HomeMy WebLinkAboutTR-8902 Michael J.Domino,President OE SO(/jy® Town Hall Annex
John M.Bredemeyer III,Vice-President �® l0 54375 Route 25
P.O.Box 1179
Charles J.Sanders Southold,New York 11971
Glenn Goldsmith ® O Telephone(631) 765-1892
A. Nicholas Krupski ® Fax(631) 765-6641
Nri
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 1382C Date: August 16, 2017
THIS CERTIFIES that the stabilization of the shoreline with the use of approximately 60
linear feet of coir logs; and revegetate the coir log and disturbed areas using native vegetation-, with the
condition to establish and perpetually maintain a 10' wide non-turf buffer landward of the shoreline-
At 3005 Wells Road,Peconic
Suffolk County Tax Map#1000-86-2-4
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated September 15,2016 pursuant to which Trustees Wetland Permit#8902
Dated October 19,2016,was issued and conforms to all of the
requirements and conditions of the applicable provisions of law. The project
for which this certificate is being issued is for the that the stabilization of the shoreline with the use of
approximately 60 linear feet of coir logs; and revegetate the coir log and disturbed areas using native
vegetation; with the condition to establish and perpetually maintain a 10' wide non-turf buffer landward
of the shoreline.
The certificate is issued to BERNADETTE HOGAN owner of the
aforesaid property.
o �
Authorized Signature
:. :ARROVED BY EXISTING ADJACENT DOCK
-
NOTES: `-=��A�Rd OF�TRUSTE -
1. ELEVATIONS REFER TO N.G.V.D 1929 DATUM
2. LOT AREA- 23,540.35 S.F. / 0.540 ACRES
3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: DAN
GREEN BY DESIGN, PLLC
6 STRATHMORE DRIVE NORTH BABYLON, NY
SURVEY LATEST DATED JANUARY 19, 2013 �•
l
Q
W2875 WELLS RAD
ILLIAM & VICTORIA D. GORDON 00' ' d
- 117 HUNTINGTON ROAD _ 203/I .�
PORT WASHINGTON, NY 11050 iCIA
o• UNE OF 10' WIDE NO
s
BUFFER ALONG BANK 1 EXISTING FIXED PIER
p.
' d 16 E / EXISTING TIDAL WELTAL.NDS AS IDENTIFIED
N 4 66 1 BY J. PATANJO ON 8/27/16
iPROPOSED COIR LOG AND PLANTINGS BANK STABIUYnON.
\ COIR LOGS TO BE PLANTED AS SHOWN IN TYPICAL SECTION
i Z f \ OR ACCORDANCE WITH TOWN AND NYSDEC RECOMMENDATIONS
CIA 60'
p \ EXISTING ADJACENT DOCK
C-` r)
225 00. D
NOV
O Soutbutd Tom
c� Rm ofTrustees
o PROPERTY OWNER:
o, #3065 WELLS ROAD BERNADETTE M HOGAN
64'66 5
0�� ALAN SSHIIR EY WATSON JONATHAN ZAVIN hupond S1W1 lira Stabilization Pemit SCALE:
3065 C,WELLS 1tD 250 WEST 90TH STREET APT 15K 1°=30'
NEW YORK, NY 10024
PREPARED BY: PROPOSED PLAN DATE*9-5-15
�`- JEFFREY PATANJO 10-29-16
106 HEWITT BOULEVARD
CENTER MORICHES, NY 11934 3oos WELLS ROAD
631-484-9332 PECONIC. TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY SHEET:
First American Title Insurance Company
AMENDED 1/22/13
SCHEDULE A
DESCRIPTION OF PREMISES
Title No. SP28716-S
ALL that certain plot piece or parcel of land, situate,lying and being at Peconic,in
the Town of Southold,County of Suffolk and State of New York,bounded and described
as follows:
BEGINNING at a point on the easterly line of Wells Road, distant 3,031.90 feet southerly
along said easterly line from the southerly line of Main Road;
RUNNING THENCE along said easterly line of Wells Road,North 05 degrees 03
minutes 10 seconds West, a distance of 110.00 feet;
THENCE North 84 degrees 56 minutes 50 seconds East, a distance of 203.00 feet to the
mean high water mark of Richmond Creek as same formerly existed;
THENCE in a generally southerly direction along the mean high water line of Richmond
Creek as same winds and turns to a point, said point having a tie line course and distance
of South 16 degrees 21 minutes 45 seconds East, 112.18 feet from the previous point;
THENCE South 84 degrees 56 minutes 50 seconds West a distance of 225.00 feet to the
easterly line of Wells Road at the point or place of BEGINNING.
The policy to be issued under this report will insure the title to such building and improvements erected on the
premises which by law constitute real property.
FOR CONVEYANCING ONLY:
TOGETHER with all right,title and interest of the party of the fust part,of,in and to the land lying in the street in
front of and adjoining said premises.
DESCRIPTION
x
5;
Y
I
r'0Je 0,,j AJd&mhe-r q Zdi& see Exhibit "A"
attached; and
2) These covenants shall run with the land and shall be binding on the
DECLARANT (S) , his/her/their heirs, assigns, purchasers, or successors in
interest and may only be modified after a public hearing and upon
resolution of the Trustees.
IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this
day of
AUTUMN INFANDINO OWNER' SI NATURE 1
NOTARY PUBLIC,STATE OF NEW YORK
No. 01IN6343803
Qualified In Suffolk County
Commission Expires June 20,2020
OWNER'S SIGNAT RE
STATE OF NEW YORK )
COUNTY OF ) ss:
On the day ofin the year 20d, before me the
undersigned, a Notary Pu—b1i- in and for said State, personally appeared
Ln1107��n.� f ll�n.4 horersonally known to me or proved to me on the basis of
satisfactoryTevidence o be the individual (s) whose name (s) is/are subscribed to
the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their capacity, and that by his/her/their signature (s) on the instrument,
the individual or the persons on behalf of which the individual (s) acted, executed
the instrument.
Notary Public
AL)
C-
/\J 0
2
DECLARATION OF COVENANTS
r{
THIS DECLARATION made this a�1 sday of 4u v s }' I 2p
. �, by :.ipv�t 4
►.� �a }�2d�A t�c i i � &,J , residing at -8o os- WON 4e d, Peck.-i ,L JJJ.
J
hereinafter referred to as "DECLARANT (S)
W I T N E S S E T H
WHEREAS, DECLARANT (S) is/are the owner (s) of certain real property located
on 30oS WeAS &c1d , �LIC:oiO i C:
Town of Southold,
County of Suffolk, State of New York, described in the Suffolk County Tax Map as
District 1000, Section 6 ' (a , Block 0'L, ), Lot U O `7 which is more
particularly bounded and described as set forth in Schedule "A" annexed hereto,
hereinafter referred to as the Property;
WHEREAS, the Property is situated on lands within the jurisdiction of the
Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant
to Chapter 275 of the Town Code of the Town of Southold or its successor, and
various activities conducted upon the property may thus be subject to the
regulation and approval of the Trustees prior to being conducted;
WHEREAS, the DECLARANT (S) therefore made application to the Trustees for a
permit pursuant to the Wetlands Law of the Town of Southold to undertake certain
regulated activities; and
WHEREAS, as a condition of the granting of a Wetlands Permit to undertake
such regulated activities, the Trustees required that a /0 4),o +- Uc11'd e—
"non-turf buffer" adjacent to and landward of 'F-k-Q-
S'h ore, l i n1 e_
NOW, THEREFORE, the DECLARANTS) do/does hereby covenant and agree as
follows :
1) Upon the substantial completion of the aforementioned permitted
activities there shall be established and perpetually maintained
f
--- �`�- to '�o�' G I d if- "non-turf buffer" as
defined by Chapter 275 of the Town Code, to wit: "A designated area
where turf grass, pesticides and fertilizers are not ermitted." and as
depicted on the S' 1 0 n) Z9 !tom
1 .
t 11 {{
F11 21
/of pages '
JOE'!�I'� �•� P!ISUHLE
�g +.:LF-F,. u'r.
Ais document will be public L i:,,,;,-si_IL-'C,:'E
record. Please remove all
Social Security Numbers
prior to recording.
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 FEES
Page/Filing Fee Mortgage Amt.
1. Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 Sub Total
Notation Spec./Assit.
or
EA-52 17 (County) Sub Total Spec./Add.
EA-5217 (State) TOT. MTG.TAX
C ��y,, Dual Town Dual County
Held for Appointment
Comm. of Ed. 5. 00 sa Transfer Tax
` Mansion Tax
Affidavit � �'
>�ertified Copy �� The property covered by this mortgage is
or will be improved by a one or two
urcharge 15. 00 , family dwelling only.
Sub Total YES or NO
Other C/
Grand Total r. � . J If NO, see appropriate tax clause on
page# of this instrument.
4 1 Dist. 3462228 1000 08600 0200 004000 5 Community Preservation Fund
Real Property P T S II IIIII "11111110 Consideration Amount $
Tax Service R VIT A
Agency 21-4UG_17 CPF Tax Due $
Verification
Improved
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO: Vacant Land
E-1 I IE 4 6 A-/J TD
cw-
/U C vo 0 r.1C /l) D 2 IC TD
� � /0 d 2 TD
Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Com any Information
310 Center Drive, Riverhead, NY 11901 Co. Name
www.suffolkcountyny.gov/clerk Title#
8 Suffolk County RecordinLy & Endorsement Page
This page forms part of the attached made by:
(SPECIFY TYPE OF INSTRUMENT)
192'ar The premises herein is situated in
SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of
In the VILLAGE
or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
12.0104.10/08kk (over)
SOF SO!/ry
Michael J.Domino,President h�� ®l0 Town Hall Annex
John M.Bredemeyer III,Vice-President 54375 Route 25
P.O. Box 1179
Charles J.Sanders CA-) Southold, New York 11971
Glenn Goldsmith ® �� Telephone(631) 765-1892
A. Nicholas Krupski `+oU Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: /3//5/7
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1 st day of construction
'/2 constructed
Project complete, compliance inspection.
