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TR-9126
Michael J.Domino,President �rjf SU(/jTown Hall Annex John M.Bredemeyer III,Vice-President ,`O� Ol0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 olyCOU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1615C Date: September 6,2019 THIS CERTIFIES that the removal and replacement in-place of approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead,• incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of-4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill-, and to establish and perpetually maintain a 10' wide non-turf buffer along newly constructed bulkhead; with the condition of the installation of gutters to leaders to ells; At 875 Hill Road, Southold Suffolk County Tax Map #1000-70-4-26 Conforms to the application for a Trustees Permit heretofore filed in this office dated October 13, 2017 pursuant to which Trustees Wetland Permit#9126 Dated November 15, 2017,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 removal and replacement in-place of approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of-4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 10' wide non-turf buffer along newly constructed bulkhead; with the condition of the installation of gutters to leaders to dmyells. The certificate is issued to Elizabeth Van Bour og ndien owner of the aforesaid property. o � Authorized Signature } pE SOTown Hall Annex OT . Michael J. Domino, Pi pmt >>', John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q � O Telephone(631) 765-1892 Greg Williams 'rOUM`1, O Fax(631) 765-6641 �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 0 DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain St day of construction 7"']', constructed Project complete, compliance inspection. INSPECTED BY: COMM NTS: a CERTIFICATE OF COMPLIANCE: EN-CONSULTANTS March 16, 2018 Board of Trustees Town of Southold P.O. Box 1179 Southold,NY 11971 Attn.: Elizabeth Cantrell Re: Elizabeth Van Boureondien,Wetlands Permit 9126 Dear Ms. Cantrell: In satisfaction of Term and Condition #8 of the captioned permit, the required Declaration of Covenant was recorded in the Office of the Suffolk County Clerk on March 2, 2018. A copy of the recorded document is enclosed for your file. Res e fully yours, im teph Enclosure cc: Elizabeth Van Bourgondien ` ll MAR 1 9 2018 i 1319 North Sea Road Southampton,New York 11968 p 631.283.6360 f 631.283 6136 wwwenconsultants com environmental consulting CC# : C18-8675 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 03/02/2018 under Liber D00012952 and Page 289 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 03/02/2018 SUFFOLK COUNTY CLERK JUDITH A.PASCALE SEAL S II VIII IIII VIII VIII VIII II III II III VIII III IIIIIIIIII 111111 VIII VIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 03/02/2018 Number of Pages : 10 At: 09 :20 :28 AM Receipt Number : 18-0039180 LIBER: D00012952 PAGE : 289 District: Section: Block: Lot: 1000 070 . 00 04 . 00 026. 000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $50 . 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 .50 NO RPT $200 . 00 NO Fees Paid $296.50 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County a RECORDEDNumber of pages 2018 Mar 02 099 2l,Z8 All JUDITH A. PASCALE :,LEFT; OF This document will be public SUFFOLK' COUNTY record.Please remove all L D00012952 952 Social Security Numbers P 21819 prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 FEES Mortgage Amt. Page/Filing Fee '} �"12. 1.Basic Tax Handling 20. 00 Additional Tax TP-584 Sub Total Spec./Assit. Notationor EA-5217(County) Sub Total j Spec./Add. EA-5217(State) TOT.MTG.TAX Dual Town Dual County R.P.T.S.A. Held for Appointment Comm.of Ed. 5. 00 y Transfer Tax Mansion Tax Affidavit The property covered by this mortgage is certified Copy _ or will be improved by a one or two `-- -r__.--••• ~' - 1 family dwelling only. NYS Surcharge 15. 00 Sub TotalYES or NO Other r3o Grand Total a Lo If NO, see appropriate tax clause on R� page# of this instrument. 4 1 Dist. 100( 3573768 1000 07000 0400 026000 5 Community Preservation Fund T S 1111 Consideration Amount $ Tax Service Real Property RPSMI AIII�� 11 11 - Agency 09-FEB48 CPF Tax Due $ Verification Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD&RETURN TO: Vacant Land TD En-Consultants TD 1319 North Sea Road Southampton,NY 11968 TD Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffolkcountyny.gov/clerk Title# 8 Suffolk County Recording & Endorsement Page This page forms part of the attached Declaration of Covenants made by: (SPECIFY TYPE OF INSTRUMENT) Elizabeth Van Bourgondien The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of Southold Town of Southold In the VILLAGE Board of Trustees or HAMLET of Southold BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over � a r r DECLARATION OF COVENANTS THIS DECLARATION made this -�Z/ day of _ 2018, by Elizabeth Van Bourgondien, 875 Hill Road, Southold,NY 11971,hereinafter referred to as'DECLARANT': WITNESSETH: WHEREAS, DECLARANT is the owner of certain real property located at 875 Hill Road, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 70, Block 4, Lot 26, which is more particularly bounded and described as set forth in Schedule "A" annexed hereto,hereinafter referred to as the Property; and 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; and WHEREAS, the DECLARANT 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, on November 15, 2017, the Trustees approved the application and issued a permit with terms and conditions; and WHEREAS, the issued permit, terms and conditions of the permit, as well as the project plan prepared by En-Consultants, last dated December 12, 2017, and stamped approved on December 14, 2017, upon which the permit is based,are annexed hereto as Schedule"B;"and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a ten-foot wide "non-turf buffer" be established and maintained landward of the bulkhead, as depicted on the project plan prepared by En-Consultants, dated December 12, 2017,and stamped approved on December 14,2017; NOW, THEREFORE,the DECLARANT does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and perpetually maintained landward of the bulkhead on the subject premises a ten-foot wide "non-turf buffer" as defined by Chapter 275 of the Town Code, as depicted on the project plan prepared by En-Consultants, dated December 12, 2017, and stamped approved on December 14,2017. 