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HomeMy WebLinkAboutTR-7365 .l Jill M.Doherty,President ti - Town Hall,53095 Main Rd. James F.King,Vice-President 16ft P.O.Box 1179 - -Dave-Bergen- - -- - - - --— —Southold;N-Y_1-1-971------------ - --_ Bob Ghosio,Jr. � Telephone(631)765-1892 John Bredemeyer ' fax(631)765-6641 BOARD OFTO.WN 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 $O SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st'day of construction '/2 constructed t/. Project complete, compliance inspection. p p •' _F ♦ it �. Y OF S:OUTHOLD TOWNTkUSTEES':BOARD ►,,,, F SOUTHOLD;`NEW PORK z PERMIT N0:,7365 DATE JULY 21` 2010 /e., 1\ s•. , . ISSUED`TO: NASSAU POINT PROPERTYOWNERS'.ASSOCIATION PROPERTY ADDRESS'. LITTLE PECONIC BAY ACCESS,ROAD, CUTCHOGUE ;? AU, HORIZATION Pursuant to the.provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of` -'t Southold and in.accordance with the Resolution of the Board of Trustee''s adopted at the meeting held on. July 21 2010,and.in considerat on-of application fee m the sum $250 00 paid by Nassau Point Property, f Owners Association and sb�ec to the Terms and con atsstated m the Resolution;the Southold Town, „....s. §'tees autliorizes,and permits he'followmg '• -`` _ / ' Wetland Permit to replace the beach access stairs; and as depicted on the site , ,r' plan prepared`by Peconc Perriut Expediting;last dated:A pril 14,t2010, and received on June 9,,2010; a IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed;' ' and:these presents to be,subscribed by a majonty-of the said Board as of this date 4 � r z It -.1 I r = i.:'iZt Z OV': iJ -•✓' .�1 s: ! ;� °':f ,of . '�r '..., t� + 9 .� "'.,. '` r, _. '�I = .r, I ,r' 1�1 i fi TERMS AND CONDITIONS The Permittee Nassau Point Property. Owners Assoc. residing at Little Peconic Bav Access Road,Cutchogue,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: l. That the said Board of Trustees and the Town of Southold are released from any and all damages,or claims for damages,of-suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Permittee will,at his or her own expense, defend any and all such.suits initiated by third parties,and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely;or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if,in the opinion of the Board of Trustees, the work shall`cause unreasonable obstruction to free navigation,the said Permittee will be required,upon due notice;to remove or alter this work project herein stated without expenses.to the Town of Southold. 8. That the.said Board will be notified by the Permittee of the completion of the work ...authorized. . 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. Jill M. Doherty,President �OF S0 Town Hall Annex James F.King,Vice-President ,`O� ��� 54375 Main Road Dave Bergen P.O.Box 1179 Southold,New York 11971-0959 ---- - Bob Ghosio,-Jr.--- --- - -- - -- John Bredemeyer O Telephone(631) 765-1892 IrDU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 21, 2010 Mr. Robert Lehnert Peconic Permit Expediting 32645 Main Road Cutchogue, NY 11935 RE: NASSAU POINT PROPERTY OWNERS ASSOCIATION LITTLE PECONIC BAY ACCESS ROAD, CUTCHOGUE SCTM# 111-9-14 Dear Mr. Lehnert: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, July 21, 2010 regarding the above matter: WHEREAS, Peconic Permit Expediting on behalf of NASSAU POINT PROPERTY OWNERS ASSOCIATION applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 9, 2010, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to.the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 21, 2010, 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, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of NASSAU POINT PROPERTY OWNERS ASSOCIATION to replace the beach access stairs, and as depicted on the site plan prepared by Peconic Permit Expediting, last dated April 14, 2010, and received on June 9, 2010. 