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HomeMy WebLinkAboutTR-9165E Michael J. Domino,President ��OF S0(/jyO Town Hall Annex John M.Bredemeyer III,Vice-President O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski • Q Telephone(631) 765-1892 Greg Williams O Fax(631) 765-6641 couffm BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD EMERGENCY WETLANDS PERMIT Permit No.: 9165E Date of Receipt of Application: February 20, 2018 Applicant: Brennan Albano SCTM#: 1000-74-1-35.53 Project Location: 4690 Blue Horizons Bluffs, Peconic Date of Issuance: February 21, 2018 Date of Expiration: 90 Days from Date of Issuance Reviewed by: Board of Trustees Project Description: Salvage and rebuild bluff stairs; remove damaged footings and restore area. Create a six foot wide bluff revetment with 1.25 — 2 ton boulders set in two feet, on top of plastic fabric to protect bluff and stairs. Rebuild stairs reusing existing stairs' components, removing any unusable materials. All work prepped by hand; large pieces moved and placed by bobcat and trailer via access point at Goldsmith's Inlet . Findings: The project meets the requirements for issuance of an Emergency Wetlands Permit as determined by the Board of Trustees. The issuance of an Emergency Wetlands Permit allows for the operations as indicated in the application received on February 20, 2018. Special Conditions: A full Wetland Permit must be obtained within 90 days in order to conduct any further activity on the property. This is not a determination from any other agency. Michael J. Domino Board of Trustees -S OU HOLD T ST S RU EE No. SII GS � - Issued To P"'rl"'AJV "MO Date Address.4410 MUS NORIZOS ftUFFS, FZCWjCoo THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICEJOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 DRAINAGE CALCULATIONS: GENERAL NOTES EROSION CONTROL MEASURES THE PROPOSED ONSITE DRAINAGE SYSTEM TO PROVIDE STORAGE FOR A 2' 1. IN ACCORDANCE WITH THE PROVISIONS OF THE USEPA GENERAL PERMIT AND THE NYSDEC,DURING THE RAINFALL. STORAGE TO BE PROVIDED IN PROPOSED 10'DIAMETER DRYWELLS 1. ALL MATERIALS AND METHODS OF CONSTRUCTION SHALL CONFORM THE STANDARDS AND COURSE OF CONSTRUCTION,CERTAIN EROSION AND SEDIMENT CONTROL MEASURES MAY BECOME GOLDSMITH'S INLET PROVIDING 68A2 CF PER VERTICAL FOOT OF STORAGE. THE DESIGN IS BASED SPECIFICATIONS OF THE TOWN OF SOUTHOLD AND THE SOUTHOLD TRUSTEES AS REQUIRED. NECESSARY TO PREVENT THE TRANSPORT OF SEDIMENT TO OFFSITE AREAS,PONDS,WATER COURSES, ON THE FOLLOWING RUNOFF COEFFICIENTS:ROOF 1.0,CONCRETE 1.0, AND 2• TOPOGRAPHIC AND EXISTIMIG CONDITIONS SHOWN ON THE PLANS FROM SURVEY DATED 3124110 BY HANDS DRAINAGE INLETS,RECHARGE BASINS,ETC. ACTUAL EROSION CONTROL MEASURES WILL BE DICTATED LONG ISLAND SOUND LANDSCAPING 0..30. ON SURVEYING. BY FIELD CONDITIONS AS CONSTRUCTION PROGRESSES,BUT THE FOLLOWING GENERAL CONDITIONS SHALL BE OBSERVED: DRAINAGE AREA 3. COASTAL EROSION HAZARD LINE AS DEPICTED ON THE COASTAL EROSION HAZARD AREA MAP TOWN OF STORAGE REQUIRED: SOUTHOLD,SUFFOLK COUNTY,NEW YORK PHOTO NO.57.556-83 SHEET 6 OF 49. EXISTING VEGETATION TO REMAIN SHALL BE PROTECTED AND REMAIN UNDISTURBED. PAVEMENT AREA: 196 SF X 1.00 X 2"112 = 33 CF - CLEARING AND GRADING SHALL BE SCHEDULED SO AS TO MINIMIZE THE SIZE OF EXPOSED AREAS w`O ROOF AREA: 676 SF X 1.00 X 2912=113 CF 4. LOT AREA AS PER METES A BOUNDS:54,509 SQ.FT.=1.251 ACRES AND THE LENGTH OF TIME THAT AREAS ARE EXPOSED. SALT MARSH LA. LANDSCAPE AREA: 4,493 SF X 0.30 X 2"112= 224 CF - THE LENGTH AND STEEPNESS OF CLEARED SLOPES SHALL BE MINIMIZED TO REDUCE RUNOFF w Ov 370 CF 5. CURRENT ZONING RR&R•40 RR:22,274 SQ.FT.R40 32,235 SQ.FT. VELOCITIES. •� (`rJ STORAGE REQUIRED: - SEDIMENT SHALL BE RETAINED ON THE SITE. PROJECT LOCATION ION MEAN HIGH WATER MARK 370 CF 168.42 CFNF=5.4 VERTICAL FEET REQUIRED 6. THE CONTRACTOR SHALL FIELD VERIFY THE LOCATION AND DEPTH OF ALL UTILITIES PRIOR TO THE SPECIFIC METHODS AND MATERIALS EMPLOYED IN THE INSTALLATION AND MAINTENANCE OF EROSION LP AS OBSERVED COMMENCEMENT OF WORK. THE CONTRACTOR IS ADVISED ALL SUBSURFACE INFORMATION SHOWN ON 5� STORAGE PROVIDED: CONTROL MEASURES SHALL CONFORM TO THE"NEW YORK GUIDELINES FOR EROSION AND SEDIMENT / 'A_ ON NOVEMBER 2,2009 THESE PLANS IS CONCEPTUAL AND MUST BE CONFORMED ACCORDINGLY IN THE FIELD. CONTROL'. G p USE 1-10'?1 X 6'DEEP DRYWELL / SILT FENCE AND �` p % 7. THE CONTRACTOR SHALL BIE RESPONSIBLE FOR SECURING ALL NECESSARY PERMITS BEFORE 2. SEDIMENT BARRIERS(SILT FENCE,HAY BALES OR APPROVED EQUAL)SHALL BE INSTALLED AS REQUIRED O • HAYBALES <�y�\ cp / PROPOSED STAIRS TO BEACH COMMENCING WORK. ALONG THE LIMITS OF DISTURBANCE FOR THE DURATION OF THE WORK NO SEDIMENT FROM THE SITE Q G t ° , (SEE DETAILS SHEETS 7) SHALL BE PERMITTED TO WASH ONTO ADJACENT PROPERTIES,WETLANDS OR ROADS. 