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Home My WebLink AboutTR-8508John 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: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1st day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 CERTIFICATE OF COMPLIANCE: John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee # 1142C 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 Telephone (631) 765-1892 Fax (631) 765-6641 Date: August 5, 2015 THIS CERTIFIES that the installation of 24- 12" x 10" coirlogs on the bluff along with approximately 20 cubic yards of sandy loam fill; installation of erosion jute matting and beach grass1p antings; the revegetation of area adjacent to top of bluff with native plants; and installation of a bluestone permeable 335 sq ft. stone patio using a crushed stone base At 3400 Lighthouse Road, Southold Suffolk County Tax Map #50-2-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 22, 2014 pursuant to which Trustees Wetland Permit #8508 Dated October 22, 2014 and Coastal Erosion Permit #8508C Dated October 22, 2014, were issued and conform to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of 24- 12" x 10" coirloas on the bluff along with approximately 20 cubic yards of sandy loam fill; installation of erosion jute matting and beach grassplantings; the revegetation of area adjacent to top of bluff with native plants; and installation of a bluestone permeable 335 sq ft. stone patio using a crushed stone base The certificate is issued to BRIGITTE MIZRAHI owner of the aforesaid property. Authorized Signature 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 Rd. P.O. Box 1 179 Southold, NY 11971 Telephone (63 1) 765-1892 Fax (63 I) 765-664 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE -CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1St day of construction '/ constructed 7 Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8508 & 8508C DATE: OCTOBER 22, 2014 ISSUED TO: BRIGITTE MIZRAHI PROPERTY ADDRESS: 3400 LIGHTHOUSE ROAD, SOUTHOLD SCTM# 50-2-2 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 1 I 1 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 October 22, 2014, and in consideration of application fee in the sum of $500.00 paid by Brigitte Mizrahi 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 install 24 - 12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base; and as depicted on the site plan prepared by Creative Environmental Design, last dated August 26, 2014, and stamped approved on October 22, 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 Burd as of this date. 0 TERMS AND CONDITIONS The Permittee, Brigitte Mizrahi residing at 3400 Lighthouse Road Southold, 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. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT #8508C Applicant/Agent: Creative Environmental Design Permittee: Brigitte Mizrahi SCTM#: 50-2-2 Project Location: 3400 Lighthouse Road, Southold Date of Resolution/Issuance: October 22, 2014 Date of Expiration: October 22, 2016 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: To install 24 -12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base; and as depicted on the site plan prepared by Creative Environmental Design, last dated August 26, 2014, and stamped approved on October 22, 2014. INSPECTIONS: Final Inspection SPECIAL CONDITIONS: (apply if marked) In accordance with Chapter 111-15 Erosion Protection Structures: N/A A maintenance agreement is attached hereto and is a necessary special condition of this permit. f John M. Bredemeyer III, President Board of Trustees 0 q soyoTown l Hall Annex ,`4 0 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 0 �Q Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT #8508C Applicant/Agent: Creative Environmental Design Permittee: Brigitte Mizrahi SCTM#: 50-2-2 Project Location: 3400 Lighthouse Road, Southold Date of Resolution/Issuance: October 22, 2014 Date of Expiration: October 22, 2016 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: To install 24 -12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base; and as depicted on the site plan prepared by Creative Environmental Design, last dated August 26, 2014, and stamped approved on October 22, 2014. INSPECTIONS: Final Inspection SPECIAL CONDITIONS: (apply if marked) In accordance with Chapter 111-15 Erosion Protection Structures: N/A A maintenance agreement is attached hereto and is a necessary special condition of this permit. f John M. Bredemeyer III, President Board of Trustees John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee October 22, 2014 pF SO!