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DEPARTMENT OF THE ARMY U.S.ARMY CORPS OF ENGINEERS,NEW YORK DISTRICT JACOB K.JAVITS FEDERAL BUILDING 26 FEDERAL PLAZA NEW YORK NEW YORK 10278-0090 REGULATORY BRANCH SEP 6 2010 SUBJECT: Letter of Coordination for Department of the Army Permit Application Number NAN-2018-00502-EVI by Janet Van Adelsburg The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity:- APPLICANT: Janet Van Adelsburg 420 Riverside Drive New York, NY 10025 ACTIVITY: Remove existing four-foot-wide by 68-foot-long fixed pier and install a four-foot-wide by 70-foot-long fixed pier leading to;a four-foot- wide by 20-foot-long fixed pier in a "T" shaped configuration. The total structures will be a minimum of four feet above tidal vegetative grade and extend approximately 29 linear feet.into,the waterway from the plane of Mean Low Water. WATERWAY: Richmond Creek, a tributary of Little Peconic Bay LOCATION: 4297 Wells Road, Peconic, Town of Southold, Suffolk County, New . York As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of . the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c)(3)(A)), the applicant has certified that the activity complies.with and will-be conducted in a manner that is consistent with the approved state coastal zone management program. In order for us to better serve you, please complete our Customer Service Survey located at http://www nan usace army.mil/Missions/Regulatory/CustomerSurvey.aspx. D E C E VE i SEP 2 3 2019 Southold Town —BoardTru e SEP 1 6 2019 REGULATORY BRANCH SUBJECT: Letter of Coordination for Department of the Army Permit Application Number NAN-2018-00502-EVI by Janet Van Adelsburg - 2 - To allow for the timely processing of the subject application, your comments are requested within 20 days of the date of this letter. If you have any questions, please contact Robert T. Vietri, of my staff, at (917) 790-8379. Sincerely, Ronald R. Pin Chief, Eastern Section Enclosures E C E E SEP 2 3 2019 Southold Town a o Tr st es USACE File: NAN-2018-00502-EVI Jean Cochran Park - CS)" Sonnino Della Southold Town _ Vita Vineyard,_, Recreation Department Southold Animal Shelter ivy Greenport Harbor t't, t7`Brewery(ReStanrani Southold Police9 Department-`f M1� ' �Jo X41 tl The Hervcst Inn 4297 Wells Road rM PROJECT LOCATION MAP � o N co =� N.T.S. -�M 1 of 3 USACE File: NAN-2018-00502-EVI V VEGETATED WETLANDS LOCATED AS LOCATED BY J. PATANJO ON 1-26--18 \ A PROPOSED OPEN—GRATE DECKNG TO BE r'6,\ \ FLOW—THRU INTERLOCKING PANELS OR EQUAL OVERALL DIMENSION 35' X 4' WIDE / V Y •Y Y �v��Y! Y - Y •Y Y Y Y •\ \Ov1 J EXISTING 68' LONG PIER TO BE REMOVED PROPOSED 70' LONG X 4' WIDE FIXED PIER IN SAME — —M.H.W— —•. ALIGNMENT AS EXISTING ® M 0 15 4s. 47" / M 29' 15 \ / PROPOSED 4' WIDE X 20' LONG FIXED PIER ��M�•W� _ IN A "T" CONFIGURATION PER TRUSTEE APPROVALS 66,E PROPERTY OWNER: JANET VAN ADELSBERG Q° ' SEAWARD END OF EXISTING PIER 420 RIVERSIDE DR. APT 5B °Q NEW YORK, NY 10025 ao o 10 20 cn ti's° c -ro scams i'-ao• PREPARED BY: IM — w JEFFREY PATANJO DOCK PERMIT PLANS P.O. BOX 582 BOHEMIA, NY 11716 DATE: 631-484-9332 PROPOSED PLAN18 JJPATANJO@GMAIL.COM 8 4297 WELLS ROAD19 REPRESENTS WATER DEPTH IN INCHES pECONIC TOWN OF SOUTHOLD9 BELOW MEAN LOW WATER SUFFOLK COUNTY, NY7'AX MAP N0. 9000-86-1-9. USACE File: NAN-2013-00502-EVI PROPOSED 70' OVERALL LENGTH X 4' WIDE FIXED .ELEVATED PIER WITH THRU—FLOW DECKING ON LANDWARD 35' SECTION PROPOSED 8"0 CCA PILES (TYP.) PROPOSED 4' WIDE X 20' LONG FIXED PIER 10 z T 74' 8 6 4' IN. 4 --- --- --- -- ------------ 2 4' MIN. OVER WETLANDS--/ 29 0 M. .W EL. O.Of _2 —4 PROPOSED TYPICAL SECTION SCALE: 1'=20' HORZ 40 0 10 20 I� SEP 232019 SCALE 1"=20' so"(- ,n,va 3 of 3 Board Of T_rp- ! FO( CO Town Hall Annex Michael J. Domino, President tio~ ay t, John M. Bredemeyer, III, Vice-President , 54375 Route 25 Glenn Goldsmith y ?, P.O. Box 1179 A Nicholas Krupski �oy • ��� Southold, NY 11971 Greg Williams � 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 1St day of construction % constructed When project complete, call for compliance inspection; BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 9301 APPROVAL DATE: AUGUST 15,2018 ' ISSUED TO: JANET VAN ADELSBERG PROPERTY ADDRESS: 4297 WELLS ROAD,PECONIC SCTM# 1000-86-1-9.5 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on August 15, 2018 and in consideration of application fee in the sum of$250.00 paid by Janet Van Adelsberg and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to remove existing 4'x68' fixed catwalk; construct new 4'x70' fixed catwalk using Thru-Flow decking over the vegetated wetlands and supported with 8"diameter cca piles; construct 4'x20' fixed pier in a"T"configuration; supported with 811 diameter cca piles; and as depicted on the revised site plan prepared by Jeffrey Patanjo,dated September 6,2018, • and stamped approved on September 18,2018. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Sea]to be affixed, and these presents to be subscribed by a majority of the said Board as of as of the 18th day of September,2018. 514 C040 .... ....... TERMS AND CONDITIONS The Permittee Janet Van Adelsberg residing at 4297 Wells Road Peconic New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved, but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 0 �� f SQUTy� Town Hall Annex Michael J.Domino,President h0 l0 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 ���COUNT`l Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 18, 2018 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: JANET VAN ADELSBERG 4297 WELLS ROAD, PECONIC SCTM# 1000-86-1-9.5 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 15, 2018 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of JANET VAN ADELSBERG applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 14, 2018, 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 was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 15, 2018, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 1 " WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, 'NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of JANET VAN ADELSBERG to remove existing 4'x68' fixed catwalk; construct new 4'x70' fixed catwalk using Thru-Flow decking over the vegetated wetlands and supported with 8" diameter cca piles; construct 4'x20' fixed pier in a "T" configuration; supported with 8" diameter cca piles; and as depicted on the revised site plan prepared by Jeffrey Patanjo, dated September 6, 2018, and stamped approved on September 18, 2018. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $770.00 Very truly yours, Michael J. Domino President, Board of Trustees MJD/dd f �O John M. Bredemeyer III, President O�pSOFFo(,� G Town Hall Annex Michael J. Domino, Vice-President �� s� 54375 Route 25 James F. King H x P.O. Box 1179 Dave Bergen oy • �� Southold, NY 11971 Charles J. Sanders �0( dao Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: JANET VAN ADELSBERG c/o JEFFREY PATANJO Please be advised that your application dated March 14, 2018 has been reviewed by this Board at the regular meeting of August 15, 2018 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) '/ Constructed ($50.00) x Final Inspection Fee ($50.00) x Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: 4'x40' dock = 160 sq. ft.x $3.00 = $ 480.00 4'x20' pier "T" = 80 sq. ft. x $3.00 = 240.00 TOTAL FEES DUE: $ 770.00 BY: Michael J. Domino, President Board of Trustees Unauthorized alteration or addition to this survey is a violation of section 7209, subdivision 2, of the New York State Education Law. Copies of this survey map not bearing the land surveyor's inked or embossed sealshall not be HEIDECKER LAND SURVEYING SECTION 86—BLOCK 1 —LOT 9.5 considered to be a valid copy. N C M m a Z \06 9 + �0 00 \703 '1036 Q� + + '10 .\0,6 \7 g5( 729 92 X067 +\0 ��\0 + `09 `023 +\ 3Q \�2s+ o NOTES \202 �7 \760 + 736 ,7 + + 066 +\Q6 + \Q 7S HEID1. FIECKEROLAND SURVEYING, PDLCPANDARILIALL2018 BY 99 �7 26 72 S \ MEASUREMENTS WERE TAKEN ON THE GROUND �2 + 22 + \096 �0 0Sg 2. NORTH ARROW IS BASED UPON GPS OBSERVATIONS 36 \?03 �7 \�S \72 + 66 �0 CONDUCTED BY HEIDECKER LAND SURVEYING, PLLC. �7 `3 4 + 9S 3. ELEVATIONS SHOWN REFERENCE MEAN LOWER LOW + + 73 + WATER VERTICAL DATUM 222 + 72 �7 �7 6 2 70 �7 09 \2 + S+ >> �7 �7 "a � 62 RS �76 � 2 +\�93 ?10 + 27 ?76 \ 2g �7 + X22 \ +2 + 6) +\7'>7 �27Q 6 \2 2 A6 3S "I,7S �7 �7 7R X27 X23 \,96 \209 8J + SG 6 3 220 + �^ \?01 + �7 + ?23 9 O M y \� 3 - 6Q ?2S +2 0 10 20 30` 39 X ���0 � �? 760 METERS :7 97 46, o3 + FEET + .7 �7 68 \4 JO 0 20 40 60 80 6 1^` I t;�n GRAPHIC SCALE 1 20 JUL 2 3 2018 I \207 ATE- a Sluthoold?nrin JOHN GERD HEIDECKER N.Y. STATE LAND SURVEYOR LIC. # 050719 DATE: SHEET NO i Board o+Tnlsiees_� __j 751 COATES AVENUE APRIL 22, 2018 EATHYMETRIC SURVEY 1 of 1 HOLBROOK, NEW YORK 11741 DRAWN BY B.M. SECTION 86—BLOCK 1—TAX LOT 9.5 PROJ. NO. (631)-772-9604 , #4297 WELLS ROAD 18HLS50 tio„ao �o�nho„+o �o�i� I CHK BY: J H TOWN OF SOUTHOLD CAD FILE- ^ NOTES: PORTIONS OF PLAN FROM SURVEY PREPARED BY: FRANK BARYLSKI LAND SURVEYING RIVERHEAD, NY 11901 SURVEY LATEST DATED SEPT. 10, 2013 dle O de \66� u` (�l� SEP 1 4 2018 ! � o, 610 fig/ \�\ R. R�Sj�F��F ` Eoartl of fntc^s _�. � I \ O \\EXISTING 75' WIDE PERMANENT VEGETATED BUFFER ZONE �' \ VEGETATED WETLANDS LOCATED AS LOCATED y W \ BY J. PATANJO ON 1-26-18 CKNG TO BE F OWOTHRUSED O INTERLOCKING NG TE EPANELS OR EQUAL APPROVED BY-,, . WN`OFS( U OW PROPERTY OWNER: JANET VAN ADELSBERG " ®le►TE 420 RIVERSIDE DR. APT 5B NEW YORK, NY 10025 EXISTING 68' LONG PIER TO BE REMOVED �,�S>>�• W W W 41 IV �► i PREPARED BY: PROPOSEDj70' LONG X 4' WIDE FIXED PIER IN SAME o\'' _v\W—"—MWA. W JEFFREY PATANJO ALIGNMENT AS EXISTING o P.O. BOX 582 BOHEMIA, NY 11716 s 6'• ml47` \ / 631-484-9332 15 �\ JJPATANJO@GMAIL.COM \ PROPOSED 4' WIDE X 20' LONG FIXED PIER 76 \ IN A "T" CONFIGURATION PER TRUSTEE APPROVALS 6S \ d�� ' s� FTAX CK PERMIT PLANS SCALE: 1"=50' SEAWARD END OF EXISTING PIER '•\ DATE: PROPOSED PLAN 2-26-18 3-28-18 7-14-18 \ REPRESENTS WATER DEPTH IN INCHES4297 WELLS ROAD 9-6-18 36" BELOW MEAN LOW WATER ONIC, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: MAP N0. 1000-86-1-9.5 1 of 2 Jean Cochran Park ;'p '� A Sannino Bella[p Southold Town Vita Vineyard Recreation eation Department \ R7 9 a Southold Animal Shelter P A Greenport Harbor ''<3 T Br6very{Restaurant 39 2 1' y P Southold Police® G Department Qa PROPOSED 70' OVERALL LENGTH X 4' WIDE FIXED ELEVATED �I PIER WITH THRU—FLOW DECKING Sedert� i `•��i .� PROPOSED 8"0 CCA PILES (TYP.) PROPSOED 4' WIDE X 20' LONG FIXED PIER 10 The Harvest Inn 5 v rim 14 e, OI. :aphael74'— �� �f ° 14297 Wells Road PROJECT LOCATION MAP 4 - N.T.S. _ - - - - - - - - - - - - - - - - M. .W. EL. 2.5f-- lJ �� �� 2 EF SEP 1 4 2018 iL D) � M.L.W EL. O.Ot ' 1 Soot gold Town _2 Qoardof;rustees_—�_ -4 PROPOSED TYPICAL SECTION H: 1"=20' SCALE: V: 1"=2' PTAX CK PERMIT PLANS SCALE: - AS NOTED OPOSED SECTIONS DATE: & LOCATION MAP 2-26-18 7-14-18 4297 WELLS ROAD 9-6-18 NIC, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: MAP N0. 1000-86-1-9.5 2 OF 2 SURVEYED FOR: JANET VAN ADELSBERG PROPERTY LOCATED AT PECONIC LOT No 2 AS SHOWN ON \ c� MAP OF RICHMOND CREEK FARMS SECTION 2 FILED MAY IB. 1999 FILE No 10282 PELLLANG N/F NI TOWN OF SOUTHOLD LOT 3 o \SG° PECONIECLILC SUFFOLK COUNTY NEW YORK �y3 S C T M D 1000-B6-1-9 5 �2y�0 Y pnllc _ \E AREA = 2 6229 ACRES \ SCALE 1-=60 NOTE THE\p9 O` 36dWETLADS OEXISTENCE REASEMENTSI OF O RECORD N 6 rlq� ^Dp[ cc�a r''r\ F WAYS 6\ IF ANYNOT ANO/OR SHOWN ARE NOT GUARANTEED e a a r.cw,r m M1 q�r C•q CCI-AIC STA[C rl C� f-0IJ �!� pllvC+�Y 00. /ryO r!"• TREES N S SC T TD .COOED MG , / J• !j s S[>/ • ���/ - \ RAD = 485 00' �•,\ /LEN = 184 49' O^ 3 °' \ MA[N ROAD RAD = 470 00' a�1p. \ 1 'yam \ (N Y.S. RTfi 28) s-a0 LEN = 178.78' a. SETBACK S 34°55'31"E EDGE y� /155.35' N 34°55'31"W 4468.99' RICHMOND " LOT I �pFNEK. O 5535• CREEK S 55°04'29"W !