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HomeMy WebLinkAboutTR-5962 Michael J. Domino, President o�pSUFFO(,��oG Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Charles J. Sanders H P.O. Box 1179 Glenn Goldsmith o • Southold, NY 11971 A. Nicholas Krupski y�o� , �aTelephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES January 18, 2017 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: DOUGLAS A. GEROWSKI, MICHELLE'GEROWSKI & DOUGLAS J. GEROWSKI 2570 CLEARVIEW AVENUE, SOUTHOLD SCTM# 1000-70-10-29.2 Dear Mrs. Moore: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, January 18, 2017: RESOLVED, that the'Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#5962 from Robert and Cheryl Scheidet to Douglas A. Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on July 21, 2004, and Amended on March 23, 2005. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at(631) 765-1892. Sincerely, Michael J. Domino, President Board of Trustees MJD/dd SUFF04 �- Michael J. Domino, President 0�0 CoG Town Hall Annex John M. Bredemeyer, III, Vice-President y-;i 54375 Route 25 Cz Charles J. Sanders y x P.O. Box 1179 Glenn Goldsmith o • Southold, NY 11971 A. Nicholas Krupski y�o� �a�� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES �owiv��r�ov'rHOL,� January 18, 2017 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: DOUGLAS A. GEROWSKI, MICHELLE'GEROWSKI & DOUGLAS J. GEROWSKI 2570 CLEARVIEW AVENUE, SOUTHOLD. SCTM# 1000-70-10-29.2 Dear Mrs. Moore: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, January 18, 2017: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#5962 from Robert and Cheryl Scheidet to Douglas A. Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on July 21, 2004, and . Amended on March 23, 2005. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office,at (631) 765-1892. . Sincerely, Michael J. Domino, President Board of Trustees MJD/dd New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40-SUNY, Stony Brook, New York 11790-2356 Phone: (631)444-0365 • FAX: (631)444-0360 - Website: www.dec.state.ny.us Denise Sheehan Acting Commissioner PERMIT MODIFICATION Robert and Cheryl Scheidet April 5, 2005 2570 Clearview Avenue Southold NY 11971 NYSDEC #1-4738-02769/00002 Scheidet Property 2570 Clearview Avenue. Southold NY Permit Expiration: 10/12/14 Dear Permittees: Your recent request to modify the above permit has been reviewed pursuant to 6 NYCRR Part 621 (Uniform Procedures Regulations). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions. Therefore, the permit is modified to authorize: Construction of the 4 foot by 4 foot platform using fiberglass grid panel decking a minimum of 1 feet above grade as shown on the plans prepared by Robert and Cheryl Scheidet last revised on 3/26/05, and stamped NYSDEC approved on 4/5/05. Special condition number 1 is revised as follows: 1. The platform shall be constructed of fiberglass grid panel decking not to exceed 4 feet in width and a minimum of 1'/z feet above grade* over tidal wetland areas (* as measured from ground to bottom of platform decking). This letter is a modification to the original permit, and as such, shall be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in t o iginal p mit. Sin ere r 1 A. Wieland i Deputy Permit Administrator cc: Marine Habitat Protection file Site Flan A Sounding;Locations Under 1)ock at NILW N/ohy M10Rsp ` �• �' �AMLW 9 �9��14Lty ���ld�ilf�t 5-i� '!''Mj.ty A rev/o Usk r IV X y' gl°�IROVrcD � � � � x2D e FL OAS ��/Nrow P�4TFoRl�l � 3 x 1 o RAMP Y 37� ?"i4Lw V, "paw 5�/ N19�w 5.��..M�►y NARsf/ Scale: 1"=5 feet 14 DMA• Project Specifications: ��� � �y �•� Robert and Cheryl 5cheidet 1. Aluminum 4 Xi' platform &wP E a 765-9d19 2. Aluminum Y X 10' rump Af�y Property Location: 25711 Clearview Ave. 7--)MD 3. Plastic floating; dock11f/1� Southold, N.Y. 11971 �� 4. Platform & dock anchored with Date flans Prepared: July 9, 200 2 %" X 12' aluminum piping; N Y S D 7 =o APPROVED AS PER TERMS -� �7.38-L'1Z 70 9 d _ � o � AND CONDITIONS OF PEFUMIT N0.1473�-Q.R769 000,0,;2- D ATE {S�/�S✓ { G V�SC f� s !��/ J B 1 Cross View pin __ran, I . 37FEEr - A Sounding Locations Under Dock at MLW � y 3 x/D �RAaE FI,ATFA'QM N�GN 5 2 D f FLMT Ll A13 f''aSTs 9 paW Y'814LW "MLw Scale: 1"=5 feet Pro'ectSltecificafions: �w, lqX ,SAID 1. Aluminum 4' XII platform R�6 Age .2. 1� ���, Robert aiid Cheryl Scl�eidet 2. Aluminum 3' X 10' ramp PW d� POST 765-9419 3. Plastic floating(loch odr Property Location: 2570 Clearview Ave. �G� (i3'1 4. Platform & dock anchored with Southold, N.Y. 11971 2 '/:" X 12' aluminum �i in ► N Y S D E C �/� Date flans Prepared: July 9,20n4 , 1 p OVED AS PERNJ TIONS OFR�fS AND CO ,5C /1l Y S D f-y�73�-D�76Y oAo,�Sz t'ERMI'T NO./-4739-ba769A0003 � DATE � ,� p,�' 1�,E V154E-b . r N 0 O 4 3 2 1 t3 B B1 3!B 601M G Q 4 v m c9 ti o ca A A ti cREAryoN 737-6?,t7 aITEM NAME: METALLIC LADDER MFG. CORP. o $&Wdet Pirttorrn CUSTOMER., Matellla Ladder Mfg,Corp, BIZ6 I REV M BY NPROVE0 ITEMNUMBER DATE g om 10201ARP 2M 00a MATERIAL: ISKET 1 OF 2 4 3 2 1 0 0 r N . o r i !9 O O L 4 a3k 2 , medcen Recreational Protrude ID eupply Aberglaes grate In these areas B B 62 314 q 81 318 0 a T-1 24 24 0 43 N4 4e � 60114 !1 W x 4'Aluminum Drive Pipe 00 4 Required A ti A wto METALLIC LADDER MG, CORP �7 `? 8oheldat Platform III M NAM: CUSTOMER: :y i Metallic Ladder Mfg.Corp, SIZE - [--mv*� DATE B TOM 0201ARP 2JI12006 MATERIAL; SHEET 2 OF 2 9 1 a C4 av O P"111( u • Square ISO 9001:2000 —i"", BF be � J t71 1t1`1"� Rectangular Product Details Ce►'tified it. isCorrosion resistant • Easy to install • Non-conductive • Fire retardant • Uniform appearance • Bidirectional Lightweight • Eas fabrication load bearing „ �� .. . . y 9 yr ' T A,. • Maintenance free • Impact resistant • Cost effective Molded Grating .•t4C.teh i•t "rzy t.�i'3 "'>•J t �o{i a.'T+`"�`.a,r{tZn t .. r,. $ }•.* �� _ �yMATE< RIAL Molded rinyl ester or polyester,RESIN/ SUF , Ocange or Dark G�ay�,, 5 -�rSr w } :T ryrL i a t fi. rg�assrAvings,cbmbirted = COLORS 5 SPF, Green or;yellov k J ➢ 0 i t t r J c 1- {, tnlvtth a Gho�cf�resiset#In s ` SGF Y w ello „Green,er a E'IATIERI� �q ���rrtsh�o tecangular r , DarkGrayf , ; k �r Iav k r - c kseni:sz suck)zk� f ; SFF `�Llght 1 fib tt9.�,ft f't��roc fl i 9 M 'a, HEGIiTS ,Sgarla1 `1(21'ot'2tx J SURFACE. Concpve 3„ }h v _ 'rtF k �n J q 4 - r LF i i S^ x`ht t ecanula �"`1 1/2"' Grlt surfac also vallae# MS S i00Ix4� ; d G, x 4WIpTHS x k�''Sq ara=3 4',or?�' v y} LOADING PI ,t lr =}� ;, Molded Square non grit shown sOr�! w ` } 1 t `tv}^�."i `lfs kfs'Reetar gU,�"drE,.g a7, � 5•k c. ,J id 1'f r i g12MFor�S#�fr Molded fiberglass is a strong mesh grating panel which allows efficient on-site cutting to minimize grating waste. It is molded in one piece with a plain concave slip resistant walking surface. _McNICHOLS®Molded Grating is the chemical resistant flooring choice for many industrial applications. Load bearing bars in both directions allow for use without continuous side support. Molded fiberglass grating is significantly lighter in weight than metal gratings. The high resin content 65% provides long maintenance free performance. A higher safety factor is achieved by designing in a higher glass content at the bottom of the grating for greater tensile strength. Special UV inhibitors also available. 1/4" 1/4" MS R-100 Top View Series Number Height Mesh #SF Open Area - --+I l.— I L MS M 150 1 1/2 3/4 x 3/4 4.4# 44% I I�u i Molded Rectangular non grit shown _ ❑r MSS 10o id 1 iC24 i-1 1/2 2 6# +.70% _ L--J 1/4' L MSS 150 1 1/2 1 1/2 x 1 1/2 3.8# 70% a t r MSJS - t tT E17EIT J I Top mew 1 L ° MS R 100 1 1 x 4 2 8# 69/ 1 0 t�, r t-°'g r* + 5 t 1.112" 3 01-';`MS R 150 1 1/2 1 1/2 x 6 3 75# 6T/ _ _ �r_ Tt/4" '.,•3"ra c* •s"�"„'' S ri `r`'`Fq Kt "i a^>. �� —I r----1 I— �p .1 } N%Wx`/A-U2=+W44124 1 �r Ed e x� _� ( r F;INini C .37 .355' Cx • f Nei t IAL ,Yr Molded vinyl ester or - 0 0 L s� c; p ' polyester f�betglass 0[} 275° p �y# S �y a ; 5 Yc y d atrOYingS '' r CT ' y t 1 pATTEF�N ` tSquare glesh Top 1(2 t q., e t oPg. Boftoir� it i/2 oP9 - D O C C t o ¢'`p I WIDTH s o x 12 pdnel ,.. WEIGHT d 3 44#sq ft' T a t' r=C}295° SURFAC ` �1Mehi�cus oP ght T ,_4� MS S-150 RESIWC, LOFTt 9GF Green �—s a oJremion MS M 150 :EOt3EN A EA s 44% '. - Fac ory Sp art Square-grit shown "` Edye 3 i h} i �. • � t b*< �E A, J yi i Km \k f is.1. MS R-100 harsh conditi ons. 