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HomeMy WebLinkAboutTR-7505 Glenn Goldsmith,President , QF so(/j Town Hall Annex A. Nicholas Krupski,Vice President ,`Oy�lO 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 1820C Date: June 3, 2021 THIS CERTIFIES that the removal of existing emer eg_ncy armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use;remove remains of existing damaged bulkhead and construct shoreguard bulkhead(approximately 58.75'); install splash pad/guard for entire length of-bulkhead• place one row of armor stone seaward of proposed bulkhead(1-3ton), qpproximately 40 tons,• include two(2).returns on the bulkhead,repair the house foundation; and repair the second-story deck and stairs; At 55705 CR 48, Southold Suffolk County Tax Map#1000-44-1-14 Conforms to the application for a Trustees Permit heretofore filed in,this office Dated March-1,2011 pursuant to which-Trustees Wetland Permit#7505.Dated March 23, 2011 and Coastal Erosion Permit#7505C Dated March 23,2011 was issued and Amended on May 18,2011 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 of existing-emergency armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use; remove remains of existing damaged bulkhead and construct shoreguard bulkhead(approximately 58 75')• install splash pad/guard for entire length of bulkhead; place one row of armor stone seaward of proposed bulkhead(I-3--ton),approximately 40 tons,• include two(2)returns on the bulkhead;repair the house foundation; and repair the second-story deck and stairs. The certificate is issued to Debbie Grillos owner of the aforesaid property. Autho . ed Signature DiSalvo, Diane From: Debbie Grillos <debbiegnllos@gmail.com> Sent: Thursday,June 03, 2021 8:16 PM To: DiSalvo, Diane ((�� 2 p� Subject: [SPAM] - Certificate of Completion ® E C E 0 V E To: Town of Southold Board of Trustees JUN 4 2M Re: 55705 County Route 48, Southold Southold Town Board pf Trustees To whom it may concern: This is to confirm that the 200 (two hundred) square foot deck and railing as included in permits #7505 and #7505C were not constructed on the above referenced property. I understand that should I wish to construct the deck and railing in the future, I will need to reapply for a permit. Thank you, Debbie Grillos 1 Glenn Goldsmith, President *QF SO(/Ty� Town Hall Annex 1 A.Nicholas Krupski, Vice President ,`O 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino G � • Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 3 X671 INSPECTED BY: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection COMMENTS: 1 CERTIFICATE OF COMPLIANCE: Jill M.Doherty,President SO Town Hall Annex Bob Ghosio,Jr.,Vice-President �� l0 54375 Main Road dW, P.O. Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer Q ® Telephone(631) 765-1892 �yCOUNN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 18, 2011 Jeffrey T. Butler, P.E., P.C. 206 Lincoln St. Riverhead, NY 11901 RE: DEBBIE GRILLOS 55705 COUNTY RD.48, SOUTHOLD SCTM#44-1-14 Dear Mr. Butler: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., May 18, 2011: WHEREAS, Jeffrey T. Butler, P.E., P.C. on behalf of DEBBIE GRILLOS applied to the Southold Town Trustees for Amendments to Wetland Permit#7505 and Coastal Erosion Permit#7505C under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, and Chapter 111 Coastal Erosion Management, applications dated April 25, 2011, and, WHEREAS, said applications were referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, in accordance with Chapter 268, said applications were found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, WHEREAS, the Board has determined that the project will not affect the health, safety and general welfare of the people of the town, and, 2 NOW THEREFORE BE IT, RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendments to Wetland Permit#7505 and Coastal Erosion Permit#7505C to include two (2) returns on the bulkhead; repair the house foundation; and repair the second-story deck and stairs, and as depicted on the site plan prepared by Jeffrey T. Butler, last revised April 19, 2011. This is not a determination from any other agency. Sincerely, Jill . oherty, Preside Boar of Trustees JMD:Ims OF COMPACTION NOTES: GENERAL NOTES BOARDI E L SUB GRADE FOR j"IVOIZK IN THIS SHT I J � 1. SHOREGUARD SEAWALL SHALL BE INSTALLED TOWN O� 50 U T H O L� \ GENERAL ,�.m G 1� AREA-SM • M I. IN ORDER FOR THE PAVEMENT TO BE DURABLE,THE SUB 6f2ADE MA15T BE v1`�" SV PREPARED, THE CONTRACTOR SHALL PREPARE THE TUB GRADE IN sO PARTIAL SITE PLAN S1 S�IP�l PER GRAVE MATERIALS INTI=RNATIONAL (GMII ®�T r:x,t+l - ��1 �Y INSTALLATION MANUAL. �$ �/ " PROPERLY1Ct ACCORDANCE WITH THESE SPECIFICATIONS,U51NG THE NECESSARY MEANS AND �av� tlenon MATERIALS TO PROVIDE THE SPECIFIED RESULTS. NOTHING IN THE FOLLOWING` 15 7 2. NO DEBRIS SHALL BE PERMITTED TO FALL INTO 25 �tG ` �M!`"_ NEIGHBORING PROPERTIES OR SEAWARD OF 51TUATION5 CAN BE FORESEEN. THEREFORE,NOTHING IN THE FOLLOWING 0� E faro -_ SHALL RELIEVE THE CONTRACTOR OF THE RE5PONSIBILITY TO NOTIFY THE PROPOSED BULKHEAD. Mlet Point Slirlinl; �' .Clexws Point ENGINEER OF SPECIAL PROBLEMS,AND IN THE END,TO PROVIDE A SOUND SUB AGE TO�ITi`: �" J r�An �+ 3.SEE DEMOLITION AND COMPACTION NOTES PRIOR ��.3 GRADE. N, SllverLskxLl - A A 0, Y / a 6. � TIE PROP. BULKHEAD 4. THERE ARE NOTO EMENT OFTED DAL WETLANDS ON O D LING _ ��;Y°nnn9 P,nl Q 2.USING 501L TEST D T ^o 9 a.6. PROP SHOREGUARD BULKHEAD TO BE y TO NEIGHBORS EX. 51TE LOCATION A.AT ITS OPTION,THE ENGINEER MAY PROVIDE 501L TEST INFORMATION TO I ` !� �' INSTALLED IN EXACT LOCATION OF BULKHEAD THE SITE. (rrrnPnrt N'.xtf Q THE CONTRACTOR. IF PROVIDED,THE DATA WILL INCLUDE CLASSIFICATION OF _Nt l_ / • • Ih•rlug Ilsrhn � THE 501L IN ACCORDANCE WITH THE UNIFIED 501E GLA551FIGATION SYSTEM / DEMOLISHED BULKHEAD (SEE SECTION 'A) �TWC.41 Fanning Point a (ASTM D24b'1). THE 51GNIFIGANGE OF THE DATA WILL DIE INTERPRETED BY TW13.42�/ x� •� ••� s>- •.� ••� .41� �.x� BW6.41�' A,xh;un°nnyuc THE ENGINEER. / APPARENT HIGH WATER 5 0 N°rton Point Nxslrxmo,oct Pond Sh 4w Ixlxud Ilelpht. APPARENT HIGH WATER s.o i B.SOILS DESIGNATED AS HIGHLY EXPAN51VE(CHI,MHO,AND OW MAY f MARK 0 EL. 4b' 13 • • , � 1 MARK 0 EL. 4b' 13 • . � EX. NEIGHBORING REQUIRE LIME STABILIZATION AND/OR SELECTIVE REPLACEMENT WITH q BULKHEAD LEGEND: Lr,lPPnna, ,• conkfiy Point SUITABLE SOILS. SUCH 5PEGIAL TREATMENTS WILL BE DETAILED IN THE SITE 12 / 1010 q PROP.WOOD DECK AND RAIL TO • 12 enanalwnA "' BID DOCUMENTS IF THE G05T IS TO BE INCLUDED IN THE CONTRACTORS BASE PROP' 10' RETURN CODE,20'x10' (200 SQ.FT) 4.6 PROPERTY LINE Jennings Point. BID. 4� ' ' G.SOILS DESIGNATED A5 HIGHLY ORGANIC(OH,OLD,AND PT)MAY REQUIRE 71N1a.5a SEE SECTION 'B' Twla.Sa "el.al Fatxtex zB • _-_ • • __ • • / Gtrext Ptmtlb tihrh, Dw6.81 . i • , DW6.81 EXISTING TO BE SELECTIVE REPLACEMENT WITH SUITABLE SOILS. THE NEED FOR AND THE �,- -LOCATION OF I 5.1 REMOVED/RELOGATED EXTENT OF THI5 TREATMENT WILL BE DETAILED IN THE 51TE DOCUMENTS IF THE 15.1 DESTROYED BULKHEAD �f' ' NxrporaPohU, z 14 '. EXISTING WATER LINE w w ,� �N',ytmnrdx"' Fresh Por COST 15 TO BE INCLUDED IN THE GONTRAGTOR5 BASE BID. 14 i TO BE REPLACED I RELOG D I-3 TON ARMOR STONE �C } D.THE CONTRACTOR SHALL INSPECT THE SUB GRADE AND NOTIFY THE FROM REMOVAL OF TEMPORARY II 7 3 OVERHEAD UTILITY LINE // // // .. � 8 ':. �� b•.. `... � 8.2 X ✓' r Ncsrh mlclslr Colon :: ` JSihe Ir l R ENGINEER OF ANY CONDITIONS REQUIRING SPECIAL CONSIDERATION NOT II / / 7.3x 6.2 x 7 x� `� Pernnir ADDRE55E0 IN THE 51TE BID DOCUMENTS. THE EXTRA 605T OF x7.1 // WALL (APPROX.40 TONS) x - _ - EXISTING GRADE x b.o Ityanx3hnres o \ fiooao Neck UNANTICIPATED REMOVAL WILL BE BASED ON THE UNIT C05T5 PROVIDED WITH I I PROP. IO' RETURN 13W7.5 PHOTO KEY �� ` xx>Ilan west Nock Point. s THE BASE BID. THE G05T OF UNANTICIPATED LIME 5TAt31LIZATION OR OTHER ew7,5 TW12.49 ly 11 x rK O O (area,Nog Nact SPECIAL TREATMENT WILL BE NEGOTIATED. TW12.49 Lnuphing l4xlvr.' I 15Gloss 5013 GRADE PREPARATION / x8.4 2 E REQ eW7.5 8.4 PROPOSED EXTENT OF iw1258a �' I 5pp'�' TW 12.84 i EXCAVATION REQUIRED LOCATION MAP: I. THE CONTRACTOR SHALL REMOVE ALL VEGETATION,SURPLUS SOIL,DEMOLITION I c 'k FOR BULKHEAD RUBBLE,AND OTHER UNDESIRABLE MATERIALS. 5UGH MATERIALS SHALL BE 6 I TIE PROP. BULKHO b GHORING NOT TO SCALE PROMPTLY HAULED FROM THE 51TE AND DISPOSED OF IN ACCORDANCE WITH GOVERNING LAWS AND CODES.THE GONTRAGTOR SHALL SHAPE THE SUB x TO EXISTING WD E0 RO F REMAINDER OF 16 GRADE IN AGGORDANCE WITH THE 6RADING PLAN,TAKIING INTO ACCOUNT THE 12.6 9.8 DAMAGED ROOF to BULKHEAD RETURN b 2.6 4 DAMAGED ROOF AIR LANDI 10.1 THIGKNE-55 OF THE PAVING 5Y5TEM. THE TOLERANCE OF THI5 ROUGH (XI315 OVER WOOD DEGK 3 1o.I � ) x13.9 Ex. BULKH OVER WOOD DECK TOB@REBUIILT MA HINERY ACCESS IS PROP05ED FROM THE RESIDENCE'SGRADING SHALL BE WITHIN I/2' HIGH TO I' LOW DURING THIS OPERATION THE i 1.9 10 PROPOSED SPLASH�6UARD RETURN Pp 5 11.9 10 CONTRACTOR SHALL NOTE ANY SOFT AREAS THAT BECOME APPARENT AFTER f P 5 (10-40 LB STONE) b WIDE x � E (ACCESS TO EAST SIDE OF DWELLING. TRAFFIC BY CON5TRUGTION EQUIPMENT AND LOADED T}2UGK5. 5UGH SOFT V Q " p 6 �N PORCH ABOVE) AREAS SHALL BE REPORTED TO THE ENGINEER FOR DETERMINING THE METHOD Wp MP�N g 18 DEEP x FULL LENGTH OF �X.10 4MP ZD 9 Of W Y0 CI1Y OF TREATMENT REQUIRED, IF ANY. `vX SO O BULKHEAD &LONG 19IMP i R0P05E0 51TE PLAN FOR: 1 �U... 2.MAINTAINING DRY 51TE CONDITIONS: y A!B j `Ji/ I1 J,g...l r r W N� 800-212-44801811 ; L �� DURING PREPARATION OF THE 506 GRADE AND UNTIL THE PAVING 15 IN PLACE,THE 5�pr1tW Gh�MN� Q EXISTING SCONE 3 5HT I G CONTRACTOR SHALL PROMPTLY TAKE REASONABLE MEASURES TO OBTAIN SITUATE AT: { NEIGHBORING SOUTH OLD NY ' ! AND TO MAINTAIN A DRY 51TE CONDITION.SUCH MEA5U9E5 SHALL INCLUDE ' I PUMPING OF FREE SURFACE WATER,MINOR HAND AND/OR MACHINE SHAPING LJ EX. 2 STY FRAMED BULKHEAD PROP. STAIRS EX. 2 STY FRAMED www.dignetnycli.com TOWN OF SOUTH OLD , } PR 2 5 2011 1 TO FAGILITATE WATER REMOVAL,AND OTHER OPERATIONS TO SPEED DRYING. 