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TR-9353
Glenn Goldsmith,President �zf so(/T Town Hall Annex y� Michael J.Domino,Vice-President- ,`O lQ 54375 Route 25P.O.Box 1179 John M.Bredemeyer III #[ Southold, New York 11971 A. Nicholas Krupski y G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 OOUNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 1678C Date: January 27, 2020 THIS CERTIFIES that the removal of existing timber bulkhead and construct,50 linear feet of new vinyl bulkhead landward of existing; remove existing 6'x20' floating dock and install a 4'x5' timber platform; a 30"xIT aluminum ramp; and a 6'x20' floating dock in new landward location of existing; install new 5' wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards of fill from the landward side of bulkhead prior to its relocation;with the condition that turbidity controls be installed during construction;. At 1405 Anchor Lane, Southold Suffolk County Tax Map 41000-79-4-4.1 Conforms to the application for a,Trustees Permit heretofore filed in this office Dated August 20, 2018 pursuant to which Trustees Wetland Permit#9353 Dated November 14, 2018,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 removal of existing timber bulkhead and construct 50 linear feet of new vinyl bulkhead landward of existing; remove existing;6'x20' floating dock and install a 4'x5' timber platform; a 30"x12' aluminum ramp• and a 6'x20' floating dock in new landward location of existing; install new 5' wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards-of fill from the landward side of-bulkhead prior to its relocation; with the condition that turbidity controls be installed during construction. The certificate is issued to Forosich Family Irrevocable Trust owner of e aforesaid property. Authorize Signature Glenn Goldsmith,President ,rjF soar Town Hall Annex Michael J.Domino,Vice-President ,`Q`k y�lO 54375 Route 25 III P.O. Box 1179 John M.Bredemeer Y � � Southold, New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams �� Fax(631) 765-6641 o�yCOUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Y7 INSPECTED BY:` �Ch.,275 Ch. 111 1 INSPECTION SCHEDULE Pre-corfstruction; haybale line/silt-boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection COM ENTS: 4 11 4-- 3 CERTIFICATE OF COMPLIANCE: L Michael J. Domino, President ;r�o eo Town Hall Annex John M. Bredemeyer, III, Vice-President �� y� 54375 Route 25 Glenn Goldsmith y ,? P.O. Box 1179 A Nicholas Krupski F y • ����' Southold, NY 11971 Greg Williamsol , dao 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 p ilt boom/silt curtain 1St day of construction '/2 constructed When project complete, call for compliance inspection; a 0) MOM USA', &!mw BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK IN PERMIT NO. 9353 DATE: NOVEMBER 14, 2018 ISSUED TO: FOROSICH FAMILY IRREVOCABLE TRUST PROPERTY ADDRESS: 1405 ANCHOR LANE, SOUTHOLD SCTM# 1000-79-4-4.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on November 14, 2018, and in consideration of application fee in the sum of$250.00 paid by Forosich Family Irrevocable Trust 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 timber bulkhead and construct 50 linear feet of new vinyl bulkhead landward of existing; remove existing 61x201 floating dock and install a 41x5' timber platform; a 30"x12' aluminum ramp; and a 61x20' floating dock in new landward location of existing; install new 51 wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards of fill from the landward side of bulkhead prior to i di its relocation; with the condition that turbidity controls be installed during construction; and as depicted on the site plan prepared by Jeffrey Patanjo, dated October 22,2018,and stamped approved on November 14,2018. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 14th day of November,2018. %saf FDJ '0 'Grenn Goldsmith-Asent 4,- V TERMS AND CONDITIONS The Permittee Forosich Family Irrevocable Trust,residing at 1405 Anchor Lane, Southold, New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required,upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. 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. Michael J.Domino,President �rjf SUUryO Town Hall Annex John M.Bredemeyer III,Vice-President h0 l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �p� Telephone(631) 765-1892 Greg Williams `OU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 14, 2018 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: FOROSICH FAMILY IRREVOCABLE TRUST 1405 ANCHOR LANE, SOUTHOLD SCTM# 1000-79-4-4.1 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, November 14, 2018 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of FOROSICH FAMILY IRREVOCABLE TRUST 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 August 20, 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, the LWRP Coordinator recommended that the proposal to replace the dock is Inconsistent with the LWRP, and WHEREAS, the LWRP Coordinator issued a recommendation that the application to replace the bulkhead, construct a 5'wide walkway and remove 15 cubic yards of soil is recommended as Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program policy to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit for the structures; requiring the use of turbidity controls; and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on November 14, 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, 2 1 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268 of the Southold Town Code, and, RESOLVED, that the Board of Trustees APPROVES the application of FOROSICH FAMILY IRREVOCABLE TRUST to remove existing timber bulkhead and construct 50 linear feet of new vinyl bulkhead landward of existing; remove existing 6'x20'floating dock and install a 4'x5' timber platform; a 30"x12' aluminum ramp; and a 6'x20' floating dock in new landward''location of existing; install new 5'wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards of fill from the landward side of bulkhead prior to its relocation; with the condition that turbidity controls be installed during construction; and as depicted on the site plan prepared by Jeffrey Patanjo, dated October 22, 2018, and stamped approved on November 14, 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: $100.00 Very truly yours, m Michael J. Domino, President, Board of Trustees MJD/dd FOj Michael J. Domirlb;"Presidentylj Town Hall Annex John M. Bredemeyer, 111, Vice-Presidenty ; . a 54375 Route 25 Glenn Goldsmith o ' P.