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HomeMy WebLinkAboutTR-8434 John M. Bredemeyer 111, President o�%%'dFF0J/( Town Hall,53095 Main Rd. Michael J. Domino, Vice-Presidents Gy P.O. Box 1179 James F. King w Southold,NY 11971 Charles J. Sanders Gy �� 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 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 '/2 constructed VProject complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8434 DATE: MAY 21,2014 ISSUED TO: RICHARD & ANNE MOORE PROPERTY ADDRESS: 790 OAK STREET, CUTCHOGUE SCTM# 136-1-38 i AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on May 21,2014,and in consideration of application fee in the sum of$250.00 paid by Richard&Anne Moore and subject to the Terms' and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: i Wetland Permit to remove existing storm damaged pier and construct a 4'x101' fixed pier; a 3'x12' aluminum ramp; and 6'x20' floating dock supported by four(4) 8" diameter piles and 3"x10" cross-bracing to support the float a minimum of 30" off creek bottom; with the condition re-vegetation of area with native vegetation where old dock is to be removed; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated February 19, 2014, and stamped approved on May 21,2014. >l i IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, j and these presents to be subscribed by a majority of the said Board as of this date. �SSaf FO��.c \ . C9 Dave Bergen-Absent Charles J. Sanders-Absent i i -------_. _....__ ! ! TERMS AND CONDITIONS The Permittee, Richard &Anne Moore, residing at 790 Oak Street, Cutchogue,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: I. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 10. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title,or interest in real or personal property held or vested in a person not a party to the permit. 0 John M. Bredemeyer III, President ��OF ryO Town Hall Annex Michael J. Domino,Vice-President �� l0 54375 Main Road P.O. Box 1179 James F. King,Trustee Southold, New York 11971-0959 Dave Bergen,Trustee G Telephone(631) 765-1892 Charles J. Sanders,Trustee OlUM Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 21, 2014 Mr. Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: RICHARD & ANNE MOORE 790 OAK STREET, CUTCHOGUE SCTM# 136-1-38 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 21, 2014 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of RICHARD & ANNE MOORE applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policies 6.3, 9, 9.3 & 10 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the use of flow-thru decking on pier; re-vegetation of area with native vegetation where old dock is to be removed; extension of dock is to gain more water depth at low tide; and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 21, 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 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of RICHARD & ANNE MOORE to remove existing storm damaged pier and construct a 4'x101' fixed pier; a 3'x12' aluminum ramp; and 6'x20' floating dock supported by four (4) 8" diameter piles and 3"x10" cross-bracing to support the float a minimum of 30" off creek bottom; with the condition re-vegetation of area with native vegetation where old dock is to be removed; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated February 19, 2014, and stamped approved on May 21, 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: $ 1,118.00 Very truly yours, John M. Bredemeyer III O President, Board of Trustees JMB/amn John M. Bredemeyer 111, President Q�OSUFFOj -CO Town Hall Annex Michael J. Domino,Vice-President � �� 54375 Route 25, P.O. Box 1179 James F. King y Southold,NY 11971 Charles J. Sanders �y �► Telephone(631)765-1892 Dave Bergen X01 �a0� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: �JKtcla44 -f C. D e_ Please be advised that your application dated 3 I has been reviewed by this Board at the regular meeting of 5/2-1 and your application has been approved pending the completion f the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 16t 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: rima t Tn sixc_4'6h —,$56.00 4 DOCAC L-'Y50' P,er (Seaward WAN-0:� 2©Usgr�• X �3.bbpey_n { = op. 3'x 12! r-a-mp = 3& sq-4P. x -f 3•06 = 0$ .0D TOTAL FEES DUE: $ Q BY: John M. Bredemeyer III, President Board of Trustees I&E VA .. -3' IL. '.' � mai �i►'� , t �. --- _ '- poli. Richard &Anne Moore 790 Oak Street,Cutchogue SCTM# 136-1-38 5/14/14 s - -a: M�ul ."4`� -'_• tom. _� ����� R ✓ e� Richard &Anne Moore 790 Oak Street,Cutchogue SCTM# 136-1-38 S/14/14 ^ - a. t a John Bredemeyer, President �SUFF94 Town Hall Annex Michael J. Domino, Vice-President ��� �°ay 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanders10- • Southold, NY 11971 Dave Bergen '�'�i ,�, �a°� Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: q4y1tt Jeffrey Patanjo on behalf of RICHARD & ANNE MOORE request a Wetland Permit to remove existing storm damaged pier and construct a 4'x101' fixed pier; a 3'x12' aluminum ramp; and 6'x20' floating dock supported by four (4) 8" diameter piles and 3"x10" cross-bracing to support the float a minimum of 30" off creek bottom. Located: 790 Oak Street, Cutchogue. SCTM# 136-1-38 Type pf area to be impacted: /Saltwater 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 Info needed: r Csr ! a ` 01a �?1 1 t pien i -t Modifications: Conditions: Present Were: J. Bredemeyer -I. Domino -King C. Sanders ­'D. Bergen Bay Constable Other Form filled out in the field by �e2k Mailed/Faxed to: Date: 461 0 John Bredemeyer, President °�.UFFo1*N Town Hall Annex Michael J. Domino, Vice-President �° ay 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: 4�/66 t Jeffrey Patanjo on behalf of RICHARD & ANNE MOORE request a Wetland Permit to remove existing storm damaged pier and construct a 4'x101' fixed pier; a 3'x12' aluminum ramp; and 6'x20' floating dock supported by four (4) 8" diameter piles and 3"x10" cross-bracing to support the float a minimum of 30" off creek bottom. Located: 790 Oak Street, Cutchogue. SCTM# 136-1-38 Type of area to be impacted: . Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ')4-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: J-e' jj �. ot- 2�c 41Y, Modifications: Conditions: J`F c �:, �` Q/1 Present Were: 1-1 J. Bredemeyer I'/M. Domino King C. Sanders -,, Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: i i f .. r a' Photo 1 MAR 1 4 2014 B ar f Tr tee � dl F s, r' Y A• �t 1 .i r{ i P 1 r i h' Nib- Photo 3 MAR 1 4 2014 SZr Cli:; li'r,A. Dar f . Southold Town Trustees Board 4f t. SOUTHOLD, NEW YORK PERMIT NO. A rxl 26 2002 .' DATE: ..._-P...� .....:........ � ... . ............. ........ � : SALVATORE PALACINO ........................ ISSUED TO ................................ x ,�ut�uri��#iari Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the • State of New York 1953; and fhe Southold Town Ordinance N+- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GWATEROR OTHER in M MATERIALS O66 LANDS UNDER TOWN Aril 24 Resolution of The Board adopted at a meeting held.on .......P.............-..� 2002 and in consideration of the sum of ;._.. . ...... Paid y Salvatore Palacino ........." ••-•• ..................................................... subject to the y of ................._Smithtown........................................... N. Y. end. Terand Conditions listed on the reverse side hereof, ms of Southold Town Trustees authorises and permits the folowing: Wetland Permit to construct a 41X 65' catwalk with (12) 411 dia. CCA pilings, two sets of steps to grade and two 6" dia. piles for a pulley system. ai in accordance with the detaled specifications as presented in .the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- `• by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this data. Trnsiees w Applicant: Sa! Palacino N PLANVIEW _ 1 Proposed: Dock y/ � Situate: Gutchogue Town: Southold r',, W s E 1 _._ , 5uFfolk County W .M. Pur ose.