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TR-8554
0 John M. Bredemeyer lit, 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 t 179 Southold, NY 11971 Telephone (631) 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 INSIYECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1St day of construction '/ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8554 DATE: JANUARY 21, 2015 ISSUED TO: ADAM WILLETS PROPERTY ADDRESS: 4415 CAMP MINEOLA ROAD, MATTITUCK SCTM# 123-5-22 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 JangM 21, 2015, and in consideration of application fee in the sum of $250.00 paid by Adam H. Willets 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 construct new 58' long bulkhead in-place of existing using vinyl sheathing; raise the bulkhead 15" higher to match the neighbor's bulkhead; construct new 15' long vinyl return; backfill disturbed area with +/-65 cubic yards clean fill; construct new 4'x6' beach access steps (retractable or fixed); and establish and subsequently maintain a 10' wide non -turf buffer along the landward edge of the bulkhead to match ° non -turf buffer sizes of adjoining properties; and as depicted on the site'plan prepared by DKR Shores, Inc., last dated November 28, 2014 and stamped approved on January 21, 2015. IN WITNESS WHEREOF, the said Board of Trustees her causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Boar of this date. � y 11� _.1 TERMS AND CONDITIONS The Permittee Adam Willets residing at 4415 Camp Mineola Road Mattituck, 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. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That -there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks.' 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. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. 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. 11. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 0 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee January 21, 2015 Ms. Agena Rigdon DKR Shores, Inc. PO Box 488 Hampton Bays, NY 11946 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD RE: ADAM WILLETS 4415 CAMP MINEOLA ROAD, MATTITUCK SCTM# 123-5-22 Dear Ms. Rigdon: 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, January 21, 2015 regarding the above matter: WHEREAS, DKR Shores, Inc. on behalf of ADAM WILLETS 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 December 15, 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 January 21, 2015, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 0 0 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 the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approves the application of ADAM WILLETS to construct new 58' long bulkhead in-place of existing using vinyl sheathing; raise the bulkhead 15" higher to match the neighbor's bulkhead; construct new 15' long vinyl return; backfill disturbed area with +/-65 cubic yards clean fill; construct new 4'x6' beach access steps (retractable or fixed); and establish and subsequently maintain a 10' wide non -turf buffer along the landward edge of the bulkhead to match non -turf buffer sizes of adjoining properties; and as depicted on the site plan prepared by DKR Shores, Inc., last dated November 28, 2014 and stamped approved on January 21, 2015. 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, -�W_ Irv% John M. Bredemeyer III President, Board of Trustees JMB/amn 9 John M. Bredeineyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen TO: r�q��guEFQ(,� �oG � N 0 � 0�1 * to, pv 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 Please be advised that your -application dated has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion o the f (lowing items checked off below. Revised Plans for proposed project Pre -Construction Hay Bale Line Inspection Fee ($50.00) 1 st flay of Construction* ($50.00) %Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 5 6 1 D 1) BY: John M. Bredemeyer III, President Board of Trustees dam Willets 415 Mineola Road, Mattituck SCTM# 123-5-22 r Michael J..redemeyerpomino, Vi er President Gs� James F. King Charles J. Sanders s 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: tiN i y /r y° D DKR Shores, Inc. on behalf of ADAM WILLETS requests a Wetland Permit to construct new 58' long bulkhead in-place of existing using vinyl sheathing; raise the bulkhead 15" higher to match the neighbor's bulkhead; construct new 15' long vinyl return; backfill disturbed area with +/-65 cubic yards clean fill; construct new 4'x6' beach access steps; and establish a 10' wide non -turf buffer along the landward edge of the bulkhead. Located: 4415 Camp Mineola Road, Mattituck. SCTM# 123-5-22 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Distance of proposed work to edge of wetland 1-0 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 No _Bay Chapt.111 other Amendment Violation Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: AIllCr /J",vF, /e }A- / /f S ,c/,EI G r.