• v �. G 15.00' C p HE TEAM](LAGS �4 or s9-I1DARRm9-ID-2213- D- zau I Y MWs vT I Tuam'"I Ki`�a1ai"'o MUMAEATU LAA S� �LSF�LA_N,S�� � • TR E-S=UAL DULL.Dl a COOCCP[D IC a".ILIO imi aLNL.iCc!OI mlw CAT aoSJI1D I(pEW•JULL aal au TO nc RRSOI r W—I,C si-t,K lel—NOW IC!R>tAtJ M - nC TlS Cfi„IAi WYVlAifAM Ar y 14 L[)C—MTaTU IN 8' 4 � �� � USIWIpRpL AD 10 II["lslrK[5 W fit uzaca'"`IIIDIp, _• ) --- --- �---- (I SURVEYED BY OVAInI[Is W[CI lvVfIab AIC IDT iH J[FIa[TO MlOTmuL `ERTIFIED ot'Tw" Si I I� FRANK BARYLSKI LAND SURVEYING CERTIFIED TO \ 1{ fI j JANET VAN ADELSBERG RIVERHEAD. NY-11901 CHICAGO TITLE INSURANCE SERVICES TITLE No, C13-7474-14718-SUFEiPHONE 631-7271730„AR ^ 1 FAX 631-284-3697 FB IISB I ! SEPTEMBER 10 2013 � I S 711 boa, Michael J. Domino, _ `t uFFOt O�Q C Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 Glenn Goldsmith o G P.O.Box 1179 ze A.Nicholas Krupski 0 ® Ppy Southold,NY 11971 Greg Williams � �a0! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD l/'l+ / Date/Time: � � Completed in field by: (� Jeffrey Patanjo on behalf of JANET VAN ADELSBERG requests a Wetland Permit to remove existing 4'x68' fixed catwalk; construct new 4'x48' fixed catwalk using Thru-Flow decking and supported with 8" diameter cca piles; install a proposed 3'x16' aluminum ramp; and install a proposed 6'x20' floating dock situated in an "I" configuration, using un-treated timber decking and supported by four (4) 10" diameter piles; and to install 3"x10" cross braces.to support the floating dock a minimum of 30" above bottom at all times. Located: 4297 Wells Road, Peconic. SCTM# 1000-86-1-9.5 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: C 4 �o /lo �/o, I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: . J. Bredemeyer �Mc. Domino --�GGoldsmith N. Krupski G. 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MAICII '� PNB•a7A -Z Nr SEE SEE SEG NO SEC.NO.we /\ M 4; s 1w taa�Nwr �� " �� __.__ �� NOTICE COUNTY OF SUFFOLK © 4 SOUTHOLD W4 O16 Bs SECTION NO —�— Rt> --•-- E Real Properly Tax Service Agency r 088 M OK Oee A tv nxp P of ON 10Do PROPERTY MAP -- -- mwaana�Mnar September 10, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 4297 WELLS ROAD- PECONIC SCTM No. 1000-86-1-9.5 APPLICATION REVISIONS Dear Trustees: Attached please find four (4) copies of revised plans per comments at Trustee public hearing on August 15, 2018. Plans have been revised to construct a fixed dock in lieu of a floating dock. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, J ,ffrey Patanjo P.O. Box 582 Bohemia, NY 11716 � EC', E �iVE SEP 1 4 2018 Southold Tmu, Board of Trustees OFFICE LOCATION: �O��o� MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N G Telephone: 631765-1938 Southold, NY 11971 • O P Fax: 631 765-3136 Q�yCOU�' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: August 7, 2018 Re: LWRP Coastal Consistency Review for JANET VAN ADELSBERG SCTM# 1000-86-1-9.5 Jeffrey Patanjo on behalf of JANET VAN ADELSBERG requests a Wetland Permit to remove existing 4'x68' fixed catwalk; construct new 4'x48' fixed catwalk using Thru-Flow decking and supported with 8" diameter cca piles; install a proposed 3'x16' aluminum ramp; and install a proposed 6'x20' floating dock situated in an "I" configuration, using un-treated timber decking and supported by four(4) 10" diameter piles; and to install 3"x10" cross braces to support the floating dock a minimum of 30" above bottom at all times. Located: 4297 Wells Road, Peconic. SCTM# 1000-86-1-9.5 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 EXEMPT from LWRP review pursuant to: B. Replacement,,rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins,jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound(excluding all creeks); The action is not located within a coastal erosion hazard area. 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 July 19, 2018 Town of Southold Trustees Town Hall Annex Building — 54375 Rte. 25 P.O. Box 1179 E C-E E Southold, New York 11971 RE: 4297 WELLS ROAD- PECONIC JUL 2 4 2018 SCTM No. 1000-86-1-9.5 APPLICATION REVISIONS Southold Town B ar of TruStses Dear Trustees: Attached please find four(4) copies of revised plans and water depth surveys as requested. Plans have been revised to include water depth and distance to neighboring shoreline as requested. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 jI ID 1 i:q JUL 2 3 2018 Southold Town Board of Trustees _ l Ge Peter Young,Chairman ti Town Hall,53095 Main Rd. Lauren Standish, Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., April 11, 2018 the following recommendation was made: Moved by James Abbott, seconded by Peter Meeker, it was RESOLVED to SUPPORT the application of JANET VAN ADELSBERG for the removal of the existing 68'X 4' wide fixed pier and replacement with proposed 48' X 4' wide fixed pier with thru-flow decking and supported with 8" dia. CCA piles, proposed 3' X 16' long aluminum ramp and proposed 6'X 20' long floating dock with untreated timber decking supported with 4 10" dia. CCA piles and 3"X 10" cross braces to support float a minimum of 30" above bottom at all times. Located: 4297 Wells Rd., Peconic. SCTM#86-1-9.5 Inspected by: James Abbott Vote of Council: Ayes: All Motion Carried r Cantrell, Elizabeth From: Cantrell, Elizabeth Sent: Tuesday, April 10, 2018 1:23 PM To: 'Jeffrey Patanjo' Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Jeff, Mike Domino is requesting a hydrographical survey be completed for this property and all future properties where docks are being proposed/modified; and as per Chapter 275 of the Town Code. Elizabeth From:Jeffrey Patanjo <jjpatanjo@gmail.com> Sent:Tuesday,April 10, 2018 8:57 AM To: Cantrell, Elizabeth <elizabethc@town.southold.ny.us> Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Thanks Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 631-484-9332 - From:Cantrell, Elizabeth - Sent:Tuesday,April 10, 2018 8:21 AM To: 'Jeffrey