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HomeMy WebLinkAboutTR-8030 James F.King,President �O� COG Town Hall,53095 Main Rd. Bob Ghosio,Jr.,-Vice-President o y� P.O.Box 1179 Dave Bergen ft Southold,NY 11'971- John Bredemeyer �� • Telephone(631)765-1892 I Michael J.Domino �P,( �'a� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD P I 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 Project complete, compliance inspection •e`y11.1•itr/r•� -' �Cloi,a s/r�Pp� :. jFP d4,.. ..:� a�a•r � 0 o9r--.; io roa s eeo6 : ° /I, :..... 9 �lv ._ �.,,�41 0/v i01!•41/j" �'... /..., Iff /fr s i 11ff 4fly �`�.•SiP f01°vv. a i �$;'�•� �l 1..2 .,.,f.g /7',,:....s,.s.S. .°1.0 i. .:..:..r .. ,'l.Ti' _..<!T+f.2YS.E£'1:6..LSL:,-,'I _ .Y?v(.'kes„w„ ..Al2L S, lsA.m? 1 ..)s..,.T ,...2 .:�'is.._ vl.ls:.. ',1' �•% _ �/s i BOARD OF SOUTHOLD TOWN TRUSTEES ° SOUTHOLD,NEW YORK h J .! PERMIT NO. 8030 DATE: JANUARY 23, 2013 s- ;i„•„a ISSUED TO: JACK BIGGANE s PROPERTY ADDRESS: 8871 OREGON ROAD, CUTCHOGUE Su M# 83-1-34 t _ AUTHORIZATION g , ' Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on January 23,2013, and Pagl in consideration.of application fee in the sum of$250.00 paid by John&Margaret_ Biggane and subject to the '? Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits ,• fIP` do/, ° the following: JJ � Wetland Permit to construct a timber stairway on the bluff; stair treads to be an a untreated lumber; and as depicted on the site plan prepared by Creative 4 Environmental Design, received on November 26, 2012 and stamped approved on January 23, 2013. r IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed and these presents to be subscribed by a majority of the said Board as of this date. h £ o M. .: M °1fl H ,o 7.1 to r °� r � 9 rrdrf f�1�.. - °rrad fN°: !°o ale°• ° rd iei"`° � .ee ea reer�a.!i .:;..:,. sr .a_°�� ..:` � :. `.: ♦a ..r •..ej�ea �- -'i•..` obi ee..' :' ,� 'FJ ,t:: ♦e ��_ .E�e oe,^ �::. TERMS AND CONDITIONS The Permittee Jack Biggane residing at 8871 Oreizon Road Cutchogue,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Pen-nit 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. James F.King,President ��0f SUI/r�o Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O l0 54375 Main Road P.O.Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer Michael J. Domino Ol� yQ Telephone(631) 765-1892 Fax(631) 765-6641 UM BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 23, 2013 Mr. Jack Biggane 168 Euston Road Garden City, NY 11530 RE: JACK BIGGANE 8871 OREGON ROAD, CUTCHOGUE SCTM# 83-1-34 Dear Mr. Biggane: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 23, 2013 regarding the above matter: WHEREAS, JACK BIGGANE 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 November 26, 2012, 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 January 23, 2013, 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 JACK BIGGANE to construct a timber stairway on the bluff; stair treads to be an untreated lumber; and as depicted on the site plan prepared by Creative Environmental Design, received on November 26, 2012 and stamped approved on January 23, 2013. 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 V ry truly yours, James F. King President, Board of Trustees JFK/amn James F.King,President en Town Hall Annex Bob Ghosio,Jr.,Vice-President u- n 54375 Route 25,P.O.Box 1179 Dave Bergen '.y �' Southold;NY 11971 John Bredemeyer '�Q $d 1 Telephone(631)765-1892 Michael J. Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: C, Please be advised that your application dated ( (D has been reviewed by this Board at the regular meeting of �efol(owing and your application has been approved pending the completion items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 sc Day of Construction ($50.00) 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: $ BY: James F. King, President Board of Trustees x 5 r'.',�Y 4 k � �ti� �`�r �� n a• ,ter a � �� N S URVE Y of XT-)XR)OPERTY A T SOUTHOLD �r , f• a. y a� TOWN OF SOUTHOLD ;'„�..-^^"qz";`6"UaV Tl "tf'° SUFFOLK COUNTY, lY. 1000--51-04 13 SCALE,• 1'-30 UND MAY 16. 