'on. Molded fiberglass withstands satisfaction. ! t 1 tar-grit shown Complete inventories insure customer Molded Rec Rectangular g pg $❑Request one of our FREE specialty catalogs. II-1300-23 --3820 www.mcnichols.com mzooaMcNICHOLS WE /a o Z/ 9. � I.00%ix 6 a. 14/ -2�e .e e •�,,,.a - v. y� . ,,, �., .,, �., I x. •, � ���. ^ . ..��. �,�, .., .r•'s. � II !!� _ *� ,.� ,. + ��a', .. �s... =w . �. ,,, __ .. ,.:. �M�: ''A✓h�^" ,f 5 f S 7'ES7' HOLE, DATA 9 (I191 IIGE DUC 9Y l6'XJALn GECI5!'YFNCE'ON JUNE T6,2") . OAPPRaxwTE a SURVEY OF PROPER'VY CESSPOOL aw f ROM Lau OL SITUATED AT ¢ /• mmm Umw STY 6.WD 11 PINE NECK O c/�l ,�• •'' 3' TOWN OF SOUTHOLD "&C 011°°`"me'°°°AMEs"'°SW SUFFOLK COUNTY, 14EW YORK � eLLTntc _ ..r S.C. TAX No. 1000-70-10—,9,2 d SCALE 1"=50' ' CL ��Zj T O POOL JUNE 13, 2000 1 j V As PER orrNER W�°1a 1�'�0�, FOR: AUGUST 29. 2000 ADDED PRDPOSSED HouSE T SEPTENIBER 28. 2000 REVISM PROP. SEPTIC 5Y,iTF1A 1' w� Y N]- j' r, �sT�O M�1.1 �S „ OCTODER 1. 2000 ADDED LOT COI/EFWE NOTE `/ T�•I _, G , NOVDASER 1, 2000 REVISED PLOT PLM �L: o DECEMBER 8, 20M REVISED PATH r ' y ELL ca I ! APRIL 25, 2001�REVISEDUARY 8S2001 LOCATEDS PE•RWF. S. KEITH, P.E. ( b APRIL 25, 200 14 C ' S 1.0 30"� _ \ J- �� � AREA = 29 7 t. rtc s ® 9 •OO" Z Q` (TO TIE LINE) O. FOUND COW- > &O� _ CERTIFIED TO: yb 2 �$d�° = @ lB �� = PECONIC ABSTRACT, Inc. J UN 3 2004 t7 r t FRI7 17RYM4ELL 2 Fi FIDELITY NATIONAL TITLE I ISUR CE COMPANY OF NEW m MARC CLEJAN z�� . — —s , {_ �� ANNA CLEJAN Southold Town Board of Trustees ul�yoy� � ;j 1 I NOTES, I 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM O y�* °� I r o I T EEXISTING CONTOUR ARE THUS: 2$11MH ARE SHOWN THUS:----6----- r tRl2 ° r\ ` 14 `1 r*1 r�v1 (. ? PROPOSED CONTOUR LINES ARE SHOWN THUS. --�---- 4 j `I FOUND J ✓`t I '9 �� LOCATION FOR EXPANSION OF LEACIRNG POOL CAPACITY. O yllpPp `I Jl!"1 L CESSPOOLS As PER Ex_ -1• � ® -ppo P,°wrtH FFLiAT suu COVER.CAST C s REQUIRED)LEACHING POOL wa 17w.t SURVEY BY PAN TUY9 T 6 s SE}�\ � �/'//I / 73 43'Y O i�G�=�L�1 1/•.7...� n/�• �G' /G/% PROPOSED ELLS cND C PRECAST CONCRETE SEPTIC TANK tzj '•4j� In 2 THE LOCATION OF WELLS AlY7 CESSPOOLS SHOWN HEREON ARE FROM FIELD f �'p ON V6(10APIrt/NONE•1'1!lZfLV'#dj0N VLFM 1,"• ..7/`-- �.y OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. S.ff LA�f!�1ED WAIH HAY DNS 6 SLt rMCZ DI1�Y CatJ5 MMM G 3. THIS PROPERTY IS IN FLOOD ZONE AE (EL 6) AS SHOWN ON / To ft fl.f,1�4LD VA1FI A �A�NA11VE H244mmm p�,�( FLOOD INSURANCE RATE MAP COMMUNITY-PANEL No. 36103CO165G / YEN MW C 8°01,1 CIS 0 AM COM9TIMIM � 4. COASTAL BARRIER LEGEND 11-16-90 COASTAL BARRIER ^. I^'y• I. FLOOD INSURANCE NOT AVA ALL.E FOR NEW CONSTRUCTION PAPROVED STRUCTURES ON AFTER It-P� Y 't q t/Mg'�{7 PA1t1 / //• ` C3 " Iu f °RNovL]IBER 1�9,ts90 DESIGNATED COASTAL B°RAMMIS. 5-_ - n /, E E � 5. ONLY cu. cu.ds. OF CLEAN L WILL BE NEEDED FOR THE SEPTIC SYSTEM. d ED E-��LLT\ AG ONLY SOY cu. s. OF OF WWLD BE NEEDED L THE EXISTING MOUND n THE r /�I 5 CENTER OF THE LOT IS OF ACCEPTABLE MATERIAL TO BACK FILL THE SEPTIC SYSTEM. l // ', :� _ IF THE MOUND IS OF UNACCEPTABLE MATERIAL TO LACK FILL THE SEPTIC SYSTEM, i .,1-+ THE MATERIAL FROM THE MOUND IS TO BE REGRADED OVER THE PORTION OF THE LOT NOT CONTAINING THE SEPTIC SYSTEM. r FL1G FLAG E�CY. I I 8. UPLAND AREA 16.207 sq. tr. �\OAL 4 � Z `\ - I ,i Zo WETLAND AREA = 13.480 COVERAGE HOUSE, PORCH t DECK OVER UPLAND LOT AREA �p ay q( x�� / �FlAG / Cj \ ? IS 4513 sq. 11. OR 15.52% } T�.� f alto m \ ° .•. i' F �\�(A 7�,[r7Z,* u.rr ;�e,�/Gc'z ✓n.Sc�i roalG� PREPARED IN Acc°riflvNCE wr1H THE m Ina PRc pu;ad �' ,� G/ /�J! 1 e1/17,7 j STANDARDS L.L FOR TrrLE s LL�AtitiD 1��'rH . I I -�°L='=.F FOR BY THE LIALS. 1 7.� I I I e��.: TITLES� YORK L.W. . COASTAL BARRIER IDENTIFIED 11-16-90LAI o f!>7Y �� 1` �L �;xfel 1. ���, ziA In or V / / Q `''� Z ;.�.�• TO THIS SURVEY 1UTHORIZED ALTERATION ATION OR AL�IXTI°" W / / � SECTION 7209 OF THE NEW YORK STATE ,� z,g Z EDUCATION LAW. Jose h A. In a no JAL / / 3 COPIES OF THIS SURVEY MAP NOT BEARING 9 9 SEWAGE DISPOSAL SYSTEM BY: THE LAND SURVEYORS DOONOT SEAL OR nE ,"� i °�° SEAL SHAM NOT���Rm La �! Surveyor Lave r TO BE A VALID TRUE corer. -pp, SAG HARBOR ENGINEERING CERTIFICATIONS INDICATED HEREON Slw RUN ONLY TO THE PERSON FOR WHOM THE SURVEY /✓ ep 381 Town Line Road, Sag Harbor, New York 6 PREPARED,AM ON HIS BEHALF TO THE �D co M, Frederick S. Keith, P.E. LENDING I�UT��HEREON, D L Tdle Surveys - Subdivisions - Site Plans - ConstrucUon Layout TO THE ASSIGNEES OF TFi£LENDING WSTI- OS � 8 TUTION. CERTIFICATIONSSF FICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727 C'� �jI 5'17' THE EXISTENCE OF RIGHT OF WAYS it AND/OR EASEMENTS OF RECORD, IF OFFICES LOCATED AT U411M ADDRESS ANY, NOT SHOWN ARE NOT GUARANTEED. 1380 ROANOKE AVENUE P.O. Box 1931 RIVMHEAD, New York 11901 Riverhead, New York 11901-0965 5 s PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel: (631) 765-4330 Fax: (631) 765-4643 www.mooreatlys.com email: pcmoore@mooreatt sy com betsy@mooreattys.com �5 a Au gust 19, 2016 Board of Trustees "�� Town of Southold :I Main Road (Town Hall Annex) AUG 1 9 2016 i Southold NY 11971 1 hand delivered fT RE: Douglas A. Gerowski, Michelle Gerowski &Douglas J. Gerowski PREMISES: 2570 Clearview Avenue, Southold SCTM: 1000-70-10-29.2 Dear President and Board members: Please Transfer the following permits to the new owners: Douglas A. Gerowski, Michelle Gerowski &Douglas J. Gerowski...permit#54a�1,permit#5962, and 6952A. 05244 The proposed elevated patio is set back from the side yard at the existing setback of the house and because of the encroaching wetlands a 2.6%lot coverage variance is required. The Zoning Board of Appeals held the public hearing and because of the wetlands, requested that we make the application to the Trustees first. The proposed patio is elevated approximately 4' (48") above natural grade and the swimming pool will be inside the retaining walls of the patio. Enclosed is the cross section of the concrete wall provided by North Fork Pool Care. With reference to the above, enclosed please find an original and 3 copies of. 1. Application for Wetland Permit signed and notarized by owner together with authorization from owner 2. Transactional Disclosure signed by agent and owner 3. LWRP 4. Short EAF ° I have also enclosed four sets of the survey prepared by Peconic Surveyors and last dated together with my client's check for the filing fee. Please place this matter on your next available calendar. Thank you and please call should you have any questions. ery t ours, encls. atricica C. Moore 1 Board of Trustees Application COUnty Of SL1IfOlk State of New York DOUGLAS A.GEROWSKI, MICHELE GEROWSKI and DOUGLAS J. GEROWSKI, BEING DULY SWORN DEPOSES AND AFFIRMS 'THAT HE;SI IE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO TIME BEST OF HIS;I IF.R KNOWLEDGE. AND BELIEF. AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROV-I;D BY TIIF SOUTHOLD TOWN BOARD OF TRUSTEES. THE; APPLICANT AGRE S TO HOED THE TOWN OF SOUTHOLD AND TIIE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING TINDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION. I IIEREBY AUTHORIZE THF.TRUSTEES. THEIR AGENT(S) OR REPRESF.NTATIVES(S), TO CNTI.?R ONTO MY PROPERTY TO INSPECT 1"I it; PREMISES IN CONJUNCTION WITI•I REVIEW OF THIS APPLICATION. t Do glas A. Ge owski Michele Gero% ski Douglas J. Gerowski Sworn t before me this ` day of . 2016 BETSY A.PERKINS otaly Pub ' :7 Notary Public,State of New York No.01 PE6130636 Qualified in Suffolk CounrZj") Commission Expires July 18, Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) DOUGLAS A.GEROWSKI AND MICHELE GEROWSKI and DOUGLAS.1.GEROWSKI.as owners of premises 2570 Clearview AVenuse. Southold.NY (setm: 1000-70-10-29.3) do hereby authorize our attorney, Patricia C. Moore. to apply for permit(s) and appear before the Southold Board of Town Trustees on our behalf. _(Owner's signature) Douglas A. Gerowski (owner's signature) Ivtichelc Gerowski �i (owners signature) Douglas J. Gerowski APPLICAN F TRANSACTIONAL IN SCLOSU R (FOR Sl;RMISSION BY OWNER all(I(1WNER'SAGEN"I") The Town vl'Suuthold's Code of Ethics prohibits conflict,ol'interest on the part ol'Tout offlicersand emplovees. The purpose of this lbrin is to Provide information. which can alert the To wri of possible conflict;ol'intercs( and allow it to take whatever action is necessary to avoid scone. Yol'R NAME: DOUGLAS A. GEROWSKI, MICHELE GEROWSKI . DOUGLAS J. GEROWSKI AND WOW`. PATKICIA C. (Last name. lirst name.middle initial.unless youarc applying in the nanic of*someone else t)r other entity,such asneoinpiin... If so.indicate the other person or company name. NATURE OF APPLICATION:(Cheek all lhatapplyj Tax Grievance Variance. Special Exception I 1-0ther:.. nanieflicactivity: Changc of Zone Approval ol'Plat Exemption from Plat or Olricial Map Other Trustees x Do you personall%.