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HomeMy WebLinkAboutTR-9302A Michael J.Domino,President �QF SUUj,Z, Town Hall Annex John M.Bredemeyer III,Vice-President ,`Q ��� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams �� Fax(631) 765-6641 oly'rou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1668C IDate: January 2, 2020 THIS CERTIFIES that the removal of existing±8' long wood bulkhead; remove uprooted cedar tree; perform partial grubbing and reshaping of the bank for material placement; stabilize_ qpproximately 18' of eroded slope with approximately 10-12 cubic yards of soil and gravel covered with one la e�r of geo textile fabric and covered with approximately 6-8 yards of 6"-8" graded trap rock; and to remove a 3' portion of existing dock, construct a 12' bulkhead with 2' and 6' returns; backfill with 3 yds, of clean fill; At Cedar Point Drive East (along Pleasant Inlet), Southold Suffolk County Tax Map #1000-90-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 17, 2018 pursuant to which Trustees Administrative Permit#9302A Dated September 19, 2018 and Amended on September 18, 2019 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the the removal of existing f8' long wood bulkhead; remove uprooted cedar tree; perform partialrug bbing and reshaping of the bank for material placement; stabilize qpproximately 18' of eroded slope with approximately 10-12 cubic yards of soil and gravel covered with one layer of geo textile fabric and covered with approximately 6-8 yards of 6"-8" graded trqp rock; and to remove a 3' portion of existing dock construct a 12' bulkhead with 2' and 6' returns; backfill with 3 yds. of clean fill. The certificate is issued to Cedar Beach Park Association owner of the aforesaid property. n � Authorized Signature Michael J.Domino, President SO Town Hall Annex John M. Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O., Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams10oU O Fax(631) 765-6641 �y �m,��' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/.constructed Project complete, compliance inspection. INSPECTED BY: 6-re COMMENTS: � o G laa CERTIFICATE OF COMPLIANCE: d� S� �- i Michael J.Domino,President �Qf so(/Ty Town Hall Annex 0 54375 Route 25 John M.BrIedemeyer III,iVice-President ,`O lQ P.O.Box 1179 Glenn Goldsmith [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams %�' �� Fax(631) 765-6641 COU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2019 Michael A. Kimack P.O. Box 1047 Southold, NY 11971 RE: CEDAR BEACH PARK ASSOCIATION CEDAR POINT DRIVE EAST, part of area along Pleasant Inlet, SOUTHOLD SCTM#: 1000=90-3 Dear Mr. Kimack: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, September 18, 2019. RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit#9302A to remove a 3' portion of existing dock, construct a 12' bulkhead with 2' and 6' returns; backfill with 3 yds. of clean fill; and as depicted on the site plan prepared by M.A. Kimack, received on August 2, 2019, and stamped approved on September 18, 2019. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Michael J. Domino President, Board of Trustees MJD/dd AiP BOARD OF 1+UU TEES � F TOWN OF SOUI HOLD -_- HL W L/N&: A 06, /Z za-R, i L Y"-Yl- 5,WeAI VA DATE S6ftAAW - .o•«��K/N>>_==-=- _ .ECE SANT D t LAAIa� TaWN o�SDUTf/DGD � _- S07441//GNU-- 90 • � alb C"CA ,, T - .- ` , • `J2fT SG�2S`BOx_s�r�iuG ,_- , - / _ -r - • • _ - ' �t sd �FT�fi�r�Q�T�JPi1lS 1 '�O/'�!�BLL/�iC' Y -- - ---- - - _ ,•� -. _ � sof. �..�-•2�r - a. ' NYSDEC �tEiSi' '�/IP.P -- J4s�• t�iY /�ci�.4i- s BEET P PER TERM • zF' - - -. - • _ _*oP OF E�Q.v.� � CONDITIONS S S OF II PERMIT NO DATE � � ,6, P.4Rk .4 55dG', j'' /t,4.RSH,Clt/.E BY• AUG 2 2019 Po.,eo 909, So4vrhoi.� C� EVVIRONHWV S'tXVIC&s sp QFt7s_ ,D � 9GV�L 4's; A44:5&ST 13' 2olaF -3FT �l,, fi�/7":�► 11101FTd/" Southold Toym _�� .-` --- - Or of Trustees -----_---- - ,By),W kI l�4GK y•�/2o/8 f4v 8/2�120�� r . _; s pis i4 Michael A. Kimack ATTORNEY AT LAW P.O. Box 1047 Southold,N.Y.11971 Cell No. 516-658-6807 E-mail: mkimack2@verizon.net August 1, 2019 Re: Cedar Beach Park Association Trustee Permit No. ?F,02- Request F02Request for Amendment To: Southold Board of trustees I respectfully request that the Board approve an amendment to the above referenced permit for Cedar beach Park Association to be in conformance with the NYSDEC permit No. 1-4738- 04613/00001. ( attached). Also attached find (2) plan/detail sheet depicting the proposed amendment as approved by NYSDEC. Attached is my check in the amount of$ 50.00 made out to Town of Southold. Sincerely Michael A. Kimack, Agent for Cedar Beach Park Association FIE 11 E..1 AUG 2 2019 Southold Tovrn Board of Trust.uq S\1FF©(K Town Hall Annex Michael J. Domino,Presid`` 'Co �� C' John M. Bredemeyer III, Vice-Pi ii ant � OG!A 54375 Route 25 Glenn Goldsmith CD z P.O.Box 1179 