- Private Moori g 5CA le: 1 11 = 401~ °°o s� , Datum: ALW to° 1 Tide Range: S 2 ' +/- + �Y`0 � (1.91 1 100` �hv+ie\ � { 3� All� m dl Yber. (461 .� Clee �� Et \ i t, tM�er and piles ore `pO * k%o x. GGA treated wUod (-3.21 � e`, All horcivore"domed °f n� a 1 i a t t •, � t (•iS1 (.051 -09� a ♦ ' 1 p>t` W { -p ' Proposed Tirtsber Y`tiolk st"It (cJOOSC�f1Q1 -b5'x 4) P1 �os•tp e +R eo t min.�C daove c ode.ytsp:to Sp�7j� grace t 4'x 4 GGA P"psts ; 111 n - ��� �±:� � • . . -011.' t0lall, ,• , CROSS SECTION yam, -0.1 F F. -I- , - 4ji _ ; Proposed Th berr Walk Scale: 1" = 20' a Jr (S,,asonal - 65''x 47 Steps to ' Steps to. mlr).• r. above 'grade grade r ; , si o.l grade 4" x 4" CGA Posts i Pile st ullley -0.0 O,i 1 ::.. j6h. r - 0011, eXlsiting elevations e 9e of ;as Serveyyed t i HeElonds I 1 I I 0I-25-02 • I � I I I I I PREPARED BY, -. .`�Ci ,1 ., ` Amended SEA LEVEL Adjoining Owners: �Q'00 'o O� 01-14-01 MAPPING Borth side, south sIdei � Q �` -� W I THIS PLOT A5 DEVELOPEDED FROM Tax a 1000-136-1-31 Tax is 1000-136-1-341 * l - 5uRVEY5 OF 02-16-99 t 0I-25-02 RIvEP6 EAST MAIN STREET Ernest d -bon 6vettinger rfillam 4 IVa Felix - 1 PmONE 516- -1 n9o1 P.O. Box 43'1 12 GI Delve P►ID1rE 516-721-3157 - 5heet:L Of;— Mastic 6eaah,NY ug52 Formaigdele,NY 11735 ROBERT H FOX NYS 1 1,4 Sn�e� t Board Of Southold Town Trustees , SOUTHOLD, NEW YORK PERMIT NO. "(_ ! [ DATE: ..MAY 26,_ 1999 l SALV 4` ISSUED TO ....................... AT...... YALACINO _........ .. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;'.'. and in accordance with the Resolution of The Board adopted at a meeting held on ...M.4..y... .4,....1999 19. ,9..9.,,, and in consideration of the sum of $. 150..00.. . paid by < 3 • P Catherine..Mesiano for.SALVA.TORE PALAGIN.Q........................ ' Y ., N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to constr, a single fam. dwell. with deck with ` condit. that no turf be seaward of the line of haybales that will '. be placed during constr. and that gutters & drywells be constr to cotwin roof runoff a in accordance wifh the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to r. be subscribed by a majority of the said Board as of this date. 1 y, .. ........................ Trus�eer , Iri SMVE 1 OF LOTS # 54-5-1 N -_5URVEYED 01-13-99 AMENDED02-25-qq 'MAP OF E 160 HEICff Ma 03-05-99,04-29-19, HL®WITH THE COUNTY AS i W6 W E 05-1 1-99,06-2499, 51TUATEv ==440 >M FND 99.09-27-01 TOM OF 50WHOLD s FINAL; 10-1-0 12-2-021 WTIOLK Wucy,M' a-26-02 Drive SUFFOLK COUNTY TAX 0 pierce Iwo_156- 1 -38 SUFFOLK GOUNTY HEALTH DEPT. REF.M RIO-99-42 C13117d�'l� SAL PAIACM 8113A?WPALA,0 0 D•+ell� 3�� 288.73' ` I� •- '.'. ..4,r,r' N82°01'10"E 1 LOL=3l ,P �,y�ap'v. N�/� !/, '•'. ' yr1 r 1 U as 25toN ^l House eoroofl �/� i.•,v V C . t. / . ♦ /.;.:-L� Al �I� ti r N S8235 "01'1 p sa n °°�k` �� nc• �a ^C OF Nfly C. O CO NOTES: ■ MONUMENT FOUND O PIPE FOUND ., .,.�.,�. LAND ai-=, HEDGE . ..:....... ... AREA =27,391 SF OR Obi ACRES •,�...•M..� •� ` '•• JOHN C.EHLERS LAND SURVEYOR GRAPHIC SCALE I"= 40 6EASTMAIN6TRFET N.Y.S.LIC.NO.50202 RIVERHEAD,N.Y.11901 .•^•^+..^«.�.••o.w,.,.n,...,.,„,.,. 369-8288Fu369-8287 REF. \\Hp serve-\d\PR05\99-f03fn].pro March 9, 2014 NYS Dept. of Environmental Conservation SUNY @ Stony Brook 50 Circle Road EMAR Stony Brook, New York 11790-2356Attention: Duty Analyst 1 4 214' 1D RE: 790 OAK STREET CUTCHOGUE, NY SCTM No. 1000-136-1-38 97i Uy.4 " APPLICATION FOR PERMIT bardr Dear Sir/Madame: We hereby submit four (4) copies of the proposed plans, applications, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332 or e-mail at jpatanjo@optonline.net. VerjLtruly yours, Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 cc: NYSDOS Town of Southold Army Corps Richard & Anne Moore .JOINT APPLICATION FORM For Permits/Determinations to undertake activities affecting streams, waterways, waterbodies,wetlands,coastal areas and sources of water withdrawal. New York You must separate) apply for and obtain separate Permits/Determinations from US Army Corps of Y PP Y State each involved agency prior to proceeding with work. Please read all instructions. Engineers(USAGE) APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart- General Services ment of State Check all permits that apply: Check all permits that apply: ❑ Stream Disturbance ❑ Coastal Erosion ❑ Section 404 Clean Water Act Check all permits that Check if this Management aPPIY: ,/applies: M ❑ Excavation and Fill in ❑ Section 10 Rivers and Harbors ❑ LyJ State Owned Lands Coastal ,.,/Navigable Waters ❑ Wild, Scenic and Act Under Water Consistency L(Docks, Moorings or Recreational Rivers Nationwide Permit(s) - IdentifyUtility Concurrence ❑ Platforms ❑ Water Withdrawal Number(s): Easement ❑ Dams and Impoundment ❑ Long Island Well 3 (pipelines, Structures ❑ Aquatic Vegetation Control conduits, ❑ 401 Water QualityAquatic Insect Control cables, etc.) ❑ Certification Preconstruction Notification- ❑Docks, ❑ Freshwater Wetlands El2/Fish Control Y / ❑ N Moorings or Tidal Wetlands ❑ Incidental Take of Endan- Platforms gered/Threatened Species �,/ �,� L� I am sending this application ❑ I am sending this dI am sending Lief I am sending this application to this agency. to this agency. application to this this application agency. to this agency. 5. Name of Applicant(use full name) Applicant must be: 6. Name of Facility or Property Owner(if different than L'9 Owner Applicant) Anne- AA pore— ❑ Operator Mailing Address ❑ Lessee Mailing Address (check all that apply) 10 PeVG W')IIISAMS D2• Post Office City Taxpayer ID (If applicant Post Office City is NOT an individual): East Zs11P State N y Zip Code /I 7 3 O State Zip Code Telephone(daytime) Email Telephone (daytime) Email 1131 • 67lS •f,77 3 Pdtov-feSV&o0P-nl#oe.Ne+ 7. Contact/Agent Name 8. Project/ Facility Name Property Tax Map Section/Block/Lot Number Sorb Pa.+4n n 790 D«,c to'rec-r lc00- 136 - 1 -3$ Company Name Project Location - Provide directions and distances to roads, bridges and bodies of waters: 6*06V- 3Trf'CT , Gs yr S�cQ�� 150' Sov-lh -F Aeree Ori.. 1 ob t/ewst+ (3Lvcl.. . Mailing Address Street Address, if applicable Post Office City State Zip Code NY _790 aal- s.��«+ e„ t��Doi 111136- Post 1436- Post Office City Town/Village/City County C'tn 4-SC AA o(*l ehe2.5 -5v LA-th o I A. Svf¢ot.lL- State Zip Code Name of USGS Quadrangle Map Stream/Water Body Name Ny 1193y SoU+kol A- CeocK Telephone(daytime) 933e�- Location Coordinates: Enter NYTMs in kilometers,OR Latitude/Longitude G31y `f• Email NYTM-E NYTM-N Latitude Longitude ,1Pa'I-wn o� oPto�I�ric.NG1 '//'ol v3� N 7a' ai•a9v�1 JOINT APPLICATION FORM 02/13 This is a 2 Page Application Application Form Page 1 of 2 Both Pages Must be Completed AOINT APPLICATION FORM - PAGE 2 OF mit this completed page as part of your Applicati 9. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose. Attach additional page(s) if necessary. Include: description of current site conditions and how the site will be modified by the proposed project; structures and fill materials to be installed; type and quantity of materials to be used (i.e., square ft of coverage and cubic yds of fill material and/or structures below ordinary/mean high water) area of excavation or dredging, volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource impacts; and where applicable,the phasing of activities. ATTACH PLANS ON SEPARATE PAGES. AAAcsh.vy 94-erivy, eG-,r, &7eA (2)e(Z a+nA- r.�s�'till VZW (te& .,..4- h 3 wcoRc u /at Govy +110419,41-1V& I irn110 wr�-Gt li u cd�C ,e o?o` tp"7 St"v'up,.L y eQoL1L 5"10/v o eL e& .,FF be{�e•r.� wetH 3 ?e' 91A -6446ei . Mw. vF Proposed Use: Private ❑ Public []Commercial Proposed8-l�i J Estimated Start Date: l Completion Date: Has Work Begun on Project? ❑Yes Cho If Yes, explain. Will Project Occupy Federal, State or Municipal Land? ❑ Yes ❑'Irlo If Yes, please specify. 10. List Previous Permit/Application Numbers (if any) and Dates: 11. Will this project require additional Federal, State,or Local Permits including zoning changes? EYes ❑ No If yes, please list: T W.