INSPECTED BY: /v, 14r�Ps!%
COMMENTS: n
males Keep p r 66,rA'�7 Ndf 6e eioA lb 9�_
CERTIFICATE OF COMPLIANCE:
r
f
h
i
' r ' IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
II
1 IIIIIIIVIIIVIIIIIIIIIII
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DECLARATION Recorded: 08/21/2017
Number of Pages: 5 At: 02 :10 :22 PM
Receipt Number : 17-0144089
LIBER: D00012926
PAGE : 185
District: Section: Block: Lot:
1000 086.00 02 .00 004 .000
EXAMINED AND CHARGED AS FOLLOWS
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $25.00 NO Handling $20 .00 NO
COE $5 . 00 NO NYS SRCHG $15.00 NO
TP-584 $0 .00 NO Notation $0 . 00 NO
Cert.Copies $6.25 NO RPT $200 . 00 NO
Fees Paid $271 .25
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
CC# : C17-35020
h.\5
COUNTY CLERK'S OFFICE
STATE OF NEW YORK
COUNTY OF SUFFOLK
I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court
of Record thereof do hereby certify that I have compared the annexed with the original
DECLARATION
recorded in my office on 08/21/2017 under Liber D00012926 and Page 185 and,
that the same is a true copy thereof, and of the whole of such original.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County
and Court this 08/21/2017
SUFFOLK COUNTY CLERK
JUDITH A.PASCALE
SEAL
John M. Bredemeyer III, President \ c�` - coG': Town Hall Annex
Michael J Domino, Vice-PresidentY� ��= 54375 Route 25
Glenn Goldsmith o z `•' P.O_ Box 1 179
A. Nicholas Krupski `� ® " - off;, Southold, NY 11971
Charles J. Sanders = 07a Y Telephone (631) 765-1892,
Fax (631) 765-6541
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
% constructed
`� Project complete, compliance inspection
TENNIS AND CONDITI(
The Permittee Bernadette Hogan residiniz at 3005 Wells Road, Peconic,New York as part of the
consideration for the issuance of the Permit does understand and prescribe to the following:
1. That the said Board of Trustees and the Town of Southold are released from any and all
damages, or claims for damages,of suits arising directly or indirectly as a result of any
operation performed pursuant to this permit, and the said Permittee will,at his or her own
expense, defend any and all such suits initiated by third parties, and the said Permittee
assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees
of the Town of Southold.
2. That this Permit is valid for a period of 24 months,which is considered to be the estimated
time required to complete the work involved,but should circumstances warrant,request for
an extension may be made to the Board at a later date.
3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to
maintain the structure or project involved,to provide evidence to anyone concerned that
authorization was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or its
agents, and non-compliance with the provisions of the originating application may be cause
for revocation of this Permit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the work herein
authorized.
6. That there shall be no interference with the right of the public to pass and repass along the
beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations in the
location of the work herein authorized, or if,in the opinion of the Board of Trustees,the work
shall cause unreasonable obstruction to free navigation,the said Permittee will be required,
upon due notice, to remove or alter this work project herein stated without expenses to the
Town of Southold.
8. 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. No right to trespass or interfere with riparian rights. This permit does not convey to the
permittee any right to trespass upon the lands or interfere with the•riparian rights of others in
order to perform the permitted work nor does it authorize the impairment of any rights,title,
or interest in real or personal property held or vested in a person not a party to the permit.
John M. Bredemeyer 11 1,President tf S0 Town Hall Annex
Michael J.Domino,Vice-President �� 0l0 54375 Route 25
Glenn Goldsmitht P.O.Box 1179
Southold,New York 11971
A.Nicholas Krupski G
Telephone(631) 765-1892
Charles J.Sanders ® Fax(631) 765-6641
I�cUUNTY,��
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 19, 2016
Jeffrey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934
RE: BERNADETTE HOGAN
3005 WELLS ROAD, PECONIC
SCTM# 1000-86-2-4
Dear Mr. Patanjo:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, October 19, 2016 regarding the above matter:
WHEREAS, Jeffrey Patanjo on*behalf of.BERNADETTE,HO.GAN, 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 September 15, 2016, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory
Council and to the Local Waterfront Revitalization Program Coordinator for their findings
and recommendations, and,
WHEREAS, the LWRP Coordinator issued a recommendation that the application be
found Consistent with the Local Waterfront Revitalization Program policy standards,
and,
WHEREAS, a Public,Hearing was held by the Town Trustees with respect to said
application on October 19, 2016, 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
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 approve the application of BERNADETTE
HOGAN to stabilize the shoreline with the use of approximately 60 linear feet of coir
logs; and revegetate the coir log and disturbed areas using native vegetation; with the
condition to establish and perpetually maintain a 10' wide non-turf buffer landward of the
shoreline; and as depicted on the site plan prepared by Jeffrey Patanjo, revised on
October 29, 2016, and stamped approved on November 4, 2016.
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.)
9
Fees: $50.00
Very truly yours,
John M. Bredemeyer III
President, Board of Trustees
JMB/dd
John M Bredemeyer III, President :'`o�� o0o Town Hall Annex
Michael J Domino, Vice-President '� y�; 54375 Route 25
Glenn Goldsmith o � '� � P O_ Box 1179
A. Nicholas Krupski :oy o - � " Southold, NY 11971
Charles J_ Sanders X01 , � � :;. Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO:
Please be advised that your application dated
–<Q>(—ct - I5; 2-0f too has been
reviewed by this Board at the regular meeting of 00095k Wt 10 and
your application has been approved pending the completion of the following items
checkeri off below.
Revised Plans for proposed project
Pre-Construction Hay Bale Line Inspection Fee ($50.00)
1 St Day of Construction ($50.00)
'/2 Constructed ($50.00)
Final Inspection Fee ($50.00)
Dock Fees ($3.00 per sq. ft.)
The Permittee is required to provide eV'idence that the non-turf buffer condition
of the 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.
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: $ ®��
BY_ John M_ Bredemeyer III, President
Board of Trustees
� w
�APPROVED•-BY'
NOTES: _ ' = I EXISTING ADJACENT DOCK
- 40ARD OF TRUSTEE
1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM IIN OF SOOT ,
2. LOT AREA: 23,540.35 S.F. / 0.540 ACRES
3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: 1Voit �ER , ��
GREEN BY DESIGN, PLLC `
6 STRATHMORE DRIVE NORTH BABYLON, NY
SURVEY LATEST DATED JANUARY 19, 2013 ' CZ
Q
O
it
#2875 WELLS ROAD
WILLIAM & VICTORIA D. GORDON 00' d
117 HUNTINGTON ROAD 203-00
PORT WASHINGTON, NY 11050 I
0000,
LINE OF 10' WIDE NON-TURF
SHS BUFFER ALONG BANK EXISTING FIXED PIER
ao �.
C '60 E EXISTING TIDAL WELTALNDS AS IDENTIFIED
840 Si / 1 BY J. PATANJO ON 8/27/16
N ,
sPROPOSED COIR LOG AND PLANTINGS BANK STABILIZATION.
COIR LOGS TO BE PLANTED AS SHOWN IN TYPICAL SECTION
OR ACCORDANCE WITH TOWN AND NYSDEC RECOMMENDATIONS
To
�
\ 60'
o \ EXISTING ADJACENT DOCK
r0010 E GENE
� s
225 0(
� NOV - 3 2016
Southold Town
0000 Board of Thistees0
oo / PROPERTY OWNER:
® 00',5p'' #3065 WELLS ROAD BERNADETTE M HOGAN
S 8Q056 ALAN WELLS ROAD
�WATSON JONATHAN ZAVIN PTAX
Sho�eR= Stabilizdion PeMit SCALE:
P065 W, S 11 D 250 WEST 90TH STREET APT 15K 1"=30'
NEW YORK, NY 10024
PREPARED BY: PROPOSED PLAIN DATE:
9-5-16
JEFFREY PATANJO _ 10-29-16
106 HEWITT BOULEVARD 3005 WELLS ROAD
CENTER MORICHES, NY 11934ONIC, TOWN OF SOUTHOLD
631-484-9332 SUFFOLK COUNTY, NY SHEET:
JPATANJOQOPTONLINE.NET AP N0. 1000-086-0,2-004 1 OF 2
xs'
- 'SO'U hold towR,r= -' - f,a"��' '' -'jllntll•r%Cnf!cp,t ';�
_ i Itnieo-riati 0•ns�:" ,-- ri 'ti,}.Nt,iaHY'/Y9iMiaf>s Ur,�;', _
- �Sou;hGiG AnnaI ShPllCrt=,t• -��,��� 'ti :� .
•2;:`'�Y.'IRdvl'IrftlIR12R1��'- f - - - w\ f ,
LOCATION
• Sc3.t'dc11bQ:.0 t7cn1�,�~'d ;�`�`". 1 - ;°:1,, .���;` - I '"
;F,�-tx¢A,r,
is A'
x'
PROJECT LOCATION MAP
N.T.S.
10 FPROPOSED 4' WIDE MARITIME PLANTING AREA ALONG
UPPER BANK. PLANT WITH ARCTOSTAOHYLOS
uva—ursi 'MASSACHUSSETTS — BEARBERRY 0 24" O.C.
PROPOSED COIR LOS STAKED 2' O.C.
PROPOSED INTER IDAL MARSH AREA TO BE
8 PLANTED W1 2" 3PARTINA ALTERNIFL)RA PLUGS
0 12" O.C.
6
4 1 E I E
2 — — — - - — — — — - - - - - - - - - - -- 2.
AF
NOV - 3 2016
APPROXIMATE M,LW EL. 0.0±
� Southold To+Nn
'I Board f Thistem
EXISTING GRADE
Pmposed Shoreline Stabilization Permit SCALE:
—4 AS NOTED
TYPICAL SECTION & DATE:
TYPICAL SECTION � _
LOCATION MAP 910-29-16
5 6
H: 1"=20' 3005 WELLS ROAD
SCALE: PECONIC, TOWN OF SOUTHOLD
V: 1 =2 SUFFOLK COUNTY, NY SHEET:
TAX MAP N0. 1000-086-02-004 2 0F 2
NOTES: EXISTING ADJACENT DOCK N
1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM
2. LOT AREA: 23,540.35 S.F. / 0.540 ACRES
3. PORTIONS OF PLAN FROM SURVEY PREPARED BY:
GREEN BY DESIGN, PLLC
6 STRATHMORE DRIVE NORTH- BABYLON, NY
SURVEY LATEST DATED JANUARY 19, 2013
O
� 0 +
#2875 WELLS ROAD
WILLIAM & VICTORIA D. GORDON p0'
117 HUNTINGTON ROAD 203.0
PORT WASHINGTON, NY 11050 /ILO
^ .�
�,-
1 O
vo sN0 _ \\ EXISTING FIXED PIER
d + o'' E EXISTING TIDAL WELTALNDS AS IDENTIFIED
4066661 BY J. PATANJO ON 8/27/16
PROPOSED RIP—RAP BANK STABILIZATION.