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams � j4 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: FOROSICH FAMILY IRREVOCABLE TRUST c/o JEFFREY PATANJO Please be advised that your application dated August 20, 2018 has been reviewed by this Board at the regular meeting of November 14, 2018 • and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project xx Pre-Construction Hay Bale Line Inspection Fee ($50.00) — (Silt boom) 1st Day of Construction ($50.00) '/Z Constructed ($50.00) xx Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30- Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. 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: l� TOTAL FEES DUE: $ 100.00 BY: Michael J. Domino, President Board of Trustees PROPERTY OWNER: PREPARED BY: FOROSICH FAMILY IRREVOCABLE TRUST JEFFREY PATANJO LINE OF EXISTING BULKHEAD L° 1405 ANCHOR LANE P.O. BOX 582 SOUTHOLD, NY 11971 BOHEMIA, NY 11716 I LINE OF BULKHEAD LOCATION TO BE e SUBMITTED UNDER NEIGHBORING APPLICATION 631-484-9332 �„•,;� _�°, �„ �A — - ' S 64'05'10'ISI JJPATANJO@GMAIL.COM 31.2e' REMOVE 15 CY OF FILL AND DISPOSE f1p PRORDSED�.X 5' PLATFORM NOTES: OF AT UPLAND LOCATION OFF SITE — ENCAVATE AND DREDGE TO DEPTH OF -�.� i'°� ,,, PROPOSED 30' X 12' ALUMIN. RAMP 1. LOT AREA: 20,782 S.F. / 0.50 ACRES 40'BELOW M.L.W.TO MATCH EXISTING o PROPOSED 6' X 20' FLOATING DOCK a o4R� PROPOSED 5' WIDE UN-TREATED TIMBER DECK I TO REPLACE EXISTING IN NEW LOCATION µ '"' f e 2. PORTIONS OF PLAN FROM SURVEY PREPARED BY: o I I �I -DING FLOATING DOCK TO BE RELOCATED a, O NATHAN TAFT CORNWIN III, LAND SURVEYING ,� to P.O BOX 1931, RIVERHEAD NY 11901 I ,° a8 _,,, d� "°°�a°�` SURVEY LATEST DATED JULY 15, 2009 I I I REMOVE EXISTING PLATFORM �� ✓ f M Ye .,t PROPOSED 50 LF VINYL BULKHEAD r S 64'05'10"E I Jr �° ' `-IN EftnNG-RID LANDWARD LOCATION 95.00' I APPARENT M.H.W. do M.LW ALONG _ _ _ �� _ ��, �a• FACE OF EXISTING BULKHEAD -` LINE OF BULKHEAD LOCATION TO BE 355 N '1 SUBMITTED UNDER NEIGHBORING APPLICATION LOCATION M A P c .0000' e c I LINE OF EXISTING BULKHEAD e I N.T.S. A OVED BY BOARD_OF 7 RUSTEES TOWN OF SOUTHOLD PROPOSED 5/4'X8' DATEIPE DECKING PROPOSED 20' LONG BUR CPIUCA TREATED TIMBER PTL$ 6' O.C. PROPOSED CCA STRINGERS&GIRDERS 1 - PROPOSED X6'CCA 1-1/2 STORY FRAME TOP, MIDD h BOTTOM RESIDENCE AND GARAGEWALE APFRGWIAE ILK.Ty y% ❑ d PROPOSED 6'X20' FLOATING DOCK W I PROPOSED 8'TIP CCA LAY-LOG PILE APPROIaWE YLM O.0.01 NO BULKHEAD PROPOSED 8'TIP CCA PILE, 6' Q S ITO BE TS LVED IN O.C.B'LENGTH.BOLTED TO ' LAY-LOG WITH 3/4' 3 GALVANIZED THRU-BOLTS. !� 4L 511®BOIIOY B.-0.S't qI GALV�TIEDROD. 8'NO.C.•DU1. JOLI W0 I PROPOSED 16' LONG CLOC O I a.y I I` 6000 VINYLSHEETING b I TYPICAL BULKHEAD SECTION I h i N.T.S. C ' J ECC � Proposed Bulkhead Permit Plans SCALE: 1"=30' PROPOSED BULKHEAD PLAN, DATE: OCT 2 6 2018 DETAILS & LOCATION MAP 8-1-18 I N 64-05-10-WI 100.00' 9-26-18 ; 10-22-18 I Southold Town 1405 ANCHOR LANE Boa of T ustees SOUTHOLD, TOWN OF SOUTHOLD ANCHOR LANE ' SUFFOLK COUNTY, NY SHEET: i TAX MAP N0. 1000-79-04-4.1 1 OF 1 I 1 \ o N 64° so 4^ to h o °�' I a' SURVEY OF o °ice ° 7o' T F r\ wY °k LOT 15 = `� M w�5 MAP OF �444 HARBOR LIGHTS ESTATES SECTION No 1 8 FILE No. 4362 FILED JUNE 8, 1965 100/./ 11�\\I�,v �� o� ow SITUATE \ \ � v BAYVIEW X �\ \a\ \ til \\\� I\ ` \I �g`°� �. �� TOWN OF SOUTHOLD \ 1 �/\1 SUFFOLK COUNTY, NEW YORK \�\ /\\ S.C. TAX No. 1000-79-04-4.1 ,p 4 Q SCALE 1"=20' N ° t JULY 15, 2009 A�,, xjzz \ \ \ \�\ \�\ \ \ �3 ry 64.0 f°0 APRIL 25, 2013 STAKE PROPERTY CORNERS 1z5 �� \\\,` \'a\ o 0 3`S°01 AREA = 21,782 sq. ft. 0.500 Oc. TO le o s `2 FR'°,yf ��, \ NOTES: / 1,8, yO� s , 1 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUMEXISTING ELEVATIONS JV'�J / BRA°a 9 ' 1r,. E&C`t'g4 f `I EXISTING CON OURLI E3 SHOWN ARESHOWN THUS: — —1B— — < 11L �oDa Syp Of a' FFL - FIRST FLOOR CFL - GARAGE FLOOR 2 a z20• lay. °yq ,A`�°° °1F F+ 2. FLOOD ZONE INFORMATION TAKEN FROM: 4a y \ f FLOOD INSURANCE RATE MAP No. 36103CO166 G ROy ZONE X` AREAS OF 500-YEAR FLOOD, AREAS OF 100-YEAR FLOOD WITH AVERAGE DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE, AND AREAS PROTECTED BY LEVEES FROM 100-YEAR FLOOD S 41 d0/' / .'m 1 o` e\ ZONE X• AREAS DETERMINED TOO BE OUTSIDE 500-YEAR FLOODPLAIN 11-16-90 COASTAL BARRIER FLOOD INSURANCE NOT AVAILABLE FOR NEW CONSTRUCTION OR SUBSTANTIALLY s IMPROVED STRUCTURES ON OR AFTER NOVEMBER 16, 1990, IN DESIGNATED COASTAL BARRIERS , a E "R � F 10 .`Y2 a OF q /x iu a /e 4 x <A e hyo E lyi ry I�'f i i V -D '00.00, x - i AUG 20 2018 PREPARED E MINIMUM SiANDARDSI FOR ACCORDANCE TITLE SURVEYS AS ESTABLISHED BY THE L" ANO APPROVED AND ADOPTED FOR SUCH USE Sri THE NEW YORK STATE IAN. TITLE ASSOCIATION - Sotlthrf'J Town ptE or- Board FBaan of Tirntee$ ;I ,_ Y 5 LIc No. 50467 UNAUTHORIZED ALTERATON OR ADDITION TO THIS SURVEY IS A h01ATI0N OF JJ SECTION 7209 OF THE NEW YORK STATE COON°F THIS Nathan Taft Corwin III COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED Land Surveyor TO BE A VAUD TRUE COPT CERRFlGAT HINDICATED HEREON SHALT.RUN �7 ONLY TO THE E PERSON FOR WHOM THE SURVEY I IS PREPARED,AND ON HIS BEHALF TO THE TTTLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTRUTION LISTED HEREON.AND Title Surveys-Subd—ons - Site Plans - Construction Layout TO THE ASSIGNEESOF THE LENDING INSTI- TUTION CERRFlCATDNS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHTS OF WAY OFFlCES LOCATED AT MAILING AGGRESS AND/OR EASEMENTS OF RECORD, IF 1586 Mom Road P 0 Box 1931 I I ANY,NOT SHOWN ARE NOT GUARANTEED Jamesport,New York 11947 RWerheod,New York 11901-0965 I, o s to ,s ' u l METERS LOCUS HEIDE`CKER LAND SURVEYING FEET \- -/ 0 10 20 30 40 ��v� GRAPHIC SCALE 1" = 10' SHELTER ISLAND SOUND J Q Z U -262 _377 -387 PROJECT SITE • -423, _459, ANCHOR SAN -477 -3 03 -264 .