} 00 0 i2 f Present Were: `"J. Bredemeyer /IM. Domino /J. King ,C. Sanders—D. Bergen Bay Constable Other Form filled out in the field by j Mailed/Faxed to: Date: W.11J-4rbpef 4XI M) • • r,,.� - :w� r • -.►cY► ;'tip,: _ .�,_ �, _� ... � �,., _' 1* w � '= L I[,1 G,..a.„ ------- N _ I4 II uNE \✓�y' em. �-�� ,,rtrorznntenefMrt.o[xcr. �f P PROPCRtt MAP —_ _—_— —_— �q— � O�� + cecc xa �� � •� �� � nmw m E s x E DR. t e a ::I. o " ^ J n 111 --0—" s NOTICE �, �i"� COUNTY OF SUFFOLK Service Agency G.— C.",RN.mxa.NY „90, � xzJ M �,. lWTMOtD SECTION N' 123 1L w[naox v„ M�s,1 PROPERTY! • s • OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 �pF SO�jyO� �y100UNTY,� • MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 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: January 13, 2015 Re: Proposed Wetland Permit for ADAM WILLETS SCTM# 1000-123-5-22 -1 JAN 1 3 2015 DKR Shores, Inc. on behalf of ADAM WILLETS requests a Wetland Permit to construct new 58' long bulkhead in-place of existing using vinyl sheathing; raise the bulkhead 15" higher to match the neighbor's bulkhead; construct new 15' long vinyl return; backfill disturbed area with +/-65 cubic yards clean fill; construct new 4'x6' beach access steps; and establish a 10' wide non -turf buffer along the landward edge of the bulkhead. Located: 4415 Camp Mineola Road, Mattituck. SCTM# 123-5-22 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. This recommendation is based on the following: 1. It is recommended that the non -tun` buffer be vegetated with salt tolerant, native plant species. 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., January 14, 2015 the following recommendation was made: Moved by Jack McGreevy, seconded by Peter Meeker, it was RESOLVED to SUPPORT the application of ADAM WILLETS to reconstruct existing 58' bulkhead in place, in place of existing, with vinyl. Raise height 15" to match neighboring bulkhead; construct new 15' vinyl return; backfill with 65 cy. clean fill and establish a 10' non -turf buffer area. Located: 4415 Camp Mineola Rd., Mattituck. SCTM#123-5-22 Inspected by: Peter Young, Peter Meeker, Jack McGreevy The CAC Supports the application and recommends retractable stairs off the bulkhead and the installation of gutters, leaders and drywells to contain the roof run-off form the dwelling. Vote of Council: Ayes: All Motion Carried ij JAN 2 0 ?0.5 • 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 Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfe /Ex n ion Received Application: `rj V�jkeceived Fee:$ Completed ApplicationjlT� • br15 i nr,( Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 _Incomplete _SEQRA Classification: --- ;I Type [----Type II Unlisted _-Coordination:(date sent) DEC 1 5 2014 T�LWRP Consistency Asses m F rm CAC Referral Sent: -_.. / Date of Inspection u - _Receipt of CAC Report f .. . _Lead Agency Determination; echnical Review: _Public Hearing Held: 1121 / S Resolution: Name of Applicant -�-- vy► _ _- _�� I ��__s_---- Mailing Address_ -} T C (� l ' /"I Ole o1CJL, 11952 Phone Number:( ) _ 911 - 1 1 U Suffolk County Tax Map Number: 1000 - 1 Z -3 `- S -- 2 2— Property Property Location: v El Telephone (631) 768-1892 Fax (631) 768-6641 provide LILCO Pole #, distance to cross streets, and location) AGENT:_ _ e, /t �_ �y( D eje s 7�n C . (If applicable) — - Address: Q \4 9 ---- _Phone:_ Gl kr5 h oy-e 5 t vyp c Lo Vrd of Trustees Applicati* GENERAL DATA Land Area (in square feet):__ 8,S;)3, -,L46_ Area Zoning:_& S,' )SLY Previous use of property: rLo Intended use of property: ---SOL tJ_� __ _ 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 INO 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? C14 e s No Prior permits/approvals for site improvements: Agency Date No S L�e-._o I CUS4ee °f s 4- pfd—_ raw t No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?—X— No Yes If yes, provide explanation: Project Description (use attachments if necessary):>'c'1,DD5�'S 471z _ie L��s_ --- l 5 �7 �� IGC�t° '^ l�, /y a �b t� _v 4. 