/j�o� � O ��O • �QI y�0UN1Y,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. David Cichanowicz Creative Environmental Design P.O. Box 160 Peconic, NY 11958 RE: BRIGITTE MIZRAHI 3400 LIGHTHOUSE ROAD, SOUTHOLD SCTM# 50-2-2 Dear Mr. Cichanowicz: • 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, October 22, 2014 regarding the above matter: WHEREAS, Creative Environmental Design on behalf of BRIGITTE MIZRAHI 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, and Chapter 111 of the Southold Town Code, Coastal Erosion Hazard Areas, application dated September 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 issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 22, 2014, at which time all interested persons were given an opportunity to be heard, and, 0 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 and Chapter 111 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of BRIGITTE MIZRAHI to install 24 - 12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base; and as depicted on the site plan prepared by Creative Environmental Design, last dated August 26, 2014, and stamped approved on October 22, 2014. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, John M. Bredemeyer III President, Board of Trustees JMB/amn • John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Creative Environmental Design for Brigitte Mizrahi �_ I Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Please be advised that your application dated 9/22/14 has been reviewed by this Board at the regular meeting of 10/22/14 and your application has been approved pending the completion of the following items checked off below. XX Proof of Mailing of Notice with Attached Certified Mail Receipts & Affidavit of Posting Pre -Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) '/2 Constructed ($50.00) XX Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50.00 BY: John M. Bredemeyer III, President Board of Trustees wry_ �v � �.♦ ,.;�.,- s -31 Y Ai�tile , 9 1 10/15/2014 17:01 t' , , lmk - kk ( �i °/15% 014 Pon q. t' , , lmk - kk ( �i °/15% 014 Pon t' , , lmk - kk ( �i °/15% 014 a POP « tiff . _ s v t, z, .03 M • John Bredemeyer, President gUFf01r Michael J. Domino, Vice-President°°�° cOGy� James F. King Charles J. Sanders • Dave Bergen 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: z ) If-,/ `t 5,4 Creative Environmental Design on behalf of BRIGITTE MIZRAHI requests a Wetland Permit and a Coastal Erosion Permit to install 24 - 12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base. Located: 3400 Lighthouse Road, Southold. SCTM# 50-2-2 Te of area to be impacted: Y Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Type of Application: Wetland Coastal Erosion Administrative Emergency Pre -Submission Notice of Hearing card posted on property: Yes Storm Water Management Review: Yes No Info needed: Chapt.111 other Amendment Violation No Not Applicable Not Applicable Modifications: ��; �✓ y Conditions: Present Were: 4"Bredemeyer /**M. Domino . Kingzc. Sanders - D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: Poi; ,f •R ! r." r r r n X j�.t (t Jai ti. `^.JDA s�� •1 . �,�`�.Y(�" ''y r; • .J `, � J why �_-y - �t .�� • h 1 .'l` -01 w ,,,,fi�gg .�►-'�. . I �` ' T Imo' M• r�j_� - - - . i mss,-.�,► -� r ;; j'- ": OCT -92014 SU n .j v .n • V1oV-+V1 I - -- � I ��" r� COUNTY SUFFOLK E "'_'^ "'" iz .. Real Property T Tax Sernce cy E Agen m...�..me.e E .. .. �... ...... w.. .....a wmou. w.n.........o. a.... .iii:' xo a we s o. tWTIgID SECTxN 0 6 SU(/r�Ol OFFICE LOCATION: O�\N'QF MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) N � Telephone: 631 765-1938 Southold, NY 11971 �p� ,�yCoUNTY,�' 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: October 15, 2014 Re: Proposed Wetland Permit for BRIGITTE MIZRAHI SCTM# 1000-50-2-2 �� II OCT 1 F %014 ' Creative Environmental Design on behalf of BRIGITTE MIZRAHI requests a Wetland Permit and a Coastal Erosion Permit to install 24 - 12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base. Located: 3400 Lighthouse Road, Southold. SCTM# 50-2-2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed actions are CONSISTENT with the Policy Standards and therefore are CONSISTENT with the LWRP provided that: 1. It is recommended that the top of bluff line be verified. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney Peter Young, Chairman Lauren Standish, Secretary • 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., October 15, 2014 the following recommendation was made: Moved by Peter Meeker, seconded by Jack McGreevy, it was RESOLVED to NOT SUPPORT the application of BRIGITTE MIZRAHI to restore the eroded bluff, install Coirlogs, approx.. 20 cy. sandy loam fill, erosion jute and planted with beach grass. Re -vegetate area adjacent to top of bluff with native plants. Install a permeable stone patio installed with crushed stone base and natural bluestone surface. Located: 3400 Lighthouse Rd., Southold. SCTM#50-2-2 Inspected by: Peter Meeker, Jack McGreevy, Keith McCamy The CAC does Not Support the application and recommends the requirement of an engineered site plan signed -off by a licensed environmental consultant. The CAC questions the stability of the Coirlogs to resist possible slumping of the steep slope. Vote of Council: Ayes: All Motion Carried John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee OF SO!/r�0� y�4UNT`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only y/ oastal Erosion Permit Application Wetland Permit Application Administrative Permit _Amendment/Transfer/Exten on �jeceived Application: /Received Fee:$ .5 D, D —.16ompleted Application _Incomplete _SEQRA Classification: Type 1 Type II Unlisted Coordination:(date sent) WRP Consistency Asses t Form _CAC Referral Sent: 3 Date of Inspection: b S _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: ` Resolution: • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 T SEP 2 2 14 Name of Applicant` Mailing Address �1 ��_ �� C�1 L':�1 toy f� 13D5� Number:oio) `fkl - 5t 5 ( Suffolk County Tax Map Number: 1000 - L)D Property Location: vLi,0D �—<,��r� ✓\4 11111 (provide LILCO Pole #, distance to cross streets, and location) AGENT: ..t� ll�' a' �►�-�C�I.cW (LZ (If applicable) rea ive nvironmen >t PO Box 160 Address: Peconic, NY 11958 Phone: -7 '3k1 -- _?V3 rd of Trustees Applicati� x GENERAL DATA Land Area (in square feet): oZ 3 ,1 !,D Area Zoning: 0 - t4D Previous use of property. A -40 Intended use of property: A -1-4 0 Covenants and Restrictions on property? Yes �No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes i/ 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 V No If "Yes", please provide copy of decision. Will this project require demolition as per Town Code or as determined by the Building Dept.? Yes 'E/ No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior hermits: approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V No Yes If yes, provide explanation: Project Description (use attachments if necessary): Restoration of eroded bluff, as per design plan, install Coirlogs, approx. 20 cu.yds sandy loam fill, erosion jute and planted with beach grass. Revegetate area adjacent to top of bluff with native plants. Install a permeable stone patio as per attached plan. (see_ a-I-_�ac 6d ) Nunemaker, Amanda From: David Cichanowicz <creativeenvdesign@yahoo.com> Sent: Friday, September 26, 2014 3:31 PM To: Nunemaker, Amanda Subject: Re: Mizrahi application Amanda, We are figuring installing 24 - 12" x 10' coirlogs for Mizrahi bluff .... also the proposed patio is set at grade, installed with crushed stone base and natural bluestone surface, completely permeable.......... . I'll get pictures to you next week ... Okay? Dave C. On Friday, September 26, 2014 2:59 PM, "Nunemaker, Amanda" <Amanda.Nunemaker(a),town.southold.ny.us> wrote: Hey Jill, Can you provide me with the number and size of coirlogs that are being proposed at the Mizrahi property? Also, is the proposed patio entirely on -grade? Thanks, Amanda Nunemaker Town of Southold Board of Trustees Phone: 631-765-1892 Fax: 631-765-6641 By#d of Trustees Application* WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 7_0 Area of wetlands on lot: Percent coverage of lot: square feet Closest distance between nearest existing structure and upland edge of wetlands: ';�V feet Closest distance between nearest proposed structure and upland edge of wetlands:�_gy feet Does the project involve excavation or filling? No ✓ Yes If yes, how much material will be excavated?_cubic yards How much material will be filled? "Lp cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): BWd of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: �0--d- AAUV\44a�' Are wetlands present within 100 feet of the proposed activity? No�� Yes Does the project involve excavation or filling? No_�4 Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? 