HomeMy WebLinkAboutTR-4176Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
Town Hail Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0618C
Date January 12, 2011
THIS CERTIFIES that the 100 If .timber bulkhead repaired with helix screws and 3' wide
stairway
At 9525 Nassau Point Rd., Cutchogue
Suffolk County Tax Map #119-1-2
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 4/27/93 pursuant to which Trustees Wetland Permit g4176 dated 5/26/93 was
issued and Amended on 3/22/06 and on 4/21/10
and conforms to all of the requirements and Conditions
of the applicable provisions of law.
The project for which this certificate is being issued is for
a 100 If. timber bulkhead repaired with helix screws and 3' wide stairway.
The certificate is issned to DAVID BERGEN owner of the
aforesaid property.
ACr,ze
Jill M. Doherty, President
James F. King, Vice~President
Dave Bergen
Bob Gho$io, Jr.
John Bredemeyer
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: /~' It~-[]
~ Ch. 275 Ch. 111
INSPECTION SCHEDULE
INSPECTED BY:
COMMENTS:
__ Pre-construction, hay bale line/silt boom/silt curtain
__ 1st day of construction
~ constructed
V/Project complete, compliance inspection.
CERTIFICATE OF COMPLIANCE:
,/
Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
Town Hall, 53095 Main Rd.
P.O. Box I 179
Southold, NY 11971
Telephone (631 ) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72
HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT
FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE
CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT.
INSPECTION SCHEDULE
Pre-construction, hay bale line
1st day of construction
¼ constructed
Project complete, compliance inspection.
Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
April 21,2010
Mr. David Bergen
9525 Nassau Point Road
Cutchogue, NY 11935
RE: 9525 NASSAU POINT ROAD, CUTCHOGUE
SCTM# 119-1-2
Dear Mr. Bergen:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, April 21,2010:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Permit #4176 from Schuyler Bergen to David Bergen, as issued on May 26,
1993 and Amended on March 22, 2006, and
BE IT FURTHER RESOLVED, that the Southold Town Board of Trustees APPROVE
the Amendment to Wetland Permit #4176 to install up to six (6) helix screws to support
bulkhead and backfill with 100 c.y. clean fill, and as depicted on the site plan prepared
by David Bergen, dated Mamh 30, 2010, and received on March 31, 2010.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
Doherty '~'
ent, Board of Trustees
JMD:eac
Jill M. Doherty. President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
P.O. Box 1179
Southold, NY 11971
Telephone (631 ) 765-1892
Fax (631 ) 765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time: % l/~/-//~
DAVID BERGEN requests a Transfer of Permit #4176 from Schuyler Bergen to
David Bergen, as issued on May 26, 1993 and Amended on March 22, 2006, and an
Amendment to Permit #4176 to install up to six (6) helix screws to support
bulkhead and backfill with 100 cy. clean fill. Located: 9525 Nassau Point Rd.,
Cutchogue. SCTM#119-1-2
Type of area to be impacted:
.J,,~.Salt~ater Wetland Freshwater Wetland __Sound ~ay'
Distance of proposed work to edge of wetland
Part of Town Code proposed work fails under:
~t.275 Chapt. 111 other
Type of Application: ~.~etland __Coastal Erosion ~Amendment
__Administrative__Emergency Pre-Submission Violation
Info needed:
Modifications:
Conditions:
Present Wer .e~J.King Jt J-"~. D. D;herty ~emeyer
B.Ghosio, V¢ D. Dze~!L- /(/"7oott~er
Form filled out in the field by
Mailed/Faxed to:
Date:
James F. K/rig, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
March 22, 2006
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. David Bergen
9525 Nassau Point Rd.
Cutchogue, NY 11935
RE: 9525 NASSAU POINT RD., CUTCHOGUE
SCTM#119-1 o2
Dear Mr. Bergen:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, March 22, 2006:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit ~4176 to repair the existing bulkhead and stairs to the beach, and to fill in holes
behind the bulkhead with 20 cy. of clean sand fill brought in from an upland source, and
as depicted on the plan prepared by David Bergen received on February 28, 2006.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
James'~. King
President, Board of Trustees
JFK:lms
Board $outhoid Town' Trustees
SOUTHOLD, NEW YORK
PERMIT'NO, ~...[..~..~' ........ DATE: ..... Sl.26J93 ........