15"' nQ,c U�`n � �2 �vYrs ConiL6.6 ---.) feps . (0 ' Sd of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: C 0-A S "C– VV --- . Area of wetlands on lot:—_C square feet Percent coverage of lot: % Closest distance between nest existing structure and upland edge of wetlands:_ . feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No ✓eYes If yes, how much material will be excavated? --cubic yards How much material will be filled? r L9 S cubic yards 1 Depth of which material will be removed or deposited: I feet Proposed slope throughout the area of operations: I " ( Manner in which material will be removed or deposited:�t L G 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Comnletinti Part I - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in 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 0 V- IE S6-WYe <. roc: Name of Action or Project: Ao(o–m W 1 Project Location (describe, and attach a location map): _ i 3 C -m0 PImeDla EiacL Brief Description of Proposed Action: �,u�m , i�Ikdn PIQ�'e LA-) vine I Naa of Applicant or Sponsor: Ua.m Mfle,--s Address: Telephone: elo 5 E-Mail:Ak r's Dr City PO: 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? If Yes, list agency(s) name and permit or approval: NAst> r-(2- 3.a. Total acreage of the site of the proposed action? 0. Z)b ';k 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 ❑Commercial dResidential (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other (specify): ❑Parkland Page I of 4 NO YES/ L!7 s • • 5. Is the proposed action, a. A permitted use under the zoning regulations? I NO J_ YES N/A b. Consistent with the adopted comprehensive plan? �L 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: --- —_ 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? 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: 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: 11. Will the proposed action connect to existing wastewater utilities? if No, describe method for providing wastewater treatment: 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES NO, YES In 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain NOYE wetlands or other waterbodies regulated by a federal, state or local agency? -Md 10 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: 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑ Forest ❑ Agricultural/grasslands C3 Early mid -successional EZWetland ❑ Urban ❑ Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed (N_OO YES ULJ by the State or Federal government as threatened or endangered? LJ 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- oint sources?�� NO YES If Yes, a. Will storm water discharges flow to adjacent properties? NO ❑YES 1:1 b. Will storm water discharges be directed to established conveyance systems (r n and storm drains)? If Yes, briefly describe: NO ❑YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes, describe: ❑ 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or NO YES-- completed) comp eted) or hazardous waste? � F-1If Yes, describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE nn� Applicantlspon ame: �- Ic-i d�-� / p�fL-�(Z4._.Date: — i a-- - --____ Signature: u [[[ 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 small impact Moderate to large impact may occur may occur ❑ I. 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? ❑j ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area (CEA)? ® ❑ 5. Will the proposed action result in an adverse 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? A j� LJ ❑ ❑ 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? f7'j LJ FA ❑ ❑ 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 0 • 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 �'j, ( ❑ problems? d 11. Will the proposed action create a hazard to environmental resources or human health? Part 3 -Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. S Town of Southold - Board of Trustees / — �� / / Name of)-5ad Agency Print okTyName f Responsible Officer in Lead Agency es Bible Officer i�eadency Date President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 r -I Ah I!" 110, Qualified in Suffolk County Commission Expires May 5, 2016 Town of Southold Erosion, Sedimentation A Storm -Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Q( low 03 SSTORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN - CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. s c Eton Ti oBroTc SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT Yea No a. What Is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within Will this Project Retain All Storm -Water Run -Off the Scope of Work for Proposed Construction) j Generated by a Two (2") Incchh Rainfall oon Site? (This item will include all run-off created by site F-1 b. What is the Total Area of Land Clearing (1!,F) Acres) V/ clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed �. Site Improvements and the permanent creation of construction activity? impervious surfaces.) Z Does the Site Pian and/or Survey Show All Proposed IDE BRIEF PROJECT DESCRIPTION (Provide Addkeonai POW -Needed) PROVIDE Drainage Structures Indicating Size & Location? This _ ❑ Item shall Include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. J t/'t�� ` 3 Does the Site Plan and/or Survey describe the erosion / Iand sediment control practices that will be used to //� ❑ control site erosion and storm water discharges. This ( r Item must be maintained throughout the Entire Construction Period. G J L Il �l 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural �— Existing Grade Involving more than 200 Cubic Yards ❑ _1f/ of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand Q — (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 (100') feet of a Wetland or General DEC SWPPP Requirements: Submission of s SWPPP is required for all Construction activities Involving soil Beach? disbubances of one (1) or more acres; Including disturbances of less then one acre that are part of a larger common pian that will ultimately disturb one or more acres of land; 7 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to El Including Construction activities Involving soil disturbances 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. ( SWPPP's Shall most the Minimum Requirements of the SPDES General Permit / 8 Will Driveways, Parking Areas or other Impervious for Storm Water Discharges from Construction activity - Permit No. GP -040-001.) Surfaces be Sloped to Direct Storm -Water Run -Off 1. The SWPPP shall be prepared prior to the submittal of the NOI. The NOi shall be into and/or in the direction of a Town right -of --way? submitted to the Department prior to the commencement of construction activity. 2. The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required, post-constnuction storm water management practices that will be used ardor Removal of Vegetation and/or the Construction of any❑ constructed to reduce the pollutants in storm water discharges and to assure - Item Within the Town Right -of -Way or Road Shoulder compliance with the terms and conditions of this permit. In addition, the SWPPP shall Identity potential sources of pollution which may reasonably be expected to affect the Area? (Tide Item WN NOT Include Me hrtelleaon of Orhieway mss') quality of storm water discharges. 3. AN SWPPPs that require the postconstrudl n storm water management practice NOTE: It Any Answer to Questions One through Nine is Answered with a Check Mark In a Box and the construction she disturbance Is between 5,000 S.F. a 1 Acro In area, component shah be prepared by a quahtfed Design Professional Lkensed In New York that is knowledgeable In the principles and practices of Storm Water Management. a Storm-Wster. Grading, Drainage 6 Erosion Control Plan to Required by the Town of Southold end Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mnk (.j) and/or Answer for each Question Is Required for a Complete Appkkellm) STATE OF NEW YORK, COUNTY OF ........................................... SS That I,_ r�.r ...... .!........... being duly sw6m, deposes and says that he/she is the applicant for Permit, (Name of Indivkkral i Docu;- nW �\1J ��1J And that he/she is the�l!l,� ..:t?7.1. ... (... �gL-'.............................................................. (Owner, Contractor JV corporate Officer, etc.j Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; th all statements contained in this application are true to the best of his knowledge and belief; and that the work will be pert a the manner set forth in the application filed herewith. Sworn to befor I ............. ........... ...... . ay RyaliHorn2).�-�� .......... No Public: atar�c.P.ubtic,• SaeoF blew York - ... .................... (Signature of Applicant) NO. Q1HnA1.Qrran I!" 110, Qualified in Suffolk County Commission Expires May 5, 2016 Bod of Trustees Application AUTHORIZATION (where the applicant is not the owner) IIIle. residing at (print owner of property) (mailing address I Ithereby authorize / l (A t) g D J� 0 S ho -/-� to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 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(S) OF RECORD: ADAM WILLETS � SUBJECT OF PUBLIC HEARING: A Wetland Permit to construct new 58' long bulkhead in-place of existing using vinyl sheathing; raise the bulkhead 15" higher to match the neighbor's bulkhead; construct new 15' long vinyl return; backfill disturbed area with +/-65 cubic yards clean fill; construct new 4'x6' beach access steps; and establish a 10' wide non -turf buffer along the landward edge of the bulkhead. TIME & DATE OF PUBLIC HEARING: 0 Wednesday, January 21, 2015 — 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 • • PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ! 