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, Jill N Doherty President, Board of Trustees JMD/eac b�Q��}EFfl�k�d Jill M.Doherty,President Town Hall,53095 Main Rd. James F.King,Vice-President P.O.Box 1179 Dave Bergen - Southold,NY - ---- Bob Ghosio,Jr. -- - - - - � a --- -- - -- Telephone(631)765-1892 John Bredemeyer �` Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: /�t 5�ac t Po i n_� PFOP" n s c��• Please be advised that your application dated June. aO/y has been . reviewed by this Board at the regular meeting of 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) '/z 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: J TOTAL FEES DUE: $ SO v BY: Jill M. Doherty, President Board of Trustees %VFO�,�Co�s ' Peter Young,Chairman H Town Hall,53095 Main Rd. Lauren Standish,Secretary u• P.O.Box 1179 EO ` 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., July 14, 2010, the following recommendation was made: Moved by Doug Hardy, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit of NASSAU POINT PROPERTY OWNERS ASSOC. to replace the beach access stairs. Located: Little Peconic Bay Access Rd., Cutchogue. SCTM#1 11-9-14 Inspected by: Audrey Horton, Jack McGreevy, Peter Young The CAC Supports the application with the Condition the stairs are constructed with erosion control devices at the base of the supports and there is an engineered approach to slowing down the run-off down the slope, such as flow interrupters. Vote of Council: Ayes: All Motion Carried i 1 REPAIR & REPLACE 1 1 ACCESS STAIRS r 1 1 ; AT THE I 1 i r LEGEND LITTLE PECONIC 1 1 TG - TOP OF GRATE ELEV. BAY ROAD (CATCH BASIN) CL - CENTER LINE OF STREET TIC - TOP OF CURB ELEV. NASSAU POINT ROAD ;TOE OF HOPE 1 1 ,eben 0 v 72.5 - EXISTING SPOT ELEV. 1 1 - NST - NEW SEPTIC TANK CUTCHOGUE NY 1 . _ 1 1 dWeiling , N LP NEW LEACHING POOL ,;; , �, o NSD NEW STORM DRAIN -- 1 1 1 .-.e-.,..:... al nae S�On Wail 11 11 �� — __� - ,; °;;►, 1 ' .M �� ° yl� ————— 72.5—— ———— SCTM # 1000 — 111 — 09 — 14 1 a 3 5 ,me fe i ; �• _— ,�. , 11 ,;��16 1) ;r" EXISTING CONTOURS ot y....,„ W W 1 1 © a' '� EXISTING WATER SERVICE ;n Wald � _ --- ,� _ REVISIONS: DATE: 1 retoln _}_ s WAIN '� FOR TRUSTEES G-8- 10 358 O2` - O NEW GAS SERVICE / N_ _ - _G (not imp -- -----------3------------ _ - E E APPLICATION mas. ; pillar 1 ��8� ° ; ------------------------------------- -_ SERVICE _ ,- - 2o`�w NEW U.G. ELECTRIC '� . F = - ----------- D- ) ( D- ) C �I L� L _ l NEW OPEN C.I. GRATING NEW 50LID C.I. COVER Lpt # 3 6 NEW 8'-0" D I A. STORM DRAIN e111n9 0 ' Iv I r,ntrrE� Tarm of i ?aFs' ,, W SOi:i i�lrin Ii„ EXISTING SITE PLAN SCALE: 1 "=30' EXISTING LANDING STAIRS TO /kP F,'0Ve FE� � REMAIN AND BE ATTACHED TO _ PROPOSED LANDING AND STAIRS OARD OF UI 33ML;i 5'-°" TOWN OF SOUTHOLD DATE h 30' z 1 PROPOSED STAIRS SITE TO BULKHEAD LOCATION _.____,_...__.- P IT 200 m I ECONIC PERM °° ft / EXPEDITING 32G45 MAIN ROAD 20' I ' _ CUTCHOGUE, N.Y. PHONE : G3 1 .734.83G I s / s 4•'f t'' GxG ACQ POST (TYP. OF ALL) EXISTING BULKHEAD _ 4-O' CONSTRUCTED AS PER NYS DEC PERMIT # . _ `I, DATE: 4-14-10 1 -4738-03733/00001 ' r . 10' - ' �� ` DR. BY: R W L SCALE: AS NOTED PROPOSED STEPS TO ' o BEACH P - °' CHKD: + ' I '•,Y5 , sl f '+ 02010 Map Quest Portions02010 NAVTEO' PROJECT NUMBER SHEET NUMBER PROPOSED STAIR SECTION LOCATION MAP SCALE: I/4 — I -0 " 0905 Sp- I I SURVEY OF LITTLE FECONIC BAY ROAD A5 SHOINN ON "AMENDED MAP A OF NA55AU POINT" N FILED AU6U5T 16, I Q22 A5 FILE # 156 51TUATE: NA55AU POINT W E - TOWN: - 5OUT-HOLD- - - - ---- - - - - -- - - - - ----- - - -- 5UFFOLK GOUNTY, NY S SURVEYED JAN. 8, 2010 REVI5ED MARCH 25, 2010 Q U E N) 00 i� JUN - 9 2010 rzpturrn "An�etur t 9 Southhold Town ning Board of Trustees 26' �elop J 1 1NNNNCflI� 1 §� g \ + , 4ence won wall i % 1 1 `11111111�1``�� 11 91 N41 Lo 35 >�r ry — DI— x , p. O a 01 _�V wood .p i v µ 1 I 1 G 'rayed) ❑� �, N N I G G "(not--------------- imp -- r r p 59�! V 7Z / ,' J r 50 ® � �` � dwe111ng ?