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HomeMy WebLinkAboutTR-9058 Michael J.Domino,President �QF SOUTH, Town Hall Annex John M.Bredemeyer III,Vice-President O� �� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith lx[ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 Cou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 17, 2019 r Ellen Herman 1655 Lake Drive Southold, NY 11971 RE: 1655 LAKE DRIVE, SOUTHOLD SCTM# 1000-59-5-8.1 Dear Ms. Herman: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 17, 2019: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit#9058, as issued on July 19, 2017. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, BO.- Michael J. Domino President, Board of Trustees MJD:dd g�FFO(/� Michael J. Domino, Pn nt O�Q �' � `, Town Hall Annex John M. Bredemeyer III,Vice-rr"esident �� �� 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams y p!• Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES / TOWN OF SOUTHOLD Date/Time: /�� Completed in field by: ELLEN HERMAN requests a One-Year Extension to Wetland Permit #9058, as issued on July 19, 2017. Located: 1655 Lake Drive, Southold. SCTM#: 1000-59-5-8.1 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. 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: 7/ 3 /e_' I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other Y� � Ellen Herman ---�--- - 1655 Lake Drive E E 11 ==, Southold AT 11971 Jul. 2 2 019 Southold Town 7/2/19 Bo rc of rn��tpes Permit NO 9058 To the Board of Southold Town Trustees, I respectfully request a 1 year extension of Permit No. 9058 for my property at 1655 Lake Drive, Southold NY 11971. Furthermore, I would like to request a change from Thru-Flow decking to IPE wood decking with spacing as deemed appropriate. Thank You, Ellen Herman 7.3�l Q l�od tSLp Ec t,�N( Ef tc'W 7-ffA-r Zai( 810 sA-IP CA-007- h16W e6A I �i2vvw T3+v aw TO l f6 , I ®� SOU�� Michael J. Domino, President �®� ®lTown Hall Annex d John M. Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders Southold, New York 11971 CP- Glenn Goldsmith Telephone(631) 765-1892 A. Nicholas Krupski ®UN ��, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENTFOR 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/silt boom/silt curtain 1St day of construction / % constructed Y Project complete, compliance inspection �h.. 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BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 9058 DATE: JULY 19, 2017 ••N �iyP �,� i s�tb:tt: ' ISSUED TO: ELLEN HERMAN j d�R1f � t 14'tpSi'�` ' r PROPERTY ADDRESS: 1655 LAKE DRIVE, SOUTHOLD .e •�.` .�lS{'. �.CJI _•'• j SCTM# 1000-59-5-5.1 I AUTHORIZATION � " I Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in arc•� . � accordance with the Resolution of the Board of Trustees adopted at the meeting held on July 19, 2017, and in consideration of application fee in the sum of$250.00 paid by Ellen Herman and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the ( >y < ar:z di'f following: % {�fi:4•�s •` k P r Wetland Permit to construct a 31x10'walkway using Thru-Flow decking and four(4) 4"x4" ` support piles attached to a 4'x16' faxed dock using Thru-Flow decking and six(6)411x4"l0cust c ti°'44 pilings;with the condition that proposed structure is to be comprised entirely of untreated �°• _t materials; and as depicted on the site plan prepared by M.A.Kimack,dated May 15,2017,and i•� ,Ist� stamped approved on July 19,2017. 4,V y �y �,��a IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of•the said Board as of this date. 61 John M. Bredemer ,- r III I ,, .- ;;�, tea• G� c° .°•��a"i+r+4� �+ �w �—. � r•.- I Per:?i y. ;'P, �}Nr i � •ys� +a; : � d 1.t,t�•A £� PSA.ji olf i�uiSviS.?v:.+tZ .'u'.uiu^,i�.x ZIVIM.Srlrdiv"+'ir.'.�itutctc,Gu+iaSitiL?isbiiiY;iS`d"i',y:illiiai'�5:2+.fxS.if�,`,"'*.GCS'YU,."rL'i'.;iZ:+`d'AJxv3,aw'7�✓'�2):GG'`u•�:!y'�"i.('v3:.�A.%CRs i'd:.i3,±FYYxT:.:iST,Qi:•_n7,'GY`X",h<i).i'�`,~ ,•= d 4Y •..�.a:.._..v_++•...�-a; �"'�,:'�n.;v,^J^^'=• e`�-�.�..-.,,*+c�,,;, �,.,_ c•,mt,^g`"`". ---•.:_...�.a:.sI..�'' `'–.. _/,,'d1 ,,,• •+ii t:i'• dpA qbt ti:f a i e,.r?' •.i° b t,�t isYi tie ./ �`•.!•,:;:+.h�ee�$." .i:;S; t� .::+ •.f, ..,r�i•ie,J.%' '.g Qeg,il i� ya b\SN' tw .s%.,i '�'�� + .� ;',}:•t TERMS AND CONDITIONS The Permittee Ellen Herman, residing at 1655 Lake Drive, rive Southold 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 al 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 Pennittee will be required,upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may subject to revoke upon failure.to obtain same. 10. 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. - 1nigC.Kw.