0 DWELLING w TO PORCH ABOVE DWELLING o or SUFFOLK COUNTY, NEW YORK 3.NATIVE 501E COMPACTION: 0 FFL 19.87 www.ca1181l.com 50TH NO.: 1000-44-1-14 w COHESIVE AND GOHESIONLE55 NATIVE SOIL SHALL BE COMPACTED TO q5%AND FFL 19.87 X14.6 (for other states) -.00e hcnld T"r"n 100%OF THE OPTIMUM DENSITY,RESPECTIVELY,PRIOR TO PLACEMENT OF X14.6 ZONING DISTRICT: N/A USE: RESIDENTIAL L--,. FILL. O_ X X12.1 FEMA FLOOD ZONE: N/A 4. FILL SELECTION AND COMPACTION: 12 I _ ....::._:......_____-.. 2 w By law, excavators and contractors working in the THE M05T DOST EFFECTIVE FILL MATERIAL FROM THE FOLLOWING SHALL BE USED, 0 five boroughs of New York City and Nassau and -SAND-GRAVEL MIX(1.5 TO 3%FINES<0.02 MM AND GBR> Il), PROP05ED PARTIAL S I TE PLAN Suffolk Counties on Long Island must contact • 13.4 DigNet, 1-800-272-4480 or 811,at least 48 hours SITE DATA: EXISTING: ej?OP05ED: -GRAVELY 501E (3 TO b%FINES<0.02 MM AND CBR>6), 4 / but no more than 10 working days(excluding AREA OF 51TE: 15,34.1.&0 S.F. (0.1228 AC) N.G. -SANDY SOILS(3 TO b%FINES<0.02 MM AND CBR>8), X18.1 0 / ' weekends and legal holidays)prior to beginning I•'+••1 -51LTY GRAVELY SOILS(b TO 10%FINES<0.02 MM AND'GBR>8), O / ' C� -51LTY SANDY SOILS(b TO 15%FINES(0.02 MM AND COR>8), c any mechanized digging or excavation work to BLDG AREA: -CLAYEY GRAVEL SOILS(OVER 20%FINES(0.02 MM AND CBR>5), / ; • , / ' • 10 5 O 10 20 50 40 ensure underground lines are marked. JgSTING DWELLING 636.25 S.F. N.G. . / ' 6RAPHIG SCALE I" = 10'-011 Excavators and contractors can also submit EXISTING PORCH IcI5.34 S.F. N.0 W -CLAYEY SANDY 501E(OVER 20%FINES<0.02 MM AND CDR>5), . ^ I� 5. THE ENGINEER RESERVES THE RIGHT TO HAVE 501L TE5T5 PERFORMED TO 200 " %" 19.6 locate requests online,through ITIC.If you do not TL BLDG5. 831.59 S.F. CONFIRM THE SUITABILITY OF ANY FILL MATERIAL. THE CONTRACTOR SHALL °'�'•�. 7�OASTAL EROSION Q' 10 currently use ITIC,please call 1-800-524-7603 [� m 5PRFA�D AND COMPACT THE FILL MATERIAL IN b INCH MAXIMUM LIFTS. EACH X . / y. j2� for more information. t LIFT SHALL BE GOMPAGTED TO q5%OF THE OPTIMUM DEN5ITY. COMPACTION 16.0 i • n HAZARD LINE AS �R�c�ON�-�` ,_OT COVERAGE GALG.: /'� � � SHALL BE AGGOMPLISHED AT NO LE55 THAN OPTIMUM MOISTURE CONTENT UP '. i / n , SCALED FROM AERIAL �- For safety reasons,homeowners are strongly TOTAL BLDG AREA / AREA OF SITE = LOT COVERAGE x ° °0 ° PHOTOGRAPH SCOPE OF HORK• 531.5q 50.FT. / 5r34�.80 SQ.FT. = 15.5555 hr-•1 TO 2%WETTER.OPTIMUM DENSITY AND OPTIMUM MOISTURE CONTENT SHALL BE c� "°: �° ® encouraged to call as well when planning any IQ LU Q A5 DETERMINED BY A5TM 0I551. O RUBBLE,TRASH R R OTHER REPUTED LOCATION OF p,• w �. LOT COVERAGE = 15.5555 Z W °o g I. NO PMR15 SHALL BE PERMITTED TO FALL SEAWARD OF AREA OF WORK OR TO ADJACENT PROPERTIES. type of digging on their property.Homeowners DEBRIS WILL BE ALLOWED A5 FILL MATERIAL IN ANY USAGE. EXISTING WATER SERVICE �o a �ZQ can contact us directly at 1-800-272-4480 or by X b.FOR UNSTABLE SOILS WITH LE55 THAN 250 P5F COHESION OR ULTIMATE / • • a ,8 0° �j 17.7 2. REMOVE EXISTING I TO 3 TON ARMOR STONE AND FILTER FABRIC, RESERVE FOR REINSTALLATION. BEARING CAPACITY OF LE55 THAN 500 P5F,6EOTEXTILE FABRIC SHALL BE r8•I j . • / 8�. ®° X 3. SEE FILL AND COMPACTION NOTES PRIOR TO ANY SITE WORK. calling 811,the national call before you dig ��' ' °ae `�° ° '�° ooI number.For excavation work completed on ADJACENT LOT O S � INSTALLED IN ALL UTILITY AND PIPING TRENCHES AND TANKHOLES TO REDUCE 0,1� ° ° e 5� . 4. CONTRACTOR TO VERIFY ALL DIMENSIONS IN FIELD PRIOR TO EXCAVATION. PROPOSED BULKHEAD MUST BE personal property, It Is the contractor's < O / '1 d.' 8 o °o' 'm 8 B' r MIGRATION OF FINE-GRAINED 501E AND SEPARATE DISSIMILAR FILL O° °°maw B INSTALLED IN THE SAME LOG,ATION OF DEMOLISHED BULKHEAD• responsibility-NOT the homeowner's-to contact MATERIALS.THE GEOTEXTILE MATERIAL SHALL OVERLAP ADJACENT eI MPERVIOU5 5UREAGE GALL: O• = dJ 6EOTEXTILE MATERIAL BY A MINIMUM OF 12'AS NEGE55ARY TO COVER THE °g 0�° 5. EXCAVATE AREA INDICATED ON PLAN FOR BULKHEAD INSTALLATION (APPROX. 40 01YDS), RESERVE EARTH DlgNet. Having utility lines marked prior to i>DJAGENT AREA = 2360.51 SQ.FT. • OL INTENDED AREA. GEOTEXTILE FABRIG SHALL BE GTFI3OEX,TYPAR 3401, EXISTING WATER `L •a 8� Lion o° , FOR FUTURE USE. digging is free of charge. GTF15OEX,OR TYPAR 3601 AS MARKETED BY EXXON CHEMICAL AT METER TO REMAIN ADJACENT LOT IMPERVIOUS SURFACE = 338.54 50.FT. = 14.34% I-800-54-EXXON. :•:� •` °° °�° � \ b. INSTALL SHOREGUARD BULKHEAD AND (2) 10' RETURNS PER MANUFACTURES INSTRLJGTIONS. APPROX.FRONT 1.BACKFILLING TANKHOLE5,ETC. X17 5 FACE LENGTH = 5763'(±7783 LONG INCLUDING 2 - 10' RETURNS). if l CV BACKFILL FOR ANY EXISTING TANKHOLE5 SHALL MEET THE'. REQUIREMENT5 OF l 17 a i/ 7.SET PIERS IN PLACE FOR PROP05ED PECK AND RAILING. ALL PIERS MUST BE SET ON UNDISTURBED SOIL. W - THI5 5ECTION.LIKEWISE,BACKFILL FOR OTHER HOLES LEFT BY REMOVAL OF 1 •••° . .••;:'' x 8. FILL AREA LANDWARD OF SEAWALL TO ELEVATION INDICATED. m SWIMMING POOLS,BASEMENTS,ETC.SHALL COMPLY WITH THIS SECTION ALSO. a. ELEVATIONS OF FILL VARY,MAINTAIN SPLASH GUARD IS" MIN DEPTH AT BULKHEAD AND UNDER 8.BACKFILLING TRENCHES: 20 3 �N DECKING (2" GLEARANGE REOV BETWEEN TA. 5PLA5H GUARD AND UNDERSIDE OF PECK STRUCTURE). _� 351.83'-FRONT FACE BACKFILL FOR UTILITY TRENCHES SHALL BE WELL-6RADED,GLEAN,FRESHWATER x �R t1P W��' SAND,FREE OF SILT AND CLAY PARTICLES.BACKFILLING SHALL OCCUR USE RESERVED EARTH FROM EXCAVATION AND SUPPLEMENT WITH SANDY FILL AGQUIRED FROM AN -i (±1783'INCLUDES 2 - 10'RETURNS) J -I V�` / 11•J-J IMMEDIATELY AFTER THE LINE OR CONDUIT IS IN PLACE TO PRECLUDE 1 X17.2 TION 0F/ W APPROVED UPLAND SITE. FILL W/ 12" LIFTS,APPLY WATER AND TAMP. PROCEED WITH NEXT LIFT UNTIL D CAVING OF THE TRENCH SIDES. PRIOR TO INSTALLATION OF THE LINE OR �p LO`✓� v+ PROP05EP ELEVATION IS ACHIEVED. (5EE COMPACTION NOTES) p GAPPING,AW-1015 ARD CONDUIT,A 4 INCH CUSHION OF SAND SHALL BE PROVIDED. /REi v+ " PART No.AW-1075 5TR 9. INSTALL SPLASH GUARD ON FILTER FABRIC. I I q.AREAS OUTSIDE THE PAVING SHALL BE FILLED AND GOMPAGTED AS W 17 a. APPROX. 25 GU.FT. OF 10-40 LB STONE. O.G. VINYL SHEET PILING, ENGINEER: NECESSARY WITH SOIL COMPLYING WITH THI5 5EGTION.EXCEPT THE TOP b / "•- INCHES SHALL BE NATIVE TOPSOIL SUITABLE FOR GRA55. AREAS j W JEM�N� 10. REINSTALL ARMOR STONE BARRIER ON LAW FILTER FABRIC SEAWARD OF PROPOSED BULKHEAD AS SHOWN TIEROD(TYP) SFORE6UARD 625 -�.• REQUIRING GUT SHALL AL50 BE PROVIDED WITH b INCHES OF NATIVE / W �X�5S\N6 P� \ ON PLAN. GAPPING EL.VARIES WALE SPLICE(IVP) TOPSOIL FOR GRASS. FINISH GRADE FOR THESE AREAS SHALL BE I INGH W ED"� OF Q' '48 J. 11.CONSTRUCT DEGK (200 SQFT) AND RAILING (4' IN HEIGHT,APPROX. 40.0' LIN. FT) PER CODE. TO BE El• 14.0'_EL.13.0'_ �M EL. 12.84'TO 13.42' (?J 6'x8'WALES _ EL.13o' �'.7" �Y�'� r 1 '' BELOW TOP OF CURB. AREAS SHALL BE SLOPED TO(DRAIN AT A MAXIMUM 17 C. / X17.3 NATURAL WOOD FINISH W/ALO STRUCTURE. ALL HARDWARE AND SIMP50N TECO CONNECTIONS TO BE - OF 4:1 UNLESS OTHERWISE INDICATED ON THE SITE OR GRADING PLAN. n _EL_12.0'____ _ 10.COMPACTION TE5TING: OL '' 17,3 GALVANIZED. THE ENGINEER WILL ENGAGE AN INDEPENDENT TE5TING LABORATORY TO 0 0 0 0 o EXISTING f+Y' X A. RAILING - MATERIAL TO BE USED o ° ° PERFORM(1)A STANDARD PROCTOR TEST(A5TM DI551)ON THE FILL IY 1. bxb POST B. DECKING -MATERIAL TO BE USED 1 11 MATERIAL (OR NATIVE 501E PROCTOR TEST(ASTM 01551)ON THE FILL NEIGHBORING C� 1 . a. POSTS TO BE A MAX. 8' O.G. I. (2) 2xI0 PECK 61RDER PER SECT. 'B' 0 0 0 0 o B`I� IKNJEAD MATERIAL(OR NATIVE 501L IF NO FILL 15 USED)AT LEAST 12 HOURS 17 IIh`II�I�II I II�'II BEFORE THE CONTRACTOR INITIATES COMPACTION AND(2)A NUCLEAR .• .. •- . • 111. 2x6 TOP RAIL Il. bxb POST o 0 0 ��� DENSITY GAUGE(ASTM D2cl22 AND A5TM 03011)OR SAND GONE(ASTM N. 2x4 MID AND BOTTOM RAIL Ill. 2x8 PECK JOISTS GRADE® EL.45' �` ,� ��I,> RANDOMLY SELECTED LOCATIONS TO /� /� v. TIE ALL RAIL POSTS INTO BOX BEAMS iv. 2x6 DECKING �~SOFES 3493 an\•�� MEASURE TEST ATA MINIMUM OF THREE L EX I5TI NC 51 TE PLAN � MEASURE THE DEGREE OF COMPACTION OF THE SURFACE 5t1BGRADE. IF USE Y2"�DX5"LG GALY. LAG BOLTS v. CONCRETE PIER PROPOSED EXISTING �''BULKFEAD � S I�� THE RESULTS FROM THI5 TEST FOR THE FILL OR NATIVE SOIL DO NOT MEET W/WASHERS a.MIN 12"m BULKHEAD TO NEIGHBORING TO TIE INTO JEFI=REY`T:-B ER, P.E. OR EXCEED THE DE6REE OF COMPACTION SPECIFIED' IN THI5 SECTION,THE COST OF TESTING WILL BE DEDUCTED FROM THE CONTRACT AMOUNT,AND RETURN b• ALL POURED CONCRETE PIERS TO BE TIE INTO SHOREGUARD EXISTING THE TESTING(2)WILL BE REPEATED. INSTALLED ON UNDISTURBED SOIL EXISTING BULKHEAD _j II CONTRACTOR MUST REMOVE THE EXISTING SANITARY SYSTEM IN 10 5 O 10 20 30 40 THE GO _ NEIGHBORING ARMOR STONE BARRIER OO O AGGORDANGE WITH THE STANDARDS OF THE 5.C.D.H.S. CONTRACTOR IS 6RAPHIG SCALE f - 10-O WP�..L NOT SHOWN FOR RESPONSIBLE FOR ALL INSPECTIONS AND SIGN-OFF OF SAME. BULKHEAD PURPOSES OF CLARITY 0 � m 12.CONTRACTOR 15 RESPONSIBLE FOR HAVING THE PROPANE TANK PUMPED OUT EXISTING EX15TIN6 Y I O v 7 AND CERTIFIED AS EMPTY PRIOR TO RELOCATION. PORCH DWELLING EX15TINO EXISTING i Z LL }- PORGH DWELLING O O Q O 331.4' 6�AGE POST TO 313.1' SHORE UP PORCH' PROPOSED DEGK AND RAILING: IO"0 x 20'L& m ~ Z }O G PROPOSED SPLASH�� 5EE SCOPE OF WORK FOR MATERIALS ry � I (10-40 LB STONE)6'W x 18'DP x GGA PILES®b'O.G. 1"" � I J RILL LEN6TH OF BULKHEAD(MIN) PORCH TEMPORARILY �- a W Q T < CE PROP.WOOD DEGK,RAIL 1 i SHORED UP BY bxb ANO�u FILTER FABRIG RIDER SPLASH GUARD SEE SECTION 8' � 1 I VARIES) I AGO P05T r t - _ w Q (� s PROP.BULKHEAD WALL GAP, I �PROP,SANDY Flu I I IOD, VI EW G � "ELEVATION DLTArI L Z E-+ � � O 5HOREGUARD AW-1075 STIR i , � FUTURE FOUNDATION �0 , I REQb TO ATTAIN I WALL d FOOTING TO •'M SPLASH�'�(O'er� -- 5EE ARCH DW65 SCALE: 3/16 - I-O 1.2 I i PROP•GRADE REPLACE SAME L05T 9TONEJ 6'WIDE x 18'PEEP x FULL FOR REBUILD Z 0 a j � (APPROX.96 G.Y) t i IN STORM EVENT LENGTH OF BULKFHEAD(P•11W INFORMATION O � -EL_t___________ _________ T.O.PROP.BIKHD A 1284 I"0 x 12'LG GALVANIZED TIE RODS O --------_-- _ _ _ 1 10 m GGA GAT EL.12_0 ---- --------------------------------- Pill ------ - o. .. o PITCH .Q � w --------------------- -----. --- (BEYOND)B ELEV.13.427 FILTER FADRIG UNDER SPLASH GUARD PROPOr�NATURAL ---------- - _EL II_0' --------------- --------- -------------------------- - ._ = - RAIL AN &ATE WTH II LOG W PROP.GRADE O Q RAIL AND GATES .. / // EL V RI , `y a-' `y , AGQ STRUCTURE VINYL SHEET PILING O EL. 100' __ _ - ( GAPPING o 5HORE6UARD 625 LY <�<�<` �/ FROM EL.12. I � � � --I fi {�; h PROP05M 5PLA5H --i O EL.q-O ------------------ -- --------- (?Jb'x8'. �j /�\�; v - -- - -- - - a - ---- - ----- ;c a,, . �/�// "o. PITGI+ c�. - - - --=-" e e -=-= - GUARD(WP RAP) " O l� - _E_L.8.0' __ _________________ ___ __ ---------_ ''; z. _ WALES '^ PROP.SI ORE6UARD -� PROP.GRADE = 1084' - - - - -- �� - -- --- - RFM01/ED FOR CLARITY ►+- �,/ PROP.10'RETURN 0 EL.l.0' --------- ------------ --- -- -9 -- EX GRADE i EL.