� r '- 'Ikuutharlaed altarotion or addltlon too.v 9 map .tl J a I-tl- fond>lrveyorb>eal I>a violation of>ecllan 1309,>ub-dlvi>fon 7,al the New York State Edvcallon Law." NOTE5t Only coplee from the Iq al of thm eu-vey arked with w orl9lrnl of the load surveyor 9 � elomped>eal shall be considered to be valid trve copto>' ■ MONUMENT roertnmouon>Indmalea hereon>lgnny wt tnl> vey was prepared In accordance with the ex- Q PIPE Ietby Gode of Prxtice far Lmd 5urvay>adapted qJ the New York State As>oclatbn of F'rote>slo%I Land su-veyor>. '.nitl certiflcallone>holl run Andy to the person for whom the survey b prepared. Area = 8,928 50 PT and 9a KtY behalf tlue campmy,gweer men- tal a grid lentl Institutbn Ilsted he on and a the egArea = 0.20 ACRES >fbb to Lertlflaa- irntitutloro ELEVATIONS REPERENGE NGVD'2Q JOHN Ca EHLERS LAND SURVEYOR GRAPHIC 5GALE 1"= 50' 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 -- --- RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.—C:\Documents and Settings\Owner\My Documents\My Dropbox\09\09\09-172.pro u, 07/ 14/2010 13 * 41 r Jill A Doherty,President Off' C4 P.O.Box 1179 James F.King,Vice-President Gy� Southold,NY 11971 Dave Bergen ti Telephone(631)765-1892 Bob Ghosio,Jr. y. � Fax(631)765-6641 John BredemeyerOe'� I Southold Town Board of Trustees Field InspectionMlorksession Report Date/Time: �� ) (� NASSAU POINT PROPERTY OWNERS ASSOC. requests a Wetland Permit to replace the beach access stairs. Located: Little Peconic Bay Access Rd., Cutchogue. SCTM#111-9-14 Type of area to be impacted: �,Sater Wetland Freshwater Wetland Sound 8ay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: I —Chapt.275 Chapt. 111 other Type of Application: ►/Wetland Coastal Erosion Amendment Administrative—Emergency Pre-Submission. Violation i Info needed: 1;1 Modifications: i I' Conditions: V IL- Present Were: JXing _J.Doherty_z Bredemeyer "ergen_ B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: li �I' 'I j NEW YORK STATE DEPAR°',\ NT OF ENVIRONMENTAL CONSERV) N Facility DEC ID 1-4738-03733 I, PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: ROBERT LEHNERT NASSAU PT RIGHT OF WAY 32645 MAIN RD NASSAU POINT RDISCTM#1000411-09-014 CUTCHOGUE, NY 11935 CUTCHOGUE,NY 11935 (631) 734-2011 p� Facility Application Contact: PECONIC PERMIT EXPEDITING INC . ,J U N - 9 2010 32645 MAIN RD CUTCHOGUE,NI' 11935 (631)734-8361. Southhold Town Board of Trustees Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Cutchogue Facility Principal Reference Point: NYTM=E: 715.044 NYTM-N: '4542.213 Latitude: 41°00'09.9" Longitude: 72°26'35.0' Project Location: Nassau Point Road- Watercourse-Peconic'Bay Authorized Activity: Reconstruct or repair an existing stairway'or walkway on a bluff or dune. All work shall be done in strict conformance with the attached plans stamped."NYSDEC Approved on 4/30/10. (JRP) SAP# 1-09-001 Permit Authorizations Tidal Wetlands-Under Article 25 Permit ID 1-4738-03733/00004 New Permit Effective Date: 4/28/2010 Expiration Date: 4/30/2015 NYSDEC Approval By, acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this i permit.t .. . . Permit Administrator:MARK CARRARA, Deputy Regional Permit Administrator. Address: NYSDEC REGION 4 HEADQUARTERS SUNY @ STONY BROOK150 CIRCLE RD STONY BROOK, NY 11790 -3409 Authorized Signature, Date*, 27 / .Zol d I . Page.1 of 6 Ds-ot v '�,•" i a!,s ue 1x J 1suE e � � 4. � � - 4 >�). ;\ `4.-�. _._ ..._._ ..__ .-- ' D-RS-9 % !-0>-x /J/ /.ip � o• � 04fe s QT ao i i �fx a.