00-V (cubic yards) Manner in which material will be removed or deposited: bu 6e Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) I ` I 1�- to �� s John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 30 -YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE (We) The owners of record of property at: 3LI00 SCTM#1000- 50 -- � - �— in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30 -Year Maintenance program for a structure as described: V ' N z5)- - � as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees thatmid lack of maintenance would risk life, property or irqpDaant natural res atures o ed signs r of record 2f &C, , Not�p�t�� Notary Public, of New York No. 02MOfi1 Qualified in Suffolk County Commission Expires March 23,20-0 This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. • Instructions for Completing 0 617.20 Appendix B Short Environmental Assessment Form 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 l based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part I - Project and Sponsor Information Name of Action or Project: Project Locatio (describe, and attach a location map): 'I 14co Brief Description of Proposed Action: Restoration of eroded bluff, as per design plan, install Coirlogs, approx. 20 cu.yds sandy loam fill, erosion jute and planted with beach grass. Revegetate area adjacent to top of bluff with native plants. Install a permeable stone patio as per attached plan. Name of Applicant or Sponsor: Telephone: -7 E -Mail: LFC4z:�aZAV,,9 . V� i 0 Address: Creative Environmental Design Box 160 City/PO: PeCOn1C, NY 11958 State: Zip Code: 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: ❑ 3.a. Total acreage of the site of the proposed action? acres b. Total acreage to be physically disturbed? acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑Urban [—]Rural (non -agriculture) ❑ Industrial E] Commercial Residential (suburban) ❑Forest ❑Agriculture El Aquatic ❑Other (specify): ❑Parkland Page 1 of 4 "1 a a 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ ❑ ❑ 1B 11 ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ a 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 a ❑ 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? NO YES 1Z LL ❑ ❑ 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 ❑ I 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: A'A& NO YES E2' ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES d ❑ 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 ❑ 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: NO YE Sy ❑ ❑ 14. Id'Ofy the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: Shoreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid -successional ❑ Wetland ❑ Urban ❑ Suburban 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 Kr ❑ 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? Ea -N' 0 DYES b. Will storm water discharges be directed to established conveyance systems (run f and storm drains)? If Yes, briefly describe: NO DYES NO YES �y LILJ ❑ Page 2 o f 4 18. Does the proposed action include construction 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 ❑ to large impact impact may 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 occur ❑ regulations? 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 ❑ 3. Will the proposed action impair the character or quality of the existing community? 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applica sor name: ; L Z _ Date: C/ — 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 regulations? ❑ 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the F-1establishment 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 reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a. public / private water supplies? F1 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-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, at the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees /o —/( )— /-) Name of Lead Agency Date k (f k- President Print or Type N of Re n Able Of icer i Lead Agency Title of Responsible Officer Signatu o e le Acerin Lead AgerVy 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 1:1problems? 