-1.1 ' �`'' - ��`Ts -- BULKHEAD WALL ' . (TVP OF 2) $ L ► '{ 1:Xl9TIN6 REiI1RN a o EL.bD' - ---------------- ���, (SEE SECTION'A') >.� j I I 6.0 MIN•i I`. .I. �� �: . 1\ (, ) 'r LL O a -------EL.50 - -- i t /• ' 0 5PCA5H 6rR / EX.NEIGHBORING 4� \ 'I. .I. i'. EZ - - 10 x10 6 W E X NEIGHBORING { 'L .45 . A 1 �i 111 !n ----- / / ���:<~• � / / �'�' I WOODEN BULKHEAD AT R MARK - �, T IGH W E ------- APPARENT H - :� ATS ARMOR � � � � ;� ,� �, RELOCATED ,. I I- A � � � RD � SHOREGU � I A --- DE OMAN / / /y -r 4J-J I I N AND RETURN 4 I / RE .0 T WALL GAPPING �L. 5 ONE M { _____ Bl1 K EAD L I 6 'AlZ 10x 2 6 AL L _ ;'SKY / I In / / - ION � t t' �I t. , 5EE 56GT �. A RN AND RETURN i I EL.3.0' ______ - T7E R,OD9 I I __ (IYPJ ::REI:dGY1• EX;`A(�Ii'b ONEM,' i 1 E It (I 70.E TON 5TQ1 TO LOCATION AS .. I SHOWN.UNDERLAIN NTH FILTER 10"0xI0L5 CGA, GAT L06 ;.',,'::.:_• .,r :::I i I Fri// / !/�! /:���<��<�` �% - -- v FABRIG. b'OGS DEADMAN _� i I ��/ LO' AREA TO BE EXCAVATED FOR ±1.0' i i b'-0'O.G. WALE 5PIGE J CONTRACTOR TO TIE SECT)ON A - BULKHEAD IN5TALLATIOK MATERIAL I i PROP.BULKHEAD TO PAGE : TO BE RESERVE FOR FILL,APPROX. + 1 + 115Y9 MEAD ANCHORING NOT 5HOWN FOR J TIEROD(lYP) (17) 10 0 X 20 LG GGA PILES � ELEVATION DETAIL 23 wYvS (5EE coMPACT1oN NOTES) ±63' �'1 -2'4, I I GONTRAGTOR TO TIE -' EXISTING BULKHEAD EEXRI�ING NEIGHBORING FA5TENIN6 AND PROPOSED BULKHEAD i I I PURPOSES OF CLARITY B b'O.G.,INSTALLED A5 SHowN o RETURN USE 6ALV. + VIEW SHNOI^N WV GAPPING REMOVED FOR CLARITY _10.0 MIN EXCAVATION REQ'D 0 10'0 x 20'LG FOR BULKHEAD ANCHORING 3.1' BULKHEAD,USE 6ALV. t " GONNEGTION HARDWARE. $ SCALE: 3/16' = 1'-0" G FASTENING AND b x 8 GGA WALE(I OF 2) CGA PILE,6'0&(TYP) 313.1' r r - GONNE(TION HARDWARE. SECTION � ELEVATION DETAIL PROP. O RESIOE IN BULKHEAD PROPOSED DECK AND RAs I L V I EW V - PLAN DETAIL $ WALL TO RESIDE M EXACT LOG 4 OF DESTROYED 1311 AO SCALE: 3/I6" = 1'-0" 5GALE: 3116" = 1'-0' O f I m 0 �1 U ih Peter Young,Chainnan H Town Hall,53095 Main Rd. Lauren Standish,Secretary a P.O. Box 1179 �, �� Southold,NY 11971 �/� Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 11, 2011, the following recommendation was made: Moved by Meaghan Burke, seconded by Derek Bossen, it was RESOLVED to NOT SUPPORT the applications of DEBBIE GRILLOS to Amend Wetland Permit#7505 & Coastal Erosion Permit #7505C to include two (2) returns on the bulkhead; repair the house foundation; and repair the second-story deck and stairs. Located: 55705 County Rd. 48, Southold. SCTM#44-1-14 Inspected by: Doug Hardy, Meaghan Burke, Jack McGreevy The CAC does Not Support the addition of returns because of the potential negative impact they would have on the neighboring properties. The CAC recommends the steep slope is addressed on the east side of the property and hay bales and silt fencing are installed contain the run-off. Vote of Council: Ayes: All Motion Carried Jill M Doherty,President QV Cp P O Box 1179 Bob Ghosio,Jr,Vice-Piesident �� Gy Southold,NY 11971 James F King C Telephone(631 765-1892 Dave Bergen � Fax(631)765-6641 John Bredemeyer '� Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: DEBBIE GRILLOS requests an Amendment to Wetland Permit#7505 & Coastal Erosion Permit#7505C to include two (2) returns on the bulkhead; repair the house foundation; and repair the second-story deck and stairs. Located: 55705 County Rd. 48, Southold. SCTM#44-1-14 Type f area to be impacted: _ altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part 9f Town CVVC proposed work falls under: �apt.275 hapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Prese Were: l�J. Doherty l//BGhosio. ing D. Bergen, J. Bredemeyer D. .Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Jill M.Doherty, President �*OF SUUjy� Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen John Bredemeyer �� Telephone(631) 765-1892 lycoU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction 1/2 constructed Project complete, compliance inspection -" 'ae'eii`'•- - 3?•.r`�-v' �''/4i.-APs•- _ - viiC"4v.`Y.� - �',���Ir.-pry-_ --y��i�'�°'r, _..��°I�.ii/Oo/s i rr•� - .� r• `' - . 1 i 1 rrr..- ,�'..i°I � r�' �MVIV I L` 'w l ��� -` °6 BOARD OF SO JT TRUSTEES - SOUTIiOLD;'NEW YORK PERMIT NO.�7505 &'750C DATE: MARCI3 23,2011 ;,/ll .. ISSUED,TO: DEBBIE GRILL 0$1 ,�► � Zai• W PROPERTY ADDRESS: 55705 COUNTY ROAD 48, SOUTHOLD 1 !rl, SCTI#'A4-2-14A TOO ` :< <{; - , (•... ..a �• ,\I if �� .. . F . � J J t iii` . . ` - � - •-. } 1• „ 'f � 1 , �,• r= Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of !/ Southold and in accordance.with.the Resolutign,of the.Board of Trustees adopted at the meeting held on E sll = ,s / March 23. 2011,and in consideration}of appticat•ons fee,iri,tlie'sum of$500.00 paid by,Debbie Grillos and " subject o the Teiins and`Conditions'as stated(iri thAe'goliitiofi the Southold Town Board of Trustees o •°1i1°f " `` . .. .,'. ;41y�', ` f authorizes and permits the following: Wetland Permit to remove existing emergency`armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use; remove remains,of existing;damaged bulkhead;and_construct shoreguard bulkhead _ = (approximately 58.75'); construct deck not tg;exceed 200 square,feet.and,railing; install °pr splash pad/guard for entire length of bulkhead; place one row of armor stone seaward rr'° of°proposed,•bulkhead,(1`=3 tdn); appr6ximateiy 4046ns', andias'_depictedion the'site plan z 4N =` prepgred�liy Jeffrey T.,Butler,;P:E:,fP1C =lastjd'ated'Apri122; 201f,- riil''stainp'ed " .! t aPProvedon-ApriF25"2011:: . - Jr IN WITNESS WHEREOF,the said Board of Trustees hereby causes;its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. .wJl/� A.a:11►�{if:�il��" � 't;.r _. t:�._ .- :,`. ',t :}= - ''.,' .. .l^^y- s � :a '_^.�'.'•.i ..a°Irl ►0�V•., .mar/I !..�` - s_�,r,.l ►:..� - rA N,,." •.�lil•! :>= - '_ �:.tee_ve.1,°.^_ <s: ,.,P..r.'"_ • . _ _ _ 4^ - ,- ' - _ , •�'it tr.i',.. _ TERMS AND CONDITIONS The Permittee Debbie-Grillos, residing 55705,County Road 48, 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 maybe cause for revocation of this Permit by`resolution of the said Board. 5. That there will be no o 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 the4ocation'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. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that maybe required supplemental'to this permit,which may be subject to revoke upon'failureAo obtain same. _ = e Jill M.Doherty,President ``*OF SO(/ryO Town Hall Annex Bob Ghosio,Jr.,Vice-President �O lQ 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer '0 Telephone(631) 765-1892 A-UM Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 23, 2011 Ms. Melissa Butler Butler Engineering - 206 Lincoln Street Riverhead, NY 11901 RE: DEBBIE GRILLOS 55705 COUNTY ROAD 48, SOUTHOLD SCTM# 44-1-14 Dear Ms. Butler: The Board of Town Trustees took the following action during its regular meetings held on Wednesday, March 23, 2011 regarding the above matter: WHEREAS, Butler Engineering on behalf of DEBBIE GRILLOS 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, and Chapter 111 of the Southold Town Code, Coastal Erosion Hazard Areas, application dated March 1, 2011, 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, in accordance with Chapter 268, said application to remove the remains of the existing damaged bulkhead and construct shoreguard bulkhead (approx. 58.75') was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application of the placement of one row of armor stone seaward of proposed bulkhead (1-3 ton), approx. 40 tons was found to be Consistent with the Local Waterfront Revitalization Program policy standards, and, 2 - WHEREAS, the LWRP Coordinator recommended that the proposed application to construct deck (approx. 720 sq. ft.) and railing was found to be Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered the Policies of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the construction of the deck is not to exceed 200 square feet, the addition of a splash pad/guard the entire length of the bulkhead, and WHEREAS, Public Hearings were held by the Town Trustees with respect to said application on March 23, 2011, 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, WHEREAS, the structure complies with the standards set forth in Chapter 275 and Chapter 111 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 DEBBIE GRILLOS to remove existing emergency armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use; remove remains of existing damaged bulkhead and construct shoreguard bulkhead (approximately 58.75'); construct deck not to exceed 200 square feet and railing; install splash pad/guard for entire length of bulkhead; place one row of armor stone seaward of proposed bulkhead (1-3 ton), approximately 40 tons, and as depicted on the site plan prepared by Jeffrey T. Butler, P.E., P.C., last dated April 22, 2011, and stamped approved on April 25, 2011. 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.) 