A.Nicholas Krupski fry Southold,NY 11971 Greg Williams Telephone(631)765-1892 dol �a Fax(631)765=6641 BOARD OF TOWN TRUSTEES Gy TOWN OF SOUTHOLD Date/Time: Completed infield Michael Kimack on behalf of CEDAR BEACH PARK ASSOCIATION requests an Administrative Amendment to Administrative Permit#9302A to remove a 3' portion of existing dock, construct a 12' bulkhead with 2' and 6' returns; backfill with 3 yds. of clean fill. Located: Cedar Point Drive East, part of area along Pleasant Inlet. SCTM#: 1000-90-3 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: �b,� I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski Williams Other NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY @ Stony Brook,50 Circle Road,Stony Brook,NY 11790 P:(631)444-03651 F:(631)444-0360 www.dec.ny.gov July 5, 2019 Cedar Beach Park Association C/O James Curran P.O. Box 409 Southold, NY 11971-0409 Re: Permit No. 1-4738-04613/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit,for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance. during the term of the permit. If you-are unable to comply with any conditions, please contact us at the above'address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. Please note, the permit sign and Notice of Commencement/Completion --of Construction form are sent to either the permittee or the facility application contact, not both. R) 0 Eli ? E JSier ly, I— AUG 2 2019an V. Ackerman Regional Permit Administrator Scuil,old Town _ SVA/Is _ Board of Trustees EwvoTV Department a STATEOf ovroann+nr •EnvironmentaF Conservation NEW YORK STATE Dkk' __�'MENT OF ENVIRONMENTAL CONSEn v HTION Facility DEC ID 1-4738-04613 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: CEDAR BEACH PARK ASSOCIATION CEDAR BEACH PARK ASSOC C/O JAMES CURRAN CEDAR POINT DR EISCTM#1000-90-3 P O BOX 409 SOUTHOLD,NY 11971 SOUTHOLD,NY 11971-0409 (631) 765-6056 Facility Application Contact: MICHAEL A KIMACK PO BOX 1047 SOUTHOLD,NY 11971-1047 (516) 658-6807 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility'Principal Reference Point: NYTM-E: 719.001 NYTM-N: 4545.413 Latitude: 41'01'49.8" Longitude: 72°23'41.7" Authorized Activity: Remove existing bulkhead and reconstruct bulkhead and returns in conformance with the attached plans prepared by M.K. Kimack, last revised 5/20/2019 and stamped NYSDEC approved 7/3/2019. Note: All construction must be done from the landward side of the bulkhead only. No disturbance of vegetated areas. 'Permit Authorizations Tidal Wetlands -Under Article 25 Permit ID 1-4738-04613/00001 New Permit Effective Date: 7/3/2019 Expiration Date: 7/2/2024 Water Quality Certification-Under Section 401 - Clean Water Act Permit ID 1-4738-04613/00002 New Permit Effective Date: 7/3/2019 Expiration Date: 7/2/2024 Excavation & Fill in Navigable Waters-Under Article 15,Title 5 Permit ID 1-4738-04613/00003 New Permit Effective Date: 7/.3/2019 Expiration Date: 7/2/2024 Page 1 of 7 NEW YORK STATE DER ,-'MENT OF ENVIRONMENTAL CONSE._.-aTION Facility DEC ID 1-4738-04613 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: SUSAN ACKERMAN, Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony B o kJ50 Circle Rd Stony Brook,NY 11 90 -3409 Authorized Signature: Date /3 /QNO Distribution List MICHAEL A KIMACK Marine Habitat Protection SUSAN ACKERMAN Permit Components NATURAL,RESOURCE PERMIT CONDITIONS WATER QUALITY CERTIFICATION SPECIFIC CONDITION GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS; WATER QUALITY CERTIFICATION; EXCAVATION & FILL IN NAVIGABLE WATERS 1. Post Permit Sign The permit sign enclosed with this permit shall be posted ina conspicuous location on the worksite and adequately protected from the weather. 2. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project,the bottom portion of the form must also be signed and returned, along with photographs of the completed work. Page 2 of 7 NEW YORK STATE DEF> _IPMENT OF ENVIRONMENTAL CONS&,,ATION � Facility DEC ID 1-4738-04613 3. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be,completely removed from the adjacent area(upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 4. Materials Disposed at Upland Site Any demolition debris, excess construction materials, and/or excess excavated materials shall be immediately and completely disposed of in an authorized solid waste management facility. These materials shall be suitably stabilized as not to re-enter any water body, wetland or wetland adjacent area. 5. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal 4 wetlands or protected buffer areas as a result of the permitted activities. 6. Storage of Equipment,Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 75 linear feet from the tidal wetland boundary. ; 7. Clean Fill Only All fill shall consist of clean sand, gravel, or soil (not asphalt, slag, flyash, broken concrete or demolition debris). 