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HomeMy WebLinkAboutTR-8491John M. Bredemeyer III, President AN®,J,._. �® Michael J. Domino Vice -President i vx James F. King, Trustee Dave Bergen, Trustee�� Charles J. Sanders, Trustee l'�couffm� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 CERTIFICATE OF COMPLIANCE # 1121C Telephone (631) 765-1892 Fax (631) 765-6641 Date: June 2, 2015 THIS CERTIFIES that the removal of timber ramp and float; construction of additional 4' wide by 30' long pier extension onto existing 4'x39' fixed pier for an overall length of 69'; installation of new 3'x16' aluminum ramp; new 6'x20' floating dock with (2) 8" diameter piles; installation of thru-flow decking over wetlands area on existing and proposed dock At 3005 Wells Road, Peconic, New York Suffolk County Tax Map # 86-2-4 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 22, 2014 pursuant to which Trustees Wetland Permit #8491 Dated August 20, 2014, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of timber ramp and float; construction of additional 4' wide by 30' long pier _extension onto existing 4'x39' fixed pier for an overall length of 69'; installation of new 3'x16' aluminum ramp; new 6'x20' floating dock with (2) 8" diameter piles; installation of thru-flow decking over wetlands area on existing and proposed dock. The certificate is issued to JONATHAN ZAVIN owner of the aforesaid property. Authorized Signature John M. Bredemeyer III, President Michael J Domino, Vice -President James F. King Dave Bergen Charles J. Sanders BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 1-0 1r Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1St day of construction % constructed 4 Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: aim Town Hall, 53095 Main Rd. P O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax(631)765-6641 7-0_ P -d /d�pP Regulatory Branch • DEPARTMENT OF THE ARMY NEW YORK DISTRICT, CORPS OF ENGINEERS JACOB K. JAVITS FEDERAL BUILDING 26 FEDERAL PLAZA NEW YORK, NEW YORK 10278-0090 SUBJECT: Permit Application Number NAN-2014-00938-EYR by Jonathan Zavin i..-.1 c SEP 1 0 2r;4 il�lut� ivtiYfl���-I The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Jonathan Zavin 250 West 90th Street, Apt. 15K New York, NY 10024 ACTIVITY: Remove existing float, ramp, piles, and pier decking and extend the existing 39 -foot long by 4 -foot wide fixed timber pier by 30 -linear feet. Install one 16 -foot long by 3 -foot wide aluminum ramp and one 20 -foot long by 6 -foot wide float secured by two 8 -inch diameter piles. The total length of the proposed fixed and floating structure will extend approximately 98 -linear feet from the Mean High Water Line into Richmond Creek. Under the authority of the Department of the Army Nationwide General Permit Number 3, perform maintenance activities consisting of replacement of approximately 22 -linear feet of board - style pier decking with open grate -style decking; and replacement in-kind of approximately 47 -linear feet of board -style pier decking. The purpose of this project is to allow access to deeper water at low tide in Richmond Creek and Little Peconic Bay for recreational boating and dockage. WATERWAY: Richmond Creek of Little Peconic Bay LOCATION: 3005 Wells Road, Town of Southold, Suffolk County, NY As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. ***PLEASE USE THE ABOVE 18 -CHARACTER FILE NUMBER ON ALL CORRESPONDENCE WITH THIS OFFICE*** SUBJECT: Permit Application Number NAN-2014-00938-EYR by Jonathan Zavin Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c)(3)(A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. In order for us to better serve you, please complete our Customer Service Survey located at http://www.nan.usace.army.miI/Missions/Regulatory/CustomerSurvey aspx. To allow for the timely processing of the subject application, your comments are requested within 20 days of the date of this letter. If you have any questions, please contact Robert Youhas, of my staff, at (917) 790-8715. Sincerely, Stephan A. Ryba Chief, Eastern Section Enclosures AIA&I-001Y-00f-T9-6�yz as WATER DEPTH IN INCHES REFERENCED TO MLW AS MEASURED BY JEFFREY PATANJO 7-4-14 NOTES: 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM 2. LOT AREA: 23,540.35 S.F. / 0.540 ACRES 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: GREEN BY DESIGN, PLLC 6 STRATHMORE DRIVE NORTH BABYLON, NY SURVEY LATEST DATED JANUARY 19, 2013 r xn 2875 WELLS ROAD & VICTORIA D. CORDON 117 HUNTMIGTON ROAD PORT WASHINGTON, MY 11050 2p3'i, 0-0 .01owl LISTING AIXIA f DOCK o �y� ••\ �0 / 226,p0 dOo .100 C oov O„ r% 2O' LONG X 8' WIDE FLOATING DOCK PILES 1II�OGEO RAMP % 3 WIDE ROPOSED 30' t' WIDE FlKfD ATED PMR EKIENSION AIPPORTED iMTH 6'XB CCA 0 8 O.�iYPICAL BO�H SIDES) E1ISTING FLOAT, RAMP & PILES o� PROPERTY OWNER: JONATHAN ZAVIN 000 P IfWltiRa 250 WEST 90TH STREET APT 15K /4.68'60 619v NEW YORK, NY 10024 5 S PEM, NY 11958 WELLS PREPARED BY: JEFFREY PATANJO 106 HEWITT BOULEVARD CENTER MORICHES, NY 11934 631-484-9332 ADJACENT DOCK PIGPONd DWF R AW PSIM itATE: � PROPwED PUN 7-9-14 3005 WELLS ROAD PECONIC, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY 1l/S YIP mn owla. AIR�OLMI • 10 s 6 4 2 0 -2 -4 /1/kN --- Zoe y -0 ogs8-EY�e d� �E i fie -s—,M N.T.S. 89' OVERALL PIER LENGTH/1,747 OPOSED FD(f�PIER EXTENSION WIDE X 30' LONG 39' PROPOSED 6`x6' CCA POSTS ( W.) TYPICAL SECTION cr.a F: H: 1"=20' V: 1'=2' ® WATER DEPTH IN INCHES REFERENCED TO MLW AS MEASURED BY JEFFREY PATANJO 7-4-14 PROPERTY OWNER: JONATHAN ZAVIN 250 WEST 90TH STREET APT 15K NEW YORK, NY 10024 PR J PALO 106 HEWITT BOULEVARD CENTER MORICHES, NY 11934 631-484-9332 hop and fth and Aerma CALE: AS NOTED "MAIL SJW.Var & wwloiv ap 7-8'14 3005 WELLS ROAD PECONIC, TOWN OF SOUrROLD SUFFOLK COUNTY, NY 2OF2 s Ll • John M_ Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • Town Hall, 53095 Main RA P.O. Box 1179 Southold, NY 11971 Telephone (63 1) 765-1892 Fax (631) 765-6641 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 13E CONSIDERED A VIOLATION AND POSSI CATION OF I HE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1St day of construction %constructed 7Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8491. DATE: AUGUST 20, 2014 ISSUED TO: JONATHAN ZAVIN PROPERTY ADDRESS: 3005 WELLS ROAD, PECONIC SCTM# 86-2-4 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 August 20, 2014, and in consideration of application fee in the sum of $250.00 paid by Bernadette M. Hogan & Jonathan Zavin and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to remove existing timber ramp and float; construct an additional 4' wide by 30' long pier extension onto existing 4'x39' fixed pier for an overall length of 69'; install a new 3'x16' aluminum ramp; install a new 6'x20' floating dock with two (2) 8" diameter piles; and install thru-flow decking over wetlands area on existing and proposed dock; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated July 30, 2014, and stamped approved on August 20, 2014. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. 0 TERMS AND CONDITIONS C� The Permittee, Jonathan Zavin, residing at 3005 Wells Road Peconic New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 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. 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. 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. 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. • John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee August 20, 2014 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: JONATHAN ZAVIN 3005 WELLS ROAD, PECONIC SCTM# 86-2-4 Dear Mr. Patanjo: • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 20, 2014 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of a JONATHAN ZAVIN 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 July 22, 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 & 9.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition . of the following Best Management Practice requirements: the proposed dock will not extend past existing adjacent docks; and existing dock on property has been previously permitted under Wetland Permit #8148; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 20, 2014, at which time all interested persons were given an opportunity to be heard, and, 0 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 JONATHAN ZAVIN to remove existing timber ramp and float; construct an additional 4' wide by 30' long pier extension onto existing 4'x39' fixed pier for an overall length of 69'; install a new 3'x16' aluminum ramp; install a new 6'x20' floating dock with two (2) 8" diameter piles; and install thru-flow decking over wetlands area on existing and proposed dock; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated July 30, 2014, and stamped approved on August 20, 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: $461.00 Very truly yours, d#4- *f% C ao-t _=-_ John M. Bredemeyer III President, Board of Trustees JMB/amn • John M. Bredemeyer Ill, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen TO: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 l) 765-6641 V 1' J Please be advised that your application dated has been reviewed by this Board at the regular meeting of Zb and your application has been approved pending the completion of the ibilowing items checked off below. Revised Plans for proposed project Pre -Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ' ($50.00) Y2 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: �flaI -15n5pec460 -dee- 656.6Z) bb Dock -fie ea-�w��I� CZE '� �>= If 2SQ,44- Xtgzbl�*`4` ?3�' -rt ba -V C2_5sQ 44. x 3,bDl TOTAL FEES DUE: $ W01. 60 BY: John M. Bredemeyer III, President Board of Trustees II&4P )onathan Zavin C, COOS Wells Road, Peconic XTIVItt 86-2-4 7'0 0 PT 777 7 f..' Pf fi n John Bredemeyer, President FOL4re Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave BergenO1 Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: a-t­-4� Jeffrey Patanjo on behalf of JONATHAN ZAVIN requests a Wetland Permit to remove existing timber ramp and float; construct an additional 4' wide by 30' long pier extension onto existing 4'x39' fixed pier for an overall length of 69'; install a new 3'x16' aluminum ramp; install a new 6'x20' floating dock with two (2) 8" diameter piles; and install thru- flow decking over wetlands area on existing and proposed dock. Located: 3005 Wells Road, Peconic. SCTM# 86-2-4 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Y Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property: /Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: r �'X-G / cf0 Modifications: Present Were: J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Form filled out in the field by Mailed/Faxed to: Date: L-1 �/" Other l Photo 1 JUL 2 2014 i - Mill ,lJ 1 A i .f��. '�" '� : t � �Yr __ . `�. ',�"` r -, a July 20, 2014 NYS Dept. of Environmental Conservation SUNY @ Stony Brook 50 Circle Road Stony Brook, New York 11790-2356 Attention: Duty Analyst RE: 3005 WELLS ROAD, PECONIC, NY SUM No. 1000-086-02-W4 APPLICATION FOR PERMIT 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. Very trul yours, effrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 cc: Army Corps of Engineers NYSDOS Town of Southold Jonathan Zavin 9 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 separately apply for and obtain separate Permits/ Determinations from State each involved agency prior to proceeding with work. Please read all instructions. .D US Army Corps of Engineers (USACE) APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart - State Td►no�fih it n I OLV r A ❑ Operator ❑ Lessee General Services ment of Check all permits that apply: ❑ Stream Disturbance ❑ Coastal Erosion Check all permits that apply: ❑ Section 404 Clean Water Act Check all permits that Check ❑ Excavation and Fill in Management ❑ Section 10 Rivers and Harbors apply: ❑ State Owned Lands lithis applies: �oastal Navigable Waters ❑ Wild, Scenic and Act Under Water Consistency L7 Docks, Moorings or Recreational Rivers [Nationwide Permit(s) - IdentifyConcurrence ❑ Utility Platforms 13 Water Withdrawal Number(s): Easement ❑ Dams and Impoundment ❑ Long Island Well (pipelines, Structures ❑ Aquatic Vegetation Control 3 conduits, ❑ 401 Water Quality ❑ Aquatic Insect Controlcables, etc.) ❑. Docks, Certification 13 Freshwater Wetlands ❑ Fish Control Preconst ion Notification - Y-/ ❑ N Moorings or ❑ Incidental Take of Endan- Tidal Wetlands Platforms gered/Threatened Species 0-I �,/� ,.,/ E I am sending this application ❑ I am sending this to this am sending this application CJI am sending this application to this agency. to this agency. application agency. to this agency. 5. Name of Applicant (use full name) Appllc�t must be: Post Office City !1 Owner Td►no�fih it n I OLV r A ❑ Operator ❑ Lessee Mailing Address Post Office City State Zip Code (check all that apply) 2 o wtsr 4o+A ST Aft IS IL 3oo6- wGl�s (�m..62 Post Office City Taxpayer ID (If applicant /Vcki Ye Alf- is NOT an Individual): State N 4 zip code 10019 Telephone (daytime) Email 91-7- $3y• 13.061 1 J'>AwAQ Loab.C..n 7. Contact/Agent Name -T FFA sts Pa.tG n 10 Company Nam Mailing Address / D (a Ne.