(or through your company.spouse, sibling. parent.or child)have a relationship with am ol licer or employee ot'the Town of Southold? ­Relaflo,,.Q1ip­ includes by blood. marriage. or business interest. "L3usincss interest' niewis a business. including a partnership. in which the To%%n oll'icer or employee has even a partial ownership of(or employment by) a corporation in which the Town officer or employee outs more than 511: of the shares. YES NO X Complete the balance of this form and(late and sign below where indicated. Name ot'person employed by the Town ol'Southold: 'Lille or position 01"thut person: Describe that relationship between yourself'(the applicant) and the Town officer or employee. Either check the appropriate line A through 1)(below)and/or describe the relationship in the space provided. The Town officer or employee or his or her spouse,sibling.parent.or child is(check-all thatapply): A)the owner oforeater than 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation): 11)the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation): C)an offlicer.director.partner.or employee of the applicant:or D)the actual applicant. DESCRIPTION OF RIA.ATIONSI IIP Submit(ed this day of-CZ&, 2P/(0 Signature: Dout,16s 'Geroi ski lly"_41e� Michele Gerowski Dotlg-las), " rowski ricia C.Moore John M. Bredemeyer III, Presiden. ¢d�05U� 4,o j- Town Hall Annex Michael J. Domino, Vice-Presidenr , oy - 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski o T� Southold, NY 11971 Charles J. Sanders y p�a Telephone (631) 765-1892 Fax(631) 765-6641 r..� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD rr , Date/Time:_1" Completed in field by: Patricia C. Moore, Esq. on behalf of DOUGLAS A. GEROWSKI, MICHELLE GEROWSKI & DOUGLAS J. GEROWSKI request a Transfer of Wetland Permit#5962 from Robert & Cheryl Scheidet to Douglas A. Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on July 21, 2004, and Amended on March 23, 2005. Located: 2570 Clearview Avenue, Southold. SCTM# 1000- 70-10-29.2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Noti77111 fng Card Posted: Y / N Ch. 275 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 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: Present were: (, J. Bredemeyer _IZM. Domino . Goldsmith _Z,,:��N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer III, President, o��g�FFO(c Town Hall Annex Michael J. Domino, Vice-President yp 54375 Route 25 Glenn Goldsmith o `� P.O. Box 1179 A. Nicholas Krupski o . ti, Southold, NY 11971 Charles J. Sanders �ay�0 �o� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: (7) �Lrlk �( Patricia C. Moore, Esq. on behalf of DOUGLAS A. GEROWSKI, MICHELLE GEROWSKI & DOUGLAS J. GEROWSKI request a Transfer of Wetland Permit #5241 from Robert A. and Cheryl Scheidet to Douglas A. Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on November 15, 2000. Located: 2570 Clearview Avenue, Southold. SCTM# 1000-70-10-29.2 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at . other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: PresenLj__ Bredeme er �-�iGl. Domino Goldsmith N. Kru ski Y p C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 � c Albert J. Krupski, President 0�► QG Town Hall James King,Vice-President �.� y 53095 Route 25 Artie Foster ti P.O.Box 1179 Ken Poliwoda I$y • Southold,New York 11971-0959 Peggy A.Dickerson �0 a0 Telephone(631) 765-1892 1 �► Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0036C Date May 3, 2005 THIS CERTIFIES that the dock, ramp and floating ,dock At 2570 Clearv'iew Ave. , Southold Suffolk County Tax Map # 70-10-29.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/30/04 . .pursuant to which Trustees Permit# 5962 Dated 7/21/04 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a dock, ramp, and floating dock The certificate is issued to ROBERT & CHERYL SCHEIDET owner of the aforesaid property. Owe 44 Authorized Signature Albert J. Krupski, President Town Hall James King,Vice-President �OSVFFD(/�'Co 53095 Route 25 Artie Foster �� �j P.O.Box 1179 Ken Poliwoda O y� Southold,New York 11971-0959 Peggy A. Dickerson y Z Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction Y2 constructed Project complete, compliance inspection. SC316S b �� �SUf Albert J.Krupski, President Q�. CO Town Hall James King,Vice-President �� G'y� 53095 Route 25 Artie Foster y P.O.Box 1179 Ken Poliwoda y, Southold,New York 11971-0959 Peggy A.Dickerson � � � �'if'O aQ� Telephone(631) 765-1892 1 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 23, 2005 Mr. & Mrs. Robert Scheidet 2570 Clearview Ave. Southold, NY 11971 RE: 2570 CLEARVIEW AVE., SOUTHOLD SCTM#70-10-29.2 Dear Mr. & Mrs. Scheidet: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., March 23, 2005: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#5962 to construct a docking facility with an open fiberglass grid panel platform 1.5' above grade. If you have any questions, please call our office at (631) 765-1892. Sincerely, 1 . AlAJO�ZK�ru p s 0,_J r. r President, Board of Trustees AJK:Ims ,.tom ���d�h�.t�`--•*�i.-.tiP'��t�-•-:'=s•--•Board Of Of Southold Town Trustees �+ SOUTHOLD, NEW YORK �`_. July 21, 2004 .9�� PERMITNO. . p....... DATE: ................................. ' ROBERT & CHERYL SCHEIDET • ISSUED TO • ............. Pursuant to the ,provisions of Chapter 615 of the Laws of 3 ' the State of New York, 1893; and Chapter 404 of the Laws of the «�•. State of New York 1952; and the Southold Town Ordinance en- ' titled ."REGULATING AND THE PLACING.OF:OBSTRUCTIONS. IN AND ON TOWN WATERS AND PUBLIC LANDS and'-the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS-.FROM LANDS UNDER TOWN VATERS;'.'. and in accordance with 'the Resolution of The Board adopted at a meeting held on 141Y..._42..... 2004 :. and in consideration of the sum of $....250.,00,..... paid by Robert & Cheryl Scheidet ; E .................................................................................................................._....................... Southold of ....... ......................... ............................................................ N. Y. and. subject to: the Terms and Conditions listed on the reverse side hereof, of S uthold Town Trustees- authorizes and permits the following: Wend �mi t to cowstcuct a dockcng vacit2 ty con�s.usting of a 14'X 5' pta tv otcm, Eta vcwa y to gxade, P X 10! z ea6 o na2 tramp, ,and a 51X 20' �Zoating._-,dock, and aU ass depicted on the pt4n ptcepan.ed by Robert 9 CheAyZ Scheidet dated Juty 9, 2004. all in accordance with the detailed specifications as presented in the originating application. y IN WITNESS WHEREOF, The said Board of Trustees hare- by causes its Corpor'ate Seal to be affixed, and these presents to be subscn'bed by a majority of the said Board .as of this date. M. O TEWS and CONDITIONS Property located at: 2570 Clearview Ave. ,, Southold. SCTM#70-10-29.2 T b Permktee Robert & Cheryl Scheidet rtsiding at 560 Water Terrace, Southold N. Y as ', pn• of the consWration for the issuance of the Permit does understand and prescribe to the fo1= 1. That the said Board of Trusters and the Town of Southold are released from any and all damages, or dal ass for damages, of wits arising.directly or Indirectly as a result of any oper- ation {werfomted will, u his or her owe expense, defend any and all such sultriddued by third 4atdes, and the said Permittee assuones full liability with respect thereto, �o--the��tplete ezdusion of the.Board of Tnutees. of the Town of Southold. 2. That this permit 1s•valid for n prdod of .tnos. which is ftddded to be the estimated time•required to eo Tlete the work involved, but'ahould maces warrant, request for an erteat ion -may be made to the Ord at a ,latter date: 3. That this Permit should be retained indefinitely, or as.long as the said Pe mittee wishes to maintain the structute or project involved, to provide evidence to anyone concerned that anth- oriza:tion was originally obtained. 4. That the wodc involved will.be subject to the inspectim and approval of the Boatel or Its agents, and non-compliance with the provisions of the odgima6ng application, maybe cruse foe revocation of this Permit by resolgioa of the said,Board. S. That there will be no unreasonable interference with navigation as a result of the wodc herds authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between bigh-and low water marks. 