�Y_ r—WROC20 w_ rf-4 �Q�_ I � APPROVEP BY 'BOARD OF TRUSTEES sH,�U�L9w_ TOWNCOF'SOUTHOLD ' DATEuL,� i -- --� I - .a.. C - --I#I r - --- ------ - - 4 z. Le- �x_9 yP.,ecsSU,PE IC C V •ve�v�- t�/�t r9s�4Ps I MAY 2 3 2017 II czvT ®4, ,-- Y_ 11971 - 1� `V A.V le .s _��o SEZ�_WQ�f•Cv�/.4 Y Southold Town 170 ArIX 40 rd of Tr tste Michael J.Domino,President ��OE SUl/P'Z' Town Hall Annex John M.Bredemeyer III,Vice-President �� �� 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® Telephone(631) 765-1892 A.Nicholas KrupskiO Fax(631) 765-6641 �y00UNTV,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 19, 2017 Michael Kimack P.O. Box 1047 Southold, NY 11971 RE: ELLEN HERMAN 1655 LAKE DRIVE, SOUTHOLD SCTM# 1000-59-5-8.1 Dear Mr. Kimack: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, July 19, 2017 regarding the above matter: WHEREAS, Michael Kimack on behalf of ELLEN HERMAN 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 May 23, 2017, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policies 6.1, 6.2 and 6.3, 9.4, and 11 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: that the proposed structures be comprised of entirely untreated materials; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 19, 2017, 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, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of ELLEN HERMAN to construct a 3'x10' walkway using Thru-Flow decking and four(4) 4"x4" support piles attached to a 4'x16' fixed dock using Thru-Flow decking and six (6) 4"x4" locust pilings; with the condition that proposed structure is to be comprised entirely of untreated materials; and as depicted on the site plan prepared by M.A. Kimack, dated May 15, 2017, and stamped approved on July 19, 2017. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $242.00 Very truly yours, fi0 Michael J. Domino President, Board of Trustees MJD/dd Michael J. Domino, President yo�psUFFO(,��oG`.i Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Charles J. Sanders tj y P.O. Box 1179 Glenn Goldsmith Southold, NY 11971 A. Nicholas Krupski 'y�ol �� Y�� Telephone (631) 765-1892 Ll Yui<{ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ELLEN HERMAN c/o MICHAEL KIMACK Please be advised that your application dated May 23, 2017 has been reviewed by this Board at the regular meeting of July 19, 2017 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) % Constructed ($50.00) X Final Inspection Fee ($50.00) — X Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: 4'x16' dock= 64 sq ft. x $3.00 = $ 192.00 TOTAL FEES DUE: $242.00 BY: Michael J. Domino, President 02� Board of Trustees Michael J. Domino,1, ent ®� IOU �C�G Town Hall Annex John M. Bredemeyer II1,Vice-rresident �� y� 54375 Route 25 Charles J. Sanders N, P.O.Box 1179 Glenn Goldsmith %O Southold,NY 11971 A.Nicholas Krupski !di ® p! Telephone(631)765-1892 dol Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: Michael Kimack on behalf of ELLEN HERMAN requests a Wetland Permit to construct a 3'x10' walkway using Thru-Flow decking, pressure treated framing, and four (4) pressure treated 4"x4" support piles attached to a 4'x16' fixed dock using Thru-Flow decking, pressure treated framing, and six (6) 4"x4" locust pilings. Located: 1655 Lake Drive, Southold. SCTM# 1000-59-5-8.1 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. 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: v J) yj 6fi& ,A . Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski Sanders Other Page 1 of 2 Michael J. Domino,P, ent OLO u�����CCG k--- Town Hall Annex John M. Bredemeyer III,Vice-President �� 2J, 54375 Route 25 Charles J. Sanders ro P.O.Box 1179 Glenn Goldsmith � Southold,NY 11971 A.Nicholas Krupski �,�0 ap! Telephone(631)765-1892 l Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Michael Kimack on behalf of ELLEN HERMAN requests a Wetland Permit to construct a 3'x10' walkway using Thru-Flow decking, pressure treated framing, and four (4) pressure treated 4"x4" support piles attached to a 4'x16' fixed dock using Thru-Flow decking, pressure treated framing, and six (6) 4"x4" locust pilings. Located: 1655 Lake Drive, Southold. SCTM# 1000-59-5-8.1 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 ^ 1 MR Y ♦ $ "' ,. 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LOa � S 70 0.11 0 r lj srg/ ti 8o 00 0, STONE DRIV WALK "I S 2139 �G� \ �° Qp� 401 °O No4/o �� o O, c,� GFo °4F°RFo 52 00// S9 � F✓ e RM °S� " O� �Pi �YOF Fti ti� 0%, Uj �, �� 0 OA I- JSs MAY 2 3 2017 a I , Southold 15 n­�' Sort o;Tr a t .� NOTES "Unauthorized alteration or addition to a survey ® PIPE FOUND ®f AAE A„ map bearing a licensed land surveyor's 2,of is e JOHN C. E H LE�S LAND S U�VEYO 9V (�r v,alal,an of seal an 720r sub–division 2, of the �-- 5TOCKADEFENCE New York State Education Low" "Only copies from the original of this survey markeorke d with an original or the land surveyors stamped seal shall be considered to be valid true copies" G EAST MAIN 5TREET N.Y.5. LIC. NO. 50202 -Certifications indicated hereon signify that this 7 survey was prepared in accordance with the ex– Area = 1 6,931 5a. Ft. RIVERHEAD, N.Y. 1 1 901 3G9-8288 Fax 3G9-8287 y the Cede of Procne for Land Surveys Profesadoptsional l by the New York State Association of Professlonol Area = 0.3887 Acres <� p� Land Surveyors Said cei-bf—tans shall run only longlslandlandaurve or.com n- !