•ss w� s � e >♦ v o � d ® v` a ty �+ —N— Iz�:Ds �Q n s � S• y o-°D' ♦I [1°^O vain_ ? r O �yor° a� d d fi �� f-I e D'o� -o-ue f � �� m I `2a �°`� y e t E 5•t i•• �^ . v� � ." ,t•qte°' 1 tit ] � to ) ] t \tt 965T tut 2 cv to Lum ? s t ) t� l ' 4.l O O efcl I 5 6 6 8 r N pc 15 L111c1 0 9 •r Y t )„ °� � U t 66 6 T O J^ ` L1AIO®� .1 9�i� tt 6i t0 fib,�FSyo T3 O m.L6ikl $ 2°P /�� 15 )t Y tr_ t! F .n. 0 p ,M°to D� IC A' /�2lilU�i p°• �i ) a to zCl . 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P SOOO PROPERTY uM L_ __ —_ o>At4rts0lWR:o-cv,un _J 'Y• 1 . 1 1 III 1 1 T ' • I I T -� File. View Toolbar Help ��;1 �1 � � It 1 / ►I � O � ® � I - t 1473889 Southold Active, R/S:1 School: Mattituck Scho i Nassau Pt Club Prprties .Boll Year: 2010 jCurF Yr . Roadlstrlhwy , Land AV: Little Peconic Bay Rd Land Size:O acres Total AV: 1 Owner Total: 1 Site Total: 0 } Name: Nassau Pt Club Prprties Prpcls: Nbad Cd: Sewer:. Water: Utilities: Addl Addr: , Street: , Little Peconic Bay Rd PO Box: City: Cutchogue,NY Zip: 11935- j Taxable Value Miscellaneous Land Total: 0 County: 0 Book: Type: FF: Depth: Acres: Sgft: Muni: 0 Page: School: 0 Mortg: Bank: , Schl after Star:.0 Acct No: 13, Sale Total: 0 Building: Section: Total: 0 Book Page Sale Date . Sale Price, Owner. Exemption Total: 0 Term Own Improvement Total: 0 Code Amount Year Pct Type Name' Dim1 Dim2 SQFT Yr Built i Special District 'Total: 0 Value 1 Code. Units Pct Type Move Tax 4 Double click to open a window J 1 _ r r ,4 View of Stairs from Bulkhead Below View of Stairs from Bulkhead Below D EC E ! W E Pro'ect : Little Peconic Bay Road Stairs JUN — 9 2010 � y Location: Nassau Point Road, Cutchogue, N.Y. Southho�d Town Board of Trustees a 41 OFFICE LOCATION: ` QF so MAILING ADDRESS: Town Hall Annex ��� lyOl P.O. Box 1179 54375 State Route 25 ~ Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 i OIyC�U�,� I LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ,: 11 To: Jill Doherty, President Town of Southold Board of Trustees J U L 1 9 2010 ( ` From: Mark Terry, Principal Planner Southold Tows, LWRP Coordinator Board of Trustees I Date: July 19, 2010 Re: Proposed Wetland Permit for NASSAU POINT PROPERTY OWNERS ASSOC. SCTM#111-9-14 I Peconic Permit Expediting on behalf of NASSAU POINT PROPERTY OWNERS ASSOC. requests a Wetland Permit to replace the beach access stairs. Located: Little Peconic Bay Access Rd., Cutchogue. SCTM#111-9-14 i The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins, jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, i Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); I j; Cc: Lori Hulse, Assistant Town Attorney i Jill M.Doherty,President ti - Town Hall,53095 Main Rd. James F.King,Vice-President P.O.Box ]179 Dave Bergen ' Southold,NY 11971 Bob Ghosio,Jr. � �'4 Telephone(631)765-1892 John Bredemeyer Fax(631)765-6641 BOARD OF TOWNTRUSTEES TOWN OF SOUTHOLD Office Use Dnly oastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/,Extension eceived Application: /D Received Fee:$ `/ _ (� �(] 'ompleted Application_ ]D lUi V -;Incomplete (p q 116 IfT(ut)& fl { _SEQRA Classification: Type I, Type II Unlisted J U N — 9 2010 Coordination:(date sent) eJ?vW Consistency Assessment Form LO Southhold Town _EAC Referral Sent: /Date of Inspection: Board of Tnastees 4� _Receipt of CAC Report: _Lead Agency Determination: Technical Review: --I�ublic Hearing Held: a-1 I l) Resolution: 55 oG. Name of Applicant N255Q v oin d {')y W'n t♦ ' Address P O B o x 3 9 ,� . Cv)'d o s ya .I y,4 W?3 s Phone Number:( ) -734— 93 .6:2 Suffolk County Tax Map Number: 1000 - III q- 14- Property Location: i ¢41-c Pe e oo knG-G53 jeOGG� (provide LILCO Pole#, distance to cross streets, and location) j AGENT: �-G N 1 1',e m x / n (If applicable) Address: 3 Gin leba A I 1!?3 5- Phone: I yard of Trustees Applicat� I GENERAL DATA I Land Area(in square feet): �> Z