✓ .f r7s✓�'�o 1 oL -r-e v S-I't tS R tnn 7 Co4,fS 1 H 4 i a D 5 12. Signatures.If applicant is not the owner, both must sign the application. I hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said project. In addition, Federal Law, 18 U.S.C., Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies, conceals or covers up a material fact; or knowingly makes or uses a false,fictitious or fraudulent statement. ignature of Applica Printed Name Title Date r e A,1,-,e tj G C r G10r94. 3- IV- i Lf Signature of Owner Printed Name n Title Date 'ft-FPre /4 Gil4- a'S-I q n ture of Agent' Printed NamE Tie Date 30INT APPLICATION FORM 02/13 Application Form Page 2 of 2 New York State Department of Envirotental Conservation PERMISSION TO INSPECT PROPERTY By signing this permission form for submission with an application for a permit(s) to the Department of Environmental Conservation("DEC"),the signer consents to inspection by DEC staff of the project site or facility for which a permit is sought and, to the extent necessary, areas adjacent to the project site or facility. This consent allows DEC staff to enter upon and pass through such property in order to inspect the project site or facility, without prior notice, between the hours of 7:00 a.m.and 7:00 p.m.,Monday through Friday. If DEC staff should wish to conduct an inspection at any other times, DEC staff will so notify the applicant and will obtain a separate consent for such an inspection. Inspections may take place as part of the application review prior to a decision to grant or deny the permit(s) sought. By signing this consent form,the signer agrees that this consent remains in effect as long as the application is pending, and is effective regardless of whether the signer,applicant or an agent is present at the time of the inspection. In the event that the project site or facility is posted with any form of"posted" or"keep out" notices,or fenced in with an unlocked gate,this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further agrees that during an inspection, DEC staff may, among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soils and vegetation(taking samples for analysis), and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s) sought by the application. Permission is granted for inspection of property located at the following address(es): -79v Do►1G S4rcc1, Cu4-eEoa,ue.. tiq 35— By signing this form, I affirm under penalty of perjury that 1 am authorized to give consent to entry by DEC staff as described above. I understand that false statements made herein are punishable as a Class A misdemeanorpursuant to Section 210.45 of the Penal Law.* 4.1 rev L M ftie , GLv /� 3• ' 14 Print Name and Title Signature Date *The signer of this form must be an individual or authorized representative of a legal entity that: • owns fee title and is in possession of the property identified above; • maintains possessory interest in the property through a lease,rental agreement or other legally binding agreement;or • is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in the property for the purpose of consenting to inspection of such property. Permission to Inspect Property Application Supplement 12/08 617.20 Appendix B Short Environmental Assessment Form ' i• Instructions for Comyietine i 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 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 Pari 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_ F >t*,JC Pleg- (? -71V ode- s-r. Project Location(describe,and attach a location map): -74ty owtL *T. C✓ireA,, ve , pJy iI?3S i- Brief Description of Proposed Action: I. Q�/►iov�G o�Xlsrhi S+vriy otaenor y*�Q PieX 44.Q "..+s-t7ac^t" .0 c...� I. x )d! d✓nr �fC,tdi P«.e- w/ 8' x6P` 1-0-7 i4l✓�+. Rw.,.P ✓✓�� *I fri P4 f7^01 Dre-k I Name of Applicant or Sponsor. Telephone: &91-1,10-15-7175 fZ i G�►.�� aw�,v c &A e E-Mail: �µovre S'/E+'d�hidhne,.ve� Address: qo Perc w.tl�•�•ns 92 • City/PO: State: Zip Code: I. 1eA st =s Li P IN K 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: j r��a5p8L f AN" 404-f r—+�1b�vsl To..,.s mL 5...(k.le2. T�vs^t'ecs ❑ ❑ 3.a.Total acreage of the site of the proposed action? 04% acres b.Total acreage to be physically disturbed? D acres i c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor. 043 acres 4. Check alpand uses that occur on,adjoining and near the proposed action. // ClUrban ❑Rural(non-agriculture) ❑Industrial ❑Commercial O esidential(suburban) []Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland I: I I . Page 1 of 4 i 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 NO YES landscape? ❑ j 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: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES Rr ❑ !: b.Are public transportation service(s)available at or near the site of the proposed action? ❑ a 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: ❑ i I' 10. Will the proposed action connect to an existing public/private water supply? NO YES A. If No,describe method for providing potable water: "a*-e- Q�� ET ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES i If No,describe method for providing wastewater treatment: .'.n a R et A R' ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES j Places? ❑ b.is the proposed action located in an archeological sensitive area? i 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? zr If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: F] ivl ` fxe�- ere e. E. `l 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: j QShorefine ❑Forest ❑Agricultural/grasslands ❑Early mid-successional I. [Wetland ❑Urban Eguburban I. 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES i by the State or Federal government as threatened or endangered? El ❑ 16.Is the project site located in the 100 year flood plain? NO YES i• 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES . if Yes, ❑ 1 a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES i b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? I If Yes,briefly describe: ❑NO DYES s 1 Page 2 of 4 i 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? i If Yes,describe. Q ❑ I t. 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: t i t EtE 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ' Applicants n Signature- r name: A, ^A o e f c- Date: i l f 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?" i 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? FJ El 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? El 1:1 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? S. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy op rtunittes? �. 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? " b.public/private wastewater treatment utilities? ❑ ❑ !. 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 1 i No,or Moderate small to large impact impact . may may �. occur occur 1 o. 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? El El Part 3-Determination of significarim 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, I duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and i cumulative impacts. F.. t z 1 I- c.. ii i 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. j 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. 1 Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 I NEW YORK STATE DEPARTMENT OF STATE COASTAL MANAGEMENT PROGRAM Federal Consistency Assessment Form An applicant,seeking a permit,license,waiver,certification or similar type of approval from a federal agency which is subject to the New York State Coastal Management Program(CMP),shall complete this assessment form for any proposed activity that will occur within and/or directly affect the State's Coastal Area. This form is intended to assist an applicant in certifying that the proposed activity is consistent with New York State's CMP as required by U.S. Department of Commerce regulations(15 CFR 930.57).It should be completed at the time whenthe federal application is prepared. The Department of State will use the completed form and accompanying inforrnation in its review of the applicant's certification of consistency. A.APPLICANT (please print) 1.Name: R j c�h a rtR- A-oy"e- t✓`O p f e. 2.Address: QO ptP6� ��1�ta•Ms Dom- CA 6t ?slip .tik 111iD 3.Telephone: Area Code( ) t b 7 ?7 3 B.PROPOSED ACTIVITY 1.Brief description of activity: 0 Qen.ovc .eAr�Sfi•v� 6�"•!M �ai»s.