✓1-rr Post Office City Ce.,+er AAort cAC-S State Zip Code Ny 1143 y Telephone (daytime) Email 6. Name of Facility or Property Owner (if different than Applicant) Mailing Address Post Office City State Zip Code Telephone (daytime) Email B. Project / Facility Name Property Tax Map Section / Block / Lot Number n 3 OOS u^r ll,s it 0^A IV* D — PS(P-02 -Op 1 Project Location - Provide directions and distances to roads, bridges and bodies of waters: s.tc C.o4re., ,✓1wP . Street Address, If applicable Post Office City State Zip Code NY 3oo6- wGl�s (�m..62 Pecc, nIC- 819Sg Town / Village / City County SOL. Tb.IQ S.Ar- Lit - Name of USGS Quadrangle Map Stream/Water Body Name $o,-nh. i it P—i c ien oe r2 C feeK- Location Coordinates: Enter NYTMs In kilometers, OR Latitude/Longitude NYfM-E NYTM-N Latitude Longitude Y!'oa•, ib ' 'I, d1s .gds' 30INT APPLICATION FORM 02/13 This is a 2 Page Application Application Form Page 1 of 2 Both Pages Must be Completed &NT APPLICATION FORM - PAGE 2 OF 2 • it this completed page as part of your Application. 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 PASES, lit t/Yt-Pve Ott bTtAo7 toi&w rt e. eat -,m P , pe is S *n4 P�Jire Sii v' re tcJc/aj o %F •� GJ►lstavi Fi X. ,%L Prt/t .J-x-tindl fitx fv � I— r- al %. 3t N/tct pl•iwtriv✓qct rKme .enJL LrXiG F�o.?,.v' A/l wr.LK. beiy Pe4o " .i2 f'i s4+-t.r� K �.Qi�c-h•st( wa�`/ cle�'r'y low Z•G . ,peeK4,v7 s.✓ Pt,Q BvL,L vVc r� t�1a2S W / � bL Tit /•+ - F%w Proposed Use: Private ❑Public ❑Commercial rroposea csornatn Prou / p Start Date: I `� _ _ Completion Date: Has Work Begun on Project? ❑ Yes ©No If Yes, explain. Will Project Occupy Federal, State or Municipal Land? ❑ Yes LM No If Yes, please specify. 10. List Previous Permit / Application Numbers (if any) and Dates: I- Ih 11. Will this project require additional Federal, State, or Local Permits Including zoning changes? Yes ❑ No If yes, please list: Ar *%.i t -cps '''"1iDgPS1 -rvwnP .•k li..+40iae-rruAte Lo' 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, - 2conceal vers up a material fad; or knowingly makes or uses a false, fictitious or fraudulent statement. 7T0 4 A -r J, .,'i✓ Z A-t✓/yy car e-/L— in f App ca Printed Name Title Date In,64re of Owner 1, 1 Printed Name Title Date New York State W W Department of Environmental Conservation AL lebw MW 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): 9005' w t l I S A- •cck, nC aoa•. «- 4 A..; y i t o -S By signing this form, I affirm under penalty of perjury that I 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 misdemeanor pursuant to Section 210.45 of the Penal Law.* 7o�Rrt tt�N Z �- ✓ � i✓ — �� Z ' � t Print Name and Title Si ture 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 Instructions for Comaletine 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: I� 3vu S we -IIS �•acQ , neo✓CL Project Location (describe, and attach a location map): Ste- N-,cP Brief Description of Proposed Action: Rei►' e- .e`WS.lcn7 (2.h P wr n oL P t A- I& Wt'!'CiwtGt� , l NS Z• l ( 16 L•✓� it $ r-✓ts�c .4(��!!/c.u.K /Qtr�f /� Name of Applicant or Sponsor: Telephone: q, .7 .3 a.y—r49 n' rrl 4,V1 AVc yl E -Mail: J -.T4 tot n e Pe b .4o✓" Address: west 10d s?. ,4.PT 15-9- City/PO: State: Zip Code. N e w %(o/- k- iv'( I've, 2y 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: 1-%4 S41:G /*4At.7 C*ZpS I %JyLO'PS 1 -r. .4 s� So✓ -i Ltold2 ! (u['t'tGl 3.a. Total acreage of the site of the proposed action? v S acres b. Total acreage to be physically disturbed?y acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? c - S Y acres 4. Check all land uses that occur on, adjoining and near the proposed action. � &Kesidential ❑ Urban ❑ Rural (non -agriculture) ❑ Industrial [_-]Commercial (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 r-7 r1 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO ❑ YES N/A ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? O ES t_J 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO YES ❑ 8. a. Will the proposed action result in a substantial increase in traffic above present levels? b. Are public transportation service(s) available at or near the site of the proposed action? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? a ❑ ❑ 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: NO YES ❑ 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES 2 ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES ✓❑� ❑ 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES EJ ❑ 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain wetlands or other waterbodies regulated by a federal, state or local agency? b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: ,v AAA94U.. %l fee-< .0 rYo sF. NO YES EM0 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: 694oreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid -successional []Wetland El Urban 2'9uburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO I YES Ey 1 ❑ 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, a. Will storm water discharges flow to adjacent properties? ❑ NO []YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ❑ NO []YES NO YES ❑ a , x k G Page 2 of 4 18. Does the proposed action include construction or other activities that result in the imPoulffment of NO YES water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes, describe: Fa ❑ 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or NO YES completed) for hazardous waste? If Yes, describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: &7 #,4,- ZA Date: Signature: Part 2 - Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action?" Page 3 of 4 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 El 11regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1:1 ❑ reasonablyavailable energyconservation or renewable energyopportunities? 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 Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long -tern and cumulative impacts. RCheck this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 No, or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El El Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long -tern and cumulative impacts. RCheck this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 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 when the federal application is prepared. The Department of State will use the completed form and accompanying information in its review of the applicant's certification of consistency. A. APPLICANT (please print) 1. Name: lv - w. 4 *14 # v h 2. Address: , Ty QST '765T A�'t_ 1 tj tj 3. Telephone: Area Code( ) 'm • �3y• 1206 B. PROPOSED ACTIVITY 1. Brief description of activity: �emo�c Afflatrift +.�0 iK+e...Q 19#e#4- 3o' 1- C*& wn-re,4, a jA <&ij r �w�r►� 4•td� 6 r�r so' 2. Purpose of activity: oht'g14 r•FArelr,-T ,-,& AEI - d CZ4 4 3. Location of activity: :5.44w— -3,06,5- County JmnSCounty City, Town, or Village Street or Site Description 4. Type of federal permit/license required: *4124" C. -s -es 5. Federal application number, if known: '— 1 A 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: 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 a of an environmental impact statement? (11, 22, 25, 32, 37, 38, 41, 43) Q 11 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) Q d. Reduction of existing or potential public access to or along coastal waters? (19, 20) []� e e. Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10) 0 f. Siting of a facility essential to the exploration, development and production of energy Shelf? rr�� ❑ resources in coastal waters or on the Outer Continental (29) U g. Siting of a facility essential to the generation or transmission of energy? (27) ❑ [� h. Mining, excavation, or dredging activities, or the placement of dredged or fill material in ❑ 3 coastal waters? (15, 35) i. Discharge of toxics, hazardous substances or other pollutants into coastal waters? (8, 15, 35) ❑ j. Draining of stormwater runoff or sewer overflows into coastal waters? (33) ❑ k. Transport, storage, treatment, or disposal of solid wastes or hazardous materials? (36,39) 1. Adverse effect upon land or water uses within the State's small harbors? (4) 2. Will the proposed activity affect or be located in, on, or adjacent to any of the following: YESMO a. State designated freshwater or tidal wetland? (44) hazard 12, 17) � Q ❑ IT b. Federally designated flood and/or state designated erosion area? (11, habitat? Q 11 c. State designated significant fish and/or wildlife (7) d. State designated significant scenic resource or area? (24) Q e. State designated important agricultural lands? (26) Q f. Beach, dune or barrier island? (12) g. Major ports of Albany, Buffalo, Ogdensburg, Oswego or New York? (3) Q h. State, county, or local park? (19, 20) Q [� i. Historic resource listed on the National or State Register of Historic Places? (23) 3. Will the proposed activity require any of the following: YES/NO a. Waterfront site? (2, 21, 22) ❑ 0 b. Provision of new public services or infrastructure in undeveloped or sparsely populated sections of the coastal area? (5) 0 1 c. Construction or reconstruction of a flood or erosion control structure? (13, 14, 16) d. State water quality permit or certification? (30, 38, 40) ❑ 13 e. State air quality permit or certification? (41, 43) ❑ a 4. Will the proposed activity occur within and/or affect an area covered by a State -approved local waterfron❑ revitalization program, or State -approved regional coastal management program? (see policies in program document*) • 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 program document*. The proposed activity must be 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: 3e f- ��" �` 1b Address: Telephone: Area Code( Applicant/Agent'sSignature: / Date: 712•I 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, One Commerce Plaza -Suite 1010, 99 Washington Avenue, 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. Revised 10/04//010 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 sheet(s) 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. 1. Explain the need for, and purpose of, the proposed work. Zs �k i'i ,dZ li ,, d &t, IL 4 n tQ mGr ?w..� S.. � ate / w,%;fe elej/7 2. Provide the names and addresses of property owners adjacent to your work site (if not shown on the application form or project drawings). 5-e -e, s,-te- elwh (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 be taken 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. & 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). 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. & 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. 6isT 4Ota vSer .(- Reerew-h,a( 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. & 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 now from the dewateringtdisposal 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-eeL.S fLLoMin6wj2,r,.,s . 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. Sj►oN.N •� � loch. 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 structures) and the United States would not be held responsible for damages to the structure(s) and vessel(s) moored thereto from wakes from passing vessels. ".ecc4td? . 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 rills such as riprap, revetments, gabions, etc. 1. Indicate the total volume of fill (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 rill 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 rills 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 riled, and show on the plan and sectional views. 0 • 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. September 22, 2014 Board of Town Trustees Town of Southold Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 JONATHAN ZAVIN Partner 345 Park Avenue New York, NY 10154 Re: Permit Fees for Dock at 3005 Wells Rd., Peconic Gentlemen: Direct 212.407.4161 Main 212.407.4000 Fax 212.658.9105 jzavin@loeb.com SEP 2 5 2014 j - Enclosed is my check in the amount of $461.00 made payable to the Town of Southold for the Permit Fees due for the permit for a dock at 3005 Wells Rd., Peconic, NY, pursuant to the enclosed letter from the Board. Sincerely, nathan av' Partner Enclosure Los Angeles New York Chicago Nashville Washington, DC Beijing Hong Kong www.loeb.com A limited liability partnership including professional corporations NY1299792.1 666666-66666 • OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 • MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 20, 2014 ' aE AUG ? 0 ?014 ' Re: Local Waterfront Revitalization Program Coastal Consistency Review for JONATHAN ZAVIN SCTM# 1000-86-2-4 Jeffrey Patanjo on behalf of JONATHAN ZAVIN requests a Wetland Permit to remove existing timber ramp and float; construct an additional 4' wide by 30' long pier extension onto existing 4'x39' fixed pier for an overall length of 69'; install a new 3'x16' aluminum ramp; install a new 6'x20' floating dock with two (2) 8" diameter piles; and install thru-flow decking over wetlands area on existing and proposed dock. Located: 3005 Wells Road, Peconic. SCTM# 86-2-4 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 determination that the proposed actions are INCONSISTENT with the below listed LWRP policy and therefore are INCONSISTENT with the LWRP: The purpose of the dock extension has not been identified. 6.3 Protect and restore tidal and freshwater wetlands. 