�, o the person for whom the survey is prepared, GRAPHIC SCALE 111= 301 V and g his behalf opt o the title company,governmen– "YS 20 tat agency and lending Institution listed hereon, and LAND Sv a the assignees of the lending instduhon Cerliflco– �_I A,9 twns are not transferable to adddional mstnulions y >• •a� .a ".!x> b`� � „'r• , �,�'t%ize.�r'��"„�' f'rf=' � ss � ,�r„'•�Y� r 1 a%i"�,�� � , "3'��;�+ '�` c ,s�"ky,'i'�,is�,/°sa'{�..'•,�'..�3 ,� "�z, •�!� ;. & Y �?a:3a - '�% ', a ,��.,-�`-^,.; s^ua1�'" �;:M.�,�,�e r^- --R”' S�,.,_6'.s �N',.s"�'°,t'''vr�r '4°�,�✓.� :v. ,S'�'�2>s: r °r¢ " ' �y ;' .�"` .m .k.''>x-.-"• adv ,� "^C%,a?, x4n !",,>," �'M:u;' �°•i'r•r" �; wn£,4"'G✓KJ.,' r✓rF .a ",`6 e4-. 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O� Off. b ,B / s a,a a•! e ° � ^ .A m !' 1 aA 1 TA(c) a Q m 0 MON.) 1 FOR PCLNO I p9 SEE SEC NO v� bary - h sOo 1';,' nm z ^mP ,P�..2""��� Off• 08101-0015 1 `t1- 83 0` GREAT POND b� oR a b s 3 Q m a^+� ,�u m ��� „ �/ a ,� o b•p°p`o ",� 1e rA +' i $ 6 wI 'ry b O--II 11 +9yy �0 ^ry 9 g + ,pd 0 b�l j^yT' "T ' m 10' "� '.+ �,•1 w'�137 INCL I \s °ry a b ,� @ b B' "a a+N 6 B o e a a '>•A s"- COUNTY OF w I SUFFOL/( y 6h00NcwESPAwO `_ B 'Y� / 4 63 1 61 ' I 1 \ 4 b JOT 31 19A(c) MO 12JWC) N� -A a b 6 6EVHW7IBiffaGllfS1 On(cI ` @•a �0 $ O g a I L 62M10^1' ® $ 11$ 55 d a 254 B M1 Z/ 2 w 305 71 ! $ ry 0 iBA ' w 10A(e)+ (10wNOFswmmf0 A mpg' '>° -0 UE180PYBR/uf.Nlp P 2E2 P{C,YITiWm111U5,NC. $ A 14 +SALc) .b cGxSafvAlwNE.SEye�O _ a +a B y IcotMYu•.vrrplt 8 ' 9 Jr tiVkw a, a 2p 'p 6 Cpl 3 a IA f \\ �� el m 1z1A b4Y 'Y FORFC NO M1 \ SEE SEC NO b 1a+Rv m --- a. �� afi9a1-0o91 a �� a n n wnrciw. N3:o ------- ------- zZ � No ry NATCH LINE MATCH LINE SEE SEC NO OEJ SEE SEC NO 069 NOTICE , COUNTY OF SUFFOLK © K r6a "�, v SOMHOLD SECTION NO Real Property Tax Service Agency Y - 059 "SQL"_"-a...��.:SS-: _ - v.«— _ -- - - - -- -- .ir^_ - _ _ _ —_ _ ----- - -- _r;.—a;•a - - ''-'�_ -•--.,e` moi,_.,--- - - __•.}_rear. - - - -' -.�.+�..r'}«Tt'^, -- ���'r' OFFICE LOCATION: S® MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 a� Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTI40LD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: July 17, 2017 Re: Local Waterfront Revitalization Program Coastal Consistency Review for ELLEN HERMAN SCTM# 1000-59-5-8.1 Michael Kimack on behalf of ELLEN HERMAN requests a Wetland Permit to construct a 3'x10' walkway using Thru-Flow decking, pressure treated framing, and four (4) pressure treated 4"x4" support piles attached to a 4'x16' fixed dock using Thru-Flow decking, pressure treated framing, and six (6) 4"x4" locust pilings. Located: 1655 Lake Drive, Southold. SCTM# 1000-59-5-8.1 Great Pond is owned by the County and is used by paddlers and small sailboats during the summer months and, sometimes, for ice skating during the winter. The waterbody is a unique natural and recreational resource that provides benefits including open space, habitat for fish and wildlife, water quality enhancement, flooding and erosion protection, scenic value, recreational and environmental opportunities. The Town recognizes the ecological , economic and aesthetic values of Great Pond. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. 6.1 Protect and restore ecological quality throughout the Town of Southold. The use and need for the dock is unsubstantiated to launch manual powered watercraft (kayaks, canoes). The installation of the proposed structures may promote electric boat traffic and the possible following negative impacts may occur: 1. Impacts to submerged aquatic vegetation, 2. Re-suspension of bottom sediments and turbidity Note § 96-17: Internal-combustion engines; mufflers of the Southold Code prohibits boats propelled by an internal-combustion engine to be operated on Great Pond. 6.2 Protect vulnerable fish, wildlife, and plant species, and rare ecological communities. Great Pond's natural environment is the home to a multitude of plants and animals. Activities and structures along the shoreline can potential damage these organisms their habitats and the complex food webs that support them. When structures such as docks continue to grow in number and size, there can be an adverse impact on the near-shore ecology. Structures on lakes, such as docks can have direct and indirect cumulative impacts on these sensitive habitats. The increasing number of docks along the shoreline of Great Pond has the potential to degrade sensitive freshwater habitat by making changes to the bottomland and water column as well as shading vegetation. During dock construction— activities along the shore may cause sediment and contaminants to enter the water column where they may interfere with rearing fish and fish food items such as insects plankton and algae. Shading by improperly designed docks and floats may reduce or eliminate the growth of aquatic vegetation an integral part of the lake food web. Chapter 275 prohibits the release of metals and other contaminants into the wetlands and waters of Southold, the use of lumber treated with chromated copper arsenate (also known as "CCA"), commercial copper quat (CCQ), creosote, penta products or homemade wood preservatives is prohibited for use in sheathing and decking. In sensitive areas leaching from other sections of dock structures treated with these pesticides/preservatives could also result in adverse impacts. Pesticides/preservatives from treated wood may seep into the water and sediments around docks and may cause lake sediments to become polluted and bioaccumulation in aquatic organisms. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The applicant must demonstrate that the following dock standards pursuant to § 275-11. Construction and operation standards have been met. (d) Review and approval of dock applications. Before issuing a permit for a dock structure, the Trustees shall consider whether the dock will have any of the following harmful effects: l-_ [2] Whether the dock will unduly interfere with the public use of waterways for swimming, boating, fishing, shell fishing, waterskiing and other water-dependant activities; It is unknown how far into the waterbody (extending past the phragmite) the dock will extend. [5] Whether the dock will cause degradation of surface water quality and natural resources; The dock structures is proposed to be constructed with the use of pressure treated wood. It is unknown if what chemical is included within the treatment. The construction methods of the dock have not been provided. [6] Whether the dock will cause habitat fragmentation and loss of significant coastal fish and wildlife habitats, See above comment. Permanent, private dock structures impact habitat. [7] Whether the dock will result in the destruction of or prevent the growth of vegetated wetlands, sea grasses including eelgrass (Zosters marina) and widgeon grass (Ruppia maritima) or shellfish; [8] Whether the dock will unduly restrict tidal flow or water circulation; [9] Whether the dock will be safe when constructed, [10] Whether the dock will adversely affect views, viewsheds and vistas important to the community; X111 Whether the cumulative impacts of a residential and commercial dock will change the waterway or the environment and whether alternate design, construction, and location of the dock will minimize cumulative impacts, and See above comments [12] Whether adequate facilities are available to boat owners and/or operators for fueling, discharge of waste and rubbish, electrical service and water service. Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. 9.4 Assure public access to public trust lands and navigable waters. E. Provide access to, and reasonable recreational use of, navigable waters and public trust lands under water. 1. Provide for free and unobstructed public use of all navigable waters below the line of mean high water for navigation, recreation, and other public trust purposes, including the incidental rights of public anchoring. Piers, docking facilities, and catwalks must not result in an unnecessary interference with use of public trust lands. Alternatives to long piers or docks include use of dinghies to reach moored boats and mooring in nearby marinas. Dredging solely to accommodate the draft of larger boats is not a recommended alternative. C. by extent and characteristics of the developable adjacent upland area and its ability to support in-water development for the water- dependent use. The adjacent upland area is a single family home. The proposal for a permanent dock to access the water for the launching of manual powered watercraft (kayaks) is not necessary for the operation of the watercraft. These types of craft require little water depth to operate within. Consider a temporary, seasonal , plank access system. C. by potential adverse effects on natural resources and their uses, and See above comments d. by potential adverse effects on public safety. It is not expected that the dock will affect public safety. The proposed action is private and noncommercial and will not support a pattern of development that enhances community character nor preserves "public" access or public recreational activities. Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. C. Foster the occurrence and abundance of the Town's marine resources through: 1. protection of spawning grounds, habitats, and water quality, Habitat fragmentation could result in a net loss of fish and wildlife habitat essential for spawning fish such as Largemouth bass (Micropterus salmoldes). There are only a few docks on Great Pond and because of the size and nature of this body of water the potential cumulative impact associated with the build out of docks on the shoreline would adversely impact the water body j Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Fo4,��a Peter Young,Chairmanti Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 i Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 12, 2017 the following recommendation was made: Moved by Greg Williams, seconded by Keith McCamy, it was RESOLVED to SUPPORT the application of ELLEN HERMAN to construct a 3'X 10' walkway with thru-flow decking, pressure treated frame and (4) 4"X 4" pressure treated pilings, attached to 4'X 16' fixed dock with thru-flow decking, pressure treated frame and six (6) 4'X 4" pilings of locust material. Located: 1655 Lake Dr., Southold. SCTM#59-5-8.1 Inspected by: Peter Young, John Stein, Peter Meeker, Keith McCamy, James Abbott Vote of Council: Ayes: All Motion Carried SO Town Hall Annex Michael J.Domino, President r John M.Bredemeyer II1,Vice-President t' 54375 Route 25 P.O.Box 1179 Charles J.Sanders VS :, Southold,New York 11971 Glenn Goldsmith - Telephone(631) 765-1892 A.Nicholas Krupsld Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: -51-3-1 Received Fee: Completed Application: Incomplete: " •': -= ``.s" .'- -�--- SEQRA Classification: Type I Type II_� Unlisted Lead Agency Determination: MAY 2 3 2017 t Coordination:(date sent): 7a =f LWRP Consistency Assepsme dorm Sent: CAC Referral Sent: ( � Souttic'd i,tirn Date of Inspection: 1,W. - Receipt of CAC Report-, Technical Review: -Public Hearing Held: -Ti LI Resolution: Legal Name of Property Owner(s); 6Z4 diEW Mailing Address: _ A • 2 d7L Phone Number: � 909 - - 6- 70,1 , Suffolk County Tax Map Number: 1000 Property Location: 1A Y'5_ z Al Y (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable); Mailing Address: �_ za / 647, ®(J?`y��p, y `1 97e Phone Number: I oard of Trustees Applicat GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: 16TI Intended use of property: Covenants and Restrictions on property? Yes X 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 _.,X__,_No, If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? ---Yes —No Does the structure(s) on property have a valid Certificate of Occupancy?^,-Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. l Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: W Project Description (use attachments if necessary): C(�/�/�f�"�U CTZ 7722WYED FMN& 3 SYIX 4 `/4 PIUNG S� l ,oard of Trustees Applicat a WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 722 CWMX-1JQr-A Area of wetlands on lot: square feet Percent coverage of lot: --Q % Closest distance between nearest existing structure and upland edge of wetlands: Z6.feet 41— Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? ,®,X No Yes If yes, how much material will be excavated?_cubic yards How much material will be filled? N1A —cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: l o--'e* )role Manner in which material will be removed or deposited: AIZQ 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): 77-,125- GA&Y Aae����LiC-SC7-OA/ 6"7-25,e5 O� 617.20 Appendix B Short Environmental Assessment Form Instructions for Comnletint; Part l -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: Project Location(describe,and attach a location map): Brief Description of Proposed Action: C'ONJyrUC A --TIX 0 GU.gL,rZy lye CJJ Q NX�h PR rSU� TiC' 5 � �ILI.,V�S A-TI4 Cf�,6V 7 0 1X ,OXO®A9QCe�64 S4-,Fr) W/7-1-1 a7zV z' _ Name of Applicant or Sponsor: Tclephonc: � 6�'�_ 6S 07 E-Ma Hw 2 C)N N Address: e, 0, A6eX City/PO: State: Zip Code: _ �.1...9.7_____ _ �I.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NU Yh,S administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that El may be affected in the municipality and proceed to Part 2. if no,continue to question 2. 2. Does the proposed action require a permit,approval or finding from any other governmental Agency? NO -.Y-ES- If Yes, list agcncy(s)name and permit or approval• MYsl'�5- e . 3.a.Total acreage of the site of the proposed action? _acres b.Total acreage to be physically disturbed? 0.1(2007 acres c Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,atijoining and near the proposed action. [J Urban ❑Rural (non-agriculture) []Industrial ❑Commercial XResidential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify):,_.... ❑Park land Page l of 4 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? ❑ 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: _ - -- - -- --- -- - -- -- - - - - - - --- - - ----- �`'`'� 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. — _ / IS71El 11. Will the proposed action connect to existing 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 NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? E]13. a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YE.' wetlands or other waterbodics regulated by it 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: _ .....RIO/!/, _. :. 14. id4ntify 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 E) Weiland ❑Urban Suburban _TK 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? 