Patanio' Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Jeff, I expect M. Domino in later today and will get back to you regarding your question. Elizabeth From:Jeffrey Patanjo<iipatanio@�mail.com> Sent: Monday,April 9, 2018 8:14 PM To: Cantrell, Elizabeth <elizabethc@town.southold.ny.us> Cc: DiSalvo, Diane<diane.disalvo@town.southold.nv.us> Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Elizabeth, Good morning. Quick question regarding the request for water depth survey. It should be understood we will not meet the required water depth and the plan shows the proposed float being supported off the bottom by piles and cross- braces.The sole purpose of the dock is to provide access to the water with kyacks and general recreation. Can you please confirm if the survey is required before I set up the surveyor to do so. 1 Thanks so much, Jeff Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 631-484-9332 From: Cantrell, Elizabeth Sent:Wednesday,April 4, 2018 10:07 AM To: Ilpatanjo@�mail.com Cc: DiSalvo, Diane Subject:Adelsberg Application;4297 Wells Road, Peconic Hi Jeff, Regarding SCTM#1000-86-1-9.5,Janet Van Adelsberg,Trustee Michael Domino reviewed the submitted project plans this morning and determined that they are incomplete with regards to the required information necessary for Trustee and LWRP review. Michael has requested that a hydrographical survey created by a NYS licensed professional be submitted; the distance between the applicants property and the property across the creek be depicted to show that the proposed docking facility does not exceed the Town's 1/3 width rule;the existing water channel located along the property;the neighboring properties docks be depicted on a plan to show both neighboring existing and proposed docks;the proposed vessel size (full length & beam)that will be kept at the dock; and the proposed docking facility must be somehow staked out at the landward end and the most seaward end to show the proposed. I know that the proposed is going in the same location as existing, however it must be somehow staked/marked out or that will cause the application to be tabled. Michael saw that you have MLW and MHW water levels on the side view, however water levels around the entire structure as well as MLW and MHW must be shown on the look-down view as well. Also, I noticed that the street address on your plans are incorrect. Please be advised that these requirements are required with every proposed new dock/replacement/expansion/etc.for the Town's application review, and as per Chapter 275 of the Town Code. With that being said, Michael also tabled the application as this information would be needed by tomorrow in order for the different departments to review in time for the April 18th meeting. Please submit 4 sets of the updated/new plans required as soon as possible for our May 9, 2018 field inspection and May 16, 2018 public hearings. 944" ewl� Senior Clerk Typist Town of Southold Board of Trustees 631-765-1892 2 Cantrell, Elizabeth From: Cantrell, Elizabeth Sent: Thursday, April 5, 2018 11:11 AM To: 'Jeffrey Patanjo' Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Everyone is busy these days. We will table this application to the May 16th public hearing with the field inspections on May 9th. Don't forget to stake the proposed dock out for that field inspection. Elizabeth From:Jeffrey Patanjo <jjpatanjo@gmail.com> Sent:Thursday, April 5, 2018 11:09 AM To: Cantrell, Elizabeth<elizabethc@town.southold.ny.us> Subject: RE:Adelsberg Application;4297 Wells Road, Peconic No way I'll make it to you today, please table.Thanks again for everything, I know I've had a lot on the plate these few months. Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 631-484-9332 From: Cantrell, Elizabeth Sent:Thursday,April 5, 2018 11:07 AM To: 'Jeffrey Patanio' Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Jeff, Are you trying to get me the requested information today, or are we tabling the application to May? Elizabeth From:Jeffrey Patanjo<ijpatanio@gmail.com> Sent:Wednesday,April 4, 2018 2:04 PM To:Cantrell, Elizabeth<elizabethc@town.southold.nv.us> Cc: DiSalvo, Diane<diane.disalvo@town.southold.nv.us> Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Can you print 11x17 easily? Jeffrey Patanjo P.O. Box 582 i Bohemia, NY 11716_ 631-484-9332 From: Cantrell, Elizabeth Sent: Wednesday,April 4, 2018 10:22 AM To: 'Jeffrey Patanio' Cc: DiSalvo, Diane Subject: RE:Adelsberg Application;4297 Wells Road, Peconic The plans need to be to scale if you email them to me. I will need to know what size paper you are using to make the project"to scale" We would ultimately need 4 sets of originals submitted immediately. Elizabeth From:Jeffrey Patanjo<iipatanio@gmail.com> Sent:Wednesday,April 4, 2018 10:16 AM To: Cantrell, Elizabeth<elizabethc@town.southold.nv.us> Cc: DiSalvo, Diane<diane.disalvo@town.southold.ny.us> Subject: RE:Adelsberg Application;4297 Wells Road, Peconic Let me see what I can put together today and get it over to you.Thanks Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 631-484-9332 From: Cantrell. Elizabeth Sent: Wednesday,April 4, 2018 10:07 AM To:jjpatanjo@Rmail.com Cc: DiSalvo, Diane Subject:Adelsberg Application;4297 Wells Road, Peconic Hi Jeff, Regarding SCTM# 1000-86-1-9.5,Janet Van Adelsberg,Trustee Michael Domino reviewed the submitted project plans this morning and determined that they are incomplete with regards to the required information necessary for Trustee and LWRP review. Michael has requested that a hydrographical survey created by a NYS licensed professional be submitted; the distance between the applicants property and the property across the creek be depicted to show that the proposed docking facility does not exceed the Town's 1/3 width rule;the existing water channel located along the property;the neighboring properties docks be depicted on a plan to show both neighboring existing and proposed docks; the proposed vessel size (full length & beam) that will be kept at the dock; and the proposed docking facility must be somehow staked out at the landward end and the most seaward end to show the proposed. I know that the proposed is going in the same location as existing, however it must be somehow staked/marked out or that will cause the application to be tabled. Michael saw that you have MLW and MHW water levels on the side view, however water levels around the entire structure as well as MLW and MHW must be shown on the look-down view as well. Also, I noticed that the street address on your plans are incorrect. 