e? S/, Area Zoning: 4 y i Previous use of property: GG G 5,5 i Intended use of'property: GG C5 5 �� i Covenants and Restrictions: Yes No If"Yes", please provide copy. i Prior permits/approvals for site improvements: Agency Date /7EG Z�— 10 No prior permits/approvals for site improvements. I Has'any permit/approval ever been revoked or suspended by a governmental agency? I _No Yes i If yes;provide explanation: I i Project Description(use attachments if necessary): R-C Al/14 cG S 0/'07 dam 2s 1Cat J / bGR G A GGG5-5 S 7,g /S . yard of Trustees Applicat_ WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: 96A 6'e GS S I � 600� Area of wetlands on lot: "1�- square feet Percent coverage of lot: O % j; Closest distance between nearest existing structure and upland - edge of wetlands: 2 , GJ' feet 1 Closest distance between nearest proposed structure and upland edge of wetlands: / feet Does the project involve excavation or filling? X —No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards i Depth of which material will be removed or.deposited: feet Proposed slope throughout the area of operations: .5'am z '00 -eX 15 ti h 9 . Manner in which material will be removed or deposited: NZA Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason e of such proposed operations (use attachments if appropriate): AGOG d/ 4d, �I c,- by -ea o�. j )ard of Trustees Applicat; COASTAL EROSION APPLICATION DATA Purposes of proposed activity: //0 c'C_ 4jrm 444*7 64 0 I / I Are wetlands present within 100 feet of the proposed activity? No__X_Yes Does the project involve excavation or filling? X No Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: N Describe the nature and extent of the environmental impacts reasonably anticipated.resulting from implementation of the project as proposed. (Use attachments if necessary) TA ke no rao 50no 14- -en V /foil M e*141 ln-,dad5 15 wept ex 16 A'h 44 II • 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM . For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION To be completed b A licant or Project Sponsor) I. APPLICANT/SPONSOR 2. PROJECT NAME lUa6yAv P , /fir ' Own ors 1�s L► l-G peGaft(, Ka 3. PROJECT LOCATION: l Municipality , S h County ®t/. O �fiT�o1 4. PRECISE.LOCATION(Street address and road intersections,prominent landmarks;etc.;or.provide map) i i • E 5. PROPOSED ACTION IS: Q Nam' Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: f� GPI/aCG S f� �H7 � na i 7. AMOUNT OF LAND AFFECTED: j Initially 2 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY.WITH`EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes 0.No If No,describe briefly 9. WHAT IS:PRESENT.LAND USE IN VICINITY`.OF PROJECT? ` Residential Industrial ❑. Commercial. Agriculture Park/Forest/Open Space Other Describe: //.. t�GGtph �GG'GSS .: /�OcrpL { 10.. DOES ACTION.INVOLVE A PERMIT APPROVAL,OR FUNDING,. OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY ' (FEDERAL STATE.OR LOCAL)1 Yes J No . If Yes,list agehdy(s).name and.perrniUapprovals: 11 DOES:ANY ASPECT OF THE ACTION HAVE A'CURRENTLY VALID.PERMIT OR.APPROVAL2 Yes No -If Yes,list agency(s)name and permitlapprovais: , 12. ' AS;A RESULT OF PROPOSED ACTION WILL-EXISTING PERMIT/APPROV AL.REQUIRE,MODIFICATION?: Q.Yes No I CERTIFY: T THE INFORMATI PROVI ED ABOVE .IS TRUE TO THE BES.T.OF MY.KNOWLE_DGE Applicant/sponsor name: . 0 GC 2_ Date:. 1 - � Signa4ure: If the.apti .Js in the Coastal•Area,-and you are a state agency, complete the ,: coastal:.Assessmen.t form beforeroceediln P 9 with is:assessment OVER 1 PART II- IMPACT ASSESSMENT(To be completed by Lead Agency] A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. QYes a No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.67 If No,a negative declaration may be superseded by another involved agency. 