8. No Beach Excavation For Fill No excavation ofthe beach is authorized for the purpose of obtaining fill or stone materials. 9. Backfilling All peripheral berms, cofferdams, rock revetments, seawalls, gabions, bulkheads or other approved shoreline stabilization structures shall be completed prior to placement of any fill material behind such structures. lo. No-Seaward Extension of Bulkhead The new bulkhead shall be constructed in place of the existing bulkhead with no seaward extension of the outermost bulkhead face. 11. Jet-in Bulkhead Bulkheads constructed directly adjacent to vegetated tidal wetlands shall be hand driven or jetted in with no disturbance to the tidal wetland. Trenching is strictly prohibited. 12. No Structures on Bulkhead No permanent structures shall be installed on the authorized bulkhead without first obtaining written department approval(permit, modification, amendment)., 13. Excavation for Bulkhead/Structure Prior to any construction or removal of bulkheads and other shoreline stabilization structures all backfill shall be excavated landward of the structure and retained so as not to enter the waterway, tidal wetland or protected buffer area. 14. No Runoff Over or Through Bulkhead or into Wetland There shall be no discharge of runoff or other effluent over or through any bulkhead or shoreline stabilization structure or into any tidal wetland or protected buffer area. 15. Wood Preservatives a. Pressure treated wood used for construction of in-water structures must have undergone a treatment process approved(stamped or otherwise marked as certified)by the American Wood Preservative Association. b. Wood treated with Pentachlorophenol (PCP)must not be used in marine or brackish waters. Wood treated with PCP,must be aged in the open air for at least three months prior to in-water use. Page 3 of 7 F Am NEW YORK STATE DE TMENT OF ENVIRONMENTAL CONSL 'ATION � __ Facility DEC ID 1-4738-64013 c. The use of creosote treated wood is prohibited both in the water and upland areas. d. Chromated Copper Arsenate(CCA)pressure treated wood must be clean and free of CCA surface deposits. Wood with surface deposits must be washed for at least 5 minutes under running water prior to use. The washing must occur greater than 100 feet landward of any regulated wetland and/or water body. (Note "E." below for handling wash water.) e. Any wood debris such as sawdust or wash water must not enter any water body, including wetlands or protected buffer areas. 16. No Dredging or Excavation No dredging, excavating or other alteration of shoreline or , underwater areas is authorized by this permit,nor shall issuance of this permit be construed to suggest that the Department will issue a permit for such activities in the future. 17. Pilings at Property Lines Pilings shall not: a. extend laterally beyond propery lines, b. interfere with navigation, or c. interfere with other landowners riparian rights. 18. No Structures on Pilings No structures, other than structures specifically authorized by this permit, shall be constructed on'pilings without further authorization from the department(permit, modification or amendment). 19. Install,Maintain Erosion Controls Necessary erosion control measures, i.e., straw bales, silt fencing, etc., are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good and functional condition until thick vegetative cover is established. 20. Incidental Disturbance to Vegetation It is the responsibility of the applicant to remedy any incidental disturbances resulting in damage or removal-of wetland vegetation. Upon completion of construction activities, any disturbed areas shall be planted with the appropriate marsh vegetation. Please contact the Bureau of Marine Habitat at(631)444-0295 for more information. 21. Contain Exposed, Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales/silt curtains (or other NYSDEC approved devices)placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 22. Maintain Erosion Controls All erosion control devices shall be-maintained in good and functional condition until the project has been completed and the area has been stabilized. 23. Bulkhead Construction All work must be done from the landward side of the structure only 24. No Interference With Navigation There shall be no unreasonable interference with navigation by the work herein authorized. Page 4 of 7 r NEW YORK STATE DER FMENT OF ENVIRONMENTAL CONSE'__._1TION w Facility DEC ID 1-4738-04613 25. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by-the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 26. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State,the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 27. State May Require Site Restoration If upon the expiration or revocation of this permit,the -project hereby authorized has not been completed, the applicant shall,without expense to the State, and to such extent and in such time and manner-as the Department of Environmental Conservation may lawfully require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 28. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved pians submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by M.A. Kimack last revised 5/20/2019, stamped NYSDEC approved on July 3, 2019. 29. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids,sediments, fuels, solvents, lubricants, epoxy coatings,paints, concrete, leachate or any other environmentally deleterious materials associated with the project. WATER QUALITY CERTIFICATION SPECIFIC CONDITIONS 1. Water Quality Certification The authorized project, as conditioned pursuant to the Certificate, complies with Section 301, 302, 303, 306, and 307 of the Federal Water Pollution Control Act, as amended and as implemented by the limitations, standards, and criteria of state statutory and regulatory requirements set forth in 6 NYCRR Section 608.9(a). The'authorized project,as conditioned, will also comply with applicable New York State water quality standards, including but not limited to effluent limitations,best usages and thermal discharge criteria, as applicable, as set forth in 6 NYCRR Parts 701, 702, 703, and 704. Page 5 of 7 NEW YORK STATE DEP,__ CMENT OF ENVIRONMENTAL CONSE LTION w Facility DEC ID 1-4738-04613 GENERAL CONDITIONS - Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a-person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. ,Submission of applications for permit renewal, modification or transfer'are to be submitted to: Regional Permit Administrator NYSDEC Region 1 Headquarters SUNY @'Stony BrookJ50 Circle Rd Stony Brook,NY11790 -3409 ' 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Excavation&Fill in Navigable Waters, Tidal Wetlands, Water Quality Certification. v 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; Page 6 of 7 Aft NEW YORK STATE DEP 'MENT OF ENVIRONMENTAL CONSEIL -TION � Facility DEC ID 1-4738-04613 d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State,of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of,the facility or facilities authorized by-the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or-to any claims,,suits, or actions naming the DEC and arising under , Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. ,Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and.assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and*rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the'permitted work nor does it authorize the impairment of. any rights,title, or interest in real or persona_1 property held or vested in a person not a party to the permit. Page 7 i. ' ' r NOTICE OF COMMENCEMENT OF CON'Z i RUCTION RETURN THIS FORM TO:COMPLIANCE Or Fax to* 631-444-0297 AM Bureau of Marine Habitat Protection-NYSDEC IRMO 50 Circle Road Stony Brook, NY 11790-3409 PERMIT NUMBER: EXPIRATION DATE PERMITTEE NAME&PROJECT ADDRESS.- CONTRACTOR DDRESS:CONTRACTOR NAME&ADDRESS: TELEPHONE: Dear Sir. Pursuant to the special conditions of the referenced permit,you are hereby notified that the authorized activity shall commence on . We certify that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions. We have inspected the project site and can complete the project as described in the permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions.The permit,permit sign, and approved plans will be available at the site for inspection in accordance with General Condition No. 1. (Both signatures required) PERMITEE: DATE CONTRACTOR: DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT.OF THE PROJECT AND/OR ANY ASSOCIATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE PERMIT AND APPROVED PLANS AVAILABLE AT THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS. Cut along this line X - X X X X X X NOTICE OF COMPLETION OF CONSTRUCTION RETURN THIS FORM TO:COMPLIANCE Or Fax to: 631-444-0297 _ Bureau of Marine Habitat Protection-NYSDEC Circle Stony Brook, NY 11790-3409 _ PERMIT NUMBER: EXPIRATION DATE: PERMITTEE NAME&PROJECT ADDRESS: CONTRACTOR NAME&ADDRESS: TELEPHONE: Pursuant to special conditions,of the referenced permit,you are hereby notified that the authorized activity was completed on We have fully complied with the terms and conditions of the permit and approved plans.