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HomeMy WebLinkAboutTR-6944 Jill M.Doherty,President V QF soar Town Hall Annex James F.King,Vice-President ,`O y�lO 54375 Main Road P.O.Box 1179 Dave Bergen l Southold,New York 11971-0959 Bob Ghosio,Jr. H John BredemeyerOl� �� Telephone(631) 765-1892 OU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 21, 2010 Mr. John Nickles P.O. Box 56 Southold, NY 11971 RE: ESTATE OF GRACE R. LEWIS 885 ROGERS RD., SOUTHOLD SCTM#66-2-39 Dear Mr. Nickles: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., July 21, 2010: RESOLVED, that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit#6944, as issued on August 20, 2008. This is not an approval from any other agency. Sincerely, Im Jill oherty Presi ent, Board of Tru ees JMD:lms July 16,2010 Board of Trustees Town of Southold Southold,NY 11971 Dear Trustees, This letter requests a one year extension to Permit#6944 issued to the Estate of Grace R. Lewis c/o John Nickles for the property at 885 Rogers Rd. in Southold (SCTM# 66-2- 39). I authorize Joy Alessi to act as my agent. Sincerely, // �G z�— Jo J.Nickle , Executor The Estate of Grace R. Lewis —- - ---- ---- I f JUL 1 b 2010 Southold Tol„ri Board of Trustees Beixedon Estates Association PO Box 1432 Q)' Southold,IVY 11971 Mr. Dave Bergen �..` c Southold Town Trustees #- j PO Box 1179 Southold,NY 11971 JAN 25 2010 CG January 20, 2010 Dear Mr. Bergen: The Board members of the Beixedon Estates Association, (a group of 48 homeowners in the Beixedon Estates subdivision in Southold) are concerned about the present condition of our community beach. Our community beach is located at the end of Rogers Road, downdrift of a recently constructed 278 ft.jetty in Southold Bay. A professional survey was conducted in February 2008 and has shown that we have lost over 30 ft of beachfront while the east side of the jetty has accreted sand. Most of the erosion occurred prior to recent high tides and storms. We have practically no beach remaining. In addition the Hippodrome estuary to the west of our community beach has incurred significant erosion and is of concern to the adjacent Beixedon Estates residents. It is our responsibility as a representative board of the Beixedon Estates Association to address the concerns of our residents pertaining to the loss of our beautiful community beach. Our residents are also very concerned about the loss of property values and seasonal rental opportunities. We would greatly appreciate it if a town representative could come to our beach to observe the situation and meet with some of the members of our Board to discuss possible ways to address this urgent problem. We feel it's necessary to work with the Town to see if there is any way we might be able to protect what remains of our beach as well as possibly recover some of the beach we have lost. You may respond to this letter by calling meat 516-385-3805 or writing to the above address. Thank you for your consideration. Sincerely, Howard Kalman, President Beixedon Estates Association Cc: Mr. Scott Russell, Supervisor Picture 1 was taken on January 21, 2010 at the mid tide cycle. It shows the present condition of our Beixedon Estates community beach, downdrift of the 278ft.jetty. qu 17,.�� s° Picture 2 was taken at the same time on the east side of the jetty. ti.f� Picture 3 shows the beaches just east of the community beach, downdrift from the jetty. There are only a few hours in each tide cycle where the water does not reach the bulkheads. AA Picture 4 (taken 12/10/2009) shows the length of the jetty shortly after high tide. P` a c Picture 5 shows the view of the jetty from our beach. James F. King,President ��oF soUryo Town Hall Jill M. Doherty,Vice-President I0 53095 Route 25 Peggy A.Dickerson P.O. Box 1179Southold,New York 11971-0959 Dave Bergen G Bob Ghosio, Jr. Telephone(631)765-1892 COU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction / % constructed t/ Project complete, compliance inspection. ' * gN,1.f..l.%S,i•:. 'r'111° <-'..r..` - i'� • 'i � ,}...-C V"ii'i•• ` .'� ° +.y.•:: BOARD OF:':SOUTHOLD.TOWN TRUSTEES Ft •SOUTHOLD,NEW YORK I . PERMIT NO. 6T 4 DATE.,AUGUST`26''1008 r ISSUED TO: ESTATE.OF GRACE.R. LEWIS C/O,JOHN NICKLES PROPERTY ADDRESS 885 ROGERS RD., SOUTHOLD �.qrr SCTM#66-1--39 1.1./ AUTHORIZATION , Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of ^,Y Southold and in accordance with the Resolution ofthe Boazd of Trustees adopted at the meeting held on ' August 20,2008 in consideration of application fee in the sum'd$Lk' b paid 6 Estate of'Grace R:Lewis Cl \ \ r John Nickles and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of , Trustees authorizes and permits the following T" c> .•QI'1 2 .. ..... Wetland Permit to restore the'eroded`beach wiM appr+' 334`cy. of clean sand, _ landward of mean high water. Install a 6' wide turf block ramp 24'X 6' replacing the , .r �,rrr existing concrete arid`wood'"ramp and remove`seaward limit`of wood'ramp: Install a cur edge, catch basin and new asphalt pitched to drain/catch-basin. Remove 1'0'X 16' concre I and re,-vegetate,2,500 sq.ft, area with Ammophilia Brevigylata. 8" V on.center, and as depicted on the plan prepared by Creative Environmental Design stamped,approved on August 20,2008. /ttrr , IN WITNESS WHEREOF,the saids Board of Trustees hereby causjbs its Cgrporate Seal to be affixed, Y and.-,these presents to bp,subscribed by a;majority:of the,^said B and as of this date Q44fF9 �., >� ' y 4`? y� J .� �i ,`ter \�; �� t � � � '`� �. � 1�-`✓fi.. v ... _ ��•w _ -.. -`i �� xti:. *\.J�,i.�uM r . �� �y1 '•-'•:w,•111�y 4' ..���r.,1y�4 TERMS AND CONDITIONS The Permittee',.Estate of Grace R. Lewis c/o John Nickles property'located at 885 Rogers Rd., Southold,NY, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the,pid Board of Trustees and the Town of Southold are released from any and all damages,'or claims-'for.damages,of suits arising directly or indirectly as.a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties,and the.said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold.. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at,a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the-structure or project involved,to provide evide.nce'to anyone concerned that authorization was originally obtained. ; 4. That the work involved will be subject to.the inspection and approval of the Board or its . agents,and non-compliance with the provisions of the originating application may be cause ` for revocation of this.Permit;by resolution of the said Board. 4} y Aff. ... 5. That there will be no unreasonable.interference with`navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low watermarks: 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if,in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will-be required,upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. tY. 8. That the said Board will be notified by the Permittee of the completion of the work authorized.`' '.,-. 9. That the Permittee will obtain all-other permits and consents that maybe required supplemental to'this permit,which may be subject to revoke upon failureto obtain same. R, James F.King,President �rjF SO(/r Town Hall Jill M.Doherty,Vice-President ��� OlO 53095 Route 25 Peggy A.Dickerson 1f P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen N Bob Ghosio,Jr. Telephone(631) 765-1892 Fax(631) 765-6641 ommV BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 20, 2008 Mr. William Baylis P.O. Box 816 Southold, NY 11971 RE: ESTATE OF GRACE R. LEWIS C/O JOHN NICKLES 885 ROGERS RD., SOUTHOLD SCTM#66-2-39 Dear Mr. Baylis: The Board of Town Trustees took the following action during its regular meeting held on Wed., August 20, 2008 regarding the above matter: WHEREAS, William Baylis on behalf of the ESTATE OF GRACE R. LEWIS C/O JOHN NICKLES applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, application dated July 17, 2008, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 20, 2008, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of the ESTATE OF GRACE R. LEWIS C/O JOHN NICKLES to restore the eroded beach with approx. 334 cy. of clean sand, landward of mean high water. Install a 6' wide turf block ramp 24'X 6' replacing the existing concrete and wood ramp and remove seaward limit of wood ramp. Install a curb edge, catch basin and new asphalt pitched to drain/catch-basin. Remove 10'X 16' concrete and re-vegetate 2,500 sq.ft. area with Ammophilia Brevigulata 8"-10" on center, and as depicted on the plan prepared by Creative Environmental Design stamped approved on August 20, 2008. 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: $50.00 Very truly yours, CZ Jame F. King ' President, Board of Trustees JFK/Ims VIEW FROM SKY LOOKING DOWN NOOM 845 ROGERS ROAD,SOUTHOLD,NEW YORK i2ODGERS LATHAM PROPERTY FREIDMAN ROAD _- ---—--- - - LINES ----- --------- - ------- ----- PROPERTY PETROSINO EXISTING BULKHEAD LINE PROPERTY--�_ 33 FEET -- -._� LINESEMSTING L L L_. L_ L_ L- LLLLLL_- (— L. (_- L- L_ L_ L._ LL_- �__ �� ET NOURISHMENT ARII:A(2 FEET Paces vG-) _ L_ (--- L- L- L- L- L.. L uSjNc - L L y- - _ •� -�~ so l_ LL L_ L L- L. L . L_ I_ LL_.