4 11. Will the proposed action create a hazard to environmental resources or human health? ❑ Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, at the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees /o —/( )— /-) Name of Lead Agency Date k (f k- President Print or Type N of Re n Able Of icer i Lead Agency Title of Responsible Officer Signatu o e le Acerin Lead AgerVy Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK Creative Environmental Design residing at PO Box 160 peco^ic, >•1Y 11giQ being duly sworn, deposes and says that on the l—� dayof , 20±�t, deponent mailed a. true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that sai otices were mailed at the United States Post Office at ��( j� , that said oh were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. Sworn to before me this U-01 Day of 20 Not ublic LORI M. w dftokwmaNNw Yak ,a2a,"l 0 John Bredemeyer, President Michael J. Domino, Vice -President James F. King 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 BRIGITTE MIZRAHI 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 DA YS residing at /dba .,,reatjvQ mental Desi PO Box 160 Peconic. NY 1195R being duly sworn, depose and say: That on the 13 day of � � , 201q, 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, October 22, 2014. Dated: nature Sworn to before me this a -0Y' Way of Ott' 20 14 Notary LORI M. HULSE Notary Public, Stab of New York No. 02M0810OW2 QuallfW In Suffolk County Corrlmission Exph w March 23, 20.0 NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(5) OF RECORD: BRIGITTE MIZRAHI SUBJECT OF PUBLIC HEARING: To install 24 -12" x 10' coirlogs on the bluff; add approximately 20 cubic yards sandy loam fill; install erosion jute matting and plant with beach grass; re -vegetate area adjacent to top of bluff with native plants; and install a bluestone permeable 335sq.ft. stone patio using a crushed stone base. TIME & DATE OF PUBLIC HEARING: Wednesday, October 22, 2014 — at or about 5:30P.M. If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES *TOWN OF SOUTHOLD * (631) 765-1892 0 Town of Southold Erosion, Sedimentation & Storm -Water Run-off ASSESSMENT FORM O.L -�}'IV PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A y01 STORM -WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN s61 -tact ectmon -go� Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION I ITEM # / WORK ASSESSMENT I Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within the Scope of Work for Proposed Construction) tX b. What is the Total Area of Land Clearing (S.. / Acres) and/or Ground Disturbance for the proposed construction activity? PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) Restoration of eroded bluff, as per design plan, install Coirlogs, approx. 20 cu.yds sandy loam fill, erosion jute and planted 1 Will this Project Retain All Storm -Water Run -Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all run-off created by site V/ clearing and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and — 01 --ns Controlling Surface Water Flow. the Site Plan and/or Survey describe the erosion ediment control practices that will be used to )I site erosion and storm water discharges. This nust be maintained throughout the Entire ,vection Period. with beach grass. Revegetate area adjacent to top of bluff lis Project Require any Land Filling, Grading or / ,ation where there is a change to the Natural F-1(/ with native plants. Install a permeable stone patio as per attached plan. ig a Grade Involving more than 200 cubic Yards _ rial within any Parcel? Submission of a SWPPP is required for all Construction activities involving sol disturbances of one (1) or more acres: including disturbances of less than one acre that are part of a larger common plan that will ultimately disturb one or more acres of land: including Construction activities involving sol disturbances of less than one (1) acre where the DEC has determined that a SPDES permit is required for stone water discharges. ( SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit for Storm Water Discharges from Construction activity - Permit No. GP -040-001.) 1. The SWPPP shall be prepared prior to the submittal of the NOI. The NOI shall be submitted to the Department prior to the commencement of construction activity. 2. The SWPPP shall describe the erosion and sediment control practices and where required, post -construction storm water management practices that will be used and/or constructed to reduce the pollutants in storm water discharges and to assure compliance with the terms and conditions of this permit. In addition, the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. 