(Both signatures required) PERMITEE: DATE CONTRACTOR. DATE THIS NOTICE, WITH PHOTOGRAPHS OF THE COMPLETED WORK AND/OR A COMPLETED SURVEY,AS APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. NEWYORK Department of STATIC OF OPPORTUNITY Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Advisor SUSAN ACKERMAN Permit Number j,&qa$v-0y6/3/=01 Expiration Date NOTE: This notice is NOT a permit Michael J. Domino, President �o�pS�FF04ee Town Hall Annex John M. Bredemeyer, III, Vice-President yam', 54375 Route 25 Glenn Goldsmith H ? P.O. Box 1179 A Nicholas Krupski o • Southold, NY 11971 y � �� Greg Williams dol Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed When project complete, call for compliance inspection; O�� �jyol Michael J.Domino,President OF SUTown Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �p� Telephone(631) 765-1892 Greg Williams OI�I,QU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9302A Date of Receipt of Application: July 17, 2018 Applicant: Cedar Beach Park Association SCTM#: 1000-90-3 Project Location: Cedar Point Drive East, part of area along Pleasant Inlet Date of Resolution/Issuance: September 19, 2018 Date of Expiration: September 19, 2020 Reviewed by: Board of Trustees Project Description: Remove existing ±8' long wood bulkhead; remove uprooted cedar tree; perform partial grubbing and reshaping of the bank for material placement; stabilize approximately 18' of eroded slope with approximately 10-12 cubic yards of soil and gravel covered with one layer of geo textile fabric and covered with approximately 6-8 yards of 6"-8" graded trap rock. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by M.A. Kimack, dated July 14, 2018 and stamped approved on September 19, 2018. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Michael J. Domino, President Board of Trustees Michael J. Domino,Pr nt O�OSUFFQ(��'OGI _ Town Hall Annex John M. Bredemeyer III,Vic6-President to 54375 Route 25 Glenn Goldsmithy _ P.O.Box 1179 Ze A.Nicholas Krupski Southold,NY 11971 Greg Williams y p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: JZ d' Completed in field by: Michael Kimack on behalf of CEDAR BEACH PARK ASSOCIATION requests an Administrative Permit to remove existing ±8' long wood bulkhead; remove uprooted cedar tree; perform partial grubbing and reshaping of the bank for material placement; stabilize approximately 18' of eroded slope with approximately 10-12 cubic yards of soil and gravel covered with one layer of geo textile fabric and covered with approximately 6-8 yards of 6"-8" graded trap rock. Located: Cedar Point Drive East, part of an area along Pleasant Inlet. SCTM# 100,0-90-3 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice f Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski ./G. Williams Other �y/ f SJu�S!111 jU I1h1Ul i�a�lt�2i�r�.�scr�sodoar� - � �lUd L L lt�r � 410Ninos j® NMOL 1-1 � �i� - _ J i i 7 / I 3, J � a � o Dar d Vail�o baa•xoa�eerr NOWIJO�--- saalseo uMol pjo pio4,jnos ic �a��ti. os-�iso >v b xosod 810? t lop &2klor - �- i d• �J_z'1S/ _ — .®! /r', 060z-00 09-06-00 04_12-01 05-17-01 ' 3-21-02 N]m 1B] NpB 1B7 05-22-03 02-01-04 - N ' 1 `f 19A(c) O,P 16 � Q ' 1s TOWN OF a SOUTHOLD k't a • O Oq,F � 14 m1 83 ® $ 207 N 13 w 0 s T LL 15A(c) v r \g 2 ' 2 3A(c) OOO, apO'( mn '•! ,.rz r^, na S1BRJ1%nER ! ti 1L151N 1 PO//1/j IDE 1 no v+i 3 i 2 ('V LAKES 47 3 uOP r 4 1tun 6 ! 1.21kL) t' 4 fab/ __ 6 1 op f'41 -- w 6 wt6\ TOWNOF ... _____ -___ 13 fuq OD s EDAR S m, SOUTHOLD` n '+• r 5.1 - S w T P0110tbefRN.rzRf..mt .m. �. rnt tat TOWN OF SOUTHOLD tot 7 tr``� ,-`` •i l 2. .�' I 14 p �'V .p OA(C) Mt 13 fon L am e- 11 / ao. 45A(c) 27 R 6 Bw 1.1 z9 , 11�eS 15 $ 25 g_ NN 1 WEST 24 23I �Ft. e LAKE SIB .n CRO w `� ,-------- 9 fnn � �� �ys 15 , �y Mcen.++w trial 13$0)__-_ ` 1 28 TOWN OF /Cc to I.mut' �1' Qe, SOUTHOLD R t ae nw 1 e 131 14.1 (50.) I 17 DR, E.29 I _ �_�o •} a w k B+mdamrel t i i I ,m W LA1m >m .�!H. nw 261 r. ---�_. f t d is 21 22 s 19 b OR bo y i i 1 ,1 7A(c) 16 17 18 t 19 20 Mm - L 21 22 m, Pn 6 , r t i i 1.2A(e) _ m � - fu4 � � 23 2 3 i T t ' t tot nmr 'mt ."-L..- o fuq toot fot mn t mo � � t"t mn i � tnn I t t ob' nbt m1 nm' nT4 _ • �.. o i tmt , i , I t HOG - NECK �._` PR��OSED SLOIn�.t'�P.4l.PA .o BAY N]1B 282 N]1B 2B2 W ' L .wea.�bfu.. mr..,f... - SECTIONNO _�_ � � �) O NOTICE amyl COUNTY OF SUFFOLK © K ® TowNOF SOUTHOLD E o.s.o..ma.� 1 2 ti.f.m.t.. --•-- ..�aeuo- --•-- om MEINI/CE.ILLIFFIOIDtIBMEOR Real Property Tax ServiceA en Y fno G smuet.u. a .r.w .wrbau. --"-- N..r rar--s,-- .a NwNr , n P hr Agency RIBNTItAl Of/InYnOnRfNt OFTIE 2 ® VILLAGE OF E __ — n.n ..au 4, county anar HIVTANaA,Nrtit)01 90 N a.�,No. ^�--- L..� �• - upf.+nu. —t-- ,rrrm.u.nu.--A-- _ �� OLKLbIINttTAT«AP is t�aN®nEo seuE wrEEr M mB ooz D 1.c1Na aI� r 1z1A(a)>,zu � -- _— ,r.aw —+-- wrra�far,r--ww-- Nowa • "ws,Evwiu rwvEarvT�xssmnsrtoN OAt ��" 1m B tm >na P msTalcr No 1600 tzt Nn PROPERTY MAP Y{ __ - _ _ _ _ g,..�- _ - - _ __ _ _-__ _ � CONVFnaoNpn*E rel to]➢It a v i.}_0'• - .u_ .. _:._- t.., _ _ .- •.r •v: _ , _ i . .4c.�e. .e -e - _ ;..b r. _ _n - -_-v 'Cedar Cedar Point Drive East,Southold SCTM#: 1000-90-3 RUM mm w , S .r`° • ' !^ �T r t4 All. �� ._ _ it � r� � � ,/ _ � ►•,�{ IN .,.I" �d r <�} '{ } a'j, '\ -..�. \ ,_ Vii• i �.: `-_ - _�• .- ► }y,.. M • 11�r/f J •`, r ; A / 1�2 /2 018,E 11 .' 3%0 , }.