2 1 Please be advised that these requirements are required with every proposed new dock/replacement/expansion/etc.for the Town's application review, and as per Chapter 275 of the Town Code. With that being said, Michael also tabled the application as this information would be needed by tomorrow in order for the different departments to review in time for the April 18th meeting. Please submit 4 sets of the updated/new plans required as soon as possible for our May 9, 2018 field inspection and May 16, 2018 public hearings. Senior Clerk Typist Town of Southold Board of Trustees 631-765-1892 3 SQ(/P�, Michael J.Domino,President ��� �r� Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route'25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith G,'�c ® y� Telephone(631) 765-1892 A.Nicholas Krupski ©liC Fax(631) 765-6641 DUNTY; BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application D E I V E Wetland Permit Application Administrative Permit Amendment/Transfer/Extensi-Af MAR 1 4 201 Received Applicatio Received Fee: $ Completed Application: Southold Town Incomplete: f r SEQRA Classification: 'Type I_ Type II Unlisted Lead Agency Determination: Coordination:( date sent): LWRP Consistency Assess }e t Form Sent: CAC Referral Sent: 3 ' Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Legal Name of Property Owner(s): e+ ;44+n Ade s e( q Mailing Address: ya-b tZlyerstele 1JewYorjZ) Ny 1oya5- Phone Number: 6 q 6- j?R 6 _d&a7 8 Suffolk County Tax Map Number: 1000- 64 Property Location: `l 9q'7 W 4 P S 12 c'a X - pzC"7 r e- 5ee- t-eA- --? 104f (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): e 74f f 11-H �a to �► 1 0 Mailing Address: P 0 • ® � 5 " Qa 4e m l h ) N y 11 -71b Phone Number: 6 3 I' `19 Y '9 3 3.;— T Board of Trustees Applicat. i GENERAL DATA Land Area(in square feet): Area Zoning: IZ e S Previous use of property: R e S Intended use,of property: e!; Covenants and Restrictions on property? Yes `� No If"Yes";please provide a copy. Will this project require a Building Permit as per Town Code? Yes ✓ No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes ./ No Does the structure(s)on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? v-�No Yes If yes,provide explanation: Project Description(use attachments if necessary): 561- e.+-tA"ek Janet Van Adelsberg 4297 Wells Road Peconic, NY 11958 SCTM No.: 1000-86-1-9.5 PROJECT DESCRIPTION: The project includes removal of the existing 68'x 4'wide fixed pier and replacement with proposed 48' long x 4'wide fixed pier with thru-flow decking and supported with 8" diameter cca piles, proposed 3' wide x 16' long aluminum ramp and proposed 6'wide x 20' long floating dock with un-treated timber decking supported with 4-10" diameter cca piles and 3"x 10" cross braces to support float a minimum of 30" above bottom at all times. Board of Trustees Appliea�. �n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 5,e,,e- e,f tt G 11 e-JQ Area of wetlands on lot: 9" 7 SD square feet Percent coverage of lot: -I. & % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? v"" No Yes If yes, how much material will be excavated? ," A cubic yards How much material will be filled?_ -.11A cubic yards Depth of which material will be removed or deposited: N .4 feet Proposed slope throughout the area of operations: o- t. Manner in which material will be removed or deposited: tJ 1/- 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): All wor1L wt-t'hih wefJt4ncPs ,kill be totelt-t;,P 64 -to s. M t n l tic ✓'V-' . I i Short Environmental Assessment Form Part I -Project Information Instructions for Completing 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: Proposed fixed pier,ramp and float to replace existing Project Location(describe,and attach a location map): See attached location map Brief Description of Proposed Action: Remove existing 68'x 4'wide fixed pier,install new 48'x 4'wide fixed pier in same location with 16'long x 3'wide aluminum ramp and 6'x 20' long floating dock supported with 410"piles and cross bracing to keep float a minimum of 30"off bottom at all times. Name of Applicant or Sponsor: Telephone: 646-696-8278 Janet Van Adelsberg E-Mail: j.vanadelsberg@gmail.com Address: 420 Riverside Dr -Apt 513 City/PO: State: Zip Code: New York NY 10025 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 ❑✓ F] 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: ❑ ❑ NYSDEC/NYSDOS/Army Corps/Town of Southold Trustees 3.a.Total acreage of the site of the proposed action? 2.6229 acres b.Total acreage to be physically disturbed? 0.006 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2.6229 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban []Rural(non-agriculture) [-]Industrial ❑Commercial 0Residential(suburban) ❑Forest ❑Agriculture El Aquatic El Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑✓ ❑ b. Consistent with the adopted comprehensive plan? ❑ ❑✓ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ❑✓ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify:Name:Richmond Creek and Beach,Name:Pecomc Bay and Environs,Reason:Significant coastal fish& Elwi i ehabitat, eason: ro ec public health,water,vegetation, scenic eau gency ou o n ow nni m.-S ... 