0 Yes ' a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: it No C2.Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: i No C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: I No 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: No C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: •I No . C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: No I C7. Other impacts,(tncluding changes in use.of either quantity or type of energy? Explain briefly: i 'No F D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CFJ1? If yes,ex lain briefly: Yes My, No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Yes explain: ❑Yes No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS; Foreach adverse effect identified above,determinewhetheritIs substantial,large,important.orotherwisesignificant 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 mustevaluafe the potential impact ofthe 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 FUL 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. . Board of Trustees Name of Lead Agency Date _Jill M. Doherty President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature-ot Responsible Officer in Lead.Agency Signature of Preparer(If different from responsible officer) N'PPosl 105 uFFQ� Town of Southold N Erosion, Sedimentation .& Storm-Water Run-off ASSESSMENT FORM W PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A O!�j W& ) 11 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN 5-1strict ect on hoc cT of CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storrs-Water Run-Off(Include Total Area of all Parcels located within 9?28 the Scope of Work for Proposed Construction) 112 Generated by a Two(2")Inch Rainfall on Site? (S.F./Acres) (This item will include all run-off created by site b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed O Site Improvements and the permanent creation of X El construction activity? impervious surfaces.) (S.F./Aces) PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location?This ❑ Item shall include all Proposed Grade Changes and ,or,,G rl&rnd%ce-eat Slopes Controlling Surface Water Flow. -/ / 3 Does the Site Plan and/or Survey describe the erosion 6 GGtG� - GS 5 5 7Gf/ry and sediment control practices that will be used to _ ❑ control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural )n 7 Existing Grade Involving more than 200 Cubic Yards j rK L �Y e� of Material within any Parcel? ` 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ❑ L I IOU ' t� (5,000 S.F.)Square Feet of Ground.Surface? 6 Is there a Natural Water Course Running through the V Site? Is this Project within the Trustees jurisdiction n General DEC SWPPP Requirements Southold Town or within One Hundred(100')feet of a Wetland or El Submission of a SWPPP is required for all ConOwporoodfloitiggiiwolving soil Beach? disturbances of one(1)or more ac , n ng rs a o e at 7 Will there be Site preparation on Existing Grade Slopes are part of larger common plan that will ultimately disturb one more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to ❑ X including Coo nstruction activities involving soil disturbances of lesss than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit Is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-040.001.) Surfaces be Sloped to Direct Storm-Water Run-Off ❑ 1.The SWPPP shall be prepared prior to the submittal of the NOI.The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2..TheSWPPP shall describe the erosion and sediment control practices and:where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ❑ — constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall Area?