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: [1 ] Whether the dock will impair navigation or be located in areas of high vessel traffic or vessel congestion; The proposed dock extension would extend into the public waters significantly farther (30') than the existing dock. The increased draft of larger vessels and decreasing water depths do not warrant incremental extension of permanent, private, dock structures in C public water bodies. Alternatives such as a seasonal mooring in pre -established areas with low biological productivity and adequate water depth furthers the LWRP policies. Further the proposal does not meet Chapter 275 standards which state: In determining the permitted length of a proposed residential dock, the Board shall seek to maintain lengths consistent with the other docks (i.e., pier line) in the waterway. Figure 1. Current dock length. [2] Whether the dock will unduly interfere with the public use of waterways for swimming, boating, fishing, shellfishing, waterskiing and other water -dependent activities; Private dock structures extending into public waters decreases the public use of bottomlands and the nearshore area. [5] Whether the dock will cause degradation of surface water quality and natural resources; Richmond Creek is a New York State Significant Coastal Fish and Wildlife Habitat and New York State Department of Environmental Conversation Critical Environmental Area. Waterfowl species observed overwintering in the Richmond Creek area include Canada goose, American black duck, mallard, oldsquaw, bufflehead, red -breasted merganser, surf scoter, and common goldeneye. Richmond Creek is also a productive habitat for finfish, shellfish and crustaceans, including blue claw crabs, clams and scallops. The creek is one of the top two creeks for crabbing in the Town and is also important for clamming (NYSDEC). [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 Any activity that would substantially degrade the water quality of Richmond Creek would adversely affect the biological productivity of this area. All species of fish and wildlife are affected by water pollution, such as chemical contamination (including food chain effects as a result of bioaccumulation), oil spills, sedimentation, excessive turbidity, stormwater runoff, and waste disposal (including boat wastes). The alternative use of seasonal moorings in areas of low biological productivity and with adequate water depths is a better option to accommodate vessels requiring greater water depths. [12] Whether adequate facilities are available to boat owners and/or operators for fueling, discharge of waste and rubbish, electrical service and water service. 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. The dock structure will extend further into public waters resulting in a net decrease in public access to public underwater lands and the nearshore area. The dock structure is proposed as permanent. The applicant currently enjoys access to public water via an existing, private, dock structure. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed actions. Cc: Lori Hulse, Assistant Town Attorney Peter Young, Chairman Lauren Standish, Secretary 0 • Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 At the meeting of the Southold Town Conservation Advisory Council held Wed., August 13, 2014 the following recommendation was made: JONATHAN ZAVIN to remove the existing timber ramp and float. Install additional 30' on existing fixed dock, 3'X 16' wide aluminum ramp, 6'X 20' floating dock with 2-8" piles. Install thru-flow decking over wetlands on existing dock and new decking on remainder. Located: 3005 Wells Rd., Peconic. SCTM#86-2-4 The CAC did not make an inspection, therefore no recommendation was made. 1=" AUG 1 4 2014 Fit?:/:..•.s.. �...�:.-. ._... -..- -... .._....,.._ • July 31, 2014 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 3006 WELLS ROAD, PEcomes NY SCTM No. 1000.o"42,004 APPLICATION FOR PERMT REVWkM Dear Trustees: r� L V r-� AUG - 5 2014 Poached please find four (4) copies of revisedl Pans showing 2 -pile bents on requested. proposed If You should have any questions or require anything further call me at 631..484.9332 ,please do not hesitate to Very truly yours, J y Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino hOpF SOUTy� f # BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit _Amendment/Trans/Exte �qn Received Application:zaf Fee:$ J ti ompleted Application % Z 2 _Incomplete _SEQRA Classification: Type I Type H Unlisted oordination:(date sent) WRP Consistency Arse m t Form AC Referral Sent: mate of Inspection: Receipt of CAC Repo . Lead Agency Determination: technical Review: CY ✓ Public Hearing Held: Resolution: Name of Property Owner(s)_ To n a -t-h Q n -04 v a ✓t • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 E c 1 JUL 2 2 2014 Address o25'o wcs-t lip ti ST. A� /SIG , /VG..y 'l -A14, n1 t( 1 0-p a q Phone Number:( ) 911 • 31 y ! o b Suffolk County Tax Map Number: 1000 - 0 4 6 - 1- oo q Property Location: 3 0 0 S' w s l (provide LILCO Pole #, distance to cross streets, and location) AGENT: ��rcc' PK Ta nom! o (If applicable) Address: /®6 A(ew(nr �'Lvc#, i! 9 3 `1 Phone: 3! YO Y-73 3 1- and of Trustees Application • GENERAL DATA Land Area (in square feet): 2 3, s vo . 3 5 t A Area Zoning: Res Previous use of property: R c s.o! c.► -r,, t Intended use of property: Covenants and Restrictions on property? Yes v No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes ✓No If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date .t' Tr- sy.eg eiezm r r St 5 2 n 13 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? —",- No Yes If yes, provide explanation: Project Description (use attachments if necessary): )?e- o L, e -•x, sr, ^, y -lr.� 6�e,_ A ""'0 A4.A 00.,,r X.4r-11 64kti.-vp( 3o FitT e.V —�1 5r16x41A CMZ , 161 X 3� �rc�a /�(w�t uvu✓l� l i 0.Git- Wf Z " 2$ P/!cs . J,,_$ 1-. ll _r4 r✓ I[,c.14,v J rveAL k, '0+4461 S �r -•arl Stµ9 8(1 of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: am �1•�T , Z'szwu v1V1 30 4;tG-t We,* tit , 16' K a' &tJ40e- Ig Al�.�►a•K...1 t�k.�►p, G k3o' Ft.�t�.✓, �! << z - �' � iJi l<s Z.� sem•. � � �r � �� -Fl.«. ,�e c kr.v,► enc l wtile•n.It o n -Wi sz..-A ol oclL ,1nve itle..o 0tCC,41 +0% J&Mt6401GIot Area of wetlands on lot: Percent coverage of lot: g sv square feet Closest distance between nearest existing structure and upland edge of wetlands: S feet Closest distance between nearest proposed structure and upland edge of wetlands: s- feet Does the project involve excavation or filling? ✓ No Yes If yes, how much material will be excavated? :r A cubic yards How much material will be filled? 1 I cubic yards Depth of which material will be removed or deposited: N A feet Proposed slope throughout the area of operations: .� Manner in which material will be removed or deposited: A., �+- 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): 7htla w,ll be Av �,ay -�"��. CG��a't- oK wc4_, �i"Ni PlilTlf!!IQ✓4 "I� flus w.1�N T+'v F �!v— F��"`� • . 617.20 Short Environmental Assessment Form Part I - Project Idermatbn. 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 cument 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: A 300,E wilts I&apk, tco�tGr wr lt�1t'g+ Project Location (describe, and attach a location map): 544— Oko--t p Brief Description of Proposed Action: J,e,On...e .�,�sTr•«� a+.*p «.ape. Re -cat . *p, -re g6L P,,eR- So 4.> 1..-7 x 3' �..�i.le .e!—.ar.�►.�..