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ❑✓ ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ❑✓ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑✓ ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: El 7v/ 10. Will the proposed action connect to an existing public/private water supply? 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: ❑✓ ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑✓ ❑ b.Is the proposed action located in an archeological sensitive area? ❑ Z 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? ❑ ❑✓ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ElIf Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 120 s.f.floating dock into Richmond Creek 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: m Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional m Wetland ❑Urban m 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? ❑✓ ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO [—]YES ❑✓ ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 3 18.Does the proposed action v,._ _ de construction or other activities that result ii. impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ ❑ 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: FV-1 ❑ 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: Z ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor na e: Janet Van Adelsberg Dater GG2 Z'0 lZ Signature: i PRINT FORM Page 3 of 3 i 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: ❑ ❑ 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: ❑ ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning E]regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: I V1 a.public/private water supplies? - b.public/private wastewater treatment utilities? El- 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 I. 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 determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F] Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental i pacts. Town of Southold Board of Trustees g Name of Lead Agency Date • President ' Print or Type Na of Response icer m Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 EAF Mapper Summar sport uesday, February 27, 2018 7:10 PM Disclaimer: The EAF Mapper is a screening tool intended to assist "? protect sponsors and reviewing agencies in preparing an environmental assessment form(EAF).Not all questions asked in the EAF are s answered by the EAF Mapper Additional information on any EAF f ' question can be obtained by consulting the EAF Workbooks Although the EAF Mapper provides the most up-to-date digital data available to DEC,you may also need to contact local or other data sources in order i ` s' t to obtain data not provided by the Mapper.Digital data is not a a `. substitute for agency determinations K9 ry2 N = i)-J :z1 ✓; .,., �y, - ➢ m ,.�. yw,.�J',� err•.. ^'p•i„ ,'g", :Sr, s{ �',��t' odlJdid. tk ' .,..,"..c 'ax`.. :T ...➢:srr _ r�4 ? •.si' �.�+„M'�. ..h� ..v"'x'q p ;p{R �+i� lk� ;+ :; ..�v :�'P a''r` FCJC,otl ttz -•' i$ C� ' �� ,"`""*"'-"`e.' (n..1M 211 _ ' n, . � p�-i.�Y /1•.1,',- ',�` Fj'n�..,....}.q,� ' .. ''`"44t �,t#a • .,.•�-H,.`, 'n.. .; '-flfi.f,�77',_ 'Al.�w�� ,,i=;.`•"=. i� �a�,orr."":.;.a�.�.,,.,a.�.-...=;,E..,:;+'a°:r§�^`� n �i �C�di+d�t��t1C'd i 5Gis.ee;s,Fsri 14 'G f. "f" 0 4`� @�V ;MdW :, k.,tVa Yf t, �' 4 m ",..,. 1!}.r,.'-�: ..�., iar,;}•°,{;` •, :,, •o''^" r`+<°'� y� i .^„..,..._ :.. -. Interrrtt$ If�GRE7u1EikT.P' _ r..P�. � -P:7 °$QiChina[, �e:.K°�€7p,"':1=srt!.• ) � � , �g�trt�'? ri, Gsrmin,; N_ ;jpes'Fsri'{,7ilaiid};'TtC£r 4,_, ra $"4w ( ice: Ctiluml4i`",j ;s `-� �i"`" �tStE'i�li# } .11� RtulEiiT. ��.. P�_,�a' 'C•NltTl):'il1t� fl7�S,S��If1�{'—.�.�.T�P � I i,.7 y� P -�w"",tfS�n d - � � S # 4"It1$1c1�r.'`p�d �?a,,9'�..,•'k��,�"C``' s Part 1 /Question 7 [Critical Environmental Yes ;Area] _ 'Part 1 /Question 7 [Critical Environmental Name:Richmond Creek and Beach, Name:Peconic Bay and Environs, ,Area- Identify] Reason:Significant coastal fish &wildlife habitat, Reason:Protect public health, water, vegetation, &scenic beauty, Agency:Southold, Town of, Agency:Suffolk County, Date:10-20-88, Date:7-12-88� � - «� Part 1 /1 /Question 12a [National Register of No Historic Places] Part 1 /Question 12b [Archeological Sites] Yes Part 1 /Question 13a [Wetlands or Other Yes-Digital mapping information on local and federal wetlands and Regulated Waterbodies] v � waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15 [Threatened or No Endangered Animal] Part 1 /Question 16 [100 Year Flood Plain] Yes ,Part 1 /Question 20 [Remediation Site] No a Short Environmental Assessment Form - EAF Mapper Summary Report 1 Board of Trustees Applica4 a AFFIDAVIT G vi e k 'V�a Ad e l s-te r y BEING DULL'SWORN DEPOSES AND AFFIRMS THAT ISE/SHE YS THE APPLICANT FOR THE ABOVE (DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINEDHEREIN ARE TRUE TO SJLBEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER STET 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 FLEE 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)0RREPRESENT ATIqES,, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si tore of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 20 1? ary Public Jimmy Nobly€public,Wts 0f P'"Yor'k id0.0jMA611G017 �uBliS�t�i�{�o�+Yar��ouniy 4,afYlfZlb551f�6q�l(K►iTOS�a9.20,20%� Beard of Trustees Applic '.on AUTHORIZATION (Where the applicant is not the owner) I/We, 1 &.1 A Y owners of the property identified as SCTM# 1000- a'6 -1 -g• in the town of -CC on LC ,New York,hereby authorizes Jam'Wr c Ut ?A-t e- VI) C to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. �`erly Owner's Signator : Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF Good , 20 1 o Public S%AMY iA Niotapy Public,Stat®of ft"YOi'6 Clualif►e,d iiv NewYork Cott* n; Micminet 5 uvnirRs SOS¢ 2020 Board of Trustees Applica' on AUTHORIZATION (Where the applicant is not the owner) I/We, .