2) The DECLARANT shall at all times comply with the Terms and Conditions of the permit, a copy of which is attached hereto in Schedule`B"annexed hereto. 3) These covenants shall run with the land and shall be binding on the DECLARANT, her heirs, assigns,purchasers,or successors in interest and may be modified only upon resolution of the Board of Trustees. (THIS SPACE LEFT BLANK INTENTIONALY) 2 IN WITNESS WHEREOF, the owner has duly executed this instrument this day of 02 2018. 1"EffiVan Bourgendien STATE OF ss: COUNTY OF On the day of , in the year 2018, before me the undersigned, a Notary Public in and for said State, personally appear lizabeth Van Bourgendien personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument,the individual or the person on behalf of which the individual acted,executed the instrument. RING OCOKYJNOS Notary Public NOM Public- of Now VoFk No.OIKOCIO1941 ®u®ltfled In SuffoOk Coungy My Commission Explms Aue.25,2020 3 SCHEDULE A ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected, situate, lying and being at Southold,Town of Southold,County of Suffolk and State of New York,known and designated as Lot number 5 on a certain map entitled, "Map of Calves Neck at Southold and filed in the Office of the Clerk of Count of Suffolk on February 15, 1972 as Map number 5673. 4 all Al j 71 14, Off A.M *W� Y- ,jw 5)-, e.c�ctr if cu.-) t� TERMS AND CONDITIONS The Permittee Elizabeth Van Bourgondien residing at 875 Hill Road 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 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. 1 l. 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. SOUTH�,OL,o TR STEES Issued To!!!4!"V ver ale 11 'WAT 19ttv Address. THIS NOTICE AAiJST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWR! OF SOUTHOLD rk SOUTnOLD, N.Y. 11971 4 TEL.: 765.1892 � C-11 y "�C SaHS HS 5 c ACa55 VIA 5LO-Ec-r PROPERTY&CANAL f3Y DAIS) RO i OP. G'0 3� RYWELL sum � tnstituus Oz comw Haast m Map 44 2000p" = 30' ' Notes; U Purpose;I.'eplace and maintain exisbnq functional 'G PROP. OP. bulkhead for flood&erosion cwttrd PP G, 2) Patum;AN W �� O 3) Approx.10 ct said/silt spud to be IncidentIly Oy dredged frwn 5'wide area adjacent to bulkhead and used as backfill(sit amain to be deployed 'v around dredcr area) 4) New bulkhead to be constructed with wnyl sheathlnq, DWEL STORY treated stncturd tim6ers,and hot-dipped LING galvaved steel"we � 5) Project plain based on land survey prepa-ed 64 John C, $\ Ehlers Lad 5;rve4or,dated 9-5-I1 cp 6) Plan and crossview diWaos ae schematic in nah;re DECK \ w ad are Intended onI to establish �y y project location,snipe, and basic construction details for pamittlnq purposes and are nit intended to serve as or substitute for x englneerinq or construction dam for constructaon purposes EX. +91'TIMBER BULKHEAD 7) PrTO BE REMOVED AND REPLACED operty Ixatlat;875 Hill Swt},dd; �. 5CtM#1000-70-4-26 (IN-PLACE) WITH VINYL BULKHEAD ADJ. BLKHD. ZM1`� S DEC 1 4 2017 >O sG° ` ' 42 �42" _ Sotj'hold Town r��'\i�GD�'F� "9 r -54'` \ • • 9� _- Boa[ o Tm to TO e'('O-�. TO q O eF / 35• !B C F 0 /rh'Q J OFqt 014 1319 NORTH SEA ROAD APPROVED BY SOUT IAMFON, W 11968 BOARD OF I RUSTEES 631-283-6360 TOWN OF SOUTHOLD PPOF05�n aUI.K M �pIMACMW TE FOP ftIZAPM VAN 60UP60NPEN ON JOCKEY CM, 5OUTHOLP, 5K COUNTY, NY 5H��f I OF 2 10-4-11, 12-12-11 �r - s 5�CVON THPU IN-FI ACS 6UMM TFLAaM f +56'<a VAR.)-�1 APPROX.AMA Of/M gTILL (APROX.10 CY SPOIL) 2"CAP w 6" x 6"WALE5 A"x 6" for CLAMPMMN.2'-6" x 16' A�*;Ob MM= 0'-01, 10"LAYLOG 5' x 70'AREA fO 9 INCIRNi fAlLY I g� DI?EDGEt7 f0-4'MLW 8 DEAI7MAN P�WTf EX.GpA1JE (Approx. 0 CY 5*V/5Lf) ., 4 MOP.VINYL f3lA.Kf-i 0IN PIKE OP EX.TIMDEP PLW 3/6" x 10" x 16'VINYL kfATHING 10" x 20'PLE5(6'0.C) DEC 1 4 2017 Iwr,obISIi LTANTS •1319 X10R\T I :Eft RGA D ROF05W 13LII UAP MAaM f SOUTHAIVIFIDN, NY 11968 F0k �UZACCTH VAN POW6ONPEN 31-233-6 360 ON JOCKEY CMFK, 5OUTNOW, 5UFOl K COUNTY, NY 5H��f 2 OF 2 10-4-11 9 �OF SDUjy Town Hall Annex Michael J.Domino,President John M.Bredemeyer III,Vice-President ~ 54375 Route 25 P.O.Box 1179 Charles J.Sanders T Southold,New York 11971 Glenn Goldsmith • �O Telephone(631) 765-1892 A.Nicholas KrupskiCOUN N�� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection { l BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 9126 DATE: NOVEMBER 15, 2017 ISSUED TO: ELIZABETH VAN BOURGONDIEN PROPERTY ADDRESS: 875 HILL ROAD, SOUTHOLD SCTM# 1000-70-4-26 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on November 15. 