3. All SWPPPs that require the post -construction storm water management practice component shall be prepared by a qualified Design Professional Licensed in New York that is knowledgeable in the principles and practices of Storm Water Management. SPATE OF NEW YORK, COUNTY OF ........................................... SS is 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 F / or within One Hundred (100') feet of a Wetland or L Beach? 7 Will there be Site preparation on Existing Grade Slopes � / which Exceed Fifteen (15) feet of Vertical Rise to v/ One Hundred (100') of Horizontal Distance? 8 Will Driveways, Parking Areas or other Impervious a Surfaces be Sloped to Direct Storm -Water Run -Off into and/or in the direction of a Town right-of-way? — 9 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right -of -Way or Road Shoulder Area? (This Item will NOT include the Installation of Driveway Aprons.) NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in a Box and the construction site disturbance is between 5,000 S.F. & 1 Acre in area, a Storrs -Water, Grading, Drainage & Erosion Control Plan is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark (4) and/or Answer for each Question is Required for a Complete Application) That I................................................................................. being duly sworn, deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) Andthat he/she is the.................................................................................................................................................................... (Owner, Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to 1beff o e me this; ................ 4....................*daof tC....------.. , 244 NotaryPublic:..... . ................................................... HULSErk ry FORM - 06!108109a02 Irqy OWM of NW 0 QuaUNed in Suffolk County Commission Explm March 23,20_0 . . ....... .... .............. ...... (Signature of Applicant) • • Board of Trustees Application County ofd State of -N r& VZ5- — I�) r1a i tt e 'UlZraV1l __..._BEING DULY SWORN DEPOSES ND 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 HISAIER 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 PROPERTYTO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. A117 , gnature SWORN TO BEFORE ME THIS DAY OF ,20 (Ll Notary Public Maysoon Awwad Notary Public ' New Jersey My Commission Expires 1.31.17 No. 2413624 • • Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) residing atS__ (print d1ner of property) (nailing addres do hereby authorize David Cichanowicz, Pres. (Agent) Creative Environmental Design to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's sra e) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Rmhibits conflicts of interest on the part of town officers and =12193M The pure this form is to provide inforination which can alert the town of nosalble conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME:` + tibia �• ? f` /�t1 1 (Lwitfiame, first name, ipiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate. the. other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "Other, name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 51/6 of the shares. YES NO If You answered "YES", complete the balance of this form and date and sign where indicated. 'Name of person employed by the Town of Southold Titic or position of that person Describe the relationship between yourself (the applieantlagent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space pr0ided. 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 o _ z - 2691 ' Signature Print Name ; t; Form TS 1 l 0 • APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and emnlovees. The nuroose of this form is to provide information which canalert the town of Rgssibie conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: �G-V L L\ Lj 5 `Z (Last name, first name, zpiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate. the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity.) _ Building Trustee Coastal Erosion Mooring Planning Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship .with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO _� If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non -corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submi. d this of 20 q Signature Print Nam Form TS 1 Town of Southold A. INSTRUCTIONS LWRP CONSISTENCY ASSESSMENT FORM 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form. should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated- as to its si iii ficant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained_ in detail, listing both supporting and non - supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at 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. D �, ` ` �I B. DESCRIPTION OF SITE AND PROPOSED ACTIONf1i )� SEP 2 2 ?n14 SCTM# PROJECT NAME , V "-!R i ��-L' - M, �� ►__ _ .