► Q-F 1J a ,q�� s G r� owners of the property identified as SCTM# 1000- �'6 -1 -`l• in the town of PSC VA L G .New York,hereby authorizes Jam'Wr c t` 1 to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. �perty Own is Signatur Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF 20 8 o Public jIMtUIY MA Notary Po.0Public, SWIS Of�erYo� ®ualft in NewYork Cocrrty wnraniaainn Funires Soot.20,2020 and of Trustees Applicatio; AF'F'IDAVIT ori e. V�a.,% A d e l s.b e r q 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 ISIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHtOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOL D AND THE BOARD OF TRUSTEES HARMLESS AMID FLEE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIR'T'UE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION(,I HEREBY AUTHORIZE THE TRUS'T'EES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING'T HE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO ICY 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 PROPER'T'Y AND AS REQUIRED 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. Si tore of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 20 C? ary Public Jimmy IVA Not"ryPUbpe,Sat®ot N8*yo' No.09MA6116017 Qu;giried in Now YoTk COun� 2® Commission rxoires Sect.20, APPLIC.ANT/AG EN`gY1ltICPRESENTATIVE, TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The pumose of this form is to provide information which can alert the town of possible confliet_c of interest and allow it to take whatever action:s necessary to avoid same. YOUR NAME: Pa —t et 'n (Last name,first name,ipid le initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee �— Change of Zone Coastal Erosion Approval of plat Mooring , Exemption from plat or official map Planning Other (if"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than S%of-die 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 appiopriate line A)through D)and/or describe in the space provided. The town officer or employee or has or her spouse,sibling,parent;or child is(check all that apply): A)the owner of greater than S%of the shares of the corporate stock of the applicant (when the applicant is a corporationX I3)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 Submitted7x744 A of f"-16 e.(o 2p 18 Signature Print Name_ a--fir ..rip , — Form TS 1 r 1 APPLYCANUAGENUREPRIESENTATIVE TRANSACTIONAL DISCLOSURE FORM 1 I a The'rown of Southold's Code of Ethics prohibits conflicts of interest on the part oft-----officers and emplovees.The nttmose 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. J n YOUR NAME: V n Ade(S!:.e rg t —3—r, .7 e.t (Last name,first name,ipiddle initial,unless you are applying to the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) I NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of die shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. I Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. i The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than S%of the shares of the corporate stock of the applicpnt (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 20_ Signature Print Name Form TS 1 Postal Postal CE ■TIFIED o ■ . o ■ ■ I ru . • �� •. Only Er qr m . 28��rn� ;a fz�}• • �� m {-�EC�1@;L li.�„.x•l`t 7,'a•.�7�� � 1• E �) k° ��`+ �€'�`• p :� l i; t,' . >s F, �lea Q+ Er Certified Mad Fee $3.45 i}� I Er Certified Mad Fee $3,45 j{ 161 c 'c2�`� r G Er 6 ra Services&Fees(check box,add lee app te) �' 'n` - L! `! Q' Extra Services&Fees(check box,add fee jpp ate) V ❑Return Receipt(hardeopy) $ '1°i,�j 37 (n ❑Return Receipt(hardcopy) $ �•t” �� 93 ❑ Return Receipt(electronic) $ 5if(.,�flU PO�tmark Q` im ❑Retum Receipt(electronic) $ $!!-f!!! �o ark �) f�i ❑Caddied Mail Restricted Delivery $ i[i, 1�' ere `� Q ❑Certified Mall Restricted Delivery $$ l !f! He Q. 0 E]Adult Signature Required $ �^�Cl — []Adult Signature Required $ h ° — ❑Adult Signature Restricted Delivery$ OVC! [:]Adult Signature Restricted Delivery$ 4 O Postage $0.50 `p Postage $0.50 �1 6° l8�31_2!"►1.8� _ Total Postage andT $6.7U Total Postage and f - - SCTM#1000-86- - >3 r- Sent To SCTM#1000-86-1-9.4 r- Sent To Becker,Susan L '-qJohnson Leung Family Trust r-9C3 $Nreef anifAj i filo.. I C3 8!reet andAj t.No.; PO Box 289 New York, NY 10128 - 181 E 901St. Apt 5D Ciry,State,ZIP+4b I � airy,$tete,ZIP+4®i Peconic, NY 11958 Postal CEI■MIFIED o . s. m • E m CUTIfi�]C�Ci 0-. Er Certified Mad Fee e r,-- $ $3.4:t 0716 0- c 06 Extra Services&Fees(check box,add/ee s� ppa[e) ❑Return Receipt(hardcopy) $ i I O ❑Return Receipt(electronic) $ 11+� Po O ❑Certified Mail Restricted Delivery $ (? He M []Adult Signature Required $ - *c E]Adult Signature Restricted Delivery$ ED Postage Ifi°cli 72 Total Postage and$6s.7, $ O �� Sent To �I SCTM#1000- 0 SYMeefandApCT(o Pellegrini Peconic LLC Ctry Siete;--i---- 23005 Route 25 r Cutchogue, NY 11935 V PROOF OF MAILING OF NOTICE A,TTACH CERTIFIED MAIL RECEIPTS d Name: STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20 , 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 that said Notices were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. i Sworn to before me this Day of , 20 i Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: SCTM#1000-86-1-9.6 SCTM#1000-86-1-9.4 SCTM#1000-86-1-9.3 Becker, Susan L PO Box 289 Johnson Leung Family Trust Pellegrini Peconic LLC Peconic, NY 11958 181 E 90th St.,Apt 5D 23005 Route 25 New York, NY 10128 Cutchogue, NY 11935 STATE OF NEW YORK COUNTY OF SUFFOLK Jeffrey Patanjo ,residing at P.O. Box 582, Bohemia,NY 11716 being duly sworn, deposes and says that on the -3 day of August ,20 18 ,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—9v c tvm-1 � ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. ` i Sworn to before me this 3 Day of August , 20 18 ENOTARY LYN S. HICKS Ulm C C,STATE OF NEW YORK n No.01H16365489 NOtary ub11C in Suffolk County i xpires ontot.er 10.2021 Michael J. Domino, President 0FOL,�- 0 CO Town Hall Annex John M.Bredemeyer III,Vice-President G���, 54375 Route 25 Glenn Goldsmith y a P.O.Box 1179 A.Nicholas Krupski ® Southold,NY 11971 Greg