2006 LONG So July 0(y 2006 ISLAND. t co a.fG+/ 4GfOsEu•, c,�G H�D5 CIE WALL wAu• AND e J1 M,N•w-AL ALO10 SEG T1E UNE) WOOD STEPS A PHEAO _OD OU N81.24'30"E car,cR, _'goner OF SLUFF. CONCRETE £� w RETNNrNG WALLS + (g Uff DECK FESE IIALL � � a WALL 21.w J � �lra o Q°7-W G p b coves © 70 •Z � C' N iti 1 STY „ruTy 'y s.s FR• .ySE• ga' POLE v N a 28.3• •�•� r 3g.t' �`Z - C7 cc I •Ay � r 1 "ram ROW�MMYS -'"'_� (GV 117.56' Wct9 fjTTUTY POLE SS3`-50'DD"W 1.--�--_ �..� ��� mGEDf PAvE�aENT soupD A VEND Coas�Q � Frosio� ,h�az�.rv�• Line �r'or„ Ca�s�� �rosio7 �d{.Za•�oG_Mo�P ,. OF NEp'Y AREA=23,047 SO. FT. TO TIE LINES �����' � '� ems'-': a� 96 8 ANY ALTERATION OR ADD177ON TO TH1S SURVEY IS A WOLA77ON PFCUNIC U EYO OF SECTION 720,90F THE NEW YORK STATE EDUCA71ON LAW. (b•31) '76.5-502U FA EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERnFICA77ONS HEREON ARE VAUD FOR 7NIS MAP AND COPIES THEREOF ONLY 1F P,0. 80X 909 SAID MAP OR .COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR is =MONUMENT 12JO TRA VELFR STREE SU WHOSE SIGNATURE APPEARS HEREON. 0 =REBAR SET SOUTHOLD, MY 11971 P r�— -� -- - z or---7- `. 1 NOV 2 6 2012 K Ohl PRoP0f a4•X 150#B�Tln+sc�Sr+il�wr�V p c"t th,id ; (SFAIM Ta IaC--IZAI.C-D 4'ABDY E CZAAEStI'E: i EL 6D EL 49- x - EL40 -- - - - ' - - flzo-P 1'K44 LA.r-IO NCA ] AI L _ - BOARD OF TRUSTEES EL25_ -- - _ V909(66)04°AC4TiMBEz ri,trwr� TOWN OF SOUTHOLQ >?oS,s �-s-S ) EL 2U- - — - -- .---- - .- ..- .- _.- . -- -DATE- t r [2-311-> _ - - -- - EL,5_ .� CL IC) j . OPFaJ 5BALN Leek - E.Y�STING CRAVE ��D�O` � =Thl2til�l ` 3o'-ro AHwM—� SACS �GG.,tii DfZGGON R'P. GuTGNoG�F-, r��/• TAB MA'Q NO ICE-R3- �4,'; �L3!: G�Fi`_--I uE 'iAL D95161.,l -13q-7723 1 � mot^•' 1' 9 _ ,. 1.`F �.-_..:";/^2..-• `.i' APPROVED BY `�, - . :• ,: ����-�w`'-�. _` BOARD OF TRUSTEES' TO,NM OF-SOUTHOLD - 1�trJ4. ToP of 6G.ticG� � - AN�;� DATA4 1 � rl Sa ExIST � I 1 JN Po°L EEKrrI �r / I /� / B P✓�F I Will 5 }4ry: ' ',;, �i�o'�?o�aED S�a�N STA12v✓,�y �E� : . _ -=_��:� Y,�',�'sa.,_ pp• - -, •��•=::�='a�M-� i - iAx 3 - o 00 MAP� 1000-08 1. -3$ E C � A'� �- 7 { 'AUG 31 2010 :y i'"•' ''i SoAhowTowa ?L,;.:`?.•�%nr ' � .yi[,hlp $ ''Baetd_af-kusten`• '.;; .,� :.-`"k,4�"' FiEr�r11�• r1�1. 734-79Z3 .� y' Peter Young,Chairman 4 Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 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., January 16, 2013 the following recommendation was made: Moved by William McDermott, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application. of JACK BIGGANE to install a new timber stairway on bluff. Located: 8871 Oregon Rd., Cutchogue. SCTM#83-1-34 Inspected by: Doug Hardy, Audrey Horton, William McDermott The CAC Supports the application with an engineered erosion control plan for the structure. Vote of Council: Ayes: All Motion Carried ECEOVE JAN 1 8 2013 Southold Town Board of Trustees James F.King,President P.O.Box 1179 Bob Ghosio,Jr.,Vice-President a y Southold,NY 11971 Dave Bergen Telephone(631 765-1892 John Bredemeyer ,y I Fax(631)765-6641 Michael J.Domino � 'F ` Southold Town Board of Trustees Field Inspection/Worksession Report OV) Date/Time: 2-L) r�-M. JACK BIGGANE requests a Wetland Permit to construct a timber stairway on the bluff; stair treads to be an untreated lumber. Located: 8871 Oregon Road, Cutchogue. SCTM# 83-1-34 Type of area to be impacted: _Saltwater 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: 4P<etland _Coastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: J. King B Ghosio D. Bergen, L-'J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: J� 1 3 ' k BOARD.OF.SOUTHOLD TOVVN:TRUSTEES ' SOUTROL%NEW YORK R PERMIT NO:'7418 . DATE-,OCTOBER 20L2010 •� 4 � ISSUED TO: ,JACK BIGGANE y ,y PROPERTY ADDRESSr 8871 OREGON.ROAD CUTCHOGUE }, SCTM#8341 34 as ` AUTHORIZATION Pursuant to.the provisions of Chapter 275 and/or Chapter 1.11 of the Town Code of the Town of Southold and in accordance with the Resolution ,f'Board e sum of$250.00 p • y S w of Trustees adopted at the meeting held on ee October 20,2010.and in consideration of application aid b Jack Bta�a_ne and, subject to''the,Terms