2017, and in consideration of application fee in the sum of$250.00 paid by Elizabeth Van Bourgondien and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to remove and replace in-place approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5'wide area adjacent to bulkhead to a maximum depth of 4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 10'wide non-turf buffer along newly constructed bulkhead; with the condition of 5' the installation of gutters to leaders to drywells; and as depicted on the revised site plan prepared by En- Consultants,dated December 12, 2017,and stamped approved on December 14,2017. �r IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, J and these presents to be subscribed by a majority of the said Board as of this date. o�S13FFD(�. O '�411 . Cos Charles J. Sandersgod l� enn Goldsmith-Absent I i 'v „e K TERMS AND CONDITION The Permittee Elizabeth Van Bourgondien residing at 875 Hill Road, 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 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. Michael J.Domino,President Vv�OF S0(/jyo Town Hall Annex John M.Bredemeyer III,Vice-President ,`O lQ 54375 Route 25 P.O.Box 1 Charles J.Sanders l Southold,New York 11971 Glenn Goldsmith G � p Telephone(631) 765-1892 A.Nicholas KrupskiO Fax(631) 765-6641 �y00UNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 15, 2017 Robert E. Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: ELIZABETH VAN BOURGONDIEN 875 HILL ROAD, SOUTHOLD SCTM# 1000-70-4-26 Dear Mr. Herrmann: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, November 15, 2017 regarding the above matter: WHEREAS, En-Consultants on behalf of ELIZABETH VAN BOURGONDIEN, 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 October 13, 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 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 November 15, 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 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 ELIZABETH VAN BOURGONDIEN to remove and replace in-place approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of-4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 10' wide non-turf buffer along newly constructed bulkhead; with the condition of the installation of gutters to leaders to drywells; and as depicted on the revised site plan prepared by En-Consultants, dated December 12, 2017, and stamped approved on December 14, 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: None Very truly yours, Michael J. Domino President, Board of Trustees MJD/dd 5 U RVEY Of LOT 5 N AS SHOWN ON A CERTAIN MAP ENTITLED ' MAP OF CALVES NECK FILED IN THE SUFFOLK COUNTY CLERKS OFFICE ON 2/15/72 AS MAP NO. 5673 51TUATE : 5 ,Al C0UTHOLD Y!� TOWN : 50UTHOLD 5U FFOLK COUNTY, NY s SURVEYED 09-05-2017 SUFFOLK COUNTY TAX # 1000 - 70 - 4 - 2G CERTIFIED T0: ELIZABETH VANBOURGONDIEN �Nr� O` ' \ 0 a`lwaYO" �D U /0 D41 E C E V EDD �, ;, . � , MEttFR� Fpm ( OCT 1 3 2017 N ^,/ ' 21�w Southold Tewn - �OBoard of Tri s ee T . .� S v W O O v \ C? T 4pT if 6Sa m° F - — ---- - o�cK g - - — - - - o , CO ZO / / (Y) -N- 011 NG-)o 4ti 4o .3 NOTES "Unauthorized alteration or addition to a survey - O� �� map beorm o licensed land surveyor's seal is a MONUMENT FOUND ,, violation of secii72osubdivision 2, of the JOHN C. E H LE R5 LAND 5 U RVEYO C N� New York State Education Law" ® MONUMENT FOUND Q "Only copies from the originalof this survey SPLIT RAIL FENCE !� ' marked with an orlginol of the land surveyor's moi/ stomped seal shall be considered to be vand true copies" 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 "Certifications indicated hereon signify that this _ survey was prepared in accordance with the ex— Area = 22,1 G S Ft. RIVERHEAD N.Y. 1 1901 369-8288 Fax 3G9-8287 r t� by fisting Code of Practice for Land Surveys adopted �' e / Q the New York State Association of Professional Area = 0.507 Acres O Land Surveyors Said certifications shall run only e5urvey@o tonline.net to the person for whom the survey is prepared, GRAPHIC SCALE 1"_ 30' J s s�2 2 and on his behalf to the title company, governmen— Fp lal agency and lending institution listed hereon, and SANDS to theass gness of the lending institution CertUfico- 17-178 tions are not transferable to additional institutions !, Southold wu Mp SITS(ACa55 VIA 51.113 Ct Ao . „8 p it PROPERLY&CANAL 6Y 13AU) h'04 s a ROP. 6'0 v' v im RYWELL ry LA y� s V N ASul Yt 44 Q� old o Custer��� c _ Z - 5uf'folk Cm*Ha,*,m Map 44 9 " = 30' 111 - +2000, - 1) Purpose;Replace and maintain exi5tlnq functional PROP. G' bulkhead for flood&erosion control �� _ DRYWELL 2) Datum;MLW t,� O 3) Approx.10 c4 sand/At spoil to 6e incidentally y O dredged from 5'wide area adjacent to bulkhead /\\ and used a5 6ackfill(51t curtain to 6e deployed y around dredge area) 2 STORY 4) New bulkhead to 6e constructed with wnyl sheathing, pj DWELLING treated structural bm6er5,and hot-dipped galvanized steel hardware 5) Project plan 6ased on land survey prepared 64 John C. Phlem Land Surveyor,dated 9-5-17 GO G w 6) Plan and cro5sview dtaq-ams are schematic in nature DECK �y and are intended M4 to establish project location,scope, and basic construction details for permittanq purposes h� and are rot Intended to serve as or substitute for X/ EX. +9 1' TIMBER BULKHEAD engineerinq or construction plans for construction purposes TO BE REMOVED AND REPLACED 7) Property location 875 Hill Road,Southold; G� 5CTM#1000-70-4-26 (IN-PLACE) WITH VINYL BULKHEAD ADJ. BLKHD. 