'nn °s'�� 8. ALL UNSUITABLE MATERIAL AND DEBRIS SHALL BE DISPOSED OF IN ACCORDANCE WITH TOWN,COUNTY, / STEPS TO ME STATE AND FEDERAL LAWS,CODES AND ORDINANCES.CONTRACTOR SHALL BE RESPONSIBLE FOR EXISTING GRADE •� / DISPOSING OF ALL UNSUITABLE MATERIALS OFFSITE. DEBRIS SHALL NOT BE BURIED ONSITE. 3. GRADED AND STRIPPED AREAS AND STOCKPILES SHALL BE KEPT STABILIZED THROUGH THE USE OF / � �� � TEMPORARY SEEDING AS REQUIRED. SEED MIXTURES SHALL BE IN ACCORDANCE WITH SOIL / + CONSERVATION SERVICE RECOMMENDATIONS. • W /��• 7 �W W / 9. DURING CONSTRUCTION,EROSION AND SEDIMENT CONTROL MEASURES TO BE UTILIZED AS NECESSARY TO ySs JO LAS D £ H / /` ``-- % BLUFF TO BE REPLANTED WITH PREVENT THE TRANSPORTOF SEDIMENT TO OFF-SITE AREAS,PONDS,DRAINAGE INLETS,ETC. THE 4. DRAINAGE INLETS INSTALLED AS PART OF THE PROJECT SHALL BE PROTECTED FROM SEDIMENT BUILDUP �p� / /� Y, g / NATIVE VEGETATION(SEE PLANS METHODS AND MATERIALS(EMPLOYED IN THE INSTALLATION AND MAINTENANCE OF EROSION CONTROL THROUGH THE USE OF SEDIMENT BARRIERS,SEDIMENT TRAPS,ETC.AS REQUIRED. BY LANDSCAPE ARCHITECT) �OS MEASURES SHALL CONFORM TO"THE NEW YORK GUIDELINES FOR EROSION AND SEDIMENT CONTROL". �y.6<, • • , iI j *��,. 5. INSPECTION AND MAINTENANCE OF EROSION CONTROL MEASURES IS TO BE PERFORMED DAILY BY THE �/ . + + f i C 10. ALL PRECAST STRUCTURES SHALL BE CONSTRUCTED WITH SUFFICIENT STEEL REINFORCEMENT TO CONTRACTOR PRIOR TO THE START OF CONSTRUCTION FOR THE DAY AND AFTER HEAVY OR PROLONGED aP� / ``J WITHSTAND AASHTO H-20 TRAFFIC LOADING ALONG WITH TEMPERATURE AND SHRINKAGE,TRANSPORT TOIle- STORMS. MAINTENANCE MEASURES INCLUDE,BUT ARE NOT LIMITED T0,CLEANING AND/OR REPAIR OF \ y � • sS SILT FENCE AND c ti ,�� �j•�/��w j !/W 0 i HAYBALES VO� THE SITE AND SITE CONDIT110NS AS SHOWN ON THE PLANS. SEDIMENT BASINS OR TRAPS,SEDIMENT BARRIERS,BERMS,DIVERSIONS AND INLET PROTECTION. //. ��✓��/err W .,� ��v��/� /STEPS TO MEET 11. ALL PRECAST STRUCTURES SHALL BE MANUFACTURED WITH 4,000 PSI CONCRETE AND SHALL BE DESIGNED, / _ 6. APPROPRIATE MEANS SHALL BE USED TO CONTROL DUST DURING CONSTRUCTION.•/ %j /y// W/• + // / -EXISTING GRAD CONSTRUCTED AND INSTALLED TO SUPPORT AASHTO H•20 TRAFFIC LOADING. G �ct� W W •. i' W W7. A STABILIZED CONSTRUCTION ENTRANCE SHALL BE MAINTAINED TO PREVENT SOIL AND LOOSE DEBRIS 12. CONTRACTOR SHALL SUBMIT SHOP DRAWINGS FOR ALL PRECAST STRUCTURES DETAILING THE STEEL F / b FROM BEING TRACKED ONTO LOCAL ROADS. THE CONSTRUCTION ENTRANCE SHALL BE MAINTAINED UNTIL NEW 14'X 14'PATIO REINFORCEMENT AND PROVIDE CERTIFICATION BY THE PRECAST MANUFACTURER THAT STRUCTURES ARE 'Qp i • W�jW W / �� DESIGNED TO SUPPORT H-20 TRAFFIC LOADING. THE SITE IS PERMANENTLY STABILIZED. '9p EXISTING STOCKADE FENCE TO BE REMOVED PROPERTY LINE REPLANTED WITH NATIVE VEGETATION 8. SEDIMENT BARRIERS AND OTHER EROSION CONTROL MEASURES SHALL REMAIN IN PLACE UNTIL UPLAND 13. MANUFACTURER TO CERTIFY THAT DRAINAGE AND SANITARY PRECAST STRUCTURES DELIVERED TO THE i / a (SEE PLANS BY LANDSCAPE ARCHITECT) DISTURBED AREAS ARE PERMANENTLY STABILIZED. AFTER PERMANENT STABILIZATION,PAVED AREAS / J SITE MEET ALL REQUIREMENTS OF THE TOWN OF SOUTHOLD AND THE SUFFOLK COUNTY DEPARTMENT OF SHALL BE CLEANED AND THE DRAINAGE SYSTEM CLEANED AND RUSHED AS NECESSARY. �60�/ / 22 �� $ ° \1 EXISTING SEPTIC HEALTH SERVICES. REMOVE EXISTING WOOD PLATFORM O / 1 STORY 58 0,0'00" SYSTEM DWELLING / NEW BILCO DOOR FRAME C� / �'��, 90 00, / ✓ Com' U" REMOVE EXISTING CHIMNEYp � 7 / ��•> / NEW CMU FOUNDATION NEW WOOD STAIRS (�o 1@_ \� 5481 V A , / ��� GG I SILT FENCE AND / NEW 10'0 X V DEEP DRYWEL , HAYBALES 0 100, FOR ROOF RUNOF �I �411fJ' ROAo 0 \ �/ opo scoo �oPa / s46°?53 4V4B°?53011 \ r( FEB 2 0 `1'018 / I LEACHING BASIN NOTES: 1. LEACHING POOLS SHALL BE PRECAST CONCRETE CEMENT STRUCTURES AS MANUFACTURED BY SUFFOLK PRECAST INC.OR EQUIVALENT. \ 2. ALL CONCRETE CEMENT USED IN THE MANUFACTURING OF PRECAST STRUCTURES SHALL ?