�t� PIC/L A�t� 2Cp�at� a+lt�i ,�tc.� +,l'arlyt ' fixed Pete, 3'�►�` Al�.n. ll...,�p iyn� 6 'arolo ��ow-}'t7 y Gu-. 2.Purpose of activity: Y-al^ee 64VI,ve d-o dAln RetedS 4'o 6 0�,-1,N q�t�v�a'�mss......._........_...__._......_....._.........._._...._...__....._.._..._.._._.__.._.._.._ ...._.__..._......_.__..___.....__.._._...___ 3.Location of activity: StofFoLV-- -s vaApttSZ -Ito 0^11 6f. � G'61'cz.0.4"e County City,Town,or Village Street or Site Description 4.Type of federal pemzit/license required: A r•✓1 H ey x ps 5.Federal application number,if known: 1., 1.4 6.If a state permit/license was issued or is required for the proposed activity,identify the state agency and provide the application or permit number,if known: N�A- C.COASTAL ASSESSMENT Check either"YES"or"NO"for each of these questions. The numbers following each question refer to the policies described in the CMP document(see footnote on page 2)which may be affected by the proposed activity. 1.Will the proposed activity result in any of the following: YES/NO a.Large physical change to a site within the coastal area which will require the preparation El 0 of an environmental impact statement? (11,22,25,32,37,38,41,43).. . ........ ..... b.Physical alteration of more than two acres of land along the shoreline,land ® ®, under water or coastal waters? (2, 11, 12,20,28,35,44)...... .. .. ..... ......... .. c.Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1). ..... ri d.Reduction of existing or potential public access to or along coastal waters? (19,20)...... cl e.Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10)... f.Siting of a facility essential to the exploration,development and production of energy resources in coastal waters or on the Outer Continental Shelf? (29)..... ..... .. ... . ... g.Siting of a facility essential to the generation or transmission of energy? (27)........... n h.Mining,excavation,or dredging activities,or the placement of dredged or fill material in coastal waters? (15,35)... .... . .............. .............. ..... ......... .. EL i.Discharge of toxics,hazardous substances or other pollutants into coastal waters? (8, 15,35) Q j.Draining of stormwater runoff or sewer overflows into coastal waters? (33)............ El ff k.Transport,storage,treatment,or disposal of solid wastes or hazardous materials? (36,39). Q ,f 1.Adverse effect upon land or water uses within the State's small harbors? (4).. .......... [I 13' 2.Will the proposed activity affect or be located in,on,or adjacent to any of the following: YES/NO a.State designated freshwater or tidal wetland? (44).. ........ . ...... . .. ...... ...... Er 13 b.Federally designated flood and/or state designated erosion hazard area? (11, 12, 17). .... c.State designated significant fish and/or wildlife habitat? (7)... ...... .. .. ...... ..... Er d.State designated significant scenic resource or area? (24). .... ...... .. .... ...... ... e.State designated important agricultural lands? (26).. ..... . . . . .. .. . .. . ... ......... f.Beach,dune or barrier island? (12). .. ...... .. ...... .... .. ...... .... .... ...... Q g.Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3)... ............ h.State,county,or local park? (19,20). .. .. .. ...... .. .. .... . .. ... .. .... ...... ... i.Historic resource listed on the National or State Register of Historic Places? (23)....... . J ' 3. Will the proposed activity require any of the following: YES/NO a.Waterfront site? (2,21,22). . . .. . . ... .... ..... . ....... . ... .. ... . .. ...... .. .. E b.Provision of new public services or infrastructure in undeveloped or sparsely populated 13 sections of the coastal area? (5). .. . . . . .... . .. .. .. .. . .. ... . ..re? I-.. .14.... . . . . � ®i c.Construction or reconstruction of a flood or erosion control structure? (13, ,16)....... d.State water quality permit or certification? (30,38,40).. ... . ..... . .. .. . . .. ...... .. e.State air quality permit or certification? (41,43) Q 4. Will the proposed activity occur within and/or affect an area covered by a State approved local waterfront revitalization program? (see policies in local program document)... ... . . .. .... C — D.ADDITIONAL STEPS 1.If all of the questions in Section C are answered"NO",then the applicant or agency shall complete Section E and submit the documentation required by Section F. 2.If any of the questions in Section C are answered"YES",then the applicant or agent is advised to consult the CMP,or where appropriate,the local waterfront revitalization programdocument*.The proposed activity mustbe analyzed in more detail with respect to the applicable state or local coastal policies. On a separate page(s),the applicant or agent shall: (a) identify,by their policy numbers,which coastal policies are affected by the activity,(b)briefly assess the effects of the activity upon the policy; and,(c)state how the activity is consistent with each policy. Following the completion of this written assessment,the applicant or agency shall complete Section E and submit the documentation required by Section F. E.CERTIFICATION The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved local waterfront revitalization program,as appropriate. If this certification cannot be made,the proposed activity shall not be undertaken. If this certification can be made,complete this Section. "The proposed activity complies with New York State's approved Coastal Management Program,or with the applicable approved local waterfront revitalization program,and will be conducted in a manner consistent with such program." Applicant/Agent's Name: �.c 4���c..l Yo►'ra,7 j a Address: 1 0 6 New."r 42 LvA , Cin fc� A.A eii el eS, tJ4 ) 9 3M Telephone: Area Code Applicant/Agent's Signature: Date: F. SUBMISSION REQUIREMENTS 1.The applicant or agent shall submit the following documents to the New York State Department of State,Office of Coastal,Local Government and Community Sustainability,Attn:Consistency Review Unit,I Commerce Plaza,99 Washington Avenue-Suite 1010,Albany,New York 12231. a.Copy of original signed form. b.Copy of the completed federal agency application. c.Other available information which would support the certification of consistency. 2.The applicant or agent shall also submit a copy of this completed form along with his/her application to the federal agency. 3.If there are any questions regarding the submission of this form,contact the Department of State at (518) 474-6000. *These state and local documents are available for inspection at the offices of many federal agencies,Department of environmental Conservation and Department of State regional offices,and the appropriate regional and county planning agencies. Local program documents are also available for inspection at the offices of the appropriate local government. ! i ENVIRONMENTAL QUESTIONNAIRE This is intended to supplement ENG Form 4345, Application for Department of the Army Permit, or the Joint Application for Permit used in the State of New York. Please provide complete answers to all questions below which are relevant to your project. Any answers may be continued on separate sheets)of paper to be attached to this form. PRIVACY ACT STATEMENT The purpose of this form is to provide the Corps of Engineers with basic information regarding your project. This information will be used to facilitate evaluation of your permit application and for public dissemination as required by regulation. Failure to provide complete information may result in your application being declared incomplete for processing, thereby delaying processing of your application. GENERAL APPLICABLE TO ALL PROJECTS 1. Explain the need for, and purpose of, the proposed work. o Gelaee— .vX, 2. Provide the names and addresses of property owners adjacent to your work site (if not shown on the application form or project drawings). See- ^4.6,A t, 5v rv4,1 , (Please note that depending upon the nature and extent of your project, you may be requested to provide the names and addresses of additional property owners proximate to your project site to ensure proper coordination.) 