���'-� .�F .r 1,',-./.•.n ti.`« _u is _�.�' '. r . f'+y`} _it �` y :� �~' �• -� a s J. ` _ `�,� a►K �"''� �, a _ -�t--+..tc„--. V r •t gE,i6 �j.. .r �. �� l t ♦ J,r,.. ��� � \� 'fir �.� � � - '� ;�,� qtr:. . b �•;. r q V' IU Ipp k. (3)Cedar Beach Park s•oc. Taken July 12,2018 Looking NE r �. 9 r W fi ., ,ddb �b, �• - s'- - e•i" �" '; "�� } Vie �•' Tib'' \# p" T 4 ' L t (4)Cedar Beach Park Assoc. Taken July 12,2018 Looking NW tayc) qrq 1g f2 b a 4 zo.T 47 2 2 WO CE AR \ •, OR PO/NT � J . d • J U y POWT f u T na I TOWN OF SOUIMIXD nay 1 2.d'(c) ^ r / /.sNcl a II 20 a 0') e ^� WESTnw 11 d LAKE • n.r 10 to P te.t -- e n. �' nn �/ y�0� .s t w.rrn ww _______fQ(1 W.) ___ n.r TOWN OF • � im n fe ZO ow) • m PO... 25 +a fe ft OR :+TN<) 16 17 fe to z „q zr a 3 ons t2(q rw e.t +wq' J IfOG NECK BAY "_. `�"'" .. """' ______ """""' COUNTY OF SUFFOLK (21) O u. �NN1atusns� NOTICE TY © E ® v 80117110LD SECTION NO uD & °•. -- - �r� _ _ .,, — •' ^°^ eal Property Tax Service Agency Y nnn^n ce nnc.nw rlta M aua °F 090 w En R 7-7 Rf We,N -- - PROPERTY MM OFFICE LOCATION: ®�A0 S®U�y®� MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) CIS Telephone: 631 765-1938le Southold, NY 11971 � ® a® TeP ® Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Assistant Town Planning Director Date: September 13, 2018 Re: LWRP Coastal Consistency Review for CEDAR BEACH PARK ASSOCIATION SCTM# 1000-90-3-21 Michael Kimack on behalf of CEDAR BEACH PARK ASSOCIATION requests an Administrative Permit to remove existing ±8' long wood bulkhead; remove uprooted cedar tree; perform partial grubbing and reshaping of the bank for material placement; stabilize approximately 18' of eroded slope with approximately 10-12 cubic yards of soil and gravel covered with one layer of geo textile fabric and covered with approximately 6-8 yards of T-8" graded trap rock. Located: Cedar Point Drive,East, part of an area along Pleasant Inlet. SCTM# 1000-90-3-21 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. 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: Damon Hagan, Assistant Town Attorney Michael J. Domino,President Town Hall Annex 54375 Route 25 John M. Bredemeyer 111,Vice-President P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A.Nicholas KrupskiFax(631) 765-6641 Fax V, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit —Amendment/Transfer/Extension Received Application: JUL 1 7 2018 ZReceived Fee: $j00,00 Completed Application: SOUTM!u Toven Incomplete:__ BQ Ed of Trust SEORA Classification: Type I Type II Unlisted ---.—Lead Agency Determination: Coordination:(date sent): WRP Consistency Assessment Form Sent: i/_CAC Referral Sent:ate of Inspection: —Receipt of CAC Report: '-Teclu-iical Review: Public Hearing Held: Resolution: Legal Name of Property Owner(s): Mailing Address: 0)< 570 VrA/aD AA Y ll,?71 Phone Number: Suffolk County Tax Map Number: 1000- Property Location: 0A1 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: 07 Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: _ _/f✓f j� Previous use of property: a& 0C7o Ie64— Intended use of property: Covenants and Restrictions on property? Yes __X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes _y _No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes _,_X, —No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes 9 No Does the structure(s)on property have a valid Certificate of Occupancy? Yes X No Prior permits/approvals for site improvements: Agency Date 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):"MoVe UP,p0066D- Ck-PA.e 7XZ e) 6-8" CSR,4POP 7BA R /F®cle - Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: xzJ wml FA Area of wetlands on lot:_ (/^/IeN C_INAL_square feet Percent coverage of lot: VA(k /oWAI % Closest distance between nearest existing structure and upland edge of wetlands: Q feet Closest distance between nearest proposed structure and upland edge of wetlands:_ a —feet Does the project involve excavation or filling? No ��Yes If yes,how much material will be excavated? ®A/- 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: 2 CAI B Manner in which material will be removed or deposited:_Gv " 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): Pg,5`6 P44 CAWiEWr®F' V 77/R,a,D/ j PURIM& 1'1,47eL Pl- J ;V o � c, �,oU 61Z20 Appendix S Short Environnlental Assessment.Form Instructions For I,0111plelfiIio Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: C C' • /4 FTO C, Project Location(describe,and attach a location map): Brief Description of Proposed Action:Ae",V—O 4900,0 h'VZ&1}1E4d�8 '�/—J 12400 —O upRooTE,D c60.QR mffE, PW AY,1/J L AeVAPIN& O .e,6r,,144P/�� �•¢•Vk !-OAC' M�Z 07105 H.4 riL 0L,4 COAZW -f7AO14/Z,--/l PRWO)e. /&fit% 0,0 �.P®afV JZOPe W/AAA/eox. /o-1Z YPS Q!= r6,16/ 4 ,V*eA Vel coVIA4y GU✓O A1W Z4XaZ of Geo rWX7745- 44.0,M, 4' Ca v6WP w/ 1¢101�pizor- Name of Applicant or Sponsor: Telephone � df"-- Jzfl/�. Cle—'..