- I r- -- L L-- L. L- I--- L _ LPL _!_== SLY , CEO L_ L_ L_. L_ L_ _ Nu► i- 0 SCALE o co- ' ONE INCH= 25 FEET U u U r f I� gg/�� . .. . PREPARED BY: 5 210 �( 150 X 2 �9M Cu. Ft =333.3 Cu.Yds. Thomas Pabslao MaMh A,M. BEACH NOUFUSHMENT PRDJECT BEIXWON ESTATES ASSOCIATION TOWN AND VILLAGE OF Wun KXD,NEW YORK w: N5 ROGERS ROAD tATNAM PROPERTY EXISTING-- BULKHEAD�-' ---- --------•--- FILL DISTANCE 70 FEET----- ----- ---- _.-.--—- - --e 1- `-- FOOT - 3 FEET �-=--.sNOURISHMENT lHEIGHT(2 FEET 3AN _.t_ L. FEET 50 FEET -- ------- ------- - f EXISTING EXISTMK3 EXISTING ELEVATION HM WATER .- WATM (SANDY BEACH) MAW LOWMARK SCALE:ONE INCH=8 FEET --'----'- 20 FEET------.------ PREPARED BY: USING FINE,CLEAN SAND BEACH NOURISHMENT THOMASPEfROSINO E SWHER$17E BYBEIXEDONESTATE$ASSOCIATION AND TRUCKED MARCH 211 2M (50+10) FT.X 150 FT.X 2 FT.(AVG.) NOH SME OF PECONIC BAY 2 RTTOWN OF SOU11HOLD.NEW YORK WW Cu.FL=333.3 Cu Yda VILLAGE OF SOUTHOLD.NEW YORK al W o r-r a) ` � U i � O 0 VIEW FROM SKY LOOKING DOWN NTH C Nourishment iJ0V Firte,d®erz',mined ® m O � O c TRUCK ACCESS yes ROAD,sOuTwUD,NEWY�c Soulfolcl,N.Y. I'1726 A rna3arta�ue Ave. ROGERS RODGERS LATHA 4 PROPERTY I FREIDDMAN ROAD ROAD — --— LINES - --—— PROPERTY PETROSIN® --EXISTING BULKHEAD LINE PROPERTY � LINES 33 --- -------�`-----�---------150FEET - -- .---r"-" i EXISTING BULKHEAD EXISTING 10 FEET BULKHEADS I' I I h L__- (— L-_. L_ ! ! I I I ! ! I I ! ! I I I 1 I 6 JRi�>-1MENT AREA(2 FEET Ta98CK AVG.) I ! j -" -- — LtSING FINE SAND _ L` 50 FEET L - -- I - L L L L L l._L i ! - , AND�LQ'Ii-I1T K OE--. idHW lP.fdlt APPROX.20 `ERXtlT_MtaN10 21, SCALE : 1 ° -- 30 FEET sue- u::rJr v_ - PREPARED BY: 6fl 1fl 7Ylomas PetrosIno 2 — 3C 9 5fl 3t 2 =9Q00 Cu.Ft=333.3 Cu.Yds. OWNER:ESTATE OF GRACE R.LEWIS REACH NaJRUWW M PACT SEMEDON ESTATES ASSOCIATION TOWN AND VILLAGE OF SOUTHOL.D,NEW YORK APRIL 16,2003(REVISED) as 0 f Alk PROFILE o0 r i X Q IfBb ® 0 IA� PROPOtTy EKMrNS MET -- - _ - -- 70 FAT - -'--.. ..._ .--- --- - - - co o rti� 2 FW LL ..LL4.L[lLl L`L LL LLL:.__: tl LLLLLFL.1[[ LLYL'..LL._I_LLLµLLL LL L�}.Ll LlLLLLLLL •t�.l4l. t.iltyt L L�i�L LLL..L-��L�...lJLL11.LLL1 I.LiAl L:L.LLI.t;l�u.l� ��1 QrCZi ASV 28 FEET _-.._ _ LLL 9D FEET w ujOUSTING c�i O 1! E)CISTItdG ELATION ► __.... w a' (SANDY BEACH) MAW � >- o z � SME : 1 s 10 iE ----- -- F$1� O v a. co z LL z o 0 FcPARM BY USING FW-CLEM SAND iu a � w c m BEACH� c p ._ �, THOAM� MWW E ERE B'v BEOX-OM WfAl=A380=TM U 'c to ° c 1M HE TO T SITE AFpm is.2m(lift o I a O m >- g 0 0nzmcn (-&A)00)FT.X 150 FT.X Z FT.(AVG.) NORM SM OF*E�NC BAY z 2 raM OF 30UTHOM NEW YM a MW Cla.Ft c 333,3 Cu Yas. MAGE OF SMFIMM,NNW YOM O ESTATE OF GRAM R LESS F- N y c ri v AVPft(P&" A$ Pid CURRENT SLOPE OF BEACH= Apex. 2.3 DIg. (-2 in in 5+O Ft) 0 AIN-0 tUONDITION LL 0) P R-MIT Pa.L F=- It W w -T .. F ._ • _ j .} � ISO s� 3 53 av ,c" • 15 8.1A(c) wog sM 1 vy 27.2A(c) sf . Alp 66 �62i w uQ Q 4.OA(c) A 10 6, Pews Pond L8 Z6 e� g z 1 co titi ti r& N LWO UAW 1 ti CIO' \C O Off ' �' �• r1,�� �'�tid'1i� ph r� s A�5 ro p`G ,(FiQ`01 't `tip ,y'� QQO� p r� p�1•,cp �4 0`p sM p� *5 4r t so j to ,�• � � ,� � ��. •STD � ~ R• rs �'.� � ��'�6 tea' � 'ti°� Q,• O �, ti `� ,s4'Q � 'y Op\r yd'�� 'S' ` .J' y g n'p' 'Tj�► .Z. rO J P James F. King, President ��OF SO yQ Town Hall Jill M. Doherty,Vice-President ,`O 0. 0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen • O Telephone(631)765-1892 Bob Ghosio,Jr. Q ��y c4U Fax(631) 765-6641 NTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: L eta siQujo (2&= 0kn -PA co-)I,o- Please be advised that your application dated "7 119 a8 has been reviewed by this Board at the regular meeting of O�dB and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 st Day of Construction ($50.00) Y2 Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ JCQ BY: James F. King, President Board of Trustees ���gg�fFOt,p�dek Donald Wilder,Chairman 4 1 Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 f, • ?'�' Southold,NY 11971 Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., August 13, 2008, the following recommendation was made: Moved by Jack McGreevy, seconded by Peter Young, it was RESOLVED to SUPPORT the Wetland Permit application of ESTATE OF GRACE R. LEWIS C/O JOHN NICKLES to restore eroded beach with clean sand, landward of mean high water. Located: 885 Rogers Rd., Southold. SCTM#66-2-39 Inspected by: Jack McGreevy Vote of Council: Ayes: All Motion Carried 94/11 Ix F)vN Lt5 jsSSN 2't 2, 71 • s y I rr . : �.� - .-. • a jai+ �. \ - •\ P� Ab `f� CI .• _.,,� purl:.�,.'F �N � �s (r• o 'I A-77 a r -_c- G;,-�.,. � � ,, �� �'o y_.l_np`S• /�� ,�v n-r.� J � � 4 �►��I !n oS ,,� .7 ��N • 11 ! !� �•y \ �• J( [, `'j,7 1. S_7 I J Fi 7�1 '/�S 1 EILs- .m ram: .. _ .. �t• �__ - '`. 2 /1 J,lc;ov %.m 9f t 1 k� 7 �r9oG) 3 MEL 1 `ram"' nF yes- � a►, ';� - _ _ _�.- ' �♦ _y Lat. � `l \ � , Ali � �. iM�: .A.� VF � - vs,�1, b m , y a � w a �3 `, ..:.. .::. r'x• 4j. OO °R/-�CJ�LSO� oO° �l�J°LSV ,s o T� w� F } . 1�0 N i r -009MR000 MOM � v _ w v f1► Ak { y. 400 Ito a � � E ii► 74 - r 0 � / 13/2MM . 10 29 s.� ,..;"Mir yr,•``�_ :: �ow,�Now • 08/13/ � � • � : � w ` A ` r Y kr I 1�" f/II1 - p ? vat r S '1 Y`� Wz • !.��' ` i \ ISe - .f'�. Al ♦ 't,�, . W tj OF.''• t aSUFFt?(� James F.King,President AV CO P.O.Box 1179 Jill M.Doherty,Vice-President �� Gy Southold,NY 11971 Peggy A.Dickerson Telephone(631)765-1892 eA Dave Bergen 0. rn Fax(631)765-6641 Bob Ghosio,Jr. Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ESTATE OF GRACE R. LEWIS-C/O JOHN NICKLES requests a Wetland Permit to restore eroded beach with clean sand, landward of mean high water. Located: 885 Rogers Rd., Southold. SCTM#66-2-39 Type f area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 Chapt. 111 other Type of Application: etland _Coastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: & Conditions: �rL41,OeAv�Gs Presen ere: IA/King Kin ohert _ .D kerson `D g. Ber en_ B.Ghosio D. Dzenkowski 9ark Terry er C j� Form filled out in.the field by ez&2 Mailed/Faxed to: Date: Environmental Technician Review- New York State Department of Environmental Conservation Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook New York 11790-3409 _ Phone: (63'1)444-0365 FAX:'(631)444-0360 Alexander B. Grannis AMENDMENT TO PERMIT Commissioner July 7, 2008 Mr. William J. Baylis, President Beixedon Estates Association PO Box 1432 Southold,NY 11971 Kard Re: Permit No. &Location:1-4738-03174/00001UL 1 7 luudEstate of Grace R.Lewis Pro>l eaRogers Road SCTM#1000-66-2-39 Southold (Peconic Bay) Southold Town of Trustees Dear Permittee: Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR,Part 621. The expiration date is extended to'July 31, 2013. This letter is an amendment 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. Sin erely, 'Laura Scovazzo Permit Administrator US cc: J. Nickles/Estate of Grace R. Lewis BMHP File New York State Department of Environmental Conservation Division of Environmental permits Building 40 - SUNY, Stony Brook, NY 11790-2356 AM Telephone (631) 444-0365 Facsimile (631) 444-0360 Erin M. Crotty Commissioner July 10, 2003 Estate of Grace R. Lewis C/O John Nickles P.O. Box 56 Southold, NY 11971-0056 RE: 1-4738-03174/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit.. 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. Sincerely, Laura J. Scovazzo Environmental Analyst LJS/ls Under the Environmental July 31,2008 Conservation Law TYPE OF PERMIT®New ❑Renewal ❑Modification❑Permit to Construct ❑ Permit to Operate * Article 15,Title 5: Protection of Waters ❑ Article 17,Titles 7,8: SPDES ❑ Article 27,Title 9; 6NYCRR 373: Hazardous Waste Management ❑ Article 15, Title 15:Water Supply ❑ Article 19:Air Pollution Control ❑ Article 34: Coastal Erosion ❑ Article 15,Title 15:Water Transport ❑ Article 23,Title 27: Mined Land Management Reclamation ❑ Article 15,Title 15: Long Island Wells ❑ Article 36: Floodplain Management ❑ Article 24: Freshwater Wetlands ❑ Article 15,Title 27: Wild, Scenic and ❑ Articles 1, 3, 17. 19, 27, 37;6NYCRR Recreational Rivers ® Article 25:Tidal Wetlands 380: Radiation Control ® 6NYCRR 608:Water Quality Certifca- ❑ Article 27,Title 7; 6NYCRR 360: tion Solid Waste Management PERMIT ISSUED TO TELEPHONE NUMBER Estate of Grace R. Lewis C/O John Nickles (631) 765-3416 ADDRESS OF PERMITTEE P.O. Box 56, Southold, NY 11971-0056 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Thomas Petrosino, Beixedon Estates Association, P.O. Box 1432, Southold, NY (718) 335-3000 11971 NAME AND ADDRESS OF PROJECT/FACILITY Rogers Road, Southold SCTM #1000-66-2-39 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Peconic Bay_ DESCRIPTION OF AUTHORIZED ACTIVITY: Place 334 cubic yards of clean sand as beach nourishment landward of mean high water. All work must 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. P1=F9MIT ADMIN STRAT ADDRESS :-Vft- d LJS Region 1 Headquarters, Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATgRE DATE Page 1 of 4 Jul 10, 2003 NFw YORK STATE DEPARTMENT OF ENVIRONMENTAL COk";0VATION SPECIAL CONDITIONS 1. The storage of construction equipment and materials shall be confined to landward of the bulkhead. 