39. P743" � B +� 11 DEC 1 4 2017 -55" ��zr� •e�;F .:�Mrr -501 O Southold Town ��o q Boar of Trustee TD�P�'O D�� TO e 54° -35" 6F �o M FiN I o' pyo �s cy �- cio �p�,, �Y qs eqc o/o`PT�oT-, EN-CONSULTANTS 1319 /CCJ SPO/C 4M< 1319 NORTH SEA ROA® APPROVED BY., SOUTHAMPTON, NY 11968 BOAR® OF I RUSTEES 631-253-6360 TOWN'OF SOUTHOLD PPOP05�P PULUAP PVLAaMf Pecef;ILft�c 2-017 FOf �LIZVM VAN POWCAONPEN ON JOCKEY CM, 50LITHOW, ' 5UFFOLK COUNTY, NY 4 5H��f 10 2 10-4-I1, 12-12-1-7 5�CION TWU IN-F�Aa C ULKHW FMAaMf 111 - 10' +56' C&VAP,.) APPPDX.ASA OF/6ACKFILL fl (APPpOX.10 Cy 5POIL) 2" CAP 10, --r•,, (5) 6" x 6"W&1E5 4" x 6" TOP CLAMP MHW- 2'-6" 06 OD MLW- O'-0" 10" LAYLO6 5' x 10' AP.EA fO 6E INCIPENfALLY sl.. 19P nPaP f0-4' MLW PUP. 60ff. EX.Zip SPE (APPpOX.10 CY 5AN7/51Lf) 8" PJ APMAN4 MLW PpOp.VINYL 131,LK pv IN +9' PEN, PLACE OF EX,fI LTF,6LKNI7, z/10" 8" x 10" x 18' VINYL 5NEATHIN6 x 20' PILE5(6' O.C.) D DEC 1 4 2017 Souti;oid Torun Board of fzuSteeS EN-CONSULTANTS 1319 NORTH SEA ROA® PPOP05�19 6U UAn r? MAaM f SOUTHAMPTON, NY 11965 FOP �I IZVMi VAN 130UPWNPEN 631-283®6360 ON JOCKEY CM, 5OUTHOL19, 5ULK COUNTY, NY 5H��f 2 OF 2 10-4-17 Michael J. Domino, Pr•E�j,uznt tflf'OSOF94 Town-Hall Annex John M. Bredemeyer, III, Vice-President ,s`� �Gy 54375 Route 25 kz Charles J. Sanders �' <: P.O. Box 1179 Glenn Goldsmith Cn .?Y` Southold, NY 11971 A. Nicholas Krupski y � Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD g TO: �tHu& ArAW Wk6e, 0 CIO 61-001JSIG`i Please be advised that your application dated 13t zoc7 has been reviewed by this Board at the regular meeting of AIN 15, U11 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) 1 sc Day of Construction ($50.00) % Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement(complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the q 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. _TheJoll_ wing-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: Michael J. Domino, President Board of Trustees Michael J.Domino,Pre: 1- o�pgtlFFO(,�cOG T wn Hall Annex John M. Bredemeyer III,Vice-President � 54375 Route 25 Charles J. Sanders y z P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 i, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ' / Date/Time: g NOV ��_ Completed in field by: �cAde t� z Sq 5Zi0 En-Consultants on behalf of ELIZABETH VAN BOURGONDIEN request a Wetland Permit to remove and replace in-place approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of-4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 5' wide non-turf buffer along newly constructed bulkhead. Located: 875 Hill Road, Southold. SCTM# 1000-70-4-26 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 ` of Ch. 275 v Ch. 111 SEQRA TYp e: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 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: r roto ;�a/ C4�)A_k VS Present were: redemeyer Ls M. Domino Goldsmith N. Krupski . Sanders Other Page 1 of 2 Michael J. Domino„Pres o�QS�FFo��-ell Town Hall Annex John M. Bredemeyer III,Vice-President may` yam, 54375 Route 25 Charles J. Sanders COPP.O.Box 1179 Ze Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski �?� p!� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: En-Consultants on behalf of ELIZABETH VAN BOURGONDIEN request a Wetland Permit to remove and replace in-place approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of-4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 5' wide non-turf buffer along newly constructed bulkhead. Located: 875 Hill Road, Southold. SCTM# 1000-70-4-26 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 Elizabeth Van Bourgondien 875 Hill Road,Southold SC.TM#: 1000-70-4-26 11-8-17 ILI - a.,a I. ELIZABETH VAN BOURGONDIEN,875 HILL ROAD, SOUTHOLD Figure 1. Looking east at face of existing timber bulkhead to be removed and replaced(in-place) with vinyl bulkhead. t' r � , 4� r 4, Figure 2. Looking west over top gfexisting timber bulkhead to be removed and replaced(in-place) with vinyl bulkhead. - - 422&'t5' r72'84�5,?i, ,,,;a1.c.?„u:,; .Y;.':.,,t;.'w 11 �r"; - - +Ooa�ti i sS 2r Z5 y = a� d� P m v F Hashamomuck Pond ' cr DR 2 C� Park O Aa w 9_ D� F 0 F Budds ° PondLA 10j uopa,semn ° ` t' ir1 fy P Vine $ ' Jeri m D IRll O c I �PV 48 25c'9 �f o k ` Hippodrome 4 ` R Ft Soutut ddd ` Pond I � o ltJ+s ® H Soc ` ;D BI EDOfI Town�` Pack S' JO -TO L D Southold � HU �' founders, ., "! L HS CrPP� Landing ', ° 511 (ACa55 VIA SL113 Cf ptHar ppM& CANAL PY 6AU) ` � �1�ek ivy BAY O 0 cem D P� w SoiL ParParkUfa Indian Mu m;, lnustiwte av w a ' 5uffdk Cou*Hagstron Map 44 ° o sq 2000' f � Gt.eeK sasui t West GREAT HOG � Qo �� NECK 0 n 4 �y BA`NIEW Burl ZN a s <, q �h " Creep r .� A,�C EDAR w 9 h SEE SEC NO z-_______ W 57 IT. RD LWc) T— C—k 0 TOM OF—CU) u 3 F M3A(c) 9m , W b 4 fiTrv,a la e 6 1 -4A(.) Of 71 3A b &6 nrn figN 10 a 40 21 ZIA 71 /1 FORPCLNO 41 SEE SEC Na Is 211 12AG) I I "( w 3 3 p 24M -19 19 9 )A 24 1 SOUTHOLD .7A(.) 20-0 MY 45 IT 37A(.) 7 344 32 11A 205 2 I 4A(G) i,5 10 I"A 23,0 v 393 IT 4 7A So .47FOR PCC NO SEE�C N& 27 �3 46 M Qm 45i _n, SOU.— UNE —————- NOTICE COUNTY OF SUFFOLK K SOUTHOLD SECTION NO Gwozm Cy E ------- — Real Property Tax Service Agen Y of Y m C...ty—w—d N IIRGI OB 070 A TmR noIWO P (21) R,OEM PROPERTY MAP ::7 EN-CONSULTANTS December 12, 2017 Mike Domino, Chairman Board of Trustees Town of Southold P.O. Box 1179 Southold,NY 11971 Re: Elizabeth Van Bourgondien, 875 Hill Rd., Southold Dear Mr. Domino: As requested at the public hearing held on the captioned application on November 15, 2017, please find enclosed three (3) copies of a project plan prepared by En-Consultants, last dated December 12, 2017, which has been revised to depict (2) six-foot diameter drywells and an increase in the width of the proposed non-turf buffer to 10 feet. Should you require any additional information before the permit can be issued, please let me know. Re pectfully yours, Robert E. Herrmann Coastal Management Specialist I ID DEC 1 4 2017 Southold Turn Board of Trustee 1319 North Sea Road I Southampton,New York 11968 p 631.283.6360 1 f 631.283.6136 www.enconsultants.com environmental consulting OFFICE LOCATION: ®� ®� MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) `,a; _hc P Tele hone: 631765-1938 Southold, NY 11971 �® COU01 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: November 14, 2017 Re: LWRP Coastal Consistency Review for ELIZABETH VAN BOURGONDIEN SCTM# 1000-70-4-26 En-Consultants on behalf of ELIZABETH VAN BOURGONDIEN request a Wetland Permit to remove and replace in-place approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of-4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 5' wide non-turf buffer along newly constructed bulkhead. Located: 875 Hill Road, Southold. SCTM# 1000-70-4-26 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 Policy Standards and therefore is CONSISTENT with the LWRP provided the following is required to meet Policy 6. 