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TR-8464A
• 0 John M. Bredemeyer Ill, President O�OgUFFQ(�-co Town Hall,53095 Main Rd. Michael J. Domino, Vice-President �� G�� P.O. Box 1 179 James F. King ti Southold,NY 11971 Charles J. Sanders �y �� Telephone(63 l)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 APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction % constructed Project complete, compliance inspection • 0 John M. Bredemeyer III, President �� SD(/r/yO Town Hall Annex Michael J. Domino,Vice-President ,`O l0 54375 Main Road P.O. Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,TrusteeD�y`,oUNNFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8464A Date of Receipt of Application: June 30, 2014 Applicant: Hope Schneider SCTM#: 67-7-11 Project Location: 1960 Mill Lane, Peconic Date of Resolution/Issuance: July 23, 2014 Date of Expiration: July 23, 2016 Reviewed by: Board of Trustees Project Description: Installation of an in-ground sprinkler system; and re- vegetate areas along the west side and in front of the dwelling using native vegetation. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Hope Schneider, received on June 30, 2014, and stamped approved on July 23, 2014. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Michael J. Domino, Vice-President Board of Trustees i 0 John Bredemeyer, President �OFF94 Town Hall Annex Michael J. Domino, Vice-President °° ° 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�o! , , �a°� Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: &I /b / HOPE SCHNEIDER requests an Administrative Permit for a 10 Year Maintenance Permit to apply roundup to weeds in driveway and backyard; installation of an in-ground sprinkler system; and re-vegetate areas along the west side and in front of the dwelling using native vegetation. Located: 1960 Mill Lane, Peconic. SCTM# 67-7-11 VType/of area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: If Conditions: Present Were: J. Bredemeyer Domino v&."king !!"C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: f ZZ 4P LA� Win+ o-F OL)L4se ,1v�u � d I ; �� h�ecf d `�A �` `"�' � . ,' �,_:�� _. � Y `• . � +� +IF Dom'� ' � _ lie_ �' � ._ � * �� � � �' � � `rt � �. �� ;�, -�. .��� ,�-#�• ..-. -�a,p .,,;; ,:K �;�, a *• -� � � �,� � r''� ` ' � � / � � � � f r' 1 � Too sw ,smw dP ,�•b P�. P`. t P O 4- V" 41 t'�.,iF` M1. 1 P •P � s f 4� x t.' womut P t P " f RD. E n..x. u. ur u. -- r --a-- u. —.x-- K a SECTION NO — Nonce ' V COUNTY OF SUFFOLK C aw,Noln E ' — r R,1 Q -,i Reel Property Tax Service Agency v O wrr a �•. --.-- yir_--r-- w P ,xo ,MO PROPEaTVMM LOT 36 ,*S9'48'00"E RIGHT OF WAY 116.55HOW ' GYPS 4£1 l DECK a 7 4.c 310' ;h 13. } N9'48 00 W 123.660 COT 34 12 �y4 �6 �d 2 • OFFICE LOCATION: O�*QF S�UryOl MAILING ADDRESS: Town Hall Annex Q P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) y Southold, NY 11971Q Telephone: 631 765-1938 Fax: 631765-3136 ol�COU ,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM D '' '� To: John Bredemeyer, President Town of Southold Board of Trustees JUL 2 3 2014 From: Mark Terry, Principal Planner -- LWRP Coordinator Date: July 23, 2014 Re: Proposed Wetland Permit for HOPE SCHNEIDER SCTM# 1000-67-7-11 HOPE SCHNEIDER requests an Administrative Permit for a 10 Year Maintenance Permit to apply roundup to weeds in driveway and backyard; installation of an in-ground sprinkler system; and re- vegetate areas along the west side and in front of the dwelling using native vegetation. Located: 1960 Mill Lane, Peconic. SCTM#67-7-11 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 EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS items "A" and which states: A. Maintenance or repair involving no substantial changes in an existing structure or facility; 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 r Annex James F.King;President O. L Town Road Bob Ghosio,Jr.,Vice-President �O P.O.Box 1179 Dave Bergen l Southold,New York 11971-0959 John Bredemeyer Telephone(631)765-1892 Michael J.Domino Fax(631)7664;641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application JWedand Permit Application Administrative Permit Amendment/T ransfer x ion eived Application: d ceived Fee:$ _ Ompleted