RIP—RAP TO BE 150 — 400 LB AND PLACED
IN A TIGHT PATTERN. SEE TYPICAL SECTION
w y � 60'
o\ � EXISTING ADJACENT DOCK
000, njD E C E � V E
SEP 1 5 2016
Southold Town
o Gard of Trustees
o /t� ! PROPERTY OWNER:
+ Y� #3065 WELLS ROAD BERNADETTE M HOGAN
S 8a�5650 3 65 WELLS ROAD 2 ALAN & SHIRLEY WATSON i 0 0T
AWEST 9IH STREET APT 15K Proposed Shoreline Stabilization Permit SCALE:
PECONIC, NY 11958 NEW YORK, NY 10024 1"=30'
PREPARED BY: PROPOSED PLAN DATE:
JEFFREY PATANJO
106 HEWITT BOULEVARD
CENTER MORICHES, NY 11934 aoos WELLS ROAD
631-484-9332 PECONIC, TOWN OF SOUTHOLD
JPATANJOC�OPTONLINE.NET SUFFOLK COUNTY, NY SHEET:
TAX MAP N0. 1000-086-02-004 1 OF 2
Sou:huld Toxn.` • „� T'MhyCoU<p–
ReaeoI—Dept�4A �, N.—Y Lmd5eepe
OSauttwldArunwl5deller\j Vr
i
Gnm"r Cu;lom re ��� se L '
VhMoa Tf<etment•1 j t c ' e
p LOCATION
Southold VWtce Pepl(�)�.=�� Ij 1 - I
nden;itr r ` ZI(jMe Harvest iMine3005 Wclfs 16
f _ 0 u, t
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n�pla<f� �t
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PROJECT LOCATION MAP
N.T.S.
10
PROPOSED STABILIZATION FABRIC
PROPOSED 150 - 400 LB RIP RAP TIGHTLY FIT
8 10 CR E A STABtrZE
6
4
- - - - A PROXIMATE M.H.W_EL. 2_5f
0 A PROXIMATE M.L.W EL. 0.0±
EXIS ING GRADE
PTAX
Shoreline Stabilization Permit SCALE:
—4 AS NOTED
YPICAL SECTION & DATE:
TYPICAL SECTION LOCATION MAP 9-5-16
H: 1 -20' 3005 WELLS ROAD
SCALE: „- ONIC, TOWN OF SOUTHOLD
V: 1 =2 SUFFOLK COUNTY, NY SHEET:
AP N0. 1000-086-02-004 2 of 2
THIS MAP IS COPYRIGHTED UNDER FEDERAL
COPYRIGHT LAWS. THE REPRODUCTION OR
DISTRIBUTION OF THIS MAP IS A VIOLATION
OF THAT LAW WITHOUT THE WRITTEN
PERMISSION OF THE AUTHOR. THE
ISSUANCE OF THE MAP FOR CONVEYANCE
PURPOSES IS NOT TO BE MISCONSTRUED AS
PERMISSION TO EITHER REPRINT OR PUBLISH
THIS MAP. ANY ONE WHO EITHER
REPRODUCES, ISSUES OR RECEIVES COPIES
FROM ANYONE OTHER THAN THE PREPARER
IS IN VIOLATION OF FEDERAL LAW AND WILL
I BE PROSECUTED:
rl
NOTE:
31 METES AND BOUND DESCRIPTION SHOWN
/ 1p
HEREON REFERENCES THE COORDINATE
00, / SC • SYSTEM SHOWN IN THE DEED.
2O3. I �
�a
N 8 /
CERTIFIED TO:
FIRST AMEor RICAN
ILS INSURANCE COMPANY
y0p�- CP FR ® CITIBANK, N.A.
ER�NG °'- SNSo m
EPN 8 Fft NE �\ FOR:
P
M e�oCK oVR 1p4K a JONATHAN ZAVIN
O (burled) BERNADETTE M. HOGAN
7S 1�0
c9
J
Unauthorized alteration or addition to this
N 1C survey is a violation of Section 7209 of the
00�
New York State Education Law
FIREPLACECopies of this survey map not bearing the
Lano PSP FR `
shall or's Inked r not beconsidered al for bea Embossed )
valid true
G
LP copy
_ \ \
the
Guarantee indicated
nfsurvey is
lor twhom the nshall np prepared,
O 4 co and on his behalf to the Title Company,
GJ N
7 -A 'y Governmental Agency and Lending Institution
LIG H a Cn 2� listed hereon, and to the Assignees of the
�ok \ Lending Institution.
r Guarantees are NOT TRANSFERABLE to additional
�F�G 109 Q�� ( a institutions or subsequent owners.
y �V1 Record description was not furnished in the
\ C- 10 preparation of this survey
GJ2' 'oj Ur 01
5•, MAP OF SURVEY OF
s
�3 DESCRIBED PROPERT
w ao SITUATED AT
o woo0 EENGE �
rn aa� PECONIC
w i
o� o w000 FENCE P�o PNS\NG Row <atear� n Elwt� JD�y TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YO
��4
o- , OH/W 1 SEP 1 5 2016
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� 0 O i bb Southold Town
O S a __bard of Trustees
�a-Z, .� / � _mSCTM 1000-086-02-004 PROJECT NO.: 1252-13
SCALE: I in. = 20 ft. DATE. JAN 19, 2013
° r NES \
J
�� �/- it _Cts, _ �Av�.rr7 usrrtc�va ar va)-Y
John M. Bredemeyer III, Presi , d��uFFQjK� Town Hall Annex
Michael J. Domino, Vice-Preside'�it— y��o� �G� 54375 Route 25
Glenn Goldsmith
j P.O. Box 1179
A. Nicholas Krupski o Southold, NY 11971
Charles J. Sanders ti�j0 ao� � Telephone (631) 7654892
xu .s Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD,
Date/Time: 1( , 2Z /2 Completed in field by: Y
Jeffrey Patanjo on behalf of BERNADETTE HOGAN requests a Wetland Permit to construct 60 linear
feet of rip-,rap using 150-400 pound stone. Located: 3005 Wells Road, Peconic. SCTM# 1000-86-2-4
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming ,Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF: '
1.
LUFF: -
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary-leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 SEQRA Type:-1 II Unlisted Action
Type of'Application: Pre-Submission Administrative Amendment Wetland-
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line
Additional information/suggested modifications/conditions/need for outside
review/consultant/application-'completeness/comments/standards:
sSsi��
d
Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski
C. Sanders Other
Page 1 of
�uFF 0(� .
John M. Bredemeyer III, Presic ,s pS �'� Town Hall Annex
Michael J Domino, Vice-President �o� �G�v 54375 Route 25
Glenn Goldsmith o `� P.O. Box 1,179
A. Nicholas Krupski o Southold, NY 11971
Charles J..Sanders y�j� ao��, Telephone (631) 765-1892
ter:�r
Fax (6,31) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Completed in Work Session by:
Jeffrey Patanjo on behalf of BERNADETTE HOGAN requests a Wetland Permit to construct 60 linear
feet of rip-rap using 150-400 pound stone. Located: 3005 Wells Road, Peconic. SCTM# 1000-86-2-4
Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=*
A. Adversely affect the wetlands of the Town:
B. Cause damage from erosion, turbidity or siltation:
C. Cause saltwater intrusion in the fresh water recourses of the Town:
D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic
wildlife-& vegetation or the natural habitat thereof:
E. Increase the danger of flood and storm-tide damage:
F. Adversely affect 'navigation tidal waters or the tidal flow of the-tidal waters of the Town:
G. Change the course of any channel or the natural movement or flow of any waters:
H. Weaken or undermine the lateral support of other lands in the vicinity:
I. Otherwise adversely affect the health, safety and general welfare of the people of the Town:
-J. Adversely affect the aesthetic value of the wetland and adjacent areas:
Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=*
A. Is reasonable'and necessary, ,considering reasonable alternatives to the proposed
activity and the extent to which the proposed activity requires a shoreline location:
B. Is not likely to cause a measurable increase in erosion at the proposed site and at
other locations:
C. Prevents, if possible, or minimizes adverse effects on natural protective features
and their functions and protective values,, existing erosion protection structures
and natural resources:
D. :525% Expansion/Calculation
Work Session Notes Application Complete
SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration
CAC:
LWRP:
Additional information on comments/to be discussed/Public Hearing:
Date: Completed By:
Present: J. Bredemeyer M. Domino G: Goldsmith N. Krupski
C. Sanders E. Cantrell D. Di Salvo Other
Page 2 of 2
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ernadette Hogan
•�005 Wells Road, ' •
ti k llC 1000-86-2-4
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ette Hogan
.0 3005 Wells Road,Peconic
CTm#: 1000-86-2-4
10/11/16
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September 12, 2016
NYS Dept. of Environmental Conservation
SUNY @ Stony Brook
50 Circle Road
Stony Brook, New York 11790-2356
Attention: Duty.Analyst
RE: 3005 WELLS ROAD, PECONIC, NY
SUM No. 1000-086-02-004
APPLICATION FOR PERMIT
Dear Sir/Madame:
We hereby submit four (4) copies of the proposed plans, applications, check,
photographs and required data for permit approval for the above referenced project.
If you should have any questions or require anything further, please do not hesitate to
call me at 631-484-9332 or e-mail at jpatanjo@optonline.net.
Very truly yours,
). PL9;;; —
Jeffrey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934
cc: NYSDOS --
Town of Southold nJD �� E � E jF�
Bernatette Hogan �'JI
SEP 1 5 2016 !L'�
i
e
{! Southold Town
JOINT APPLICATION FORM
For Permits/Determinations to undertake activities affecting streams,waterways,
waterbodies,wetlands, coastal areas and sources of water withdrawal.