2. Equipment operation below apparent high water is strictly prohibited. 3. Proposed sand fill shall be of similar grain size, texture and color of the existing beach material. 4. No fill is authorized below apparent high water. DEC PERMIT NUMBER PAGE 2 of 4 1-4738-03174/00001 'ORK STATE DEPARTMENT OF ENVIRONMENTAL CC VATION _ ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5), a4, 75, 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 oralter 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 under6NYCRR Part608,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 least48 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 DreDared by Thomas Petrosino stamped NYSDEC approved 7/9/03. DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-03174100001 i NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL COivseKVATION 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,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 underarticle 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 ib'4odifications,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 4 OF 4 1-4738-03174/00001 -2ai tate�—sd New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed- below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Number Ex i rat i n ®ateJ 3 p o NOTE: This notice is NOT a permit 10 G) m IEW FROM SKY LOOKING DOWN A NORTH Iw�uWIg 1,�, ,mhmd Slow `RUCK _ ACCESS II 900 via W ROGERS ,3OUTHMD,NEW Y(M �7 I us Ave. ROGERS R soufflow,N.Y. RODGERS. LAB PRc RTY ! I DMAN ROAD LIMES -- PROPERTY PEMOSINO EXISTING BULKHEAD LINE PROPERTY 33 FEET f- --- LINES _1-�'- -—1,%MET — __ _ EXISTING BULKHEAD EXISTING � - - - -r-- -- -- -- - � - 10 EEET BULKHEADS i;-�- �-CL t- L_ -(_� ����� i�L_ LL-L-L_ i i i i i i i i ! " L_ NC1�DR sHmENT AmA(2 FEET-m"AYG.) I -L- i �__!— L_ I_L, USING FlNE SAND -- LLLLL iLL "PROWD ASS MR TERA" �- APPROX.20 FEET AND CONDITIONS OF t+AI 11At9�C PER1,4IT NO. -1I 3� SCALE: 1 ' a 30 FEET DATE 6 MLW PREPARED BY: 50¢1O � - X 150 3t 2 = Cu.Fta 333.3 Cu.Yam. T m PetroWno OWNER:ESTATE OF GRACE R.LEWIS BEACH NOURISHMENT PROJECT BEiN ESTATES ASSOCIATION TOWN AND VILLAGE OF SOUTHOLA,NEW YoRK APRIL.16,2=01EMED) F- 7- ;r r rr ril Ift ,®r", x X 12 In Yl� � � -NNW 3' fill e .7 P. 7 'n A. —1 NOTICE OF COMMENCEMENT OF CONSTRUCTION AM RETURN THIS FORM TO: COMPLIANCE Iftwe Marine Habitat Protection mew NYSIDEC Building 4,0-SUNY FOR FAX TO: (631)444- Stony lk, NY 11790-2356 - - _,TICE OF COMMENCEMENT OF C, 4TRUCTION RETURN THIS FORM TO: COMPLIANCE Marine Habitat Protection NYSDEC Building 40 -SUNY OR FAX TO: (631)444-0297 Stony Brook, NY 11790-2356 PERMIT NUMBER: v�V ISSUED TO: PROJECT LOCATION/ADDRESS: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to Supplementary Special Condition D 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 available at the site for Inspection in accordance with general Condition No. 1. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT AND/OR ANY ASSOCIATED 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.PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON- COMPLIANCE WITH PERMIT CONDITIONS. Cut along this line ............... .........................................................................................................................................,................................. ....... NOTICE OF COMPLETION OF CONSTRUCTION COMPLIANCE RETURN THIS FORMTO: . Marine Habitat Protection NYSDEC Building 40-SUNY Stony Brook, NY 11790-2356 OR FAX TO: (631)444-0297 PERMIT NUMBER: ISSUED TO: PROJECT LOCATION/ADDRESS: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to Supplementary Special Condition D of the referenced permit, you are hereby notified that the-authorized activity was completed,.on We have fully complied with the terms and conditions of the permit and approved plans. (Both signatures required) PERMITEE - DATE CONTRACTOR ___ DATE THIS NOTICE, WITH PHOTOGRAPHS OF THE COMPLETED WORK AND/OR A COMPLETED SURVEY, AS APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. 95-19-3 (8/00)pfp JOINT APPLICATi vi.. :�.... York state FOR PERMIT " ' United States Army Corps of Engineers Applicable to agencies and permit categories listed in Item 1. Please read all instructions on back. Attach additional information as needed. Please print legibly or type. 1.Check permits applied for. 2.Name of Applicant (Use full name) by Thomas Telephone Number (daytime) NYS Dept of Environmental Conservation BEIXEDON ESTATES ASSOCIATION Petrosino 718 335 3000 ❑ Stream Disturbance(Bed and Banks) Mailing Address P. 0. Bog 1432 ❑ Navigable Waters(Excavation and Fill) Post Office State Zip Code Docks,Moorings or Platforms ❑ (Construct or Place) SOUTHOLD NY 11971 ❑ Dams and Impoundment Structures 3.Taxpayer ID (If applicant is not an individual) (Construct,Reconstruct or Repair) 11-1353410 ❑ Freshwater Wetlands ❑ Tidal Wetlands 4.Applicant is a/an: (check as many as apply) with deeded ❑ Coastal Erosion Control ❑Owner Operator ❑Lessee ❑Municipality/Governmental Agency rl hts ❑ Wild,Scenic and Recreational Rivers 5.If applicant is not the owner,identify owner here- otherwise, you may provide Agent/Contact Person information. ❑ 401 Water Quality Certification Owner or Agent/Contact Person ❑OwneXMAgent/Contact Person Telephone Number (daytime) ❑ Potable Water Supply GRACE LEWIS ESTATE — JOHN NIMES 631-765-3416 ❑ Long Island Wells Mailing Address P. 0. Box 56 ❑ Aquatic Vegetation Control post Office State Zip Code ❑ Aquatic Insect Control SOUTHOLD INY 11971 ❑ Fish Control 6.Project/Facility Location (mark location on map, see instruction 1a.) NYS Office of General Services County: Town/City/Village: Tax Map Section/Block /Lot Number. (State Owned Lands Under Water) SUFFOLK SOUTHOLD / SOUTHOLD ❑ Lease,License,Easement or Location (including Street or Road) Telephone Number (daytime) other Real Property Interest BEACH IN FRONT OF 845 ROGERS RD. SOUTHOLD 717 335 3000 ❑ Utility Easement(pipelines,conduits, cables, etc.) Post Office State I Zip Code 1 7.Name of Stream or Waterbody (on or near project site) ❑ Docks,Moorings or Platforms SOUTHOLD NY 11971 NORTH SIDE OF PECONIC BAY (Construct or Place) 8.Name of USGS Quad Map: Location Coordinates: Adirondack Park Agency ❑ Freshwater Wetlands Permit NYTM-E NYTM-N 4 ❑ Wild,Scenic and Recreational Rivers J.Project Description and Purpose:(Category of Activity e.g.new constructionrinstallation,maintenance or replacement; Type of Structure or Activity e.g.bulkhead,dredging,filling,dam,dock,taking of water, Type of Materials and Quantities; Structure and Work Area Dimensions;Need or Purpose Served) Lake George Park Commission - ❑ Docks(Construct or Place) - ❑ TO RESTORE ERODED BEACH WITH FINE SAND ON Moorings(Establish) ___ ---------------------------------------------------------- ______________ US Army Corps of Engineers BEACH IN FRONT OF 845 ROGERS ROAD ❑ Section 404(Waters of the United States) ❑ Section 10(Rivers and Harbors Act) (K TENDING 150 FEET EAST-OF_ROGERS-ROAD-AND_ SOUTH-50 ❑ Nationwide Permit(s) Identity Number(s) ------ T__01F_THE.-EXISTING-BULKHEAD-AT_8.45_ROGERS-ROAD)------------- For Agency Use Only: DEC APPLICATION NUMBER ---------------------------------------------------------------------------------------- US ARMY CORPS OF ENGINEERS ropos se: 11.WIII Project Occupy 12.Proposed Start 13. Estimated Completion El El El State Land?❑ a Date: ASAP Date: 31 MAY 2003 Private Public Commercial Yes No 14.Has Work Begun on Project? (If yes, attach ❑ 15.List Previous Permit/Application Numbers and Dates: (If Any) explanation of why work was started without permit.) Yes No 16. WIII this Project Require Additional ❑ IM If Yes, BEACH NOURISHMENT Federal, State,or Local Permits? Yes No Please List: 17. If applicant Is not the owner,both must sign the application I hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further,the applicant accepts full responsibility for all damage,direct or indirect, of whatever nature,and by whomever suffered,arising out of the project described herein and agrees to indemnify and save harmless the State from suits,actions, damages and costs of every name and description resulting from said project. In addition,Federal Law,18 U.S.C.,Section 1001 provides for a fine of not more than or use f 0 Imprisonment for not more than 5 years,or both-__/ applicant k i d willingly falsifies,conceals,or covers up a s or knowinglys or uses a Ise,fi Gous or fraudulent statement. f Date '✓ O� Signature of Applicant �� Title Date Signature of Owner Title 14.16-4(12/97)—q SEAR PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1—PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME BEIXEDON ESTATES ASSOCIATION BEIKEDON BEACH RESTORATION 3. PROJECT LOCATION: BEACH IN FRONT OF 845 ROGERS