-284 -327. -409 -421 -4.01, -398. • FLOATING -4 108 ��] NtOI -3 21 -2.69 -385. -313, -451, -436, -397, _333, .-2.79 .-281 M N -280 -433, -403, • -3 67 -3 97 -321. ,-2 62 .-249 " -471 M .-483 •-248 T -277. -342. -411 , -469. -447. -451. -478. 1000-71-2-11 2 240 WINDJAMMER LLC FLOATING DOCK '99 -480 -314 -281. -328. -409. -471, -459. -423. -387 -304. -262. m T tj -358 -411, -476. -492. -430. -398. -314. -259. -3 82 a N g -394, -431, -471, -486, -468, -354, -257, x -425. U O z O a .-417 p -268 00 -410, -433. -466, -479 -474. -444. 1000-79-4-a ZARA/KASNIA FLOATING DOCK 6 0' -443 -2.97 GO GO J a tl •-379 ,-377 -4.39, -4.71. -484, -487, -421.• -377, N .-281 z -3 58 I%) -369 -427, -474, _481 -456, _448 -322, 11 1 -476, N U �l O m tl'-)cD -368 j ,zF -510 o a o -3 51, -4 00, -4 61, -4 79, -4 85 -4 46, 1000-79-4-8 p LL ZARA /KASNIA ' FLOATING DOCK 62 -470. -370 -279. -2 79 3 28 -407. -419. -453. -479. -302. -347 -4 50, -410. .-239 1- -3.48 -411 -404 -449 -489, -455, -413, -277 N -351, 1 N� -3 27 't Y$ -410 NOTES Z -3 56 _3 91, -3 83, 71-2-25 1.FIELD WORK WAS CONDUCTED OCTOBER 17, F _q 13 -4 33 -4.31 100 0HEIDTMANN -2 73 2018 BY HDDECKER LAND SURVEYING,PU-C 4 DOCK AND ALL MEASUREMENTS WERE TAKEN ON o o ' FLOATING .-3 02 THE cfloutlD p V LL 60 -430 2 NORTH ARROW IS BASED UPON GPS to 08SERVATIONS CONDUCTED BY HODECKER p LAND SURVEYING,PLLC C) 3 ELEVATIONS SHOWN REFERENCE MEAN I'- LOWER LOW WATER(MLLW)VERTICAL DATUM -279 -3 68 -383. -367. -403. -426. -387. -277. -2 34 299. � n1 9 0- -299. -329. -256. -321, -342. -338. -325. -315. 1000-79-4-6 1 -214. -179 RHODE/CROWELL _322• FLOATING DOCK , -2 61 • E C E � VE- 0 -1 92. -287. -340. -362. -345. -263. -247. -244. 1 •-1 77 -1 44• Q -200. -264. -312. -321, -332. -244. -201 c, O CT 2 U 2018 1 -251 -215. -281 -251, -198 182, 1000-79-4-5 FLOATING DOCK -2 16 Snot InIJ lwn SALADINO Soard of lrusfees -1 52 Unaothon-d alterahon o ATE add,bon to thisse"ey�s a JOHN GERO HEIDECKER NY STATE LAND SURVEYOR UC 050719 Wolabon of s..ban7209, g DATE BATHYMETRIC SURVEY SHEo Io s bdnisian 2,of the New York 751 COATES AVENUE OCTOBER 19, 2018 State Ed-u-Law Capes oTHDLBRDDK,NEW YORK 11741 DRAWN Br B M ANCHOR LANE, WINDJAMMER DRIVE, PROJ.NO this survey map not beann9 & SCHOONER DRIVE ISHLS125 ehe land mbossed seal yshallinked or not be (631)-772-9604 CHK BY J H TOWN OF SOUTHOLD CAO FILE onsniered to be a v Inl lhe,decker®healeckerls eom copy SCALE 1"= 10' SUFFOLK COUNTY, NEW0 1e'e-sr'y'P Michael J. Domino,Pi ,nt - �0 Co Town Hall Annex n M. Bredemeyer III,Vrce-President 54375 Route 25 Glenn Goldsmith C3 z P.O.Box 1179 A.Nicholas Krupski V Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �� Completed in field by: 7K Jeffrey Patanjo on behalf of FOROSICH FAMILY IRREVOCABLE TRUST requests a Wetland Permit to remove existing timber bulkhead and construct 50 linear feet of-new vinyl bulkhead landward of existing; remove existing 6'x20' floating dock and install a 4'x5' timber platform'; a 30"x12' aluminum ramp; and a 6'x20' floating dock in new landward location of existing; install new 5' wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards of fill from the landward side of bulkhead prior to its relocation.' Located: 1405 Anchor Lane, Southold. SCTM# 1000-79-4-4.1 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 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: t I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / /M. Presentwere: Bredemeyer Domino G. Goldsmith N. Krupski G. Williams Other 1405 Anchor Lane Photos i F w _ rL' a � � \ S� 1 V Asa �M HF /39 1 IED RD. s T+rK 1 4 M 4.2 ° � 9 SOU rHOCD 3 B� Ow N � aw � n4 � b . u w BAY 1I' ♦d w 13 2 %µ,i w '32 iz 29 u awM@11� d 1TAIc) � 1 38$ IOPEx Sw�CF1 �' Jf n'�_ a 3.1 NOTE /9 CCOONN.TIONN E=TS 17A(c) a /.J 1/. w ♦' ^ta q , 'x F 9 3r w of m BEfM.EEN aANCEIs z) 1)° - w 60]8-08-011, 15T /A78 8) Is I>,p w a 5, 31g�A9 A.11 1- 1TA /2 24.1. WA N f B+ S r,T A 6l n, w ,.yvq W I4A � Je� t)) „-cpr♦clwn lmwr ni 18 O +)Aay ® X29 s m w 5r 3 1x A a co - 1\ „w 2, 31m'_ .1y° ZP yp N w 39.BA r>,zr b i 15.]A 4 ' a 3 ,u331 anKEl fl ,♦./ nl m i 1.SA 13 - /1 b 1 ) 1I."" 1S1 a It, TOWN OF 1.S1A SIXITigID "' _ n't 1y wl 19 w s 162 - ,.BA 72 °' B p s 3 13 • t/,5 I 11 1B �n 1.rA - ,• v3o ^ � 51 w 13A(cl (1 113 w I rye v w 1731 ^ 12.1 1]1B w f 15 y0A - 11 W B2'wt I2 1.3A(c) C O .121, fEe ; 11 w zsA 201 ai Z ,3wr t. +as Q 3A(c) 70.16 o1B 8•'A_ 'GAA I 19 ro „ i 5 ,]19 m N n p O5 TOKwar 234c1 zIA m ' A ., ]1 O BOIrI1101D I k N. INYVIEW ,B 85- W B 1.{A(c) 13A(c) 1 B IB.fp qi°,.,�r I 189A zf yp y♦ u zY�l fl1H '^wwe I As 1.sAlcq ,sN=) ,.Wcl 15♦(c) , 0 Wq m 2i� 1.iNc) 1.Nyc) 3 ♦ v)� 1m. w 13 51 _ 53 Sr I m _ s9 B p ,3.>s © • 28 _ . N 51 1 n SIA iM 13 3D 3x B $ _ 31 , 1A24A ' TOWN OF SIXITNOlO I 44 wt r 3 Imo' zn.r e w 71 zA .b z'a � w, 3s 0 '�/ �� s a .V a/A aam q I S 1 3, B+ I rra, -ws tom w �� ♦, .ti, MATCH Z---- IINE _ II n+ 11ATC11 11NEe^ SEE SEC.NO.OBB ' A e SEE SEC.N0.098 ii of lOU7110LD ;• - _ A M ee e1a ri,oe on ea NoncE COUNTY OF SUFFOLK K SECTION NO -.o in ProprtyReal Tax Service Agency r x OFFICE LOCATION: r3f sv�jyo MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G • aQ Telephone: 631 765-1938 COU�,�� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From_ Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: November 13, 2018 Re: Local Waterfront Coastal Consistency Review for FOROSICH FAMILY IRREVOCABLE TRUST SCTM# 1000-79-4-4.1 Jeffrey Patanjo on behalf of FOROSICH FAMILY IRREVOCABLE TRUST requests a Wetland Permit to remove existing timber bulkhead and construct 50 linear feet of new