3 Fees: $ 50.00 Very truly yours, Jill . Doherty President, Board of Trustees JMD/eac Jill M.Doherty,President ��OF soutz' Town Hall Annex 1749 Bob Ghosio,Jr.,Vice-President �� l0 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer �� O �O Telephone(631) 765-1892 lif'COU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT#7505C Applicant/Agent: Butler Engineering Permittee: Debbie Grillos SCTM#: 44-1-14 Project Location: 55705 County Road 48, Southold Date of Resolution/Issuance: March 23, 2011 Date of Expiration: March 23, 2013 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: Coastal Erosion Permit to remove existing emergency armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use; remove remains of existing damaged bulkhead and construct shoreguard bulkhead (approximately 58.75'); construct deck not to exceed 200 square feet and railing; install splash pad/guard for entire length of bulkhead; place one row of armor stone seaward of proposed bulkhead (1-3 ton), approximately 40 tons. The Coastal Erosion Management Permit allows for the operations as indicated on the site plan prepared by Jeffrey T. Butler, P.E., P.C., last dated April 22, 2011, and stamped approved on April 25, 2011. INSPECTIONS: Final SPECIAL CONDITIONS: (apply if marked) In accordance with Chapter 111-15 Erosion Protection Structures: X A maintenance agreement is attached hereto and is a necessary special condition of this permit. BY: PA - &_L4 Jill M. D erty, President Board of Trustees Jill M.Doherty,President � ��� Town Hall Annex Bob Ghosio,Jr.,Vice-President �� 54375 Main Road James F.Fing P'0-Box 1179 Southold,New York 11971-0959 Dave Bergen John Bredemeyer Telephone(631)765-1892 Fax(631)765-6641 130ARD'OF TOWN TRUSTEES TOVVN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION OTRUCTURES CHAPTER 111-15 OF THE SOUT OLD TOWN CGDE i 1.(We)-- 1 e. 61 e. �r . I`©�j The owners of record of property at: 551 D 5 y 8 SCTM#1000-_ H — in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: as shown on the attached licensed survey of the as-built structure. It is mylour understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any - maintenance which involves more than 50% of the!length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees t at said lack of maintenance would risk life, property or imp:otariied s a ur I resource tur signature of owner of record otary Public aVorary ,2� l Qua��mmissron expires /1P1 1) This maintenance agreement shall only be valid u�n the attachment of a licensed land survey made within one year of the original construction and validated to show the final approval of the administrator. 1 E Z, i LONG ISLAND SOUND N 72'2,9'3®~ E 56.17 OE) 0 ` L Q wAT k DWG 4 WALL WALL 04W 0 14 5 I'W k / 9WG 81 5 t WOODEN 12 9 k BULKHEA �3 �k/3g k2G —_7 BLDG W ONE CODE ROOF OVER 0 4 W - ULYJIEAD WOOD DECK LL 0 w X20.9' 9 3 k (Aio i I MAR - 1 2011 oh�'V-- z Cl r #55705 F k/z/ 2 STORY w /e o FRAMED - �,, DWELLING D 0 � �N FFL 19 87 0 0 �z0 L 20.& 15.-,A0 4'W I O / Iz O Irn z I N � I D N ..• D /'96 I O — 1,133' I I k D I 3 I _ s 76 3W w . o' I N/7'4 k �g ASPHALT SHOULDER I ` 4' MAR - 1 201 1�VI1�PDLE ROAD (C.1�. 48) ' � I ��.�. S-�-tl,old fSZ�r�1 � I CONCRETE ROADWAY ^3i(1 Q1 Trustees I I 20 0 10 20 40 1 1 1 1 1 1 I I I 1 inch =20 ft. GRAPHIC SCALE ( IN FEET ) ELEVATION SHOWN REFER TO NVD DATUM 55 SURVEY NOTES I UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY 15 A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY CERTIFICATIONS INDICATED HEREON L y SHALL RUN ONLY TO THE PER5ON/PER5ON5 FOR WHOM THE SURVEY IS PREPARED,AND ON HIS/HER/THEIR BEHALF TO THE TITLE COMPANY,GOVERNMENTAL I\1TJ AGENCY,AND LENDING INSTITUTION LISTED HEREON CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR 5UI55EQUENT OWNERS O 2 THIS SURVEY 15 SUBJECT TO ANY EASEMENT OF RECORD AND OTHER PERTINENT FACTS WHICH AN A55TRACT OF TITLE MIGHT DISCLOSE 3 OFFSETS SHOWN HEREON ARE FOR A SPECIFIC PURPOSE AND SHOULD NOT BE USED AS A BA515 FOR CONSTRUCTION OF FENCES OR OTHER STRUCTURES 4 SUBSURFACE 5TRUCTURE5 AND/OR UTILITIES,IF ANY NOT SHOWN 5 HEDGE AND FENCE OFFSETS SHOWN ARE TO CENTERLINE UNLE55 OTHERWISE NOTED I CERTIFY THAT THIS MAP REPRESENTS AN ACCURATE AND TRUE ACCOUNT OF A SURVEY,PERFORMED IN THE FIELD UNDER MY 5UPERV15ION ON 02/10/201 1. OF THE LAND THEREIN PARTICULARLY DESCRIBED THE RECORD DESCRIPTION OF THE SUBJECT PROPERTY FORMS A MATHEMATICALLY CLOSED FIGURE THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE CURRENT CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS T. EASON AND SURVEYOR SUFFOLKCOUNTYDIST. 1000 �HALLOCKA VENUE,PORT]EFTERSON STATION,N.Y. 11776 SEC. 44 BLK 01 LOT 14 Phone(631)474-2200 /Fax(631)899-9085 email TEAS0NLS@OPTONLIIVE.IVET DATE: 2 10 11 SCALE: 1"=20' TOPOGRAPHIC SURT 1iY PRO CTIVUMBEB: TEA11-023 SUBTVEYFOK: JOSEPH M. YENNA MAP OF.- DESCRIBED PROPERTY LOCATION- GREENPORT, TOWN OF SOUTHOLD, NEW YORK CERTIFIED TO: JOSEPH M. YENNA o , . LIC 050452 Jill M.Doherty,President ��0f SOUry� Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road James F. KingP.O.Box 1179 AW Southold,New York 11971-0959 Dave Bergen G John Bredemeyer �� ® �O Telephone(631) 765-1892 Fax(631) 765-6641 U BOARD OF TOWN TRUSTEES TOWN OF-SOUTHOLD TO: �^ � 'J�►�-�� iC�S Please be advised that your application dated Inai-CA d has been reviewed by this Board at the regular meeting of m c?,,,,o?0C I and your application has been approved pending-the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) % Constructed ($50.00) _ Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please-make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: I TOTAL FEES DUE: $ �� BY: Jill M. Doherty, President Board of Trustees b�OguFFO��-fid �� ' Peter Young,Chairman ti Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 ? Southold,NY 11971 Telephone(631)765-1892 P� j* Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., March 16, 2011, the following recommendation was made: Moved by Doug Hardy, seconded by Audrey Horton, it was RESOLVED to NOT SUPPORT the Wetland Permit and Coastal Erosion Permit applications of DEBBIE GRILLOS to remove existing emergency armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use. Remove remains of existing damaged bulkhead and construct shoreguard bulkhead (approx. 58.75'), construct deck (approx. 720 sf.) and railing, and beach access stairs. Place one row of armor stone seaward of proposed bulkhead (1-3 ton), approx. 40 tons. Located: 55705 County Rd. 48, Southold. SCTM#44-1-14 Inspected by: Meaghan Burke, Audrey Horton, Doug Hardy, Peter Young The CAC does Not Support the applications because there is a concern with encroachment on public property and public access, and there is stormwater run-off issue. Vote of Council: Ayes: All Motion Carried OguFFQ(,� Jill M.Doherty,President Off` CQ P.O.Box 1179 Bob Ghosio,Jr.,Vice-President � Gyp Southold,NY 11971 James F.'King y Telephone(631765-1892 Dave Bergen Fax(631)765-6641 John Bredemeyer Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: DEBBIE GRILLOS requests a Wetland Permit and Coastal Erosion Permit to remove existing emergency armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use. Remove remains of existing damaged bulkhead and construct shoreguard bulkhead (approx. 58.75'), construct deck (approx. 720 sf.) and railing, and beach access stairs. Place one row of armor stone seaward of proposed bulkhead (1-3 ton), approx. 40 tons. Located: 55705 County Rd. 48, Southold. SCTM#44-1-14 Typp-of area to be impacted: /Saltwater Wetland Freshwater Wetland VSlound Bay Distance of proposed work to edge of wetland Part,of Town CVe proposed work falls under: k6hapt.275 / Chapt. 111 other Type of Application: Wetland P"'C-oastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: Conditions: �G �C ` ��- 4 -, M cels f C1,14 Present Were: J.King Doherty�. Bredemeyer D. Bergen- B.Ghosio,, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: 4 or a. dp 55iO5 County Road Southold } SCTM#44-1-14 ♦ ♦ ♦♦ -; }t t fit� - ♦ ♦ .... ��. •. S..Tt., t, y�� { ,-ate'_ 1 ♦ ♦ ♦ y -7V yip X/ 4 4r Xfl�s L � ' -ti _ "Gr 5 M �+�..LZ C � e ' \ i f � WN It q� y ,F 1 a S� � A k i i y � r , s1 1 r 4. k4 #1 Immmaw— foo r , ,a R" s i y "4 h r 1V _ rWIWI I z _ r j � 1 V h av slip ■w- � r � �'�� a '� f i 'sa �r .w� _ ..t. r 01/05/2011 14:15 531- 0350 NYSIEC R1 PERM: PAUL al/fid NYS DEPARTMENT OF EWRONMENTAL CONSERVATION EMERGENCY MtHORIMTION Pursuant to Environmental Conservation Law Article 70(13 NYCRR Part 521) N.Y.S.D.E.C.REGION 4 _ DIARIon of Enwront"W"l Psnnitg DEC# 1 4738.04a�15i00001 SUNY Q Stony Brook 50 Circle R044 Stony Brook,NY 11790-3409 EFFECUM DATE: 01/06/11• EXPIRATION DATE:020 / .Name &Addreee of Permittee/Appiloant: Debbie Gdilos 2316 Burnett 5t ._;; JAN - 7 2011 114- ; Br+ooldyn, NY 11229 Sa:itnl�,ir Te.,rn _. 8 Telephone•#: (917)859-2738 Burr" o. Name &Address of ContactlAgent: Melissa Butler 208 Lincoln $t Riverhead. NY 11 901 Project Location: 55705 Sound View Ave(Route 48), Southold, KY SCTM•A 1000-44-1-14 Eme%Lem II►uModg 2a Twe X ,Article 25 of the ECL, BNYCRR Part 661: Ti0el Wetland* ❑ Article 34 of the ECL, 6NYCRR Part $05: Coastal Erosion Hund Areas ❑ Article 15, Title 5 of,the ECL, 6NYORR Part 80$: Protection of Waters ❑ Article 15, Title 5 of the ECL, ONYCRFt Part 6W: Water quality Certification Article 24, Title$of the ECL, 6NYCRR Part Q63: Freshwater Wetlands Article 15, Title 27 of the ECL, 15NYCRR Part 068, Wild, Scenic&Recreational Rivers Praimrct Deschlptlon• Install 1 —3 ton stone seaward of the wMing house foundation. 'place 30 cubic yawls of clean sand fill landward of the stone: Install 6'x 6' pasts to support the existing porch. The project shall be accordance with plains prepared by Jeffrey T.Butler, P.E.. P.C.on 12/27110 and stamped WSDEC approved 0110$/11. Finding That An Emeroenev.U21m: Based on them Department's review of the situation and they information provided by the Tovvnn of Southold Board of Trustees and kWng consulted with the pepa3rtmefrrt'a Bureau of Habitat-Tidal Wetibrids, the Department has determined that this situation met.thedefinition of an emergem'cy, "an er di which oaoak,an immediate thermal to life,health,orgg2Mj.or fiat r4I ourft f,"as defined in the Uniform Pmcefdures3 regulations, Section .621.10). There was an immediate threat to public safety, property, transportation Infrastructure and natural resources. TO 39dd SdWOHl d3-1inE EEO8LZLTE9 9b:ZT TTOZ/L0/T0 01/05/2011 14:15 fi31 •0360 NYSDEC R1 PEIRM] PAGE 03/03 NEOf 41 �1/#�O • i• we��V�pt�l�N� %; s ®• o 11CrZ w reSs` � p .