3. Photographs of the project site should be submitted. For projects in tidal areas, Photographs of the waterway vicinity should betaken at low tide. Using a separate copy of your plan view, indicate the location and direction of each photograph as well as the date and time at which the photograph was taken. Provide a sufficient number of photographs so as to provide a clear understanding of conditions on and proximate to your project site. 4. Provide a copy of any environmental impact statement, or any other environmental report which was prepared for your project. 5. Provide a thorough discussion of alternatives to your proposal. This discussion should include, but not necessarily be limited to, the "no action" alternative and alternative(s)resulting in less disturbance to waters of the United States. For filling projects in waters of the United States, including wetlands, your alternatives discussion should demonstrate that there are no practicable alternatives to your proposed filling and that your project meets with current mitigation policy (i.e. avoidance, minimization and compensation). `7-he- ,vo AC-+I-.> Wm,,ta hasvc,} r,u - ke- Loss o F S"'6f,A-*? Sam rM d�ir.a y edZ Pt apt- s..+dL vt c r F w..ty�-- �G�li Tt�. �t,o��l�'►a S DREDGING PROJECTS Answer the following if your project involves dredging. 1. Indicate the estimated volume of material to be dredged and the depth (below mean low water) to which dredging would occur. Would there be overdepth dredging? 2. You can apply for a ten-year permit for maintenance dredging. if you wish to apply for a ten-year permit,please provide the number of additional dredging events during the ten-year life of the permit and the amount of material to be removed during future events. 3. Indicate of your drawings the dewatering area(if applicable)and disposal site for the dredged material (except landfill sites). Submit a sufficient number of photographs of the dewatering and disposal sites as applicable so as to provide a clear indication of existing conditions. For ten-year maintenance dredging permits, indicate the dewatering/disposal sites for future dredging events, if known. 4. Describe the method of dredging (i.e. clamshell, dragline, etc.) and the expected duration of dredging. 5. Indicate the physical nature of the material to be dredged(i.e. sand, silt, clay, etc.) and provide estimated percentages of the various constituents if available. For beach nourishment projects, grain size analysis data is required. 6. Describe the method of dredged material containment (i.e. hay bales, embankment, bulkhead, etc.)and whether return flow from the dewatering/disposal site would reenter any waterway. Also indicate if there would be any barge overflow. MOORING FACILITIES Answer the following if your project includes the construction or rehabilitation of recreational mooring facilities. 1. It is generally recommended that any fixed piers and walk ramps be limited to four feet in width, and that floats be limited to eight feet in width and rest at least two feet above the waterway bottom at mean low water. Terminal floats at private, non- commercial facilities should be limited to 20 feet in length. If you do not believe your proposal can meet with these recommendations, please provide the reason(s). M cctS fL +f 2. Using your plan view, show to scale the location(s), position(s) and size(s) (including length, beam and draft) of vessel(s)to be moored at the proposed facility, including those of transient vessels) if known. 3. For commercial mooring sites such as marinas,indicate the capacity of the facility and indicate on the plan view the location(s) of any proposed fueling and/or sewage pumpout facilities. If pumpout facilities are not planned,please discuss the rationale below and indicate the distance to the nearest available pumpout station. 4. Indicate on your plan view the distance to adjacent marine structures, if any are proximate and show the locations and dimensions of such structures. 5 .,r,.� o N e s s 5. Discuss the need for wave protection at the proposed facility. Please be advised that if a permit is issued,you would be required to recognize that the mooring facility may be subject to wave action from wakes of passing vessels, whose operations would not be required to be modified. Issuance of a permit would not relieve you of ensuring the integrity of the authorized structure(s) and the United States would not be held responsible for damages to the structures) and vessels) moored thereto from wakes from passing vessels. NIO"G AlgvtrcdL BULKHEADING/BANK STABILIZATION/FILLING ACTIVITIES Answer the following if your project includes construction of bulkheading (also retaining walls and seawalls) with backfill, filling of waters/wetlands, or any other bank stabilization fills such as riprap, revetments, gabions, etc. 1. Indicate the total volume of rill (including backfill behind a structure such as a bulkhead)as well as the volume of fill to be placed into waters of the United States. The amount of fill in waters of the United States can be determined by calculating the amount of fill to be placed below the plane of spring high tide in tidal areas and below ordinary high water in non-tidal areas. 2. Indicate the source(s) and type(s) of fill material. 3. Indicate the method of fill placement(i.e. by hand, bulldozer, crane, etc.). Would any temporary fills be required in waterways or wetlands to provide access for construction equipment? If so, please indicate the area of such waters and/or wetlands to be filled, and show on the plan and sectional views. The foregoing requests basic information on the most common types of projects requiring Department of the Army permits. It is intended to obviate or reduce the need for requesting additional information;however, additional information may be requested above and beyond what is requested in this form. Please feel free to add any additional information regarding your project which you believe may facilitate our review. t P� _y .aiat s �... 2 Y -------------- ----------- •,' F e F F b E9A* F �' L — -- Nonce COUNTY OF SUFFOLK © e v soui„gn secnoR No E^��—'� —�— R+t --�— "' --T-- ; Real Property Tax Service Agency r v H136 ��. M---- ,.. --- --•-- --•-- J%.g `°w'.c«..N..m..aN.,,«, M O ti� a •. ,x�/M w'�tY• •• -_- �u --•-- u�u.--�-- n • 3"�" p ttrro tON PROPEiR'/MM OFFICE LOCATION: *rjf SOUryQI MAILING ADDRESS: Town Hall Annex O P.O. Box 1179 54375 State Route 25 l Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) N �r Southold, NY 11971 �� Telephone: 631 765-1938 Q Fax: 631 765-3136 co LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 1 , t To: John Bredemeyer, President Town of Southold Board of Trustees MAY 2 1 2014 From: Mark Terry, Principal Planner JJir ;O;si 60'LWRP Coordinator Date: May 20, 2014 Re: Proposed Wetland Permit for RICHARD &ANNE MOORE SCTM# 1000-136-1-38 Jeffrey Patanjo on behalf of RICHARD &ANNE MOORE request a Wetland Permit to remove existing storm damaged pier and construct a 4'x101' fixed pier; a 3'x12' aluminum ramp; and 6'x20' floating dock supported by four(4) 8" diameter piles and 3"x10" cross-bracing to support the float a minimum of 30" off creek bottom. Located: 790 Oak Street, Cutchogue. SCTM# 136-1-38 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 INCONSISTENT with the below Policy Standards and therefore is INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. Chapter 275 defines Dock as: DOCK Any permanent or seasonal structure, except a building, located or proposed to be located on lands abutting or comprised of freshwater or tidal wetlands or connected to a bulkhead or the upland and extending over the water's surface, designed to secure vessels and provide access from the shore to a body of water. For the purpose of this chapter, this term