� POSTS-STEEL,T OR U SHAPE TYPE DEVELOP A MINIMUM COMPRESSIVE STRENGTH OF 4,000 P.S.I.IN 28 DAYS. OR 2'HARDWOOD 3. NO TRENCH,PIT OR OTHER EXCAVATION SHALL BE LEFT OPEN OR UNATTENDED, FENCE-WOVEN WIRE 14.5 GAUGE EXCAVATIONS TO BE PROTECTED WITH FENCES,BARRICADES AND OTHER APPROVED 6"MAX.MESH OPENING METHODS. � FILTER CLOTH-MIRAFI 14ON OR APPROVED EQUAL 5. INVERT ELEVATIONS MAY BE ADJUSTED BY THE ENGINEER IN THE FIELD TO MEET FIELD CONDITIONS TO AVOID CONFLICT WITH UTILITIES AS ORDERED BY THE ENGINEER. 6. ALLOW FOUR(4)INCHES FOR FINAL ADJUSTING OF CASTING.ADEQUATE BEARING WILL BE y� PROVIDED USING CONCRETE BLOCK,BRICK AND/OR 1:2 MORTAR MIX. \ N 36'MIN.FENCE POST p z z 7. THE CONTRACTOR SHALL PROVIDE ADEQUATE SHEETING AND SHORING DURING b h N Y S D E C M HAYBALES TRENCHING TO INSURE THE SAFETY OF WORKMEN AND THE GENERAL PUBLIC EXPOSED TO APPROVED AS PER TERMS N ■ ' DRAINAGE/NLET(IYP) THE HAZARDS OF FALLING AND SLIDING MATERIAL IN CONFORMANCE WITH THE co d F DE REGULATIONS,PART 1926 S AND CONDITIONS 09- REQUIREMENTS OF THE TITLE 29 CODE 0 FEDERAL R SAFETY AND PERMIT `� 'ice MIT NO. - �N UNDISTURBED GROUNDoo Fr Yy ■ HEALTH REGULATIONS FOR CONSTRUCTION(OSHA). DATE Z fLOW SILT FENCE NOTES: FLOW BOUND STRAW BALES COMPACTED BY8. BACKFILL DJ TOTING OTR OTHION ER APPROVED MEANS.L BE IN 6"LIFTS. L BACKFILL MATERIAL TO BE FAQnjd f \ , COMPACTED BACKFILL "tY 1. WOVEN WIRE FENCE(MIN,14112 GAUGE MAX.6'MESH SPACING) ■ tt 9r 1 "X6"TRENCH ■ WITH FILTER CLOTH OVER FENCE. SUFFOLK COUNTY STANDARD DRAIN MANHOLE FRAME AND ■ EMBED FILTER z 2X2 WOOD SLOTTED COVER PATTERN No.1383 AS MANUFACTURED BY 2. FILTER CLOTH TO BE FASTENED SECURELY TO WOVEN WIRE FENCE CLOTH 6'MIN. STAKES�•) WITH TIES SPACED EVERY 24"AT TOP AND MID SECTION. INTO GROUND (SEE BEDDING CAMBELL FOUNDRY OR AN APPROVED EQUAL. DETAIL) p PRECAST 3. WHEN TWO SECTIONS OF FILTER CLOTH ADJOIN EACH OTHER THEY FLOW `y CHIMNEY ED GRADE FINISH SHALL BE OVERLAPPED BY SIX INCHES AND FOLDED. STRAW BALE INLET PROTECTION DETAIL TWO REBARS,STEEL PICKETS, yr 8"TRAFFIC BEARING REVISIONS OR 2)Q'STAKES DRIVEN � 4. MAINTENANCE SHALL BE PERFORMED AS NEEDED AND MATERIAL NOTES: 4'V ERTICAL TOP SLAB 2'INTO GROUND.FIRST FACE REMOVED WHEN"BULGES"DEVELOP IN THE SILT FENCE. 1.BALES SHALL BE PLACED AT THE TOE OF A SLOPE OR ON THE CONTOUR SECTION AND IN A ROW WITH ENDS TIGHTLY ABUTTING THE ADJACENT BALES. STAKE DRIVEN AT ANGLE 24' TOWARDS PREVIOUSLY LAID BEDDING DETAIL WOVEN WIRE FENCE(MIN.14112 GAUGE MAX.6"MESH SPACING) 2.EACH BALE SHALL BE EMBEDDED IN THE SOIL A MINIMUM OF 4 INCHES STRAW BALE.DRIVE STAKES fr' ,. POSTS(TYP.) 36'MIN.FENCE POSTS. AND PLACED SO THE BINDINGS ARE HORIZONTAL. FLUSH WITH TOP OF BALE 10'MAX CENTER TO CENTER DRIVEN 16MIN.INTO THE ' •" GROUND 3.BALES SHALL BE SECURELY ANCHORED IN PLACE BY EITHER TWO STAKES (jptj;jam:f i •' OR RE-BARS DRIVEN THROUGH THE BALE. THE FIRST STAKE IN EACH ANGLE FIRST STAKE TOWARD + �"•� WRAP WITH 6 OZ.(MIN.)NONWOVEN SALE SHALL BE DRIVEN TOWARD THE PREVIOUSLY LAID BALE AT AN ANGLE . - ; ". : w PREVIOUSLY LAID BALE -- GEOTEXTILE(FILTER MIRAFI '�++" , � ___ 140N OR AN APPROVED EQUAL. PRECAST DRAINAGE ` TO FORCE THE BALES TOGETHER STAKES SHALL BE DRIVEN FLUSH ,+ z WITH THE BALE. . z ; o ; : ? Flow N __ SHEET PILING AS REQUIRED-�/ RINGS i.>I 4. t E 4ANSPECTIONSHALLBEFREQUENTANDREPAIRREPLACEMENTSHALLBE + "• ^ ' . Plans are�reparedDyCmdonEnglneerirg.P.C.ft(sevldaAondlheNewYak3labEdua6onlav, co s __ :i :,. aide%,Secem nos,for any perem aAeae stens mda to dream ds foerraed R obs*nBl u, RADE PROMPTLY AS NEEDED. v + EXCAVATE AND BACKFILL 3 FEET AROUND t`' t ,;," Engineer,NdideCt or LaM satvayar,b aver my item any way.rm ro■n a«,sea dm _ „" + LEACHING RINGS WITH SUITABLE POROUS EoghreeAmMect,orLand Smayorisdered,theaperinpFnssneer,Nrlrib0.«Landsneyaahep .�,. ••1.,,,`..;:'r•.;",""'' :•,•qt:' 3:',•` effuIla tothemNOwreeaandUnnoWmWeredWfollovredbyHsftff*ftmendthe&%d 53ALES SHALL BE REMOVED WHEN THEY HAVE SERVED THEIR USEFULNESS MATERIAL AS APPROVED BY THE ENGINEER. :',f,• . t: +, '�' :0 AS NOT TO BLOCK OR IMPEDE STORM FLOW OR DRAINAGE. , : :: "`; t �.r•• R¢ auchaMerflone,and a apecfiedesalpemdlheal6eraem. 6"PENETRATION INTO - - 'f• ;t •'`��.:: .: :`:.. '. '' .;'.,�;,t; •'•.'�:'.: GROUND s•s, `•a-,. � :Y: .;'• _.