New York You must separately apply for and obtain separate Permits/Determinations from US Army Corps ofEngineers(USAGE)
State each involved agency prior to proceeding with work. Please read all instructions.
APPLICATIONS TO
1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart-
General Services ment of State
Check all permits that apply: Check all permits that apply:
his
❑Stream Disturbance 13 Coastal Erosion ❑Section 404 Clean Water Act Check all permits that Check if tanagement apply: . a lies:
M
❑ Excavation and Fill in ❑Section 10 Rivers and Harbors ❑ State Owned Lands L`7 Coastal
Navigable Waters ❑Wild,Scenic and Act
Recreational Rivers Under Water Consistency
R
❑ Docks, Moorings or ❑ Nationwide Permit(s)-Identify ❑Utility Concurrence
Platforms ❑ Water Withdrawal Number(s): Easement
❑Dams and Impoundment ❑ Long Island Well (pipelines,
Structures ❑Aquatic Vegetation Control conduits,
11401 Water QualityAquatic Insect Control cables,etc.)
❑
Certification Preconstruction Not fication-
❑Docks
❑ F eshwater Wetlands ❑ Fish Control F-1Y / N Moorings or
ElIncidental Take of Endan- Platforms
Tidal Wetlands gered/Threatened Species
� ElI am sending this application ❑ I am sending this Blam sending
2e/
I am sending this application to this agency. to this agency. application to this this application
agency. to this agency.
5. Name of Applicant(use full name) Applica must be: 6. Name of Facility or Property Owner(if different than
Owner Applicant)
Se-•nd.A,-,$$e_ 14p -AA ❑Operator
Mailing Address ❑ Lessee Mailing Address 4
(check all that apply)
VJ16s"r Ctots, AP-r ISK
Post Office City Taxpayer ID(If applicant Post Office City
K_ is NOT an individual):
State \I Zip Code ' ®� State Zip Code
Telephone(daytime) Email Telephone(daytime) Email
9t� - G�R - ���q
7. Contact/Agent Name 8. Project/Facility Name Property Tax Map Section/Block/Lot Number
3®®5' &Ve'I16 fz4 • lve"p - 6,6&-®q-a,0-1
Company Name Project Location- Provide directions and distances to roads,bridges and bodies of waters:
Mailing Address Street Address,if applicable Post Office City State Zip Code
NY
DVb F�@mss +-ir
PeConae a ►�s�
Post Office City Town/Village/City County
C,z�+$er e✓I®�Ich� �®��-�1 r� Sv F•F®SIG
State Zip Code Name of USGS Quadrangle Map Stream/Water Body Name
><0,tim 'P'9 A Creek-
Telephone(daytime) I• y 9 Location Coordinates: Enter NYfMs in kilometers,OR Latitude/Longitude
Email NYTM-E NYTM-N Latitude Longitude
P��an .� � mQ•r��lia+� •��' X14"Pal•16�{
I v ' !P!—T• '" e'�.iN't' r n. ' ,r'(i
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' eia� 7'•y .a!'n "`f'_^,i!FF-1} n'L]�¢� .Or G y �erl!-St`rs[jd `r i�,.A ifi,
r, ! Y I 1.,:—�1 y"'upil�lMY'rA'x„,3`3•e �y 4 T ) fi} Ir fh t ,+ i'_ 1 •Si�
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JOINT APPLICATION FORM 02/13 This is a 2 Page Application Application Form Page 1 of 2
Both Pages Must be Completed
r � -
30INT APPLICATION FORM-PAGE 2 OF Z
Submit this completed page as part of your Application.
9. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose.Attach additional pages)if
necessary. Include: description of current site conditions and how the site will be modified by the proposed project;structures and fill materials to
be installed; type and quantity of materials to be used (i.e., square ft of coverage and cubic yds of fill material and/or structures below
! ordinary/mean high water)area of excavation or dredging,volumes of material to be removed and location of dredged material disposal or use;
work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource
impacts; and where applicable,the phasing of activities. AnACH PLANS ON SEPARATE PAGES.
!
f �
� ff �thte CrDr inV L' IL WCk� A(i-tZr%•10 Gtvic� 51'ra°�eee`rc®,5
.q'I .�,®l�'!� 2'® (2,-tA,?41ecQ a,hmu� r•l �e ��
d& Srj.,P4"aa� �® �C �2"c�$'a �} f
sS) -(-L fa ems rf� a .
Proposed Use: 2Private ❑ Public ❑Commercial Proposed , . d Estimated !2
Start Date: Completion Date:
Has Work Begun on Project? ❑Yes No If Yes,explain.
!
Will Project Occupy Federal,State or Municipal Land? ❑Yes o If Yes,please specify.
10. List Previous Permit/Application Numbers(if any)and Dates:
1 � 4-73 �
11. Will this project require additional Federal,State,or Local Permits including zoning changes? Yes ❑No If yes,please list:
ij'14lbtp&II /
•Tows .9P CSvu4hvid- Te scot: ,es
12. Signatures.if applicant is not the owner, both must sign the application,
I hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge
and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.
Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered,
arising out of the project described herein and agrees to indemnify and save harmless the State from suits,actions,damages and
costs of every name and description resulting from said project.in addition,Federal Law, IS U.S.C.,Section 1001 provides for a fine
of not more than$10,000 or imprisonment for not more than 5 years,or both where an applicant knowingly and willingly falsifies,
conceals,or covers up a material fact- or knowingly makes or u es a false,fictitious or fraudulent statement.
/�� I ,x,--,�3 A c t'i C 0 6 A-,.1 Aef 1,a-4"
Sig re of Applicant U Printed Name Title Date
TOA 1-11A�6. 71 1 Al 1PwVA44-' /Z. eL
IS ature of Owned printed Name Title Date
i Si a e of A e Printed Naline T— Tit# Date
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JOINT APPLICATION FORM 02/1$ Application Form Page 2 of 2
1 I
NEWYORK ®tep�P't81�en$ of
STATE OF
O PORTTUMITY, I nvironP1 entai PERMISSION TO INSPECT PROPERTY
Conservation
By signing this permission form for submission with an application for a permit(s) to the
Department of Environmental Conservation ("DEC'), the signer consents to inspection by DEC staff
of the project site or facility for which a permit is sought and, to the extent necessary, areas adjacent
to the project site or facility. This consent allows DEC staff to enter upon and pass through such
property in order to inspect the project site or facility, without prior notice, between the hours of 7:00
a.m. and 7:00 p,m., Monday through Friday. If DEC staff should wish to conduct an inspection at any
other times, DEC staff will so notify the applicant and will obtain a separate consent for such an
inspection.
Inspections may take place as part of the application review prior to a decision to grant or deny
the permit(s) sought. By signing this consent form, the signer agrees that this consent remains in
effect as long as the application is pending, and is effective regardless of whether the signer,
applicant or an agent is present at the time of the inspection. In the event that the project site or
facility is posted with any form of "posted" or "keep out" notices, or fenced in with an unlocked gate,
this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of
inspection.
The signer further agrees that during an inspection, DEC staff may, among other things, take
measurements, may analyze physical characteristics of the site including, but not limited to, soils and
vegetation (taking samples for analysis), and may make drawings and take photographs.
Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s)
sought by the application.
Permission is granted for inspection of property located at the following address(es):
3®Ds- .PQ a cc.,iae
By signing this form. I affirm under penalty of perjury that 1 am authorized to give consent to entry
by DEC staff as described above. / understand that false statements made herein are punishable
as a Class A misdemeanor pursuant to Section 290.45 of the Penal Law.*
F,6eer&�Qe- e 2e4ni vwnet;— I q JZ /cam
Print Name and Title Slgnat& Date
*The signer of this form must be an individual or authorized representative of a legal entity that:
owns fee title and is in possession of the property identified above;
maintains possessory interest in the property through a lease, rental agreement or other
legally binding agreement; or
is provided permission to act on behalf of an individual or legal entity possessing fee title or
other possessory interest in the property for the purpose of consenting to inspection of such
property.
Permission to Inspect Property Application Supplement 3/16
Short Environmental Assessment Form
Part 1 -.Prgject hifornmtion
Instructions for Completing
Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part I based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency,attach additional pages as necessary to supplement any item.
Part 1-Project and Sponsor Information
Name of Action or Project:
301,05' wells A& — P.eooniL
Project Location(describe,and attach a location map):
S to (,v C w.'f"i ern /Abu
Brief Description of Proposed Action:
CoASc Ave+ 6 G LF v f- (1.4,/° IS koro 1i He 54-e46LI-tovt'7 oN
ae10-15 -xcshny ereo�e,? b"IL
Name of Applicant or Sponsor:� EE-Mail:
elephone: 91 6 g � g&
eCeJe'+ a yo q w
Address.
860 WeST 901t6 5-r APT 16"K—
Zip Code:
A)
City/PO: State.
Nem y�.�� l nosy
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ®'
may be affected in the municipality and proceed to Part 2 If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
NybOifL I hJ4SD17fV Tor.+ -P 5sv+A*11Q T'rv�'1'ttS
3 a Total acreage of the site of the proposed action? V.S`t acres
b. Total acreage to be physically disturbed? -a.D 13 acres
c. Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? O•�4 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban []Rural(non-agriculture) ®Industrial ❑Commercial B<esidential (suburban)
❑Forest ❑Agriculture ❑Aquatic [3 Other(specify):
❑Parkland
Page 1 of 3
5. Is the proposed action; NO YES N/A
a.A permitted use under the zoning regulations?
b. Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ® a
7 Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:Name:Peconc Bay and
Environs,NameRichmond Creek and Beach, Reason:Protect public health,w
ater,
vegeaion, sceniceauy, eason: igniscancoasaiswildlifeaia, gency: uoouny,
El Z
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
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? NO YES
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? NO YES
If No,describe method for providing potable water.
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment Er 1:1
12 a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? V
b. Is the proposed action located in an archeological sensitive area? ® 0
13. a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency?
b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: l=J
14. Identify the typical habitat types that occur on,or are likely to be found on the project site Check all that apply:
®Shoreline ®Forest ®Agricultural/grasslands []Early mid-successional
® Wetland ®Urban ❑Suburban
15.Does the site of the proposed action contain any species of ammal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? ® Z
16 Is the project site located in the 100 year flood plain? N® YES
17. Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? ®NO ®YES
b. Will storm water discharges be directed to established conveyance systemsrunoff and storm drains)?
