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HomeMy WebLinkAboutTR-7831 �,,OfF04 James F.King,President �p OG Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President o y� P.O.Box 1179 Dave Bergen Southold,NY 11971 John Bredemeyer • Telephone(631)765-1892 Michael J.Domino Qj �`a0! 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 1 st day of construction % constructed Project complete, compliance inspection �,�..-�r. ... _:. ,,1,3' •'••iir i�-•�• �rr,�.,.�_ ,•,��V'r i�rrr r r CNtriVr erl�,.., � _ � -r,CiT rrrr ' '-y, ♦i;� �_,�\ �P r-�,'�_ II�r //r.. , 0 11/. V� P/r. -.�t 1 /fin •����� If IW - 1 Sill �, BOARD OF SOUTHOLD TOWN TRUSTEES r SOUTHOL'D,NEW YORK PERMIT NO: 7831, DATE: JUNE.20,2012 ISSUED TO: AUDREY ROTHMAN PROPERTY ADDRESS: 3995 WELLS.AVENUE, SOUTHOLD,: SCTM#70-4-1 .v AUTHORIZATION Pursuant to the provisions of.Chapter 275 and/or Chapter.l 11 of the Town Code of the Town of ' .:•I s Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 20,2012,and in consideration of application fee in the sum of$250.00 paid by Audrey Rothman and subject to K the Terms and Conditions as stated in the Resolution,the Southold Town Board.of Trustees authorizes and h•�i� permits the following: Wetland Permit for the in-kind/in-place replacement of existing deteriorated fixed.pier with an extension of the pier seaward 12'-to reach greater,water,depth and ,►,,.� removal of 112' of existing catwalk; and as depicted on the site plan prepared by Melrose Marine Services, Inc., last dated April 2012, and stamped.approved on June •r 2%120.1.2. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, 1 and these presents.to:be subscribed;by.a majority, of the said Board as of this date. A� Q, A _ y J�a .l �' +�v'at''�,�i'sib,Y�f.�B?.dd'ft�^4td�Y'��. `.L�"le�1�'.`.f. 4�e'Id.$�I.'�°T.IA'"Na,�9,edA;ed:Isr� '�-'•,W',71r LA6? .T.B�@i�'aa.e�.un£r`�r:.7�w'"°11'°u. a+.'Iti n au�i�"`�Fua a.(f.: I'r�"Tel dS��` � ���.• m >.,�•'•�iL_:rtr'x,.��._. ...."-� rlrl,�r�:.�:- _..^ :iAr ,1,I,Ve. : " .Ai�._�,iii� s:=' `t:"'��/il::!:+iS� •rii���lr�r��� € "�d�rrl,_���ii��fi. TERMS AND CONDITIONS The Permittee Audrey Rothman residing at 3995 Wells Avenue Southold,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages,or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense,defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is'considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as'long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its. agents,and non-compliance with the provisions of the originating application may be cause for revocation.of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if,in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required,upon due notice,to remove or alter this work project herein statedwithout 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 SUUj�o 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 G Q Michael J. Domino �0 Telephone(631) 765-1892 Fax(631) 765-6641 �yCOUNT`I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 20, 2012 David Melrose Melrose