Application n Incomplete D SEQRA Classification: ' Type I Type II Unlisted _Coordination:(date sent) -7111 J, JUN 3 0 2014 ,XWRP Consistency Assessment Form �AC Referral Sent ate.of inspection ��� l Receipt of CAC Report: L.ead Agency Determination: /Technical Review: ublic Hearing Held: Resolution: Name of Applicant J10 el Mailing Address Q U i �T G1 r�1 5 l 1791v Phone Number:(A i) '7!o 7 Suffolk County Tax Map Number: 1000- (o — - - Property Location: (0 0 N111 L a- A+ P L �C -C4 �J. 4= ,�o u rid d�,�,,�,4d C (OA) Q140) (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: • James F.King,President �0�SD�j�, Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O 54Main Road P..U.O.Bax 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer Telephone(631)765-1892 Michael J.Domino Fax(631)765.6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION INSTRUCTIONS ADMINISTRATIVE WETLAND PERMIT In accordance with Chapter 275-5(B)Administrative Permit&275-7(A) Permit Fees Application Fee - $100.00 As-136ilt-"Fee - $2o0 4Q' Original completed application packet and one photocopy of the completed application packet. One original and two photocopies of a survey of the property. One original and two photocopies of the site plan/project plan depicting the proposed project. Current photographs of the subject area showing the proposed area of operations from at least two opposite directions. Each photo should be labeled with the date, time and direction. Wd of Trustees Applicatio* GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: 1- Intended use ofro P Pe�Y� 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 1--�140 If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes /✓ No Does the structure(s)on property have a valid Certificate of Occupancy? '' Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permittapproval ever been revoked or suspended by a governmental agency? c.- No Yes If yes,provide explanation: Project Description(use attachments if necessary): h (T!64•"4 A� ty,&.: A _f' 4 W e-,e-" (SrirwL LACeAs c�fv :r�_u ��c � 1kb1))e:% i a dli-& -dw �,bc,c?X 0/d Tr � nS�akk&4►a \ a ad> Jf� c�.�, �nali�AnrJ .�D�nK.I.�/ in -F�bn�- j1brch a- ori 44ae t3t,f4n 5-'Je o�- � e4tleq,-,,J\AgZ(K Iso L4 o" Id Vx 4-0 4�a \! e ftq-, de z)-{ h v t^-):- CWn-kA Side) Blew of Trust*ass Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Gt.t _��_ AmLp L j t-d S Aklas 46r l 12afit CHLPAral4t Area of wetlands on lot: square feet jPercent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? cubic yards How much.material will be filled? cubic yards Depth of which material will be removed or deposited: -- feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: -- Statement of the effect,if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): Jadd 1r r k( OA k/ i� lei- I�t�u�lers Vvvu lei h��- �� ha/mom . B 0 d of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: LJ t-d-5� J t Area of wetlands on lot: square feet IS Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? cubic yards How much.material will be filled? -- cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: -- Manner in which material will be removed or deposited- Statement of the effect,if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): nab---.Q e M Ai r d -� 4J 1,4l odd lr..t It I 0_ ©A cy C" 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing, Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I-Project and Sponsor Information Name of Action or Project: f�oudvJ1 f ILL;-{ � �r t�unc� 5p/I,�rIiJ �/1S�allcr�vti Project Location(describe,and attach a location map): t41,0 j'#p Lal%t,peN U,� Brief Description of Proposed Action: (p �ol pelm, 4 ,j.dQQT p� ro u /leiup4-05 Mel 11 a C Lye,sed. / 1— S m A I I A /e A 4-© I n s4ci i I I-�o 5a h nej ti/ Name of Applicant or Sponsor: Telephone: 4 3 i- 7 I<7 4 4 a I &Mail: �-{d�e S,'-e J.cd6i. Address: �2 Damm CrrClt City/P0: State: Zip Code: 7 �GmPs n.