If Yes,briefly describe NO ®YES
Page 2 of 3
18 Does the proposed action include construction of 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 facllitc'�
If Yes.describe u
20.IHas the site of the proposed action or an adjoining properly been the subject of remediation(ongoing or, NO YES
completed)for hazardous waste"
If Yes,describe•
I AFFIRM THAT THE Ili TFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: 4d own Date.
Signature-
PRINT
imature-PRINT Fq® M. Page 3 of 3
SAF Mapper Sump J Report Wednesday, September 07,2016 9:11
PM
Disclaimer: The EAF Mapper Is a screening tool Intended to assist
project sponsors and reviewing agencies In preparing an environmental
assessment form(EAF).Not all questions asked in the EAF are
answered by the EAF Mapper.Additional information on any EAF
question can be obtained by consulting the EAF Workbooks. Although
U the EAF Mapper provides the most up-to-date digital data available to
DEC,you may also need to contact local or other data sources in order
to obtain data not provided by the Mapper.Digital data Is not a
substitute for agency determinations.
'r�, I � - '�• �{)t0:c%Pa, �loritrom7 ,,� ,,
•7llU' 17 ri P.a'
• - - nJ�t.,u `��„ i• stir ''�'• ,
j� Toronto
4� - �I ��,�Rocheslor-' � A •
+t��4fti�1 •• ' ,-�' '• ��"'- - I(��,,!<fr•rI-• �A9toany ,
;Boston
CPevitstDtl - ;t f` }�)?',;Provictenee
5ciice;'••EsrLN'ERE,,06Lcrme,USES. `� i r, •,»;4}}s ,-ti
....,.•-r{�`•f's�2G'r'i• fir,„+ii�,,, ���,•,•z,»,
tty'rslt�i�144fnQm3�i`-iriia�m it;P, cep., t7RCAN,Esri air, n� pitttbur a Se�sc `ii, E.
cr JaFsri;lulETl;E�ii.C}iina;�#{Crig'Kcn�)?Esri Cdumbud,,n'', DeLp4 _ddt?as.InteamaP.
Ilk .inamentt'Cerp., PdRCAtJ,
r— °a4ti' cont ibutcrs,and tiie•GIS,User Community iclrinati :+ a"' I 'fl�laFIan,NIETl,Es'ri,Chins'•,,
Part 1 /Question 7 [Critical Environmental Yes
Area]
Part 1 /Question 7[Critical Environmental Name:Peconic Bay and Environs, Name:Richmond Creek and Beach,
Area- Identify] Reason:Protect public health,water,vegetation, &scenic beauty,
,Reason:Significant coastal fish &wildlife habitat,Agency:Suffolk County,
Agency:Southold, Town of, Date:7-12-88, Date:10-20-88
Part 1 /Question 12a [National Register of No
Historic Places]
Part 1 /Question 12b [Archeological Sites] Yes
Part 1 /Question 13a [Wetlands or Other Yes- Digital mapping information on local and federal wetlands and
Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook_.
Part 1 /Question 15 [Threatened or Yes
Endangered Animal]
Part 1 /Question 16 [100 Year Flood Plain] Yes
Part 1 /Question 20 [Remediation Site] No
Short Environmental Assessment Form - EAF Mapper Summary Report 1
NEW YORK STATE DEPARTMENT OF STATE
COASTAL MANAGEMENT PROGRAM
Federal Consistency Assessment Form
An applicant,seeking a permit,license,waiver,certification or similar type of approval from a federal agency which
is subject to the New York State Coastal Management Program(CMP),shall complete this assessment form for any
proposed activity that will occur within and/or directly affect the State's Coastal Area. This form is intended to
assist an applicant in certifying that the proposed activity is consistent with Nev York State's CMP as required by
U.S. Department of Commerce regulations(15 CFR 930.57). It should be completed at the time when the federal
application is prepared. The Department of State will use the completed form and accompanying information in its
review of the applicant's certification of consistency.
A.APPLICANT (please print)
1. Name:- 13er%-d,-4+ci4plera
2. Address: ?5® -RebT '4e9 4b 5T .AP', d 6-K d A�eW b/®dK, J04 t 6s ay
3. Telephone: Area Code( ) q 17 _ ep -& 4 - 1 q
B.PROPOSED ACTIVITY
t
r
1. Brief description of activity:
r
2. Purpose of activity:
f"eS-r)Ap er®A� daoa. -Fa Ca.t�reAt et&,ck eebren
3. Location of activity:
County City,Town,or Village Street or Site Description
4. Type of federal permit/license required: 4-0 1.4
5. Federal application number,if known: ?JJA
6. If a state permit/license was issued or is required for the proposed activity,identify the state agency and
provide the application or permit number,if known:
1
C.COASTAL ASSESSMENT Check either"YES"or"NO"for each of these questions. The numbers following
each question refer to the policies described in the CMP document(see footnote on page 2)which may be affected
by the proposed activity.
1.Will the proposed activity result in any of the following: YES/NO
a. Large physical change to a site within the coastal area which will require the preparation
of an environmental impact statement? (11,22,25,32,37,38,41,43) 0
b. Physical alteration of more than two acres of land along the shoreline,land ❑
under water or coastal waters? (2, 11, 12,20,28,35,44)
c. Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1) ❑
d. Reduction of existing or potential public access to or along coastal waters? (19,20) ❑
e. Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10)
f. Siting of a facility essential to the exploration,development and production of energy
resources in coastal waters or on the Outer Continental Shelf? (29) ❑ [f
g. Siting of a facility essential to the generation or transmission of energy? (27) ❑ [�'
h. Mining,excavation,or dredging activities,or the placement of dredged or fill material in
coastal waters? (15,35) ❑_ �_
i. Discharge of toxics,hazardous substances or other pollutants into coastal waters? (8, 15,35) ❑
j. Draining of stormwater runoff or sewer overflows into coastal waters? (33) ❑ [�'
k. Transport,storage,treatment,or disposal of solid wastes or hazardous materials? (36,39) ❑
1. Adverse effect upon land or water uses within the State's small harbors? (4) ❑ [�
2.Will the proposed activity affect or be located in,on,or adjacent to any of the following: YES/NO
a. State designated freshwater or tidal wetland? (44) [l Q
b. Federally designated flood and/or state designated erosion hazard area? (11, 12, 17) all-
c.
Qc. State designated significant fish and/or wildlife habitat? (7) a❑
d. State designated significant scenic resource or area? (24) Q-a
e. State designated important agricultural lands? (26) a a
f. Beach,dune or barrier island? (12) ❑. [�
g. Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3)
h. State,county,or local park? (19,20) 12 ff
i. Historic resource listed on the National or State Register of Historic Places? (23) Q L
3.Will the proposed activity require any of the following: YES/NO
a. Waterfront site? (2,21,22) ❑ 0'
b. Provision of new public services or infrastructure in undeveloped or sparsely populated
sections of the coastal area? (5) ❑ [7
c. Construction or reconstruction of a flood or erosion control structure? (13, 14, 16) a❑
d. State water quality permit or certification? (30,38,40) ❑
e. State air quality permit or certification? (41,43) ❑ [�
4.Will the proposed activity occur within,and/or affect an area covered by a State-approved local waterfron❑_
revitalization program,or State-approved regional coastal management program? (see policies in program
document*)
1 �
1 -
D.ADDITIONAL STEPS
1. If all of the questions in Section C are answered"NO",then the applicant or agency shall complete
Section E and submit the documentation required by Section F.
2. If any of the questions in Section C are answered"YES",then the applicant or agent is advised to
consult the CMP, or where appropriate, the local,waterfront revitalization program document*. The proposed
activity must be analyzed in more detail with respect to the applicable state or local coastal policies. On a separate
page(s),the applicant or agent shall: (a)identify,by their policy numbers,which coastal policies are affected by the
activity,(b)briefly assess the effects of the activity upon the policy; and,(c)state how the activity is consistent with
each policy. Following the completion of this written assessment,the applicant or agency shall complete Section E
and submit the documentation required by Section F.
E.CERTIFICATION
The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved
local waterfront revitalization program,as appropriate. If this certification cannot be made,the proposed activity
shall not be undertaken. If this certification can be made,complete this Section.
"The proposed activity complies with New York State's approved Coastal Management Program, or with the
applicable approved local waterfront revitalization program,and will be conducted in a manner consistent with such f
f
program."
Applicant/Agent's Name: - " e't-i ��'�`�.'I e
Address: 1916 14ew a i 1 VA, O-e-i c-r AlI co Pi G�,e 5, /J4 t 1 q'-�y
Telephone: Area Code( 6�' ) q b q ;-
Applicant/Agent's.Signature: gwz_ Date:
F.SUBMISSION REQUIREMENTS
1. The applicant or agent shall submit the following documents to the New York State Department of State,
Office of Coastal, Local Government and Community Sustainability, Attn: Consistency Review Unit, One
Commerce Plaza-Suite 1010,99 Washington Avenue,Albany,New York 12231.
a. Copy of original signed form.
b. Copy of the completed federal agency application.
C. Other available information which would support the certification of consistency.
2. The applicant or agent shall also submit a copy of this completed form along with his/her application to the
federal agency.
3. If there are any questions regarding the submission of this form,contact the Department of State at
(518)474-6000.
*These state and local documents are available for inspection at the offices of many federal agencies, Department of
environmental Conservation and Department of State regional offices,and the appropriate regional and county planning agencies.
Local program documents are also available for inspection at the offices of the appropriate local government.Revised 10/04/1010
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NOTICE SECTION NO
COUNTY OF SUFFOLK 086
Real Property TaX Service Agenry Y
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L A --- OPERTY MAP
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D FTR:0PERW—
October 29, 2016
Town of Southold Trustees
Town Hall Annex Building C E � V
54375 Rte. 25
P.O. Box 1179
Southold, New York 11971 NOV - 3 2016
RE: 3005 WELLS ROAD, PECONIC, NY Southold lown
SCTM No. 1000-086-02-004 Board of Trustegs
REVISED DRAWINGS
Dear Trustees:
We hereby submit four (4) copies of revised plans per comments made at the recent
public hearing. Plans have been revised to include a 10' non-turf buffer along with the
proposed stabilization to be coir logs and plantings in lieu of rip-rap as originally
proposed. We will forward the $50 final inspection check once received from client.