�rr''" rrLrR,wr, E STMf ®. b eEIRt►d5 . P.ROV r rEw. "Am wiff•Tp � • 9KORE W PIOWA � �• 1• • tiOD' L.Q(�l►TIOfd OF � '� FWV05W 30 YVS TO W pagdv v 1 UIQ sAwy ru • �X1�7111u� � V � ry • -FRQF SPADE 404' - FMOP FILTbR F/M*-' ' ":MLL VOM BETNEEH 1+1 JAN 7 2011So,ithhoij Town w: ` [3aam, of T,osieEs ZO 30dd SdWOHl N311m EE08LZLTE9 9b:ZT TTOZ/L0/TO f f l Jill M.Doherty,President �,QF Soury Town Hall Annex James F.King,Vice-President h�� ��� 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 Bob Ghosio,Jr. G John Bredemeyer � �O Telephone(631) 765-1892 Cot Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD EMERGENCY WETLANDS PERMIT Permit No.: 7453E Date of Receipt of Application: December 29, 2010 Applicant: Debbie Grillos SCTM#: 44-1-14 Project Location: 55705 County Road 48, Southold Date of Issuance: December 30, 2010 Date of Expiration: N/A Reviewed by: Board of Trustees Project'Description: Due to recent storm damage, temporarily place one-to-three ton stones in front of existing foundation, including 30 yards clean fill; install 6"x6" post from existing foundation to support porch. Findings: The project meets all the requirements for issuance of an Emergency Wetlands Permit as determined by the Board of Trustees. The issuance of the Emergency Wetlands Permit allows for the operations as indicated in the application received on December 29, 2010. Special Conditions: A full Wetland Permit and Coastal Erosion Permit must be obtained in order to conduct any further activity. This is not a determination from any other agency. vr` Joa M. Doherty, Preside rd of Trustees DEC 2 9 t "ou, oW lcmil t 01`T'i}SES LICE of S To A M .. t3TtAj t-t AC Y � _ ,w 14ELIE E' y w Xx LE i F D EC 2 9 10 •,' r • Sn 'hho�:t Town Bur Of Truslus • �I • • To • 6K� 1 IST�� 1 tf4vSE Ll AJ f / q di r� J/ D E 2 9 ;too,. fi IF ern+� 10 •• • , lft i 1 _. !c' r aw wi +Yc �1 w •1� 11,V v / ]Rx- I]0 1 f tOS o. Y M11µd\ Y COUNTY Oi SUii0.1t I J ♦a 2' Sl a +-1 SO Id l P 0 O2 sp cow vu.NA sEE sEc xo 20\J Np � 015-01-AI � 6 t t a 1 9 4O 26 1 B1 / 'Et CF SUFf0.R '� 7 4 OM1. t M1d 7 COUNTY V SU .1 2t M r �2w 19 NORSN ,y .y O sxwml 9°" oma�oc\\c� ,t •t z � 3 - \4\ / 1\ \ r O a � a G r' H _ _ aN�0. COUNTY OF SUFFOLK © E L I SOUTHOLD SECTION NO .dam.. * .s a NOTICE E,„ —�— 1211 — —_ _ MEN E,.ETE Ad E�N Real Property Tax Service Agency Y w e 044 E N`.e.ww —2,3- .... m —_— e —_ —_ —_ —_ osTTdwmT rcr.nr weTcw w Tle Cw ty Center Wverhwe N E a901 N ou b1F0 Y.UE w iF£G N OSx]um o —_ —_ ,u.—.. n.ila .TI x Ecx� ai Tw o Aer 20 F ] m�T m SOOO PROPERTY MM l.'<a. - _"S.," ,r� - ,-•`-v'w 0.�. �S.y-.«:'• _���-�.,;� -':�ti1w -.I,=� ^_-•.�:+�•,-�ma�__"-z;.�_rc_•. ,. _ James F. King,President ��OF S0UTy0Town Hall Jill M. Doherty,Vice-Presidentl0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G • �O� Telephone(631)765-1892 John Holzapfel OCOU Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 'r r APPLICATION FOR AN AMENDMENT TO AVEL L� ERMIT ii f �? ° APR : 2 5 2011 DATE ocYhh ac d ToKm of T;ustess OWNERDI�F-.61(- (PU L&O-S PHONE C7/0) 269- ADDRESS . �� �Utl Z 12-2- 9 AGENT JkZ-1, A 2�TZ461?- PHONE C ►� 208 ADDRESS 2o6I�� j71 1r � Zit lekv7r� PROPERTY LOCATION 56 7 o`J (Z9 6/ �501472-1020 AIW TAX MAP NO. UWe request an Amendment to to Permit# to�,��/�/�O��� ) /D '�C s /J-,►2 D.L/7�/�'h'� ��iJ��1/✓ r� Signed By: r Jill M. Doherty,President Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President coo P.O. Box 1179 James F.King �A Southold,NY 11971 Dave Bergen �IJQ ��? Telephone(631)765-1892 John Bredemeyer �` Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of DEBBIE GRILLOS COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING 2 I, mLld� �T �, residing at/dba �G I� D6 ei 10t 9 being duly sworn, depose and say: That on the � day of /r 2011, 1 personally posted the property known as -70_ fy? f �/S 7yv1 J�oa k rl- 1 y) 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 Wed, May 18, 2011 on or about 6:00 PM. Dated: ;Ozz'� - (signa ure) worn to before me this day of// 20 r ,4G ary Public JANET M.TOOKER Notary N0.01TOS05of 1905 w York Qualified in Suiiolk County Commission EApires November 13,20_3 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Deb ie C.rrillos residing at 55705 C2=U Road 4.8 (print owner of property) (mailing address) Sout�QW NX 11971 do hereby authorize Jeer T.Butler.P,E. (Agent) to apply for permit(s)from the Southold Board of Town Trustees on my babel£ r (Ownefs SiFmture) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Vishakha Desai&Robert Oxnam 320 Central Park West,Apt 12H New York, NY 10025 County of Suffolk 310 Center Drive Riverhead, NY 11901 Karen Daly 34-27 79th Street Apt 31 Jackson Heights, NY 11372 AY 1 8 2011 STATE OF NEW YORK COUNTY OF SUFFOLK - --- -,= —� 4�4k� �•Cel�f`L�f'�� SOG OIG IT l II I` Sv 3oa 9 emus eee , residing atPte'441 ►' . hrl6s being duly sworn,deposes and says that on the day of 20 l k , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names;that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment rpll of the Town of Southold;that said Notices were mailed at the United States Post Office at o p1 -\^ , /V.t� ,that said Notices were Mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of ,20 i ` �otltry Public Tanya Lachenmeyer NOTARY PUBLIC, State of New York No.01LA5032219,Suffolk County Commission Expires,August 22,2D Jill M. Doherty,President Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President wP.O.Box 1179 James F.King �A Southold,NY 11971 Dave Bergen �/� ��� Telephone(631)765-1892 John Bredemeyer Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of MARIA STANISIC COUNTY OF SUFFOLK) STATE OF NEW YORK) dd AFFIDAVIT OF POSTING 1,- z,' I��l' ,residing at/dba LSA ( c -���Q u� S-uv\"' , 5 s-4 2-r �e�. d , )jX `t Q 63 being duly sworn, depose and say: That on t e i day of MA\-( , 201 , I personally posted the property known as iSN'c — IgIIZS Sov^A\j w A,n, 5; W pJ . i1�tl1 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 Wed,May 18, 2011 on or about 6:00 PM. Dated: (signs ure) Sworn to before me this day of\A%. 701( Notar�Pubh Tanya Lachenmeyer NOTARY PUBLIC,State of New York No.01 LA5032219,Suffolk County Commission Expires,August 22,20 1 . i - f i f i - t NOTICE TO ADJACENT PROPERTY OWNER 6 1 BOARD OF TRUSTEES,TOWN OF SOUTHOLD In the matter of applicant: Maria Stanisic SCTM#1000-51-4-1 ! YOU ARE HEREBY GIVEN NOTICE: 3 !i 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Please See Attached Project Description. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 19725 Soundview Avenue, Southold, NY 3. That the project which is subject to Environmental Review under Chapters 32,37, and/or 97 of the Town Code is open to public comment on: 5/18/2011 You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: Maria Stanisic MAILING ADDRESS: P.O. Box 1453 Southold, NY 11971 PHONE#: (:ail -'-765-- M0 Enc: Copy of sketch or plan showing proposal for your convenience. apt CUBIC YDS OF CLEAN FILL - LONG ISLAND SUuND �,�UPLAND SOURCE, PROPOSED S81'31'50*e BULKHEAD AS REQUIRED TO MATCH ADJACENT GRADES i+ 120.21' i a ANG PLATFORM EXISTING 118• WOOD BULKHEAD PROPOSED TO BE RECONSTRUCTED IN PLACE USING STEEL SHEET STAIRS PILING 17. LO 5' NG ! ADJACENT GRADES WSHAKHA DESAI ROBERT OXNAM LIMITS OF 320 CENTRAL PARK WEST BACKFILL APT 12H RETIAINII'IG MB NG W EXIST 1 ,n TIER o EXISRNG NEW YORK, NY 10025 S 6�15 AIRS R xETRACTABLE c TYISJI u, STAIRS °D 3.5 z3 IXISTING °D LATFpRM 3'x8' 5 x11 STAIRS PLATFORM STAIRS 711'451 E7ooSTINOD WORD, WALL BLU •x4' S. STING TIMBER- WNGEXTSTING RETAINING WALL o BRICKPLA.SRM Sra� 1'E _ of PATIO 2.ew CEHq C ES„ 12.3 25.4 KAREN DALY 12-3 34-27 797H STREET CELLAR APT 31 ONE-STOP _-/1 JACKSON HEIGHTS. NY y m FRAME o 13 24.0' CEHA LINE CONC. c rQ 13.o' d) i A- 0 N 22.2 _ ` N 2-STORY W \ n GARAGE p 22.2' .NOTE y /° 3.3'E FD.STONE 94.00• MST 13' 40'W FD.CONCR. TIDAL WETLANDS LINE IS SYNONYMOUS MON. WITH THE AHWM AS OBSERVED BY LAND USE ECOLOGICAL'SERVICES, INC, "POLE ON 2-7-11. SOUND VIEW AVENUE 1801 SCALED N a 40' 0 40' cao. TITLE PWAM FM MARIA STANISIC AT: 19725 SOUNDVIEW AVE. PROPOSED BULKHEAD RECONSTRUCTION SOUTHOLD, NY 11971 SITE PLAN Compiled by:D.H. Date: FEB 11, TAX MAPS: LAND USE ECOLOGICAL SERVICES, INC prepared by:R.K. Scale: AS SHOWN 1000-51-4-1 570 EXPRESS DRIVE, SUITE 2F project Mgr. D.H. File:STANISIC Medford, New York 11763 (631) 727-2400 ° NO. 1 OF 2 Rev: 2-28-11, 4-18-11, 4-25-11 r� I. y 0 n `c s .r u r 73' TO CEHA UNE I 66' t TO EXISTING 1 PROPOSED 30 CU.YDS. HOUSE OF CLEANFILL FROM UPLAND SOURCE TO BE EXISTING 118' OF WOOD PLACED TO MEET EXISTING BULKHEAD TO BE GRADE AS REQUIRED RECONSTRUCTED IN PLACE (DISTRIBUTED AREAS USING STEEL SHEET PILING, PROPOSED TO BE PLANTED 17.5' LONG WITH BEACH GRASS ON 12' CENTERS HELICAL TIE BACK 6' O.C. E S-TING GRADE ]� 6.0'1(VARES) EXISTING 6' x 6' WHALERS I AHWM TO BE RECONSTRUCTED. EXISTING GRADE— CCA TREATED STEEL SHEET PILING, 12"X20' CCA TREATED PILE, 17.5' LONG 6'0.C. CROSS SECTION A-A SCALE: 1" = 10' LEGEND: NOTE EXISTING WOOD BULKHEAD (-118' LONG) TO BE RECONSTRUCTED IN PLACE TIDAL WETLANDS LINE IS SYNONYMOUS USING STEEL SHEET PILING WITH THE AHWM AS OBSERVED BY _ LAND USE ECOLOGICAL'SERVICES, INC, ® PROPOSED —100 CU.YDS. OF FILL TO BE 'ON '2-7-11. PLACED TO MEET EXISTING GRADE. PFUAM'FM MARIA STANISIC mw- 19725 SOUNDVIEW AVE. PROPOSED BULKHEAD RECONSTRUCTION SOUTHOLD, NY 11971 SECTION VIEW Compiled by.D.H: Date: FEB 11, 2011 TAX may: LAND USE ECOLOGICAL SERVICES, INC 570 EXPRESS DRIVE, SUITE 2F Prepared bpR.K. Scale: AS SHOWN 1000-51-4-1 Project Mgr. D.H. File:STANISIC Medford, New York 11763 (631) 727-2400 0 N0'Rev: 2 OF 2 Stanisic — Southold Project Description: (4-25-11) The applicant is proposing to reconstruct approximately 118 linear feet of existing timber bulkhead in place utilizing steel sheeting. 