Marine Service, Inc. 123 Huron Street#2 Brooklyn, NY 11222 RE: AUDREY ROTHMAN 3995 WELLS AVENUE, SOUTHOLD SCTM# 70-4-1 Dear Mr. Melrose: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, June 20, 2012 regarding the above matter: WHEREAS, Melrose Marine Services, Inc. on behalf of AUDREY ROTHMAN 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 April 25, 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 June 20, 2012, 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, z 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 AUDREY ROTHMAN for the in-kind/in-place replacement of existing deteriorated fixed pier with an extension of the pier seaward 12' to reach greater water depth and-removal of 112' of existing catwalk; and as depicted on the site plan prepared by Melrose Marine Services, Inc., last dated April 2012, and stamped approved on June 20, 2012. 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: $554.00 Very truly yours, iames F. King President, Board of Trustees JFK/eac i James F.King,President 4�OgUFFp(�CO Town Hall Annex Bob Ghosio,Jr.,Vice-President �� Dye 54375 Route 25,P.O.Box 1179 Dave Bergen y Southold,NY 11971 John Bredemeyer �,y Telephone(631)765-1892 Michael J.Domino �Ol � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: AUDREY ROTHMAN Please be advised that your application dated April 25, 2012 has been reviewed by this Board at the regular meeting of June 20, 2012 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) 1st Day of Construction ($50.00) '/2 Constructed ($50.00) XX Final Inspection Fee ($50.00) XX 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: Final Inspection Fee = $50.00 Fixed Pier 4'x42' = 168sq.ft.x$3.00 per sq.ft. _ $504.00 TOTAL FEES DUE: $ 554.00 BY: James F. King, President Board of Trustees (no"�eU� 7/9/la �s Peter Young,Chainnan 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., May 9, 2012 the following recommendation was made: Moved by Audrey Horton, seconded by John Stein, to TABLE the Wetland Permit application of AUDREY ROTHMAN for the inkind/inplace replacement of existing deteriorated fixed pier with an extension of the pier seaward 12' to reach greater water depth and removal of 112' of existing catwalk. Located: 3995 Wells Ave., Southold. SCTM#70-4-1 Inspected by: Audrey Horton, John Stein The CAC Tables the application because the proposed seaward extension of the dock was not staked. The CAC recommends a 10' non-turf buffer along the landward side of the bulkhead. Vote of Council: Ayes: All Motion Carried I I I I i i i a --. OVERALL PLAN VIEW -- _ AND VICRgM MAP y - - - - SCALE: I"=75' APR 2 5 2012 PROPOSED: REPLACE PORTION OF FIXED DOCK. gh� ADJACENT PROPERTY OWNERS: y;. JOCKEY CREEK 1.JOSEPH BUCZEK& CHRISTINA SPOMBERGER , _• f `�� �r, ,' 3895 WELLS AVE SOUTHOLD NY 11971:�� SITE OF PROPOSEED FIXED PIER ' �. ' REPLACEMENT 2.VILLAGE OF SOUTHOLD P.O.BOX 1179 `�•j SOUTHOLD,NY 1-132t SUFFOLK COUNTY TAX MAP#; EBBSECT.