and Conditions as stated in the Resolution;the Southold Town Board of Trustees authorizes and permits the following:' Wetland Permit'to`construct a timber stairway on the bluff;with the condition that the project conforms to Chapter 236 of the Town Code—Storm Water nt• and as.de icted.on the ite plan,;prepared by Creative.Environmental Management; p Design, received,on,August 31,2010; and stamped.ap.proved on.October 20,2010.' IN WITNESS WHEREOF,Ahe said Boardof Trustees 1lereby causes,its Corporate Seal to be affixed 4 a majority of the said Board as of this date. ' and.these presents to be subscribed.by, 1 h' v �Ogu'CFQLx� `I 7 4' W r'' __.._....-J'CN '�aW�nP3� uY7xh.:�•rsat+a*r� �iTYih'S:An.�Ra��'� t�r'� rarawcrwtt�'^�r"u�.. i�"'T' a' '['" 'Y' "Y.�'. iFY�vr° -�ir'.�V��p M '�.r 4.-;�r `.�. �,. - yr x �•:. • p • OYI3 14 TaP eG 0-1A. Y % 4. f I � •� // l ! lfl/fll/ l ?. pz. , . A wewwcl//l/I// ornt / " LIN it ,f 1 '•11 / / ////%/// Yam. / / AHWM • _ ... cP'i'��P_7f�¢ALN 57AI¢WG`L.Pu-��i .. - �,;=*�'_`'':• APPROVED BY pgE /Qo Curc/JaGue,N,y, 5* BOARD OF TRUSTEES y �'�A••�: ±. 7AY N10 1000-083-I,O-.34•Oo Q TOWN OF SOUTHOLD ' JO'a0 /d &ALE AUG : P= 3ofo' '�slor+ua a �ice.." 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A �� - -- aa� --w— o�W --x-- NOTICE COUNTY OF SUFFOLK © K RF SOOTNOlO SECTON NO c , Real Property Tax Service Agency v o .enaem.rRHN,.,a.Nr„Ba, M .. .Bc.xo 83 A w ..o P PROPERTY MAP �� xnewfvamfx WAuss2uKM OFFICE LOCATION: ��,q,so yo MAILING ADDRESS: . Town Hall Annex ,`O l0 P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) y Southold, NY 11971 Telephone: 631 765-1938 G Q • �� Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM P E C E VE To: Jim King, President JAN 2 2 2013 Town of Southold Board of Trustees From: Mark Terry, Principal Planner Southold Town LWRP Coordinator Board of Truste s Date: January 18, 2013 Re: Proposed Wetland Permit for JACK BIGGANE SCTM#1000-83-1-34 JACK BIGGANE requests a Wetland Permit to construct a timber stairway on the bluff; stair treads to be an untreated lumber. Located: 8871 Oregon Road, Cutchogue. SCTM#83-1-34 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 CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F.King,President ��OF SUUT�o Town Hall Annex 01 54375 Main Road Bob Ghosio,Jr.,Vice-President h0 l0 P.O. Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer Michael J. Domino A �� Telephone(631) 765-1892 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 fExte Sion ,,� ceived Application: Z ; („mE j eceived Fee:$ f � L� f :�Xompleted Application Z j): 1 Incomplete � i> NOV 2 6 2012 _SEQRA Classification: .� Type I Type II Unlisted _Coordination: date sent -�- - U��'�r� TOir; _�,ZLWRP Consistency Assessment Form —ZCAC Referral Sent: 3 _Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: '311,3 Resolution: Name of Applicant Mailing Address i 6 f;_IJ S 710 4 .,,, Ce 4n, ,j 4 j Phone Number:( ) 631 -7-; L// 2 3 (-) Y3 Suffolk County Tax Map Number: 1000- &�3 -0 / - 3 L/ Property Location: (2 or.e t " �,�� (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: B d of Trustees Application GENERAL DATA Land Area(in square feet): r Area Zoning: L S , Previous use of property: 0--c S, Intended use of property: Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? VINO Yes If yes, provide explanation: Project Description(use attachments if necessary): it�STR2L/+-i�dw d� '� $Vt�. s�,,iY�✓•r-� Cls.l��u'�'l� —hY e a J_J Q-,c.i V h. Bo of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ft�.;�-�,,A!:!, Am Aim ,ef-s Imo. �� T=C' Area of wetlands on lot: ZS a V square feet Percent coverage of lot: g o J % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? (/ No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Bo< of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: kcc e ss- Are wetlands present within 100 feet of the proposed activity? No Yes Does tthhe`project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) „ `D�t�J S �AivCcu.ci A-s a�5 James F.King,President �QF SO(/Ty Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O� ��� 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer N G pQ Telephone(631)765-1892 Michael.J.Domino O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE (We) TO L, C-- 64, c► The ownerVf record of property at: F tw G1 Vn C o--- 614 tL .. 