ISSUED 'TO ........... ~.C..~.U..~..:.~.~;~..C':..~:...N ................................................
,utl nri atinn
PursuaWr fo fhe provisions of Chapter 615 of fhe laws of
{.he Slate of New Yorl~, 1893: and Chap{.er 404 of fhe Laws of {'he
Sfa'~e of New York 1952; and {.he Southold Town Ordinance en-
t1{.led "REC-ULATINC= AND THE. PLAC:INC= OF OBSTRUCTIONS
IN 'AND ON TOWN WATERS AND PUBLIC LANDS and {'he
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" end in accordance wifh {'he
Resolution of The Board adopted a{. a mee{'ing held on ....5.LZ&t.9.~ ....
19 ........... and in consideration of fhe sum of $ .................... pa!d by
of ....................................................................................... N. Y. and subiect {.o the
Terms and Conditions lld'ed on the reverse side hereof,
of Soufhold Town Trustees authorizes and permits '~he roi owing:
Repair/replace as necessary 100 l.f. of Hmber bulkhead and
wide stalrway~ Approx. 200 c.y. of clean sand will be trucke~
in. from upland source. Nassau Point
all ir~accordance 'with {.he derailed specifications as presenfed in
the originating application.
IN WITNESS WHEREOF, The said Board of. Trustees here-
by causes its 'Corporafe SeaJ {.o be affixed, and fhese presenfs to
be subscribed by a majorlfy ~id BOard as of this daf=.
-- ~ COUNTY OF SUrFaK (~ I~'~'~'~ 119
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
(cot. Main Rd. & Youngs Ave.)
Southold, NY 11971
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
Telephone: 631 765-1938
Fax: 631 765-3136
To:
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
Jill Doherty, President
Town of Southold Board of Trustees
From: Mark Terry, Principal Planner ~
LWRP Coordinator
Date: April 19, 2010
Re: Proposed Wetland Permit for DAVID BERGEN
SCTM#1000-119-1-2
DAVID BERGEN requests a Transfer of Permit ¢¢-4176 from Schuyler Bergen to David
Bergen, as issued on May 26, 1993 and Amended on March 22, 2006, and an
Amendment to Permit ¢f-4176 to install up to six (6) helix screws to support bulkhead and
backfill with 100 cy. clean fill. Located: 9525 Nassau Point Rd., Cutchogue. SCTM#119-
1-2
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 action is CONSISTENT
with the below Policy Standards and therefore is CONSISTENT with the LWRP.
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
April 1, 2010
To Southold Town Trustees,
2010
Please transfer permit # 4176 from Schuyler Bergen to David Bergen for my property located at 9525
Nassau Point Road, CutchogueTax map # 1000-119-1-2.
Sincerely,
David Bergen
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
~.~el~phone (631) 765-1892
i~' ~ (~'~ 765~6641
/'!. ~ ~!~ I~.~ il il,,'/ ?~ ~- ,
,,; -. ~L /[ ..;
BO~OFTO~USTEES/ ' ",,'.,a 8 ~
TO~ OF SOUTHOLD /
AGENT PHONE
ADDRESS
PROPERTY LOCATION ~ ~"~-~- ~1~..~,,,~. /3,,,..., .~ /'~d (~'.,~
TAXMAPNO. {I ~- ~- ~
Signed By:
April 1,2010
To Southold Town Trustees,
Please transfer permit # 4176 from Schuyler Bergen to David Bergen for my property
located at 9525 Nassau Point Road, CutchogueTax map # 1000-119-1-2.
Sincerely,
David Bergen
OBoard of Trustees Applicat~n
County of Suffolk
State of New York
(~ o-~ ', ~ ~ ~ ~ BEING DULY SWORN
DEPOSES AND AFFIRMS ~L~T HETSHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FOKTH IN THIS APPLICATION AND AS MAY
BE APPKOVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS A_ND 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.
~gnature~q'
SWORN TO BEFORE ME THIS ['3' DAYOF ~(~: ( ,20. ~0
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the hart of town 0fficem and emolovees. The ourooso of
this form is to on>vide information which can alert the town of oossible conflie~ of intewst and allow it to take whatever action is
neco~sarv to avoid same,
(Last name, first name,~aiddle initial, un y app y'ng'
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
o f 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.