__ . The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ElBoard of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Restoration of eroded bluff, as per design plan, install Coirlogs, approx. 20 cu.yds sandy loam fill, erosion jute and planted with beach grass. Revegetate area adjacent to top of bluff with native plants. Install a permeable stone patio as per attached plan. 0 0 0 Location of action: 3gOO P-'rett--1 IQ Site acreage: < < Z4 W --S a2), U-10 5q Present land use: Present zoning classification: (4, - W 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: )oa 2 -A -& V' (b) Mailing address: (c) Telephone number: Area Code ( ) '7 -114 -`?'1'a ) (d) Application number, if any: Creative Environmental Design Peconic, NY 11958 Will the action be ' ectly undertaken, require funding, or approval by a state or federal agency? Yes ElNoIf yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criter' . Yes ❑ No ❑ Not Applicable C�a, yE__ 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 U Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP S tion III — Policies Pages 6 through 7 for evaluation criteria Yes ❑ 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 LWRP Sectio III — Policies Pages 8 through 16 for evaluation criteria 9 Yes ❑ No ❑ Not Applicable V"44% —V y\ Wl `✓1:IIVI 'L� (C�jio�\ Attach additional sheets if necessary Policy 5.. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III — Polic' s Pages 16 through 21 for evaluation criteria Yes ❑ No ❑ 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 throu 32 for evaluation criteria. r ❑ ❑ Yes No Not Apl able 0 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 ❑ Noof Applicable Attach additional sheets if necessary Policy 8. Minimize a ironmental degradation in Town of Southold from solid waste and hazardous substances and waste . See LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. El YesO No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIEO 0 Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses in suitabl ocations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estua 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 foreval tion criteria. F-1YesF1No 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 Q Not Applicable PREPARED BY -7-') "`, L Li &,& 9 t-" TITLE ��'QS►�u� �`C�� DATE 401q SOUND " jSy" D 86.83* j,ONG N 82'52'5_0~ E ; V.9 COASTAL EROSION HAZARD LINE FROM COASTAL EROSION HAZARD AREA MAP PHOTO NO. 56-570-83 Averc..��- �l'cc.cae �.rov!}�C- f/S�'• = el. :.v`�"5 ANY AL TERATIDN DR ADDITIDN TD THIS SURVEY IS A VIDLATIDN \ DF SECTION 7209 DF THE NE.✓ YDRK STATE EDUCATION LAW. EXCEPT AS PER SECTIDN 7209 -SUBDIVISION 2, ALL CERTIFICATIDNS HEREON ARE VALID FDR THIS MAP AND COPIES THEREDF ONLY IF SAID MAP DR CDPIES BEAR THE IMPRESSED SEAL DF THE SURVEYDR WHDSE SIGNATURE APPEARS HEREDN, SCDHS. Ref. # RIO -00-0274 0 CvQo� ar . 1 C•P N/OIF KA THARINE BICKNELL S. 83'47'00' 50.00 AREA = 229283 SO. FT. To Tie Line Fln. Gmde IE c.q.s 900 gal. Septic Tank SURVEY OF PROPERTY A T SO UTHOLD TOWN OF SO UTHOLD SUFFOLK COUNTY, NEW YORK Removo sA lis I - Materfal, Add 3' collar sd:. of Sand & Gravel sl and a i g►ovN .Septic System 30 (DWELLING' WELL 150'+ Crossection 1000-50-02-02 SCALE: 1 "=40' OCT. 17, 2000 NOV. 8, 2000 ( revision J NOV. 27, 2000 ( revlslon 1 DEC. A 2000 ( prop. hw. 1 DEC. 27, 2000 ( prop. rel. waN d oreh ) FEB. A 2001 ( parBol logo ) APRL 13, 2001 (sepllc revision 1 Aloy 7, 200/ (revision) June 12, 200/ (revisions) JUL Y 20, 2001 ( prop. hse. ) OCT. 14, 2001 ( prop. hse. ) OCT. 22, 2001 ( average grade ) a MARCH 6, 2002 (foundation) OCT. 28, 2002 ( final ) May 28, 2003 (addlfions) Oct. 22, 2014 (revisions) ADJACENT DWELLINGS AND TOP OF BLUFF FROM SURVEYS OF SAID PROPERTIF_S BY 0 THERS TEST HOLE DATA IIBrown sandy, loan OL 0.5' 2' Brown loony sand SM FQ; 0 T z �. IC ) „ Southold own CERTIFIED TO, BRIGITTE A41ZRAHI Brown Clayey sand with v.. gravel in layers -C% ��`VV �� ✓ r i Water in brown c aye sand .qnd sandy ,'lay with heavy A -y; I ytir�g' SC.'B,c4;J Y.S. LIC, ND. 49618 YDRS, P.C. 61' (631) r02]0 FAX:(631) 765-1797 Water in brown fine P D. BDX 909 to Coarse sand SW 67' 1230 TRAVELER STREET n h SDUTHDLD, N• K 11971 (/ ( / —,P 7 LONG 15LAN[) N rax MAP # 10 I FT) Uj UJ06,�v 0.ay s = m Q 00 Uj UJ06,�v CL Z CL Q �. m Q Q