1. Require turbidity controls during construction in Jockey Creek. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. _ ��e Peter Young,Chairmany Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 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., November 8, 2017 the following recommendation was made: Moved by Keith McCamy, seconded by John Stein, it was RESOLVED to SUPPORT the application of ELIZABETH VAN BOURGONDIEN to remove and replace (in-place) approx. 91 If. of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a max. depth of- 4'MLW and use approximately 10 cy. sand/silt spoil as backfill; and establish a 5' wide non-turf buffer along newly constructed bulkhead. Located: 875 Hill Rd., Southold. SCTM#70-4-26 Inspected by: John Stein, Peter Meeker, Keith McCamy The CAC Supports the application with the Condition of a 10' non-turf buffer landward of the bulkhead. Vote of Council: Ayes: All Motion Carried ®guFFOI,�Cd John M. Bredemeyer III,President '' �¢ Town Hall Annex Michael J.Domino,Vice-President54375 Main Road H P.O. Box 1179 James F.King,Trustee d Southold,New York 11971-0959 Dave Bergen,Trustee Telephone(631) 765-1892 Charles J. Sanders,Trustee Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application it_Wetland Permit Application Administrative Permit —Amendment/Transfer/Extension 1Received Application: Received Fee:Z'5-OrM Completed Application D E E — V E C (I Incomplete la Il UV I'= SEQRA Classifcion: Type I Type II Unlisted Coordination: (date sent) OCT 13 2017 ��LWRP Consistency Assessment Form ICAC Referral Sent: l©,�17 e/ Date of Inspection: /11-5-111Southold Town — ar of ru e _Receipt of CAC Report: —Lead Agency Determination. Technical Review: Public Hearing Held:- 11-19-417 Resolution: Name of Applicant Elizabeth Van Bourgondien Address 875 Hill Road Southold,NY 11971 Phone Number: 631 765-1213 Suffolk County Tax Map Number: 1000 - 70-4-26 Property Location:875 Hill Road, Southold Property is located on south side of Hill Road,+/-483'east of Wells Road (provide LILCO Pole #, distance to cross streets, and location) AGENT: En-Consultants (If applicable) Address: 1319 North Sea Road, Southampton,NY 11968 Phone:631-283-6360 V ff'4A a Board of Trustees App: ration GENERAL DATA Land Area(in square feet): 22,116 Area Zoning: R-40 Previous use of property: Residential,one-family dwelling Intended use of property: No Change Covenants and Restrictions: Yes X No If"Yes", please provide copy. Will this project require a Building Permit as per Town Code? Yes X 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 Building Dept. Yes X No Does the structure(s)on property have a valid Certificate of Occupancy Yes No Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description(use attachments if necessary): Remove and replace(in-place)approximately 91 if of existing timber bulkhead with vinyl bulkhead;incidentally dredge 5'wide area adjacent to bulkhead to a max.depth of-4'MLW and use approximately 10 cy of sand/silt spoil as backfill;and establish a 5'wide non-turf buffer along newly constructed bulkhead,all as depicted on the project plan prepared by En-Consultants,dated October 4, 2017. Board of Trustees Applic, `ori WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To replace and maintain existing bulkheading for flood and erosion control. Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 Closest distance between nearest existing structure and upland edge of wetlands: N/A feet Closest distance between nearest proposed structure and upland edge of wetlands: N/A feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? +/-10 cubic yards sand/silt dredged spoil How much material will be filled? +/-70 cubic yards backfill(on-site dredged spoil and upland soils) Depth-of which material will be removed or deposited: -4 feet MLW Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: Approximately 10 cubic yards of combined spoil and excavated upland soil will be collected by a land based excavator and dumped and graded behind the newly constructed bulkhead as backfill. 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): The project proposes to construct a new vinyl bulkhead in place of existing timber bulkheading,which has retained and protected the property from flooding and erosion since prior to 1977. There is no viable non-structural alternative means of maintaining and protecting the upland portion of the property in its current location,so without replacement and maintenance of the bulkhead,the subject and adjacent properties would be exposed to flooding and erosion damage. In addition to providing the ecological benefits associated with replacing a treated timber bulkhead with untreated vinyl sheathing,the project will establish a 5'non-turf buffer adjacent to the newly constructed bulkhead. And the localized, ephemeral effects of the proposed incidental dredging to recover lost upland material(to be retained on site as backfill) will be contained by a silt curtain. Therefore,the project will effectively maintain the existing conditions along this bulkheaded canal shoreline without any change in or significant adverse impact on the adjacent unvegetated tidal waters of Jockey Creek. 