If you should have any questions or require anything further, please do not hesitate to
.call me at 631-484-9332 or e-mail at jpatanjo@optonline.net.
Very truly yours,
I
_ d
Jerey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934
a
r
� f SO�j�
OFFICE LOCATION: ®� ®1 MAILING ADDRESS:
Town Hall Annex CIO P.O. Box 1179
54375 State-Route 25 Southold, NY 11971
(cor.Main Rd. &Youngs Ave.) C
Southold, NY 11971 a� Telephone: 631 765-1938
®l�C Fax: 631765-3136
h
LOCAL WATERFRONT REVITALIZATION PROGRAM
a
TOWN OF SOUTHOLD
MEMORANDUM
To: John Bredemeyer, President
Town of Southold Board of Trustees
From: Mark Terry,,LWRP Coordinator
Date: October 11', 2016
Re: LWRP Coastal Consistency Review for BERNADETTE HOGAN
SCTM# 1000-86-2-4
Jeffrey Patanjo on behalf of BERNADETTE HOGAN requests a Wetland Permit to construct 60
linear feet of rip-rap using 150-400 pound stone. Located: 3005 Wells Road, Peconic. SCTM#
1000-86-2-4
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold-Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation that
the action is CONSISTENT with the below listed Policy Standards and therefore is CONSISTENT
with LWRP provided:
1. A vegetated', non-turf buffer is established landward of the wetland line to further Policy 6.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
�tgUFF04
Peter Young,Chairman y Town Hall,53095 Main Rd.
Lauren Standish,Secretary P.O.Box 1179
Southold,NY 11971
Telephone(631)765-1892
Fax(631)765-6641
Conservation Advisory Council
Town of Southold ,
At the meeting of the Southold Town Conservation Advisory Council held Wed., October
12, 2016 the following recommendation was made:
Moved by John Stein, seconded by Keith McCamy, it was
RESOLVED to NOT SUPPORT the application of BERNADETTE HOGAN to construct 60
If. of shoreline stabilization utilizing rip-rap to prevent further erosion of the existing bank.
Located: 3005 Wells Rd., Peconic. S,CTM#86-2-4
Inspected by: Keith McCamy, John Stein
The CAC does Not Support the application.to harden the shoreline and recommends the
shoreline is re-graded and vegetated with native plantings, and a 5'-10' non-turf buffer is
installed landward ofthe bank.
Vote of Council: Ayes: John Stein, Keith McCamy, Peter Young, Greg Williams
Nay: Jack McGreevy
John M.Bredemeyer III,President Town Hall Annex
Michael J.Domino,Vice-President 54375 Main Road
P.O.Box 1179
James F.King,Trustee Southold,New York 11971-0959
Dave Bergen,Trustee '
Telephone(631)765-1892
Charles J.Sanders,TrusteeC Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
oastal Erosion Permit Application
Wetland Permit Application Administrative Permit p r�
njD
/ _Amendment/Trans r/Extgnsion L� li 1� E
LReceived Application: 1��(s�
✓✓ Received Fee:$ 6 1 M
DD
Completed Applicatio 1-I SEP 1 5 2016
_Incomplete_, ___SEQRA Classifica0 on:
Type 1 Type l l v Unlisted outhold Town A"
Coordination:(date sent) R rd of Trustees '
�LWRP Consistency Ass Form 10.7i*1(-
CAC Referral Sent:
GG33ff (r�
_Date of Inspection: 10-MID
_Receipt of CAC Report:
_Lead Agency Determination:
Technical Review:
Public Hearing Held: )0,1q,1
Resolution:
Name of Applicant 13,e r»n de-t-+e A n
Mailing Address P So ' w e s-T q o sT At44' 1 SI4 o N e--s
nl y 1 C a-y Phone Number:( ) 917- 6%q 8_jq`1
Suffolk County Tax Map Number: 1000- Si 6 - A - N
Property Location: 3 0o S ul e I I,$ leo u e2' Peeo n J G , 'i y l 19S�b
(provide LILCO Pole#, distance to cross streets,and location)
AGENT: J P 6 CCL4 Pa-t_anl a
(If applicable)
Address: I V& `Prwt-r+ 61V A OeA+e( /�nftc�e S, /may
t l q a y
Phone: b-61 13 3
_ �C
Board of Trustees Applic.—on
GENERAL DATA
Land Area(in square feet):2
Area Zoning: Qom,$ i leh-h^l
Previous use of property: (Z e S 1 dpcN
Intended use of property: 2 c d-e r)+iA,L
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 No
If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review
and Elevation Plans will be required.
Does this project require a variance from the Zoning Board of Appeals? Yes ✓No E
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? ---�Y es No
Prior permits/approvals for site improvements:
Agency Date
Te",STees ' $1 yob 201 3
'TrvC,-r -A AV, 2y ,
No prior permits/approvals for site improvements. /
Has any permit/approval ever been revoked,or suspended by a governmental agency? ✓ No Yes
If yes,provide explanation:
Project Description(use attachments if necessary): ' Cw»s-rrL,c-r b c LIF� v F
ShorGlln� stwb►li-�u.-4-io,� �-��I� ��nr� (z�P_ (�kP .�'�
�ftvcn� �yf-��� .C�St�✓1 mF 2,Dc�S�t'i»q �a»1L ,
Board of Trustees Applicai,. -jn
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Cmn r„ o L F -P F
�o Ptc�an-� !✓vrt�+�c ��roS?o,� ®¢ -�c«ririy ��i✓r1Z. .
Area of wetlands on lot: $5u square feet
Percent coverage of lot: V. 0 3 %
Closest distance between nearest existing structure and upland
edge of wetlands: S feet
Closest distance between nearest proposed structure and upland
edge of wetlands: S feet
Does the project involve excavation or filling?
No Yes o
If yes,.how much material will be excavated? /V cubic yards
-How much material will be filled? cubic yards
Depth of which material will be removed or deposited: 1 , feet
Proposed slope throughout the area of operations: S 7
Manner in which material will be removed or deposited: A1( wo X K.-- 4o
bt Pry�vreacr- Frow L.vnCk A✓te# W.11 he do- e- wttk
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):
.Alt will bk Tidlc✓i -to d,sr p?'iun
Short.Environmental Assessment Form
.Part 1 -.Project Information
Instructions for Completing
Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding, are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1-Project and Sponsor Information
Name of Action or Project:
3 co 5 we It S dL — Pe oo4 a c-
Proj ect Location(describe,and attach a location map):
S t-e Jn&
Brief Description of Proposed Action:
CoAVt-A,,e.+ 6,0 LF v P A -(L�/� S�o/'e �a vac $-'reGet I 3ei�?asv
-iXLShny efPdeJ0 b"11-
Name of Applicant or Sponsor Telephone. 91 w .7 9
qvyet E-Mail:
Address:
$Sb we sT 9 o lr-� 5-r AP-C 1 sIL-
City/PO: State: Zip Code.
N e.N N V 1 P o a%�
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2 If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval: ❑ Z
N4440fr' AJ4SDv1P Tow,.s 64-
3
E3 a. Total acreage of the site of the proposed action? D.sY acres
b. Total acreage to be physically disturbed? -0-013 acres
c. Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? O-S 4 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) ®Industrial ®Commercial Ef residential(suburban)
❑Forest ❑Agriculture []Aquatic []Other(specify):
❑Parkland
Page 1 of 3
5. Is the proposed action, NO YES N/A
a•A permitted use under the zoning regulations? ® Z
b. Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES,
landscape? ® 21,
7 Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:Name:Pecornc Bay and Environs,Name-Richmond Creek and Beach, Reason•Protect public health,water,
vegetation,&scenic beauty,Reason-Significant Coastal is wi i e habitat,AgencyMtrok county,
me nro snrltlInl El Z
8 a Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b, Are public transportation service(s)available at or near the site of the proposed action?
LJ�^
El
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? NO YES
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? NO YES
If No,describe method for providing potable water: Er El
11. Will the proposed action connect to existmg wastewater utilities? NO YES
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 YES
Places?
b. Is the proposed action located in an archeological sensitive area? Rl El
® El
13. a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? ® 91
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 F_]Early mid-successional
❑ Wetland ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered?
16 Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will stonn water discharges flow to adjacent properties? ❑NO ®YES
b.Will storm water discharges be directed to established conveyance systemsrunoff and storm drams)?
If Yes,briefly describe: �]NO []YES
Page 2 of 3
18 Does the proposed action include construction or other activitie,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:
Ea 0
19.Has the site of the proposed action or an adioinmg property been the location of an active or closed NO YES
solid caste management facility'
If Yes;describe.
20 Has the site of the proposed action or an adjoining property been the sul?lect of remediation(ongoing or NO YES
completed)for hazardous waste')
If Yes;describe•
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name- ow Date:
Signature
I
PRINT F M Page 3 of 3
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)9
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)for hazardous waste?
If Yes,describe: ❑ ❑
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: Date:
Signature:
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land? ❑
3. Will the proposed action impair the character or quality of the existing community? ❑
4. Will the proposed action have an impact on the environmental characteristics that caused the ❑
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?
7. Will the proposed action impact existing: ❑
a.public/private water supplies?
b.public/private wastewater treatment utilities? ❑
8. Will the proposed action impair the character or quality of important historic,archaeological, ❑
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
No,or Moderate
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑
problems?
11. Will the proposed action create a hazard to environmental resources or human health?
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.
1
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.
RrCheck 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 A Town of Southold-Board of Trustees �(�
Name of Lead Agency Date
7 IK,��� eve`?+^ President
Print or Type of Responsi le Officer i Lead Agency Title of Responsible Officer
Sign e esp nsib e fficer in Lead Ag cy Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
Wednesday, September 07, 2016 9:11
9F Mapper Slumn Report
PM
Disclaimer: The EAF Mapper is a screening tool Intended to assist
project sponsors and reviewing agencies in preparing an environmental
assessment form(EAF).Not all questions asked in the EAF are
answered by the EAF Mapper,Additional Information on any EAF
question can be obtained by consulting the EAF Workbooks. Although
it the EAF Mapper provides the most up-to-date digital data available to
DEC,you may also need to contact local or other data sources in order
'I to obtain data not provided by the Mapper.Digital data is not a
substitute for agency determinations.