vinyl bulkhead landward of existing; remove existing 6'x20' floating dock and install a 4'x5' timber platform; a 30"x12' aluminum ramp; and a 6'x20' floating dock in new landward location of existing; install new 5' wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards of fill from the landward side of bulkhead prior to its relocation. Located: 1405 Anchor Lane, Southold. SCTM# 1000-79-4-4.1 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 actions to replace the bulkhead, construct a 5' wide walkway and remove 15 cubic yards of soil are CONSISTENT with the LWRP policies. A Wetland Permit(1652) was issued for the bulkhead in 1983. A permit for the dock was not issued at the time. The file references Association approval. It is my recommendation that the proposal to replace the dock is INCONSISTENT with the Policy Standards (Policy 6.3) and therefore is INCONSISTENT with LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. In the event the action is approved the following is recommended to further Policy 6. 1. Require turbidity controls in compliance with Chapter 275. The 5' wide easement extends over this parcel. 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 --A �. Peter Young,Chairman Q Town Hall,53095 Main Rd. Lauren Standish,Secretary , P.O.Box 1179 Ep 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 Mon., October 15, 2018 the following recommendation was made: Moved by Caroline Burghardt, seconded by James Abbott, it was RESOLVED to SUPPORT the application of FOROSICH FAMILY IRREVOCABLE TRUST for the removal of the existing timber bulkhead and landward replacement of 50 If. of new vinyl bulkhead. Remove existing 6'X 20' floating dock and install 4'X 5' timber platform, 30" X 12' aluminum ramp and 6'X 20' floating dock in new landward location of existing. Install new 5' wide untreated walkway landward of proposed bulkhead. Included in the work is the removal of approx. 15 cy. of fill from landward side of bulkhead prior to its relocation. Location: 1405 Anchor Lane, Southold. SCTM#79-4-4.1 Inspected by: James Abbott, Caroline Burghardt Vote of Council: Ayes: All Motion Carried October 22, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25D E C � Q %% EDD P.O. Box 1179 Southold, New York 11971 OCT 2 6 2018 RE: 1405 ANCHOR LANE -SOUTHOLD SCTM No. 1000-79-4-4.1 Southold Town REVISED APPLICATION ar o Trustees Dear Trustees: We hereby submit one (1) original and three (3) copies of the revised project plans, water depth survey and project description for above referenced project. Plans have been revised to include existing floating dock information 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 RE: 1405 ANCHOR LANE. -SOUTHOLD SCTM No. 1000-79-4-4.1 PROJECT DESCRIPTION The proposed project includes the removal of the existing timber bulkhead and landward replacement of 50 LF of new vinyl bulkhead. Remove existing 6' x 20' floating dock and install 4' x 5' timber platform, 30" x 12' aluminum ramp and 6' x 20' floating dock in new landward location of existing. Install new 5' wide un-treaded walkway landward of proposed bulkhead. Included in the work is the removal of approximately 15 CY of fill from landward side of bulkhead prior to it's relocation. Q E - IVE OCT 262018 Southold Town f rus ee Cantrell, Elizabeth From: Cantrell, Elizabeth Sent: Thursday, September 13, 2018 10:13 AM To: jjpatanjo@gmail.com Cc: DiSalvo, Diane; Michael Domino Subject: Forosich Family; SCTM# 1000-79-4-4.1 Jeff, Regarding the above referenced application,the Board has started their review and determined that the application is incomplete at this time for the following reasons: 1. The project is to replace existing bulkheading, attached to said bulkheading is a ramp to a floating dock. As this structure does not have a permit with this office,the Board requires that it be added to the application. 2. When applying for docks/floating docks please submit updated plans showing N.Y.S. licensed professional water depths at low tide around each floating dock; distance/length of the body of water across the canal to ensure the 1/3 width rule; size of the vessel(s) being kept at each of the floating docks; details/dimensions of new docking facility(any fixed structures, support piles, ramp and floating dock) or details/dimensions of existing fixed structures,support piles, ramp and floating dock; distances between each floating dock, and the docks that abut each floating dock; add neighboring floating dock structures to plan (if not already depicted)to show proposed floating dock length. 3. According to the review of the Town's Building Dept.the proposed replacement of the decking along the landward side of the bulkhead will need a variance from the Zoning Board of Appeals if it is not going to be reconstructed on/at grade level. Please update the project plans to depict the proposed reconstruction of said decking and whether it will be on grade or above grade. 4. Please update the application where necessary to include this email request. 5. Upon submission of the requested revisions,the Board will again review your application for completeness. ski & Senior Clerk Typist Town of Southold Board of Trustees 631-765-1892 1 ���� S�UT�t7 Town Hall Annex Michael J.Domino,President ti0 l� John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A.Nicholas Krupski �lg'COUN� f�l Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extensio 2-6 Received Application °' '�g Lnj� _-`'^ ~111 Received Fee: $ �®1� �� Completed A licat' n• '36 complete: i� J J Incomplete: AUG 2 0 2018 SEORA Clas ific ion: Type I_ Type II Unlisted Lead Agency Determination: �Coordination:(date sent): LWRP Consistency Assepmen Form Sent. - ----�, ZCAC Referral Sent: 11.2&19_ Date of Inspection: _70,10. Receipt of CAC Report: Technical Review: Public Hearing Held: r' Resolution: Legal Name of Property Owner(s): Fo,r o s r c,A f-_a m d!, Mailing Address: 1 ° S A ,vc Gi®,t. L ^c- $®,,4 � b j cQ� /J 1-7 I Phone Number: o+ " 3- L1 Suffolk County Tax Map Number: 1000- -7 9 ` a 9 -y j nn Property Location: y S A,,,c,4 o r 14 n c_ - S o v+1t'bI k Sit L o G �-'-f-1 C", /✓i,q (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): tI4- rem PA to kl1 o Mailing Address: Q• �x S g a- 13 a 4e m l A r nl y , 11-711. Phone Number: b 31• Ll d q - 4 3 3 L- \/ 4 �0V Board of Trustees App]' 'ation GENERAL DATA Land Area(in square feet): 11 , 7 8 2- Area Zoning: l S Previous use of property: S Intended use of property: c S 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 ny 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 a No prior permits/approvals for site improvements. Has any pen-nit/approval ever been revoked or suspended by a governmental agency? ✓No Yes If yes,provide explanation: Project Description(use attachments if necessary): S{.e a- RE: 1405 ANCHOR LANE. -SOUTHOLD SCTM No. 1000-79-4-4.1 PROJECT DESCRIPTION The proposed project includes the removal of the existing timber bulkhead and landward replacement of 50 LF of new vinyl bulkhead. Remove existing 6' x 20' floating dock and install 4' x 5' timber platform, 30" x 12' aluminum ramp and 6' x 20' floating dock in new landward location of existing. Install new 5' wide un-treaded walkway landward of proposed bulkhead. Included in the work is the removal of approximately 15 CY of fill from landward side of bulkhead prior to it's relocation. Board of Trustees Hippl I&tion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: S*e ttu e (1 d Area of wetlands on lot: square feet Percent coverage of lot: N A Closest distance between nearest existing structure and upland edge of wetlands: /CIO feet Closest distance between nearest proposed structure and upland edge of wetlands: /oo feet Does the project involve excavation or filling? No ✓ Yes If yes,how much material will be excavated? IT— cubic yards How much material will be filled? /-"bt cubic yards Depth of which material will be removed or deposited: 3. feet Proposed slope throughout the area of operations: - a- Manner in which material will be removed or deposited: 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): T'h e rc_ w i I 6.e- a a Wec, - o,7 w. e fi/—R e s d we o F NC.,✓ Short Environmental Assessment Form Part I -Project Information Instructions for Cormnleting 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: 1405 Anchor Lane Bulkhead Project Location(describe,and attach a location map): 1405 Anchor Lane-Southold,See location map Brief Description of Proposed Action: Remove existing bulkhead,install new 50 If vinyl bulkhead landward of existing.Install 6'x 20'floating dock to replace existing 5'x 22',install new 30"x 12'aluminum ramp and 4'x 5'platform.Remove 15 CY of material between existing and proposed bulkheads and deliver to upland location Name of Applicant or Sponsor: Telephone: 203-564-3580 Forosich Family Irrevocable Trust E-Mail: rodney sermons@gmail corn Address: 1405 Anchor Lane City/PO: State: Zip Code: Southold NY 11971 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: ❑ ❑ NYSDEC/NYSDOS/Town of Southold Trustees 3.a.Total acreage of the site of the proposed action? 0 50 acres b.Total acreage to be physically disturbed? 0 01 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.50 acres 4. Check all land uses that occur on,adjoining and near the proposed action. " ❑Urban El Rural(non-agriculture) ❑Industrial ❑Commercial [Z]Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic El Other(specify): ❑Parkland Page 1 of 3 1 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? ❑ Z 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify:Name Peconic Bay and Environs,Reason-Protect public health,water,vegetation,&scenic beauty, ❑ Agency Suffolk oun Date: - - 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: ❑ ❑ 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? Z ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 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 El Early mid-successional m Wetland El Urban W]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? Tiger Salamander,Piping Pl.. ❑ Z 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: ONO AYES Page 2 of 3 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: Z ❑ 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: a ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor��name: Forosich Family Irrevocable Trust Date: t l Signature: or/ C& t �rz �a�� e� �•s�lf�>rtir�%r PRINT FORM Page 3 of 3 EAF Mapper Sun....ary Report - ' Monday, July 30,2018 5:31 PM Disclaimer: The EAF Mapper is a screening tool intended to assist t • r ro ect sponsors and reviewing agencies in preparing an environmental 7,l©0-1,00-15000 i. `�_ P 1 P 9 9 P 1_J 7'16,0=-160-16001'T100=200=7000; assessment form(EAF).Not all questions asked in the EAF are -� 1- +• answered by the EAF Mapper.Additional information on any EAF �, 1,00=�66-26000,71© '1'eoo=1'7060 ;7r�00,200' a00� ,_~ r t- ,- 7100 2Q0'-'I 00'1 question can be obtained by consulting the EAF Workbooks Although 7100=(100 27000 I 7'l d0 240 Q03 ''•1 r 7 100 200=600017'100 260-1402 ), the EAF Mapper provides the most up-to-date digital data available to 1 7,1;00100-20000'- ! �- ! ,, r<_ 1. . 1 DEC,you may also need to contact local or other data sources in order I-"—-_--x+74100-200'-20,007100-200;,16000f),''' 100 100.724001"7,'100'-1'00L';180 00 ,d r ,_ r r + to obtain data not rovided b the Ma er.Digital data is not a •_ �a -� '-7100-20D-, 0p0 71130-2001,700© P Y PP -�•- + s / r , '�i,{a substitute for agency determinations. ,71o0=iod=1900.07100-20o=acio471I100 200�I00.00'" Q, �-_, -, 1900-300,=-5400 -'7 ,x104:200-90©4 - 7100=200_-13L)A000-' }t, -__J-7900000�002 �'7900'�0=1000;.; '4 f 7100-200-:I 8000 -- �~-J .