( /17t�c� 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 (v1 may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site df the proposed action? • L4 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? • 1 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ��//' ❑Urban [:3 Rural(non-agriculture) ❑�,,,,i�ndustrial []CommercialpResidential(suburban) i� ❑Forest OAgricultum Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. is the proposed action, NO YRS N/A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? rT 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ❑ 7. Is the site of the prop action located in,or does it ad'oin,a state listed Critical Environmental Ares? NO YES 'v If Yes,identify: d��,M i-3'1n;5 7c-f\�,p�k ❑ 13. 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 1 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: lG) ❑ 10. Will the proposed action connect to an existing publielpn�water supply? NO YES ff 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? 13.a.Does any portion of the site,of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square fact or acres: 14. Idyntify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest (]Agricuitural/gtasslands ❑Early mid-successional ftp-Wetland 0 Urban - 3 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? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? N Y&S If Yes, ❑ s.Will storm water discharges flow to adjacent properties? �NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: NO ❑YES Page 2 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? a ❑ b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? El Q �}e 7. Is the site of the action located in,or does it ad'oin,a state listed Critical Environmental Area? NO YES " If Yes,identify: aG Sty i "ro IJ ` S. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 1 YES b.Are public transportation service(s)available at or near the site of the proposed action? a c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 4.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: Q 10. Will the proposed action connect to an existing publiclprivate 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: El 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO1 . YES Places? b.Is the proposed action located in an archeological sensitive area? 411'el TT 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? a If Yes,identify the wetland or waterbody and extant of alterations in square feet or acres: 14. fdontify m typical habitat types that occur on,or are likely to be found on the project.site. Check all that apply-," Shoreline ❑Forest [3 Agricultural/grasslands C3 Early mid-suc:eessional a Wetland oUrban p4OSuburban I S.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? (""1 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO , I YES If Yes, a.Will storm water discharges flow to adjacent properties? 16NO OYES b.Will storm water discharges be directed to established conveyance systemsNOffand storm drains)? If Yes,briefly describe: OYES Page 2 of 4 i 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor ant/sponsor n e: Date: Signature: Part 2-Impact Assessment: The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions'in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to targe impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the (�[ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse ohange in the existing level of traffic or ❑ affect existing influtructure for mass transit,biking or walkway? 6. Will the proposed action-cause an increase in the use of energy and it fails to incorporate ❑ T!!2Mk1X available energy conservation or renewable energy opportunities? 7. Will the proposed action impiVct existing: ( ❑ a.public/private water supplies? r b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ archit otural 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 P , 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? L�1 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-tern,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, FJ 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 Thastees Name of Lead Agency ©ate President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT: Page 4 of 4 No,or Moderate small to large impact impact may may occur occur 14. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? Kn 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 Z 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 insult 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 shcxrt-team,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 targe or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the infiumation and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental im Town of SouthW-Board of Tmstees / �f Name of Lr /d Ag en j Date Al �[LL<2 / J . l/O wt,til .o President Print or Type Name of Responsible fficer in LeadAgcncy Title cfRpdiionstb[e Officer Signature of Respo i�fficer in Leal Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 � - Town of Southold Erosion, Sedimentation 8r: Storm-Water Run-off ASSESSMENT FORM PFWPMM t.00ATiDN: S.CT.M.* THE FOUR MItINQ ACTIONS MAY REQUIRE THE SUMISSION OF A STORMWOM SKADING,DRAINAGE MO VIRWO CONTROL PLAN -per, o-c CERTIFIED BY A IMMON PROF1111115MYNAL IN TM STATE Or-WWVWK. SCOPE OF WORK. - PROPOSED CONSTRUCTION rrEM# / WORK ASSESSME1we Yes No a. What is the Total Area of the Project Parcels? ' i`A au-1 I VW this Project Retain AN Storm-Water Finn-Orf (Include Total Area of all Parcels located within r Generated by a Two(2'�Inch Rainfall on Sits? the Scope of work for Proposed cortshtictlori) (s.F.t Acme) I (This item willInclude all nut-off craved by ade b. what Is the Total Area of land Clea ft clewing"or cgnMucdon aclWas as well as W --- andfor Ground Disturbance for the proposed — Site improvements and the pennartent txeallon of conshuctlon a' W. impervious std.). I t 2 Does the Site Pim andior Survey Show m Proposed PROVIDE BAR PxOJELT`D SCnP'tION (MnNe-AAlMiorulPapessatVa•d•A a structlmrs, ft Stas&Location?This Item sh4itclude ah Proposed Graft Cut Ves and El hl t)u c1 ��Ice 4 l 1111 T Sp�I,� � S�fk vl S Slows Controliing Surface WSW Flow. --- ---�' Do"the Site Pian SOON Su"y dewrbe the mesion 5o -+hC?4- z W od Id bl able � P/0/7 3=6 h✓ e and' p�� 41 t)6 used to c aalta&wW and w ZrIft This -- l0A q c�n'P s J e v ) props i A muatbet t tout 04 ML/ ', � a��� Ccxsahii�ion�rfoa:` N om-' �a wiN Ee ' Land .talnn or Exeavattat aierejs a 14 the Naku'al uooct td b6 yt E t'�1�"<� Cc eel r f 11 a�>o � In m o caalcYards0Z tau!d a 150 1 (;r G i ll 0r of .. +am ? I/)n�en0 n�' helm; —p, ,( -r-- � WE this Application tared�AC4ivltlsa `1 C Encornpassing an Area in Excess d Five Thousand E] y(5,000 S.F.)square Fed of Grund Surface? 1 f- W,111 n d ama i' )� l - P Y � ra 6 .Is tt�a Natural water course Runrft through the S t is is Pro*within the Tnzatess) WIction GamrM DEC WW"anftWM or within One Hundred(100')fest of a WWand or Submisiol rt of*SWPPP is mqukW for alt Coral x&m eases i wdit ad Beach? dlebairanoss of ata(i)or mon.ears:hedudkrp diekrrboreoset of kea tlaerrarto eaa that 7 Will tham to Site on t adWq tirade$topes ore pert of a Mater oontanre piwt ihatwl/edEirnigelr dishrb ores ormcise saes of latttk` 'which Exceed Fifteen(15)feet d`veroCal i�tr`tu` �U MCWdtrey Colts re aothitios kwalvkq ad eAehsbattcos of Ilea then ores(i)aae whore One Hundred(1 W)d Horbootal Distance? the DEC has ddwmbnd anti a SPOES pwn*b m*dmd for seam wetsr diedrowoes. (SNIS "s UM moat the Mh*Mm Re*drsmwets of the VMS Ow"Petty t 8 Wiii Driveways,i'uMV Ames or other Impervious Z for tlrewrre Wdw Dhshwgn fear Gaatneedon scd tt;r-Penml No.QP44aao13 Surfaces be Sloped to Direct Sto rn-Water Run-Off i.The WVPW OW be prspwW prior ID to stet dkW of dee NOi.The b"sW be Into and/or in the direction of s Tom rigfrtv-wW srrbraMd to its D�terinrent prtorto as ammemcorresrtt detorubtration adfuity. 2.Tho SWPPP shed de.abe the sroaau end sodimsrit amW Fadices and whore $ WiI this Project Require the Plaoementof,INtRerfav, htitirK post enaruetlon sbnm water mermwnmt- 11 #W will be wsd xxft Rernovai of VegeWon and/or the Oa7strueliori of trry conebuded to reduce Ow ports to dorm waterdisotarga end a eeeune diem Wikhtn the Town RtghEof Way or Road shoulds�r o xvft co wmt to tune end oorerllora of 0*porn-In oddkim%the SWPPP d*A Area?