J. Sanders,Trustee Telephone (631) 765-1892 l�`,oU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1091 C Date: January 29, 2015 THIS CERTIFIES that the excavation on landward side of existing 132' long bulkhead, addition of vinyl sheathing, replacement of all dead-men, lay logs, and tie-rods, addition of new face piles adjacent to existing face piles, addition of 4"x6" clamp timber, new 2' wide timber cap; and a 15' wide non-turf buffer along landward edge of bulkhead At 1290 Willow Terrace Lane, Orient,New York Suffolk County Tax Map#26-2-24 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 14, 2014 pursuant to which Trustees Amendment to Wetland Permit #5-88-26-24 Dated March 19, 2014 and Coastal Erosion Permit#8385C Dated March 19, 2014 were issued and conform 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 excavation on landward side of existing 132' long bulkhead, addition of vinyl sheathing, replacement of all dead-men, lay logs, and tie-rods, addition of new face piles adjacent to existingfae piles, addition of 4"x6"clamp timber, new 2' wide timber cap; and a 15' wide non- turf buffer along landward edge of bulkhead. The certificate is issued to HULSMANN LIVING TRUST c/o ROBERT&ANN HULSMANN owners of the aforesaid property. a Authorized Signature CC# : C15-8607 �:yjlS! �'''=ate,,..^�^'h• COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 03106/2015 under_Liber _D00012809 and Page 238 and, that the same is a true copy thereof, and of the whole of such original. In'Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 03/06/2015 SUFFOLK COUNTY CLERK JUDITHA.PASCALE APR 1 3 2015 i t ;T 0, SEAL ♦9 I IIIIIII IIII IIIIIIIIII(IIII IIIII IIIII 11111 ff11r IIII-IIII IIIIIIIIIIIIIIIIIIIIIIIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: . 03/06/2015 Number of Pages: 6- At: 11 :06 : 01 AM Receipt Number : 15-0028564 LIBER: D00012809 PAGE : 238 District: Section: Block: Lot: -r000- 026-.00 02 . 00 024 . 000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $30 . 00 NO Handling $20 .00 NO COE $5 . 00 NO NYS SRCHG $15 .00 NO TP-584 $0 .00 NO Notation $0 .00 NO Cert.Copies $7 .50 NO RPT $60 .00 NO Fees Paid $137 .50 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County HP LaserJet 400 M401 PCL 6 (Copy 1) LANDRECORDSC04 RECEIPT Suffolk County Clerk JUDITH A. PASCALE County Clerk Receipt Number 15-0028564 Payor Name ROBERT N HUSMANN --------------------------- ------- DESCRIPTION TRANS AMOUNT ----------------------------------- Type of Instrument: DECLARATION Page/Filing $30 .00 Handling $20. 00 COE $5 .00 NYS SRCHG $15. 00 TP-584 $0 . 00 Notation $0 .00 Cert.Copies $7 .50 RPT $60. 00 Fees Paid $137 .50 LIBER D00012809 PAGE 238 DATE: 03/06/2.015 TIME: 11 :06: 01 AM -------------------------------- RECEIPT TOTAL $137 .50 CHECK AMT PAID $137.50 TOTAL AMOUNT PAID $137 .50 CHECK REFUND . $0 .00 ----------------------------------- COMMENTS MARTIN D.FINNEGAN SCOTT A.RUSSELL TOWN ATTORNEY Supervisor martin.finnegan@town.southold.ny:us ®F so STEPHEN F.KIELY ®� ®�® Town Hall Annex, 54375 Route 25 ASSISTANT TOWN ATTORNEY g g P.O. Box 1179 stephen.kiely@town.southold.ny.us Southold, New York 11971-0959 ®LO I M.HULSE � q ® Telephonehone(631) 765- 1939 ASSISTANT TOWN ATTORNEY Facsimile (631) 765-6639 lori.hulse@town.southold.ny.us ®U OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD Ann and Robert Hulsmann February 25,2015 P.O. Box 188 Orient,NY 11957 RE: Wetlands Permit No. 5-88-26-24 Dear Mr. and Mrs.Hulsmann, I have reviewed the Declaration of Covenants submitted to this office with respect to the-above-r-efer-enced-application concerning-the fifteen foot wide-non=turf buffer area located along the landward edge of the bulkhead to be established and subsequently maintained as depicted on the revised survey prepared by John C. Ehlers, Land Surveyor, last dated October 31,2013 and stomped approved on March 19,2014. The covenants and restrictions document must be executed and filed with the County pursuant to §275-10(K)of the Southold Town Code. Please note that a co y of this document or, in the alternative, a sworn statement attesting to the filing is to be presented to the O' ce of the Board of Trustees within 90 days of issuance of the permit. Regards, Lori M. Hulse Assistant'Town Attorney (631) 765-1939 Cc: Board of Trustees ' 51 Number of pages RECORDED 2015 Mar 06 11:06.01 AM JUDITH A. PASCALE CLERK OF This. document will be public SUFFOLK COUNTY record: Pleese:remove all .L..DO0012809 Social Security Numbers. = . F' ``�' prior to=recording. -Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Reco ding/Filing Stamps 3 FEES . `' Page/Filing Fee Mortgage Amt. 1. Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub;Total Notation Spec./Assit.' r, or EA-52 17 (County) Sub Total ``J �� ' Spec./Add. EA-5217 (State) TOT.MTG.TAX Dual.Town Dual County R.P.T.S.A. Held for Appointment Comm.of Ed. 5. 00 Transfer Tax Mansion Tax Affidavit ' 5� The property covered by this mortgage is Certified Copy or will be improved by a one or two N family dwelling only. YS Surcharge 15. 00 Sub Total YES or NO Other If NO,see Grand Total appropriate tax clause on page# of this instrument. w 4 1 Dist. 2887600 loon 02600 0200 024000 Community Preservation Fund TS I Real Property RPLWI A I(IIIIIIIIIIIIIIIIIIII IIIIIIIIII IIIII IIIIIII onsideration Amount Tax Service 06-MAR-1 Agency CPF Tax Due $ .. Verification - 'Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address - RECORD& RETURN TO: --Vacant Land TD \ TD Mail to: Judith A. Pascale, Suffolk County Clerk 7T Title Comany Information 310 Center Drive, Riverhead, NY 11901 o.Name www.suffolkcountyny.gov/clerk Title# 8 Suffolk County Recording & Endorsement Page This page forms part of the attached �-e G 1ACA-tA 0� made by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY,NEW YORK. I TO In the TOWN of S o A ,,o L-6 In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12•610C.10/08kk (over) DECLARATION OF COVENANTS THIS DECLARATION made this day of 0 U kk , 20_A5, by i�T,�' � residing at p hereinafter referred to as "DECLARANT (S) " : W I T N E S S E T H WHEREAS, DECLARANT (S) is/are the owner (s) of certain real property located on� � i�1�\� w`VCc ���� �� \ 4 Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section Block _, Lot which is more particularly bounded and described as set forth in � "A" annexed hereto, &VW hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town 