Williams y p! r Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ' --------------------------------------------------------------- In the Matter of the Application of JANET VAN ADELSBERG COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS INPLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, Jeffrey Patanjo , residing at/dba PO Box 582,Bohemia,NY 11716 being duly sworn,depose and say: That on the W day of August , 2018 , I personally posted the property known as 4297 Wells Road, Peconic,NY SCTM# 1000-86-1-9.5 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,August 15,2018. Dated: cf 6 I ir o4 ture) Sworn to before me this / day of Aug. 2018 MARILYN S. HICKS NOTARY PUBLIC,STATE OF NEW YORK 'Iffld A,i A(\rx Registration No.01 H16365489 Qualified in Suffolk County Notary Public Commission Expires October 10,2021 August 6, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 D �v Southold, New York 11971 RE: 4297 WELLS RD- PECONIC AUG l 0 2018 SCTM No. 1000-86-1-9.5 AFFIDAVITS Southold own ar f ruSteestees Dear Trustees: Attached please find Affidavits of Mailing and Posting as required for public hearing. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, J rey Patanjo P.O. Box 582 Bohemia, NY 11716 NUTILk: Uim HtAKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: JANET VAN ADELSBERG SUBJECT OF PUBLIC HEARING : For a Wetland Permit to remove existing 4'x68' fixed catwalk; construct new 4'x48' fixed catwalk using Thru-Flow decking and supported with 8" diameter cca piles; install a proposed 3'x16' aluminum ramp; and install a proposed 6'x20' floating dock situated in an "I" configuration, using un- treated timber decking and supported by four (4) 10" diameter piles; and to install 3"x10" cross braces to support the floating dock a minimum of 30" above bottom at all times. Located: 4297 Wells Road, Peconic. SCTM# 1000-86-1-9.5 TIME & DATE OF PUBLIC HEARING : Wednesday, August 15, 2018 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Towyn of Southold LWRP CONSISTENCY ASSESSIMNT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its 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" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. 'Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM!# F4 - l -_—I- f PROJECT NAME `faQ-7 we lls 1ey c a Pe/i The Application has been submitted to(check appropriate response): �y Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees I-J 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: Se.0 01ac�c� r Location of action: °I 7 w e I Pecmn << Site acreage: •h a.\9 Present land use: 12-'e 5 Present zoning classification: f2-e 5 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: 74 n-e A- \14 Y, 14de-1 S e dI (b) Mailing address: `j a o 0%v e rS i S-e- _ A p-1-. 5-6 NeL.o yO't - , N `I fvo�s (c) Telephone number: Area Code( ) 6 q b-6016-$s7 8 (d) Application number,if any: ''' 1,4 Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes Ef No❑ If yes,which state or federal agency?N`t s vee-! N NS o o.s/+'" C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the foram be returned for completion. DEVELOPED COAST POLICY Policy 1. Poster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LVkW Section )IMI—Policies; Page 2 for evaluation criteria. RrYes ❑ No ❑ Not Applicable erelee4 Ina14s b•cne- emd se -F xs Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section RXI—�-P-�oli/cies Pages 3 through 6 for evaluation criteria ElYe§ ❑ No 2 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ✓❑� Yes F-1 No ❑ Not Applicable Pr',eCk Pro, (J-`s j.+<t' of ere+c1C. wtfy j ov✓td G� A aw%4 STC-e r,.x t Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See 1LWRIP Section III—Policies Pages g through 16 for evaluation criteria ❑ Yes ❑ Ivo Ivot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the`Down of.Southold. See LWRF Section III —Policies ]Pages 16 through 21 for evaluation criteria R Yes 0N D Not Applicable ro j e e.4 Pry"'4-e s r�ew Ae/r- w cath -r4,r✓ -Flow dee-11-# #i$ 4-* w e fil t t CR A r o.�-rtl Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the `gown of Southold ecosystems including Significant Coastal Fish and W ldNfe Habitats and wetlands. See LVVRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not tippincable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the 'gown of Southold. See LWRF Section III — ]Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No�ot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold ffrom solid waste and hazardous substances and wastes. See lLWRP Section III—}Policies; Pages 34 through 38 for evalunatiop criteria. ElYes 1:1No LDaRot 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 ILWIRP Section III—Policies; ]Pages 38 through 46 for evaluation criteria. FY YeED No❑ Not Applicable — rej-e a?jowS 6/1- 5.%Fe Aeerss -t-b w&,tws (:e4- e. ewP.ddl` bon rip Attach additional sheets if necessary WORKING COAST P®L1q,igS Policy 10. Protect Southold's water-dependent uses and promote sating of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No E�rNot 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. 1:1Yes 1:1No U Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural Hands in the 'Town of Southold. See LWRP Section III -Policies; Mages 62 through 65 for reevaluation criteria. ❑ Yes ❑ Ido I'1 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVVRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No El"Not Applicable PREPAID BY J 4 a �"a J o TIT'LL Al e n DATE 4-ab-)g March 8, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 ,� 9 V E P.O. Box 1179 D E Southold, New York 11971 RE: 4297 WELLS ROAD-PECONIC MAR 1 4 2018 SCTM No. 1000-86-1-9.5 APPLICATION FOR PERMIT Southold Town B ar Tru s Dear Trustees: We hereby submit one (1) original and three (3) copies of the proposed plans, application and check for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Ve truly rs, J rey Patanjo .0. Box 582 Bohemia, NY 11716