-70,BLOCK-04,LOT-01 sG DATUM:AMLW 0.0 FLOOD ARR-031512 VICINITY MAP /s h 1 ' ac�sry.n 1•pu�C.ne'+ry �''• tnya. PREPARED BY: PROPOSED: MELROSE REPLACE EXISTING Aa DETERIORATED MARII�SERVICE INC. R CEXISTIN N DTERIORATED FIXED PIER f sd PROJECT SITE 500 ROBINSON ROAD ON:JOCKEY CREEK AT: SOUTHOLD GREENPORT, ,r COUNTY:SUFFOLK STATE:NY APPLICATION BY:A.ROTHMAN S W YORK 11944 ��� MELR� MARINE SERVICE,INC. MELROSEMS COM SHEET:1 OF 4 DATE:APRIL 2012 S PLAN VIEW EXISTING ' SCALE: V=20' O Ov$U 38'-0"TO ROAD GUARDRAIL d DETERIORATED PILES AND MISSING CAP pv$ 3$ �.' \ 2 O GO �� m k' \ CATWALK SECTION RUNNING PARALLEL TO THE BULKHEAD TO BE REMOVED AS PER DEC REQUEST EXISTING TIMBER BULKHEAD AMLW 0.0 s.o P/L \ FLOOD GREATER MAJORITY OF THE FREE-STANDING PIER AND A• — EBB DECKING REMAINS INTACT %�/ EXISTING 1 PILE DOLPHIN _ e EXISTING 2'1?ILE DOLPHIN 52 EXISTING 2 PILE,DOLPHIN \' JOCKEY CREEK -S.B- PREPARED BY PROPOSED: MELROSE MARINE SERVICE INC. REPLACE EXISTING AND DETERIORATED FIXED PIER. 500 ROBINSON ROAD ON:JOCKEY CREEK AT: SOUTHOLD GREENPORT, MELROSE NEW YORK 11944 COUNTY:SUFFOLK STATE:NY APPLICATION BY.A.ROTHMAN 631-477-1546 SHEET:2 OF 4 DATE:APRIL 2012 MARINE SERVICE,INC. MELROSEMS.COM ARR-031512 _ PLAN VIEW —AMHW+2.4_ PROPOSED SCALE:I"=10' PROPOSED STRINGERS AND vt DECKING TO EXTEND OUT AND APPROVED' T. OVER EXISTING BULKHEAD FOR ACCESS BOARD OF TRUSTEES,- PROPOSED TO.. � OVE THE r EXISTING CATWALIK AND ALL \• TOWN OF SOUTHOLD PILES PER NYSDEC RECOMMENDATION EXISTING BULKHEAD PROPOSED TO REDUCE REBUILT DOCK TO 4'WIDTH TO FIT TO TOWN r, OF SOUTHOLD CODE REPLACE ALL DECKING o WITH NEW APPROVED + 2.5" DECKING AMLW 0.0 PROPOSED NEW TIMBER PILES -3.0" �PiL A Os`_ EXISTING PILE DOLPHINS(3)TO% REMAIN -'� 12' SEAWARD EXTENSION TO REACH GREATEST WATER DEPTH AT MOORING AREA. AN EXCHANGE OF 48 SQ.FT.IN LIEU OF THE 112 SQ.FT. SACRIFICED PIL -5.0" PREPARED BY: PROPOSED: MELROSE REPLACE EXISTING AND DETERIORATED FIXED PIER. MARINE SERVICE INC. 500 ROBINSON ROAD ON:JOCKEY CREEK AT: SOUTHOLD GREENPORT, NEW YORK 11944 COUNTY:SUFFOLK STATE:NY APPLICATION BY:A.ROTHMAN MELROSE 631-477-1546 SHEET:3 OF 4 DATE:APRIL 2012 ARR-031512 MARINE SERVICE,INC. MELROSEMS.COM SECTION A-A SCALE:3/8"=1' PROPOSED NEW TREATED TIMBER PILES(10) PROPOSED NEW TOWN APPROVED DECKING PROPOSED NEW STRINGERS PROPOSED NEW SPLIT-CAPS 0 0 0 cv 4'-0" AMHW+2.4' - - - - - - - - PROJECT NOTES: I.ALL PROPOSED MATERIALS TO CONFORM TO TOWN OF SOUTHOLD STANDARDS. A.ALL PROPOSED PILES AND UNDERPINING TO BE TREATED(CCA)TIMBER. B.ALL PROPOSED DECKING TO BE OF APPROVED TYPE HARDWOOD OR COMPOSITE. C.ALL PROPOSED HARDWARE TO BE H.D.G. AMLW 0.0'- - ------- - - 2.AS PER NYSDEC RECOMENDATION THE EXISTING CATWALK THAT RUNS ALONG BULKHEAD TO BE REMOVED. 3.PROPOSED DECKING TO BE 2.5'ABOVE AMHW TO MEET NYSDEC AND TOWN REQUIREMENTS. 0 PREPARED BY: PROPOSED: MELROSE MARINE SERVICE INC. REPLACE EXISTING AND DETERIORATED FIXED PIER. 500 ROBINSON ROAD ON:JOCKEY CREEK AT: SOUTHOLD GREENPORT, NEW YORK 11944 COUNTY:SUFFOLK STATE:NY APPLICATION BY:A.ROTHMAN MELROSE 631-477-1546 SHEET:4 OF 4 DATE:APRIL 2012 ARR-031512 MARINE SERVICE,INC. MELROSEMS.COM N SURVEY OF PROPERTY - -__- - A T .SO UTHOLD TOWN OF SO UTHOLD APR 2 5 2012 SUFFOLK COUNTY, N. Y• 1000-70-04-01 SCALE. 