'of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANTS) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a "non-turf buffer" adjacent to and landward -of NOW, THEREFORE, the DECLARANT (S) do/does hereby covenant and agree as follows: i i 1 i 'Bargain ane..Sale Deed with Covenants Against Grantor's Acts-mdividWal or Corporation CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE, made the p-"o y of 2014 BETWEEN ROBERT N. ULSMANN and AN . HULSMANN, as co- stees of the HULSM LIVING TRUST dated 15, 1993, re:s ted by Second Amend ent on O ber 21,2003 oth residing at 1290 Willow Terrace ne, ient, NY, 11957 party of the first part, ROBERT N. H SMANN, as Truste f the ROBERT N. HU ANN TRUST da �'u►i 30 , 2014, resi ' g at 90 Willow Terra Lane, Orient, NY, 1 7, to an undivide. iffy (50%) percent i Brest; and ANN-V ULSMANN, as Tr tee of the ANN V. ANN TRUST date 4, residing at 1290 Will race Lane, Or' t, NY, 11957, as to an undivided fifty (50% ercent interest l � party of the second part, .�C k e CL .� WITNESSETH, that the party of the first part, in consideration of TEN ($10.00) dollars, lawful money of.the United States paid by the party of the second part, does hereby grant and release-unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land,with the buildings and improvements thereon erected, situate, lying and being.at Orient, in the Town of Southold, Suffolk County,New York, shown and �- designated as Lot No. 5 on a certain subdivision map entitled"Map of Willow Terrace, Section 1"at Orient, Town of Southold, Suffolk County, New York,which said map was filed in the Suffolk County Clerk's Office on November 2.8, 1969, as Map. No. 5407. BEING AND INTENDED TO BE the same premises conveyed to the part} of the.first p art by deed dated July 1, 1993 recorded in the:Office of the Clerk of the County of Suffolk in Liber 11796 at page 957.. TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof. d a the estate and rights of the art of the'first art in and to said TOGETHER with the appurtenances an 11 h g party p . premises. TO HAVE AND TO HOLD the premises herein granted unto the party of the second part;-the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been incumbered in any way whatever, except as aforesaid. I i 1) Upon the substantial completion of the aforementioned permitted act'vities there shall be established and subsequently maintained °`v0M '1'ti , . ,, t,t "non-turf buffer" as defined by Chapter 275 of the Town Code; and as depicted on the > and r 2) These covenants shall run with the land and shall be binding on the DECLARANT (S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner (s) has/have duly executed this instrument this day of r�,,,: � /� d 20 ti O NER'S SIGNATUIRE OWNER'S SIGNATURE STATE OF �ew \ 9, C. ss: Y COUNTY OF Sk-L-t-VO 4<. ° On the day of in the year 20 , before me the under i ned, a Notary Public in and for said State, personally appeared ^ �, lCaHi\CAG�d personally known to me or proved to me on the basis of sati factory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they execute d^ the same in his/her/their capacity, and that by his/her/their signature (s) on the instrument, the individual or the persons on behalf of which the indi ' ual (s) acted, executed the instrument. Notary Public Mean Palermo Notary Public,St1*0f NOW York Pale 2 No.MK9887 Notat;r •'myork QUSI Scl In Suffolk �(,u 1 ,. COmmlaalon Expiros` 1_ �`� Quaufl n Suff- County Com sion Expires I i i I ' I , i 5URVEY Of LOT 5' N ON A CERTAIN 5UbDIV151ON MAP ENTITLED 'MAP Or VvlU-0W TERRACE, SECTION 1"WHICH SAID MAP WAS FILED IN THE SUFFOLK COUNTY CLERKS OFFICE ON NOVFM5ER 28, 1969 AS MAP NO 5407 w E SITUATE: ORIENT. TOWN: 5OUTHOLD 5UFfOLK COUNTY, N.Y. S SURVEYED 10-31-2013 5UFrOLF,COUNTY TAX# H E Q I-El V 1000-2G-2-24 CERTIFIED TO: LFEB 1 4 2014 HULSMANN LIVING TRUST 7 0 -0> X\ & 0 N.; �\ /�.. ` yam? / �/ \ \ \� r(i �o 0 0, 110 0. 0 0 o 0) APPROVED BY BOARD OF TRUSTEES TOWN OF SOUMLO C. DATE A PE Pi VINn FEFOUNDNa. JOHN C. EHLER5 LAND SURVEYOR Area 18.1 16 EM.Ft. Area n 0.416 Acres r.EAST MAIN STREET N.Y.5.UC.NO.50202 GRAPIlfC 5CALE I RIVERHEAD,N.Y. 1 1901 369-8288 Fax 369-5287 fon-3islandland5urveyor.com V= i rVA Y tow ic ,� •c T�.:.�� ld aw W wq a o a a y[ �( Illy til � �'T�1- INC e� Q 'rs^�lti ILJI r ; t Y" .70 FEB 1 4 2014 o • 0 0 J j P --�-- - o Y � • 4 . 'JG b ;:APPROV Y �. s av C� }r v,SM k l3t4 Imo• MARTIN D.FINNEGAN SCOTT A. RUSSELL TOWN ATTORNEY Supervisor martin.finnegan@town.southold.ny.us �q sv(/ry STEPHEN F.KIELY ,`O�' Ol0 Town Hall Annex, 54375 Route 25 ASSISTANT TOWN ATTORNEY P.O. Box 1179 stephen.kiely@town.southold.ny.us CA hc Southold, New York 11971-0959 LORI M.HULSE 0 Telephone (631) 765-1939 ASSISTANT TOWN ATTORNEY Irmo Facsimile (631) 765-6639 lori.hulse@town.southold.ny.us OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD Ann and Robert Hulsmann February25, 2015 P.O. Box 188 Orient,NY 11957 RE: Wetlands Permit No. 5-88-26-24 Dear Mr. and Mrs. Hulsmann, I have reviewed the Declaration of Covenants submitted to this office with respect to the above referenced application concerning the fifteen foot wide non-turf buffer area located along the landward edge of the bulkhead to be established and subsequently maintained as depicted on the revised survey prepared by John C. Ehlers, Land Surveyor, last dated October 31,2013 and stamped approved on March 19, 2014. The covenants and restrictions document must be executed and filed with the County pursuant to §275-10(K) of the Southold Town Code. Please note that a copy of this document or, in the alternative, a sworn statement attesting to the filing is to be presented to the Office of the Board of Trustees within 90 days of issuance of the permit. Regards, FEB 2 7 2015 !