-_.-.--.-- -- E-Mall ,4,qk Z V4VZ1U1- Address ^� City/PO: State: Zip Code: M.v I Aly B/971 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: NYS®tee 3.a.Total acreage of the site of the proposed action? (l1VA, JAlq t�,,Wacres b.Total acreage to be physically disturbed? M004--acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? VAI&pj VM ,acres 4. Check all land uses that occur on,adjoining and near the proposed action. E]Urban ❑Rural(non-agriculture) ❑industrial ❑Commercial El Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic Other(specify):C'¢Hf'l D.V 00,4 7 _POG.& ❑Parkland Page 1 of 4 5. Is the proposed action, N6 YES N/A a A permitted use under the zoning regulations? m(� b Consistent with the adopted comprehensive plan? ❑ (❑� 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? El 7. 9 the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area`? NO YES If Yes,identify: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES_ b.Are public transportation service(s)available at or near the site of the proposed action? �l c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? I❑J 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10 Will the proposed action connect to an existing pub I ic/private water supply? _ A NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: _ AIIA 12. a.Does the site contain a structuie that is listed on either the State or National Register of Historic NO y YES Places? --- C] b.Is the proposed action located in an archeological sensitive area? 13.a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? El b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? �'( ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: I� 14. Identify the typical habitat types that occur on,or are likely to be found on the project site.^Check all that apply: Shoreline El Forest ❑Agricultural/grasslands ED Early mid-successional Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? 9 j—`j 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, Ela. Will storm water discharges flow to adjacent properties`? ❑NO �S'ES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: F-]NO ❑YFS Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: _ _ _ DL;21 El 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: _. 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: f�71 (� I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: - ,y / � � ,�/rfj�►C'o(e Date:_ 'r 1-16-22 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of'Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? (� 3. Will the proposed action impair the character or quality of the existing community? I_ t 4. Will the proposed action have an impact on the environmental characteristics that caused the I�1 establishment of a Critical Environmental Area(CEA)? �J 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate (` I reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? L_u l b.public/private wastewater treatment utilities? � 8 Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? LY J 1._J 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, (� waterbodies,groundwater,air quality,flora and fauna)? 1--J Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? ❑ 11. Will the proposed action create a hazard to environmental resources or human health? ❑� Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency detennined that the impact may or will not be significant. F:ach potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environment I impac . Town of Southold-Board of Trustees / Michael �� Narne of Lead A ency M i C h a e I J. ®m i n o President Print or Type Taj me 9AResp sib Ic Officer in Lead Agency Title of Responsible Officer — Signature of Re onsl e Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT—] Page 4 of 4 Board of Trustees Application AFFIDAVIT _ 9C./g a l .; A)ws 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 BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRE'D TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner SWORN TO BEFORE ME THIS `/2 �DAY OF ,,7-UZ- � , 20Le_ Notary Public MICHAELA.IQMACK Notary Public,State of New York No.02K15056823 Qualified in Nassau County Commission Expires March 11,2022 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) residing at 2016 4 A49,4 illVEW4, (print name of owner of property) (mailing address) do hereby authorize_ _ (Agent) &!I/C &?,46 ,4. A;;Z 9-CXto apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM Thr'rown of Southold's Code of Ethics 0mltihi15 conflicts o£intergat onhe art cr town ofFcors and cat I , ees The ur ose of this form is.to provide infcrittaliou tyht't:lj cgtr�a ,q tlLe town o£nossible c nflicts of interest rind ttllaw it to take i�h never actino ie nee•S�Uxrlj l ami`;. YOUR NAME: —_rC1 ��� ,.. BI� — ___—__�_ ___ ___ (Last name,first name,middle htitial,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 .N_ Planning _ Other (11ff'Other',name the activity.)