9.
Name o f pers0n employed by the Town of Southol~ i~.5 ,~
Title Or position of that person t ~'~-~ ~
Describe the relationship between yourseif {the applicent/agent/representative) and the town officer or employee. Either cheek
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 o?vner of greater than 5% oftbe shares of the corporate stock of the applicimt
(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, parmer, or employee oftbe applicant; or
__.D) the actual applicant..
DESCRIPTION OF RELATIONSHIP
Form TS I
Submiited this ~_da.y 9f
Signature t
Print Name
2o &
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
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
nmking a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
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 signifi6ant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
If any question in Section C on this form is answered "yes", then the proposed action may affect the
achievement of the LWRP policy standards and conditions contained in the consistency review law.
Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a
determination that it is consistent to the maximum extent practicable with the LWRP policy
standards and conditions. If an action cannot be certified as consistent with the LWRP policy
standards and conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: online
website (southoldtown.northfork.net) the Board of Trustees Office/;~h'
· · ,
local hbrarles and the Town Clerks office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
The Applieatlon bas been subnmtted to (check appropriate response).
TownBoard [] Planning Dept. [] Building Dept. [] BoardofTrustees
Category of Town of Southold agency action (check appropriate response):
(a)
(b)
(c)
Action undertaken directly by Town agency (e.g. capital ~'~
construction, planning activity, agency regulation, land transaction) ~
Financial assistance (e.g. grant, loan, subsidy)
Permit, approval, license, certification: .~
Nature and extent of aCtion:
Location of action:
Site acreage:
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:
(b) Mailing address: No y
(c) Telephone number: Area Code ( ) '7 7 ~/'" ~ 7 / ~
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes [~] No ~ If yes which state or federal agency?
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation
criteria.
[] Yes ~ No ~.Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
[~ Yes [] No [] Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
Yes ~-~ 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
Section III.- Policies Pages 8 through 16 for evaluation criteria
Yes [] No ~-~ Not Applicable
,
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
Yes ~ No ~4Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
through 32 for evaluation criteria.
Yes [--~ No [~ Not Applicable
Attach additional sheets if necessmy
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
~ Yes [] No ~ Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of. Southold from solid waste and hazardous
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
~ Yes ~ No ~. 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.
YeF] No ]NotAppiicahle
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria.
[] Yes [] No [] Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
[] Yes [--] No ~ Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for evaluation criteria.
~ Yes ~ No [-"~_ 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.
7d Yes [] No Not Applicable
Created on 5/25/05 11.'20 AM
TOWN OF SOUTHOLD
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO .... [[.~ ~' ....
DATE: ...... 5/267.9.3 .......
ISSUED TO SCHUYLER BERGEN
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893: and Chapter 404 of the Laws of the
State of New York 1952: and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on .... 5/26./93 ..
19 ....... and in consideration of the sum of $ ....................... paid by
of .......................................................................................... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Repair/replace as necessary 100 l.f. of timber bulkhead and 3'
wide stairway. Approx. 200 c.y. of clean sand will be truckee
in-from upland source. Nassau Point
all in_accordance with fhe detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of ~id Board as of this date.
· ~t~ ~. ~upski, ~r.
~'ohn B. Tuthill
Telephone ($I~) 76~-1892
Fax (~16) 765-1823
SU~VISOR
SCOTT L. HARRIS
BOARD OF TOWN THUSTEES
TOWN OF SOUTHOI~
Tow~
$3095 MaL~ Road
P.O. Box 1179
Southold, New Yodc 11971
COASTAL EROSION MANAGemENT PERMIT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
TRUST~- LANDS PERMIT APPLICATION
We- ' . Office Use Only:
oastal Erosion Pe..r~zt Application
tland Permit App.licatiOn
Ls~T~rustee Lands Permit Application ~
e .ance e tred,
~cNe~ghbors notified Date: ~ ~- S~D~7~
! . TOWNOF SO!JTHOLD
__Insp. camp./date: <~-%:~-~f ~
SE~l:t~ DeV..e~./clare:
_ ?ub.l. ia Hearing/da'ce: Findings:
Special Conditions:
( also see file } Application Fee:
Application Number; SCTM ~1000- 119-1_--2
Project Name (If any)
Date Prepared:
April 23, 1993
Applicant. -
EN-CONSULTANTS, INC.