�•:.. -ice .. o ELEVATION COTTAGE IMPROVEMENTS (SEE SECTION) ANCHORING DETAIL ,r�, ,.;' rf{�,�;:;+ Scale:! =30-0 ° Condon Engineering, P.C. EXCAVATE Ai MNIMUM OF V INTO VIRGIN STRATA g g Country Route 48 OF SAND AND GRAVEL OR TO BOTTOM OF DRYWELL 1755 Si Sbee Road Peconic New York Mattituck SILT FENCE DETAIL STRAW BALE DIKE DETAIL WHICHEVER DEEPER. DRYWELL DETAIL Drawn by:JJC g y OF ,New York 11952 NOT TO SCALE NTS (631)298-1986 (631)298-2651 Fax Date: 3/3012010 www.condonengineedng.com SITE PLAN tr •Lys (�� ,. �a 1 fi a,. "9 T . moi• � � Ar ru r INV- 77,77 7 40 .�. ..,, ., � I �•� _ ^ ire a I I '• *; i\ 7N, 16 It i r i Michael J.Domino,President ��0f SU!/T�O Town Hall Annex John M. Bredemeyer III,Vice-President �� lQ 54375 Route 25 P.O.Box 1179 Charles J. Sanders Southold,New York 11971 Glenn Goldsmith G ® � Telephone(631) 765-1892 A. Nicholas Krupski O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1413C Date: November 13, 2017 THIS CERTIFIES that the construction of bluff stairs consisting of a 3'x6'9" upper platform, 3'x14'8" stairs down to a second 3'x3' landing 3'x3'8" stairs to a third 3'x4'2" landing with a bench, 3'x12' stairs to a fourth 3'x3' landing 3'x7'4" stairs to a fifth and final.3'x3' landing with a set of 3'x6'1 I" seasonal hinged stairs down to existing grade at bottom of bluff,• with the condition of the installation of a fence alongthe he top of the bluff-, and that no construction take place during active bird nesting periods; At 4690 Blue Horizons Bluffs, Peconic Suffolk County Tax Map#1,000-74-1-35.53 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 16, 2017 pursuant to which Trustees Wetland Permit#8976 Dated March 22, 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 construction of bluff stairs consisting of a 3'x6'9" upper platform 3'x14'8" stairs down to a second 3'x3' landing, 3'x3'8" stairs to a third 3'x4'2" landing with a bench 3'x12' stairs to a fourth 3'x3' landing 3'x7'4" stairs to a fifth and final 3'x3' landing with a set of 3'x6'1 I" seasonal hinged stairs down to existing grade at bottom of bluff-, with the condition of the installation of a fence along the top of the bluff-, and that no construction take place during active bird nesting periods. The certificate is issued to BLUE HORIZONS BLUFFS LLC c/o RICHARD J. PRINCIPI,JR. owner of the aforesaid property. Authorized Signature NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY @ Stony Brook;50 Circle Road,Stony Brook,NY 11790 P•(631)444-0365 1 F (631)444-0360 www.dec.ny.gov April 12, 2017 BHB LLC C/O Richard Principi Jr. P.O. Box 1248 Southold,'NY 11971-1248 RE: Permit No.: 1-4738-04530/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. Please note, the permit sign and Notice of Commencement/ Completion of Construction form are sent to either the permittee or the facility application contact, not both. Sincerely, Gene R. Zamojcin Environmental Analyst GRZ/Is NEW YORK Department of oT OTUN" Environmental Conservation NEW YORK STATE DE_ .__iTMENT OF ENVIRONMENTAL CONS "ATION Facility DEC ID 1-4738-04530 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: BHB LLC BHB LLC C/O RICHARD PRINCIPI JR 4690 BLUE HORIZONS BLUFFISCTM 1000-74- 1-35.53 PO BOX 1248 PECONIC,NY 11958 SOUTHOLD,NY 11971-1248 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Peconic Facility Principal Reference Point: NYTM-E: 711.673 NYTM-N: 4547.382 Latitude: 41003'00.6" Longitude: 72°28'52.8" Project Location: 4690 Blue Horizons Bluff - Watercourse - Long Island Sound Authorized Activity: Construct an elevated stairway structure with platform landings down the face of the existing bluff. Revegetation of affected bluff areas. All authorized activities must be in strict conformance with the attached plans stamped NYSDEC approved on 4/12/2017. (GRZ) Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-04530/00001 New Permit Effective Date: 4/12/2017 Expiration Date: 4/11/2022 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: SUSAN ACKERMAN, Deputy Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony roo 150 Circle Rd Stony Brook,N 117 0 -3409 Authorized Signature: Date L Distribution List Marine Habitat Protection SUSAN ACKERMAN Page 1 of 5 'NEW YORK STATE DE_-.__.TMENT OF ENVIRONMENTAL CONS "ATION Now Facility DEC ID 1-4738-04530 Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS 1. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 2. Notice of Commencement At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned; along with photographs of the completed work. 3. Concrete Leachate During construction, no wet or fresh concrete or leachate shall be allowed to escape into any wetlands or waters of New York State, nor shall washings from ready-mixed concrete trucks, mixers, or other devices be allowed to enter any wetland or waters. Only watertight or waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms. 4. Vegetate All Disturbed Areas The permittee shall revegetate all exposed faces and disturbed areas to prevent soil erosion prior to the project completion or expiration date of this permit, whichever comes first. 5. Prohibition Period for Nesting Birds To protect.nesting shorebirds, including threatened and/or endangered species, no regulated activities may occur between April 1 and August 31, inclusive, of any calendar year. 6. No Alteration of Bluff for Stairway Alteration of the existing grade of the bluff or hill during construction of the stairway is prohibited. 7. Stairway Design The stairway must be elevated a minimum of 3 feet over grade to minimize disturbance or loss of the natural vegetation and reduce the potential for causing or accelerating erosion of the bluff or hill. Disturbance to the natural vegetation or topography seaward of the crest (top) of the bluff or hill must be restricted to an 8-foot wide area, including the width of the stairway, as shown on the approved plans. 8. Equipment, Material Stored Away from Crest of Bluff The storage of construction equipment and materials shall be confined to upland areas landward of the crest of the bluff or hill. Page 2 of 5 'NEW YORK STATE DE'_-___�tTMENT OF ENVIRONMENTAL CONS IATION 'ROW Facility DEC ID 1-4738-04530 9. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 10. State May Require Site Restoration If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 11. Precautions Against Contamination.of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 12. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Condon Engineering, P.C. (two sheets), dated 3/30/2010 and stamped NYSDEC approved on 4/12/2017 . 13. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. GENERAL CONDITIONS - Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. Page 3 of 5 r NEW YORK STATE DE-!____TMENT OF ENVIRONMENTAL CONS. ATION Facility DEC ID 1-4738-04530 A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals, Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal, modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook, NY11790 -3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute, regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 4 of 5 -NEW YORK STATE DE_-___LTMENT OF ENVIRONMENTAL CONS' 'ATION � Facility DEC ID 1-4738-04530 NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: 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. Page 5 of 5 NOTICE OF COMMENCEMENT OF CONSTRUCTION RETURN THIS FORM TO-COMPLIANCE Or Fax to. 631-444-0 Bureau of Marine Habitat Protection-NYSDEC fume 50 Circle Road NOW Stony Brook, NY 11790-3409 PERMIT NUMBER- EXPIRATION DATE. PERMITTEE NAME&PROJECT ADDRESS i f CONTRACTOR NAME&ADDRESS TELEPHONE: Dear Sir- Pursuant to the special conditions of the referenced permit,you are hereby notified that the authorized activity shall commence on We certify that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions We have inspected the project site and can complete the project as described in the•permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions. The permit, permit sign, and approved plans will be available at the site for inspection in accordance with General Condition No. 1 (Both signatures required) PERMITEE. DATE CONTRACTOR: DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT AND/OR ANYASSOCIATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE PERMIT AND APPROVED PLANS AVAILABLE AT THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS Cut along this line X X X X X X X NOTICE OF COMPLETION OF CONSTRUCTION RETURN THIS FORM TO-COMPLIANCE Or Fax to: 631-444-0297 Bureau of Marine Habitat Protection-NYSDEC 50 Circle Rd. Stony Brook, NY 11790-3409 - PERMIT NUMBER: EXPIRATION DATE: PERMITTEE NAME& PROJECT ADDRESS: CONTRACTOR NAME&ADDRESS. i TELEPHONE. Pursuant to special conditions of the referenced permit, you