ROAD, SOUTHOLD SUFFOLK Municipality County 4. PRECISE LOCATION:(Street address and road intersections,prommen andmarks,etc.,or provide map) BEACH EXTENDING 150 FEET EAST OF ROGERS ROAD AND 50 FEET SOUTH OF THE EXISTING BULKHEAD ON THE PROPERTY OF 845 ROGERS ROAD 5. IS PROPOSED ACTION- 0 New ❑ Expansion *FModification/alteration 6. DESCRIBE PROJECT BRIEFLY., TO RESTORE AN- ERODED BEACH FOR RESIDENTS USE 7. AMOUNT OF LAND AFFECTED: 0.11 0.11 Initially acres Ultimately acres B.tILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If no,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? XX Residential ❑ Industrial -0 Commercial ❑ Agriculture ❑ Park/Forest/Open Space. ❑ Other Describe: PRIVATE BEACH FOR RESIDENTS 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(Federal,State or Local)? ❑ Yes X3 No If yes,list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes JkNo If yes,list agency name and permittapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes ❑ No N/A I, ERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE _ 7 ApplicBnUSponsor Nam D �T�U� NU 4 des I D,-� y�S GIv�j/Dh/ Date 7/.74 Signature ,r �✓ >�-L� ��-CJ If the action Is in the Coastal Area,.and you area state agency,.. complete the Coastal Assessment Form before proceeding with this assessment OVER B lion Oq 04 JSo p N NAAIp �, y RS 3 A.W BEACy uC NOgT LANE m Ay m�N fLC O OV �! 9y �I IE R m o e° a° yes t — � o C BEACNROAD pEC �� 'o�N In. IC ORT c ° PARK w fS ARA 6t e c EI D 'L y ®!/TH � YENNECDT N •1. p4e d a� L i a �J rz ; MAIER S,F 1 P Pf G D tE NFLDS R. _ (/ ERS 9T. N ..olF � ,- o po• O1, BLD��jjARLIN D S?�ep`L�`prJ"✓�. � p o o /eNyyDy~. J a \ o �p bddpkyd ?z ECHANI TOWH KDR •. 1 $2 _wE 6 y1\° SGH ST p � � W,P• c R,R. Z CaP 5 HARD1 R1 •PLRD.E. L�AAM " oa+� �, f�°5 Q h• 11LLLlllllPEC JERNIC o !O Vd+D �P ��`•` rem oC n apP /JMYIrApl P/ SCHOOL Cr cie a din0 w4 ¢�. fth 11971 RDN E 3NLPA�hv� Q� STOP o R m N SOUTHOL - � 3 �'V• V$ SJ CR �go+ro Goose a I NEST NECA' TH P rER PC. Cr" �O. I BEACy sE V\EDR^E' T 0 y y/c Ny.F.AV �O \ 1 FHi ooy i �O \`�I R°' 2 ma �/�y' GPF' �O.yJ09 H9 R K Pr HATE IT 9FF ti a.fke PC,�e'p° y6 Q;yC� B� I m Ro D. Richmond a /POyc e )o lllJJJLLL 111LLL — `0 BDWRD d �•//yJ q0 \� a �P OP Z 90 CrNk W 6WAM xO E o io 90@� e6 u 9i 0� �S` I OERS F LLEY HOOTLED F 4 2 S•tQp, W vUN ST O �,� rip OQ •F O H �° were Cohy o`o <F wA_oPR 9Pe° �j?P D EF ese. 8431RO p0�1 �bs oEEO N ` � C/� .P � ti0a n00 Qo QB/MSONQ I H1D0iPAtN�\t John J. Nickles Box 56 1 Southold, New York 11971 April 4, 2003 To Whom It May Concern: I am the owner of the beach in front of 845 Rogers Road,Beixedon Estates, Southold, New York. This parcel is know as lot 39, Block 2, Section 66, and District 1000 on the Suffolk County Tax Map. I authorize The Beixedon Estates Property Owners Association to make application to NYSDEC for the purpose of adding sand to the aforementioned parcel. VT. NkUl T 1 Jo , Executor Thf Grace R.Lewis JJN:hs AMMW , : r. BAY Ell • — �.� J rr•Ii ROUTE 25 JERICHO TURNPIKE N,r•�; .i 4 SLR'�In/,` I rJ 9 8��1' ' 86.*J 8z.7/ 8Z.7/ 9Z.69 V 7 •o M1_1q P OF ° ^° z �° 3 yo 4 N 3 E/XAED O V ES TA TES \ a*o �r �t'I ^-, `y .3 ti TO W/V OF- SO CJTHO 2fn) ti ego > n SUFFOLK COUNTY, /V. Seo/e in feet Z o too too 700 • — — p 'V �+ao 7 �r 1 4 p p /ca:ys o n QJ z 2 N PROPERTY OF l�Qa • y -e•�- }-�,�7 j�.�. /�. Fc/PMERLY GRACE/I'OGERS D_r8arZDON ° by ^ Q/ S° / r n 9• ro ` �� !r^o ff 4 GQJ ^� /9 y �. / ��• h n 4\ Z7a n� p "9 / In Not'v. No offer 0 f dcdieotiorr of the strceTa /3 y°�o/ 2' z y .,, orb c,chea fier4e r i9/.,,./e tv Me/oah/ic. ". 4 a� /6lov ay ,o Al / e Z o H.va• 'r#'c. p i o Iwo ." 16 d �( ,�, dd• 0 f' lal•fr t�. � •n /`/.7•I't/'moo"E. . Iwo d•.00 I`a.ol i ao[ F i 7 ` .. Y o .•7� Q � N.7a•0o•6. 1- -•�. ., -• AA"� d .a. I: ° t6i ' �w �8 •' to �' lop .—Do 1; I� C4 10♦Fp`f Z ^° �51 ,L a •• •� oo ^o . N W a POOROME o'•+'O I�d•c .� 1�-.t � QM rLa•7rop o. o ,iv � /9 ^ r N Z 00 1 l Za a 4 n ^ o 0 1(I ° 9 0 {. o 97.° ° \Y 1r�� 1OO no � � 2709 ' 21 41 e•° } ° ' I elzoli 2 .1. M1� ,t c z Z n — ' V ya j.0 '9j°, ° 1 -%®F I'�Q°lo°•° -f d� l2ot J 1V12.3 3 \=. I u C I;n .4 It e W5 • - �o , %�1 .•c� ` s is oosa +a'+`' .s.>a'°t•wZ w� l,ol °ti • _ 0 o° IL . _. — •- (P�;�--r�• tom,, - J�_ A E p- by me fPai.rts � • ; S art,/Wy �/ 11 _[ , � � - ram; <'+�'.: �����a`= �. � � / . . . '' "' .- . � S �-. . ��_ -- � -� � 1 . ��'` ���_- .a" ij _ �.ti... :. Vie, :: a ..� � .+�' __ 1 _ � Z� ''i; � •w� it �.} ....bra•.�Ir --d�'Ty•yy��� ,! •.�Y�i.��*t« -� • 15 _ wM •:, � / ,•:-�� awe 1 _ .,w � � !�*�, � :..i.. �1 , ----_ i i _�• •wo I �•1�.�tit.aw: :l i 11 1 1 l�1 1 1. July 16, 2008 Board of Trustees Town of Southold Town Half 53095 Route 25 Southold, NY 11971 Re: 1000-066-02-039 The Estate of Grace R. Lewis Dear Trustees: Enclosed you will find an application to place sand on the aforementioned lot. The purpose is to re-establish beach area reduced by erosion. We would like to request a pre- submission meeting on August 13, 2008 with the trustees for advice and direction on how to proceed. Sinc ly y ur Willia lis P.O. B x 816 South o Iv'Y 11 71 �� C `�E � � "* 1J i1 fJ i ' J U L 1 7 2008 Southold Town Board of Trustees • LEWIS NICKLES East Main Road • P.O. Box 877 • Southold, NY 11971 REAL ESTATE Phone: (631) 765-3416 • Fax: (631) 765-4096 www.lewisandnickles.com July 9, 2008 Board of Trustees Town of Southold Southold, New York 11971 Dear Trustrees; This letter authorizes you the trustees to meet with Mr. Willaim J Bayliss ,who is acting as my agent on a beach nourishment application$Wthe following property known as , Lot 39 , Block 2, Section 66 and District 1000. thank you. Sic r ly, 1 ` Jo i J. Nickl , Executor For the Estate of Grace R. Lewis MEMBER: New York State Association of REALTORS ,\ National Association of REALTORS James F.King,President ��q SoUryO Town Hall Jill M. Doherty,Vice-President �O l0 53095 Route 25 P.O.Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen • O Bob Ghosio, Jr. Telephone(631)765-1892 � � CDUNTI,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION INSTRUCTIONS IN ACCORDANCE WITH CHAPTER 275—WETLANDS & SHORELINE § 275-6. Application. A. Contents of application. A permit may be issued upon the written, verified application of the person proposing to perform operations on wetlands. Three copies of the complete application, including all written descriptions, pictures and surveys, shall be submitted to the Clerk. Such application shall contain the following information: [Amended 10-11-2005 by L.L. No. 17-2005] (1) The name and address of the applicant and the source of the applicant's right to perform such operations (e.g., whether applicant is the owner, lessee, licensee, contractor, etc.). In all cases where the applicant is not the owner of the premises where such operations are proposed to be conducted, the notarized consent of the owner, duly acknowledged, must be attached to said application. (2) A scliedule'for the proposed activities with a completion date. (3) The purpose of the proposed operations. (4) The amount of material proposed to be removed or deposited, and/or the type, size and location of any proposed structure. (5) A description of the area from which the removal or in which the deposit of material is proposed, or in which structures are to be erected. The description shall be appropriately referenced to a permanent reference point or monument. (6) The depth to which the removal or the deposit of material is proposed throughout the area of operations, and the proposed angle of repose of all slopes. (7) The manner in which the material will be removed or deposited, or structures erected. (8) Such application shall be accompanied by a survey and topographical map, created no more than one year prior to the date of application, with contours at two-foot intervals, showing all wetlands within a two-hundred-foot radius of the area from which the removal or in which the deposit of materials is proposed, or in which structures are to be erected, certified by a registered land surveyor or registered professional engineer, licensed by the State of New York. Such survey and topographical map shall show the soundings of the area in which operations are proposed to be conducted. The horizontal control of said survey shall be based on an approved local coordinate system. The vertical control for elevations shall be based on the United States Coast and Geodetic Survey datum. [Amended 10-11-2005 by L.L. No. 17-2005] 2 (9) A statement of the effect, if any, on the wetlands and tidal waters of the Town that may result by reason of such proposed operations. (10) A statement describing any known prior operations conducted on the premises in question and whether any prior licenses or permits have been issued to erect structures or to dredge or deposit fill on said premises and whether any such permits or licenses were ever revoked or suspended by a governmental agency. (11) Documentary proof of permits that have been applied for, are pending, and have been granted, including but not