Address:
1329 North Sea Road
Southampton~ NY 11968
Phone (516) 283-6360
Interest: ( owner, consultant, lessee, etc. ) Consultants
Owner of Property:
Address
SCHUYLER BERGEN
9~5 Nassau Pr.Road
Cutcho~ue, NX 11935
Phone (516) 11935
Subject Property Location:
(ProviUe LiLCO Pole ~, Distanca to cross Streets if not on
location map )
Yds~ to be excavated: ~0 Yds. to be filled: 200
Manne~ in which material will be removed or deposited:
Trucked in, dumped & graded
Width of canal, creek or bay fronting property: 5± miles
Depth at low tide: 0 Aver. rise in tide: '2'-6"
Distance to nearest channel.:~ N~A Distance project
extends beyond similar projects in area:
Area zoning: Land area in acres~ acres
Is project for private or business use: private
Intended use ~of property: one' family ~esidentia~ (nO change)
Describe known prior operations conducted on premises:
None known
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises: No
Has.any license or permit ever 'been revoked or suspended by a
Governmental Agency:
No
Project Description
The project description must also include plans for reclamation
of land disturbed during construction of the principle and
accessory structures and underground Structures (i.e., pipeline
and septic system; make additional attachments if necessary).
See attached
Authorization (Where the applicant is not the owner)
I MARGARE~ B~RGEN residing at 9525 Nassau Pt. Road,
(Print-owner of subject property) (Mailing address-phone)
Cutchogue, NY 11935
do hereby authorize En-Consultants, Inc. to apply for
coastal Erosion permit (s) from the Southold Town Trustees
' SignatUre ~THIS IS NOT A~ PERMIT Page 2
PROJECT DESCRIPTION
Re: SCHUYLER BERGEN
Repair/replace as necessary 100± 1.f. of timber bulkhead
and 3' wide stairway. Approximately 200 cy of clean sand
will be trucked in from upland source via Anderegg parcel
for backfill. All bulkhead repairs will be in kind and
place. Structures were damaged by 12/11/92 storm.
County of Suffolk )
state of New York )
SWORN TO BEFORE ME THiS ~(~% DAY OF
ROY L. ~JE BEING'DULY SWORN DEPOSES ~D
AFFI~S T~T HE/SHE IS THE APPLICMT FOR THE ABOVE DESCRIBED
PERMIT(S) MD T~T ALL STATEMENTS CONTAINED HEREIN dE ~UE~TO
THE BEST OF HIS/HER ~OWLEDGE MD BELIEF, MD THAT WO~ WILL BE
DONE IN THE MANN~ SET FORTH IN THIS APPLICATION MD AS MAY BE
APPROVED BY THE SOUTHOLD TON BO~D OF ~USTEES. THE APPLICMT
AGREES TO HOLD THE TOM OF SOUTHOLD MD ~E TON TRUSTEES
HARMLESS ~D FREE FROM ANY AND ALL DAMAGES MD C~IMS ~ISING
UNDER OR BY VIRTUE OF SAID 'PERMIT(S)% IF GRANTED.
IN COMPLETING THIS APPLICATION, I HEREBY A~HORIZE THE ~USTEES,
THEIR AGENT(s) OR REPRES~TATIVE(s), TO ~TER ONTO ~ PROPER~
TO INSPECT THE PREMISES IN CONJ~CTION WITH REVIEW'OF THIS
APPLICATION.
~~/ :'[[ NOTARY ~BLiC Sta~ of New York
~ ;U No. OlO~L Suffolk Cou~'v
Suggested space for location Map
THIS IS NOT A PERMIT
Page 3
14-16-4 (2/8?)--T~xt 12
PROJECT I.D. NUMBER
J 617.21
.. Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT' FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPUCANT/SPONSOR I 2. PROJECT NAME
SCHUYLER BERGEN by En-Consultants
3. PROJECi LOCATION:
Municipality TOWll of Southold County' Suffolk
SEQR
.4.