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I-Project Information.The applicant or project sponsor is responsible for the completion of Part 1.Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 I-Project and Sponsor Information Name of Action or Project: Van Bourgondien Bulkhead Project Location(describe,and attach a location map): 875 Hill Road,Town of Southold,Suffolk County,NY,SCTM#1000-70-4-26;property is located on south side of West Hill Road,+/-483'east of Wells Road,location map provided. Brief Description of Proposed Action. Remove and replace(in-place)approximately 91 if of existing timber bulkhead with vinyl bulkhead;incidentally dredge 5'wide area adjacent to bulkhead to a max.depth of-4'MLW and use approximately 10 cy of sand/silt spoil as backfill;and establish a 5'wide non-turf buffer along newly constructed bulkhead,all as depicted on the project plan prepared by En-Consultants,dated October 4,2017. Name of Applicant or Sponsor: Telephone: 631-765-1213 Elizabeth Van Bougondien E-Mail: Address: 875 Hill Road City/PO: State: Zip Code: Southold NY 11975 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. X 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: DEC,COE,DOS X 3.a.Total acreage of the site of the proposed action? 22,116 sf t b.Total acreage to be physically disturbed? <5,000 sf c Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 22,116 sf 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑ Industrial ❑Commercial ® Residential(suburban) ❑Forest ❑Agriculture ®Aquatic ❑ Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b. Consistent with the adopted comprehensive plan? X 6.Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape X 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:Peconic Bay and Environs,Reason:Protect public health,water,vegetation, and scenic beauty, Agency: Suttolk County,Date: 7-12-88. X 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b. Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 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. N/A 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: N/A 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: N/A 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? X X 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? X 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: Approximately X 350 sf bottom area of Jockey Creek will be temporarily disturbed by incidental dredging to recover lost upland material. 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 animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? X 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: X 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: X 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: X I AFFIRM THAT THE INFO ATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Rob .Herrmann,Coastal Management Specialist Date: October 10,2017 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 I 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 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? -4 / Part 3-Determination of significance.The Lead Agency is responsible for the completion of Part 3.For every question in Part 2 that was answered"moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part I 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 of result in any significant adverse environme al i pacts. 1-7-11 617 / Na e of Le gency Date N ' l 62� '0 114,4V e, 6� - Print or Type N4me of Re7popqble Officer in Lead Agency Title of Responsible Officer !)W� k6_�V� Signature of Re onsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 r I Board of Trustees Application i _ I AUTHORIZATION (Where the applicant is not the owner) f I/We Elizabeth Van Bourgondien I owners of the property identified as SCTM# 1000- 70-4-26 in the town of A Southold New York,hereby authorizes En-Consultants 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. i C r f Z N/A Pro0hy Owner's Si ature6r't Property Owner's Signature Elizabeth Van Bourgondien I I SWORN TO BEFORE ME THIS DAY OF_ ll , 20—i-1 No ub is MARINA KOKKINOS Notary Public-State o9 New York No.01 K061 91941 QualMed in Suffolk County My Commission Expires Aug.25,2020 f -t' Board of Trustees Application I County of Suffolk State of New York Elizabeth Van Bourgondien BEING DULY SWORN fff€ 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. v-Z G�� Signature, Elizabeth Bourgondien i SWORN TO BEFORE ME THIS^a DAY OF Y( 20n i i I - ry ublic MARINA ISOKVJNOS Notary Public-Ststs of Now York No.01 K06191941 Qualified In Sugolk County My Commission Expires Aug.25,2020 1 y f i f APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is ` necessary to avoid same. YOURNAME: Van Bourgondien, Elizabeth (Last name,first name,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 X Change of Zone Coastal Erosion t Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) E Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation kin which the town officer or employee owns more than 5%of the shares. i YES NO ✓ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. i The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): i A)the owner of greater than 5%of the shares of the corporate stock of the applicant i (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2-A da of APL4 204 t 7 Signature i'P�=�dlc r,! aLLJg2 Print Nameliizabeth Van BourgKndien Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same YOUR NAME: HPrrmarm Robert F (Last name,first name,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.