limited to NYSDEC, Suffolk County Health Department,USACOE. (12) A description of how the proposed activities will be mitigated, including erosion control, replanting and restoration, designated points of access. All proposed operations will be clearly defined on a survey and described in a project narrative. The Trustees reserve the right to require specific replanting and restoration methods. Any replanting and restoration guidelines shall be in keeping with guidelines set by the Town of Southold. (13) Current photos of the subject area showing the proposed area of operations from at least two opposite directions. Each photo should be labeled with the date, time and direction. The location of the photos shall be noted on the survey, project plan or provided on a separate sketch map. (14) Drainage upgrade. At the discretion of the Board, nonadministrative applications may require submittal of a drainage upgrade plan. This plan must indicate how all existing and proposed on-site drainage from a two-inch rainfall is retained within the subject parcel landward of the wetland boundary. Retention can include but is not limited to infiltration or impoundment. All drainage plans shall show the calculations used to develop the plan. At the discretion of the Board said plans may require certification from a licensed engineer. (15) All permit applicants shall submit to the Board of Trustees an affidavit signed by the owner of the project property which indemnifies and saves harmless the Town of Southold from any claims arising out of or connected with operations under the permit and from all acts, omissions, commissions or negligence on the part of the applicant, his agents or employees, in such form as shall be approved by the Town Attorney. (16) An ethical disclosure statement as provided by the Town of Southold relating to applications for permits and other governmental requests. (17) A statement indicating that submission of false information will result in rejection of the application and may subject the applicant to criminal sanctions. (18) A completed Local Waterfront Revitalization Program Consistency Assessment Form. [Added 10-11-2005 by L.L. No. 17-2005] B. Waiver of certain requirements. The Trustees, upon request of the applicant for a permit, may waive, in whole or in part, the provisions of Article II, § 275-6A(8), (11), (14) or § 275- 11A(2) where it finds that the nature of the proposed operations is such that the requirements of such provisions are not necessary for a proper consideration of a permit application. The resolution providing for the waiver shall clearly indicate why the waiver was granted. § 275-7. Fees. A. Every application for a permit filed with the Clerk shall be accompanied by a filing fee of $250, which includes the first site visit, no portion of which shall be refundable. The fee for an administrative permit shall be $50. For structures that have been previously built without a permit, the fee will be doubled. If a preapplication site visit is requested, the fee shall be $50. [Amended 10-11-2005 by L.L. No. 17-2005] 3 B. In addition to the filing fee, the Trustees, upon the adoption of a resolution authorizing the issuance of a permit, shall determine the amount of the inspection fees to be paid by the applicant to the Clerk upon the issuance of a permit. Inspection fee costs will be based on $50 per site visit. C. Pursuant to New York State law, all costs incurred by the Town for SEQRA review shall be paid by the applicant. D. Consultant fee. The Board, at its discretion, depending on the scale and potential impact of proposed operations, is authorized to require the posting of a consultant fee by an applicant. This fee shall be used to hire an independent, expert consultant to investigate the site for the proposed project and to examine the plans or other information submitted by the applicant to assist the Board in evaluating potential adverse impacts upon a resource area by the proposed project. The Board, in its discretion, will determine whether the complexity of the activity, the difficulty in determining the threat to the resource areas or the size of the request or project involves and requires more information and analysis than can reasonably be supplied to the Board without independent technical professional assistance. (1) The Board may require the payment of the consultant fee at any time in the deliberations prior to a final decision. (2) The consultant fee may be required for expert opinion regarding,but not limited to, wetland resource area surveys and delineations, analysis of resource area values, wetland resource area reports, hydrological and drainage analysis, wildlife habitat analysis, shellfish surveys, and environmental land use law, or any of the following: (a) Placement, removal or grading of at least 50 cubic yards of material; (b) Five hundred square feet or greater alteration of a resource area; (c) Shoreline or bank alteration to a coastal or inland waterway; (d) Five hundred square feet or greater alteration to land in a naturally vegetated condition that constitutes a resource buffer area. (e) Discharge of any pollutants into or contributing to surface or groundwater of the resource area; (f) Construction of any storinwater control facility, or water control structure. E. Dock and float fee. Every application for a new dock or float shall include a fee equal to $3 per foot of linear length for residential and commercial docks. Commercial docks are any structures that are rented, leased or otherwise used to generate income, including, but not limited to, those structures located on properties zoned MI and M2. [Added 10-11-2005 by L.L. No. 17-2005] James F. King, President *0f SUUIy� Town Hall Jill M. Doherty,Vice-President �� l0 53095 Route 25 P.O.Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. �� Telephone(631) 765-1892 Iy�DUN�'� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit —Amendment/Transfer/Extension _Received Application: Received Fee:$ _Completed Application _Incomplete _SEQRA Classification: Type I Type II Unlisted —Coordination:(date sent) _LWRP Consistency Assessment Form _CAC Referral Sent: _Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Teciviical Review: Public Hearing Held: Resolution: ' Name ofApplicant C i F o� LEWIS Address -T-, ,3d� .5L SOtt 101CC NY ` !nj�l- aOS� Phone Number44 Q�Y- 3 N I b Suffolk County Tax Map Number: 1000 - Property Location: EAC� �FbdT O F 5 � �37afjL) I+y �Oew'r'5 S-0 '� o� (provide LILC rO Pole (#, distance to cross streets, and location) AGENT: W 1 t �1 f'►'t I A- !lS (If applicable) Address: SOAOJ© Iv l 6 l 0�)b Phone: ` �, / Board of Trustee's Application BGENERAL DATA Land Area (in square feet): I ! j G Area Zoning: qo Previous use of property: JA m m kip L-H Intended use of property: W IM ► qk) 1k-t-I Covenants and Restrictions: Yes 1/ No If"Yes",please provide copy. Prior permits/approvals for site improvements: Agency aF ��/✓in�N► g[ Cori 0-0 03 0 400a 10 03 Ab U5 mrvl f 09450�-- No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? _ No Yes If yes, provide explanation: Project Description (use attaclumnts if necessary): �&Ack ✓gio b 004,91(4. MQAOT Board of Trustees Application WETLAND/TRUSTEE L( 21ANDSAPPLICAA�T11ION DATA. Purpose of the proposed operations: �4G1„ ( � IV 0 k( bh Yti► � Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 0 N feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? Z—No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? 334 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: J oN& ' A Fi 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: �j Gh l0'� p LA t Sh M P 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?, INo�J� (cubic yards) How much material will be filled? 33`1 (cubic yards) Manner in which material will be removed or deposited: l R u C Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) �ID 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. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) (registered)mail. Sworn to before me this Day of , 20 Notary Public 617.20 SEOR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be complete b Applicant or Project Sponsor) 1.APPLICANT/SPONSOR D00niv 2.PROJECT NAME 3.PROJECT LOCATION:Municipality ecufl' o County 5 Lkr-F-L?L1(- 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map StAKO L-VI r?oAtv+� Tlrk Y-W 1 Do o -t.G - - 3 5.IS PROPOSED ACTION: New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: 'UX't215� v-,1; 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ❑Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space Other (describe) __6 l; wi, �__QZ)^) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FZN. State or Local) ❑Yes If yes, list agency name and permit / approval: 11. DO ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APP OVAL? es ❑No If yes, list agency name and permit / approval: 020 9 -t 1-�1'73$rV3l �y-- Dov � �� o � ��ia�o3 2 Ps v � CyN . 