PRAISE LOCATION [Strut addr~s and road Intemecti~s, prominent I~dma~s, etc.,_ or provide map)
9525 Nassau Pt. Road
Cutchogue, NY
SCTM: 1000-119-1-2
5. IS PROPOSED ACTION:
[] New [] Expansion [] Modification/alteretion
6. DESCRIBE PROJECT BRIEFLY:
SEE PROJECT DESCRIPTION
7. AMOUNT OF LAND
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
[] Yes [] No If No, describe briefly
9. WHAT IS P~.~.NT LAND USE IN VICINITY OF PROJECT?
[] Residential [] Industrial [] Commercial
Describe:
[] Agriculture [] Park/Forest/Open space [] Other
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
[] Yes [] No If yes, list agency(s) and permit/approvals
DEC_, DOS, COE
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
[] Yes [~[No If yes, list agency name and permWapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
, CERTI~ TH~ TH/~ ,FO.MATION PROV,DED ABOVE iS TRUE TO THE BEST OF MY K.OWLE~
Applicant/sponsor name: SCHI~L~ '. B~G~b¥/ / En-Consultants Date:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Fo~ before proceeding with this assessment
OVER
1
4/20/93
.loire M. Bredemeyer, IlL Pre, idem
Albert .l. I(~'apski. Jr., Vice President
He~ry P. Smflh
John B. Tuthill
William G. Albenson
Telephone ($16) 765-1892
Fax ( z6) 765-1823
I (we),,
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHO! D
30 year Maintenance Agreement
Erosion Protection Structures
Chapter 37 Southold Town Code
Southold Trustees as Administrator
SCHUYLER BERGEN
type or print name(s)
the owners of record of property'~t:
Cutchog~e, NY 11935
SUPERVISOR
SCOTT L. HARRIS
Town Hall
53095 Main Road
P.O. Box 1179
Southold, Ne~v York 11971
9525 Nassau Pt. Road,
(type or print street address) Su'iM #1000-119-1-2
in applying for a Coastal Erosion permit for an Erosion
Protection Structure do hereby agree to a 30 year maintenance
program for a structure commonly known as a re~aining wall
of 100± 1.f. as shown on the attached
feet of length
licensed survey of the as-built structure.
It is my/our understanding that we are to maintain this
str?ct?re with materials designed'to endure 30 years and or
~~_h~..th? ?rlg.lnal approved s..~t-uc~.e and that for anx
,,,=~,,~=~,=~a== wn~cn ~nvo~ves more rman ~ in length of this
structure we are to give prior written notice to the
administrator, waiting for their approval in all but true
emergency situation's which would seriously endanger life,
property and important coastal natural resource features such as
bluffs or wetlands. 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 Trustees that said lack of
maintenance would risk life, property or important natural
resources features including protected, rare or threatened s:
animals and plants.
Notarized Signature~ owner of record
SWORN T? BEFOP~
NOTAR~0~LIC-
ME THIS ~ DAY OF ~ ,',~,
This maintenance agreement shall only be valid upon attachment
three copies of a licensed land survey made within one year of
the original construction and validated to show the the final
approval of the administrator. Subsequent owners may apply to
the Southotd Town Trustees to re-authorize this
T~ ~hom it May Concern:
This is to authorize ENCONSULTANTS, INC.
of Southampton to obtain the necessary per. mits
on my behalf.
Vote of Council: Ayes: Ali
Motion carried.
Page
Moved by Patricia lsaksen, seconded by Stephen Angell, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
I of the Wetland Application
to repair/replace as necessary 100+/- I.
timbei and 3' wide stairway. Approximately 200 c.y. of
clean sand will be trucked in from upland source via Anderegg parcel
for backfill. All bulkhead repairs will be in kind and place.
The Council recommends approval provided all work in in kind and in
place and not placed in front of existing bulkhead.
9525 Nassau Point Road, Cutchogue
Vote of Council: Ayes: All
Motion carried
Moved by Patricia Isaksen, seconded by Stephen Angell, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
WITH STIPULATION of Wetland Application of MARIAN ALES
119-1-20 to repair/replaces needed a total of 106 +/- I.f. of
timber bulkhead and 3' wide stairway from top of bluff to' beach.
Approximately 200 c.y. of clean sand will be trucked in form upland
source via Anderegg parcel for backfill. All bulkhead repairs will
be in kind and place.
The CAC recommends approval provided all work is in kind and in
place and not placed in front of the existing bulkhead.