1'= 40' I•_ SEPTEMBER 20, 2011 OCT. 20, 2011 (wetland flags) A . LLs WE • EDO� PvMN�• �p0� . r� f�•COR. � 3S - ogE N , J O N 9 NON 2 N 70 OY 12 61 , . Fj* �o SE• g,8 12.2 �01 O • N 1112Ns�• � FR N O 3 .2 0 nG • A lob CONC. 4li Np�R5 ®� 0011 04, N � Y 0 11 p%ES to BR1p0E WOOD DOCK ( � CONC• IN DISREPAIR V' rw J AREA = ,22 396' SQ.FT•- 1 CORC,�.55I�3E. 1S��4. • ■ MONUMENT �,��'., . RG ® WETLAND FLAG LANDWARD EDGE OF TIDAL WETLANDS DELINEATED r F `• `: E °� BY SOFFOLK ENVRONMENTAL CONSULTING INC. ON OCT. 18, 2011 LOT ®REFER TO PLAN OF LOTS OWNED BY GEORGE H. WELLS" FILED IN THE SUFFOLK COUNTY CLERKS OFFICE NOV.28, 1927 FILE NO. 859. � Lrv� JSL 7C. NO. 49618 ANY AL TERA 710N OR ADDITION TO THIS SURVEY IS A VIOLA TION PtCONIC EYORS, P.C. OF SECTION 7209OF THE NEW YORK STATE-EDUCATION.LAW. (631) 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.0. BOX 909 - SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET 11-200 WHOSE SIGNA77JRE APPEARS HEREON. SOUTHOLD, N. Y. 11971 } 4%Uf FO(,� James F.King,President Qv CQ P.O.$ox 1179 Bob Ghosio,Jr.,Vice-President I Gyp Southold,NY 11971 Dave Bergen y Telephone(631 765-1892 John Bredemeyer ,y Fax(631)765-6641 Michael J.Domino !`F Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: 9/ AUDREY ROTHMAN requests a Wetland Permit for the inkind/inplace replacement of existing deteriorated fixed pier with an extension of the pier seaward 12' to reach greater water depth and removal of 112' of existing catwalk. Located: 3995 Wells Ave., Southold. SCTM#70-4-1 T pelof area to be impacted: _Saltwater Wetland Freshwater Wetland Sound y 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: Wetland _Coastal Erosion _Amendment Ad min istrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: 1,,!�Ufr JrAet pzz�,I< Pres t Were: ,,- J. King B Ghosio D. Bergen, J. Bredemeyer_/,"" Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Audrey Rothman 3995 Wells Ave.,Southold SCTM#70-4-1 6/13/2012 - p _ AV Ry 1 r 0 -- p. i,. Audrey Rothman 399S Wells Ave.,99 Southold ud 1 1 12 F it a ' a r� Audrey Rothman 3995 Wells Ave.,Southold SCTM#70-4-1 S/9/2012 + r TL :�~/, , ' f y{'^`�`7� ' rw�' r •a ^N - `^1, a PHOTO SHEET 16�7 C - r _ r FROM(A)LOOKING SOUTHEAST FROM (B)LOOKING SOUTH ji OL FROM(C)LOOKING NORTHEAST FROM(D)LOOKING NORTHWEST APPLICATION: PREPARED BY: Robert&Audrey Rothman M1a.ROSIi.MARIN[:sl:KVici:INC. At: 3995 Wells Ave. 5W ROIIIN%ON RD. On:Jockey Creek (631) 77-I.NY,119N PO: Southold County:Suffolk State: NY MELROSE % �`'� �' �l�a.l(osctiis.cOV� All Photos taken at Low Water(+.3')5:30pm 9/11/11 MARINE SERVICE,INC. Winds: South-Southeast at 0-51(nots Sheet 1 OF 2 (including PHOTO MAP) PHOTO SHEET AND MAP 1 ,d T I CAL- FROM (E) LOOKING NORTH ARIAL VIEW MAP �.w A o� E \B 1 APPLICATION: PREPARED BY: Robert&Audrey Rothman MI.I.ROSL MARINI'SERVIC1.INc. At: 3995 Wells Ave. 500 ROBINSON RD On:Jockey Creek (31: 477-15 KIl'. 