` Lori M. Hulse Assistant Town Attorney E.._ ._.. . .. ....._... (631) 765-1939 Cc: Board of Trustees Scl #a6 -d-d y { John M. Bredemeyer 1[[, President �OSUffD(�c Town Hall,53095 Main Rd_ Michael J_ Domino,Vice-President ,�Z� GG� P.O.Box 1]79 James F.King C1.3 Southold,NY 1 t971 Dave Bergen �14 �� Telephone(631)765-1892 Charles J.Sanders ���1 � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE F INSPECTION: j Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/sift boom/silt curtain 1 st day of construction / %2 constructed V Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: —/�1" John M. Bredemeyer I11,President gUFFO( Town Hall,53095 Main Rd. Michael J. Domino,Vice-President ,`�� �Gy P.O. Box-1179 James F. King. y Southold,.NY 1-1971 Charles J.Sanders �y � Telephone(631)765-1892 Dave Bergen 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 4PPOINTMENT.IFOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO- SHALL BE CONSIDERED,A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. ;.N ` JAN 2 0 2015 I ' f F INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction % constructed Project complete, compliance inspection f Adik taboo "NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL-CONSERVATION Facility DEC ID 1-4738-04350 r' PERMIT r Under the Environmental Conservation Law ECL. Permittee and Facility Information Permit Issued To: ` � 5_. - � s i `ma y �„ ���t W�� F'acility� ROBERT N HULS-MANN �aA0, � HULSMANN PROPERTY PO BOX 188 `'h =w 1290 WILLOW TERRA E,LNISCTM# 1000-26 2-24 q ORIENT,NY 11-957-0188 ORIENT,NY 11957 _ (631)323-278+9 x Facility L�oeation: in SOUTHOLD in SUFFOLK COUNTY' Facility Principal Reference Point: NYTM-E: 726.68 NYTM-N: 4556.96 [' Latitude: 41°07'56.3" Longitude: 72'17'57.9" t Project'L-ocation: 1290 Willow Terrace Lane, Orient,NY 11957 Watercourse: Orient Harbdr, Authorized Activity: Reconstruct 132 linear feet of bulkhead landward of the existing bulkhead and backfill with 30 cyd of clea fill from an upland source: Install new bulkhead face pilings adjacent to the existing bulkheadf%face pilings. Construct a two foot wide timber cap landward of the bulkhead Maintain a 15'wide non-tuff' buffer. All authorized activities shall be done in strict conformance with the attacheplans stampedU "NYSDEC Approved=""on g/6/1�4F',SAP 1-08-010 .P. rove rx a, Permit Authorizations TidalWetlands -Under Article 25 Z Permit ID 1 4738 04350/00001 . -Effective Date: 8/7/201f4 �- ExprahonkDate8/6/201- 9 Excavation,.&Fill,in NaY gable Wa$g�cs iTn�ler�lrt c1e 15 T�it1e 5 3 3£ Rmi� "Ix Permit ID 1 4738-04350/00002 . New Permit Effective Date: 8/7/2014 Expiration Date: 8/61,2 9 Water Quality-Certification -Under Section 401 -Clean Water Act ° Permit ID 1-4738104350/00003 £ �.7. New Permitfi:z, Effective Date: 8/7/2014 Expiration Date: 8/7/2019 -�i �; !f__.-•_J..-..~..-.� '.J .......-v...`t i t �I JAN 2 0 2015 �.... Page 1 of 7 f NOTICE OF COMMENCEMEN I OF U0146 I KUC:I IUN ETURN THIS FORM TO:COMPLIANCE Or Fax to: 631-444-0297 Bureau of Habitat-TW 50 Circle Road Stony Brook;NY 11790 3409G%1J'W— DE.RMIT NUMBER: `+ �� EXPIRATION DATE: DERMITTEE NAME & PROJECT ADDRESS: :ONTRACTOR NAME&ADDRESS: ` C - /!'L.G' T"ELE HONE: .>(-:ar Sir. ums ,PdPla special conditions of the referenced permit, you are hereby notified that the authorized activity shall commence,on. ' _. We certify that we have read the referenced permit and approved plans.and fully understand the authonzed'•project and,all t.-m uns. We have inspected the project site and can complete the.project as described in the perr'nitand as depicted on'th'e 101) . We can do so in full compliance with all plan notes and permit conditions.The,permit, permit sign, and approved.plans will )e available at the site for inspection in accordance with General Condition No. 1. (Both signatures required). < PERMI NT ACTOR' b-TE CO R I-HIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT IND/OR ANYASSOCIATED ACTIVITIES. FAILURE TO RETURP`I THIS ItiGTCF- PEST TIME PERMIT SIGN..OR HAVE THE PERMIT AND 'iPPROVEO PLANS AVAILABLE AT THE WORK SITE FOR THE DURA-T/O.N.OF Tr rE PROJECT MAY SUBJECT THE r}ERMITTEE 4NDiOR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES POR'NON-•COMPL.IANCF WITH PERMIT CONDITIONS. i.rt along this line \ \ N. -'� XX X NOTICE.OF COMPLETION'OF G01VS1'i'vlJCT'ON ;E'rURN THIS FORM TO:COMPLIANCE Or Fax to: 63-1-A44-021,,7 Bureau of Habitat- TW 50 Circle Road \ Stony Brook, NY 11790-3409 Sf.=:RMIT NUMBERA— _ '- on :';�PtRr;t IvPJ.C?a TE.___.. ,E_RMITrEE NAME& PROJECT ADDRESS: :ONTRACTOR NAME &ADDRESS: C. 0 F CS,� �_��q� TELEPHONE: )!,,'suant to special conditions of the referenced permit, you are;hereby not,xFw.d that the authorized activity was completed on We have fully complied-with the terms and conditt r s of the permit and approved plans. (Both signaiores required) PERMIT EE:. _...., . 4)A I E \ CONTRACTOR: DATE HIS NOTICE. WITH PHO GRAPHS OF THE G�MPLET ED IWORK A..✓\t .'DR A Cn:!Pr'r 1 D SURVEY, APPROPRIATE, MUST BE 'ENT TO THE ABOVE AD ESS WITHIN 30 DAYS OF tr014`FLET!ONI OF TI11t.=PF.O.!:CT � J� JAN 20 2015 a 0 n 'n j 323 A NY E N 111�1 I - -J , 7 h.( 1201, .......... ........ Ra� -R'x-, AT, "A R6 o x, iv P.O. NUMBER TERMS PROjECT --------------------- QUfiNTITY '. —DESCRIPTION RATE A:,MdU'Nt Planting of Beach Grass as Proposed 1,836.0) 1,836.00 LESS DEPOSIT -918.0) -918.00 NYS SalesTax 8.625% 0.00 fill ft MAZ JAN 2 0 2015 C R O W A-1 MARINE TELrFAX. 631'.323.1772 POST OFFICE B01 618 St CELL: 63,1.831.1740 GREENPORT; NY 11944 - - - CC. Stiamg Cove GoadomWum DOC BULKHEADING DECKS KS BEACH STAIRS September 16, 2014 : .. Bob:Hulsmann_ IZow.Terrace Orient 1V Y..':1107 Dear Bob; The Final Invoice breaks down as follows: Total cost to':remove and replace bulkhead. . . $40,000.00 Return sheathing on Segalhs side. $1,100.00. l� i .J - AN J 2' 0 .2015 a' Total Cost.: $41;2ft 00 Balance due. ., $41,200.00 Please return NYS Capital Improvement form.with fmad payment. -Regards,. Ian Crowley . Crowley Marine Contracting Cell.Phone 631-831-1740. Telephone/Fax 631123-177z email icrowleyCa optorlline.net • ���� ��': , ii mm im"a�, �� � ,� .. `� ,�. ,:� �,. 4 � , _ '�.Al�' F. X� ►'�' V_.. M1OV� �w � �M 't�y. �y-��'.. - p�,� -, �. ��� - �. �W�IiV�� � _� 1, �_ s �f -�_ '; r �:, � �' i y� �:. iii �':i ry l �;� F�� ��1; 1 IIII.,: i / I� %��; ��� �on S� ✓cam c.� tt Ii uy�yl '. I.