0 ❑ 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 storm water discharges flow to adjacent properties? XNO DYES L__l b. Will storm water discharges be directed to established conveyance systems(ruilpff and storm drains)? If Yes,briefly describe: No ❑Yl?S Page 2 of 4 18. Docs the proposed action include construction or other activities that result in the impoundment of NO WYES water or other liquids(c.g. i etention pond,waste lagoon,darn)? If Yes,explain purpose and sire: 19. I las 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: �� W_ _.. ...... ____-_-- —_ ( ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: A/-ZC'A 164--/"i,,. I/H-- CJG_ _ Date: 4�2Z DI.�. ... Signature: .._____._____..__ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Par•(2. Answer all of the lollowing 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"I lave 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 I. Will the proposed action create a material conflict with an adopted land use plan or,coning ❑ 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? � [L 4 Will the proposed action have an impact on the environmental characteristics that caused the t❑ establishment of a Critical Environmental Area(CGA)? t._..J 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? 1=1 b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, (� architectural or aesthetic resources'. L _ 1 9. Will the proposedl action result in an adverse change to natural resources(e.g., wetlands, — waterbodies,groundwater,air qualify,flora and f'aurra)? - Page 3 of 4 _..__..___.-.._ _ . .....-.�.. ._...-- _-_ _ __ ._...__.__....___ __-- _-_- _ .,___ --.----• . No,or Nlodcr•ate j small to laI.-C 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. Check this box if you have determined, based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental 'mpac s. Town of Southold-Board of Trustees 7 ( V / 7 �,,._. NiilTle Of I,ec Agency Frosfdenl l' t�, IC e- T ° PwJ Pi int orType Na fg Res onsible Officer in Lead Agency Title of Responsible Officer SigWItUre of'Rcsp siblo.Officer'—in-Lead Agency SiW=,mature of 1'rcparer(ii'different from Responsible Officer) PRINT Page 4 of 4 API LICANT/AGENT/REII>RESEN`I'ATIVIC TRANSACTIONAL DISCLOSURE FORM The Town cif SouthoI&S('ode of Ethics t r t#b#t5 conflicts of interest on the part of town bfficors and erurrloyees.'lie nurnpse of i#tris frat i5 to provide in format 101,which can alert the town afpossibld conflicts ofinterest and.allow,itto ttiire_wtratcveraetion is necessary to avoid sante. YOUR NAME: Zir �✓ (Last name,first narrfe,.Middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring _ Exemption from plat or official map _. Planning Other (If"Other",name the activity.) — Ido you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a pai dal ownership of(or employment by)a corporation in which the town off icer or employee owns more than 5%of thc_shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicattt/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of gre ater than 5%of the shares of the corporate stock ofthe applicpnt (when the applicant is a corporation); B)the legal or beneficial owner of any interest,in a non-corporate entity(when tile, applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted t ' d y of 201T Signature Print NameN._ Forth TS 1 { Board of Trustees Application AFFIDAVIT ,0'41/x' hWRA A-1 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 BOARD OF 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,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY,TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A-FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCIE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION-PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Siature of Property Owner Signature of Property Owner�~ SWORN TO BEFORE ME THIS DAYOF 20J_7- - - - - Notary Public =PU13LIC, A.KI ACK TATg OF NEW YORK o.b'2W06823 Nassau Countyires March 11,2018 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, _ -ofL 444 owners of the property identified as SCTM# 1000- p — J & in the town of New York, hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Sigature Property Owner's Signature SWORN TO BEFORE ME THIS _ DAY OF Notary Public MICHAEL A.KIMACK NOTARY PUBLIC,STATE OF NEW YORK Registration No.02KI5056823 Qualified in Nassau County Commission Expires March 11,2019 APPLICANT/AGENT/REPRESENTATIVE T'RANSAC'TIONAL DISCLOSURE, FORM The Town of Soothald'w,,Code of Ethics prpl i r1 R,ti co llict orf intereei q►t the rt�yf town officers tef empl ve— he nttrnose of t tis f 'rn is to ra 'd rnfo'' utiort which can a e the taw f los ible cnflitietc of interest and allow it to take whatever action is CCCSSA to avaid's' e. YOUR NAME: �'1G �__.0 � L -• ' - (Last name,first n me,.iltiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance _ ______ Building Variance Trustee Change of Zone _ _...