8925 Nassau Point Road, Cutchogue
Vote of Council: Ayes: All
Motion carried.
Moved by Patricia isaksen, seconded by Stephen Angell, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
WITH STIPULATION of Wetland Application of ARISTEDES SPERES
119-1-76 to remove and replace (in same location and configuration)
100 I.f. of existing timber bulkhead and backfill with 200 +/- c.y.
of clean sand to be trucked in from an upland source via Anderegg
parcel. Replace 3' wide stairway.
The CAC recommends approval provided the work is done in kind and
in place and not placed in front of the existing bulkhead.
Nassau Point Road, Cutchogue
Vote of Council: Ayes: All
MOtion carried.
Moved by Patricia Isaksen. seconded by Stephen Ange. ll. it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
WITH STIPULATION of Wetland Application of JOSEPH
MANDELBAUM 119-1-75 to remove and replace (in same location
and configuration) 92 +/- I,f, of existing timber bulkhead and
backfill with 200 +/- c.y. of clean sand to be trucked in from upland
TRUSTEES
John M. Bredemeyer, III, President
Albert J. Krupski, Jr., Vice President
Henry E Smith
John B. Tuthill
William G. Albertson
Telephone (516) 765-1892
Fax (516) 765-1823
SUPERVISOR
SCOTT L. HARRIS
Town Hall
53095 Main Road
EO. Box 1179
Southold, New York 11971
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 12, 1993
Mr. John Holzaphel, Chairman
Southold Town Conservation Advisory Council
Southold Town Hall
Main Road
S0uthold, NY 11971
Dear Mr. Holzaphel:
Transmitted herewith are the following applications for a wetland
permits:
Robert Celic
George Buckley
~.~Schuyler Bergen
Marian Ales
Aristedes Speres
Joseph Mandelbaum
Thomas Losee
John Tobin
Virginia Meyran
123-8-29
71-1-8
119-1-2
119-1-20
119-1-76
119-1-75
118-4-2
118-4-3
99-3-1
Please prepare a written report of findings and
recommendations with respect to this application.
Very truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB: j md
/
I
/
/
!
/
LITTLE
HOG
NECK
NASSAU
POINT
F
EN-CONSULTANTS
1329 NORTH SEA RD,
SOUTHAMPTON N, Y. i1968
516-283-6360
EN-CONSULTANTS INC
15~9 NORTH SEA RD,
SOUTHAMPTON N. Y. 1196~
516-Z83-6360
iTO'~N OF $OUTHOLD
EN--CONSULTA~IT$
1329 NORTH SEA RD,
SOUTHAMIrlrON N, Y. 11968
516-283-63~0
~P~ 2 7' 1993
,_.T..~3WN OF SOUTHOLDi
tq 184x ~0 E.
150
75i
,¥5
447'
D
EN-CONSULTANTS INC,
1329 NORTH SEA RD,
SOUTHAMPTON N, ~ 11968
516-283-6360
VAN
'TUYL
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
March 22, 2006
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. David Bergen
9525 Nassau Point Rd.
Cutchogue, NY 11935
RE: 9525 NASSAU POINT RD., CUTCHOGUE
SCTM#'I 19-1 o2
Dear Mr. Bergen:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, March 22, 2006:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit #4176 to repair the existing bulkhead and stairs to the beach, and to fill in holes
behind the bulkhead with 20 cy. of clean sand fill brought in from an upland source, and
as depicted on the plan prepared by David Bergen received on February 28, 2006.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
James .K~ing
President, Board of Trustees
JFK:lms
'
Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Wed., March
15, 2006, the following recommendation was made:
DAVID BERGEN to Amend Permit #4176 to repair the existing bulkhead and stairs to
beach, and to fill in holes behind bulkhead with 20 cy. of clean sand fill brought in from
an upland source.
Located: 9525 Nassau Point Rd., Cutchogue. SCTM#119-1-2
The CAC did not make an inspection, therefore no recommendation was made.