SO
i Tbrani:Aii
eA
^-' . 5cu,t�•s::Esei,y,H1=f?'E:�L'ELcem�,U5G5, , _, _ ..�- .` i .. 4'^„�;..w �„7
1'nt+tmsp;,inLiemeritl''perp., NRCAN Esri rr;�;.,�' lot tt bu Sokr ^Esri, E,
t :Jspst;fu9ETlaEsii Ckin�„ifon�`I<esngj?:Eei , Ccfumbuc;,t'' DeLdt�dlrsCt3,Inteemap,
1Tiiailsn'd),Alspmy,Ihbis„�7 GF: treetfylap•} cs €i rrs r4 ., P`' 6 inM inert F Ceep.,,NRv .W,
ti omni G-z,and the GI&,User Ccm'mun Ii;Ir3n:96 ;
ity” r''tN� lt9Pn, hAETI.,E�Pihiiis,
Part 1 /Question 7 [Critical Environmental ?Yes
Area]
Part 1 /Question 7 [Critical Environmental Name:Peconic Bay and Environs, Name:Richmond Creek and Beach,
Area- Identify] 'Reason:Protect public health,water, vegetation, &scenic beauty,
;Reason:Significant coastal fish &wildlife habitat,Agency:Suffolk County,
Agency:Southold, Town of, Date:7-12-88, Date:10-20-88
Part 1 /Question 12a [National Register of �No
Historic Places] ;
Part 1 /Question 12b [Archeological Sites] `Yes
Part 1 /Question 13a [Wetlands or Other Yes- Digital mapping information on local and federal wetlands and
Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook.
Part 1 /Question 15 [Threatened or Yes
Endangered Animal]
Part 1 /Question 16[100 Year Flood Plain] Yes
Part 1 /Question 20 [Remediation Site] 'No
Short Environmental Assessment Form - EAF Mapper Summary Report 1
a°gu` k Town of Southold
y Erosion, Sedimentation & Storrii-Water Run-®£f ASSESSMENT FORM
PROPERTY LOCATION: s.C.T.M.q: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER,GRADING,'DRAINAGE AND EROSION CONTROL PLAN
s'UTTtoi ea'`cro—n IIIOCIC Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE Or NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT NO
a. What is the Total Area of the Project Parcels? Will this Project Retain All Storm-Water Run-Off
(include Total Area of all Parcels located within.3 5 t1® &.Fy Generated by a Two(2")Inch Rainfall on Site?
the Scope of Work for Proposed-Construcdon)
(S.F./Acres) (This item will include all run-off created by site
b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all —
and/or Ground Disturbance for the proposed V Site Improvements and the permanent creation of
construction activity? impervious surfaces.)
(S. I Acres)
Z Does the Site Plan and/or Survey Show All Proposed
PROVIDE BRIEF PROJECT DESCRIPTION (Provide AddNanel Pallas ssNeeded)i Drainage Structures Indicating Size&Location?This
Item shall include all Proposed Grade Changes and
C a�AS_4Pv t t" �p C
a/- Slopes Controlling Surface Water Flow.
3 Does the Site Pian and/or Survey describe the erosion
and sediment control practices that will be used to
control site erosion and storm water discharges. This
item must be maintained throughout the Entire
Construction Period.
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
of Material within any Parcel?
5 Will this Application Require Land Disturbing Activities
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.)Square Feet of Ground Surface?
6 Is there a Natural Water Course Running through the �
Site? Is this.Project within the Trustees jurisdiction 1 e/
General ITEC SWPPP Requirements or within One Hundred(1001)feet of a Wetland or
Submission of a SWPPP is required for all Construction activities involving soil Beach?
disturbances of one(1)or more acres, including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes El —
are part of a larger common plan that will ultimately disturb one at more acres of find; which Exceed Fifteen(15)feet of Vertical Rise to
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 meet the Minimum Requlrements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious —
for Storm Water Discharges from Construction activity-Permit No.GP-a-00-001.) Surfaces be Sloped to Direct Storm-Water Run-Off
1.The SWPPP shall be prepared prior to the submittal of the N01.The N01 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-constructlon storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any
constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder
compliance with the terns and conditions of this permit.In addition,the SWPPP shall Area?(This nem xm"T Include the Installation Of odveway Aprons.)
identify'potential sources of pollution which may reasonably be expected to affect the
quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark
3 All SWPPPs that require the post-construction storm vrater management practice In a Box and the conobuction site disturbance Is between 5,V00 SA&f Awe in area,
component shallbe prepared by a qualified Design Professional Licensed In New York a Storm-Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of
that is knowledgeable in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit.
(NOTE A Check Mark(d)andfcr Answer for each Question is Required for a Complete Application)
STATE OF NEW YORK, A ,J {
COUNTY OF. e
Aw.... .0.�1..........SS
That I,..•. ��?^� �... �6. .'r n..................being duly sworn,deposes and says that he/she is the applicant for Permit,
......... ......
(Name of individual signing D ant)
Andthat he/she is the ®LA0 me�............................................................................................................
(Owner,Contractor,Agent,Corporate Officer,etc.)
Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have perfbmled the said work and to
make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and
that the work will be performed in the manner set forth in the application filed herewith.
i
Sworn//to before me this;..:l.. .......=ov
1�...... .Notary Public: ..... ........................
(Signature of App6tant)
FORM a 0183110
ANTOINETTE PEPPER
Notary Public,State of New York
NO.01PE4973633
Qualified In Nassau County
Carilficate filed in New York County
COMMISafon Expires January 7,2019
October 9, 2016
Town of Southold Trustees
Town Hall Annex Building
54375 Rte. 25
P.O. Box 1179
Southold, New York 11971
RE: 3005 WELLS ROAD, PECOIVIc, NY
SCTIVI No. 1000-086-02-004
AFFIDAVITS
Dear Trustees:
Attached please find affidavits of posting and mailing for the above referenced project.
If you should have any questions or require anything further, please do not hesitate to
call me at 631-484-9332.
Vtru yours,
11
D ,
r Jeffrey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
M-ehrrnGO 02-/0 Wel15 ,�cl.-- Prom C'
7015 1730 0000 0894 5312
�Lvt�l) p,-(-ont& _ 116t6-8
7015 1730 0000 0894 5329
0 A 1 ntx:r -W P.d 05 ov (oaf
7-015--1730,--0000- 0894 5336
INCLbby) 3o(o5 wails_ p ?-ecoyLJc, PV- ))&168
7015 1730 0000 0894 5343
STATE OF NEW YORK
COUNTY OF SUFFOLK
&4rL. , residing at (p to 4tLA! f3(Vrj
h J nY (4 t;)4 being duly sworn, deposes and says that on the
--day of_0C:WV)Q , 20_Lo, deponent mailed a true copy of the Notice
set forth in the Board of Trustees Application, directed to each of the above named
persons at the addresses set opposite there respective names; that the addresses set
opposite the names of said persons are the address of said persons as shown on the current
assessment roll of the Town of Southold; that said Notices were mailed at the United States Post
Office at 41M g that said Notices w e mailed to each of said persons by
CERTIFIED MAIL/RETURN RECEIPT.
Sworn to before me this
Day of
Notary Public
Loriann Pataniio
Notary Public State oftew York
Qualified in Suffolk County
No:01 PA6150861
Commission Expires 08/07120 0
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:el o to eee•e !I i e1 1 _—_-_e.,e - ______ z_- ---•^--�
John M. Bredemeyer Ili, President �o�, o� Town Hall Annex
Michael J. Domino, Vice-President �� ��' 54375 Route 25
Glenn Goldsmith y ? P.O. Box 1179
A. Nicholas Krupski y �� � Southold, NY 11971
Charles J. Sanders 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
BERNADETTE HOGAN
COUNTY OF SUFFOLK
STATE OF NEW YORK
AFFIDAVIT OF POSTING
TO BE COMPLETED AFTER POSTING REMAINS INPLACE FOR AT-LEAST SEVEN,
DAYS PRIOR TO THE PUBLIC HEARING DATE
J PG-(,-VL(O , residing at/dba 100 W l bt Pl Ind .
C. moYI C'013
being duly sworn, depose and say:
That on the I day�of OC+D , 2011 , I personally posted the property known as
3c os W61 (s koar1
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held Wednesday, October 19, 2016. .
Dated: 0,
( i ature)
Sworn to before me this
day of 0�+ 20 (0
Notary Public
n Pa
LO nn ata o
Notary Pu York Notary Public y pf�lew York
t�o Qualfied 1 Suffolk County
No:01 PA6150fl61
COMMISSl XI -�� Commission Expires 0f3/07120f0
NUTIL 'I: U1 HtAIRING
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: BERNADETTE HOGAN
SUBJECT OF PUBLIC HEARING :
For a Wetland Permit to construct 60 linear feet of rip-rap using 150-400 pound stone. Located:
3005 Wells Road, Peconic. SCTM# 100086-2-4
TIME & DATE OF PUBLIC HEARING :
Wednesday, October 19, 2016 — 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
Board of Trustees APPIieation
Neu) York
County of_Suff19W
State of New York
-e-r o,,_Ac4-._ 4-kAn BEING DULY SWORN
DEPOSES AND AFFIRMS AT 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 IJ fh—DAY OF ,20A
Notary Public
ANTOINETTE PEPPER
Notary Public,State of New York
No.01PE4973633
Qualified to Nassau County
Certificate filed in Now York County
Commission Expires January 7,2018
I�
Board of Trustees %pplication
New York
County ofik
State of New York
Jto A awn ela:4,v BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE!SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,,AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR
REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
;ature of Pro erty 0 ner
SWORN TO BEFORE ME THIS DAY OF, Zd
, f
Notary Public
ANTOINETTE PEPPER
Notary Public,State of Newyork
No.OIPE4973633
Qualified in Nassau County
C®rtiticate filed In New York County
Commission Expires January 7,2019
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
residing at ZS"o
(print owner of property) (mailing address)
AO-+ iSIL, rJe,+�`�d�IL���{ »®a,4 do hereby authorize � fz
(Agent)
to apply for permit(s)from the
Southold Board of Town Trustees on my behalf.