�r7'i 00.200-_116b -� �; I d h�aaitr8at F _ 7900 300-6000 r'{ I_�-1 ; -� � ; +1 8000'10©-20Q02 rt; ttavra l i n -400-8000' _ t J {l f J ., 7900-'300 7000 -799��I 7900400-4.5400) - ' 0-400 W01` r I` .:,. .4 o Id-7so0400:7000�� - -- 7900=300 80061 L__-7900_. ' rz 000 1, -- `r 4 7900=450=39000;7.900l4ob6'46000 7900`300 30000 -r- _' r - ; 7.900 600'1 p1 -- —49- 400-'12.000-7900-400 + Toronto �y 7 900x 100 '14 00, 1`' 4~, 4 x i lr 7900;404=12.000.79,00-400 38000' 7900 400 F7,0 Rnrho for r 1900;300'-31000 7900-400-150007900-400;1'1000 j 1nr ` --+ `1-- j' b�i�rr'"o `I1 •'icil .�1'?tir►�r T , ---� ; 1�; r 7;900 400-48000 __ 7''detrolt o '-' 61oston 790 °300=32000 '790©-400M30607,906'4 1.0000 � __ •' , y� 7940 0-170 _1 f 7WROU `� :�;Prr�adence 940 400-17025itJ Esr!',t� Clovcr►d - 1900--3,00-33000 °- 7900-460 II(ti rfi��OSt`��` ini. �0 - f ! _ '• � 7.9_OO�i�, ��fl',EsriChin ' gtr' �r '1, sr it j, f' rih 1. rii,Sgiac yp�ciYT ftrr jCG3r Es HERE,Garmin, 7900-300-1'4000 7904 4D6-17003 � r{ op d?' 40", ' ` Cdltlmblle' °fit binrgli USG IIrrtL> sp,INCREMENT 79660 4Jo-'17rpt r' len-. G 1 f f f F riSfr ttji�p rh�csPand"t ESDI+ _ 'f.W� 3sn,EsriJapan,tu1ETl, 7,900 300-35000 7900 100-52000 �x� :r--! f'• i 7900 440 1,i 407 �7�¢1;3�1 L�j r clnnali 1 E;f Ina{Hong lCcng},,Esri Part 1 /Question 7 [Critical Environmental Yes Area] --------- - --- -- -- - - -- Part 1 /Question 7[Critical Environmental Name:Peconic Bay and Environs, Reason:Protect public health,water, Area- Identify] vegetation, &scenic beauty,Agency:Suffolk County, Date:7-12-88 Part 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] waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15 [Threatened or Yes Endangered Animal] Part 1 /Question 15[Threatened or Tiger Salamander, Piping Plover Endangered Animal-Name] Part 1 /Question 16 [100 Year Flood Plain] Yes Part 1 /Question 20 [Remediation Site] No Short Environmental Assessment Form - EAF Mapper Summary Report 1 LIUeMIUnJ if rkiri b UJlllg�,. 111C 11110111lallun CUIILalIIOU In rail i uuu VLI101 IHCLOZtuub JUU1UILMU uy 1.310 Plujcu aNuuaui ut otherwise available to the reviewer. When answering the questions thereviewer should be guided by the concept"have my responses been reaso,` considering the scale and context of the propose, "ion?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? El El 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? 0 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ n 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? u 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate �❑ seasonably available energy conservation or renewable energy opportunities? _ 7. Will the proposed action impact existing: (� a.public/private water supplies? L_J b.public/private wastewater treatment utilities? EJ t. i 8. Will the proposed action impair the character or quality of important historic,archaeological, (� ❑ architectural or aesthetic resources? -J 9 Will the proposed action result in an adverse change to natural resources(e g,wetlands, {� waterbodies,groundwater,air quality,flora and fauna)? El Page 3 of 4 . c 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. 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 impacts. Town of SauWg d-5oard of T ustees _ M (i a &LD*min® Date President Print or Type Name f Responsible fficer rn Lead Agency Title of Responsible Officer Signature of Respo plible4ficerin Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees App"')a:tioxi J A1FFEDAW r �:i I+r Y1.ty f l'Irl o AS BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAYBE 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 COIMPLETING 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 MNAL 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 TIME BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. � a Signature of Pr erty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF ,20 otary P is MARINA KOKrJNOS Notary Public s State o4 Now York RIo.BD'l K06191941 ®ualltW In Suffolk County Ally Commlealan Etpims Aug.go, C Board of Trustees App- __,"ataon AFFMAVIT Nmal'SIP- F060'-'.(6# iR11 oA)S BEING YDUILY SWORN DEPOSES AND AFFIRMiS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED 1PERMIT(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 FORTIS 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)NT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BE RE ME THIS 1 DAY OF 4UGUST- ,20. �•••••i eL LAF0 •.. Notary Public .•��P,. '�'�'•e, �T,A t4 ENv VTA ,LLAFURTUNE - a NOTARY UP iC,S T ATT 01.NEW YORK N A(/B L�G ., J, . ,•" fie. kt�, ;Y9tionNo.01LA63,)?S44 Q Qaal:Ded in Kings County '•i -•''- y Commission Expires 06/07/2021 ''•is� �F�NEa`,,, Board of Trust tee App's, 1�:atjion AUTHORIZATION (Where the applicant is not the owner) I/We, Alac(cu(o,, Foa, cQAr4a-,y, - owners of the property identified as SCTM# 1000- -7 y in the town of New York,hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature tk SWORN TO BEFORE ME THIS DAY OF A0GUST ,20 Notary Public 414 RC1 Tq m= EWANUFLL:VORTUNE m __ NOTARY OF NEWYORK : L t V Rignsto6onNo 11Ir.'a63,'%8 QuIlifit'd M Kings County Commission Expires 06/07/2021 iIle�i�,o,OF'N,E�',o,,o,,�� Board of Trustees App], -`again AUTHORIZATION ON (Where the applicant is not the owner) I/We, B�vt� 5•r e�n,s owners of the property identified as SCTM# 1000- -7 9 - o y - q. in the town of s o k lti o 1 C9-- .New York,hereby authorizes CW to act as my agent and handle all necessary work involved with the application process for permits)from the Southold Town Board of Trustees for this property. f tom' Property O er's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF ,20 O Notary Public MARINA K®KkINOS 140bry Public-State of Now York Pio.01KO6191941 Quallfled In Suffolk County Icy COmminl®n Expires Aug.26,2090 TRANSACTIONAL DISCIi;0S l U4 FORM The Town of Southold's Code of Elhim prohibit~conflicts of interest on the part of[owl)officers and employees.Thc Purpose of this form is to provide inforination which can alert the town of possible conflicts of'interest and allow it to take whatever action is necessnry to avoid same. YOUR NAME: (Last name,first name,apiddle 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:uty officer or employee of tlrc'rown of Southold? "Relationship"inclndus by blood,ntarriage.or business interrst."Business interest"means a business, including a.partnership,in which the town officer or employee has even a partial ownership of(oremployment by)a cotporation in which the town officer or employee owns more than 5%of the shares. YES 'NO \//" — if you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner bf greater than 5%"ofthe shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is nota corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 20 1� Signature7X �2 Print Name_.Z <;�— Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL.IDISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.'I1te purpose of this form is to provide information which can alert the town of possible conflicts of interest and nllow it to take whatever action is necessary to avoid same. T �[ YOUR NAME: ?a-f-a► n I o J e T T C`1 _ - (Last name,first e,apiddle initial,unless yoi 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 I 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)haven relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,njarriage,or business interest."Business uiterest"means a business, including apartnerslilp,in which the town officer or employee has eyeil a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of th ares. YES NO ' I 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 5%ofthe 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 co_rpornlion); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this g day of A 20-1- Signature 018Signature Print Name Form TS 1 Postal ■ • Frru- / Ir ru OFFICE gay I Er X Certited Mad FeeLt j . jll) Certified Mad Fee %t ! Lr) Extra Services&Fees(check box,ad$d fee as apPropdets) 1` $ ro dna t r I []Return Receipt(hardeopy) I ` \ Pr p, Extra SeNlces Fees(check box,add fee as aP P �) 0 []Return Receipt(electronic) $ He [Ratum Receipt(hardc°p10 , I 0 ❑Certfied Mail Restricted Dellyery $ 0 [Return Recelpt(electronic) $— Here f' � Adult Signature Required $ 0 [CemFled Mad Restricted Delivery $�— \ /, / I Adult Signature Restricted Delivery$ C3 [AdultSignatureRequired V� ,(SPS I C3 Postage Adult Signature Restricted Delivery$.�� \.-_ C3 Postage - - 1 p Total Postage an SCTM#1000-79-4-14 M $ o Total Postage an SCTM#1000-71-2-27 "D $ent TO Faraguna,John & Eleanor $ lannucci, Pasquale &Emily NSiheefandApt'117, 12 E. Farm Lane cO Sent To St. 17-1102 Lexingtonctry,staia, rP+a Richfield, CT 06877 o Streeiandi�Pt:N Westbury, NY 11590 scat®.ziP+s I - .e e.r•�- ■ , MAILP,REGEIPT Ln Q 0 -0 Domestic mail only HUAIN ■ Er , nj rn N • ? S's (`�' '( >sY „, (? I Certified Mall Fee • . � Extra Services&Fees(checkbox,add fee es apProPdate) Q Certified Mad Fee }{�R/ Q 0 Return Receipt(hardcopyLn �- ro date) ,r7 ❑Return Receipt(electronic) $ 1'I LI) $ SeNlces&Fees(check box add fee as epP P a r3 !3 I Extra $— arlit E:3 1 r3 0 Certified Mall Restricted Delivery $ = , Return Receipt(har�ccPl� y etecuenic) 0 [Adult Signature Required $�' 'I 0 0Retum Receipt( cted Delivery $ 6Te - [Adult Signature Restricted DellvaN$ 0 [Certdled Mall Rests $ _ —' 0 Postage 0 [Adult Slgnature Required 0 [Adult Signature Restricted Delivery$���w,\ .. $ -p postage C3 Total Postage att �I _ _ - SCTM#1000-71-2-9 cc $ 1 `` —��/ Sent To •n Tota►Postage and #1000-79-4-3 I r9 Rogers,APRT#I &Rogers,QPRT#II C3 SCTM Emily o s-reeiaAd CIN 1329 Broadway Avenue $ Pasquale& co Sent T° lannucci, Holbrook, NY 11741 � ton St. Cdy�Sfate,ZIP++a C3 SfreetandAFM 102 Lexing Westbury,NY 11590 , r --- - US : crty state,zip+a . / GERT_ I 1 0 MAIL"RECtIPT o ■ ■ "� cohlesticMail dnjy !n Ir fU � � t l.f) Certified Mall Fee ,� �---� - � � � � � /yam y\ .I] �t�(r IA A, Ln Extra Services&Fees(cheek box add fee es appropriate) �p� Certified Mad Fee 1 Y1► t� O'�` J' 0 Return Receipt(hardcopy) $ - $ add fee as apProPd�e) 7 = ❑Return Receipt(electronic) $ Po arl( ,s L n Extra Service$&Fees(eheckbo $�T \ Certified Mall Restricted Delivery $T— Here v I (3 Return Receipt(hardcopy) pA°�•tg''`t0$tfllark .r'{ _ ❑ ❑Adult Signature Required $ G 0 electronic) 1 I [Return Receipt( ��Delivery $--� /I /1 \\\ 0 [Cetulied Mall Rests [Adult Signature Restricted Delivery$ 0 [Adult Signature Required $��� �� ❑ Postage 'S O •� 0 $ / - [Adult Signature ResMeted Delivery$��—' .\ (\ —J 0 Postage Total Postage and SCTM#1000-71-2-1.1 p TotaIPostage a' SCTM#1000-79-4'-5 4 $ent Te Harbor Lights POA $ Saladino,Karla sieeiarraAPtliro, PO Box 1327 c0 Sent To 19 Dorchester Cou crr,srare,Z/P+4t Southold, NY 11971 C3 S[reefandApf.7 NY 11738 r` ziP+ Farmingvllle, :.. City Stale. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS �t,.r.,!':f"��ti•�C..%f't-.i,�'a;3.,, A Y•'�� S_e'k, Name: y ; 440 �:�?w: ���-e tet- t:�S,L` ., sa v4 .••[. ; `'v.t»::� .. '? '"r:. '>-',�.»;,^^ 4�r.� er.z^- 'tk:. ,''itF_:,�r i"� Y., _';"'k.:•, :24•���:y - i�-*;•.a� -.:1 •�s.-,�;�. r.>sJ _ �^:A.tr_�'c.`.�"�. �: ,q;l..w_:"�.. r 4:'.' "'L.:fib':?'`-:i-'yn•.b"93f� � .Nn..•:+? ,'{ n�Y yx ...I�Ix 'A.. -,LY!,..hzp•.:.3r ,.: .�i'; » ., ``�1✓r.r t.�;''�"�nµ.',"`r?v.;.�y^p�•a-V:���"t`i;�• ^�'_�: -�3'4:.