12. AS A RES 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 / S nsor N me Date �A "Signature �J 61 If the ac on 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 E EED 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 b superseded by another involved agency. ElYes Vo 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: 00..E 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: W.._ ... _ __.._._. ........ .. ......... _... ...... _....... 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 C1-05? Explain briefly: _._...._. ............._ .._.._...... . ........_.. _._.... _...... _...... _..._.._.__. C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: cJ ON D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTA REA(CEA)? If Xes,ex lain briefl : Yes RNo E. IS THERE,OR IS RE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yesEl 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) Board of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS TH T HlYISHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHOMREOF , THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTERY TO SPECT THE PREMISES IN CONJUNCTION WITAPPL ATION. i natu e SWORN TO BEFORE ME THIS DAY OF C.t I 20 0 Notary P IC Lorraine LaRosa NOTARY PUBLIC,State of New York No.01 LA6059257 Qualified In Suffolk County Commission Expires May 29,20 I Board of Trustees Application J AUTHORIZATION (where the applicant is not the owner) residing .at f (print owner of property) (mailing address) do hereby authorize (Agent) W ' j n 3 �" `� � �=�. �1�� � �� to apply for permit(s) from the. Southold Board of Town Trustees on my behalf. caner° s signature) 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: �. t (Last name,first name,diddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other !� \ ,�) (If"Other",name the activity.) L7 ai g�'� "�t121 Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%o e shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of `� � 200 Signature Q Form TS 1 y Print Name .�4 /"U!C/�L�o d45 � Town of Southold g Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM col PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN District Section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. ---------------------------------------------------- Item Number: (NOTE: A Check Mark(4)for each Question is Required for a Complete Application) Yes No ---------------------------------------------------- Will this Project Retain All Storm-Water Run-Off Generated by a Two(2")Inch Rainfall on Site? (This item will include all run-off created by site clearing and/or construction activities as well as all Site — Improvements and the permanent creation of impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location? ElThis Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFlowl — 3 Will this.P�oject Require any Land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? — 4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of ❑ Five Thousand(5,000)Square Feet of Ground Surface? 5 Is there a Natural Water Course Running through the Site? F] Is this Project within the Trustees jurisdiction or within One Hundred(100')feet of a Wetland or Beach? — 6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen(15)feet of Vertical Rise to ❑ One Hundred(100')of Horizontal Distance? 7 Will Driveways,Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off ❑ into and/or in the direction of a Town right-of-way? 8 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of ❑ any Item Within the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within the One Hundred(100)Year Floodplain of any Watercourse? ❑ NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, a Storm-Water,Grading, Drainage&Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit! ---------------------------------------------------- EXEMPTION: Yes No Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question,a Storm-Water,Grading,Drainage&Erosion Control Plan is NOT Required! — ———————————————————————————————————————————————————— STATE OF NEW YORK, COUNTY OF...........................................SS That I. ................................................................................ being duly sworn,deposes and says that he/she is the applicant for Pennit, (Name of individual signing Document) Andthat he/she is the .................................................................................................................................................................... (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner of Owner's,and is duly authorized to perform or have performed the said work and to make and file tus application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work v611 be performed in the manner set forth in the application filed herei6th. Sworn to before me this; ............................................... clay of............................................ ,20..... NotaryPublic: ...............................................................I.......................... ........................................................................... (Signature of Applicant) FORM - 06/07 95-193 (WW)Pfp JOINT APPLICATION New York State . FOR PERMIT " United States Army Corps of Engineers Applicable to agencies and perinit categories listed in Item 1. Please read all instructions on back. Attach additional information as needed. Please print legibly or type. 1.Check permits applied for. 2.Name of Applicant (Use full name) by Thomas Telephone Number (daytime) NYS Dept.of Environmental Conservation BEIKIDON ESTATES ASSOCIATION Petrosino 718 335 3000 ❑ Stream Disturbance(Bed and Banks) Mailing Address P. 0. Box 1432 ❑ Navigable Waters(Excavation and Fill) ❑ p Code Docks,Moorings or Platforms Post Office SOUTHOLD NYState Z111971 (Construct or Place) ❑ Dams and Impoundment Structures 3.Taxpayer ID (If applicant is not an individual) (Construct,Reconstruct or Repair) 11-1353410 ❑ Freshwater Wetlands ❑ Tidal Wetlands 4.Applicant is alan: (check as many as apply) with deeded ❑ Coastal Erosion Control ❑Owner .Operator ❑Lessee ❑Municipality/Governmental Agency rl hts ❑ Wild,Scenic and Recreational Rivers 5.If applicant is not the owner,identify owner here- otherwise, you may provide Agent/Contact Person information. ❑ 401 Water Quality Certification Owner or AgentlContact Person ❑Ownep)gTAgent/Contact Person Telephone Number (daytime) ❑ Potable Water Supply GRACE LEWIS ESTATE — JOHN NICKLES 631-765-3416 ❑ Long Island Wells Mailing Address P. 0. Box 56 ❑ Aquatic Vegetation Control Post Office Code ❑ Aquatic Insect Control SOUTHOLD NY e Zip 11971 ❑ Fish Control 6.Project/Facility Location (mark location on map, see instruction 1 a.) NYS Office of General Services County: Town/CityNillage: Tax Map Section/Block /Lot Number. (State Owned Lands Under Water) SUFFOLK SOUTHOLD / SOUTHOLD ❑ Lease,License,Easement or Location (including Street or Road) Telephone Number (daytime) other Real Property Interest BEACH IN FRONT OF 845 ROGERS RD. SOUTHOLD 717 335 3000 ❑ Utility Easement(pipelines,conduits, cables, etc.) Post Office State Zip Code 7.Name of Stream or Waterbody (on or near project site) ❑ Docks,Moorings or Platforms SOUTHOLD NY 111971 1 NORTH SIDE OF PECONIC BAY (Construct or Place) S.Name of USGS Quad Map: Location Coordinates: Adirondack Park Agency ❑ Freshwater Wetlands Permit NYTM-E NYTM-N 4 ❑ Wild,Scenic and Recreational Rivers J.Project Description and Purpose:(Category of Activity e.g.new constructionfinstallation,maintenance or replacement; Type of Structure or Activity e.g.bulkhead,dredging,filling,dam,dock,taking of water, Type of Materials and Quantities; Structure and Work Area Dimensions;Need or Purpose Served) Lake George Park Commission ❑ Docks(Construct or Place) - - ❑ Moorings(Establish) TO RESTORE ERODED BEACH WITH FINE SAND ON ------------------------------------------------------- --------------------- Us Army Corps of Engineers BEACH IN FRONT OF 845 ROGERS ROAD ---------------------------------------------------------------------------------------- ❑ Section 404(Waters of the United States) ❑ Section 10(Rivers and Harbors Act) -______--(EXTENDING-150- FEET-EAST- -OF_ROGERS-ROAD-AND_ SOUTH-50 -------- ---- ------ ---- - ------- ❑ Nationwide Permit(s) Identify Number(s) FEET__OF-THE_EXISTING-RULKHEAD_-AT_8.-45_ROGERS-ROAD)------------- For Agency Use Only: DEC APPLICATION NUMBER --------------------------------------------------------------------------------- US ARMY CORPS OF ENGINEERS 10.ProposedUse: 11.Will Project Occupy 12.Proposed Start 13. Estimated Completion pa ❑ ❑ State Land?