BAY
SOUTHOLO
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time:
Name of Applicant:
Name of Agent:
Property Location: SCTM# & Street
Brief Description of proposed action:
Type of area to be impacted:
__Saltwater Wetland __Freshwater Wetland
Sound Front
o~aY Front
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
__Chapt.97 Chapt. 37 other
Type of Application: Wetland __Coastal Erosion ~(M~nendment __Administrative
__Emergency
Info needed:
Modifications:
Conditions:
Present Were: __J.KJng ~.Doherty __P.Dickerson D. Bergen__J.Holzapfel
Other:
Mailed/Faxed to: Date:
PLANNING BOARD MEMBERS
JERILYN B. WOODHOUSE
Chair
VgiLLIAM J, CREMERS
KENNETH L. EDWARDS
MARTIN H. SIDOR
GEORGE D. SOLOMON
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY
Telephone: 631 765-1938
Fax: 631 765-3136
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
To: Town of Southold Board of Trustees
From: Mark Terry, Senior Environmental Planner
LWRP Coordinator
Date: March 20, 2006
Re: Request for Wetland Permit for David Bergen
SCTM#119-1-2
DAVID BERGEN requests an Amendment to Permit #4176 to repair the existing
bulkhead and stairs to beach, and to fill in holes behind bulkhead with 20 cy. of clean
sand fill brought in from an upland source. Located: 9525 Nassau Point Rd.,
Cutchogue.
The proposed action has been reviewed to Chapter 95, 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 generally CONSISTENT with the Policy Standards
and therefore is CONSISTENT with the LWRP provided the following best
management practice is applied;
To further support the LWRP and the policies~ assess the feasibility of the
installation of a silt boom/turbidity screen to be employed during
construction of the bulkhead to minimize turbidity in the water column.
2. No CCA is used in the re-construction of the bulkhead and stairs.
3. Require a non- turf buffer landward of the new bulkhead.
Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in
preparing its written determination regarding the consistency of the proposed action.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
PegKy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OFTOWNTRUSTEES
TOWN OFSOUTHOLD
APPLICATION FOR AN AMENDMENT TO A PERMIT
ADDRESS
AGENT
ADDRESS
PHONE
PHONE --"'
PROPERTY LOCATION
TAX MAP NO. I (
I/We
Si~ed By:
I am requesting an amendment to Permit ~4176 to provide structural support and minor
repairs to existing bulkhead. Specifically, storm erosion has resulted in the beach level
falling approximately 4.5 feet since the bulkhead was constructed. As such, the sheathing
has started to "bow" out and is in danger of breaking open. This could result in
catastrophic failure of the entire bulkhead, resulting in the collapse of the bluff and
significant damage to both my property and the property of the adjoining property
owners. The bulkhead has been evaluated by Mr. John Costello of Costello Marine. He
has recommended the installation of a second stringer row, using 4X6 timbers, to be
installed about halfway between the existing beach line and the existing stringer. Repair
work is needed to address two stringers which were broken in a recent Northeaster. It
was further recommended that the two sink holes created behind the bulkhead be filled
in.
The stairway from the bulkhead down to the beach was damaged. Specifically, five steps
were washed away long with the handrails. I simply want to replace the missing steps
and one handrail.
David Bergen ~r Date
James F. King, President
Jill M. Doheny Vi~,,-President
Peggy A. ])ickerson
John 1to] zapf el
Town Hall
53095 Route 25
P.O. Box ] ] 79
Southold, New York ] ] 971-0959
Telephone (631 ~ 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application of
...... .........................
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ('~c.-~r f'~._. , residing at '~'~-ZS'- F~.~.=~.,
be~ng'~uly sworn, depose and say:
That on the i day of t-~...~ , 200~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 heating noted thereon to be held O.1~. 'b'll~.~ h a~*l, ~00~ '-
Dated:
(signature)
Sworn to before me this
tCorary~ublic
ILENE S. KREITZER
Notary Public, State of New york
No. 02KR5085427
Qualified in Suffolk County., --
Commission Expires Sept. 22,
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
('3 ~..~ ,:( ~ ¢ .~ ,~-, __, residing at
~4~c4_~:~_ _ : , being ~u. ly sworn, dgposes and says that on the
.~..~4'~ '/day~f ~'~r,,,~,-. ,200¢,,dePonentmailedatruecopyoftheNotice
set forth in the Board o~'~r~s[ees ~pplication, 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 o.f. the To)vn of Southold; that said Notices were mailed at the United States Post
Office at ~L.~J~ ( ~ I d , that said Notices were mailed to each of said persons by
(certified) (registered) mail,
Sworn to before me this ~
Dayof ~9~r~a.~t._,20 o~
ILENE S. KREFI'ZER
Notary Public, State of New Yoet~
No, 02KR5085427
Qualified in Suffolk Cou~l~ ~ - ~ ~,
Commission Expires Sept. 22, '~(?~ /
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OFTRUST~ES~TOWNQFSOUTHOLD
In the matter of applicant:
Dav%d Bergen SCTM# !!9-!-2
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the inteaation of the undersigned to request a Permit from the Board of Trustees
to:
Amendment to permit #4176 to provide structnrR1 repairs/support to bulkhead
plus repair steps to beach damaged by storms. Bring in about~ CY of
clean fill/sand from upland source to fill in holes created by storms
behind bulkhead.