are hereby notified that the authorized activity was completed on We have fully complied with the terms and conditions of the permit and approved plans: (Both signatures required) PERMITEE. DATE CONTRACTOR. DATE THIS NOTICE, WITH PHOTOGRAPHS OF THE COMPLETED WORK AND/ORA COMPLETED SURVEY,AS APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. • a 1 ' it S0 Michael J. Domino,President �0AN l0 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 �O ® �� Telephone(631) 765-1892 A. Nicholas YrupskicOtINSY,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 22, 2017 Richard J. Principi, Jr. Blue Horizons Bluffs, LLC P.O. Box 1248 Southold, NY 11971 RE: BLUE HORIZONS BLUFFS, LLC 4690 BLUE HORIZONS BLUFFS, PECONIC SCTM# 1000-74-1-35.53 Dear Mr. Principi: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 22, 2017 regarding the above matter: WHEREAS, Richard J. Principi, Jr., on behalf of BLUE HORIZONS BLUFFS, LLC, 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 February 16, 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 Policy 4.1 of the Local Waterfront Revitalization Program to the greatest extent possible tIhrough the imposition of the following Best Management Practice requirements: the,design proposed is consistent with pre-existing structures and minimizes the loss and damage of structures on the water; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application March 22, 2017, at which time all interested persons were given an opportunity to be heard, and, � 2 1 1 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-,-------- --- -- -- - - ----------- ------- - -- ----- ---- - - - 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 BLUE HORIZONS BLUFFS, LLC to construct bluff stairs consisting of a 3'x6'9" upper platform, 3'x14'8" stairs down to a second 3'x3' landing, 3'x3'8" stairs to a third 3'x4'2" landing with a bench, 3'x12' stairs to a fourth 3'x3' landing, 3'x7'4" stairs to a fifth and final 3'x3' landing with a set of 3'x6'11" seasonal hinged stairs down to existing grade at bottom of bluff; with the condition of the installation of a fence along the top of the bluff; and that no construction take place during active bird nesting periods; and as depicted on the survey prepared by Hands on Surveying, last dated March 23, 2017, and stamped approved on April 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: $50.00 Very truly yours, p Michael J. Domino President, Board of Trustees MJD/dd I N 4M VP ,Iq IL 'Oak. I'S dr. 'I -j 7" Jt—, Aq T TI -M UST�-4�BE::�,D"I;S,P'LA-�zY-.,E Thi S-NO_ D`,',DxURtN -CONSiii TEES" EJ770i :W 0 FRC Or. 71. p"n UTH 0 THUS I 17111--, L. lx� yr r I rte}:_' " -T L Di 365-189 T�E - ~• a WTCH --------- ---- 121--- No. Yom.. 1 FOR PCL NO. n 4O 12� 1�Nq SEE SEC.W. 'Iass. _ SEE SEC.No. nO R bOL°t° I d ,t-W 1 853 °°eN-0W 1Y11 RD. H.sll ry7? �` � � s' Ry ' �• - 9s I a `� FF` �°L aetnwiwrnuns �! a A^ <y ♦ p I n �i'.•o .s`" off' �,� �;�* 9^ .•i! Jy 4 a NO Y e T aP Sou`d O a 1n I oe�s�r aceta ~ )4c) I I � ♦ ♦ 2a -— I I asaHa PO• .vd M1 I I� P FOR PCL NO. I a., P sEE WC.Ho. I 51..y0 0°60,-001. y1 FOR PCL NO. SEE SEC.N0. im tlZ 0t6M-0621 1.M d I FOI PCL W. FOH PCL.NO. .21 Fpi PCL NO. SEE SEC.W t.Qyc) SEE SEC.N0. F SEE SEC.NO. �—i2 °1601A15 aes -----------Z az am –> 0 21B1W/1CH --IJHE. 22Vc) � � ------�------- ————————————— �--- �Hm lllj WSEE SE4 NO TCH ---- E SEC.W.065, gF g�NO.yy .O� SE aac.aait 1 _ _ COUNTY OF SUFFOLK © K to 0°° SOUTHOLD SECTION NO NOTICE E E (ztl r 0 ---— "-"- --„-- �MF,«„�..,F6..a,°.�a Real Property Tax Service Agency r 074 G...���.. ______ o_+. o...� --•-- e•••�--"'-- wn,c,mox aFP cwHr C.ma,u,.ar°,Nrnwt M m1 w. as •vim N ..r •.• .• or �v. --:-- --..._— `wnFi' t„[ 'm P ta�tw 1000 PROPERTY°1AP1 I 4L�g���t�dd Jill M.Doherty,President ti Town Hall,53095 Main Rd. James F.King,Vice-President P.O.Box 1179 Dave Bergen ,f, r 'g Southold,NY 11971 Bob Ghosio,Jr. Telephone(631)765-1892 m John Bredeeyer Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Emergency PFrmit Application _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit / Amendment/Transfer/ExWnsion Y Received Application: Received Fee:$ �y� Completed Application c FinE 1�ren r!