7. That if future operations of the Town of Southold require tha removal and/or alterations in the location of-the work iterela-authorized, or if, in the opiaioa of•the.Board of Tntstem the. work.shall cause anromnable obstruction to free navigation, the sold Peamlttee will be required, upon due notice,to remove or alter this work or project herein stated without=pea= to the Town • of $gttholcl. $. That the said Board will be notified by the Fermitwe of the completion,of the work ao& odwd. 9. That the'Pamittee will obtain all other permits and wo me that may be required sap. plemental,to this permit which maybe subject to nwoke upon,failttre to obtain suns '' Albert J.Krupski, President Town Hall James King,Vice-President �� �'y 53095 Route 25 Artie Foster 7, C - P.O.Box 1179 CA Ken Poliwoda Southold,.New York 11971-0959 Peggy A. Dickerson Telephone (631) 76571892 1 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 21, 2004 Mr. & Mrs. Robert Scheidet 560 Water Terrace Southold, NY 11971 RE: 2570 CLEARVIEW AVE., SOUTHOLD SCTM#70-10-29.2 Dear Mr. & Mrs. Scheidet: The Board of Town Trustees took the following action during its regular meeting held on Thursday, July 21, 2004 regarding the above matter: WHEREAS, ROBERT & CHERYL SCHEIDET applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 30, 2004, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 21, 2004, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS;the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, 2 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 ROBERT & CHERYL SCHEIDET to construct a docking facility consisting of a 4'X 5' platform, stairway to grade, 3'X 10' seasonal ramp, and a 5'X 20' seasonal floating dock, and all as depicted on the plan prepared by Robert & Cheryl Scheidet dated.July 9,.2004. 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: $440.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims l gQFF04�► Albert J. Krupski,President OVA �0 Town Hall James King,Vice-President �'1` Gym 53095 Route 25 Artie Foster 4 4 P.O.Box 1179 2 Southold, New York 11971-0959 Ken Poliwoda Peggy A.Dickerson �fi O� Telephone (631) 765-1892. Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: (��U Please be advised that your application dated has been reviewed by this Board at the regular meeting of `} 1c,Z 1 and the following action was taken: ( ✓) Application Approved (see below) Application Denied (see below) {�}Application Tabled '(see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: w �hO� /093 TOTAL FEES D : $ � �I O 00 �� ('lam c n`1a3y� � SIGNED. • PRESIDENT, BOARD OF TRUSTEES O�QSV�f�(�CO Telephone o Town Hall (631)765-1892 53095 Route 25 O .tC P.O.Box 1179 'y 0� Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, July 13, 2004, the following recommendation was made: Moved by Don Wilder, seconded by Bill Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of ROBERT & CHERYL SCHEIDET to construct a 5'X 20' dock, 10' ramp, and 4'X 5' platform. Located: 2570 Clearview Ave., Southold. SCTM#70-10-29.2 The CAC recommends Approval of the application with the Condition no treated lumber is used. Vote of Council: Ayes: All Motion Carried New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40 -SUNY, Stony Brook, New York 11790-2356 Phone: (631)444-0365 • FAX: (631)444-0360 - Website: www.dec.state.ny.us Erin M.Crotty Commissioner PERMIT MODIFICATION Robert Scheidet April 21, 2004 560 Water Terrace Southold, NY 11971 E C E W E Re: Permit # 1-4738-02769/00001 J U N 3 0 2004 0, Dear Mr. Scheidet: Southold Town Board of Trustees Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR Part 621 (Uniform Procedures Regulations). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is modified to authorize: Reconfiguration of septic system and extension of 4' wide path, as shown on plans prepared by Joseph Ingegno, dated 6/13/00, last revised 4/25/01, stamped NYSDEC approved on 4/21/04 and subject to the following additional speciai condition. 13. Path through vegetated wetland shall only involve trimming of vegetation. No ground disturbance is authorized by this permit. This letter is a modification to the original permit, and as such, shall be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. Sincerely, Mark C. Carrara Permit Administrator cc: MHP P. Moore File NEI `K STATE DEPARTMENT OF ENVIRONMENTAL CONSE ION DEC PERMIT NUMBER EFFECTIVE DATE ` 1-4738-02769/00001 December 26, 2000 FACILITY/PROGRAM NUMBER(S) n c n MT I EXPIRATION DATE(S) Under the Environmental Conservation Law December 26, 2004 TYPE OF PERMIT ■ New Cl Renewal ❑ Modification ■ Permit to Construct ❑ Permit to Operate I � ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR' of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management ❑ Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain Island Wells Management ❑ Article.24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Thomas Meyer (631) 427-1040 ADDRESS OF PERMITTEE 8 Notch Court, Dix Hills NY 11746 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER EnConsultants, Inc., 1329 North Sea Road, Southampton, NY 11968 (631) 283-6360 NAME AND ADDRESS OF PROJECT/FACILITY Meyer property, 2570 Clearview Avenue, Southold LOCATION OF PROJECT/FACILITY SCTM #1000-70-10-29.2 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Goose Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construct single family dwelling with deck,septic system,pervious drive and 4'wide access path. All work is to be done in accordance with the attached plans stamped NYSDEC approved. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara (CKW) Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE Page 1 of 4 December 26, 2000 NEV. :_;X STATE DEPARTMENT OF ENVIRONMENTAL CONSI` nON NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees,agents, and assigns for all claims,suits,actions,damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals,lands,easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right.to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right.to trespass upon the lands or interfere with the riparian rights of others in order to.perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility,including relevant records,is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whetherthe permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department,issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities(HWMF), major Air Pollution Control (APC)and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02769/00001 } NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5),24, 25,34 AND 6NYCRR PART 608 (TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State,the owner may be ordered by the Departmentto remove oralterthe structural work,obstructions,or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed,the owners, shall, without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall. in no case,be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes,and no claim or right to compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining.any other permission, consent or approval from the U.S.Army Corps of Engineers,U.S.Coast Guard,New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall,without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303,306 and 307 of the Clean Water Act of 1977(PL 95-217)provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by: Joseph A. Ingegno dated 6/13/00 last revised 12/8/00 DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-02769/00001 NEV. . :lK STATE DEPARTMENT OF ENVIRONMENTAL CONSL_: _MON SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer.areas. 2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. Stabilization of the entire disturbed area with appropriate vegetation (grasses, etc.). 5. The storage of construction equipment and materials shall be confined to within the projectwork site and or upland areas greater than 75 linear feet from the tidal wetland boundary. 6. All fill shall consist of"clean"sand, gravel, or soil (not asphalt, flyash, broken concrete or demolition debris). 7. To protect the values of the tidal wetlands, a permanent vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography within an area extending 50 linear feet landward of the tidal wetland boundary. 