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO 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(agent/representative)and the town officer or employee Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP i Submitted thisy of 0 Ct 209 17 Signature Print Name - E. Herrniarm Form TS 1 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Elizabeth Van Bourgondien SCTM#1000-70-4-26 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Remove and replace(in-place)approximately 91 if of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5'wide area adjacent to bulkhead to a max.depth of-4'MLW and use approximately 10 cy of sand/silt spoil as backfill;and establish a 5'wide non-turf buffer along newly constructed bulkhead, all as depicted on the project plan prepared by En-Consultants,dated October 4,2017. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 875 Hill Road,Southold 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: DATE: Wednesday,November 15,2017 @ 5:30 p.m. You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. Elizabeth VanBourgondien PROPERTY OWNERS NAME: 875 Hill Road MAILING ADDRESS: Southold,NY 11971 PHONE #: 631-765-1213 AGENT: En-Consultants MAILING ADDRESS: 1319 North Sea Road,Southampton,NY 11968 PHONE #: 631-283-6360 Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTIC _ ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Sean&Leslie Olsen 12 Musket Lane Darien,CT 06820 Shirley E.Bratle Trust P.O.Box 1154 Southold,NY 11971 Patrick&Carol Maloney P.O.Box 558 Southold,NY 11971 Allison Nathel 55 W 95th Street,Apt.PHE New York,NY 10025 Town of Southold P.O.Box 1179 Southold,NY 11971 Paul Birman 4240 Galt Ocean Drive#2104 Pamela Panepinto Ft.Lauderdale,FL 33308 William&Mary Dewey P.O.Box 10 Southold,NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK Robert E.Herrmann doing business at En-Consultants 1319 North Sea Road Southampton,NY 11968 , being duly svmm, deposes and says that on the __ day of 20 17 , 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 their 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 Southampton , that said Notices were Mailed to each of said persons by (certified)(ragk;oerzc� mail. i Robert E. ann Coastal Managment Specialist Sworn to before ,"Im- e this `7 � KIM H. STEPHENS day of� ��''h66 ,2017 STNOTARF PUBLIC TE 0COMMISSION N0 . 5015931 QUALIFIED IN SUFFOLK COUNTY Notary blic EXPIRES AUGUST 2 , 20_Zj Michael J.Domino,F'-,---dent O�QSVFFOjs-COG ti- Town Hall Annex John M.Bredemeyer III,Vice-President yJ, 54375 Route 25 Charles J. Sanders C z P.O.Box 1179 Glenn Goldsmith 0 fry Southold,NY 11971 A.Nicholas Krupski 'y �ap`� 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 ELIZABETH VAN BOURGONDIEN 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 1, Robert E. Herrmann ,residing at/dba En7-Consultants 1319 North Sea Road, Southampton, NY 11968 being duly sworn, depose and say: That on the 3rdday of November , 2017, I personally posted the property known as 875 Hill Road, -Southhold. S C T M 11000-70-4-26 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,November 15, 2017. Dated: (signatur Sworn to before me this 15thday of Nov 2017 ary ublic H, STEPH€NS NOTARY PUBLIC STATE OF NEW YORK COMMISSION N0 . 5015931 DUALIF ► ED IN SUFFOLK COUNTY EXPIRES AUGUST 2 . 20_n)_L1 ■ ® A //// Er Ir e� a f11 !o ru m �- U )� Certified Mail Fee Certified Mail Fee �� T r- erie O Q� � Extra Services&Fees(check box,add fee as appropriate) r,�MP Extra Services&Fees(checkbox,add fee as approp ate" .•� ❑Return Receipt(hardcopy) $ ,ryV ❑ Return Receipt(hardcopy) $ J !�' ❑Return Receipt(electronic) $ �✓ Postmark 0 ❑Return Receipt(electronic) $ ®V—7��tg-+.p�jk O ❑Certified Mail Restricted Delivery $ Here Q ❑Certified Mail Restricted Delivery $ _ t1e/r'/e/( El Adult Signature Required $ NOV- q E ❑Adult Signature Required $ ` -- C®1 El Adult Signature Restricted Delivery$ ❑Adult Signature Restricted Delivery$ ,7— C3 Postage e O Postage 796gi_�1�J O $ $ Total Pas `v6g_�CJ`Q5 ru Total Postal $ $ Shirley E.Bratle Trust r- SentTo Patrick&Carol Maloney r- Sent To rq P.O.Box 558 rl P.O. Box 1154 -- E3 Stieefanc C3 Street and'AC� Southold,NY 11971 �• Southold NY 11971 : cry scar- -------- ion ----- A © ■ ■ n'I M N M „ :. s i✓M,y �:':"i e.;xz J rt" t doxy • ✓""'` €',.,y• t (,:� i i` t \aa, s:-.,a Certified Mail Fee n p r� $ [ 1 "M P,7p q rq Certified Mad Fee Extra Services$Fees(check box add lee as appropnate) ``'C` '6',y M $ ,1 y�M P r-3 ❑ Return Receipt(hardcopy) $ J /� Extra Services&Fees(check box,add fee as appropriate) 'C�f-` ❑Return Recelpt(electronic) $ 0 POstm t y ''� 0 ❑Return Receipt(hardcopy) $ C3 ❑Certified Mad Restricted Delivery $ X10\I •-(..Ij�fI}I 0 ❑Return Receipt(electronic) $ , Postmark ❑Adult Signature Required $ IY V-� E=l ❑Certified Mail Restricted Delivery $ p� He X7 Signature Restricted Delivery$ Q ❑Adult Signature Required $ IV�V t-V'� C:3 Postage J j []Adult Signature Restricted Delivery$ � = $ - 7�sv-Z gCJ� 0 Postage Total Pasta ru Total Postr 7968 r`- Sent Allison Na±hel $ C3 St�eelandf 55 W 95"'Street,Apt.PHE _----' � Sent To William&Mary Dewey N New York,NY 10025 _ §tFeetand, P.O.Box 10, ------- --------- Southold,NY 11971 •_____ Citt r J 1 A ■ r`- e. e l u�jMESS= X Im rn a r-q . � f � IS E r I Certified Mad Fee Certified Mail Fee $ �p,i�k P j p $ PTO Extra Services&Fees(check box,add fee as appropriate) �•�� /F/ Extra Services&Fees(checkbox,add/ee as appropriate) 'V ❑Retum Receipt(hardcopy) $ - r ❑Return Receipt(hardcopy) $ J O �j 0 ❑Retum Receipt(electronic) $ POStmarki F= ❑Return Receipt(electronic) $— l}fJ Postmark ,I /) p ❑Certified Mal Restricted Delivery $ —Hefei)i Certified Mail Restricted Delivery $ lOV ._ let t� i 0 E]Adult Signature Required $ v [I Adult Signature Required $ ❑Adult Signature Restricted Delivery$ E]Adult Signature Restricted Delivery$ V l p: 0 Postage 0 Postage - - --- 'a0, ,t�Q� = $ ap25-V- rU TotalP fyb� ril Total Pot Paul Birman 1 $ Town of Southold $ Pamela Panepinto sent r � Sent P.O. Box 117,9 4240 Galt Ocean Drive 42104 --------- N Southold, 11971 Street Street a, Ft.Lauderdale,FL 33308 c,ry,sra :ee o e e a e e e ' • A o . sbe M U r 51i, r-1 Certified Mad Fee v V o $ �� Extra Services&Fees(checkbox,add fee as appropriate) ® Z ❑Return Receipt(hardcopy) $ Q t�t n O ❑RReturnReceipt(electronic) $ 1y OIPOstmark!"1 O []Certified Mail Restricted Delivery $ I: -_Here E ❑Adult Signature Required $ = ❑Adult Signature Restricted Delivery$ 7y9 Sf�� p Postage 68- C:3 8-C:3 $ - = Total Postagt ru N Sent To Sean&Leslie Olsen ra 12 Musket Lane Cry- StreetandAj Darien, CT 06820 City State,2 e e 1 lee• - - - N UTI C 'k: U 'i=' H tA K--- I N G 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: ELIZABETH VAN BOURGONDIEN SU BJ ECT OF PU BLIC H EARI NG : For a Wetland Permit to remove and replace in- place approximately 91 linear feet of existing timber bulkhead with vinyl bulkhead; incidentally dredge 5' wide area adjacent to bulkhead to a maximum depth of -4' MLW and use approximately 10 cubic yards of sand/silt spoil as backfill; and to establish and perpetually maintain a 5' wide non-turf buffer along newly constructed bulkhead. Located: 875 Hill Road, Southold. SCTM# 1000-70-4-26 TIME & DATE OF PUBLIC HEARING : Wednesday, November 15, 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 I the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 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 si nim beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- 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# 70 - 4 - 26 PROJECT NAME Elizabeth Van Bourgondien The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 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) El (c) Permit, approval, license, certification: Nature and extent of action: Remove and replace(in-place)approximately 91 if of existing timber bulkhead with vinyl bulkhead;incidentally dredge 5'wide area adjacent to bulkhead to a max. depth of-4'MLW and use approximately 10 cy of sand/silt spoil as backfill;and establish a 5'wide non-turf buffer along newly constructed bulkhead,all as depicted on the project plan prepared by En-Consultants,dated October 4, 2017. All policies have been checked"Not Applicable"because it is our understanding pursuant to Town Code§268-5("Review of Actions") and the corresponding definitions of"action"and"minor action"by§286-3 ("Definitions")that the project meets the following definitions of minor actions and is thus not subject to waterfront consistency review pursuant to chapter 268: "GG.Within all Town Creeks,replacement of existing bulkhead on the applicant's property m the same location with a silt contain deployed prior to and during construction" (bulkhead replacement);and"A.Maintenance or repair involving no substantial changes in an existing structure or facility"(incidental dredging adjacent to bulkhead to recover lost soil material during bulkhead replacement). • { 1 L Location of action: 875 Hill Road,Southold Site acreage: 22,116 SF Present land use: Residential,one-family dwelling. Present zoning classification:R-40 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: Elizabeth van Bourgondien (b) Mailing address: 875 Hill Road Southold,NY 11971 (c) Telephone number: Area Code 631-765-1213 (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?NYSDEC,USACE,NYSDOS 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. ❑Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III- Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [—] Yes ❑ No ® Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III- Policies Pages 8 through 16 for evaluation criteria ❑Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ® 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. ❑Yes 1:1 No ® Not Applicable v Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ❑ Yes FIN o® Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southoiu`s water-de pendent 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 'Z Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ElYes ElNo ® Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PREPARED BY TITLECoastal Management specialist DATEOct. 10,2017 Robert E.Mcif9hann Amended on 811105 EN-CONSULTANTS October 10,2017 Town of Southold Board of Trustees ECECVE 54375 Main Road D Post Office Box 1179 Southold,New York 11971 OCT 13 2017 Re: Elizabeth Van Bourgondien 875 Hill Road, Southold Southold Town SCTM#1000-70-4-26 oard of Trustee Dear Board of Trustees: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Four(4)Wetland Permit Applications including: a) Short Environmental Assessment Form; b) Authorization&Affidavit Forms; c) Applicant/Agent/Representative Transactional Disclosure Forms. 2. Survey prepared by John C.Ehlers Land Surveyor, last dated September 5,2017. 3. Project plan prepared by En-Consultants,dated October 4,2017. 4. One(1)set of site photographs. 5. Application fee of$250.00. 6. Three(3)LWRP Consistency Assessment Forms including: a) Project plan(as referenced above). I trust this information shall allow you to process our permit request. Should any additional information be required,please do not hesitate to contact our office. Since ely, Robert E.Herrmann Coastal Management Specialist /khs Enc. 1319 North Sea Road I Southampton,New York 11968 1 p 631.283.6360 f 631283.6136 www.enconsultants.com environmental consulting