� __ Incomplete ^_SEQRA Classification: Type I Type II Unlisted F E B 2 0 2018 —Coordination:(date sent). LWRP Consistency Assessment Form ECAC Referral Sent: R)ii0idd Tnnn _Date of Inspection: Board t Trust e� I _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant Brennan Albano Address 105 W 13th St. 17A, New York, NY 10011 Phone Number:( ) 413-530-6627 Suffolk County Tax Map Number: 1000- 74-1-35.53 Property Location: 4690 Blue Horizon Bluffs, Peconic, NY 11948 County Rd. 48 & Henry's Rd. (provide LILCO Pole#, distance to cross streets,and location) AGENT: Richard J. Principi Jr. & Eric Martz (If applicable) Address: PO Box 1248, Southold, NY 11971 Phone: (516) 852-0651 & (917)916-3724 Board of Trustees Appli,— ion GENERAL DATA Land Area(in square feet):46174 Area Zoning: RR/R40 Previous use of property: Year Round Residence Intended use of property: Same as Above Covenants and Restrictions: Yes X No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes X No If"Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency . Date DEC 04/12/2017 Trustees 03/22/2017 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):Salvage and rebuild damaged bluff stairs. Remove damaged footings and restore area. Create a six foot wide bluff revetment with 1.25 - 2 ton boulders set in 2 feet, on top of landscape fabric to protect bluff and stairs. (To be worked into the future bluff revetment project.) Rebuild stairs reusing existing stairs components, removing any unusable materials. All work will be prepped by hand, and large pieces will be moved and placed by bobcat and trailer via access point at Goldsmith's Inlet. Board of Trustees Apply-^-Ltion WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: Salvage and rebuild damaged bluff stairs. Remove damaged footings and restore area. Create a six foot wide bluff revetment with 1.25 - 2 ton boulders set in 2 feet, on top of landscape fabric,to protect bluff and stairs. (To be worked into the future bluff revetment project.) Rebuild stairs reusing existing stairs components, removing any unusable materials. Area of wetlands on lot: 5135 square feet Percent coverage of lot: 9.42 % Closest distance between nearest existing structure and upland edge of wetlands: 125 feet Closest distance between nearest proposed structure and upland edge of wetlands: NA feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? cubic yards How much material will be filled? 1 cubic yards Depth of which material will be removed or deposited: 5 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Material to be deposited by hand. 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): No negative impacts to the wetlands or tidal waters of the Town of Southold are anticipated. Board of Trustees Appli ',:ion COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Salvage and rebuild damaged bluff stairs. Remove damaged footings and restore area. Create a six foot wide bluff revetment with 1.25-2 ton boulders set in 2 feet, on top of landscape fabric, to protect bluff and stairs. (To be worked into the future bluff revetment project.)Rebuild stairs reusing existing stairs components, removing any unusable materials. Are wetlands present within 100 feet of the proposed activity? X No Yes Does the project involve excavation or filling? No X Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? 112 (cubic yards) Manner in which material will be removed or deposited: By hand. Describe the nature and extent of the environmental impacts reasonably anticipated.resulting from implementation of the project as proposed. (Use attachments if necessary) No negative impacts to the wetlands or tidal waters of the Town of Southold are anticipated. PROJECT ID NUMBER 61 SPQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME Brennan Albano 3.PROJECT LOCATION: Municipality Peconic County Suffolk 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 4690 Blue Horizon Bluffs, Peconic, NY 5. IS PROPOSED ACTION: 1:1New ElExpansion FV_1 Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: Salvage and rebuild damaged bluff stairs. Remove damaged footings and restore area. Create a six foot wide bluff revetment with 1.25 - 2 ton boulders set in 2 feet, on top of landscape fabric, to protect bluff and stairs. (To be worked into the future bluff revetment project.) Rebuild stairs reusing existing stairs components, removing any unusable materials. All work will be prepped by hand, and large pieces will be moved and placed by bobcat and trailer via access point at Goldsmith's Inlet. 