shall also include the associated structures necessary to cross wetlands and adjacent natural areas. The term "dock"includes the terms "wharves," "piers," "fixed docks," "docks,"or "floats." The proposed action does not identify the purpose of extending the dock structure and detailsof a proposed vessel. Further, the applicant has not demonstrated that the following dock standards pursuant to § 275-11. Construction and operation standards have been met. (d) Review and approval of dock applications. Before issuing a permit for a dock structure, the Trustees shall consider whether the dock will have any of the following harmful effects: [5] Whether the dock will cause degradation of surface water quality and natural resources; The mean lower low water (M L L W) at the terminus of the dock structure ranges between -0.5 and -0.8 feet and is inadequate to support most motorized vessels and keeled vessels (due to draft). Further, due to the inadequate water depths, operation of a motorized vessel to and from the dock could result in bottom scaring and increased turbidity in the water column impacting marine life in the water body. It is recommended that the Board clarify the size and type of vessel and tidal range. (6] Whether the dock will cause habitat fragmentation and loss of significant coastal fish and wildlife habitats, The proposed action is located within a DEC Critical Environmental Area. The proposed construction practices of the dock have not been identified. It is recommended that the applicant identify the proposed construction practices. Activities during dock construction can destroy vegetation either above or below the tide line by pulling them from the substrate or destroying their root system. The peat beds underlying salt marshes can also be compacted through the improper use of heavy equipment. It is recommended that the Board clarify the methods of construction. 11] Whether the cumulative impacts of a residential and commercial dock will change the waterway or the environment and whether alternate design, construction, and location of the dock will minimize cumulative impacts; and The action is also inconsistent with the following policy standard: Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. 9.3 Preserve the public interest in and use of lands and waters held in public trust by the state and the Town of Southold. A. Limit grants, leases, easements, permits or lesser interest in lands underwater in accordance with an assessment of potential adverse impacts of the proposed use, structure, or facility on public interest in public lands under water. Use the following factors in assessing potential adverse impact: 1. environmental impact, As discussed above, M L L W at the terminus of the dock ranges between -0.5' and -0.8'. Placing dock structures in areas were water depths are inadequate to support motorized or keeled vessels could lead to environmental impacts such as bottom scarring and increased turbidity in the water body. Policy 10. Protect Southold's water-dependent uses and promote siting of new water- dependent uses in suitable locations. The proposed action is for the construction of a private dock located within a DEC listed Critical Environmental Area. The shallow depth of the creek limits the use of the creek by motorized vessels. The creek does and will support manual powered personal recreational vessels, such as kayaks, rowboats etc. with shallow drafts. In the event that the action is approved it is recommended that to further Policy 6 that a non- disturbance buffer landward of the wetland edge be required. It is further recommended that the non-disturbance buffer incorporate the existing vegetation on-site. 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 gUFFQ� Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O. Box 1179 ♦ '1;' Southold,NY 11971 Telephone(631)765-1892 J* Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., April 16, 2014 the following recommendation was made: RICHARD & ANNE MOORE to remove existing storm damaged dock and construct 4'X 101' fixed dock, TX 12' aluminum ramp and 6'X 20' floating dock supported by four 8" piles and 3"X 10" cross bracing to support float a min. of 30" off creek bottom. Located: 790 Oak St., Cutchogue. SCTM#136-1-38 The project was not staked, therefore no recommendation was made. Board;� Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension '' �eceived Application: / ! Received Fee:$rl_5U°= L/Completed Application -5/111 MAR 1 4 2014 _Incomplete _SEQRA Classification: Ju�fiG `cv�i Type I Type II Unlisted Board of Trustees Coordination:(date sent) VWRP Consistency Assessment Form .A_rL /y AC Referral Sent:, :W/`� _Date of Inspection: '11/1411q Receipt of CAC Report: Lead Agency Determination: �clinical Review: blic Hearing Held: 3 1/ Resolution: Name of Applicant i c, r6(L }F Jk0? AA vote_ Address olo PerC111AM6 Ts4P .N4 W130 o Phone Number:( ) b 3 l • 6 7 g $'7 3 Suffolk County Tax Map Number: 1000- 1 3` - 3 8 Property Location: `74 a 00.V.- S4• I 113 5- I to ' Ito ' s.u4.6 of PigCct PXIV� . (provide LILCO Pole#, distance to cross streets, and location) AGENT: --sc 4:1-F re cq Qa'1'a 1 0 (If applicable) Address: 1o(o wt't"'C 13Cu ,,Aonehe5 Phone: X31' y�y'933a UY 3�� I Board of Trustees Application GENERAL DATA Land Area(in square feet): o� '�, 3 31 Area Zoning: 9--e S Previous use of property: (?-,e -64-e,n+,«,(� Intended use of property: 12 c S#"k e-in 4 t,k C Covenants and Restrictions: Yes X No If"Yes",please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes ?e No Does the structure(s)on property have a valid Certificate of Occupancy )!� Yes No Prior permits/approvals for site improvements: Agency Date K No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): (LsrnovL �5�!'in+q 5�'eP++ C�aMay�J7� P7 etc- e*^ P— Co,,.s<cuc+ W wick x I of ' Lo.�9 f weX f etc, 3'w#ilc x N"t-9 41...1--" 4-r"1 ••V),L 6�wuQ6 x �O' Lavfl plo4-l'�n+9 �e�lL S�e(lor�'.edz � Fe�� $K � p�Lei �w+lt- 3"hto'J Ct-eSS BfJLCiNJJ - v 54f&f4r Pl•J+-t ml,v1,w-*V itsPk Cfac1L tfoa--�-v'.+ . Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: O&M 'e AQ;�2 .0.4 y'w+dc x tot' (, ,vy F%xeA PieA , V wsde- x +3' 1~1 Alu•ni.�++�n /Za.Hce w.ecQ v(wriPc �! ao' L•ry �/►w'f/,w� Aof.JL !oy .6vL 0"0 P:&S wn.� 3 "X►°" Cvy.ss br.►cra..J -n---n v` 3 o u . d* crtGlL- Area of wetlands on lot: b Y 1 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: O feet Closest distance between nearest proposed structure and upland edge of wetlands: O feet Does the project involve excavation or filling? ✓ No Yes If yes,how much material will be excavated? t''J A cubic yards How much material will be filled? N(A cubic yards Depth of which material will be removed or deposited: IA feet Proposed slope throughout the area of operations: Ito 1 Jr Y Manner in which material will be removed or deposited: e-JA 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): 7'bCrc, w#// N!44- 1-e- .F-Fec+- 0-0 L(Ac4-16..(tel6 s.x t,ce«l wutZ+Gs . -r- crc w►ll eJ�gec+ d,�c -1'e (J�r�Oebed�- flow- ?�+ry s(tcKi�+y oN NCw Ptclt• 6I Z20 Appendix B Short Environmental Assessment Form Instruetions for Completing s 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: �1 Project Location(describe,and attach a location map): -7-1 o watt: a r. C✓rip we , NL( t?3 S- BriefDescription o(Proposed Action: S+tvrm ota.-nx y 40 121eX ee4,Q Go..+CT!✓6't` .ts�..� . H x 10, �..�r x�dz Pre s-- "i► 8 K d z l.v�� 4 ho,". R.a O. w• Name of Applicant or Sponsor: Telephone: 491-j.10-157-75' fl i a &A op/e E-Mail: Rytooce S'/(t'+d��inl.nc,we Address: qv ��rc w.tl�NMS 9R City/PO: State: Zip Code: !. fAvr =SLtP NK 11730 1 . 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: va•t'apbeC- cv►.? 40'b/5) +-A4Soos1 Toru of- 60.4"WL Trvs�i'ees ❑ ❑ I 3.a.Total acreage of the site of the proposed action? 0.61% acres b.Total acreage to be physically disturbed? 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor`? 