__ Coastal Erosion Approval of plat __ Mooring Exemption from plat or official map _ Planning Other (If"Other",name the activity.)_ Do you personally(onthrough yourcoinpany,spouse,sibling,parent,or child)haven t'elationsltip with tory officer or employee cif the Toww.of Southold? "Relationship"includes by blood,marriage,ur business interest,"Business interest"mcsms n business, including A partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporsitioli in which the town officer or employee owns more than 5%of the shares. YES _ NO —_ .x If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold - Title or position of that person — describe the relationship between yourself(the applicant/agerithepresentative)and the town officer or employee.Either check the appropriate line A)through D)4nd/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 applipiit (when the applicant is a corporation); B)the legal or beneficialowner of any interest in a non-corporate.entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 4, day of 20� Signaturc Print Name Form TS 1 µK� 1 Michael J.Domino,President �� p V¢F©j�Co` Town Hall Annex John M.Bredemeyer I1I,Vice-President ¢��� G� 54375 Route 25 Charles J. Sanders P.O.Box 1179 Cn Glenn Goldsmith o �}� Southold,NY 11971 A.Nicholas Krupski ®@ ; Telephone(631)765-1892 Fax(631)765-6641 Kzzzrl:cr.''-� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ELLEN HERMAN COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE oeAe"residing at/dba PC. /J OX Z6 4 7 being duly sworn, depose and say: That on the�ay of vVZ , 2017, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,July 19,2017. Dated: 71aP1'2 b17 (signature) Sworn to before me this �$jjl day of fq Zo(7 ,Q ),� Notary Public DIANE DISALVO NOTARY PUBLIC-STATE Of NEW YORK No. O1 D1475593 Qualified In Suffolk County p My Commission Expires Apill 30, 20/9 m 9 � � I � ��-o rr f:• k• � (7. ■ ■ � � ©�x � ©A o o r Il_I rq �BREidTW�10D v=�lY 1�71�I L Ln U pp,s • fit' WHITE ST.O�IE'-,i Y, � 7 r r r UI ru Certified Mall Fee 9 Certified Mall Fee 7 3� e $ $3.35 cC� G��i 7�` $ J.J•1 0971 � ul Extra Services&Fees(checkbo,,all tee appro nate � 4>> � Extra Services&Fees(check box,add tee as dp b nCeJ �� )�4 ❑ Return Receipt(hardcoPY) $ I j ILI ) ��,- v t ❑Return Receipt(hardcOpy) $ �il r-'� ❑Return Receipt electronic r� ❑Return Receipt electronic , P(electronic) $ V P( ) $ O f—tmark ❑Certified Mall Restricted Delivery $_ .-• � -�� � ❑Certified Mali Restricted Delivery $ G OStm �') 9 q $ '�;." 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OWNER(S) OF RECORD: ELLEN HERMAN - SUBJECT OF PUBLIC HEARING : For a Wetland Permit to construct a 3'x10' walkway using Thru-Flow decking, pressure treated framing, and four (4) pressure treated 4"x4" support piles attached to a 4'x16' fixed dock using Thru-Flow decking, pressure treated framing, and six (6) 4"x4" locust pilings. Located: 1655 Lake Drive, Southold. SCTM# 1000-59-5-8.1 TIME & DATE OF PUBLIC HEARING : Wednesday, July 19, 2017 — 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 eoSIUFFQ� Town of Southold Erosion, Sedimentation & Stanii-Water Run-off/ASSESSMENT FORM O.L PROPERTY LOCATION: s.c.T.M.u: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ! ��Q �CJ STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN ! DDti�rlct -S+ect�on oc Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. i SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the project Parcels? I Will this Project Retain All Storm-Water Run-Off (include Total Area of all Parcels located within /_ / Generated by a Two(2')Inch Rainfall on Site? I the Scope of Work for Proposed Construction) f1 (S.F.l Acres) (This item will include all run-off created by site ® 1 b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all N� and/or Ground Disturbance for thero osed Site Improvements and the ermanent creation of construction activity? p p ®' 000107(S.F.1 Acres) impervious surfaces.) p I PROVIDE BRIEF PROJECT DESCRIPTION (Provide Addillenalpages;esNeeded) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location?This VO Item shall Include all Proposed Grade Changes and �V Slopes Controlling Surface Water Flow. / y Does the Site Plan and/or Surveydescribe the erosion ` a`���� / ¢'eU ���� j�rir3 and sediment control practices that will be used to /V control site erosion and storm water discharges. This 0 1!94A Egorme6 19064 7__9P P)Z)AI&S Item must be maintained throughout the Entine r p �9 q rx 16"A19 AP ®OCIE Construction Period. �- i7 cP7� 4 Will this Project Require any Land Filling,Grading or j / 6 it S+Q ,rr.' 6vL7 � Excavation where there is a change to the Natural � { `7 Existing Grade Involving more than 200 Cubic Yards — f p e�f of Material within any Parcel? /�//✓ �JL/ �/l 11V/e S Will this Application Require Land Disturbing Activities ® / �s�� rJ Pp� q 9 x ' o Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? j 6 Is there a Natural Water Course Running through