� III �► _ I r 1', ON. 2:Z� U �r��.siY611aM11 �q`e�ryl � 1�A inwt , {{ryrye� a tl- ����t' 1 1 /r � I f 0 John M. Bredemeyer 111, President g►{FFD(pc Town Hall, 53095 Main Rd. Michael J. Domino, Vice-President GG�� P.O. Box H79 James F. King ; Southold,NY 11971 Charles J. Sanders d Telephone(631)765-1892 Dave Bergen �Ol * �$a 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 'It day of construction Yz constructed Project complete, compliance inspection John M.Bredemeyer III,PresidentO��r3F SQUlyOI • Town Hall Annex Michael J. Domino,Vice-President O 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold, New York 11971-0959 CP Dave Bergen,Trustee �O Telephone(631) 765-1892 Charles J. Sanders,Trustee �COU '� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 19, 2014 Robert & Ann Hulsmann P.O. Box 188 Orient, NY 11957 RE: HULSMANN LIVING TRUST C/O ROBERT & ANN HULSMANN 1290 WILLOW TERRACE LANE, ORIENT SCTM# 26-2-24 Dear Mr. & Mrs. Hulsmann: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 19, 2014 regarding the above.matter: WHEREAS, HULSMANN LIVING TRUST C/O ROBERT& ANN HULSMANN applied to the Southold Town Trustees for an Amendment to Wetland Permit#5-88-26-24 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, and for a permit under the provisions of Chapter 111 of the Southold Town Code, Coastal Erosion Hazard Areas, application dated February 14, 2014, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 19, 2014, at which time all interested persons were given an opportunity to be heard, and, 2 • • 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 submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 and Chapter 111 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of HULSMANN LIVING TRUST C/O ROBERT & ANN HULSMANN for an Amendment to Wetland Permit#5- 88-26-24 and for a Coastal Erosion Permit to excavate on landward side of existing 132' long bulkhead; add vinyl sheathing, replace all dead-men, lay logs, and tie-rods; add new face piles adjacent to existing face piles, add 4"x6" clamp timber, new 2' wide timber cap; and maintain a 15' wide non-turf buffer along the landward edge of the bulkhead; and as depicted on the site plan prepared by Ian Crowley, last dated September 11, 2013 and stamp approved on March 19, 2014; and as also depicted on the survey prepared by John C. Ehlers, Land Surveyor, last dated October 31, 2013 and stamped approved on March 19, 2014. 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, John M. Bredemeyer III President, Board of Trustees JMB/amn John M. Bredemeyer III,President OF SUUj�o • Town Hall Annex Michael J.Domino,Vice-President �� lO 54375 Main Road yy P.O.Box 1179 James F. King,Trustee '! Southold, New York 11971-0959 Dave Bergen,Trustee A Q �0 Telephone(631) 765-1592 Charles J. Sanders,Trustee yCOUNN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT#8385C Applicant/Agent: Hulsmann Living Trust C/O Robert& Ann Hulsmann Permittee: Hulsmann Living Trust C/O Robert & Ann Hulsmann SCTM#: 26-2-24 Project Location: 1290 Willow Terrace Lane, Orient Date of Resolution/issuance: March 19, 2014 Date of Expiration: March 19, 2016 Reviewed by: John M. Bredemeyer III, President DESCRIPTION OF ACTIVITY: To excavate on landward side of existing 132' long bulkhead; add vinyl sheathing, replace all dead-men, lay logs, and tie-rods; add new face piles adjacent to existing face piles, add 4"x6" clamp timber, new 2' wide timber cap; and maintain a 15' wide non-turf buffer along the landward edge of the bulkhead; and as depicted on the site plan prepared by Ian Crowley, last dated September 11, 2013 and stamp approved on March 19, 2014; and as also depicted on the survey prepared by John C. Ehlers, Land Surveyor, last dated October 31, 2013 and stamped approved on March 19, 2014. INSPECTIONS: Final Inspection SPECIAL CONDITIONS: (apply if marked) In accordance with Chapter 111-15 Erosion Protection Structures: XX A maintenance agreement is attached hereto and is a necessary special condition of this permit. �.y - 6 BY: tl John M. Bredemeyer 111, President Board of Trustees James F.King,President �q SOUTy Town Hall Annex Bob Ghosio,Jr.,Vice-President h0� OHO 54375 Main Road y P.O.Box 1179 Dave Bergen T 4 Southold,New York 11971-0959 John Bredemeyer on Michael J.Domino t �O Telephone(631)765-1892 O�y Fax(631)765-6641 ��UNT1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE\SOUTHOLD TOWN CODE I (We) m�4P � �� c1c� hlh\1 ` ` \�1 \ 5Mt�NN The owners of record of property at: SCTM#1000- `— C — — in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: f 3'V I vl q bulkhead as shown on the attached licensW survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or important na ural resour a features. Notarized signature of/owner of record Notary Public " IMOssa Pakmno Notary Public,State of Now York No.4949897 Qualified In Suffolk Commission Ekpim�j [J This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. C\ 0 John M. Bredemeyer III, President y�gpFF0J t Town Hall Annex Michael J. Domino,Vice-President oY4 49GV&' 54375 Route 25, P.O. Box 1179 James F. King w x Southold,NY 11971 Charles J. Sanders Telephone(631)765-1892 Dave Bergen Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: 6.C7e-Ck Ann auISmQnn Please be advised that your application dated I has been reviewed by this Board at the regular meeting of_ 3 and your application has been approved pending the completion 6f Se following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) % Constructed ($50.00) 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: $ S D . Vv BY: John M. Bredemeyer III, President Board of Trustees 46 r Town Hall Annex John Bredemeyer, President �aurrot,r�� 54375 Route 25 Michael J. Domino, Vice-President © P.O. Box 1179 James F. King Southold, NY 11971 Charles J. Sanders �� f �aorg Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field lnspectionlWork Session Report Date/Time: /`'/ - / -/ 7 /J HULSMANN LIVING TRUST, c/o ROBERT & ANN HULSMANN request an Amendment to Wetland Permit #5-88-26-24 and for a Coastal Erosion Permit to excavate on landward side of existing 132' long bulkhead; add vinyl sheathing, replace all dead-men, lay logs, and tie-rods; add new face piles adjacent to existing face piles, add 4"x6" clamp timber, new 2' wide timber cap; and maintain a 5' wide non-turf uffe along the landward edge of the bulkhead. l Located: 1290 Willow Terrace Lane, Orient r SCTM# 26-2-24 Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound _BaY Distance of proposed work to edge of wetland n ' Part of Town Code proposed work falls under: _Chapt.275 _Chapt. 111 _,other Type of Application: Wetland !—Coastal Erosion Amendment _Administrative _Emergency —Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: —Z�J• Bredemeyer M. Domino J. King C. Sanders Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: THIS PERMIT IS CONDITIONED INST Tit$ USE Ok' TBT OR OTHER QRWo bOTTQ,11 PAINTS EXCEPT .{+<lf$Rg EXPRESSLY PEPUTMT IN WRITING ar That,--.xowfir !Y' vsrs:�- d >,.RTY�'si Jam. Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO 5.887.26 2.4..... DATE May.:ag.;:4%41. ISSUED,-TO .._.RCAERT_HULSMA T. .