0.613 acres 4. Check aland uses that occur on,adjoining and near the proposed action. // q rban []Rural(non-agriculture) ❑Industrial ©Commercial R<Idential(suburban) ❑l:orest ❑Agriculture ❑Aquatic []Other(specify): ©Parkland IIII I . Page 1 of 4 j i 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 NO YES landscape? ❑ Q' I 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: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO AYESS ° Er b.Are public transportation service(s)available at or near the site of the proposed action? I i LTJ I o.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? I 9.Does the proposed action meet or exceed the state energy code requirements? NO If the proposed action will exceed requirements,describe design features and technologies: ❑ } Er s 1' 10. Will the proposed action connect to an existing public/private water supply? NO YES . If No,describe method for providing potable water: r-:•rt-e- 11. 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: n e- F sfi A 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES j Places? b.Is the proposed action located in an archeological sensitive area? ❑ I �. 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? El l' If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: iol ` f+xeX Qiek 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: []'Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional dWetland ❑Urban [Rtuburban 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? a ❑ 16.Is the project site located in the 100 year flood plain? NO VES T-T TT 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES . If Yes, ❑ 1 a.Will storm water discharges flow to adjacent properties? ❑NO E]YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES j Page 2 of 4 jI 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: I 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: ' Q ❑ i r 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES oompleted)for hazardous waste? If Yes,describe: ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/s n r name: N✓�— wA o o t e. Date: • t - i� 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 ooncept"Have my responses been reasonable considering the scale and context of the proposed action?' No,or Moderate i 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 D 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? ET ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? ❑ 5. Will the proposed action result in an adverse change in the existing level of traffic or El 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 El available enc conservation or renewable energy o rtonities? 7. Will the proposed action impact existing: r,Y ❑ a.public/private water supplies? LLLL!1 b.public/private wastewater treatment utilities? 121 ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, (� I 1 architectural or aesthetic resources? u u 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 I t. No,or Moderate j small to large H impact impact . may may V• occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 0- 11. Will the proposed action create a hazard to environmental resources or human health? El E 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 ifthere 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 i 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. 4' 1 E: E 1. ti. i . Check this box if you have determined,based on the information and analysis above,and any supporting documentation, at the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. I 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. `m�a' Z'/a ln Nof Lead Agency ate Print or Name of Responsible Officer in Lead Agency --° Title of Responsible Officer �,8!nkfiire of Responobirdificer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 • • PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: MICH0,C► ►�acco �� oar Cu, ►� W I l 1 A41Al 1 r �w 4tta n 1- 113 5 m �.lv� .� V � � a v i 5 ��►�(�. �: c��a cue, 11 q3'� STATE OF NEW YORK COUNTY OF SUFFOLK S�- J QIA-19An d , residing at (O ny I - , being , sworn,deposes and says that on the �` day of_A P�.L , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application,directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office ate, `(Y (I( that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. 42nj Sworn to before me this q" Day of 20 J Notary Public Loriann Patani' � Notary Public State ofNew York Qualified in Suffolk County No:01 PA6150861 Commission Expires 08/07/20 John Bredemeyer, President � � Town Hall Annex Michael J. Domino, Vice-President ogurrot hie °as 54375 Route 25 James F. King y P.O. Box 1179 Charles J. Sanders o 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 RICHARD & ANNE MOORE COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, Zf�f nI y, residing at/dba 010 +7& l ttB/yJ being duly sworn, depose and say: That on the 1a- day of qf��l.— , 201 I personally posted thepro rt known as �- I I�� by placing the Board of Trustees official poster wh e 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,April 23,2014. Dated: (sin ure) Sworn to before me this 1A day of 2014 Notary Public Loriann Patantto� Notary Public State ofNew York Qualified in Suffolk County No:01 PA6150861 Commission Expires 08/07/20A 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. '--K; cJrjc4-J Z, OWNER(S) OF RECORD: Moore.. SUBJECT OF PUBLIC HEARING: To remove existing storm damaged pier and construct a 4'x101' fixed pier; a 3'x12' aluminum ramp; and 6'x20' floating dock supported by four (4) 8" diameter piles and 3"x10" cross-bracing to support the float a minimum of 30"off creek bottom. TIME & DATE OF PUBLIC HEARING: ft tJ,An 1* r* 1 .2 ,3, 'NNOlq --&- OrQN6cv*--+ Sb*30 esc(�L)1111`14 Oe If you have an interest in this project, you are invited to view the Town file(s) which are available for ins ection rior to the day of the hearing during normal business days between the ours o 8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 0 0 Board of Trustees Application County of Suffolk State of New York A MAI e— A mo t<- BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)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. Signa re SWORN TO BEFORE ME THIS W DAY OF -920j_+_ Notary Public Lodann�Paetaonio Notary Pubic S�AoofNew York OdWifiedin County No:01 PA6150861 Commission Expiros 08/07/20 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) NNc AADo4,t residing at 110 17t/cH (print owner of property) (mailing addr se s) W. I h..e,,,s V2- E•►sl 7-6/t p do hereby authorize --J � rL� (Agent) l to apply for permit(s)from the Southold Board of Town Trustees on my behalf. ga-nl� (Owner's signature) 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessM to avoid same. rr'' YOUR NAME: AAO®r e I V C �a!tX • � �N G (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map 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. 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 (v day of AA&,.,c,,(7 241 K Signature /L! Print Name r Form TS 1 . .. . 