11944 PO: Southold County: Suffolk State: NY MELROSE M11► OSIMJ6 ry: 111ARIf�E SER�`!CF'„INC. �(1`I•KOtiliMti.('UM All Photos taken at Low Water(+.3')5:30pm 9/11/11 Winds:South-Southeast at 0-5Knots Sheet 2 OF 2 (including PHOTO MAP) ._a �>w �-_4�"=c_• • *`_��'j�,±^.r- _lam-3--�L'�.�z'kGn ui."sn^•.*'r'g".'`:�'.�'"-�:""ti s.cc�e,� :�• Boar f uthol;d: -own Tr n ustees i SOUTHOLD,- .NEW YORK �s 1. PERMIT NO: 414:8 ............... • r: -_� IS �. SUED,TQ ROB ROTHMAl Pursuant' to the rovisions of Che ter.b 1..5 .of 'the Laws'.of Iy� >° P .'Chapter the Stote•of New York, 1893, arid-Chapter 404 of the Laws of the f 6 -State of New York. 1952;, and.'the: Southold Town Ordinance en titled: REGULATING: AND THE'.:RLA.CING OF OBSTRU:CTIQNS ! " ? _ .:IN AND`OIY.TOWN'.W ; -:. ATERS.:AND :,PUBLIC` LANDS, and +{te . ; g t1\ REMOVAL OF.SAND;.GRAVEL OR:.OTHER:MATERIALS FROM ' s ` . LANDS UNDER TOWN: 1N.ATERS';" ,and. in accordance with:the. Air R1.9 soju��and nn of hconsid.e.ra aon}of•theasmm.of g held:on•....g.�Z.9 �4 `'��t ''•� u paid: ............................. . .............................I........................... <. Of ..... N. Y. and subject to the. ,k" a• !r^>; 'Terms and. Conditions listed on the. . reverse side hereof, �? of .Southold Town.Trustees authorizes.and..permits the.following: Grandfather Permit to replace 'dock.inkindlinplace as per -survey. all in' accordance with the detailed .specifications as presented in the-originating application: IN. WITNESS WHEREOF, The: said Board of4 Trustees.h+ere- ea:uses.its Corporate Seal to be. affixed, and these presents to be subscribed by a majority of ;e said Board as of this date. rf T aes ,ta •a r�..y�,>�.rt.,:x.E.c,`��`G::�"�.a3Si,r'�.P�'z'�.y::r,�=�.r�-�•-�-,.tr �,. - IN.+uN.Wi•:��^' L+RiCjy.'d:�V �-r+•Y.CdY �4• `,F� K'f firtl'_A.� � i� 1 *({ 1�.-•Y`l G'J?f�N.�►i•o.s � 1 h aS��~ !' Y •.......+neviiw:s:u.�.z::.�_�_::r+¢s_u...ti........:.... �..� ._� �' .....�....._i�.rssz:a-�.�.: TRUSTEES,` . .. �' .. 'SUPERVISOR John M..Bredemeyer; III, President t6 SCOTT.L.HARRIS Albert J. Krapski,'Jr.:Vice President Henry.P. Smith `�; ' , Town. Hall John.B. Tuthill' 53095 Main Road �. William:;.G:;Altiertsbn ®! ®� . P.O:Bax.11'79 T61ephone (516)765-1892 Southold;`New:York 11971 i .179x5I6)'7654523 ,BOARD OF TOWN TRUSTEES :TOWN OF SOUTHOLD 30:' year -Mainteri Ace Agreement .' Erosion Protection Structures j . ghapter;'37 Southold Town Code: Southold:Trustees as Administrator i /,2c) r', Nl 1q,/V . type"or. print name:(s) Ithe owners of.:..record:_of::-propert. at:. Y (type; or print street address) SCTM ] 000� s in .agplying for a.;Coastal. Erosion, permt for an Erosion Protection Structure '.do-hereby agree to a 30 year ma: nt.enance Program forma structure commonly known as a Of,. as shown:on the attached . feet of :`length`. licensed: survey o the as-built structure.. t is I0 /our understanding that We are. to maintain this: . truesture•.witli materials designed to endure 3.O. ..years and or quivalent to;. the original approved structure and that for any ainteftance % licli . nvolve:s more than 5% in- length