(This item will NOT include the Installation of Drivewa Identify potential sources of pollution which may reasonably be expected to affect the y Mmn£) quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre In area, component shall be prepared by a qualified Design Professional Licensed in New York a Storrs Water;Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable In the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE A Check Mark(4)and/or Answer for each Question is Required for a Complete Application) STATE OF NEW YO IM /` / ` NOTARY PUBLIC-STATE,OF NEW PORK COUNTY OF... Q..l..�l,...... """'SS 02MC6131514 11at I, : Dllr.7 ...... G h`! rr Qualified ed in Suffo�{,l,k, County being duly sworn,deposgy�y �(� ` t (Name o ndividual signing Document) " ll SFrf�i'yC{I And that he/she is the .................................. G!z..7.:. (Owner.Contractor.Agent,Corporate Officer.etc.) ............................... Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this.application are true to the best of his knowledge and belief;and that the work will be performed in the.manner set forth in the application filed herewith. Swom to before me this; ...... /tr. d y of. ................ ..20.!o Notary Public: ........ . . .......................................... ...... (Signature of .plipnt) FORM - 06/10 I I PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS I Name: Address: I� Robert & Joan Lehnert 5 Kilburn Road, Garden City, NY Geraldine Barton 30 Franklin Court, Garden City., NY Stephanie Marinelli 25 Beachwood Road, HoHoKus, . NJ John Flynn 2250 Little Peconic Bay Rd, Cutchogue, NY I STATE OF NEW YORK COUNTY OF SUFFOLK Robert Lehnert , residing at 32645 'Main Road Cutchogue , being duly sworn, deposes and says that on the 6 day of July ;20 10, 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 Cutchogue ,.that said Notices were mailed to each of said persons.by (certified).(registered)mail. I Sworn to before me this Day of LCEllN� � Notary Public T) JUL 2 1 2010 ALICIAWALKER Southhold Town Platte public state of I4ew York Board of Trustees No.0IWA6153064 . jujjffi Commission Expires SeUt.2 5n--z i ii �$b~ CdG Jill M. Doherty,President 4 Town Hall,53095 Main Rd. James F.King,Vice-President o � P.O.Box 1179 Dave Bergen d,f, • Southold,NY 1197165 Bob Ghosio,Jr. '�/ Telephone(631)7 -1892 John Bredemeyer �� �`� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of NASSAU POINT PROPERTY OWNERS ASSOC. COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, Z-e 4n e,-- ,residing at/dba e-1 being duly sworn, depose and say: That on the,/3 day of Tv�y ,2010, 1 personally posted the property known as 4 71A Pee_an is Ady 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 Wed.,July 21, 2010 on or about 6:00 PM. Dated: signa e Sworn to before me this aJ day of S_�ti 200 o E E Notary Public J U L 2 1 2010 ALICIA WALKER Notary Public State of New York No.OIW46153064 Southhold Town Qualified in Suffolk County 2oard of Trustees Commission Expires Sept.25,Zo`z `3oard of.Trustees Appli.ca _ �a AUTHORIZATION Jk (where the applicant is not the owner) I, ROI4,4 kthno4- VJp NL104esiding .at 3,� 6g5-- /Muiq f91 A print owner of property) (mailing address) I 1 �y7 G "Aly L N do hereby authorize (Agent) PeGOniG /'%�� Jr,/l /tlI'�5 to apply for permit(s) from the I Southold Board of Town Trustees on my behalf. I f . i i . I II I I 8 Board of Trustees Application County of Suffolk State of New York F0 be, L -� n /1 t� BEING DULY SWORN I DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERAET(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS 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 ANYAND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLIC ON. ig re SWORN TO BEFORE ME THIS DAY OF w n e, ,20 J O I i MTER R. iceftow NOTARY PUtIIC•STATE Of HEW PORK No. 02MC6131314 Oualllied in Suffolk County ✓`,`'` .My COmmigi0n Expini August 08, f&W ,tea Notary Public 3 i 1 APPLICANT/AGENT/REPRESENTATNE 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. L YOUR NAME: /\ O�er T L-e A ii d✓ (Last name,first name,griddle 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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other,name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.