+. Myr P pocx— Name of Applicant or Sponsor: Telephone: q� 7.3 �y • 1�m6 T n -tyt i►vi r) E -Mail: �w yr 0, L o0, b •Larry Address: 2 m a✓--st IV d 57. ApT /r 9- City/PO: City/PO: State: Zip Code: ,j e w %(aA K' AoO' / icy 2 Y 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 21 El 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 fimding from any other governmental Agency? NO YES If Yes, list agency(s) name and permit or approval: ❑ Q "%4 5 19eG I *d.� crc#0S 1 so-isoaps ! T�..�w •< t.�+h.teQ TZu,100 1 3.a. Total acreage of the site of the pressed action? o• Vq acres b. Total acreage to be physically disturbed? o acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor o •S' V acres 4. Check all land uses that occur on, adjoining and near the proposed action. residential ❑Urban ❑Rural (non-agricutt re) ❑ Industrial ❑Commercial (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(speafy): ❑Parkland Page 1 of 4 • • 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A Pi O I�r 6. Is the proposed action consistent with the predominant character of the existing built or natural lanclsa"? NO ❑ dYES 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO ❑ S. a. Will the proposed action result in a substantial increase in traffic above present levels? b. Are public transportation service(s) available at or near the site of the proposed action? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? NO YES on: ® O 9. Does the proposed action med or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: NO YES ❑ NO YES lo. Will the proposed action conned to an existing public/private water supply? If No, describe method for providing potable water. 2 ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES a ❑ 12. a. Does the site contain a stnudure that is listed on either the State or National Register of MUD& Places? b. Is the proposed action located in an archeological sensitive area? NO YES Li 1 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain wetlands or other wate bodies regulated by a federal, state or local agency? b. Would the proposed action physically cher, or encroach into, any existing wetland or waterbodyf? If Yes, identify the wetland or waterbody and extent of alteration in square fact or acres: 3o A/t J 0%%,& l &lr-< s r Z o &f. NO YES ❑ 14. I orthe typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: 6&Shoreline ❑ Forest ❑ Agriculturallgresslands ❑ Early mid -successional p''Wedand ❑urban 1216uburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO YES U ❑ 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action mate storm water discharge, either from point or non -point souroes? If Yes, a. Will storm water discharges flow to adjacent properties? O NO OYES b. Will storm water discharges be directed to established conveyance systemsnraoff and storm drains)? If Yes, briefly describe: UNO OYES NO I YES a El s " Page 2 of 4 18. Does the proposed action include eonstrucdon or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO . YES Moderate D small 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: NO YES impact impact 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES occur occur 1. Will proposed action create a material conflict with an adopted land use plan or zoning I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name• `'r r''T ttdr 2,4 Dom• �• 2 0 , l� Signature: L Part 2 - Impact Assessment. The Lead Agency b responsible for the completion of Part L 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?" Page 3 of 4 No, or Moderate small to large impact impact may may occur occur 1. Will proposed action create a material conflict with an adopted land use plan or zoning � D 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? I �.I ❑ 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? �J ❑ 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? ?. Will the proposed action impact existing: Q a public / private water supplies? b. public / private wastewater trentmerit utilities? ❑ S. 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 Part 3 - Detervhnation of significance. I%e Lead Agency is responsible for the completion of Part I For every question in Part 2 that was answered "moderate to larger impact may occur", or if thea 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 bees included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potatial for short -teams, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that t�hee� proposed action will rat result iin any significant adverse environmental impacts. a w`d Ld (1 1 d �.✓`� " � o Mrif of �� � � � nod Aamry Daft Paint or Type Name of Re46nsible Qftiq"n Lead Agency riff of Responsible Officer of Responsible Mc - r in Lead Agency signature of Prepanx (if different from Responsible Officer) PRINT page 4 of 4 • C: FORM - 06110 p " No�Iv P Nawwk C ocrnfftiaSion t W7/20Ai Town of Southold Erosion, Sedimentation & Storm -Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.CT.Xt THE FOLLOWINO ACTIONS MAY REQUIRE THE SUBMISSION OF A M-18MATER, GRADING, DRAINAGE AND EROSION CONTROL FLAN %b 10 .) 1 osp the eZ ct it-ec9"�-BTock— �£o — CERTIFIED BY A DESIGN rwFEWIDICAL in THE STATE NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORKASSESSMENT Yes No a. What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm -Water Run -Off (Include Total Area of all Parcels located within93SWG .Sg Construction) Generated by a Two (2') Inch Rainfall on Site? the Scope of Work for Proposed (This Item will include all run-off created by site ❑ b. What Is the Total Area of Land ClearingF !) clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed 12. P do ? Site Improvements and the permanent creation of construction adivityr? Impervious surfaces.) (&f. l Acres) Propo w All Sur 2 Does the Site Plan PROVIDE BRIEF PROJECT DFSCREMON lam• +P -w m d1 ion? T is Indic ting Sy e & Location? Drainage Structures Indicating Size &Location? Thls Item shall include all Proposed Grade Changes and fit +7.� .ems s r �•*9rP .t � �(.o ?– . Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion / e*-tetid F l e -l_ D' Q tgg • Cf",, I I and sediment control practices that will be used to / F-1 control site erosion and storm water discharges. This ' r r item must be maintained throughout the Entire Construction Period. ��n �or.1L • 4 Will this Project Require any Land Filling, Grading or Natural Excavation where there Is a change to the r"71 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 or within One Hundred (900') feet of a Wetland or General DEC SiNPPP litupirements: Submission of a SWPPP is required for all Construction ac Wdes involving sob Beach? disturbances of one (1) or more saes: including dishabancn of less than one We that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common pan that will re ultimately disturb one or moacres of land; which Exceed Fifteen (15) feet of Vertical Rise to ❑ including Construction scnvgies Involving sol dlshurlmnoes of less then one (1) acre where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. ( SYYPPP's Shan meet the Whimum