of 'this truest re•;.we are to,giVe .prior written notice to the dm nistrrator; waiting. for their approval in all but .true . �mergecy s.ittiation's which would seriously endangor life, roperty, and i-Mportant' coastal natural resource: features such. as tuffs ior.toetl:ands: We .further .understand that. failure- to maintain the.: structure could result in- a requirement to..past a: �ond aril or. have 'the.r.epairs ordered as a lien .against the roperty upon a 'fi xid�rig' by the Trustees' that said. lack of aixteranc;e .would kis'k 1i fe, property or important ;natural esources features. including protected e or threatened nimalsi :and: plants; Notarized Signature of owner of xecord. . . WORN TO BEFORE ME THTS. . DAY OF ,19. OTA.. PUBLIC ;Please submit three copies of a licensed land survey made within ne ,Year 'of.. the original .construction.. This maintenance greement shall only. be valid .upon .the final .approval. of- the. dmini.strator.. Subsequent' owners may apply to, the Southold Town Trustees to: re=authorize this maintenance agreement. . C',, Yso/. TRUSTEES r SUPERVISOR-:. John;M:Bredemeyer;III„President Albeol.Krt Jr.,Vice President I - SCQTT L.HARRIS p, T.. Henry:P. Smith' own 11 John B:.'Tuthill: ` . T H .... !! iaIIt tJ Albertson ; , et. 53095 Main..Road . P.O: Box' 1179 TeIephofie.•(516) 765-1-892 `3 Southolri,-1Vew York 1f971 '. .` I Fax(516)765-'1923. r BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office use On1Y: . DATE REC.: : A. .Coastal. Exositin. Permit Appli cation i Coastalrosori Variance Application ` : :Wetland...Perriizt .A � ,,. ;.. pplicatibn Wai;vor from. Chapter, 97(Application/per rus'�tee. Iarids Permit App.lcation Gxarxdfa'ther 'Perma,t: <Appl .cation Completed.'APFs- `Date:: rxspectioil;' ate,_: :. . APR �.:' ' CA. c6Mments::Ja-t.e: Sent Rec. LI :.: vri'an:ce RegizXed:. ".{Y/N Ne :�I?ba�rs 'neti;fied-Date• TQv ' QFQQQ' ,sEpk .Type: Cflord::: .Date::.sent SER#1 Deterr�iirr./date Public Heat rig�.date.: Fi iidin.gs . Approved (YIN) special Garielta.oris: (YIN) '(see f 1e . Application. Fee: Permzt(s) issued'-date: f APPlication Number;.SCTM#1000- .'7Q: Date- PPlicant: ��.60/2% J20-r .OfiLfAI Ac7dress:- r [�. �-- � L. � .Phone jlnterest.: (owner, consulltant,-lessee;etc. ) �wner of Property.: i address i Phone '( ) Subject Property Locations i i {Provide LILCO .Pole. #; Distance to cross Streets if riot on�ocation map). . . THIS IS NOT A' PERMIT Page 1 ;yds. . t0 be. excavated: Yds.: ' to be f'i.11ed,: Manner in .which material will be removed or deposited: IWidth .of c'anai:,. creek .or. ,bay fronting ,property:- 0 X-,; ibepth at low tide`: rise in tide: stance .to neatest channel: S=_ T. Ds.tance project 'extends beyand. imilar..proj.ects .in area: N Area zoning: . /2 5.. :Land area in acres; . . . 