30+/- cubic yards of clean fill from an upland source is proposed landward of the reconstructed bulkhead as required to match the existing adjacent grades. The applicant also proposes legalization of all existing stairs,platforms and timber retaining walls as depicted on the project plans prepared by Land Use Ecological Services, Inc. last revised 4-25-2011. T "-! Ec Ell VEI MAY 9 2011 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS T Address: Ln ru, ru rq C' L M co Postage $ ru Certified Fee $2. 01 Postmark C3 Return Receipt Fee Bior2 011 M (Endorsement Required) AY E3 Restricted Delivery Fee ED (Endorsement Required) F-i IZI Total Postage A F—q .41 $5.59 ovili-%l M Sent To SCTM: 1000-44-3-2 r-3 Street Apt Natalie Poliwada r— or PO Box A ---- 55660 County Road 48 City State;d L Southold,NY 11971 fikuresiding Z-1AVOLA) being duly sworn, '7 ZA day of 201L, deponent mailed a true copy of the Notice set forth in the Board of T stees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment rQll Qf the Town of Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said ersons by —L---,/F-TV (certified) (registered)mail. Sworn to e me a this- q Day of 20 Notary Public JANET M.TOOKER Notary Public State of New York No.01Y0-5n51905 Qualified in Suifolk County 11-7 Commission Expires November 13,20L) SCTM: 1000-44-1-13 SCTM: 1000-44-3-1 SCTM: 1000-44-1-15 John Xikis John Xikis Robert Dietrich 32-55 Steinway St. 32-55 Steinway St. 55755 County Road 48 Astoria,NY 11103 Astoria,NY 11103 Southold,NY 11971 SCTM: 1000-44-3-2 Natalie Poliwada 55660 County Road 48 Southold,NY 11971 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: y.EL, -6-0—I L.L(S - SCTM# I QQ -_LJ LJ Ll ® L _q YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ,..,�D 15�nfD 1 r7i1- -7606 41 T At7i5i5c — ,Z VaVlDe- -n1110 Lz-) Ze7Vi2ivS &V ilii ; P.-014 / -4A_'-' ,4 D 6�eccw1D 6)vjzy Dec/C Avo 61-ma's 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: '557705 40A0 16 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is opera to public comment on: DATE: 2 01/ 08104 / YZ_ 6 QQ Aw 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. PROPERTY OWNERS NAME: D�e*6 A41Lt o_s MAILING ADDRESS: 5 706 601,/dW�. 4g icy l J97 J PHONE#: AGENT: MAILING ADDRESS: _ 2 06 Z weMV c-1.7, �j� ' Ao/ PHONE #: _ CC�lY 2D9-9S5-Q Enc: Copy of sketch or plan showing proposal for your convenience. Jeffrey T. Butler, P. E. , P.C. 206 Lincoln Street Architectural and Engineering Services Riverhead, NY 11901 Tel: (631) 208-8850 Fax: (631) 727-8033 7 v E April 14,2011 APR 14 2011 � y 1 Lauren Standish Board of Trustees Office Town of Southold 53095 Main Road Southold,NY 11971 RE: Grillos Residence—55705 County Road 48 Dear Ms. Standish, Enclosed are 3 sets of plans which have been revised per the Trustees comments at the March 23,2011 hearing. The following changes were made: 1. Deck has been reduced to 200 sq. ft. 2. Splash guard installed for entire length of bulkhead 3. Beach access stairs have been removed 4. Two (2) 10' returns have been added Should you have any questions,please do not hesitate to call. Thank you for your attention to this application. Sincerely, Melissa C. Butler Enclosures x� r OFFICE LOCATION: *OF S®(/jy MAILING ADDRESS: Town Hall Annex Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 cn Telephone: 631 765-1938 ® p� Fax: 631765-3136 ®l�c®U01� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM MAR 2 3 2011 ; To: Jill Doherty, President Town of Southold Board of Trustees i3es����Ttes�ess From: Mark Terry, Principal Planner LWRP Coordinator Date: March 22, 2011 Re: Proposed Wetland Permit for DEBBIE GRILLOS SCTM#1000-44-1-14 The proposed action is located within the Coastal Erosion Hazard Area and a FIRM Special Flood Hazard Area AE (EL 16); coastal flood zone with velocity hazard (FIRM Panel 36103C0158H) Butler Engineering on behalf of DEBBIE GRILLOS requests a Wetland Permit and Coastal Erosion Permit to remove existing emergency armor stone and filter fabric used to protect dwelling from further tidal damage and reserve stone for later use. Remove remains of existing damaged bulkhead and construct shoreguard bulkhead (approx. 58.75'), construct deck (approx. 720 sf.) and railing, and beach access stairs. Place one row of armor stone seaward of proposed bulkhead (1-3 ton), approx. 40 tons. Located: 55705 County Rd. 48, Southold. SCTM#44-1-14 ' 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 Standard's. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, I recommend the following: - e.,71sf e•ter �., ..R.Jy r % -.;r ••! •. ''� 'a..; .,. .• „y^"' ';``«vx.", _°� ' g - >� '<A �'^�'. 3,4h,�i 'fV F, >F � "`$^k•a`:8°"•� '. ,y..'' % K �y'„yry 6 .f < .�' a�. .. - .a.7ls.'.as dD .2,Fy`S„j '�`' q .•�,». y . ^' ;,K'2.. s' ` .. ' +^ F... '- •:''*meg• •�•: "sRW '-` i ...�,a R"4 is=_•"` „t. ,...i d s.s •r:d��"?gym � ����.. �.,,€ ,� t: :,:w"" `i" ✓° 1 y , �. :t.'� .. r 4',a,'.aA.. �=}fid _..i`'.,q_� >� .?' ., _„�-. ..Ys:.'-'rn,'.� "•"" , w ..a'. ,!'mom• ,r.` „,r.:..«. .-a.. � tea. 4 > iF•L '' ,,,, :w^" � �e��e `� m�%�":s _.,' � :.^.��Zl �=m` , r •r.s+' w--, 5 t F.W�'L3 ,>'� ,tV�• .iT` 6... Figure 1. Subject parcel. The placement of one row of armor stone seaward of proposed bulkhead (1-3 ton), approx. 40 tons is recommended as CONSISTENT based upon the following: 4.1 Minimize losses of human life and structures from flooding and erosion hazards. D. Use hard structural erosion protection measures for control of erosion only where: 2. Vegetative approaches to controlling erosion are not effective. This section of the shoreline is subject to frequent and severe tidal and storm surges capable of eroding the beach. 3. Enhancement of natural protective features would not prove practical in providing erosion protection. See above 4. Construction of a hard structure is the only practical design consideration and is essential to protecting the principal use. The principal use is a private residential residence (not water dependent). The purpose of the proposed structure is to dissipate tidal and wave energy during storm events to minimize erosion of the beach seaward of the structure. 5. The proposed hard structural erosion protection measures are: a. limited to the minimum scale necessary. The proposed erosion control structure is limited in design using natural stone. However, it is recommended that the Board assess. 1. How does the applicant propose to access the site for construction and placement of fill? 6. Practical vegetative methods have been included in the project design and implementation. Due to the severe erosive forces during tidal and storm event , the use of vegetation within this area to control erosion is not practical. The replacement of the existing bulkhead is an EXEMPT action. The construction of the beach .access stairs is recommended as CONSISTENT, In the event the action is approved to further Policy 5, the following is recommended: § 275-11. Construction and operation standards. A. General. The following standards are required for all operations within the jurisdiction of the Trustees: (2) Erosion control. Installation of an erosion control structure is necessary during any building, grading, landscaping or site work activity within Trustee'jurisdiction. This structure may include, but is not limited to, installation of a silt fence, hay bales, wood chip berm and silt booms. The placement of the erosion control structure(s) shall be determined by the Trustees or their designee. All intertidal construction and excavation requires the installation of a silt'boom that will retain all suspended sediments within the immediate project area. The proposed deck (approx. 720 sf.) and railing is recommended as INCONSISTENT. The proposed action is not permissible pursuant to § 111-10. Structural hazard area. B. § 111-10. Structural hazard area. The following restrictions apply to regulated activities within structural hazard areas: B. The construction of nonmovable structures or placement of maior nonmovable additions to an existing structure is prohibited. I would recommend that the Board evaluate the need for a splash pad in the same area where }the deck is proposed to prevent potential erosion behind the bulkhead during storm events. A splash pad is permissible pursuant to 4 111-15. Erosion protection structures below. § 111-15. Erosion protection structures. The following requirements apply to the construction, modification or restoration of erosion protection structures: A. The construction, modification or restoration of erosion protection structures must: (1) Not be likely to cause a measurable increase in erosion at the development site or at other locations. (2) Minimize and, if possible, prevent adverse effects upon natural protective features, existing erosion protection structures and natural resources such as significant fish and wildlife habitats. B. All erosion protection structures must be designed and constructed according to-generally accepted engineering principles which have demonstrated success or, where sufficient data is not currently available, a likelihood of success in controlling long-term erosion. The protective measures must have a reasonable probability of controlling erosion on the immediate site for at least 30 years. C. All materials used in such structures must be durable and capable of withstanding inundation, wave impacts, weathering and other effects of storm conditions for a minimum of 30 years. Individual component materials may have a working life of less than 30 years only when a maintenance program ensures that they will be regularly maintained and replaced as necessary to attain the required 30 years of erosion protection. D. A long-term maintenance program must be included with every permit application of construction, modification or restoration of an erosion protection structure. The maintenance program must include specifications for normal maintenance of degradable materials. To assure compliance with the proposed maintenance programs, a bond may be required. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney Town of Southold Board of Trustees Application Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit V' _Amendment/Transfer/Extension V✓Received Application: 11 ✓Received Fee:$ S/ ompleted Application I _Incomplete _SEQRA Classification: Type I Type It Unlisted r _Cpordination:(date sent) C WRP Consistency Ass ssment Form -j- q I U __ MAR - 1 2011 _ �AC Referral Sent- I _,-5-ate of Inspection: Receipt of CAC Report: _Lead Agency Determination of ? u;iecs Technical Review: Vl(u'blic Hearing Held: L Resolution: Name of Applicant Address J� ; ZW42�W_V' ZW Z2_02 Phone Number:( 269, 79,3Y Suffolk County Tax Map Number: 1000 - //4/— _1q Property Location: 5!5–/0ea �lt (provide LILCO Pole#, distance to cross streets, and location) AGENT:��� � (If applicable) Address: 206 4/AA 1-ii) -Phone: C� .a� E .d of Trustees Application GENERAL DATA Land Area(in square feet): 3 (7, 00 rh Area Zoning: �Ll Previous use of property: Intended use of property: i 1 YA)T_1 A L_ Covenants and Restrictions: Yes __�<,_No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes No If If"Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date Al PAA 6eaMjrd,0, I lil7v7�i Ll®lS ODf?Ol No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary):y �L � - 461nw!J✓ �G O/4F AN �� i�o� s7�✓v� ` dam'�dLey: s L--2d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: a©rac + 4�, i a TU Area of wetlands on lot: ® square feet Percent coverage of lot: 15,66 % Closest distance between Barest existing structure and upland edge of wetlands: a, feet Closest distance between nearest proposed structure and upland edge of wetlands: 6. '3 feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? 40 cubic yards How much material will be filled?-09 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 1010 Manner in which material will be removed or deposited: �,' re- 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): i Bo--A. of Trustees Application COASTAL EROSION APPLICATION DATA 41 Purposes of proposed activity: o51G� Are wetlands present within 100 feet of the proposed activity? No�_Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? cubic yards) Manner in which material will be removed or deposited:/�.�I/ ,AO,AOZO m it � C,. /�'r� /S ��'✓�T LL�� Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) 617.20 SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 9-PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT!SPONSOR 2 PROD CT NAME DJ`s/d,-- (-/,6)0&V6--' 3,PROJECT LOCATION: Municipality County d PRECISE LOCATION: Street Addessand Roajd� Intersections Prominent pg landmarks etc -or provide maD rH U9 5 IS PROPOSED ACTION ❑ New ❑Expansion xModification/alteration 6.DESCRIBE PROJECT BRIEFLY 7P� - 41 z-0 :5?-A'J Avo ��i�� �b ���/ � vt i2� �L c aq�g qo �S 7.AMOUNT OF LAND AFFECTED- Initially acres Ultimately acres 6 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS, 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 7VIOther (describe) � - �1& 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes No If yes, list agency name and permit 1 approval: 11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes D<No If yes, list agency name and permit / approval 11722.. IA'S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION Des C&No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor N o✓btt'1e—�����l0�j Date Signature —" If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART 11- IMPACT ASSESSMENT(To be completed by Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes 21 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes - Q No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: No • C2.Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: No • C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly. No C4.A community's existing plans or goals as officially adopted,ora change in use or intensity of use of land or other natural resources?Explain briefly: No C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: No 06.tang term,short tern,cumulative,or other effects not idenlified in C1-05? Explain briefly: No C7. Other impacts(including changes in use of either quantity or type of energy? g;lain briefly: No D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED,THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CFA? If yes,explain briefly- E]Yes Q No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es a Iain: Yes a NO PART M-DETERMINAMON OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS; Foreach adverse effect identified above,determine whether it is substantial,large,Importantorotherwise significant Each effect should'be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ff question d of part ti was checked yes,the determination ofsignificance mustevaluate the potential impact ofthe proposed action on the environmental characteristics ofthe CEA. Check this box Nyou have identfied one or mare potentially large or significant adverse impacts which MAY occur.Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actio VWLL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting thi determination. Board of Trustees---- Name rustees --Name of Lead Agency Ddte Jill M.Doherty President or Type Name of sp risible Officer in Lead Agency Title of Responsible Officer L Si nature of R ponsible ffi r in Lead Agency Signature of Preparer(If different from responsible officer) �doSUk Town of Southold � z Erosion, Sedimentation & Storm-Water Ryan-off ASSESSMENT FORM .t� PROPERTY LOCATION: s.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A `7p1atwt1 STORM-WATER,GRADINGS DRAINAGE AND EROSION CONTROL PLAN strict se o oc of CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a What is the Total Area of the Project Parcels? Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within Generated by a Two(2")inch Rainfall on Site? — the Scope of Work for Proposed Construction) (S.F/Acres) (This item will include all run-off created by site It. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? (S F/Acres) impervious surfaces,) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Pmvlda Addihanal Pages asNeeded) Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and espas Controlling Surface Water Flow. s the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. c� 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural V Existing Grade Involving more than 200 Cubic Yards / of Material within any Parcel? �� 5 WIII this Application Require Land Disturbing Activities X ��AJ ���' J �i ►/°� Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? Li ar /aoA , — 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction IV V General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or El X Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that '7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately dlstulD one or more acres of land, which Exceed Fifteen(15)feet of Vertical Rise to Including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 WIII Driveways,Parking Areas or other Impervious El „/t for Storm Water Discharges from Construction activity-Permit No.GP-0.10-001.) Surfaces be Sloped to Direct Stone-Water Run-Off 1.The SWPPP shalt be prepared prior to the submittal of the NOI The Not shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder E-1 -4 compliance with the terms and conditions of this permit in addition,the SWPPP shall Area?fThls Item will NOT Include the Installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE- If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm vratef management practice in a Box and the construction site disturbance is between 5,000 S.F.&9 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Stone Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable In the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE A Check Mark(,J)and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, .6q COUNTY OF.../..(.................. ...............SS That I,.,.,.. �t ....�✓�..�.. -F.................being duly sworn,deposes and says that he/she is rhe applicant for Permit, (Name of individual signing Document) Andthat he/she is the .......................................Onwm<................................................................................................. (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me s; ............/" .............. ay ..... 20./1 Not.0 Public: ... 30 .. r ................... NOtay c- (Slgnatura of AppOcanq FORM - 061'1® 4.-4 2 r Qualified 4 r R' Coinri;is�iton oXpii+cs� �(� r s� jpf F01/r Jill M.Doherty,President 4 Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President , CAP.O.Box 1179 James F.King � Southold,NY 11971 Dave Bergen A a �O�' Telephone(631)765-1892 John Bredemeyer Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD GFE r ------------------------------------------ In the Matter of the Application of MAR 1 5 2011 J 1- DEBBIE GRILLOS COUNTY OF SUFFOLK) STATE OF NEW YORK) ,g� AFFIDAVIT OF POSTING I, � V 1 Ltj, ,f T-L&L, ,residing at/dba' a L&L 2D6 LJA) 1.A 6a-, QjUk�AO . AM being duly sworn, d ose and say: That on the I`f da of V110YUtt , 201 , I personally posted the property known as 6v-7 06 by placing the Board of T -tees 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 Wed,March 23,2011 on or about 6:00 PM. Dated:/P/h1a7/ /Z� 2011 (signature) Sworn to before me this day of 20! I� I Notary PUN is a JANET M.TOOKER Notary Public,State of New York No.01T05051905 Qualified in Surfolk County Commission Expires November 13,'20-0 r 1000-44-1-13 1000-44-1-15 John Xikis Robert DietrichIK 32-55 Steinway Street 55755 CR 48 I y, ®D° Southold,NY 11971 I ' '- _µ r Astoria,NY 11103 !,! ®® aM fru ° - ° MW 1000-44-3-1 i ' ° �L° } ° ° ° ASI 'y 111(3 � - John Xikis � � ..� 3 i_a �-..,� 32-55 Steinway Street ' Postage $ - $0.61 0901 Astoria,NY 11103Certified Fee $2.80 06 O Postmark O Return Recelpt Fee Here O (Endorsement Required) $2.30 Restricted Delivery Fee 1000-44-3-20 (Endorsement Required) ".0 Natalie Poliwoda m 55660 CR 48 _a Total Postage&Fees_ $, _ $5.71 _ _ _03/-14/2011 Southold,NY 11971 sent To , 1000-44-1-13 C' Street Api John Xikis 3 or PO Box r` -----state,-- 32-55 Steinway Street ;...