0 eo� k Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM o PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 01 1 oDo r$(► t 30 STORM WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN yMRE7 a on— -Black - o—t CERTIFIED BY A DESIGN PROFESSIONAL IN THE.STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? ' 4 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within t Generated b a Twa 2" Inch Rainfall on Site? the Scope of Work for Proposed Construction) �7)33 0•b3 y ( ) (s F/ acs) (This item will include all run-off created by site b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed ll� Site Improvements and the permanent creation of construction activity? (S.F./Acres) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed D PROVIDE-BRIEF PROJECT DESCRIPTION (Provide Additional Paces as Needed) Drainage Structures indicating Size&Location?This Item shall Include all Proposed Grade Changes and — fi r ta+: /t uV(, rsa¢„�iY► �QLi/Y/u LOQ Slopes Controlling Surface Water Flow. /1 3 Does the Site Plan and/or Survey describe the erosion pie/, twST'1 '� a( [of FI kt el c ti and sediment control practices that will be used to ✓ a control site.erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. �-a m Aon (v t w l�r >r 7 O r lti to y 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural /eM•f-r Nry D v c(L. Existing Grade Involving more than 200 Cubic Yards _ of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area In Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction a — General DEC SWPPP Reaulrements: or within One Hundred(100')feet of a Welland or Submission of a SWPPP Is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres;including disturbances of less than one acre that7 Will there be Site preparation on Existing Grade Slopes are part of a larger common pian that will ultimately disturb one or more acres of land: which Exceed Fifteen(IS)feet of Vertical Rise to including Construction activities involving soli disturbances of less than one(1)acre where One Hundred(100)of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shag meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other impervious for Storm water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The NOl shall be Into and/or in the direction of a Town right of-way? El submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shag describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, / required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall Area?(Thle)tem will NOT Include the Installation of Driveway Aprons) Identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any a swerloconstruction Questions One disturbance is Nina is Answered S.F.with ACheck Mark 3.AN SWPPPs that require the post-construction storm water management practice in a Box and the cathing,Drainage aIle&Erosion n C b between 5,000 S. 8,1 Aare in area, component shall be prepared by a qualified Design Professional Licensed In New York a Storm Were,Brading,Drainageo Erosion Conan/Plan n Required Building Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Mustark(Submitted for Review Pricedrior to Issuance offorry Building Permit (NOTE; A Check Mark(�)and/or Answer for each Question Is Required for a Complete Application) STATE OF NEW YORK, COUNTY OF...IS........ .............SS That I,...........!!�`......... !� - ......................being duly sworn,deposes and says that he/she is the applicant for Penn i4 (Name of Individual signing Document) p �' And that he/she is the ........................................DW!�"' • ............................. . . ...... . .............................................................. .. .. (Owner,Contractor,Agent,Corporate Officer,eta) 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 before me this; day of...... . .... ,201 (n,",..................... ...r....... .... NotaryPublic: ............... . ....... . . .. . ............. ... .. ......... ................. (Signature of Applicant)• FORM - 06!10 Notory Ua iifiedcYorkin S ou y No:01 PA6150861 Commission Expires 06/07/201�- 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",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 136, - t - 3 v The Application has been submitted to(check appropriate response): Town Board © Planning Dept. 0 Building Dept. 0 Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital 0 construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Er Nature and extent of action: R„r.•..< "soAft] S'ror.a 0601A-J�fx PIsR- *r.A tms-f-il W' k lot +L�.,-ry F+hem Rw-Al S✓PPrf-r't� bt •Fiy.L ���� Pt�rS �� �..�tv` r/•Sl lsrkoi.,.y -fo Sr/P•It' 1�l•w-r *I ow 0'� / FG ere<<L (�O{.�•..� 0 0 Location of action: 7 9 n 0414- '5-r- Co-tG ko a vt Site acreage: 0.63 Present land use: IZ e s 1(P4-^+1 w L Present zoning classification: 9-e & 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 jv o (b) Mailing address: q o Pecc!j w,I I',—"S flot. Ica sr zscj p ,.r ti 117 30 (c) Telephone number:Area Code (d) Application number, if any: JA Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 2 No❑ If yes,which state or federal agency? H S DELI ��Is fob 1 Atn� G+1-p s 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 F-1 Not Applicable Pfr�tt.k Qt.pIKtcS s-t•ron P#t/4 Awt- cc6L-rfs —f• W&+44-$ w[-th it V t c-l1 a7 /yew SZr rGt,fI'C 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 No [� Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes [1] No © Not Applicable Qrrltt•Jc he fe'n f rnpf,4 -h 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—PoliciesPagesS through 16 for evaluation criteria Yes 11 No [ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria 0 Yes F No U blot 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 R No M Not Applicable p r+n i S.c d� P c t w t l v'!►C c 4-h tv -F l a.o o(s t l t••�y o v�ic-- 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[� 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 I4 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. �1 YeEl No❑ Not Applicable Q<b'1eck Prd"&A-S FvA,- Qvbltt, vie ..r- wp te,etwL%� f ^na Olc..l.Ll.w� v ( y>pa-t t 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 ❑ Not Applicable Qf�►�st� hovt.rQGS /tet tJt -to A-4..-9!:4 s 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. ElYes ❑ No 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 —1No I•'J 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 Lr7 Not Applicable Created on 512510511:20 AM March 9, 2014 Town of Southold Trustees Town Hall Annex Building EMAR 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 1 4 2014 RE: 790 OAK STREET. CUTCHOGUE, NY SCTM No. 1000-136-1-38 dcilt"' ' APPLICATION FOR PERMIT Dear Sir/Madam: We hereby submit one original and three (3) copies of the proposed plans, application, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very my yours, Je ey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 cc: Richard &Anne Moore Dfrfbfue _ ipie /rcEXISTING ADJACENT DOCK o ° PROPOSED OPEN-GRATE DECKNG TO BE \ FLOW-THRU INTERLOCKING PANELS OR EQUAL 1 \ \\ PROPOSED FIXED ELEVATED PIER 101' LONG X 4' WIDE v I i 288.73 \ \�° SUPPORTED WITH 6"0 PILES 0 8' O.C. (TYPICAL BOTH SIDES) W1 �1 �`^\ O � I = . o \ PROPOSED HINDGED RAMP Ii i 01\ 12' LONG X 3' WIDE Z\3 N82°��'10lE� — — i a � f \ A 66'11 —o.� —o.s T + KO-01 PROPOSED 20' LONG X 6' WIDE FLOATING DOCK y 07 X80 / —o.� SUPPORTED WTH 4 8-0 PILES cam- 2 7 I ( ) S8200r � REMOVE EXISTING DAMAGED PIER n -1.0 APPROVED BY MAA I BOARD OF TRUSTEES EXISTING ADJACENT DOCK SJJIt viuA 'f if TOWN OF SOUTHOU� Board of Trustees —o.7'1 REPRESENTS ELEVATION OF BOTTOM DATE Zf tLl PROPERTY OWNER: NOTES: RICHARD PERC&W NILLIANE ODRIE Proposed Dock & Float SCALE: 1"=30' 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM EAST ISLIP, NY 11730 2. LOT AREA: 27,331 S.F. f 0.63 ACRES PREPARED BY: PROPOSED PLAN 22-19-14 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: JEFFREY PATANJO 106 HEWITT BOULEVARD Iso OAK STREET JOHN C. EHLERS LAND SURVEYOR CENTER MORICHES, NY 11934 CUTCHOCUE, TOWN OF SOUTHOLD 6 EAST MAIN STREET RIVERHEAD, NY 11901 631-484-9332 SUFFOLK COUNTY, NY SHEET: SURVEY LATEST DATED MAY 5, 2009 TAX MAP N0. 1000-136-1-38 1 of 2 4 z j LOCATION • ty 4 . PROJECT LOCATION MAP N.T.S. 101 PROPOSED FIXED ELEVATED CATWALK 60' 4' WIDE X 101' LONG W/ UNTREATED DECK n` THRU-FLOW DECKING OVER WETLANDS PROPOSED 6"x6" CCA POSTS (TYP.) 10 nMAH - - -- ONG ALUMINUM HINDGED RAMP 8 �__ - - -- -- - ----- 6' WIDE X _ LONG oar fTru ee 6 GRE NHEART FLOATING CK -- BER -_ TO OLD FLOAT MIN. 0 30" OFF CREEK BOTTOM AT LW PROPERTY OWNER: 4 _ _ - --_ _ -_-- __ - _._ - _ _ RICHARD & ANNE MORROE — _APPROXI 90 PERCY WILLIAMS DRIVE A _M .W. EL. 2.5t IEAST ISLIP L 11730 _H 2 — PREPARED BY: EXISTING GRADET --- - ---- JEFFREY PA ANJO 106 HEWITT BOULEVARD 0 __- _ ___� __- - __ __ _ _77 _ _� _ APPROXIMATE M.L.W EL. 0.0± CENTER MORICHES, NY 11934 --- -- - - - i- - -- _ 631-484-9332 -2 � --- -- _ � 1- _ - � _ _ _ PROPOSED 8". .0 PILE -- CCA (TOTAL OF 4) -o.s' -1.1' -1.4' Proposed Dock & Float SCALE: —4 AS NOTED TYPICAL SECTION & DATE: TYPICAL SECTION LOCATION MAP 2-19-14 790 OAK STREET SCALE: H: 1 =20' CUTCHOCUE, TOWN OF SOUTHOLD V: 1 =2 SUFFOLK COUNTY, NY SHEET: TAX MAP NO. 1000-136-1-38 2 of 2