Requirements of the SPDES Gererai Permit 8 Will Driveways, Parking Areas or other Impervious for Storms Water Discharges from Construction activity - Permit No. OP440-M-) Surfaces be Sloped to Direct Stomp -Water Run -Off ❑ I/ 1. The SWPPP shall be prepared prior to the submittal of the NOI. The NOI shag be into and/or In the direction of a Town right -of Way? submitted to the Deparbnent prior to the commencement of construction activity. The SWPPP shall describe the erosion and sediment control practices and where g Will this Project Require the Placement Of Material, required, postconsbuclion stoma water management practices that will be used and/or Removal of Vegetation and/or the Construction of any Fi ucted to reduce the pollutants in storm water discharges and to assure constructed ch Item Within the Town Right-cf:Way co Road Shoulder — compliance with the lemma and conditions of this pwmk. in addition. the SWPPP shag Area? m ft nem wWNoT include tit Msinowen al -mo err sprat.) Identify potential sources of pollution which may renewably be expected to affect the q�mY of storm water discharges. NOTE: IfAny Answer to Questions One through Nine la Answered with a Check Mark 3. AN SWPPPe that require the post -construction storm water management practice In a Box and the constmetlon site disturbance is between 5,000 Si. dh 1 Acre In area, a Ssorm-Water. Grading, Drainage & Erosion Control Plan is Required by On Town of component shall be prepared by a qua0fied Design Professional Licensed in New York that is knowledgesbls in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Perrntt (NOTE: A (*ad Mark (4) andror Answer for ssdh 4uesficn is Requited for a Complete Apq'dbn) SPATE OF NEW YORK, COUNI'X OF ........................................... SS .... v•"•• • ••.•.••••. being duly swum, deposes and says that he/she is the applicant for Permit, (Name of Individual signing Document) Andthat he/she is the .............................. ... .. .................................................................. (Owner, Contractor. Agent, Corporals Officer, ftj Owner and/or representative of the Owner or Owners, and is duly authorized to perforin or have performed the said wont 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; // ''�. v '' day of .... ............... r... , 2(x.4 NotaryPublic:.... ..... ............................................... (' naWreotApprhrant) FORM - 06110 p " No�Iv P Nawwk C ocrnfftiaSion t W7/20Ai Name: Gordon M-Cky-mar) STATE OF NEW YORK COUNTY OF SUFFOLK • PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: I V1 4u n -. ngton �oLoS L,3el t s RA. Pec on't c, 119518 C 29 30� Wei1s Pecon►c, X21 o c�-e415 l"Z�Q . conl 49s'F, a��,` �) 4, O residing at I � �C W i le), V C[ Cco N \4 1 \ 0 being duly sworn, deposes and says that on the day of 20L, deponent mailed a true copy of the Notice set forth in the Board o rustees 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 at Center rcbf j that said No • were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. ll �— Sworn to before me this g Day of,u(� 20- _ �� o Not Public Loran Patanl1'o� No�ry Public State ofn e. York �tuali led in Suffolk County No 011=xPA6150861 Commissar nli 06/07/2018 1. J John Bredemeyer, President g�►FFO( Michael J. Domino, Vice-Presidento�o xc°oy� James F. King y Dave Bergen • Charles J. Sanders BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of JONATHAN ZAVIN COUNTY OF SUFFOLK) STATE OF NEW YORK) • Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, Se -Trey iPa+rArl (U , residing at /dba 1 Q (p AC W Itt-- E5� \d . C �IQKIC* ) U 11P-34 being duly sworn, depose and say: That on the 10 day of A tAII�j' u�'-+ , 201'f I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, August 20, 2014 Dated: Sworn to before me this 10 day of AT - 2014 �6ua� IVa Notary Public Lona Patan' Notary Pubic, York Qualified�iM?/20.& No: 0 Commission 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. OWNER(S) OF RECORD: To ai" \*-n SUBJECT CSF PUBLIC HEA,RING- Remove existing timber ramp and float; construct an additional 4wide by 30long pier extension onto existing 4'x39' fixed pier for an overall length of 69'; install a new 3'x16' aluminum ramp; install a new 6'x20' floating dock with two (2) 8" diameter piles; and install thru-flow decking over wetlands area on existing and proposed dock. TIME & DATE OF PUBLIC HEARING: Weane8q, tqa PA 8 If you have an interest in this project, you are invited to view the Town file(s) which are available for ins rection�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 Bc& of Trustees Application • County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Pro ert Owner SWORN TO BEFORE ME THIS V) DAY OF �v l ,20 1T C�1(� Notary Public Loran Pate Pubec S �� Qf Yogic in S noNc County No OIPA6150861 Commission Expires 081070.6 Ad of Trustees Application . AUTHORIZATION (where the applicant is not the owner) I 7.,nt-t����•, residing at 2ry w{��T 7o y sT (print owner of property) (mailing address) Aft Is I K, „���, y..,cl�� N7oo_T/ do hereby authorize (Agent) Pa Tani to apply for permit(s) from the Southold Board of Town Trustees on my behalf. er's si APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM to avoid same. YOUR NAME: (Last name, first name, Middle initial, unless you are applying id the name of someone else or other entity, such as a company. If so, indicak 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 of 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 ✓/ lf.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 • day of 0� i "j Signature Print NA/ Form TS 1 C7 Town of Southold 0 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 malting 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 um the coastal area (which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will 'affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be Lx2hZ=ed in detail. listing both suunot`ting and nou- suneortina facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the 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# P g 10 _ o 2- _ co y PROJECT NAME 3,00S wGllS 49".'a, - C JUL 2.2 2014 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees LI Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) ❑ (b). Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: . payrf,,� -h ft brA RAMP w4aQ . 'I fiXtdL �i-A l� h 3`w.s�c /G..hrN�..� Iwrn�tP, r'i`X�-o` CJ~r"��sGk. l.+f ¢- f / hl- y•�s'il! ?4irn�,_�41-w .t tem ft A✓<r tr er1.yg RS va -io[ sjr.r� t3el4-- •tn� ,mac r.� 6i l c�Gr� i/ �c.�vnsrr n rQyt. • Location of action: 3evr wc11A-P-ta F Pt<o^,t. Site acreage: o• Syv Present land use: R -r s t 4 rs l_ Present zoning classification:_ • 2. If an application. for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: T it k rh a n 'I-- v r h (b) Mailing address: 9 50 9 0 � 5T APT 15'14. . 