`Business interest".means a business, including a partnership,in which the town officer or employee has even a partial.ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant . (when the applicant is a corporation); 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 I Submitted this ay o 20Q O Signature' Print Name AJ 1 L d e1 Form TS 1 Town of Southold -" LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant li beneficial and adverse effects upon the coastal area(which includes all of Southold Town) i 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 i conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all i local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME h i t4 h, kelan IG pa Raad kGtS 5 377991 ✓s The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees FA 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) i ❑ I (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval, license,certification: FZA j Nature and extent of action: Rejkee. G����► t pia�s S �,rs, Location of action: ` - �t te-GOJ9 iG j Site acreage: i 2 Present land use: G 17 CGS 3 I Present zoning classification: 0 j 2. If an application for the proposed action has been filed with the.Town of Southold agency, the following information shall be provided: j (a) Name of applicant: ltlkt56 of el pin 09-lr awAe/5 (b) Mailing address: , Q, 9 o K 34 6 o�ve (c) Telephone number:Area Code( ) (d) .Application number,if any: Will the action be directly undertaken,require funding;or approval by a state or federal agency? , I Yes ❑ No IX 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 jPolicy 1. Foster a pattern of development in the Town of Southold that enhances community character, j 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. i Yes ❑ No [] Not Applicable Ao e5 o O -ei Owot D /✓G 5 100 POIN I j Attach additional sheets if necessary. Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWR.P Section III=Policies Pages 3 through 6 for evaluation criteria � ❑ Yes ❑ No Not Applicable i 1 I Attach additional sheets if necessary I 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 i ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES i Policy,4. .Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP i ! Section In—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No IN Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III j —Policies Pages.16 through 21 for evaluation criteria ❑ Yes ❑ No ['ZSJ Not 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. n ❑ ❑ �I Yes No Not Applicable I i I i Attach additional sheets if necessary i Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. I ❑ Yes ❑ No' Not Applicable I' I Attach additional sheets if necessary I Policy 8:. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable ! i j PUBLIC COAST POLICIES i, i 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. ❑ YJJ No L4�' Not Applicable Attach additional sheets if necessary I I, i I i i WORKING COAST POLIC16-a Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No Not Applicable i i i Attach additional sheets if necessary Policy 11. Promote sustainable- use of living marine resources in Long Island Sound, the Peconic j Estuary and Town waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. i ❑ Yes ❑ No Not Applicable i . I i 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. i ❑ Yes ❑ N014 Not Applicable { i Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable I I i PREPARED BY TITLE S o DATE G Z- I9 i