7 AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? FX]Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) ®Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10."DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑Yes ry__1 No If yes, list agency name and permit / approval: 11 DUES ANY A�SPLGI UF IHL ACTION HAVE A CURRENTLY VALID PERM A R VAL? ❑Yes F71NoIf yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applica nsor Name Richard Prin ipi Date: �y Signature ` _N 0t=-::= 2 40 - I C> Q3If the actiona Costal Area,and you are a state agency, complete the Coastal sessment Form before proceeding with this assessment Board of Trustees App? &tion AFFIDAVIT_ 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($), 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 COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERAUT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner }Signature of Property Owner v,reut�cw► Albwo - om-� SWORN TO BEFORE ME T S, DAY OF No Iic NOTARY PL1BBM S 1 P e L l _of York Af� c +--to 38: 23 S .Ouelified In 002000661 York County Commission Expires Oct.23,2018 Board of Trustees Applin on AUTHORIZATION (Where the applicant is not the owner) VG owners of the property identified as SC'IW 1000- _ in the town of zes. New York,hereby authori '`�^°`'`� 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 Signature Property Owner's Signature SgWO T BEFORE ME S a-D DAY OF 20 � -7h2Notary is JEREMY S.COLGAN we ' �+o NOTARY PUBUC,State d Now Wk No.02006154378 Qualified in New York County Commission Expires Oct-23,2D18 APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the tart of town officers and employees The purpose of this for ti 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: Albano, Brennan _ (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 A 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&uthold? "Relationship"includes by blood,rgarriage,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 applicantlagent/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 applic?nt (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 day of 200_ Signature. Print Name Form TS l - i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Tomm of Sothold's I Code of Eµia Rm its conflicts of interest on the Dart o roam officers and trnolovees The ounose of lbill form is to_umv_ide information whicb ce_n__alert 1he_tow_n_of f possible con-fllste of intema ffid allow It to U&I whatever actloft s nr_rr.=to avoid same. YOURNAME: Albano, Brennan (Last name,first name.,gilddle tnitial,unless you aro applying ;>e name of sorneme else or other entity,such as a company.If so.tadicW tht.odW person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Tung Variance Change oCZone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Platming 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? d,m "Relationship"includes by blood, 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 S%of the shares. YES NO X If you answwed"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Tide br position of that person Describe the relationship between yourself(the applicant/aprit/representative)and the town officer or employes Either check the appropriate line A)through D)and/or describe in the space provided. The town oMcer or employee or his or her spousq sibling,parent,or child Is(check all that apply): A)the owner of greater than S%of the shares of the corporate stock of the applicgttt (when the applicant is a corporatlonk B)the legal or beneficial owns of any interest in a non-corporatc entity(when the applicant is Dot a corporationk C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submittedthis y f 20� Signature. Print Name t�twa• w Form TS I i APPLICANUAGENT/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 puroose 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. Wto YOUR NAME: Gaf Nom? (Last name,first name,4die. 'tial,unless you are applying in the name of someone else or other entr 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 00, 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 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 orbeneficial 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 Submittes day of 204 S ignatur Print Name Form TS 1 ~