- - Ant- lorizatinn 'Pursuant to the provisions oli Chapter..615 of the Laws of i r fhisi State of Naw York, 180;and pter 4d4`of the Laws of the State of;New York 1952c.and�the. thold Town,Ordisamce en• , titled "REGULATING AND ;[f-0 ACING OF OBSTRUC'UQNS, v. IN AND ON TOWN WATENS AND PUBLIC LANDS and the f REMOVAL OF SA►JD, GRAVEL o OTHER MATERIALS FROM LANDS ►JNDER TOWN WATERS" and in accordance with the Resolution of The Board adopted'at a meeting hold on May-41. .-I688 ! 19.............and in consideration.of The sum of 3-:.._......._._.,...:.!Paid by.... Y. of ..._.Qxiaa4r N. X:__. . : _ N. Y. and subject to the - Terms and Conditions listed on the .reverse sole ,Ireseof, Of.Southold Towa Trustees authorizes and permits the folio mpg: . Construct 135' timber bulkhead, backfsll to be trucked in firom an-.upland- source; new-construction to:be kept,in line, with existing bulkhead. all in accordance with the detailed specifications as presented.in _ the originating application. IN WITNESS WHEREOF, The said Board of Trustees hare- by causes Its Corporate Seal to'be'affised, and these PPresents to be subscribedby a;majority of I said,Board as of Ais,data• ! I Oc�1FF4�r AN Trnstrrr q y Please tear off.and return to the Trustee office. Board Of f South-old ` Town Trustees SOUTHOLD, NEW YORK Mooring Pennit No. Date: Mooring No. - I• certify thatthe-work as ' authorized in this permit has bean completed and is new ready for your inspection. Also, the,.number required on this.: project is clearly visible. I further understand this .permit is not-valid until this tear off sheet is returned to the Trustee offide:•. ' TERMS and CONDITIONS The Permit ROBERT HULSMAN residing car 64 Willow St Floral Park. N.Y. 11001 7WY- pact of the consideration for the Ismeatt of the Pemdt don understand and prescribe to the fob lowing: 1. That the Southold Trustees Permit must be prominently displayed on the premises effected thereby during the period of work That the said Baud of Ttusmea m and the Town of Southold a released from soy and „)all damages, or rleims for damage;of sobs prising directly or imlirnxtiy a a tesdt of any opeo- untie m orlon performed parsanat to this permit, and the acid Psentims will, a his car her own nape¢:, the '"defend any and all sack suits initiated by third patties,and the said Permitter-an— fail gabilby Perini with respect thrreo,to the complete e m ces, of the Board of Trustees of the Town of Southold 3. That this French is valid for a period of JM 24 coos: whit is considered to be rise .sufficient time required to complete the work involved, hot should chcrosnmea warren, request. for an ea:tmaion may be made to the Board at a late dart. 4: That this Permit should be tendered ie lefceitely, or a long.a the said Pesenittae widen . to msimtieu the structure or project iuvotved, to provide evidence to anyone concerned that amhr otizatiore was originally obtained 5. That the work involved will be subject to the inspection and approval of the Board or In.agents, and cwo-compUance with the.provisions of do miginatiog application,may be nose for mutation of this Permit by resolution of the said Bond. 6. That rbem will be no amnsotmble interfrence with navigation as a result of rise work herein authorized. _ 7-. That there shall be no interference with the right of the public to pees and repass along the batch between.high and low water marks.. B, Thu if fume operations of the Town.of Southold require the removal and/or alterations In the location of the work hrzdn atethoci ed, or if,in the opbdon of the Board of Trusted,the: work shall cause unreasonable obsttumon to:free navigation, the said Permktm will be required, upon due notice,to remove or alter this work or project herein stated without expenses to the Town Of Southold 9. That the said Board will be notified by the Permitter or the completion of the work mad- mined (See tear off sheet.) 10. That the Permitter will obtain all ad= permits and contents,that may be required cop.. plemenal m this permit which may be subject to make upon failure to obtain same i I FT TY�v1aa Panwup F"iL7!'t r � Loi-ti J3 ACK riLk 'FIO-M r ZO�---r`vf Cross 5�� �0 ✓ - /1/o SCAA< f'ropo6so TW& W IERD ' ` •�j for GLY19��(SANo�'f b/�rgyeL U1�CMl�%LG �OB<f� N. P"4 A +Ai ,X;ey � //.ZO �aIILGOIJ Trr A<f _LN. s'x .o" `Comic s oN� APP /o- ss- 1112 Mw /ode. 6 o.c. pl Llrv'G 6x 6" s tRt v%I lz a" x6" ; CLAM P -�'y x/d�Ieny Tc Roos 5.0 Now /o�x 8, fitk�. r/<r.Deann.aN a"x /o��KJH�aNG' ' SHERruiNG — �"o�ese �( 47 r B4 L,K H Efip Sic"7�On1 -Rs(y<rt /V. NpLSAIAn� Ar o Sr.o L t 14'/bw /✓AiLS,_go�f's�r l:r Roar /Va• GAAMA"'Ira 1. /✓•)! AFL wo.p Lo C.GA. TM TEO AvP. � /O� •6s - II/Z HENRY P.SMITH a ' TELEPHONE JOHN M.BREDEMEYER,IIIi President, (516)701892 John Bednoski, Jr. Q ALBERT ERUPSKI,JR., Vice-President BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall,53095 Main Road P.O.Box 728 Southold,New York 11971 i February 10, 1988 Mr. Robert Hulsmann 64 Willow Street Floral Park, New York 11001 Re: 1000-026-2-24 . Dear Mr. Hulsmann: Pursuant to your request for a determination of jurisdiction regarding the . construction of a single family residence on the above property, please be advised that in accordance with the survey dated and revised on October 21, 1987 the Trustees have no jurisdiction in this matter as proposed. - Please note that if in the future any work is anticipated on the property 75' or closer to the waterlwetlands a permit will be required. This determination is not a determination made for any other department or agency which may have jurisdiction in this matter. Should you have any questions or concerns, please do not hesitate to contact this office at the telephone number listed above... Ve truly yours, h.1m. Bredemeyer, III, President .. Board of Town Trustees JidB:ip .. c<: Bldg. Dept. Board of Appeals _ Terry Latham, Latham Sand and Gravel.. - lit yyta j 0 O N ZU_' o y I F r!€ES€1i la < 1 .r u11<yy y��.i �. rc '� N x O n G 4t fi y€x . Iw of Kn Nnc� to Q r I J � VI' aN �IWZ U6 00 a N.0 0 a I Y WKW U W " Z Y Q L � D 4J ))11110i, a g � r J _U J i no+ ee4d. - aee flied ma,a � b' N 10 > NQO ru�iIu p, .p tl. N S42 I :d N L o f 14 W.O 4 N 6 N !1 2 y tam .,a. tYd91 _14 n .hy _� ty1A�OF Ft+OPEfL'7-' UJIk`�,NJ " .`� 3URvEYSO iL�t '� 9 t »RQ�E s ROBE RT b , s SUFW COM DEFARnM OF NMTR SWIM XT FM Sinoe Fsm DF CDNSTADCTI08 OF ,,p wi ago _ _'ter-Iti, Sia{b Fam_iry ResdenceppD��nly r E li� ��,►i ,rt�.1 ' Nouap. i N TE 1''�`�' HS REF. p�iSO1� �!'Hh.l?' A,9 ', .�x- '$u.•..1. 