(►ors ewe tyre rrortodws a*inswoom or oowMry�M�3 idwdlfr poll n i sources of DoNWlon which may roily 4s eucpeatgd to amrGt the NOTA NAM Answer t o.Ci aro w 0m Nha is Anewwol wM aCMrak Mak 3.AN W M thawalt in a 8wc and tkr oareNrudoa slur lei tiofwNie n am E F a f Apr to ahs, is AN tiYVPPPa tltat riegt/re uta padoombrtatlore storm wrier reensownw4PUftea EMrmAtrstar,firadMs,Oreiaayo a Erwion CorarsiiKsir it fasads+a irl►ees Town of ampoewrt d wA bo pmwod by o quWlbd Design Pwbnbnai EtowoW Me NewYode EouYeoNt weal Yeah los SubrniMsdfor t0-visw Prlarb Mseana of Any EuMdkg hmdt NW Is tatowiedpeeVrM h the prfrto�les aced P00011001 of Seam Wafer Mr eesu per, A Chade WAe(d)-+dkv A mw OeapiMe kP Notary Public,Me 51 New YOPR S'TA'TE OF NEW YORK, No.01 BU6185050 COUNTY OF ...........SS QuaHfied in Suffolk County Commission Expires April 14,2-91 11tat I.............».. o i..».........,»».being duly sworn,deposes and says that he/she is the applicant for Permit, And that he/she is the .................»..»»..................t ......».........................»....,.........»......». s Coi#aaoi;Ate:c"oFvot�iSi>�:ice.')" Owner and/or representative of the Owner or Owners,and is duly authorized t D 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 bast of his knowledge and belief:and that the work will be performed in the manner set forth in the application filet herewith. Sworn to before me this; ................ . ...................day of �...�. .......,204 Notary Publie: ... '.r:'.: A. .» ........ ». ................ .. .+ .................... ( d Ami FORM - 06110 B* 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 INTHISAPPLICATION 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. b Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF � _ ,20� r---P Notary Public CONNIE D. BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County Commission Expires April 14,2 ci) 10 L5 W O-oki, Town of Southold Erosion Sedimentation & Storm-Water Run-oft ASSESSMENT FORM PROPEttTY LpCAT10N S CT M tt: TW ROLIAtiMa10 ACTIOIIt;1fAAY�11U THE titlSNl>�ION OF A 0 E!qMM CONTROL PLAN a� WO—OM" 'BoT "01 SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yee No a What Is the Total Area of the project Parcels? ' ILA cc rc VW this Project Retain AN siomt-Waier Run-Off (Include Total Area of all Parcels located within Generated by a Two(2')Inch Rairfafl on SIN? the Scope of Work for Proposed Construction) (This teem wtii include ati run-off cued by site (s P.r Acres) and/or owlauction adndties as weti as all b. What is the Trial Area of Land Clearing; t9eerh�g andfor Ground I)Wutbanoe for the proposed — SIN Improvements and the pemmnent creation of construction activtiy4 impervious surfaces.) 1s R.r A 2 Does the Site Plan andfor Su<va)r Show All Proposed PROVIDE13R iII P oj=DUCWnON t A P+w=*v*D DrshWe Structures Indica ft Stm&Location?This .. Item shuid include A Proposed Grade Cher ges and 3 N o u 1 ke -16 g 5p,1 4 kLe " S yam Slopes Controllft Surface Water Flow. d 3 Does the Site Plan srWor Stn*doscrNe the erosion -AL-2} 1 W opt /d �� C//J/� � /�/Cao 4 h� and sedaaent control practices that will be.used to control site erosion and storm Water dednaoges. This on q o 4,e S%cJ e a-�- WLJ pylop,01�-q +i'✓i item must be maintained ftoughout the Entire ---2— Construction Period. 4 will this RuJod Require any Lana r-W9.Grading or 1 b u !d ba 0 F e cJ e '6 obt/W`{ 5 J(Y1-i 1/ a%e Excavation where Owe to a dueae to the Nast a L Existing Grade tmvavartg more than tot)Cubic Yards Ddu Id a 15o 1,6 4 id-tt V-ha i,)4ena no a he/m, W ill this cit plicalwithin err equineParcel? �_ � Will this Application Require Land Diatw'bing Activities ❑ �s p P V u nd u i 4 `all e ��o/d�h-n SLS 'fha Enoomp�skug an Area in Excess of Frye Titausartd - (6,0006.F.)S"m Feet of Ground Surface? d ams e . ►` l . e v e'S �° "89 Is time a Nabual Water Course Rumft through the Site? Is title Piajectwithin the Tntateeskslediction ..__ © oEc ayMPP>•toiranrenfa: or within One Hundred(1001 feet of a Wetland or Swbmissbn of s sWPPP b mqukW nor ad Constadon aotABn ImroMrto sot Beach? dbhbubtsiM or one(1)or caro awes;kwkdinig d wbsnoa of lees than ane*MOW 7 iMl there be Site preparation at Existing Grade Stopes E] z irepartofa�cateran PlwtthatwitUWMd iy a(fi ataamans paresofhrA whaehExceedFffIw(16)feetofVw t sIRise10 bdudNtB Ccn*ucgon soOfts 1 wd ft sad dbhabwwn of Isis uron one(i)acre where One Hundred(100')or Horbontat Distance? the DEC has ddsn*wd that s SPooS permit b w**W for slam water dadNflW (siwPPP's sw meet the nb*n&n Raquireatnds of On sP=Osnsrd Pam* 8 WM