0 SCTM#1000- 01--3 V in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or import t natural resource features. N sized signatu a of Mer of record Notary Public CONNIE D. BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires,ftpril 14,2010 This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one Year of the original construction and validated to show the final approval of the administrator. PROJECT ID NUMBER 617.20 SEAR 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 3.PROJECT LOCATION: Municipality Ce,--k-L" JJ_ County 4.PRECISE LOCATION: Street Iddess and 'Road Interliections, Prominent landmarks etc -or provide map d d�r�19�✓ /'�'� 1 1. U'�'W�a)�v-� �j d U r �.v.�il7 � � r"��!€� ��-. 5.IS PROPOSED ACTION: 1-1 NI ew ❑Expansion edification/alteratio 1- 1 n nn / 6.DESCRIBE PROJECT BRIEFLY: 7.AMOUNT OF LAND AFFECTED: Initially , o acres Ultimately a V acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? es ❑ No If no,describe briefly: 9.WH 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 1N>OLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, ate or Local) ElYes o If yes, list agency name and permit / approval: 11.DO ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑No If yes, list agency name and permit / approval: 12. AS A RES OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑1'es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Son or ame Date: �+ Signature `�l�G' I>✓ If the act'on is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment i PART it- IMPACT ASSESSMENT -To be completed by Lead Agency). A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617'A? If yes,coordinate the review process and'use the FULL EAR ❑Yes Q No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes 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: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish'or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or inte nsity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related,activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in CI-05? Explain briefly: - --- -- C7.Other impacts(including changes in use of either quantitX.or type of ener ? Ex lain briefl c- - D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If .es,explain briefly: Yes a No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: ❑ Yes a 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 CFA Check this box If you have Identified one or more potentially large orsignificant adverse impacts which MAY occur.Then proceed directly to the FULI 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 p fjryj✓ a z- 20/3 Name of Lead Agen3 Date jgt Jf�7s )C, �`//L-� President p Print or Type Name of Responsible Offi in Lead Agency Title of Responsible Officer Signature of Responsible Officer in d Agency Signature of Preparer(If different from responsible officer) James F.King,President ti Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President o P.O.Box 1179 Dave Bergen �,ty '� Southold,NY 11971 John Bredemeyer �! Telephone(631)765-1892 Michael J. Domino a1 �`� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD _ E BOARD OF TRUSTEES: TOWN OF SOUTHOLD JAN 2 3 2013 --------------------------------------------------------------- In the Matter of the Application of Southold Town Boar of Tr to JACK BIGGANE COUNTY OF S ) STATE OF NEW YORK) AFFIDAVIT OF POSTING Q , residing at/dba ,PX-7t -z� being duly sworn, depose and say: That co�n7 the � day of QG v , 2013, I personally posted the property known as by placing the oard of Trustees official p ster where it/can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,January 23, 2013. Dated: ( ature) Sworn to before me this a-7Wday of J"M' 4, r20/9 Notary ublic EMEAGAN WALSH ublic-State of New York0. 