8. A row of staked hay bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 50 linear feet from the tidal wetland boundary, or as per NYSDEC approved plan, at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 9. Roof runoff shall be directed to drywells a minimum of 75 feet landward of the tidal wetland boundary for immediate on-site recharge. 10. Driveways and parking areas shall be constructed of pervious material. 11. Sanitary system (bottom of,tank and leaching pools) shall be located a minimum of 2' above seasonal high groundwater. 12. The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated tidal wetlands associated with Goose Creek are located at Suffolk County Tax Map Number:District 1000, Section 70, Block 10, Lot 29.2, otherwise known as the properties of Thomas Meyer and his heirs, assigns, or successors. This property is subject to the provisions of New York State Environmental Conservation Law (ECL) Article 25 or its successor, and the conduct of regulated activities may occur only pursuant to ECL Article 25 if prior approval is given by the New York State Department of Environmental Conservation (NYSDEC) or its successor. Regulated activities include, but are not limited to the erection of any structure(s); excavation; dredging grading and filling; clearing of vegetation; and application of chemicals." This deed covenant shall be recorded with the Clerk of Suffolk County within 90 days of the issuance of this permit. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sentwithin one calendaryearof the issuance of this permitto:NYSDEC,Regional Manager,Bureau of Marine Habitat Protection, SUNY Building 40, Stony Brook, New York 11790-2356. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02769/00001 rolyelnytene yanywaX is uvx.iwul,Fur^ ds.... +s•' J.t« ,e:.. -ruv :...ev R. rk...a6,: . i:..•mJ. �, r. .: * t.- [.a y>«._�.�....^..:I P.E. gangway to 8` `' at kit, w/stainless steel hdwe. 4004 ,, �ry 5 .° r,:1 FPART# aaosao APART� 100240:or 100340,o00600.���;�,,,F�r� �_..,, ,wf \ Galvanized steel hinge bracket and hardware, forA. wood walkways 24" a , ^ (61cm), 34" (86cm), or 60" ~ �.. (1.5m) wide. Kits include hardware connectors with nuts, hinge-to-float bracket, Hinged polyethyler hinge-to-plank bracket and 2 gangplank stiffeners with carriage smooth transition be bolts, nuts, and washers. Lumber not included. and deck surface. WIDTH FITS FLOAT WIDTH PART# " �t4".�X mj,��,40','�c 60""f 80"�loatj �,pocke connection '` �100240 1 •....Cw�r�-.-$,r( � �..ra..•,..�.r'su...r- -.....,w,...-...oho-�.'�...-.s.r.�w:;.c<.....a..".6a:"�J 24" (61cm) w/Stainless steel hardware 1002405S 111, t11, r ,�... n r�' ^:l¢�;r"`Fffi'; n "r�rv'i'b�. fr. '" "s ,,a a m-rs,.•+ ra„— ,t •.�.,: ¢P%IRT#."f0301SS.or 5� 34" (91cm) w%Stainless steel hardware W~1003405S� 60" (1.5m) w/Stainless steel hardware 10060OSS "`x",,..."s"n �"K""�,F".�"'» t,. •n+� '€:r�s°e r+— yam•.Fc "']" ,. ��.t Q Smj `801 tao ket�onaecf�an x."r�,Fk.u00680 r 60" (1.5m) w/Stainless steel hardware 10068055 , ..4k� �'Sfrore••end„hmg�adaptar kits :="�r�'.:.`,-s.� t"'`"na"; "'z �.•5.. '"?_ .:'""r :.t j `Y.,�,.� :, y`�.:,,...�r'"�_ Kit for 34".(9m) gangway 1503(400 -motra"r['°'."'•`' p.TTs-.Tt+,r,."''^"' 4>3 i'" ' r ."'. �-c�'"riQV� � f -. Klt Ia� �.{,�w�J w'. t•" a.xw A:.�i.:,` s. ..h.. Kit for 34" (9m)gangway abutment w/roller 140340 - ` �- •ST w- Bracket attaches to _. (91cm) and 5' (1.5m) c bolting to shoreline x � 4. WIDTH PAlRT# 3003i0:fo-500530, r=# y i ; .,'7_�g ,�--> Aar a 60" Gan .wayhas welded 977 t ' •.� cons uction with slip- resi ant walkway, side 1Q0650SSo cur , and rails. Lengths fr m 10'-30' (3m-9.1m), and 'idths from 3'-5' (1 m-1.5m). . S WIDTH LENGTH PART # r�'^�t ;ate+-.sfr ,s!'"k* x ��i�L.r .:,...�. r •w ^^KY"� r (r��+ '�`'x 1w.�t �tl�ra�� Y....._-_._ `' 30Q3j0 M�'$�`• ` �tr e with railing 300314 q..�* �r v r+^.�jr'.•fi :�, �.'ye"•lr�v.yp•w9.^ro ^v+w..-.. ,; �- z ;_ s� n rgil.!n���• ..:_.._ «3.00320-v�. -" r, 3' 25' with railing 300325 Hinged bracket witf ,rs-cs ^•�, �� Y' rac` r r s r .< 0, t "^^•.--T Zrw i„ :raig � ` .w.y=30033Q � gangway to dock. 5' 10, with railing 500510 and 80" (2m)widths. ' � y 1 " ryr ` w th^ f YiI n1yt +.5Q5 i 4 i�s� POCKETS c 5 20, with railing 500520 ar r L:,C^+y�f•-..^t,�aa,� t F.-Sm'..i�'�r-#`T�'�s��na�-:ar mturc•a.^ye.�•:�;t�+^�T�•--n �•r'Y ..�:.h.j;:�.:�•�_. ...�_.,...�,.,,. ,�,25�?�;� �.�„�;,�w�h.raJfng�sp ._.`,SOp525_�� - �. 4 do 09 MR . . DOCK O1/® I/oT 77 The Right ®ock For Every Application.: Rugged, adaptable_`;_reliable, safe the EZ Dock'system fias it al + Our`lowdensity polyethylene docks, boaf lifts, and PWC 11fts h e 7.a unique design that delivers outstanding o9d capacity, functto ity, 1 c and.safety A variety of dock sections and lifts,:plus an ex sive _ selection of.anchoring systems and accessories =make it sy to �%'� = �s . I customize the system For,private commercial or public f illties the:EZ Dock system is aloes-maintenance,versatile design that ovides years of convenient;-dependable use EZ Dock's patented on iece; self floating design is fasf and easy to install Sections come in veral sizes with evenly spaced coupler, hardware, and anchor:p kets. `:You'choose the configuration that suits your application. -A. B:w C. D. . Features & Benefits. • Cow maintenance »ems r � _ :• Beige color --. _ - E. • Variety of anchoring options The NeW Ha1f.Hexa Dock .*..Convenient accessories Adds Versatility. • Versatile modular design • Secure connection couplers Imagine the configurations now made possible by •.Strength and flexibility this unique dock design. Combine modular half- -`- Safe, slip-resistant surface hexagon sections for a platform of almost any size, • Four-season accessibility or as a starting point for unusual dock angles. r SIZE WEIGHT FLOTATION PART# P/IRL'#i307900=.�s�r„� v x���'�?�u Hai CAPACITY O0_lbs 100016s 204060 ! 1 m x 1.5m x 38cm � __.....Y.. _�..-.•45.4 kg _.y_..�...�453.6.k9 .190;Ibs ._ _..y_._. _ 2000 Ibs _.� _yw. 204010 1 m x 3.1 m x 38cm 86.2 kg 907.2 kg T a 4 285 Ibs 3000 Ibs 206010 ! s1.r t Ft`,�SC• + arv,e. - - .._ .,. _v.0 .�. _.. ___..�..__ _>......._._..__ ..,.. ._a_y.�_...-...__..___..___.... 1.5m x 3.1 m x 38cm 129.3 kg 1360.8 kg 4 � Special connection couplers are designed to 2m x 3.1m x 38cm 175 kg 1814.4 kg allow sections to move independently under Y� 60 x 10 x 15 210 Ibs 20001bs 260120 high-stress conditions, yet provide unified _ _�uE r,_�. .__ ...._ s .___ _ .� ... r_._, ._ .._.._.:,2 _. .. ,u stability. Made with recycled material, the 1.5m x 3.1 m x 38cm 95.3 kg 907.2 kg couplers are compounded to prevent fatigue problems. The composite coupler bolt and US Ppfenf#5,281,055 nut eliminate rusting in all water conditions. U.S.Patent#5,281,055 NOTE:Because of the rotomolding process,weights and dimensions may vary. Coupler set[bulk pack)w/hardware 301100 (800) 654-8168 Couplersetl2.�airlw/hardw�ra._<.�,:,301200' 'j Coupler set(3 pair)w/hardware 301300 DOCK ry www.ez-dock•com ©2004 EZ Dock,Inc. A Division Of®PLAYPOWEK INC. New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40-SUNY, Stony Brook, New York 11790-2356 - Main Phone: (631)444=0365 Matt Penski Phone: (631)444-0358 Denise Sheehan Website: www.dec.state.n�us Fax: (631) 444-0360 Acting Commissioner Request for Additional Information March 22, 2005 Mr. Robert Scheidet 2570 Clearview Avenue Southold NY 11971 Re: NYSDEC #14738-02760/00002 Permit Modification Dear Mr. Scheidet: The Department's technical staff reviewed your requested modification and provided the following comments: Simple revisions to the plans and proposal are necessary. Please change project specification number 1 on your plans to state: "4' x 4' fiberglass grid panel platform 1.5' above grade." Please also revise the cross view diagram to show and label the platform to be 1.5 feet above grade. Please include the revision date on the plans. Please provide three (3) copies of the revised plans showing the requested changes. Thank you. Sincerely, Matthew R. Penski Env. Analyst Tr.1 cc: file Site Plan J.0 A Sounding Locations Under Dock at NILW 9' 9 MLW i10 .114A w 53 NMt,w NAN �tEYipvS�Y ' o ' 6'X2o �FLOAT � w��P` P1r9TFORJ�1 3 x l d RAM_A . Rln�Ag7�+ ► ' 37'' I "Ml.w Al "luta w 9 A Mt,w Scale: 1"=5 feet ;z 010, AIA. ro'ect S necifications: Robert and Cheryl Scheidet 1 Alumiuum 4' XI' platform 765-9419 "' 2.Aluminum X X 10' ramp Property Location: 2570 Clearview Ave. . '":3. Plastic.floating dock Southold,N.Y. 11971 4.Platform &c dock anchored with Date Plans Prepared: July 9, 2004q. . / 2 '/2" X 12' aluminum piping - - /d�0� f' qua � t P AJrVem � �� ; Cross View Dia ram z�— I . 