the ++ Site? Is this Project within the Trustees jurisdiction E] General DEG SWPPP Requirements: or within One Hundred(100')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 are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to ; Including Construction activities involving sag disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES penult Is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parting Areas or other Impervious q for Storm Water Discharges from Construction activity-Permlt No.GP-040.001.) Surfaces be Sloped to Direct Storm-Water Run-Off ILf' 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of-way? El submitted to the Department prior to the commencement of construction activity. j 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, !k required,post-conetruclion 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 terms and conditions of this permit.In addition,the SWPPP shall Area?(mis item will NOT include the installation of brivevray Aprons) El I Identify potential sources of pollution which may reasonably be expected to affect the quality of stone water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SW PPPs that require the post-construction storm water management practice In a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area, I component shall be prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion Control Plan is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit that is knowledgeable In the principles and practices of Storm Water Management (NOTE: A Check Marc(.(I)andlor Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, p� COUNTY OF..� ...................SS That I,... ..C/'Ale?.A:... � /t��r��..............being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of Individual signing Document) And that&she is the ..........................4. 74.................... . ... . . ......... .. .. ... .. .............................................................. ....... .. (Owner,Contractor,Agent,Corporate Officer,eta) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to { make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and fi that the work will be performed in the manner set forth in the application filed herewith. Sworn to before mes; r ' .................... a?................day of... J ......................2017 Notary Public: .�.Jl.l4!�l�i�r. ....... .... !!l ....... ✓� r °�E !/. .... i Il (Signature or Applicant) I! FORM - ®6110 TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,261 Towyn of Southold LWRP CONSISTEIr1CY ASSESSMENT FORINT 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 s Tjj icant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. rhus, each anmyer niust be cxplainM in detail, listing.both suptaorting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME /l� X O The Application has been submitted to(check appropriate response): Towyn 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: 0 07 07ROCI',� .311114 IX411 S� �s�rur� AR254r�,P AWINicis ro 4( 64 'x .4//X 4// p/L/NGS OF 0 CV 5r J",� r' f p Location of action: 1_6J3_7 ZW Site acreage: , Present land use: Present zoning classification: �l� 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;_ L�Z46AI h6e&.4/(-� (b) Mailing address: 3iz /3 � .r�-,� �r AM, z (c) Telephone number: Area Code( (d) Application number,if any: . Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed hest Management Practices that will further each policy. Incomplete answers will require that the foram 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. Yes F] No EJ Not Applicable J L 0 L O Q4 o C0.4 L/rV.� � !j 1' CrRX to) p Q . /c/,f2 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWII.P Section III—Policies Pages 3 through 6 for evaluation criteria Yes 0 No U Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRF Section III—Policies Pages 6 through 7 for evaluation criteria Yes No 0 Not Applicable )AWd u'4'1'42Z V Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria D Yes 1:1 No ['2J" Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No 'Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. El 0 X Yes No Not Appucable _ 0 T V GUI 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 ❑ Noo Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in 'Town of Southold from solid waste and hazardous substances and wastes. See LRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 1:1 Yes F] No No�I 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. (� ❑ YeO NoJE71 Not Applicable IT A16 AV,921 c EY 25AW 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 P_� 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 1-1 No 4L'J- Not Applicable ' AIV 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. ElYes ❑ No,�l'( Not Applicable NO 11G W Attach additional sheets if necessary ` Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No 21 Not Applicable PREPARIIM ]BY1YZC �, �- /�I,q e1G TITLE_ _ C, it�,� DATE ,O,)7