[:] a Date: ASAP Date: 31 MAY 2003 Private Public Commercial Yes No 14.Has Work Begun on Project? (If yes, attach ❑ 15.List Previous Permit/Application Numbers and Dates: (if Any) explanation of why work was started without permit.) Yes No 16. Will this Project Require Additional ❑ ]M If Yes, BEACH NOURISHMENT Federal, State,or Local Permits? Yes No Please List: 17. If applicant is not the owner,both must sign the application 1 hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further,the applicant accepts full responsibility for all damage,direct or indirect, of whatever nature,and by whomever suffered,arising out of the project described herein and agrees to indemnify and save harmless the State from suits,actions, damages and costs of every name and description resulting from said project. In addition,Federal Law,18 U.S.C.,Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years,or bothZwh a an applicant kn to ty and willingly falsifies,conceals,or covers up a material fact;or knowingly maysor uses a false,fi 'cious or fraudulent statement.Date ✓ O Signature of Applicant / �� / Title��P f Date Signature of Owner TitleC �� 14-16-4(12/97)—q SE(�R PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPUCANT/SPONSOR 2. PROJECT NAME BEIXEDON ESTATES ASSOCIATION BEIXEDON BEACH RESTORATION 3. PROJECT LOCATION: BEACH IN FRONT OF 845 ROGERS ROAD, SOUTHOLD SUFFOLK Municipality ounty 4. PRECISE LOCATION:(Street address and road intersections,prominen andmarks,etc.,or provide map) BEACH EXTENDING 150 FEET EAST OF ROGERS ROAD AND 50 FEET SOUTH OF THE EXISTING BULKHEAD ON THE PROPERTY OF 845 ROGERS ROAD 5. IS PROPOSED ACTION: ❑ New ❑'Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: TO RESTORE AN ERODED BEACH FOR RESIDENTS USE 7. AMOUNT OF LAND AFFECTED: 0.11 0.11 Initially acres Ultimately acres 8.1eVILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? AkYes ❑ No If no,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? XX Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open Space. ❑ Other Describe: PRIVATE BEACH FOR RESIDENTS 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(Federal,State or Local)? ❑ Yes X7 No If yes,list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes ]&No If yes,list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes ❑ No N/A I, ERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE _ 7 $cIX� vt' `STrf't�5 Applicant/Sponsor Nam /0 ' _TeZ709)e' 0'��eS 1 D'_ y�SkGl v�j/ON Date 3 ��l 5 Signature `-rd t`�-�J r, ✓(� �G����-CJ If the action Is In the Coastal Area, and you area state.agency,. complete the Coastal Assessment Form before proceeding with this assessment OVER i.•HLtlN3oo�N � \OallosNiBc oa o a ODti V stay, a b1PWod TA 1fl 33a�b I Oy N`b0 as 3 O OHO tlM X41.3 3 a 000 �� °tea a -, ffd •O O . 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Nickles Box 56 -� Southold, New York 11971 April 4, 2003 To Whom It May Concern: I am the owner of the beach in front of 845 Rogers Road,Beixedon Estates, Southold, New York. This parcel is know as lot 39, Block 2, Section 66, and District 1000 on the Suffolk County Tax Map. I authorize The Beixedon Estates Property Owners Association to make application to NYSDEC for the purpose of adding sand to the aforementioned parcel. Ve yo Jo . Nickl , Executor Th state of Grace R.Lewis JJN:hs ■ rf As AtWrt&BAN _ A � r v �?9 OLD byrM n R n d go o- A lie, s 1 1 N � ®RT c fa�A.Y ff •� 1. E byp ®UTH YENN ? F o fi 3 3 i w ~ ,* G O : SL Ll V 7� v 9► vp�' t r A*d r/d az �• •}rb � a � eQq 7Qp ycN. EtTNI �9� D b O .E. wr M A. y, ` LA it1 ,RItNtG (!� �p/�•�0 o mot. a J• , a J °row9dori � til' G lewdly B 11971 WD _O D. SOUTHOLD a !' �M�EST NECK ti� i[ Nb ! Rf! !• a 00 bb GQS �,yrt BAY O. Rk O �G a O S fE'E' OOILEL Y E _ a .7lO. • �r \\ CC+wi ( M '' K/.\ Eghk� �� ~ e� OG[�I,SNE J ' yV J • J 0 V ROUTE 25 JERICHO TURNPIKE /./•,l.M�•E�.. .0 seplae/) I 910 B6.tJ BZ.J/ dZ.J/ 544-9 MA P O F Z 3 `o 4 � � . �.E/XED ON ES T11 TES ` O* T r F i''1 no; `,/ N�a !o•/o� /*o.o0. ^/ ^ TO WN O/e SO LITHO�O ^y o ` SUFFOLX COUNTY, N. Y. S- 6 ^ * 4 a h /F ^` 6- � � � n a /oo Jo° Joo roo Soo Co /rn.o i(Syd 7 , /u1 n p z 2 N 5^ PROPERTY OF e �' /F GRACE R. N/CKL_ES • F,/h4MERLY 6RACEROGERSDEBE/XEDON � � ° ��,�(o,A `9 ^tirP� � y _ 20 ^ Jo( do '" .9 Y •t9a Y / 41 e Vo7`C: NO af`tr o f dedication of fhe strccYs Or be/ehea shown heraa %d m.r/e 7`004 �,i r �o � /.g I . �•g a f /h E. Booth � Z i 70.° � i 16 M I d c .e cQc t) is M i /7(J2 - � '.� bd. 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(Flo �9 Se by m e Y I r urveyor orr,N.Y j x RAJ i. �Y r ' •tl i a r t f J' r N � �' •n ; 1j r�°j 1 A 1JOe ao N 0 1po op rp sst w �ro-� •y`' �v s p�ti o 9 a Gym cJ uz n 93 ?q(c J T �� j�> 9 oQ�,yq /, n y` 5L 1�8 1� �s �rr� :� ti (3 �./ jL 1.s ol ra)`�6' C3 5� c+ �r rAL j9 r � J� `p� t� r> 9 a r� ett 9L 9ri d)cb ?�6 ��oetto opt cA a \ N i 1-3 `9or Ln Sri 6' r 9vs� •? r� d) • al r: riSO o �� •y z a rfi' �J9 `r 99 $ �ell l r � , 1p it 0 �� •> fp Ln �o jay� y % Id" .0' 9� g4 .ryp���y lava, p O• �;, F O w:, "-5-/ 0 SvCT l / s. -�WRI _ �.�.t�—s� _ \/ f l�� 1� i I v ,� lid•1� / � w ,._- •__,fir'--- "�,, �../l' ;�~ ,f, ,T,�1, .t. v. .�:;' \ � ` 1! 417 ii I fig lie � � �. � ►�y LV low— -., f, ..:.;;+�►'Via► ��. i"- �_ � / f.� �'►Q`S ( '-' �vM', � ^P � 4"'t�1 1-I !nQ� -�•.� !� 7,� I .�/ \ gv- 7� +I J tj /1 17 �a 1, kA 7 ,ti90 a r r Tr i i OFFICE LOCATION: 4,° ° MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 ��S�FFO(,��o Southold,NY 11971 Main Rd.&Youngs Ave. �O Gti Telephone: 631 765-1938 Southold,NY 11971 Fax: 631 765-3136 0 y Z O � � LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Jim King,President Town of Southold Board of Trustees l IL�t I From: Scott Hilary and Mark Terry,LWRP Coordinators a g�~ AUG 2 0 Date: August 13,2008 Re: Chapter 268,WATERFRONT CONSISTENCY REVIEW Southold Town Wetland Permit for ESTATE OF GRACE R.LEWIS C/O JO NICK--Ward of Trustees SCTM#66-2-39 William J. Baylis on behalf of the ESTATE OF GRACE R.LEWIS C/O JOHN NICKLES requests a Wetland Permit to restore eroded beach with clean sand, landward of mean high water. Located: 885 Rogers Rd., Southold. SCTM#66-2-39 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program(LWRP)Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is our recommendation that the proposed action is CONSISTENT with LWRP policy standards and therefore is CONSISTENT with the LWRP. Policy 4 Minimize loss of life,structures,and natural resources from flooding and erosion. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. C. Enhance existing natural protective features and processes, and use nonstructural measures which have a reasonable probability of managing erosion 1.Enhance the protective capabilities of beaches by using fill,artificial nourishment, dredge disposal,or by restoring coastal processes. a.Use only clean sand or gravel with a grain size equivalent to or slightly larger than the native material at the project site. The proposed beach nourishment is a preferred approach to control erosion because of fewer environmental impacts than harden structures such as groins and bulkheads. The following best management practices (BMP's)are recommended. 1. Establish a natural drain system(vegetated) as buffer between beach and road-end. 2. Remove existing impervious road end surface and replace with permeable surface which will mitigate high flow stormwater demands. The BMP's will further LWRP Policy 5 Protect and improve water quality and supply in the Town of Southold. 2 - ' - 44 Pursuant to Chapter 268,the Board of Trustees shalt consider this recommendation in preparing its written determination regarding the consistency of the proposed action. James F. King, President ��OF S0!/Tyo Town Hall Jill M. Doherty,Vice-President l0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G '�' • �O Telephone(631) 765-1892 Bob Ghosio,Jr. �OIyCQUNTI Fax(631)765-6641 5 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ,,Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit Amendment/Transfer/'E'xttension ceived Application: 9 1 11 — VSeceived Fee:$ _Cempleted Application _Incomplete ? ! f _SEQRA Classification: J U L 17 2008 ji Type I Type II Unlisted _C ordination:(date sent) WRP Consistency Assessment Form Sout}hold Toivn :✓CAC Referral Sent: i O$ Board of Trustees _,-5ate of Inspection: U _Receipt of CAC Report: _Lead Agency Determination: Technical Review: 4<b-lic Hearing Held: O Resolution: Name ofApplicant CST t pa of e4kC k. Lewis c Address 'T C) ,`�d� 5-L SoLJuck NY l `qq1- 6)05,4 Phone Number:(44 Q�S" 3N i b Suffolk County Tax Map Number: 1000 - 10 C Property Location: �EAC 'rb o-r (� Zry r--O-rr • (provide LILCO Pole#, distance to cross streets, and location) AGENT: W V I F1"f'�'l I jlS (If applicable) Address: "0`��� � ACY / In /So Iv �� / D� C Phone: ` t 5 ✓� 9 ! v� Board of Trustees Applica n GENERAL DATA Land Area(in square feet): I l G Area Zoning: Previous use of property: ,( Intended use of property: V► qk) Covenants and Restrictions: Yes No If"Yes",please provide copy. Prior permits/approvals for site improvements: NA Agenev Date �F fLV&NA*AI Cod 4.1'493 D 3 0 -000q 1 03 GXP `/31 1Q00 9 A45 dS MMw c0450 rvpa W0103 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): :2pack. 5atu b 00!J0,A. M"-r Board of Trustees Applica n WETLAND/TRUSTEE LANDS APPLICAAAT��ION DATA. Purpose of the proposed operations: JA2A"� 5 ('b N 0 k 91'51 � Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 0 N feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 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? 