37F,6Er A Sounding Locations Under Dock at MLW ' 'OF # � o RH �X 3kIo ,VMS PI,ATxG�1 F'L SAT �9Rs�1 N fSTS 9 Mew , ► y'8'�MLw i MLw j S,iz.r MLW 1 Scale: 1"=5 feet . Pro'ect S ecifications: 1. luminum 4' X f platform ,2, �,� blh, Robert and`Cheryl Scheidet .Aluminum X X 10' ramp POSTS 765-9419 3. Plastic floating dock Property Location: 2570 Clearview Ave. 4. Platform & dock anchored with Southold, N.Y. 11971 2 '/2" X 12' aluminum piping Date Plans Prepared: July 9,2004 L' , N ysD�c 'f- 73�-o 76� Oro s e- 41 x y ' r-m -4, eA' lass IkI l d �&.4,1 It March 7, 2005 To Whom it May Concern; Chuck Hamilton from the NYS Dept of Environmental Conservation has been working with the Trustees of Southold Town to move from a 3 '/z ft. high platform that connects the dock ramp to a 1 ft. high platform. This new design has been approved by the Trustees of Southold and Chuck Hamilton. I have been asked by Mr. Hamilton to re- submit my approved plans(NYSDEC#1-4738-02769/00002)to allow for this new structure. I have included revised drawings(both views),the spec sheets for the platform from Metallic Ladder Mfg. Corp, and the spec sheets for the fiberglass top grating from McNichols Co. I will be utilizing the MS S-150 grit mesh. For any questions you can contact Mr.Hamilton or myself at 631 875-8445. We have moved to the new location: 2570 Clearview Ave Southold,N.Y. 11971 Thank you, Robert Scheidet pECE WE MAR 1 0 2005 Southold Town Board of Trustees t ' Site Plan 37'�AEET ® Sounding Locations Under Dock at NILW ��MLW ly�1011HA.W 5�3 NMJ.W �z • A A A A IV Wag � A�Ev ov�D Y x w wiL� PL�9T�oRJ�1 3 x l o AA MP 2� FLOAT 7�NW TON �Y V' -� y j�� � 1+1s� !� �� 9��w A M�.w AIA R VI � - V Y � �. i z At•.t, rosrS •4�E �1 Scale: 1"=5 feet �z WA• Project Specifications: Robert and Cheryl Scheidet 1. Aluminum 4' X 5' platform 765-9419 2. Aluminum 3' X 10' ramp Property Location: 2570 Clearview Ave. 3. Plastic floating dock Southold, N.Y. 11971 4. Platform & dock anchored with Date flans Prepared: July 9, 2004 2 '/2" X 12' aluminum piping 1VY$D 7 �c /- 738-�-2 �9 1-1Ys1) F0 M'111101YED As I'Llt '1'1'itAIS- A;+l) I'I:it:ll'1' 000, Cross View MaLTl'am Z .3 A Sounding Locations Under Dock at MLW Z4Aor �X q 3 kto H/GN �� M N l✓ !g'r LW y8MW S'2 MLW i Scale: 1"=5 feet Project Specifications: Robert and Cheryl Scheidet 1. Aluminum 4' X 5' platform 'z �R �r 1)f,4' 765_9419 Z.Aluminum 3' X 10' ramp POSTS 3. Plastic floating dock PropertY Location: 2570 Clearview Ave. 4. Platform & dock anchored with Southold, N.Y. 11971 2 '/2" X 12' aluminum piping N Y 8'Y) H C a/oZ Date Plans Prepared: July 9,2004 t, AI r Ci):[) AS PER N )/5P,5C ANI) )NI)1'1'li)N3)N3 OF PI--''MIT 140,1-973d-n,�;?74 10009 a w 0 0 4 S 2 1 6 t11 Sld t3 60114 O 4 4 U ►y PPRoyED BOARDOF TRUSTEES a Tow OF SOUTHOLD A u 3 23 METALLIC LADDER MFG. CORP. o 3che[det Pl�tbrm 'NDr+ttelllI Udd®r Mfg.Corp. WE REV. B am" 0201 ARP 2M oaa ,H MATERJAL ISN9ET 1 OF 2 4 8 Z 1 ti o 0 w o a a L� 4 8 2 ti m®rtcan Recreational P'rodurJs to m*ply fberglm grate In these area • B 52 314 a61 We Q H � T-' 24 24 0 43114 dB ti 60114 1 1W x 4'Aluminum Drive Pipe a° 4 Requlred va A METALLIC LADDER MFG, CORP, aTIN WWI oheldrt Plettorm CUSTKIMEtt B MetmUio Ladder Mfg.Owq. B °m 0201ARP 2nt2 oos 3 MATERIAL: SHEET 2 OF 2 1 to a a Molded Square Fiberglass Grating-Integral Gi! Page I of 1 - . . - _ �\��m •� . e �iGo Back 6ttp:/www.mcicho&c m/pod/&£begas/modd/saar&{/ s-incgrg_c#hm 726204 New York State Department of Environmental Conservation Division of Environmental Permits Rrn 121, Building 40-SUNY Stony Brook, New York 11790-2356 Telephone (631) 444-0365 Facsimile (631) 444-0360 Erin M.Crotty Commissioner October 13, 2004 Robert and Cheryl Scheidet 560 Water Terrace Southold NY 11971 RE: Permit# 1-4738-02769/00002 Dear Permittees: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6 NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Matthew R. Penski ECPA MRP Enclosure NEW STATE DEPARTMENT OF ENVIRONMENTAL CO' VATION DEC PERMIT NUMBER ® EFFECTIVE DATE 1-4738-02769/00002 C® October 13,2004 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental Conservation Law October 12,2014 TYPE OF PERMIT ■New ❑Renewal ElModification ❑Permit to Construct ❑Permit to Operate I I ❑ Article 15,Title 5:Protection of Waters ■ 6NYCRR 608:Water Quality ❑ Article 27,Title 7;6NYCRR Certification 360: Solid Waste Management ❑ Article 15,Title 15:Water Supply ❑ Article 17,Titles 7,8:SPDES ❑ Article 27,Title 9;6NYCRR 373: Hazardous Waste Management ❑ Article 15,Title 15:Water ❑ Article 19:Air Pollution Transport Control ❑ Article 34:Coastal Erosion Management ❑ Article 15,Title 15:Long ❑ Article 23,Title 27: Mined Land Island Wells Reclamation ❑ Article 36: Floodplain Management ❑ Article 15,Title 27:Wild, ❑ Article 24: Freshwater Wetlands Scenic and Recreational Rivers ❑ Articles 1,3, 17, 19,27,37; ■ Article 25:Tidal Wetlands 6NYCRR 380:Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Robert and Cheryl Scheidet (631)765-9419 ADDRESS OF PERMITTEE 560 Water Terrace, Southold NY 11971 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Scheidet Property,2570 Clearview Avenue,Southold NY LOCATION OF PROJECT/FACILITY SCTM#1000-70-10-29.2 COUNTY TOWN . WATERCOURSE NYTM COORDINATES Suffolk Southold Goose Creek E:716.6 N:4547.4 Description of Authorized Activity Construct a 4-foot by 5-foot platform,stairway to grade, a 3-foot by 10-foot seasonal ramp, and a 5 foot by 20 foot seasonal float as shown on the plans prepared by Robert and Cheryl Scheidet on 7/9/04, and stamped NYSDEC approved on 10/13/04. By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable regulations,the General Conditions specified (see es 2-4)a any Special Conditions included as part of this permit. PERMIT ADM ISTRATOR: ADDRESS Bldg.#40,SUNY,S ony Brook, NY 11790-2356 John .Wi and (MRP) AU H RI ED IGNATURE DATE Page 1 of 4 October 13, 2004 I ORK STATE DEPARTMENT OF ENVIRONMENTAL CONSE`, ..,SON SPECIAL CONDITIONS 1. Dock or platform shall not exceed 4 feet in width and shall be a minimum of 3'/2 feet above grade*over tidal wetland areas (* as measured from ground to bottom of dock sheathing). 2. Platform/ramp/float may not(a)extend laterally beyond property lines, (b)be placed so that docked boats extend over adjacent property line, (c) interfere with navigation, (d) interfere with other landowners riparian rights. 3. No permanent structures may be installed on platform/ramp/float without first obtaining written Department approval (permit, modification, or amendment). 4. The ramp and float shall be installed and removed on a seasonal basis. The ramp and float shall be installed on or after April 15`of each calendar year and must be removed by December I"of each calendar year. 5. Floats and ramps may not rest on or be stored in any vegetated tidal wetland. 6. Platform/ramp/float reconstruction or replacement or seasonal installation shall not involve expansion or substantial modification of existing structures or facilities. 7. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 50 linear feet from the tidal wetland boundary. 8. No dredging, excavating or other alteration of shoreline or underwater areas is authorized by this permit, nor shall issuance of this permit be construed to suggest that the Department will issue a permit for such activities in the future. 9. The use of wood treated with pentachlorophenol in the construction of structures that will be in contact with tidal waters is strictly prohibited. 10. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland)and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02769/00002 I FICATION OF OTHER PERMITTEE OBLIGA Is Item A: Permittee Accepts Lega. ..-,.ponsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC")for all claims, suits, actions, and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions,or to any claims,suits,or actions naming the DEC and arising under article. 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands,easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility,including relevant records,is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires.Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities(HWMF),major Air Pollution Control(APC)and Solid Waste Management Facilities(SWMF);and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1,SUNY Bldg#40,Stony Brook NY 11790-2356 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify,suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification,suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-02769/00002 'ORK STATE DEPARTMENT OF ENVIRONMENTAL CONSC ION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5),24,25, 34 AND 6NYCRR PART 608 (TIDAL WETLANDS ) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health,safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission,,consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit,the project hereby authorized has not been completed,the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved.plans were prepared by Robert and Cheryl Scheidet on 7/9/04. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02769/00002 NOTICE OF COMMENCEMENT OF CONSTRUCTION Aft RETURN THIS FORM TO: COMPI' _ �E ; OR FAX TO: 631 . . 1-0297 Marine Habitat Protection NYSDEC Building 40-SUNY p Stony, Brook N 11790-2356 PERMIT NUMBER: �+�176 - oa�6 O D. D O c� ISSUED'TO: - a PROJECT LOCATION/ADDRESS: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to General Condition#9 of the referenced permit,you are hereby notified that the authorized activity shall commence on . We certify that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions.We have inspected the project site and can complete the project as described in the permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions.The permit sign,permit and approved plans will be avdllable at the site for inspection in accordance with general Condition No. 1. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT AND 10R ANYASSOCIATED REGULATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE PERMIT AND APPROVED PLANS AVAILABLE AT THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE PERMITTEEAND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS. Cut along this line .............................`................................. ...........................................................`.............................`............................�`...........---.......... NOTICE OF COMPLETION OF CONSTRUCTION RETURN THIS FORM TO: COMPLIANCE OR FAX TO: 631-444-0297 Am Marine Habitat Protection NYSDEC - Building 40-SUNY Stony Brook,NY 11790-2356 PERMIT NUMBER: ISSUED TO: PROJECT LOCATION/ADDRESS: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to General Condition#9 of the referenced permit,you are.hereby notified that the authorized activity was completed on We have fully complied with the terms and conditions of the permit and approved plans. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE, WITH PHOTO.GRAFIMS OF 7 =UW0RKA1V070KAC MPLETED SURVEY,AS�4PPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. ` Site Plan 97 fEFf A Sounding Locations Under Dock at MLW x •�l W ov'9"M1.W ly�l®"Mt►old g'3 yMA.w 1 A A A /Oan*r STEPS Y X 5 r PL47MORM 3 X I o'RAMA 5 40 'FL OAT NAAS/� 'te Y Y Y Are, ros"rs ARE Scale: 1"=5 feet ;z `X4 DMA• Proiect Specifications: Robert and Cheryl Scheidet L.Aluminum 4' X 5' platform 765 9419- 2.Aluminum 3'X 10' ramp Property Location: 2570 Clearview Ave: 3. Plastic floating dock Southold,N.Y. 11971 4.Platform & dock anchored with Date Plans Prepared: July 9,2004 2 Y2"X 12' aluminum piping 1-�7 z7�9 NY S D E C APPROVED AS PER TERbfS AND CONDITIONS OF t��ry/ � PERMIT NO.!_7 738'-(hoc/ 69/�0009, DATE 13 D . z Cross View Diaeram ,3 Far Sounding Locations Under Dock at MLW S�� 3klO 16� � 'X 20 FLOA7 Ll YAA2 PW pl�.w 7S S 2 MLW g Scale: 1"=5 feet Proiect Specifications: z �� �/���� Robert and Cheryl Scheidet L AIuminum 4 X 5 platform p;At D 765 9419 2.Aluminum 3' X 10' rampS76 Property Location:. 2570 Clearview Ave. 3.Plastic floating dock Southold,N.Y. 11-971 4.Platform & dock anchored with a/a Date Plans Prepared: July 9,2004 ' 2 /27 X 12' aluminum piping APPROVED AS PER TERMS N ysD9C - AND CONDITIONS OF PEiCIAIT NO,/-g7✓e'0-?74 0000ab DATE /0=0, oll 95-20-1 (11/03)—9d New York State Department of Environmental. Conservation NO.TICE tuba v The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law, for work being conducted at this site. For further information regarding the nature and extent of the approved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number hown when c tacting the DEC. 0 Regional Permit Administrator Permit Number Expiration Date NOTE: This notice is NOT a permit • - 15 A � a `f It STATE OF NEW YORK DEPARTMENT OF STATE 4 1 STATE STREET ALBANY, NY 1 223 1—000 1 GEORGE E. PATAKI RANDY A. DANIELS GOVERNOR October 15,2004 SECRETARY OF STATE Robert A. Scheidet I 560 Water Terrace Southold,NY 11971 Re: F-2004-0815 U.S. Army Corps of Engineers/New York District Permit Application-Robert Scheidet-Install 4'x 5'platform; a 3'x 10' ramp; and a 5'x 20'float Goose Creek,Town of Southold, Suffolk County General Concurrence Dear Mr. Scheidet: On October 11, 2004 the Department of State received your response to our September 27,2004 request for information. The.Department of State has determined that this proposal meets the Department's general consistency concurrence criteria. Therefore, further review of the proposed activity by the Department of State,and the Department's concurrence with an individual consistency certification, are not required. When communicating with us regarding this matter,please contact us at(518)474-6000 and refer to our file #F-2004-0815. Sincerely, Supervisor of Consistency Review and Analysis Division of Coastal Resources sm cc: COE/New York District-Michael Vissichelli NYS DEC Region 1-John Pavacic WWW.DOS.STATE.NY.US • E-MAIL: INFO@DOS.STATE.NY.US RECYCLED PAPER . z Cross View Diagram ,37 FEET Sounding,Locations Under Dock atMLW 3' t H/" 3k�oy FLOAT MCCON H ARSEL II �� P20kSTS �. a Scale: 1"=5 feet. Proiect Snecirications:. 2 �� �/ Robert.and Cheryl Scheidet. I.-Aluminum.4' X 5' platform 765-9419 2..Alumiinum 3' X 10' ramp POSTS Property Location: 2570 Clearview Ave. 3.Plastic floating dock. Southold,.N.Y.. 11971 4:Platform & dock anchored with, Date Plans Prepared:-July 9,.200 2 Y2 X 12' aluminum piping. N Y5 ec --q' JUL 12 20n4 Southold Town Board of Trustees Site Plan; Sounding Locations Under Dock at MLW M/G� MI?RSN �. n. t y"MLW ,��pNILWlot y�IO��m4 w g',�ylM►t w PAMOv,SAY STEPS. ' • 6'xIO 'FL OAT W146 A91Pt s�,� PIATPORM ' 3 x 1 G RAMP. 3 r y Mcw y MAw 5 0 OW04 5 N AA It S9 � r Ate• P-05*rS �tRE Scale::1"=5 feet DIA' Proiect Specifications:. Robert.and Cheryl.Scheidet I.-Aluminum 47 X 5' platform 765 9419- 2_Aluminum 31 X 10"ramp Property Location: 2570 Clearview Ave. 3:Plastic floating.dock Southold,N.Y. 11971 4.Platform& dock anchored with Date-Plans Prepared:.July 9,2004 2 %19 X 12''aluminum piping /yYSDEc J U L 12 2004 Southold Town Board of Trustees WELL TEST HOLE DATA (PEST HOLE DUG BY ON A9VE 15, 2000) O SURVEY OF PROPERTY oft so"UVM I1L Z SITUATED AT Wmm`"Yg"'som sr PINE NECK ' ' TOWN OF SOUTHOLD �:. PAE mmw ATE m 030m&-m Sw v DWNG = SUFFOLK COUNTY, NEW YORK C7 ° &2' S.C. TAX No. 1000-70-10-29.2 CCESSPOOL r� SCALE 1"=50' �� 171 O JUNE 13, 2000 10. FINE /A� j PEItAs oeT+FR AUGUST 29, 2000 ADDED PROPOSED HOUSE 1 �+ V �J�T pow y� SEPTEMBER 2B, 2000 REVISED PROP. SEPTIC SYSTEM ,1 � 1 V IJ tr -+- 12 OCTOBER 1. 2000 ADDED LOT coVEFAGE NOTE i \ B2' y 02 G �_ NOVE►SBER 1. 2000 REVISED PLAT PLAN / \\ O oo 1s' I I J�UARY 26, 2001 LOCATED TEST WELL CEMBER 8. 2000 REVISED PATH i �N OPEN) \ � b ; I APRIL 25, 2001 REVISED SEPTIC SYSTEM AS PER F. S. KEITH, P.E. S at'css30- ` Sit �\ ;o0 1_ E so• 1 -0S'30" 3 :T f- s APRIL 25, 2001 REVISED S1TE PLAN .� ��' 9 •Ocr x o �?� AREA = 29,687.55 TO IIE CAPPED AND 2s, - g Fast1 w� z (To TIE UI z CERTIFIED TO: tz: -p ; PECONIC ABSTRACT ' •- `<� o i : ° FIDELITY NATIONAL DTI I SUR N 0 P OF ORK MARC CLEJAN 904 -_7 N,� ANNA CLEJAN a o o c,\c'Qy b�' �� �~ { Southold TO= tt---�N �" F�f* 'b ? NOTLPS Board of Trustees v I�' .6 O y�� - i 1. ELEVATIONS ARE RE I P. { IfEXISTING C EXISTING ONTOUR _LINES ARE N sHoww U THUS: - FOUNDDTI -6-- , PROPOSED CONTOUR LINES ARE SHOWN THUS: ---�i -- `� \1Yg CONC.Mom- �' 1 .� LOCATION FOR ExPANsm or LEACHING POOL CApACf}Y. A N I 1 jl/ CR YAM MVrOW CH LN• cTss>aaL.s u PER EXISTING WELL+ � ® iP°DEEP,Dwr6TH MT SLAB COVER. b RFAURED)mNO POOL TRIG O SURVEY BY VAN TUYL F�...I 6'Dw. 'L S� i'/ r . 'S Q ON SEPTEIBfR 6. 1973 , ®PROPOSED 1000 GALLON PRECAST CONCRETE SEPTIC TANK t/ 6- S Icq� 4�.\ .� 1, / ,3 m O ICJ i/SeG1/G� ��.