142 (- 0--, 4 - 0--,y 1002 (c) Telephone number: Area Code ( ) 'I / 7 . 3 3 y- /;Ob (d) Application number, if any: r t 't Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ETNo ❑ If yes, which state or federal agency?�''i s 6 /w7sDv A� �N Coo?-' C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III — Policies; Page 2 for evaluation criteria. [�fYes ❑ No ❑ Not Applicable Pole i eeA AA, b* -*f,= GtTiurt�l 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 ❑ No Lr I 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 (EfYcs ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LNW Section III — Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ 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 ElYes 0 No U Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III — Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable P/✓11G4 PliT+atS SAG wG"ri—As 4N w.t.Of I,vfT..%Il�� �w/v�r`•w 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 F -,-Kot 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. 1:1Yes ElNo 1=!s.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. DYes❑ No ❑ Not Applicable w a«ss —l-� �S•dr�7. Attach additional sheets if necessary WORIING 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. 2Yes ❑ No ❑ Not Applicable ca4 -vi It -r Ge ve-IL[ .moi . Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No U 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 2 Ivot Applicable PREPARED BY J ` %�f c �- � 7 � �► TITLE Aleel DATE -� C7 July 20, 2014 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 Re: 3005 WELLS ROAD, PECONlc, NY SUM No. 1000-086-02-004 APPLICATION FOR PERMIT Dear Trustees: • We hereby submit one (1) original and three (3) copies of the proposed plans, application and check 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 truly yours, /effirey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 JUL 2 2 2014 Son WATER DEPTH IN INCHES REFERENCED TO MLW AS MEASURED BY JEFFREY PATANJO 7-4-14 NOTES: 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM 2. LOT AREA: 23,540.35 S.F. / 0.540 ACRES 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: GREEN BY DESIGN, PLLC 6 STRATHMORE DRIVE NORTH BABYLON, NY SURVEY LATEST DATED JANUARY 19, 2013 #2875 WELLS ROAD WILLIAM & VICTORIA D. GORDON 117 -HUNTINGTON ROAD PORT WASHINGTON, NY 11050 203./ , *0 c� k EXISTING ADJACENT DOCK 50 m_ . / 9 / 225.00 / _ / o /PROPERTY OWNER: JONATHAN ZAVIN o / / 50,, 250 WEST 90TH STREET APT 15K #3065 WELLS ROAD NEW YORK, NY 10024 S 56 840 3 65 WELLS ROAD �WATSON m PECONIC, NY 11958 AUG 2014 PREPARED BY: JEFFREY PATANJO 106 HEWITT BOULEVARD Southold Town CENTER MORICHES, NY 11934 Rmrd of Tmstpps 631-484-9332 BENTS TO HAVE 2-6X6 POSTS ONLY 36" 3-6X6 POST BENT AT END OF PIER ONLY --PROPOSED 20' LONG X 6' WIDE FLOATING DOCK �W/ 2-8"0 PILES PROPOSED HINDGED RAMP �16' LONG X 3' WIDE PROPOSED 30' LONG 4' WIDE FIXED ELEVATED PIER EXTENSION SUPPORTED WITH 6"X6' CCA ® 8' O.C. (TYPICAL BOTH SIDES) REMOVE EXISTING 'FLOAT, RAMP & PILES PROPOSED OPEN—GRATE DECKNG TO BE FLOW—THRU INTERLOCKING PANELS OR EQUAL EXISTING ADJACENT DOCK 7-30-14 REVISED TO SHOW 6X6 FOR BENTS 10 8 6 4 2 0 _2 -4 •ComuryPrmLSibi so.Uda\iv\: G 1addn Drpi<. - - Timothy Colley o, N.1wly (Am}idscr�e Inca LOCATION PROJECT LOCATION MAP N.T.S. 69' OVERALL PIER LENGTHPROPOSED FIXEDPIER EXTENSION 4' WIDE X 30' LONG 39' PROPOSED R N EXCEPT ENDOF T( PIER) ':•'� 1 it �► ---, •, ---_„ I I�II��l�i1WA. HINDGED • ���-DECKING- "OPOSED • WIDE1 • ME • �. S.' hddAdti Shotr.0 IIT_ I.�I.I.�I,�I,�II1�1�1�II - Grunes acr¢n-,<. - " - - -� •. ' ,N5v4Sn,TRdVritiY ��� f f�. __ iiiiiiii�i�iili■I■� Qa. . 'southultl VdicetjeprG;�a�� IS II�I�I�II�I�I■II■I■I� �_ �I■ ■IIZ11�11�1�1■II■I■ISI APPROXI'ATE I� IVILW EL. 0.0± iil�ll�l�l■II■I■ISI GRADE "�I�!■II■I■ISI . I■ PROPOSED : • 'lea[V1rtraV._ _ pi. Wil.. _ _ 5 _�.' - �i . Timothy Colley o, N.1wly (Am}idscr�e Inca LOCATION PROJECT LOCATION MAP N.T.S. 69' OVERALL PIER LENGTHPROPOSED FIXEDPIER EXTENSION 4' WIDE X 30' LONG 39' PROPOSED R N EXCEPT ENDOF T( PIER) .TYPICAL SECTION SCALE: H: 1 "=20' V: 1 "=2' i 30WATER DEPTH IN INCHES REFERENCED TO MLW AS MEASURED BY JEFFREY PATANJO- 7-4-14 AUG - 5 2014 PROPERTY OWNER: JONATHAN ZAVIN 250 WEST 90TH STREET APT 15K NEW YORK, NY 10024 PREPARED BY: JEFFREY PATANJO 106 HEWITT BOULEVARD CENTER MORICHES, NY 11934 631-484-9332 7-30-14 REVISED TO SHOW 6X6 FOR BENTS ':•'� 1 it �► ---, •, ---_„ I I�II��l�i1WA. HINDGED • ���-DECKING- "OPOSED • WIDE1 • ME • �. IIT_ I.�I.I.�I,�I,�II1�1�1�II II■ __ iiiiiiii�i�iili■I■� �al��l■ IS II�I�I�II�I�I■II■I■I� �_ �I■ ■IIZ11�11�1�1■II■I■ISI APPROXI'ATE I� IVILW EL. 0.0± iil�ll�l�l■II■I■ISI GRADE "�I�!■II■I■ISI . I■ PROPOSED : .TYPICAL SECTION SCALE: H: 1 "=20' V: 1 "=2' i 30WATER DEPTH IN INCHES REFERENCED TO MLW AS MEASURED BY JEFFREY PATANJO- 7-4-14 AUG - 5 2014 PROPERTY OWNER: JONATHAN ZAVIN 250 WEST 90TH STREET APT 15K NEW YORK, NY 10024 PREPARED BY: JEFFREY PATANJO 106 HEWITT BOULEVARD CENTER MORICHES, NY 11934 631-484-9332 7-30-14 REVISED TO SHOW 6X6 FOR BENTS �fARNING,: THIS MAP IS COPYRIGHTED UNDER FEDERAL COPYRIGHT LAWS. THE REPRODUCTION OR .� r DISTRIBUTION OF THIS MAP IS A VIOLATION D v' '' OF THAT LAW WITHOUT THE WRITTEN PERMISSION OF THE AUTHOR. THE ISSUANCE OF THE MAP FOR CONVEYANCE tIUL, 2 2 2014 C�- PURPOSES IS NOT TO BE MISCONSTRUED AS PERMISSION TO EITHER REPRINT OR PUBLISH THIS MAP. ANY ONE WHO EITHER ;. REPRODUCES, ISSUES OR RECEIVES COPIES FROM ANYONE OTHER THAN THE PREPARER IS IN VIOLATION OF FEDERAL LAW AND WILL BE PROSECUTED. NOTE: METES AND BOUND DESCRIPTION SHOWN HEREON REFERENCES THE COORDINATE SYSTEM SHOWN IN THE DEED. CERTIFIED TO: FIRST AMERICAN TITLE INSURANCE COMPANY for#SP28718-S ITIBANK, N.A. FOR: JONATHAN ZAVIN > BERNADETTE M. HOGAN >� Unauthorized alteration or addition to this survey is a violation of Section 7209 of the New York State Education Low. Copies of this survey map not bearing the (0� Land Surveyor's Inked Seal or Embossed Seal shall not be considered to be a valid true copy. Guarantee indicated hereon shall run only to the person for whom the survey is prepared, and on"' his behalf to the Title Company, Governmental Agency and Lending Institution listed hereon, and to the Assignees of the Lending Institution. Guarantees are NOT TRANSFERABLE to additional \ institutions or subsequent owners. Record description was not furnished in the preparation of this survey. MAP OF SURVEY OF DESCRIBED PROPERTY SITUATED AT PECONIC TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK SCTM 1000-088-02-004 PROJECT NO.: 1252-13 SCALE: 1 in. = 20 ft. DATE: JAN 19, 2013 P_11\ �OFNEyyro C.I\�Qe��� >. AND :�URIEYQR .. y r fi P.L.S.: All RightsI?.S7RA1h1i4ldl�"&' "'' .. , B,�,BYL-IN; N—E-�C.YORi .1 . c was performed y .cj1ft+renzon.ne 1AV LIC. #049759-1 V 2013 Copyrigh. Reserved I hereby certify th+ by me on the date LOT AREA: 23,540.35 s.f.; 0.540 ac. - cHARLEsi