2. Th~ He property w~ch is the su~ect of Environmental Review is locked a~acent to
your property and is deschbed ~ follows:
9525 Nassau Point Rd, Cutchogue, NY
lhat the project which is subject to Environmental Review under Chapters 32, 37, and/or
97 of the Town Code is open to public comment on: March 22, 2006 . You
may contact the Trustees Office at 765-1892 or in writing.
The above-referenced proposal is under review of the Board of Trustees of the Town of Southold
and does not reference any other agency that might have to review same proposal.
OWNERS NAME: r)nv~ ~ BergPn
MAILING ADDRESS: Box 1008 Cutohogu~, Ny 11935
PHONE#: 734-6719 Home; 451-4040 Office
Enc: Copy of sketch or plan showing proposal for your convenience.
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics omhibits conflicts of interest on the oart of town ollieers and em~love*s. The nurvose of
~his form is to nmvide information which can alert thc town of ~ossible conflicts of interest and allow it to take whatever action is
pec0ssarv to avoid same.
YOURNAME: ~¢~'~-'~t~ ~'~'~-'~"J ~
(Last neff%, ftrst name, ~niddle initial, unless you are applying in the name of
someone else or other entity, such as a company. Il'so, indicate, the other
person's or company's name,)
NAME OF APPLICATION: (Check all that apply.)
Ts grievance Building
Variance Tmstee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(lf'~Other'', name the activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship ~vith any officer or employee
of the Town of Southold? "Relationship" includes by blood, marriage, or business interest, "Business interestn 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% oftbe 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 Soluthold -~
Tiile br po~i~i6n of that persoh
Describe the relationship between yourself(One 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, of Child is (cheek all that apply):
A) the owner of greater than 5% of the shares of the corporate stock of the applic0nt
(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
Form TS 1
Submitted this Z ~:5 {a~ of ~C-~. ~
Signature ~- ~ tO ~
Print Name J~ ~ ~ ~ ~ I~ ~-~ ~ ~
200C~_
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southotd 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.
Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
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-
suvvortine facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold ' s
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# lO CO - tl c{ - i - 2.._
PRO.CT N ME
The Application has been submitted to (check appropriate response):
TownBoard ~ Planning Board ~-~ Building Dept. r'-'~ BoardofTrustees~
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:
Location of action:
Site acreage:
Present land use:
Present zoning classification:
If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Nameofapplicant: ~.~J
(b) Mailing address: [~ (c>o ?>
(c) Telephone number: Area Code ( )_ 7 ,~5~- ~ 7;~ t~ ~-'~ - ¥c:~ ~-c~/)
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes [] No ~ If 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 eomplefion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation
criteria.
[] Yes [] No ~ Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
[] Yes [] No ~Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
~-~ Yes ~-~ 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
Section III - Policies Pages 8 through 16 for evaluation criteria
5 Yes ~ No ~-] Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
Yes No otApplicahle
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
through 32 for evaluation criteria.
Yes No Not A~cable
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
Atlach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
[--] Yes [--] No [-~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.
[] Ye~f-~ No~7[ Not Applicable
Atlach additional sheets if necessary
· WORKING COAST POLICi
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria.
Yes [] No ~-~. Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconie
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
V~ Yes ~-~ No [~Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for evaluation criteria.
[] Yes ~-] No [fl~ot 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 ~'-~. Not Applicable
PREPARED BY ~ o o-,~ {~ ~ 23-'" TITLE ~ ~ -~-e-~ DATE