��/��1�� 2. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD \La,go, k, I ,Q/lltppjpURCRLI t'A.' •L. •>/ _- U.'r! OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. / '(O 5(N2: VkH HAY OAL5 i 5LT CtW I'V=MAE N` JG110N. 3. THIS PROPERTY IS IN FLOOD ZONE AE (EL 6) AS SHOWN ON / EL`K.*=V"A WW A'wm.W N•T•R1:R D!5'L1 " / FLOOD INSURANCE RATE YAP COMMUNITY-PANELTY-PACOMMUNITY-PANELNo. 36103C0166G 1N1:1Gt71'SDS(8,ONE A-UCON511 1M 4. COASTAL COOS LEGEND 11-LOOD I COASTAL BARRIER FLOOD INSURANCE NOT AVARA6LE FOR NEW CONSTRUCTION [LEAldr7PASH / y OR SUBSTANTIALLY IMPROVED STRUCTURES ON OR AFTER S--- _4�LL� O / — /� 5. 200tyds.NOVEMBER OF CLEAN FILL DESIGNATED LLL BE NEEDEAL D F�.THE SEPTIC SYSTEM. 7. / EDGE OF WETLANDS FLAGGED p , y -- BY EN-CONS ULTAMS,INC + ONLY 501 w yds. OF FILL WOULD BE NEEDED IF THE EKISTINO MOUND IN THE < 1 /.i/ IF�THER MOUND ALOOF UNACCEPTAABLE WT MATERIAL TO BACK1 FILL TTHHE SE SEPTIC PTIC SYSTEM, FLAG Fll�cMATERIAL FROM T14E��� FLAG Z /C1--. I ! j I /G� LOOT NOT CONTAINING THE SEPTIC ISYSTTEME REGRADED OVER THE PORTION OF THE '•�O y il{(� a `\ II { i 6. UPLAND AREA = 16.207 sq. it. yQ 35/ 0 WETLAND AREA = 13,480 aq. it. IMPERVIOUSsq. LOT} COVERAGE S VERAGE (HOUSE, PORCH h DECK) OVER UPLAND LOT AREA ty` JLL J4L r1i r, o rrlir7iirsurr� re�,Fl azcS j✓�r�1.Sc/i oG`�G�/ / `\ ham - WV:'ri WO PREPARED IN ACCORDANCE WITH THE MINWUM G Lin'f 1' I�'I T N / j I 13Y THE LI FOR TALE SURVEYS As ESTABLISHED i] i. ( BY 7Uff LI.ALS.AND APPROVED AND ADOPTED P, t�;v FOR SUCH USE BY THE NEW YpRK7 TILE ASSOCIATION.16• ALL COASTAL BARRIER - \416 ���It,-+I• ,�''�• IDENTIFIED 11-16-90 oAL � o V Lip. No. 48APA •\ _ To THIS ALTERATION�0 011 / /• /�v�' `"� SECTION 7209 OF THE NEW YORK STATE CODG LAW. Jose A. Ingegno COPIES DF THIS SURVEY MAP NOT BEARING ��`' ,3 SEWAGE DISPOSAL SYSTEM BY: THE S ��E C SI Lan Surveyor �, To BE AA VAIN TRUES COPY. BE CONSIDERED SAG HARBOR ENGINEERING CErmFrAmNS INDICATED HEREON SHALL RUN N 74, ry 381 Town Line Road, Sag Harbor, New York tS REPARED PERSON Two THE G 32'1$y -211 (o M Frederick S. Keith, P.E. LENTM-D�+P�. ION LISTED AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction LENDING INSTITUTION USDID HEREON,AND LOl'°Ut ENDING INST1- 0OASR w w TTvRON CERTIFICATIONS ASSICNEES OF THE NOT TRANSFERABLE. PHONE (631)727-2090 Fax (631)727-1727 CR-pzk 8S-17, THE EXISTENCE OF RIGHT C WAYS OFFICES LOCATED AT M41JNG ADDRESS - AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. 1380 ROANOKE AVENUE P.O. Box 1931 RNERHEAD, New York 11901 Riverhead, New York 11901-0965 - - Albert J.Krupski,President ��,� CD Town Hall James King,Vice-President =� GZ� 53095 Route 25 Artie Foster y P.O.Box 1179 Ken Poliwoda � Southold,New York 11971-0959 Peggy A.Dickerson y � �� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Co stal Erosion Permit Application _ etland Permit Application /Major Minor Waiver/Amendm nt/Chan es Alreceived Application: 1 O Ot .4kt5ceived Fee:$ WSCr _,feompleted Application rC :sl _Incomplete_SEQRA Classification:Type I Type IIUnlisted Coordination:(date sent SAC Referral Sent/Date of Inspection:Receipt of CAC Report: _Lead Agency Determination: Technical Review: -;;;;Public Hearing Held: d —Resolution:- Name of Applicant 90,8FXT 77Cf�'E/QYL SCfL 7 Address .5-61 7; %Tz%P/Q�C� SO�/T OL.D, /r•/ Phone Number:63) 76.� / �5 -k COP4✓ Suffolk r ffolk County Tax Ma Number: 1000 - SEC. 70 &4C A0Z-,2 9 Property Location: ,25-70 r (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application GENERAL DATA Land Area (in square feet): 7. 5•5 Area Zoning: Previous use of property: MCAIV T Intended use of property: /eFS/DEN T��L Prior permits/approvals for site improvements: Agency tlet 310 V6//Z Ft�/API IG DAP7,• a � AEC y 2/ a �/-y7�8 oz76�voo/ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen�y a governmental agency? ✓✓ No Yes If yes, provide explanation: Project Description(use attachments if necessary): U-VS% SN,PREt,/NE 6PC ,Wi9PW1eTY H 1711 ,4,4 P hoVb t ~T 11/611 )"7Men ©AI Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 617.20 SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT l-SPeNeeR 2.PROJECT NAME Df/QT 2- Ei�2Y�C sct1E/l�ET ,RACK 3.PROJECT LOCATION:,,�r,O j:z"f/� AA J Municipality Q�/7�p� County .9U�Fax� 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or pr a map A570 ��K,Fk/AI/E - 9Q �EE'T A� S'Fr' /0 J.o7.-Z SEE ATT�C�� /'��►� 5.IS PROPOSED ACTION: New ❑Expansion ❑Modification./alteration 6.DESCRIBE PROJECT BRIEFLY: / / OCR� X r(fS+T ofF sr5�0/ �wE one'•ZO D d W17Tf1 /04MP 09/V P .2 FODT f�/�'h� �L�9 TFi1�PJ�1 C 7.AMOUNT OF LAN AFFECTED: Initially ,*IV 4cres Ultimately acres 8.WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.VVV4 IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES TION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENC (Federal, State or Local) E�Ies ❑No If yes, list agency name and permit / approval: G /� 11.DOS ANY bWECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? YesLIP o If Ye �a�IOF n 'Dly / %IPEr'C/'7/T 12. AS A RESUe OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spo a Date: Fj Z,�W/ Signature If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II- IMPACT ASSESSMENT(To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Longterm,short term,cumulative,or other effects not identified in CI-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If es,ex lain briefl : Yes nNo E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Xes ex lain: Yes No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur.Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) } SVFF���Alb Town Hallert J.Krupski,President 0�,� COG James King,Vice-President 53095 Route 25 Artie Foster o P.O.Box 1179 va Z Southold,New York 11971-0959 Ken Poliwoda O Peggy A.Dickerson A � O� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING residing at fi;AO being duly sworn, depose and say: That on the,3�ofVPL Y , 2001K,I personally posted the property known as 70 -9vTfi'oLD �Y //t'7/ 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 0211 ' Dated: (signs ) Sworn to before me t 's 3,cl d y ofJu.1v 200 141 &io t —. Notary Public KST No" DbcQC'- dftw Yak PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ✓7W PA f-V wA Y svvTh��� W.X. //19,71 'Ole f-,A011?S. PAR��.>- ,�'I� �' �•es ,8l,�ti/D�v 7 PE/X�YY ? 9- Mi�� MES.S/rt/A /D TLVOXl,81, 9ye STATE OF NEW YORK COUNTY OF SUFFOLK ROOT�'�3lEieYL SIyE/1>6T ,residing at .160 9072PT 72POtc V.Y, //97/ ,being duly sworn, deposes and says that on the day of af/L y ,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)(registered)mail. Sworn to before me this Day of Notary Public KATHLEEN M,SANTORO f Notary Public.State of New York No.4892d27. ` Qualified id Nassau County Commission Expires May 1.1,�(�G NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES,TOWN OF SOUTHOLD In the matter of applicant: /PO iQT?"CHERY� SCA' e1JW7— SCTM# 7O �'�� '�Z 9•�Z YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the oard of T tees to: CONJ97-RVGT �'9 FLvATI.-VG DOC& e 4 i<.?O i 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: #, 6 9 ACC RES/j>__='N;r741_ Ti 0Relf TY /HAVPc h 67NE IAMi[ Y NoME W17A1 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: c7/,CYZ/, -20DK You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: /?iPW5 7- �f�E•e�L- SC�E/��T MAILING ADDRESS: S'�D Wh7ZW T�rfiP9CF PHONE#: Enc: Copy of sketch or plan showing proposal for your convenience. NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES,TOWN OF SOUTHOLD In the matter of applicant: SCTM# YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: PHONE#: Enc: Copy of sketch or plan showing proposal for your convenience. Board of Trustees Application County of Suffolk State of New York ,/�/;� ,�.I `i �jlF✓?/L 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/I ER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signat re U/ SWORN TO BEFORE ME THIS Z� DAY OF jzvi ,20 c Notary Public PATRICIA CORWIN Notary Public,State of New Yak No.01C05017852 Qualified in Suffolk County Commission Expires Sept i3,� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of ppssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,.rpiddle 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 TO o< (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 ev a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of arcs. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. 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