Driveways.Paining Area or other I npervaous No.W ❑ for storm tl dK otadWq"theta Co ntrueftn w6ft-Porten 4MO-M.) Surfaces be Sloped to(Wed Sbin-Water Run-Off f L/_ 1.fha t31iVPPP shat bs pnpsrod prior to Mw submlaet of Mn WW.Thi Nol shd be Into andtor in the direction of a Tom NhI- f way? sutmdeed to Wa cepa bmf Pdor W the aoanW4*enrd or wndn a m shy WN sola P the Placement Msiisrtd, 2.The SWPPP SW dee"N the areebn wo sWMrnrd aanbal padlm and where g Reqs requke4 poo4moducoon slam water managwwd pa$Ioa Mot wit be usW andbr Removal of VegeteHon andAar the Construction OF anyEiz =*W&ed to caduca the pdtdards in slomrwaterdiadmrpss and to asrse item Wffhtn the Town ft"May or Road Stwuldsr ardmWMmofthbwmiLinaMMm�#wSWPPP$hd usaattxr lr be aorpaebad W aIle$ftArea?trenr ea..an tearroeero.m.rrr.a �s r Idwdifquftoffit of Bonn water dlednrga NOTir. K Mor AMWW to Good oris Ods through Nha h Anawsrsd vM a CMak iduk s:AA WJPPPs Mot roquhe the P*-=Bbuotlon storm v"w mawwgenmm p� in a Boar amt j a rarer DmI sae&&ee sass to between 4000p* a t Asa to arm, oompor shad bo pgmmd by a qusBdad Ouipr+Profoe ftW ummo in Naw Yodc a storm w W wet be .ntrdasge o P Rale Control Plan M trsgdnd by Mrs Town of Mot is bnawledgsstyte to Mn pdrralpia and prsaffoes of Stam MUatar iYnagteneed. aoarrold cad fleet be tlydrraMasd rorttwkw P4lorte Marnrroa o/Any autldMg PsnnM. ptC71E: ACiaidcflwk(�)r+drarNwwr OaageMApP�V Notary Public,StaIG OT New YON SPATE OF NEW YORK, No.01 BU6185050 COUMT OF .,`5............SS Qualified in Suffolk County Commission Expires April 14,2 fyo 1fia<f,...........,, �,� Wit...................being duly sworn,deposes and says that he/she is the applicant for Permit, Andthat he/she is the .......................................... ,a+aor'a"rr iS ;:ac"j............................................................... 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 swe rnents contained in dtis.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 before' pme this, k.!-' "` ............day of ...............20` ............ .... .... N Public: .............- 1ar'.::�.... .. .. ................ C� `I�:::.. .. ................................. Notary (3i had of APrA ) FORM -06/10 APPLICANT/AGENTIREPRESEN'I ATIVE TRANSACTIONAL DISCLOSURE FORM i this form is to nrovlde inf,Qd—natinn which can the on of UMM conflicts of Merest and allow it to take what=actian is nMMONevoid same. YOUR NAME: C (Last name,first name, piddle initial,WIM you are applying in the name of someone else or other entity,such as a company.If so,indicate,the.other person's or company's lame.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change ofZone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other iC p P'f 11 '{'Q C(�Q tq Ird u pf"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 ihtemst"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. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent1representative)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 anon—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 1 day of 20#L • Stgnature�J����z; - Print Name Form TS I 11CW of Trustees application • AUTHORIZATION (where the applicant is not the owner) I, residing at (print owner of property) (mailing address) do hereby authorize_ {Agent} to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) Town of Southold • • LWRP CONMSTENCY 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 sib'fieant beneficial and adverse effects upon the coastal area{which includes all of Southold TownZ 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 Mplained in detail, listing both MMrdn¢ and non- sunpo•tin cis. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be underta�Cen. A copy of the LWRP is available in the following places: online a a1yn Of-S;ai n1�1' website(southoldtown.nortMork.net), the Board of Trustees Offi Ea�in t, local libraries and the Town Clerk's office. �., _.., ` _ B. DESCRIPTION OF SITE AND PROPOSED ACTION JUN 3 0 ?014 SCTM# (0-1 rI I ._ _r . PROJECT NAME L h tie; inn n lU�/ i r��-u f I u �n n�l n e�✓hA The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept ❑ Board of Trustees I. 