6y JOIN STATE OF NEW YORK COUNTY OF SUFFOLK residing at Trp 071- %qEX9 being duly sworn, deposes and says that on the day o�j 201 _Y -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 ro 1 of the Town o Southold; that said Notices were mailed at the United States Post Office at at said Noti were mailed to each of said persons by CERTIFIED /RETURN CEIPT. Sworn to before me this Day of 20 Notary Public "AN OERACI Notary Ptak; Sante of NawYeli- No. 01 GE6122947 o r GEIO f 3y N Quallfled in Suffolk Cod +11 Commiselon ExPlres• &NW 0 John Bredemeyer, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders • Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ii--• - - -.--. BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- JAN 2 1 2015 In the Matter of the Application of ADAM WILLETS COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS residing at /dba a 3 $— / -oy being duly duly sworn, deposd'and say: That on the'b dayof OL. -' , 201 S, I personally posted t e 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, January 21, 2015. Dated: Sworn to before me this ZI day of .jt,, 20 [ 5' S_U Com. �--�M�' Notary Public SUSAN GERACI NOS P��, I%* of 14aw York No. olGE6122947 Q j C,6_ial';23j q-7 Qualified in Suffolk Cociniy Commission E-Ires Ik joun.y ^� /�J/__7 County of Suffolk State of New York Sod of Trustees Application • //I �//c / BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THIS /0 DAY OF �C' ,204 VILMA DAVIDS NOTARY PUBLIC OF NEW JERSEY My Commis" Expires 712712015 • • APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'sCode of Etbics-pmbibitsi int r t t f town Offic rs prid cmplQy p, The purp2sc of this form is to provide information which can alert the town of pnjssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Laslaww, frWit name, -ti die initi , unless you aro 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 his even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5°!° of c 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 sponse, 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. or) e_- Ir N v(o V DESCRIPTION OF RELATIONSHIP Submitted tht day of 00 _ Signature Print Name TS / Ryan Him Notary Public, State of New York No. 01H06186669 Qualified in Suffolk County Commission Expires May 5, 2016 Town of Southold A. B. 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 siQmficant beneficial and adverse efTects 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- suuaorting 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. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# I WO - PROJECT NAME �u.LV_RA-6-d ) <0_6: MS The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: DEC 1 5 20i� LA cou,!" i Ir•� 1 w S+ 4L 6 --P- �" ae�� 49� Location of Site acreage: 0 • a10 -D-' Present land use: 1 rn!�-,Q Present zoning classification: Std, 4 Ead — I n LA O"k., 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: i G%p (a) Name of applicant: A66MUJ i* It t v • 6 K I 5 ho:L tC „ (b) Mailing address: JDX $ � nH ilcj�4(, (c) Telephone number: Area Code ( )'210 3 1 — a (D (d) Application number, if any: Will7NOF] tion be directly undertaken, require funding, or approval by a state or federal agency? Yes If yes, which state or federal agency? V-1SD ZCI 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. dYes ❑ No ❑ Not Applicable 1'5 - _ J Attach additional sheets if necessary Policy 2. Protectand p erve historic and archaeological resources of the Town of Southold. See LWR,P Section III — Po ' ies Pages 3 through 6 for evaluation criteria ❑ Yes n No Not Applicable A.� Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III — Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No D 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 Secti n III — Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable r , 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 throu 21 for evaluation criteria 1:1 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 Vildlife Habitats and wetlands. See LWRP Section III — Policies; Pages 22 through 32 for evaluation c ;7 ria. Yes No ~Not App abl 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 ❑ No Not Applicable Attach additional sheets if necessary Policy 8. Minimize enviro mental degradation in Town of Southold from solid waste and hazardous substances and w;Not . S LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Applicable PUBLIC COAST POLICIES Policy 9. Provide for pub 'c access to, and recreational use of, coastal waters, public lands, and public resources of the. Town o outhold. See LWRP Section III — Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIA is Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses in sui le locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. Yes ❑ No ❑Not Applicable fJ r o�.e ei s ccDc� s 1� m,4=em- Attach additional sheets if necessary Policy 11. Promote su ainable use of living marine resources in Long Island Sound, the Peconic Estuary and Tow7NotApplicable s. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 1:1 No Attach additional sheets if necessary Policy 12. Protect agricu tural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 forZNot on criteria. F] Yes ❑ NoApplicable Attach additional sheets if necessary i Policy 13. Prom/appriate use and development of energy and mineral resources. See LWRP Section III — Poli5 through 68 for evaluation criteria. Yes ❑ Nopplicable Ae S j PREPARED BY TITLE Le -IC DATE / a 1 1 Cf New Vinyl 15' Retum \77i-- 7, 71^, `'o. Prop. 4'x 6' DECK �6+ '� $ p Beach Access �ys� % ..0 Stairs -S 1c; \j Tnoo '�, a c� n N\ �-New Vinyl Blkd to Tie Into New Czenszak �—yulkhead SCALE 1 "= 20' 2 STY RESIDENCE walkway APPLICANT PROPOSES TO REMOVE SECTIONS OF EXISTING TIMBER BULKHEAD, TO RECON (IN PLACE) OF EXISTING 56' BULKHEAD 15" HIGHER THAN EXISTING, TO CONSTRUCT 15' NEW VINYL RETURN, TO BACKFILL STRUCTURE WITH 65 CY OF CLEAN FILL,TO INSTALL 4'X 6' BEACH ACCESS STAIRS. AT CAMP MINEOLA,ROAD, GREAT PECONIC BAY, MATTITUCK, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK. SH DRIVE G DEC F �- 10' NON -TURF BUFFER AREA REQUIRED I , 5/4" x 6" CAP 2"X6" FOLLOWER 3/4" HDG HARDWARE SCALE 3/8"= 1' 1"X 12' LONG HDG TIE ROD 110"0 CONTINUOUS LAYLOG 5" X 5" CCA WALES(2 ELEVATIONS) WEEP HOLE IN VSP@ 9' O.C. " CCA PILE - 16' LONG @ 6' O.C. ESP 4.5 VINYL SHEET PILE (TYP)- 12'LONG ructed 15" higher than existing timber bulkhead 8" X V LONG ANCHOR PILE @ 6' O.C. APPLICANT PROPOSES TO REMOVE SECTIONS OF EXISTING TIMBER BULKHEAD, TO RECON (IN PLACE) OF EXISTING 58' BULKHEAD 15" HIGHER THAN EXISTING, TO CONSTRUCT 15' NEW VINYL RETURN, TO BACKFILL STRUCTURE WITH 65 CY OF CLEAN FILL, TO INSTALL 4'X 6' BEACH ACCESS STAIRS. AT CAMP MINEOLA,ROAD, GREAT PECONIC BAY, MATTITUCK, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK. Applicant: Adam Willets Location: 4415 Camp Mineola Road, Mattituck Purpose: Bulkhead reconstruction Datum: Apparent Low Water S. C. T. M. N O. 1000-123-5-22 LOCUS: 40°58'48" 72°31'35 " DKR SHORES INC, P.O. BOX 488 28 Nov'14 HAMPTON BAYS, N.Y. 11946 SHEET 2 OF 2 ` J COWES OF THIS SURVEY UAP NOT BEARING © w i THE LAND SURVEYORS EMBOSSED SEAL SHALL (if NOT HE CONSVERED TO BE A VAtm TRUE :DCl 0 COPY. STOCKADE CE 0) K) cr y©� cv FRAME to (D 30 �o�a FD CM .- 3.3' .5' 3q N/F YORK, N 76'35'40"E 1.60' FORMERLY JONES 6 CM ,q� OL7 SURVEY OF GUARANIUS MIDICAMO HEREON SHALL RUN ONLY TO THE PERSON FOR mmom n -E SURVEY I DESCRIBED PROPERTY IS PREPARED, AND ON HIS BEHALF TO THE WEE COMPANY, GOVE7?NUENTAL AGENCY, SITUATE LE7KIJG /NSn7UWld IF LISTED HERECK AND MATTITUCK, TOWN OF SOUTHOLD 58° TO W ASSIGNEES OF TH£ LENDING INSTITURON. GUARANTEES ARE NOT TRANSFERABLE TO AD017KWAL INSWL/r/ l•15 OR SUBSEQUENT ONNERS. GRAVEL DRIVEWAY UNAUniOPOI£D AL7ERAPON OR AMnON rO THIS - SURVEY p FOR; ADI, �- b w SURVEY IS A W "AnQN OF SEC" 7209 OF rQ C14 O n+E .11Rrr.. .,tl 10.7' r I m b 2 -STORY ' 61 RESIDENCE z E Lu v o -11.2' w i 2' WDOD DECK w/RNuvcs wow sgrs X �i ' �'' J COWES OF THIS SURVEY UAP NOT BEARING i THE LAND SURVEYORS EMBOSSED SEAL SHALL (if NOT HE CONSVERED TO BE A VAtm TRUE 0 COPY. STOCKADE CE 0) K) Li cv FRAME to (D Z � SHED .- 3.3' .5' U 3 0 SURVEY OF DESCRIBED PROPERTY „OW snn SITUATE is MATTITUCK, TOWN OF SOUTHOLD 58° SUFFOLK COUNTY, N.Y. - SURVEY p FOR; ADI, �- b w C14 O d U) GUARANTEED TO: \T WOWDECK O ADAM WILLETS FIDELITY NATIONAL TITLE INS. CO. w/lux0 s V) NORTH FORK BANK • Tis AM CMJWALL EI TMJ 1000-123-05-022 SURVEYED: 18 OCTOBER 2002 SCALE 1"-20' AREA 60' 0.202 ACRES S c'� r) SURVEYED BY STANLEY J. ISAKSEN, JR. Ij ! P.O. BOAC 294 L NEW SUF'.K. N.Y. 11956 �CENS NL1 SURV OR NYS Licit No. 4927 02R1186