01WA6155906 fied in Nassau sou tyssion Expires_ (JT .1 (-"N E Ow F HEAR11 �l NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: SUBJECT OF PUBLIC HEARING: Con.54ru►c+a1&6r S4w-cGQm)/on*e1%LJ*, treda be 4r+ua+ber TIME & DATE OF PUBLIC HEARING: eo►t�d 1 'tip Tanuo�ry a 3, o�o�� - on or o�bo�►t y.vo PM If you have an interest in this project, you are invited to view the Town file(s) which are available for inspecfion prior to the day of the hearing during normal business days between the hours of 8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765-1892 PROOF OF MAILING OF NOTICE u ATTACH CER D MAIL RECEIPTS JAN 2 3 2013 ■ 3- h-d ni e C3 o, MIN Id zvmm Name: �n tiLn Postage $ M Certified Fee f 1"` �' Z •. Retum pecelpt Fee E3 (Endorsement Requr ae) ,,`•i Pogtr air i t C3 ]{r Here Restricted Delivery Fee 0 i i l (Endorsement Required) m ti Total & e Fees Postage V / IT1 Sent To ...._...'_�__..% N r -`ji�S _s•� v - Street Apt. o.; or PO N Box No. Q i City,State,ZIP+4"••-"•' FiT Y" �- - -•---- -i--_---------- -74 U STATE OF NEW YORK COUNTY OF SUFFOLK Q � o�tU- �; ' CV 4� ,residing at �� d ekrr .�L ( being duly swom,deposes and says that on the day of 20 3 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 Ciqt.4.C.N Sov ./� that said Notices were mailed to each of said persons by CERTIFIED MAIL TURNS I +CEIPT. Sworn to before me this Day of 2013 Notary Public Oarhara A.Van Welt i7atary public 11ew Yorh VA47G21 Qualified in Nassau County Commission Upires March 30,20 PROOF OF MAILING OF NOTICE � JAN 2 3 2013 ATTACH CERTIFIED MAIL RECEIPTS Southold Town D 0 Name: o- F• z.a • ( •s• Fes''' ru in Postage $. (� ,. J. Certified Fee gs f7l Postmk M Return Receipt Fee Here 1 O (Endorsement Required) j C Restricted Delivery Fer) ; 4di13 O (Endorsement Re uired �, 0 Y� m .,_...F r r; fU Total Postage&Fees Is m cc Sent To aA1E r✓ f/�� - C3 - ----- ------------------------------------------------- C3 b4r'eef Apt:Mr, r, or POBox1 �v Y, 3/7(, --- - ----------------------------------- r City, te,ZIP,+4 STATE-OF NEW YORK r COUNTY OF SUFFOLK e ,residing at Cu jc. • being duly sworn,deposes and says that on the day of 4 tr,J ,201 S 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 assessmen roll of the To of Southold; that said Notices were mailed at the United States Post Office at G, Se ui-i,, P•�.that said Notices were mailed to each of said persons by CERTIFIED MAI L/RETURN RECEIPT. Sworn to before me this Day of 20 13 Notary Public Barbara A.Van Well Notary Public,Slate of New Yortc NO.OIVA4762111 Qualified in Nassau County ll(1 Commission Expires March 30,20 r_/ Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM 0 .L PROPERTY !OCaTION: s.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s6i�rfc—t section —9Toc cF— Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRU ON ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? , Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within /Qp Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) (S.F./Acres) O (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 F-9 and/or Ground Disturbance for the proposed �� (S.F./Acres)d j , Site Improvements and the permanent creation of construction activity? impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and �. Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion ❑ 4-o and sediment control practices that will be used to T control site erosion and storm water discharges. This 1 Z'11,11IN item must be maintained throughout the Entire Construction Period. ►✓ r�� 4 Will this Project 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? cj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand — (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Er— Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? Er— 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 WIII Driveways,Parking Areas or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-0-10.001.) 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? u submitted to the Department prior to the commencement of construction activity. 