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: 1n !1 I n arli a Agri11XICK5 t )0 Ve- f burdt.c1y � �✓� �- Location of action0 M'111 LecaA' Site acreage: Present land use: re 64d, 440 Present zoning classification. t° `' J t.'ii'i'�' I+ 2. If an application.for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: C -Gln ri e; �e l (b) Mailing address: 12 D G r" V-'/,c I t }'S T.,,o i n eS, NV 11780 (c) Telephone number:Area Code W1 -7o-y 9 o (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ `No If s,which state or federal agency? C. Evaluate the project to the oBowing 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 Not Applicable Attach sWitional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Poli 'es Pages 3 through 6 for evaluation criteria ❑ Yes 1:1 No Not Applicable Location of action: l 0 M i d{ 011e r- !emit C Site acreage: C1 G ' Present land use: �' ' e A t `' Present zoning classification: ' 2. If an application.for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: -++c,12 e e-ii rt e t do- (b) Mailing address: 12 G nn:tx C' /'C i t ST., in eS, 178y . (c)`Telephone number:Area Codef jt l 7 G�- q q o 1 (d) Application number,if any: _ Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No 1� If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further ksupport 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 '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—9:Applicable ' Pages 3 through 6 for evaluation criteria ❑ Yes 11No \ . 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 Q 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 t F Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No �ot 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. n ❑ U Yes No Not Apble 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 ENot 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 E2'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. F] —1 u No Applicable t I'cable Ye� o Attach additional sheets if necessary Yes No Not Apable Auach 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 Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from sotid'wasxe and hazardous substances and wastes. See LWRP Section III--Policies; Pages 34 through 38 for evaluatiog criteria. Yes F] No YNot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III=Policies; Pages 38 through 46 for evaluation criteria. Ye: j No Y/NotApplicable Attach additional sheets if necessary WORKING COAST POLIO 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 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 ONot Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands-in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No PNot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 68 for evaluation criteria. ❑ Yes ❑ No,0 Not Applicable PREPARED BY TITLE DATE OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation(DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631)444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services 360 Yaphank Ave., Suite.0 Yaphank, NY 11980 852-5700 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 917-790-8007 N.Y.S. Dept. of State Coastal Management 99 Washington Ave. Albany, NY 12231 518-474-6000 N GpLDS.&l �Tq IN L.� SURVEY OF PROPERTY E>�¢STS RuD RAP AT PECONIC TS78�3'pp; �,� 62. E TO WN OF SO UTHOLD M.H W M `" � slob , SUFFOLK COUNTY, AFPk(,)l,1E0 BY Raw 1000-67-07-11 ' BOARD C RUSTEESrSCALE 1"-20 �NFJ SEPTEMBER 7, 2006 TOWN OF ..`I JTNOID DATE to 712-3114LOT 35 to N O , t ECFSET �, � RM it EopN� 22.4 9 JUN 3 0 2014 s' � l sTY. 0.1'E i _'• O S► PLASIT o FR. H �5. • `•p + O 21.8 o g.2' 6'8• -{ 11.8' c m ♦ N � �_ J�50- ~ tr o D fS�1 AREA-6,070 SQ. FT. �o TO TIE LINES s3 Sp, qpF 'tQ��oF M �Yp LOT NUMBERS REFER TO "MAP OF BAILEY PARK" FILED 5 �t"-T. - T2c IN THE SUFFOLK COUNTY CLERK'S OFFICE ON SEPTEMBER 26, 1932 AS FILE NO. 1097. SILL o. * 618 ANY AL 7ERA LION OR ADDI7701V TO THIS SURVEY IS A VIOLATION ROAD ECONIC SU Y • OF SEC77ON 7209OF 7HE NEW YORK STATE EDUCA7701V LAW. (631) 765-50 1 97 EXCEPT AS PER SEC77ON 7209-SUBDIVISION 2. ALL CER77nCA77ONS �,;•. HEREON ARE VALID FOR 7H1S MAP AND COPIES THEREOF ONL Y IF P.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRA VELER S —,213 *103E SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y 1197