1 Gl OI WhY i�t-50t1fPD�10 Ayn ' �!3•r� . .Paa�- 'is,i:_ ��.i 1 . t a�'. F$•1NWAEAD&FAQM h ,.eL'". :�Ij.. 4G .. p ♦ LO_i'S Ap i ist a«r.D4-mx wiCe Bnnd of r �'�'," �'f be„k .K,wrn+etYi A r.T,te...Q.r✓�s.P1 ���1�. . 14 II " `fAw # a bRl ""Y' xi" ` ELiW r t sWP �i A� M1kt,},i `�•�, LicGN3aE'Ylkf1 '�u.e/`�"'. ''t.� `'- .'•.', .<°k ;. .. .t l'q, 86 eevivm,4 J,.251 CllreripoCt,Riew Y'wK ��Si'� .ti ;.X4F WN I. aG'M'rWA'}st'.ac$ �11a^ ow. u5 pp cau-OSVO , POW[ h8atitl.'3>%*ate. KeRJC fi 1, 1 1 OF b p I I � °�}Vi { G1^, Ir4, c �c p• d'I-n "Yomw n r Irn�w, •p,. e _ o N y • .0 R III• x .. � '� •. ` m $ ♦ g 69 ®r Ro 26 fl Pmpwty T=SNM A9 v . �_ � ___— ____ .ter--__ .�� •• e pF SOUry� OFFICE LOCATION: `O l� MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) CIO Southoldold, NY 11971 . i� Telephone: 631 765-1938 Cow,��' Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM to ' 2014 To: John Bredemeyer, President LMAR 1 3 Town of Southold Board of Trustees Trustees I From: Mark Terry, Principal Planner LWRP Coordinator Date: March 13, 2014 Re: Proposed Wetland Permit for HULSMANN LIVING TRUST, c/o ROBERT &ANN HULSMANN SCTM# 1000-26-2-24 HULSMANN LIVING TRUST, c/o ROBERT &ANN HULSMANN request an Amendment to Wetland Permit#5-88-26-24 and for a Coastal Erosion Permit to excavate on landward side of existing 132' long bulkhead; add vinyl sheathing, replace all dead-men, lay logs, and tie-rods; add new face piles adjacent to existing face piles, add 4"x6" clamp timber, new 2' wide timber cap; and maintain a 15' wide non-turf buffer along the landward edge of the bulkhead. Located: 1290 Willow Terrace Lane, Orient. SCTM# 26-2-24 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the below listed Policy Standards and therefore is 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 ,�h�O�gyFFOt,�c Peter Young,Chairman y Town Hall, 53095 Main Rd. Lauren Standish, Secretary ,O T P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., March 12, 2014 the following recommendation was made: Moved by John Stein, seconded by William McDermott, it was RESOLVED to SUPPORT the application of HULSMANN LIVING TRUST/ROBERT &ANN HULSMANN for the existing 132' bulkhead; to excavate existing bulkhead on the landward side, 132' long, add vinyl sheathing, replace all deadmen, lay logs and tie rods, add new face piles adjacent to the existing face piles, 4"X 6" clamp timber, 2" timber cap to cover entire wall, and to maintain 15' wide non-turf buffer. Located: 1290 Willow Terrace Lane, Orient. SCTM#26-2-24 Inspected by: Peter Young, John Stein, William McDermott The CAC Supports the application with the Condition the bulkhead remains at the same height, the removable stairs are depicted on the plans, the project includes a drainage plan, and a 15' non-turf buffer is installed along the landward side of the bulkhead. Vote of Council: Ayes: All Motion Carried MAR 1 7 2014 Bard Biard of Trusteos James F. King,President so Town Hall Annex Bob Ghosio,Jr.,Vice-President 54 Main Road P..O.O. Box 1179 Dave Bergen 4 Southold, New York 11971-0959 John Bredemeyer C40Q '.. :e� • �O Telephone(631) 765-1892 Michael J. Domino Fax(631) 765-6641 coulm BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application D E (�a+_ _.p Wetland Permit Application Administrative Permit Amendment/'rransfe /Ext ns'on ZCRecei dApplication: I FEB 1 4 2014 Received Fee:$ Completed Application _Incomplete _Type Classification: --- ------ Type I_Type 11 Unlisted _Coordination:(date sent) ,X LWRP Consistency AsseWent�CCAC Referral Sen �C Date of Inspection: _Receipt of CAC Repo _Lead Agency Determination: Technical Review: 11 Public Hearing Held: _Resolution: °\'7 Name of Property Owner(s) Address X qk I Phone Number:( ) cz Z� Suffolk County Tax Map Number: 1000 —� Property Location: �� Q \�\Q,.r� E r 'C" K L'R�\ (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Cn n c�3��III �rd of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes �No If"Yes", please provide a copy. / Will this project require a Building Permit as per Town Code? Yes �/ No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes --� No If"Yes", please provide copy of decision. Will this project require y demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency \� Date 153 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?�No Yes If yes, provide explanation: �Descuse attachments if necessary): ".2 1 fi a °-,4 'ry b�FR�C , o� l'S c4 K,;z G`N\ wvk Q%wC�T Bood of Trustees Application• WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: i i Area of wetlands on lot:- square feet Percent coverage of lot: C) % Closest distance between nearest existing structure and upland edge of wetlands: N feet Closest distance betweep nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No_��Yes If yes,how much material will be excavated93 © cubic yards 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: 0 Manner in which material will be removed or deposited: 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): B d of Trustees Application• COASTAL EROSION APPLICATION DATA Purposes of proposed activity: v'\ \ Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? Now Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? 2-© (cubic yards) Manner in which material will be removed or deposited: \ v. l-1 �\ Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) 1 \ \ \ P\�,N\ l;:,,\ ley 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 1 -Project and Sponsor Information '�) (� Name of Action or Project: Project Location(describe,and attach a location map): �'t, N \\O\ $ 1 Brief Description of Pr osed Action: Name of Applicant or Sponsor(: Telephone: E� ^� E-Mail: Address: �Z Q Zy\\\a City PO: Q R) Q \C%% State: \\ \ 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 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: O 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. �,( El Urban ❑Rural (non-agriculture) ❑Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify/: ❑Parkland Pagel of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural O YES 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: K El 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 No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: � ❑ 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? rR 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 waterbgdy 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 El Early mid-successional ❑ Wetland El Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? O YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? O YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO AYES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: DNO DYES 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—�{I YES completed)for hazardous waste? If Yes,describe: ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor a��'C� V\ �NDate: Signt Signature: Y � Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in 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? r/ ❑ 3. Will the proposed action impair the character or quality of the existing community? LL�—II ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the I-71 ❑ establishment of a Critical Environmental Area(CEA)? Z 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 �7f ❑ reasonably available energy conservation or renewable energy opportunities? u 7. Will the proposed action impact existing: a. public/private water supplies? Ll El 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 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. 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. Town of Southold-Board of Trustees -3 - ✓ ) -/`'/ Name of Lead Agency Date J/C f c/'I t C�'7 (i' r President Print or Type Name of Responsible'Officer in Lead Agency Title of Responsible Officer a re of RespbTrMle Officer in Lad Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Town of Sou old ® Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM 1b PROPERTY LOCATION: S.C.TIA.a: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A \0 ac -Z_G 'Z' -�4 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN -0101cF 3RHU.- Block To-fY CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW PORK. SCOPE OF WORK - PROPOSED CONSTRUGnON rrEM# / WORK ASSESSMENT Yes No a. What Is the Total Area of the Pmjed Parcels? (include Total Area of all Parcels located within , (�.�„ Will this Probed Retain All Rainfall Water Run-Off the Scope of Work for Proposed Construction) Generated by a Two(21 Inch Rainfall on Site? (s F/Ages) (This item Wig Include all run-off created by site It. What Is the Total Area of Land Clearing C clearing andlor construction activities as well as all El and/or Ground Disturbance for the proposed ?-It Q Site Improvements and the permanent creation of construction activity? t impervious surfaces.) (S.F./Agee) / PROVIDE BRIEF PROJECT' DESCREMON rPo AaamoM Paaee-Nea.al 2 Does the Site Plan and/or Survey Show All Proposed '\v—// ❑ Drainage Structures Indicating Size&Location?This ^,\ Item shall Include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. l $ Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or J Excavation where there is a change to the Natural —// Existing Grade Involving more than 200 Cubic Yards ❑ _ of Material within any Parcel? fj Will this Application Require Land Disturbing Activities ❑ Encompassing an Area in Excess of Five Thousand Or"I z"s 1' \�,. r\ t k�_\0a (5,000 S.F.)Square Feet of Ground Surface? G \ 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirement,: or within One Hundred(100')feet of a Weiland or Submission of a SWPPP is required for all Construction activities involving sol Beach? disturbances of one(1)or more acres; Including disturbances of less than one Sere that 7 Will there be Site preparation on Existing Grade Slopes ❑ — are pan 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 sobviges Involving sol disturbances of leas than one(1)acre whew One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. (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,cavity-Permit No.GP-0.10-001.) Surfaces be Sloped to Direct Stom1-Water Run-Off 1.The SWPPP shag be prepared prior to the submittal of the NOI.The Not shag be into and/or In the direction of a Town right-of-way? submiaed to the Department prior to the commerxxement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction stoma water management practices that win be used andlor 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 tams and conditions of this permit in addition,the SWPPP Shag Area?(rats Ism will NOT Ir,cMa tin ImtalleNon a Drwe yAprons) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If My Answer to Question,One through Him Is Answered with a Check Mark 3.AN SWPPPs,that require the poslaonslmctbn storm water management practice Ina Box and me construction site dlsturbem:a Is between 5,m S.F.a 1 Ann In am, component shag be prepared by a qualified Design Professional Licensed In New York a Storm-Water,Grading,Drainage d Erosion Control Plan is Requited by the Town of that Is knowledgeable in the principles and practices of Smrm Water Management Southold and Must be Submitted for Review Prior to leaumru of Any Building Permit MOTE: A(Tack Mark(.f)amem Amwwrfar each Quesfion b Required rare Ownplate App�I j S'1'A17E OF NEW YORK, ro (� COUNTY OFF...`_ u:...`51q�6..............SS That0 -4Z ...1�!.'... v..`...(.M being duly swum,deposes and says that he/she is the applicant for Permit, (Name of Individual signing Document) And that he/she is the V4 .................................................................................................................................................................... (Owner,Con radDr,Agar,Corporate Officer.etc.) i' 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. Sworn to befo pe this; ............ .� d�y of.. 1�Q�F.... ........ ,20A1 Notary Public. ... .... ... .. .. � � .. .......................... (Signature of Appgranl) FORM - 06/10 Pawfmo Margery Public,State of New yonlc No.411/II3a7 QuatNled m In=Coaihr- c Comgeeion �I"SU John Bredemeyer, President o�%uFFotkco Town Hall Annex Michael J. Domino, Vice-President �a 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of HULSMANN LIVING TRUST, c/o ROBERT & ANN HULSMANN COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS , residing at/dba being duly sworn, depose and sa . That on the 5 day of �P�6� , 201j, I personally posted the property known as 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, March 19,2014. Dated: AU (signature) Sworn to before me this day o4JU420 19 NN ary u lic CYP M.CLIW1 Conlr iisswn Enpires Oct�0 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK \ COUNTRY O�F SUFFOLK iding at Ci lit \\QW , being duly swom, deposes and says that on the day of , 20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named C\�_ persons at the addresses set opposite there respective names; that the addresses set v 1 1 1 opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post \ \ 1 