�+� x�"",_i�el,>.t+��'r;k:,'`,.i y� ��': 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 MAIL/RETURN RECEIPT. Sworn to before me this Day of 120 Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: SCTM#1000-71-2-1.1 SCTM#1000-79-4-3 SCTM#1000-79-4-5 Harbor Lights POA lannucci, Pasquale & Emily Saladino, Karla PO Box 1327 102 Lexington St. 19 Dorchester Court Southold, NY 11971 Westbury, NY 11590 Farmingville, NY 11738 — I SCTM#1000-79-4-14 SCTM#1000-71-2-9 SCTM#1000-71-2-27 II Faraguna,John & Eleanor Rogers,APRT#I & Rogers, APRT#II lannucci, Pasquale& Emily 12 E. Farm Lane 1329 Broadway Avenue 102 Lexington St. Richfield,CT 06877 Holbrook, NY 11741 Westbury, NY 11590 — 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 TIA day of November , 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 that said Notices were mailed to ch of said persons by CERTIFIED MAEURETURN RECEIPT. i th Sworn to before me this Day of November , 20 18 Aq c MARILYN S.HICKS NOTARY PUBLIC,STATE OF NEW YORK Ni;t4 Public Registration No.01H16365489 Qualified in Suffolk County Commission Expires October 10,2021 a Michael J.Domino, President0SOFFQI4' ` Town Hall Annex John M. Bredemeyer III,Vice-President �� y� 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 A.Nicholas Krupski Q 07 Southold,NY 11971 Greg Williams 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 FOROSICH FAMILY IRREVOCABLE TRUST COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE 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 apday of November , 2018 , I personally posted the property known as 1405 Anchor Lane, Southold- SCTM# 1000-79-4-4.1 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,November 14,2018. Dated: �t Vh P4&— (sign ture) Sworn to before me this�� day of Nov. 2018 MARILYN S.HICKS VAA I NlOrfrARY PUBLIC,STATE OF NEW YORK RegNotary Public QualifiediAi NSuffolk'C�oLm�ry Commission Expires October 10,2021 v November 9, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 1405 ANCHOR LANE -SOUTHOLD SCTM No. 1000-79-4-4.1 AFFIDAVITS Dear Trustees: Attached, please find original affidavits of posting and mailing 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. Very truly yours, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 NUTILL Uim Ht: ARING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 (\/lain Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: FOROSICH FAMILY IRREVOCABLE TRUST SUBJECT OF PUBLIC HEARING : For a Wetland Permit to remove existing timber bulkhead and construct 50 linear feet of new vinyl bulkhead landward of existing; remove existing 6'x20' floating dock and install a 4'x5' timber platform; a 3033x12' aluminum ramp; and a 6'x20' floating dock in new landward location of existing; install new 5' wide non-treated walkway along the landward edge of new bulkhead; and to remove approximately 15 cubic yards of fill from the landward side of bulkhead prior to its relocation. Located: 1405 Anchor Lane, Southold. SCTM## 1000-79-4-4.1 TIME & DATE OF PUBLIC HEARING : Wednesday, November 14, 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 Town of Southold LWRP CONSISTI';NCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its 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# -7 °� - cf _ Y. � PROJECT NAME ILI OS— A.+aakV /L Lake - So -( ko1cA The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees L=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: S.lc a44AAe4 , Location of action: t y a ss A v c A o r- L a,n c — S tv co 4t a t& Site acreage: d• 5-D Present land use: S Present zoning classification: 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: `Fo(o S t c A f 4 m t I`1 '1 t f-ev oG 4kt err v ST t (b) Mailing address: 14 0 6— It rz e- � S ov4-('L b t � (c) Telephone number: Area Code( ) Z 0 —3 5760 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes U No ElIf 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 LWItP Section III—Policies; Page 2 for evaluation criteria. ✓ Yes ❑ No ❑ Not Applicable fol,eV4 MetA(-J 12«e4C,e,r.) use. a� Coh5-r^t �'�w Crtrk�t5 ,Fi.n, how -tr�rti, hs1jrn2 V#14 I et-H,.a Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the '.Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No L"J Not Applicable i 1 Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP P Section III-Policies Pages 6 through 9 for evaluation criteria Yes ❑ No ❑ Not Applicable PC 0 ,ecA ero✓l Aes i✓Cw adv GIGS e,%j qp N Q Oo e,16 t aaq RGC 1•f-t es ea.-J sl S•Fsn'f UI Lv l'fit h t t g Flo h h y A D P�t c,l -t-/�n�S . Attach additional sheets if necessary NATURAL COAST POLICIlES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See I,WPj? Section III-Policies Pages S through 16 for evaluation criteria �- -� Yes F] No ❑ Not Applicable 1�2( ee,4 fek-ett"S 404(07SI4 Ge Ss o F Lwrrd elW C i+c�� cVlertt, i.t-1-/' qndL 1S -oaScd•f- &t-tk Wet!2A10, 4,Q taw+/,--S "e Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWIZP Section III -Policies Pages 16 through 21 for evaluation criteria ErYes ❑ No ❑Not Applicable P(o, rc-( P/®tie-rs k 5 a s-f SC�P�M en r4 44, --e/L-S, — -l"'a ��StoY1 b✓1 '` RI'r.DL hi,Ll��iLc..GP . i Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III--Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Yes No —t Applicable n(r�<c� /o✓ QpS iUrcQw4ra ,f-e C', -af-toJ u� IJrC(C�earQ 4 -t e re oL fl o,s Yi-gle 4;c w Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III – Policies Pages 32 through 34 for evaluation criteria. Yes ❑ No lot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LVVRP Section III–Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes 1:1 No �I 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. Yeo No❑ Not Applicable -1,ee-4 tIlo,.i — � c4,t'C/ZS �r! _ 4,0' hcnn -F Avi4 --tAet� !0,,c 5e S. i Attach additional sheets if necessary f • WORKING COAST FvLICIES 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 Ej Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living amarine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. F1Yes ❑ No U Not Applicable ' Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. F1 Yes F] No 1 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and 'Mineral resources. See LWRP Section III-Poli;=plicable 5 through 68 for evaluation criteria. ❑ Yes ❑ No PREPARED BY r� �� T-ti ny TITLE A- el1-�- DATE S August 9, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 JD P.O. Box 1179fE C E � V E Southold, New York 11971 AUG 2 0 2018 RE: 1405 ANCHOR LANE -SOUTHOLD SCTM No. 1000-79-4-4.1 APPLICATION FOR PERMIT Southold Town ard of Trustees 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. Very truly yours, Jffrey Patanjo P.O. Box 582 Bohemia, NY 11716