2.The SWPPP 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 ET — compliance with the terms and conditions of this permit.In addition,the SWPPP shall Areas(This Item will NOT Include the Installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the 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 Storm-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 .� and/or Answer for each Question is Required for a Complete Application) r Notary Public,State of New York STATE OF NEW YORK, No.01 BUS185050 COUNTY OF....�.(A."E�.. ............SS Qualified in Suffolk Cou ty Commission Expires April 14,2��(0 That I.................................................................................being duly sworn,deposes and says that lie/she is the applicant for Permit, (Name of individual signing Document) Andthat he/she is the .................................................................................................................................................................... (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. Sworn to before me this; .........c ...6.rt!:.1.......................day of.NC7��'M; l...........,201a 1. Notary Public: ..... .. ... . ..... .. ........................................ (Signatur of Applicant) FORM - 06/10 Boa of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN.THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Z�- n-- Signature o Prop rty 7-:Owner SWORN TO BEFORE ME THIS DAY OF Notary Public CONNIE D. BUNCH Notary Public,Mate of New York No.09 BU59 85050 Qualified in Suffolk County Commission Expires April 14,2.-C)f Bo of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, residing at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) 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 ssible conflicts of interest and allow it to take whatever action is necessa_ry to avoid same. YOUR NAME: (Last name,first name,.piddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate.the.other person's or company's name.) NAME OF APPLICATION: (Check all that.apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 50/ oft a shares. YES NO Ifyou 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 th y's da ffd l/ 200 V Signature. c_ Print Name % Y�— Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a.determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form.should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated. as. to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained.in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME^ ST��S G w 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: 5 rid Location of action: ��� Vic - � ✓�- nJ, Site acreage: ! A Present land use: Present zoning classification: 2. If an application.for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (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? 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 LNW Section III=Polic' ages 3 through 6 for evaluation criteria ❑ Yes ❑ No 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 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 LW11P Section III—Policies Pages rough 16 for evaluation criteria ❑ Yes ❑ No 21"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 =Policies Pages 16 throug or evaluation criteria ❑ Yes ❑ No 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 evaluatio 6riteria. ❑ ❑ Yes No t Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes [:] No NApplicable Attach additional sheets if necessary Policy 8. Minimize enviro ental degradation in Town of Southold from solid waste and hazardous substances and wastes. ee 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 So W old. See LRP Section III-Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ N Not Applicable Attach additional sheets if necessary Policy 11. Promote sustai le use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat . 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 eval on criteria. ❑ Yes ❑ N Not Applicable Attach additional sheets if necessary Policy 13. Promote a opriate use and development of energy and mineral resources. See LWRP Section III—Policies- ages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE 0 u= DATE / Y� ✓