Office at that said Notices were mailed to each of said persons by CERTIFIED MAJRETURN RECEIPT. i Sworn to befor me this Day of re 20 i Notary Public CYNTHIkW&SATI 011 I :; fe 0 L'7"]Ik Commission 6cpres Oct 2045� U.S. Postal Service • . Postal LrnU (Domestic Mail Only;No Insurance Coverage Provided) CERTIFIED MAIL,,, RECEIPT (Domestic Mail OMY;NO Insurance EIPT Coverage Provided) 51 Postage $ $0,49 0g54 M1 5 , M1 PostageW ru Certified Fee $3.30 05 r` gcvO Retum Receipt Fee Postmark fU Certified FeO (Endorsement Required) $�•70 Here J� Postmark O Return Receipt FeRestricted Delivery Fee O (Endorsement RequiredHere G (Endorsement Required) $0•90 O Restrcted Delivery Fee(EndorsemeatRequiredTotal Postage&Fees $ $6.49 03/0u/2014 O^ m O Total Postage B Fees „r,1 014 0 FO'Po o m .. rzi .._C l�rl 0 , S _.f_)Q )V...._ O SenlTo O �r No. �- -- O .....:............................. � r. Bax No. U Q.y 1� � Streeq ApGNtate,ZlPt4 or PO Box No. O \ \ q M1 Clry, foie, �Pi4_ .. "-"'._._--`-�_ _.ti/._!-_:._----- — - �/ •. U.S. Postal Service C3 CERTIFIED MAILT,,, RECEIPT it •' • c (Domestic Mail Only;No Insurance Coverage Provided) rq a rq .n lizil- -. M1 Postage $ $U.4" r` ^` 1: M1 :�y4 M1 Postage $ $0.49 Uri. Certified Fee M1 rV $3,3() ru CaNtietl Fee $:3,.30 Q?U' Postmark Return seme Receipt Fee Postmark O Return Receipt Fee O (Endorsement Required) "0 Hare O ^ v5 Here O (Endorsement Required) $e..'4 Restricted Delivery Fee O (Endorsement Re ui Restricted Delivery Fee �C3 q red) $f)•00 r (Endorsement Required) O Total Postage&Fees $ $G ,q_/.}_;,-,'014 117 r r,( (; Rl •4I O Total Postage&Fees $ •1.". J./0u:O)1 m Sentro M1 coriry P,Os rBeor x N ..A�O ...... .......a..................._....,..A p`Z N---- � se.n. r..r 'a o � ; - .. ,-,\ p . .__.4_v\..<�.....f....___._�-.- ......... --------------- e orPOBoxNo.CC ----- - .. __ _a.......- , i I I I I I NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. 0'as~n I'✓A3 TAsf • s OWNER(S) OF RECORD: c/o AA*.%4 iA� Im&nn ����,y.y,��S�UBJ Wetland ECTP OF PyUZBLICa HEALING: excavate on landward side �existing long buk ead; dd Vtnyl , r all , toy lop, , add now adisCent to existing face pWcs, add CA" clamp timber, new 2' wide timber ca ; and maintain a 15' wide non-turf buffer alongthe landward edge of the bulkhead. JW TIME & DATE OF PUBLIC HEARIG: • GJedtes�ay, ^LrCh I? Z+ol y - o -or�S 3�•� Pm If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 BqSd of Trustees Application• County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Propert Owner in SWORN TO BEFORE ME THIS DAY OF I I i VICKITOTH Notary Public Sintqq of New York CommNo.OI`f06190696 ty ssoeFinSufffolkC28 20��Q Notary Public I APPLICANUAGENTBEPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'I Code of Ethics prohibits conflicts of interest on the hart of town officers and emElovees The oumose of this`--is provide information which can alert the town of mssible conflicts of interest and allow it to take whatever action is necessary to avoid same. - YOUR NAME: �A\5\ Ci t!ns I (Last name,first nara qiicldlc initial,unless you i4applying 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 i Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning _ Other (if"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest`Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. 'I' Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); _C)an officer,director,partner,or employee of the applicant;or _D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day off 200 Signature ey `Yl 1 sue_ Print Name " Form TS 1 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, listine 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 f'So olds rS website(southoldtown.northfork.net), the Board of Trustees Office, a fanning Department, local libraries and the Town Clerk's office. FEB 1 4 2014 B. DESCRIPTION OF SITE AND PROPOSED ACTION PROJECT NAME \&V The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval, license,certification: Nature and extent of action: ' Q� NC, MC'c\et�R\ V5 W1 NOIJ - � V by 11 �S Location of action: Site acreage: 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: \1 \\ (a) Name of applicant: C��i� (b) Mailing address: (c) Telephone number: Area Code( (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes No❑ If yes, which state or federal agency? S C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No NY Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes 0 NoKNot 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 �1 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable L Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section HI —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No MNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Yes No Not Applale Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes [:] No r� Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ 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. ❑ WE] 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 LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. Yes ❑ No 7 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No 1�Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ NoT� Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No' Not Applicable PREPARED BY TITLE_ L������ DATE * 1 1A 1' lY� aB'Bolo rVA t a ��ar - 1�p 0oe0 goo- PA trw 0A 0 for Ist a r e J o • Ipixlp'SLR ° � v c87 f x • D Y a' � y v o ° � � y�,�,�„�, 6 Y•g o r o 3 X° D K • x i r � ��Y 1�LA•i i B:R� d V .o d Y • K X yea flud. IV ° ° e p� r '` f r[FEB 2014 p 0 0 0 0a °u _ i. i .4 �aoy ° ° r o a ° ° B y IV YC Y � AW 4 b APPROV D Y sM N ' �AVWc v a _ W WE 3 �R t SURVEY OF LOT 5 N ON A CERTAIN SUBDIVISION MAP ENTITLED "MAP OF WILLOW TERRACE, 5ECTION I " WHICH SAID MAP WA5 FILED IN THE 5UFFOLK COUNTY CLERKS OFFICE ON NOVEMBER 28, 1 9G9 A5 MAP NO 5407 SITUATE: ORIENT W E j TOWN : 50UTHOLD SUFFOLK COUNTY, N .Y. g SURVEYED 1 O-3 1 -201 3 5UPFOLK COUNTY TAX # P 1000 - 26 - 2 - 24 CERTIFIED TO: FEB 1 4 2014 HULSMANN LIVING TRUST �� � I vim\,v Z v d o �p \ .� \ 0 o A � �o �� s5.✓o 6 00s� O ��� otiF�� lvo V I O APPROVED BY BOARD OF TRUSTEES \ TOWN OF SOUMLD �� �� C. �o DATE SF� � UPd NOTES 7 ---- > PIPE FOUND T - - VINYL FENCE JOHN C . EHLERS LAND SURVEYOR yl ---Area = 8, I G sq. Ft. —---- -- - -- - Area = 0.41GAcre5 G EA5T MAIN 5TREET C SCALE N.Y.S. LIG. NO. 50202 GWHI I "= 30' RIVERHEAD, N.Y. 1 1 901 369-8288 Fax 369-8287 °e�^��" s�^F Ionglslandlandsurveyor.com mr giro .o ° F m ne..a Fe q .