__ Astoria,NY 11103 V7 so�1. ��1ri � . A L �s fr1 ® Ulf IVn- Postage $ $0.61 0901 Certified Fee $2.80 06 D Return Receipt Fee Postmark } ) '�"° '"+ M (Endorsement Required) $2.30 Here �- �4 1 }) L ) Restricted Delivery Fee ; IYI (Endorsement Required) $0 _ r Postag fir,, kx } F, .' CO . Certified Fee. ^F 8� r�r rD' Total POStanq&Peas -03114!2011- o o (Endorsement Require ` �� " — ere sen t To -10'00-44-1-15 ! r Restnelivery Foe !Q� O Sireet,Ap; Robert Dietrich �- ! o (EndorsemenctedDtReq.lred) or PO Box Op r- c iy""suis 55755 CR 48 -0 Total Postage&Faas. Southold,NY 11971 Sento 2� L Er 1000-44-3-27- b s Io IM Sheet Apt Natalie Poliwoda- or PO B. ` 1 cy-site; , 55660=CR 48 Southold,-NY 11971 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK residing at&-rL&I 20b LocoW !��T, 90 , being duly sworn, deposes and says that on the day of ,20j_�_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names;that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold;that said Notices were mailed at the United States Post Office at 2wkA e t) , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. 0 Sworn to before me this Da of , 20_fl� Notar P�blic JANET M.TOOKER Notary Nob01T05a151905 w York Qualified in SuTfolk County Commission Expires November 13,20 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:' �1,d ��LLd� SCTM# 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 existing emergency armor stone&filter fabric used to protect dwelling. Reserve stone for later use. Remove remains of existing damaged bulkhead. Construct shoreguard bulkhead(approx.58.75'). Construct deck (approx.720 sq.ft.) and railing and beach access stairs. Place one row of armor stone seaward of proposed bulkhead(1-3 ton,approx.40 tons). Repair foundation of existing dwelling. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 55705 County Road 48,Southold SCTM: 1000-44-1-14 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: z2!ZW y ;Z 2pAYou may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: 'i a1—z-JLZOS MAILING ADDRESS: PHONE#: —99i® ,g ��- Enc: Copy of sketch or plan showing proposal for your convenience. March 21, 2011 To: Southold Town Board of Trustees From: Debbie Grillos Re: Grillos Property 55705 C.R.48, Southold, NY To whom it may concern: Please be advised that due to my inability to attend, I give my husband,Joseph Yenna, my permission to speak and act on my behalf at the Trustees meeting to be held on Wednesday, March 23, 2011. If you have any questions or comments, my contact information is listed below. Thank you, Debbie Grillos 718-259-7934 917-859-2739 djyenna4@aol.com March 21,2011 `# MAR 2 2 2011 `f 1 r To: Southold Town Board of Trustees _._-_. ' ' ' __ - f_E` From: Debbie Grillos Re; Grillos Property 55705 C.R.48,Southold, NY To whom it may concern: Please be advised that due to my inability to attend, I give my husband,Joseph Yenna, my permission to speak and act on my behalf at the Trustees meeting to be held on Wednesday, March 23, 2011. if you have any questions or comments,my contact information is listed below. Thank you, Debbie Grillos 718-259-7.334 917-859-2739 djyenna4@aol.com ---rd of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. JPAAj- � Signature SWORN TO BEFORE ME THIS DAY OF �/- ,20j Notary Repub : Na 24.4840482 Qualified in-MM-, TY 01 ► c mmissioli c rpim �/� Notary Public -..:.::.rd of Trustees Application AUTHORIZATION (where the applicant is not the owner) I -'IDe,Wt>;Q, C�Tr 11��� residing at 5 /" �� ID (print owner of property) (mailing address) do hereby authorize /f (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. IOAI-11� Ao�:k= (Owner's signature) 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: (Last name,first natne,middle initial.unless you aie 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 Ti ustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption fiom 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 your self(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/oi describe in the space provided. The town officer o employee o 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 Submitted tlt' _day f 206 L Signature Print Name e S2 ri oS Form TS I 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 tivithin the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online 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# 0(2 - _- —/q The Application has been submitted to (check appropriate response): Town Board 0 Planning Dept. 0 Building Dept. E Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital 0 construction,planning activity,agency regulation, land transaction) 0 (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Azwbw /L L G1, S e�;^✓v7rC f" d �cC& C/}�,�r1dx. 72� ..�T � /�✓� d L1n/G / vim /��� � '52 &d;,0V16,, o C!v 3 7 010_ ,�/fAW, ACO 7VIV-5. Location of action: Site acreage: 531-17 00 Present land use: 1 DW .A L Present zoning classification: - RLAo 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: ja6&6- (ni4Lurs (b) Mailing address: 2-3117> 1VV 112-2-9 (c) Telephone number: Area Code 2-sq 7gAt' (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Yes ❑ No [—] Not Applicable 'ImoA 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 IA 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 0 No 0 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 0 No 0 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 0 Yes 0 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 0 No� Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ NoX 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 KM Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye- No•MNot Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No K Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes 1:1No� 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 ElNo� Not Applicable Created on 512510511:20 AM 7 i Jill M.Doherty,President Q - Town Hall,53095 Main Rd. James F.King,Vice-President u,. P.O.Box 1179 Dave Bergen EO �` Southold,NY 11971 Bob Ghosio,Jr. '1y Telephone(631)765-1892 John Bredemeyer p Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD +1 a- QOM e Use Only V �me�^JrCncy pe0'r+, �l�u on _Coastal Erosion Permit Application Wetland Permit Application Administrative Permit I DEC 2 9 2010 "° y _Amendment/Transfi //Exxtt sion Yeceived Application: t eceived Fee:$,�— Southliol;l Tmn _Completed Application L__,_BoarJ of Traslecs _Incomplete _SEQRA Classification: Type I Type II Unlisted —Coordination:(date sent) LWRP Consistency Assessment Form _CAC Referral Sent: _Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: _Public Hearing Held: _Resolution: -7 ��� � 3�C 3�•� Name of Applicant bib b e_� ®5 Address Z Z°1 Phone Number:(V) Z Sol--3-� Suffolk County Tax Map Number: 1000 - 3 S q4 -1-11-1 Property Location: SS_+Q Nl NO t"r_s-� (provide LILCO Pole#, distance to cross streets, and location) AGENT: je_7 e-c— CC— Cr L-rl-rs e_r'� (If applicable) 1-13 I �` Address: 0- S �� �+C\ 4-�v'� N l�/ 1 �-e) 2 Phone: (r�3 11-11 ' "--xd of Trustees Applicatic,l GENERAL DATA Land Area(in square feet): 'JS Z8 Area Zoning: n2 S &-cl, Cl- Previous use of property: SeIN,soC-,a 1 re-st AQ_4-\C1L Intended use of property: S e CS o(,\0�-. re-S 1 (AC�N CZ 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 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): 'PL Ke- on)E-- To - r/' �-CC (O S I D,AJ C S W ri—O4tJ( Oi—� L-7-xisT1 liG- rOL)A)b J C LU1)1Al6- 10 Y)S SAK)bY y -iG�i 2u.s'(,/I ' S d�zrJa7z�di 7c ],,-- .cd of Trustees ApplicaticL_ WETLAND/TRUSTEE LANDS APPLICATII1ON DATA Purpose of the proposed operations: p e cLf-e I d U 1`�n Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: S feet Closest distance between nearest proposed structure and upland edge of wetlands: to feet Does the project,involve excavation or filling? No'- d Yes If yes,how much material will be excavated? d cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 3 3 n Manner in which material will be removed or deposited: 6_P_ye zd&1dr 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): 1)oh t PROJECT ID NUMBER 617.20 SEAR 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 3.PROJECT LOCATION. rr Municipality , 5©J+�"O ��_ County 4.PRECISE LOCATION. Street Addess and Road Intersections, Prominent landmarks etc -or provide map 'e-t L4g I W 5.IS PROPOSED 'ACTION: New1:1Expansion �Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: AC,I✓IA >✓ Y O t= I-3 To 0 s To N o ) N r I?©17 0F X15TI1J � I-c�JWbP,_T10K) ItJGt,L)bItQ1& 30 I,,)bY T I lel_ Fol? 1R)ALK-F l LL ,Ti ale k b d 57 I�ra.�i �Y�S/,irg U 4 Q �/ o'l T') S 4��o i��✓� r c�17 7 AMOUNT OF LAND AFFECTED: Initially 0, 1 Z acres Ultimately �� 1 Z 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) LzN 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 ❑No If yes, list agency name and permit / approval- 11 DOES ANY Abl-EG I, UF I HE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes F71 No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes [:IN, NIA I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name � L Date: Signature /1161 /L/Z8�10 If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment �oard of Trustees Applica—rn County of Suffolk State of New York o 5 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS o DAY OF 0Q C 120 10 LAUREN Ni.STANDISIJ NbtarY Public,State of New York Qty l Plod in Suffolk Countyy �`1' Uot��1lss1011ExpiresApril9.20A ry Public y canard of Trustees Applicata AUTHORIZATION (where the applicant is not the owner) &C-t L,:- residing at 2316 'Bjnce_�4- S4- (print owner of property) (mailing address) ,1bM0Y--Y\ W do hereby authorize (Agent) Or to apply for permit(s) from the r'Gt�`� �S C_S� Southold Board o� Town Trustees on my behalf. (owner' s signature) 8 r; - -- - - '-- - I 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: (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 o&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 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-Z,g day o 240Signature ,��/�+ Print Name l� L67e, Gr 11oS Form TS I