(Owner's signature)
Board of Trustees Z��,PUCzt iOn
AUTRORIZATiON
(where the applicant is not the owner)
- --- - --residingat_ 2-,q Wes-r _90th
(print name of owner of property) (mailing address)
Apr I SILK AIe-O g4IY� V j__t-PPa y do hereby authorize
_ _.. ,_ (agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
:er's sipatA're) i
el
i
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's ode of Ethics prohibit conflicts of interest on the nart of own officers and em to ees.The u ose o t
this form is to rovide information which can alert the in ef'assible conflicts of interest and allow it to take whatever action is
necessary to avoid same.11 -
YOURNAME: L1044n,
(Last n9ne,first namemiddle mitral,unless you are applying in the name of
someone else or other entity,such as a company.If so,indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.) r
Tax grievance Building
Trustee
Variance
CCoastal Erosion
Change of Zone
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 ofi<cer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or business interest`Business interest"meanbusiness,
including a partnership,in which the town officer or employee has even a partial ownership or(or employment by) corporation
in which the town officer or employee owns more than 5%of
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 applicanVagenttrepresentative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation); .
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONS141P
Submitted this day of��200 (0
Signature 2° a c–
Print Name �c n+a e-4e dvv &A
Form TS 1 -
r��'PLICr�t'4T/AGENT'/)�I'Rrr- Iii r tt;i,
TRANSAC T J ONt*�-L DISCLOSURE,FORM
t of SottillSllsl's t nrlg r�r lit)t_e;;=mhilaiy crteitt,ai jtLterest n_tht}tart r,Ctet+rCilexes;rn�l_rniyluvr: 5�lwlre p€e roc of
lltis farni_is tc,?pS1c irifrNEn,�tttnn�5hiela�ir_y_ttl,:e(_4�;,3E°:,::r E 1_°�sr t;iv,s„�,�>,�'_'=`E;n;„interest 1i1t��tllt)ty Sl t�t�fiC W11iltEVCf i!CtiC�ll 1.1
»U�cIOLI avoid s sne.
YOUR NAME: .. �Jt o a �-- �? - ____ ____-- - -- --• -
fl aSt tat nic, t min€e,triildle hii:°ial,ra.{c-s Vu r:^ applying in t is»am of
someone else or ether entity,such as a eonipariy.I f so.indicate+11r;other
person's or coinpany's name.)
NAME OF APPLICATION: (Clieck all that apply)
13uildin� -
Tax grtesancr. Trustee
Varlance _ .___
Chanoc of Lone a._ ..-_-..._ Coas�ta!Erosion __- -_--._
Arnr;•vafOfPlat —._-- sipoti»g ___ --
E::afilplion l;(,:7:plat or official Map
Other
(lf"C3ther'',Haile ihs:activity.}J _,....,,,�__.._..�...----.--- •----�-- - --
Do l au per:,t)til (ur 111milrth ywr ctxupanv•M'Ouv:,sjWirrg,parent,or child)ha.e a relationship%%ilb my officer or emptayec
of the rowlt or Saulhvitl? "Rcl.rtiar)<hip”include::by blood, ill-riage i, nus-ess interest,-Business interest"means a business,
inctu:iuig,ii partncrshii<;ire,atria,lilt to,vn Of,iecr or employee h:,s cv..»a partial Ownership of for cs;rloynient by)a corporation
to which ibe'tovill officer or cnlpluyee otv;ir,more N;in i,(,t?`lb`;shares.
YLS - NO + .
ICwou a:iswercd ,yrS complete the balance,of this form and date and sigu wherc
Notno of person etnploytd kv the Town of Southold ---
Title or position of tfial person __ -.--..- ----•- ------ .- ___ _ _--..._
ti:e town cfftcer t r cmplo t»:.Either cl:cek
Describe the relationship br:t,aeen yourself(thc appLcrnL'agcnVrepresentative}.ind
the approplratc Sine A)through D)andlor describe in the space provided
'I'm town officer or cmployec or his orher sponse,sibling,patent,ix child is f(ArZA all that apply):
,'t}th,�Uwrv)r t7!grl•:rscr than 7`%a of ilic Yli,Utis Ari tilt ali7it)rrtz si�i.: s�f life af�plt�(:nt
- -- (i5liCtt the;}pl)1F1'ant is a uirl--urAoit);
B)the idol or beneficial nw:`rcr ol'iiuy ill a lion-vorpulan•Cal€tv'(when the
appharrtt is nut a turporattun);
(?Ricer.din:cmr,Palmer,or Crnlrlo,re nf't!i afi}rli:ar=.t:or
--D)t)le aciunt applicant.
DESCRIPTION OF ULATIONSHIP
Submitted this ;;L": d2,y of _2 J�
SignaturePrint Nallie
FUrnl S i
APPI,ICANT/A,C,,F,N,T[RF-PRESF-NTATX.- rE
nZANSACTIONIAL DISCLOSURE FORM
"Ct}��.�,-;int,:„�I°`tca}}tta�llc!'s��ce 4rf i�tfiic �ite tihit:wct?;titicE�:c,i'it:��:ra.�t tt€3 tP}e,t=�rt_rlf'€tlrsa:c}�cixrc: kat,, ct c�atf�iusccs '!'3}e_-�t2,r�c,�c�FSI' ,
Ll�vs&I I 111 is k—towo ig�111�e�rsf—nn(L-A LinvdittaLa–k-m
YOUR NAME: n
(Last nitrile,irtziatue.-middla initial,.mless you are applyins ill the;n lI oC
someone else or other entity,such is a compaiky.If so,indicatAItlra other
person's or coarany's n=Q.)
NAME OF APPLICATION: (Check all that apply)
Tax grievance Building
Variance Trustee
Change of ZoneCdwtal Erosion
Approval Of plat Mooring
Exemption from plat or official map m. Planning
Oiber
(If"Other",name the utivity.)
Do yoo Nmonally(or through YOM Company,squluic.-ilhjing.rnicni,or child)have a relationship with arty-officer or employee
,
of the'rown of S'010old` "Relatiollship"includ6s by 111mid,iwirrinjT�l or business Merest."Business interest",means a b us silness
including pprincrohip,in which llw town OMcer or ernployev 11,1�,avt-;j at partial oiyncv,4jip of(or employment by)a co"raeton
in whip li 1he town officer OWIS MON thiel 5,".s of III,-shn-C&
YES NO
if you ajjs%Vor0dypS,,,Complete tho balance of this form.and date and sign whore indicated.
Namt:orperson employed by ft--Town of Southold
Title
Msctibc the relationship between yourself(the and the town olfficer or employee,Either chcok
the appropriate line A)ftugh D)and/or describe in the,space provided.
The town affileer or employee or his or her spouse,sibling,patent,or child is(6,eck all that apply):
the o-.vjjer 9f grepier t1lon,51/9 of the nharc4 of the corporate Ao&of t1W applictitit
(when the poplicallt ig a qorj*r31io1j);
_B)the lcgal or*bcnoficial owner orany intuest in a noft-Curpolaw entity(when aw,
lipplicurij is not a corporation).-
__jC)an oiricer,(111tclor,Partner,or enlployeu of or
bj the actual applicant.
DESCRIPTIM OF RELATIONSUIP
Subrnitted this /Oday 6rL14-___.,_20/
Signature
Print Nairne—,...
FOTMTS I
f
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coaatal ar6a;(which includes 6110£Southold Towel.
y
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 supp-orting,and non-
supporting facts. If an action cannot be certified as consistent with the-LWRP policy standards and IV
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# ma - a" - q _
PROJECT NAME .3006- w e 11 s 1-01-40 - e�*con I C—
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:
C�nST2uGT 60 (.F gpf e,h,ra 14Ae s�'e��oIIi24,-+Yon vt �l �i✓ty
i2iP- RKY -�� pre✓GAf- -AAr-t her effSloA --F ZAJS-ttny lva,711,
i
Location of action: *3 00 5' We-Its (L I , 9e Can l C
Site acreage: d• 54 a
Present land use: !Q a e.04 4'14,1—
Present zoning classification:
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: e-ef n c&Ae44-e �1D q�+.►'�
(b) Mailing address: -'L$o -wt ST R c 4k��
N%4 LOO a-4
(c) Telephone number:Area Code( ) 417 s 649
(d) Application number,if any: r+1.4
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
1 �
Yes EfNo❑ If yes,which state or federal agency?^,v i S(ee 1 PJ 4 s 0'V-5
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.
ZYes ❑ No ❑ Not Applicable
L
Pi`. OTS
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 [J 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
Arcv�+inN Fvr��►a( �f®i2oA �� d-h�- ?�4.n1L
Attach additional sheets if necessary
NATURAL COAST POLICIES
C
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP F
Section IH—Policies Pages 8 through 16 for evaluation criteria
Yes ❑ No ❑ Not Applicable
IP� jec, l' Proye d tS Cvd- tir®stun. R-p4e-cp p.� ew7a I-Vu •f. 14 n&I
— V
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
ErYes ❑. No ❑Not Applicable
Prbia�+ Sf•QS e(®Slann ar►dL. dt.LS o t:t sc-t"c .� S epi rrtvn-t'K�"s®.t r F w�e'C�(S .
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.
❑ ❑ lJ
Yes No Not Applicable
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[eNot Applicable
Attach additional sheets if necessary
l=
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 I T 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. �_�
❑ Yes❑ No U Not Applicable
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 _
g
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.
❑ Yes ❑ NoNot Applicable
PREPARED BY J pe,-rot n I TITLE A i c Yi DATE Q 7. 1 b
. J
September 12, 2016
Town of Southold Trustees nJD E E V E
Town Hall Annex Building
54375 Rte. 25 SEP 15 2016
P.O. Box 1179
Southold, New York 11971
outhold Town
RE: 3005 WELLs ROAD, PECONIC, NY B rd of Trustees
SCTM No. 1000-086-02-004
APPLICATION FOR PERMIT
Dear Trustees:
We hereby submit one (1) original and three (3) copies of the proposed plans,
application and check for permit approval for the above referenced project.
If you should have any questions or require anything further, please do not hesitate to
call me at 631-484-9332.
Very truly yours,
t
Je rey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934