334 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: No 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 Applica n COASTAL EROSION APPLICATION DATA Purposes of proposed activity: N 0 u 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?'INo(JJ- (cubic yards) How much material will be filled? 33`1 (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) (�oN� James F. King,President ��oF S0�ryo Town Hall Jill M.Doherty,Vice-President h0 l0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson 411 Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. �� �Q Telephone(631) 765-1892 ly`,ou Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of COUNTY OF SUFFOLK n STATE OF NEW YORK) AFFIDAVIT OF POSTING residing at b�5-y hW1;1�� ►T �V�'� V0-�ou Doti OlC( 0- l being duly sworn, depose and say: That on the 3 day of ju , 20 I personally posted th roperty known as "0A) e M i�� coo - - 1 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held 9_ 06a.Qt�O,06 P77, Dated: (signature) Sworn to before me this day oQu 142009 0,CL�tf No ary Public Lorraine LaRosa.:: NOTARY PUBLIC State of Neer l(OrIC No.01 LA605925f Qualified in Suffolk County- commission Expires.May 2SrL2Q,L NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: S CTM# 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. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,residing at ,being duly sworn, deposes and says that on the day of , 20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) (registered)mail. Sworn to before me this Day of , 20 Notary Public PROJECT ID NUMBER SEQR APPPENDIENDI X C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be complete lo Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT �, l ilia,(P.5T4re of--C.4AC4,, �. ice+ 1J s W- IV- oL(9('5 Ylil �T` 3.PROJECT LOCATION: r Municipality 9,C)"A o County .5 LkrFl7 L�\ 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 5'uFf_oLV1 Com,af� Tprk 0140 1ao o -LG - - 3 5. IS PROPOSED ACTION: New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: -u Lt V- 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ❑Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Feder State or Local) ElYes No If yes, list agency name and permit / approval: 11. DO ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPFOVAL; es No If yes, list agency name and permit / approval: I LI/ N 9 17&�- -*I-Ll07aa 031 0y-, D000 � ��ia o3 - '� 2 Ps v P- 510 . 12. AS A RESLIkT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Oyes UrNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S �ns>or N me Date - Sig Si nature V" 7 If the ac on 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 E EED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. 0 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 b superseded by another involved agency. Yes IFNo 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: 0 �L ..4_Or 9 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: ....._. �.0..... ......... .... ............_.. ...._. ......_............. ............ _........._. .....__....... .. ......... ........_...... _._.._. __.._.. _..._...... C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: Ilk- C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: L?fj 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 ENVIRONMENTA REA CEA? If Xes,ex lain briefl : Yes YNo E. IS THERE,OR IS RE 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 impactof 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) Board of Trustees Application County of Suffolk State of New York �Ali I _�Y I A-VLP S BEING DULY SWORN DEPOSES AND AFFIRMS TH T HENHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/BER 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 USTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO I OPERTY TO INSPECT THE PREMISES IN CONJUNCTION WIT RE OF HI 7APPL ATION. i natu SWORN TO BEFORE ME THIS DAY OF G 120 p g A pa, Notary P 1C Lorraine LaRosa NOTARY PUBLIC,State of New York No.01 LA6059257 Qualified In Suffolk County Commission Expires May .2011 1 LEWIS NICKLES East Main Road • P.O. Box 877 • Southold, NY 11971 REAL ESTATE Phone: (631) 765-3416 • Fax: (631) 765-4096 www.lewisandnickles.com July 9, 2008 Board of Trustees Town of Southold Southold, New York 11971 Dear Trustrees; This letter authorizes you the trustees to meet with Mr. Willaim J Bayliss ,who is acting as my agent on a beach nourishment application O/the following property known as , Lot 39 , Block 2, Section 66 and District 1000. thank you. Sic r ly, ` Jo J. Nickl , Executor For the Estate of Grace R. Lewis MEMBER: New York State Association of REALTORS National Association of REALTORS Board of Trustees Applii ion i AUTHORIZATION (where the applicant is not the owner) I, " ' d-qc vje14e:� esiding .at (print owner of property) (mailing address) ,aiglftyk,? r) / ' do hereby authorize ! Y (Agent) to apply for permit(s) from the. Southold Board of Town Trustees on my behalf. Yowner, s signature) 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action,s necessary to avoid same. I `� YOUR NAME: v (Last name,first name,x6iddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) 1�}�-1/� 5,4TJ 1, Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%o e shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); . B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of `� `�� 200 Signature Q Print Name .f4 t-,M1 s N f c lit o Form TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its si nif beneficial and adverse effects upon the coastal area(which includes all of Southold Town 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. _Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board o - s- s e�t1TPt epartment, all local libraries and the Town Clerk's office. ❑ B. DESCRIPTION OF SITE AND PROPOSED ACTIOT I1 I 1000 ❑`fit J U L 17 2008 I; -y SCTM# - 2 - 39 Southold lown PROJECT NAME GY-A r►,Lteji �Ij py4c Board of T tees The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation, land transaction) ❑ (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval,license, certification: Nature and extent of action: Location of action: Fool O �A (�,b �� I�or� �LS Soy Rol4 Site acreage: Present land use: Qi16Yi� Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: /n� n (a) Name of applicant.- �qq D f b QhC�'� I _U"S N,,-,ka-sa �o I (b) Mailing address: ? O �7( o k 15% So &4t-�a I l g Ir> (c) Telephone number: Area Code( ) %S` 3 Ll(10 (d) Application number,if any: Will the action be di ctly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III ' Policies Pages 3 through 6 for evaluation criteria ElYes ❑ No 2 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No [2 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Vyes ❑ No ❑ Not Applicable f�`✓ IP,;5 L. S 17�i�-fi Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 t;Notgh 1 for evaluation criteria Yes ❑ No Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Er Yes No Not.- ,dlicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 3;Not evaluation criteria. ❑ Yes ❑ No Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. S e LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YesEl No IP Not Applicable Attach additional sheets if necessary WORKING COAST POLI S Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP Yes ❑ No Not App Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ licable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town water . See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ElYes ❑ No E' Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P ges 65 through 68 for evaluation criteria. ❑ Yes ElNo Not Applicable PREPARED 131" L, TITLE gt,) 7 DATE r? 15 fig" tilt �A-y Li 5 July 16, 2008 Board of Trustees Town of Southold Town Hall - 53095 Route 25 Southold,NY 11971 Re: 1000-066-02-039 The-Estate of Grace R. Lewis Dear Trustees: Enclosed you will find an application to place sand on the aforementioned lot. The purpose is to re-establish beach area reduced by erosion. We would like to request a pre- submission meeting on August 13, 2008 with the trustees for advice and direction on how to proceed. Sine ly y cure l5 ji i JUL 1 7 2008 � 1 Willia lis ! P.O. B x 816 ---------__.____. - Sa;:tnoltl Town Southo NY 11 71 Board of Trustees 0 U, *g CM M Roo- "It'R K PC g4,�t 'N' jr �,Qw RZ, A 40P PgN FWAY A _pi.. 4eW 41� �la nt, A vv­ f 4 41 -va p"4 1�� APO ME, Ap:40 YV, J4, wl N VV, \d&X\,As( ............................. W �UA ION 4t, i� Y VY oqj OF L>jEpv,�j_ t 7 1 t,4 rvy-1 I 4T 1006 rip 6f. .......... 4". Atyew�y 25oo _-.1cr 1, flAf, t Q., A ,v VM ze, 50 ok 41, C0MCZVrF_ tW-D KA C Ar-�A "XI ;,T P SfxWA�0 Ll)-IIT 0 I Mi "'0 Q4 W APPROVED BY ON _ BOARD OF TRUSTEES TOWN OF SOUTHOLD Ng, DATE WIWI AUG A, C7, v prr<4wf� lo HEW cATe-1) gt6j�A Trus te A A A 4�,W 4appf,lt, 2, M, t4 NOWi 01 v �11 v I�x YC, Le X1 HOUL"l- SOO DiZAR-P-71!� -f F P `7n