._._ Du you personally(or throU f41r your company,spouse,sibline,,parent,or child)have a relationship with any officer or employee of the'I'own ofsouthold? "itelationsl7ilt"includes by blood,marriage,or business intrrest."Business inlcr'est"meaais a business, including a parinur,hip, in which the town officer or employcc has even n partial ownership or(or employment hy)a curporsttion in wltieh tilt:town officer of cupployce,owns more:than 5%of the shares, YES NO X If you answered"YFS",complete the halance.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 appliewit/agcnt/iepresentative)and the town officer or employee. Either check the appropriate line A)through U)and/or describe,in the space provided. 'Che 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 appliclnt (wizen 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 j day of I?JLV zo f f' Signaturo_�Print Name Name GAR,PI�L rclBlGl Form TS I r APPLICANIYAGENU REPRESENTATIVE TRANSACTI®NAL DISCLGSURM,FORM The Town of SouthoWs Code of Ethics prohibits can flicts of interest on the kart of town officers and emnloyees The nu aor osc of this form is to provide 011 which can alert the town of possible conflicts of interest and allow it to take whatever action is necessa tory_oov_alk, state. YOURNAME: �/�/MLaI- ..__�J/.1��� -- (Last name,first name,tpiddle 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 cornpany,spouse,sibling;,parernt,.or child)have it relationship with Euty officer or employee; orthe Town of'Southold? "Itclut.ionslup" includes by blood,a;atriag;e,or business interest."Businu-ss interest"moans a business, itnt:luding.t partnership. in which the town of c r or employee.has even it partial ownership of(or employment by)a corporation in which(lie town officer or employm 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); A)the legal or beneficial owner of arty 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 M#day of �' 20V8 Si;nttitirc � �_ m Print Name 1V CHS L A. i�"C& Form TS 1 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 lvithin 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 signiLigagnt beneficial and adverse effects upon the coastal area(which includes all of Southold`Gown`), 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail listing, both supporting and dion- supporrtine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be underta keia. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME_ C,ED4,e �4 /f ,6Z. �c, The Application has been submitted to(check appropriate response): Town.Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action:RZt-MOwe 40-OOP 8040k*/V2AP 48 W, ,e,=1-Ma Vue 11PAOMP QZA4R ZWO., PA,r imz C-ROOBIM& e <5J1RP1,& N)k. Coit 4FFOC"f-IVO M4,r"z pL,��h, XrA.8/4/2& APAWMe. /BfT OL EXmoo) _W, o�,� zwyAz a,-- taea Tom" e-woelc e co V,r qv a/.4/'J,,�ax. �d' Yds i Location of action: CA5pAR PQ/NT �Z,Qjy, ��S'r3 igN Site acreage: UNlG�1/BGIJA/ ___ Present land use: CO R&ON .06C& 04- 45A Present zoning classification: 'V 1,-4 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:C te.O" 49.00 C. (b) Mailing address: _d. GaC 4®g!_� -TO(91 AMY //fZ/ (c) Telephone number: Area Code �A Z (d) Application number,if any: Will the action be directly undertaken,require finding, or approval by a state or federal agency? Yes 1-1 No V<1 If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. R Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through b for evaluation criteria Yes L_] No X Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes 1:1 No F-1 Not Applicable Attach additional sheets if necessary u� — Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes 0 No gNot 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, �� ❑ 9 Yes No Not Applicable x-ze-:-c-,,r wlzz &4M VD-9 -AM0164 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 R NoX Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWR.P Section III-Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes R No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III-Policies; Pages 38 through 46 for evaluation criteria. ❑ YeJ:1 NoX Not Applicable 1�-A&-eA 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 nen ZH,0 Q7- CPAI 6442:2 R_ 0 7-11.r�s Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic IEstuary and 'Town waters. See LWRP Section III–Policies; Pages 57 through 62 for evaluation criteria. �-1 Yes ❑ NoX Not Applicable /V6 /"R4C?-&N L1Y/Affg L LM C s Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III – Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No-0 Not Applicable fl mszf r Ad, CULY _�'aDT Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III–Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No X Not Applicable PREPARED BY__ZjLqZ4SL TITLE HATE s r