'JIs pr.a:jeet for:priv'atE).or. business .use: f V4 T:t llrtend�-_d .use `of property: l2;;,4 i .Describe known prior operations conducted. on premises: . I Has any prior license or .permi.t been issued 'to erect structures, i dredge, or deposit fill on said premises: 4- h S has any. license .or permit ever b ' .revoked. or suspended by a .'0overnmental Agency: A/o Project Description 'he project description must also in plans for reclamation ?f. land disturbed.during construction of the principle ,and �access:orp structures and underground structures (i.e.., pipeline nd' septic system;' make additional .attachments .if necessary) . 70 THIS IS NOT A PERMIT Sage 2 :County of Suffolk . ) State. of New York .) } BEING..DULY .SWORN DEPOSES. AND iAFFIRMS. THAT:HE/SH-t IS. THE APPLIC: TT... bEr.:..TI E;;.ABQVE; DESCRIBED PERMIT(S) AND THAT ,ALL :STATEMENTS "CQNTAI1�iED HEREIN ;ARE 'TRUE TO.'' THE: BAST 'OF HAS/HE1 .,KNOWLEDGE ANp...BELIEF'; ;AND.THAT WQRK: WILL:BE jDONE IN TJIE M1ANNER SET FORTIS IN THIS.::APPLICATION AND A8 MAY.BE . IApPRE3VEU BY.T$E SOUTHOLD TQWN BOAS OF TRtTSTSES . APPLT'�ANT t�GREES1,1'TO HQLD T$E, TOWN OF SQUTHO1 A'ND 'I'FI$ TOw,, THUSTEES HAHGESS AND FREE EOM ANY ?,NI7 TALL I?AMAEB A1QD CDAIS .ARISTN.G t]NDEH 7? BY VZI'I'�T ', OF. 5 ID r PL T(tS) ;, IEz' GRAN2'ED IN CbMPT�ETTNd ' L4;8 'A PLICAT., r I HL''Rh" Y �:I7'FHC3R yE ,'i'HE TRUSTEES.r TE AUET(s OR REPRESEI'I'AT.m`( }r. Q ENTER.,'O110`,,;MSS: ?ROPEIZTY STD fiNSPEC1x 'HE PREP+�ISE INON (7NC1I'SC1N S^IYTiH REVIEW:;pF..T$IS: ' J . ! . SIGNATURE. I P 1993 1SWORN TO BEFORE ME. THIS DAY OF i i NOTARY PUBLIC I I ' i i . SuggeSted. space.for location Map THIS. IS NOT A PERMIT . BOARD OF TOWN TRUSTEES TOWN. OF SOUTHOLD Telephone: Main Road (.5161765-1892 Southold, New. York 1.1971 , P E R M I T MOORING RENEWAL RERMIT i {. *Permit .No....:$28..........:........ *Moo:ring No. S'S ... Fee Paid.. .5..0 0� Renewal Expi ration -D ate.:Pe] uary'.28 •19$6 i To: NAME.... Robert.,Rothman ....... ... ........... ... ADDRESS'.:36'15.Wel,ls Avenueti- Southold'c.New.York._ 971.... ...... TELEPHONE NUMBER.'.7653903 .'• r ... ,.... :.-:... e Jockey Crek LOCATIO.N..'. .. TYPE OF MOORING....?:.s$:�:les.............•... .......... .. ......�..•..:..� �. . BOAT•.27 ft. S799P .............. ...REGISTRATION NO.NY.�.kI j:Vll...:.:. *This .Permit.'is invalid unless the-moor_ ing number as'shown above is clearly i. indicated :on the mooring and boat being moored. : ............ Pre e t, o rd o Southo Town,'Trus ees By. .. Clerk Board of Southold w• rustee's I • ALL &i00,RINCS AND STAKES MUST DISPLAY VISIBLE MOORING'NU,MBERS. i . t ' e fxr� I* r J ! r. AM I _ alot 1 Is is :_✓ ..ivw.. .,�:. ..�..> .•_..gym:.�, ....�.. _ � ..•7Y----�--^� �- f 7 - Y _ T 5 FF. LK C E ' wmvL9iEs NOTICE _ r(1 - W. pine ,lunwYari uRP\1�sYE:06 , .Red Prop1yPo0% Ery�e�genCy _,Y _ y nna's�-- _ 'Sysdleo't, '.s6 E .ono.. -�— am.a[►amw 121) O r;' sutT rnm __ fly M p orncrio ERir3u/r�i t armmlm b 000 lYP. F,`- N °" .. e.•'.� 9 ,v. 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'61 60 F � � n g 51,a SO E a 15 � °.R1 -'a Yw•YT m m�" w SEE SFfi•Yl % /./�� �d4: 5 6FS.RVE9 \VE °°, IT® n 1/ Q n n n m Sf f • x6] 4 b1 1!2 �m `' � +t)<°� sa m Y1TCI LL` g uytpp � 16,_ zT 1y 19A LOY4 Y w of•. 53 �'� ��)F 52 st s1 n L�11 [ im�ll aE n py - s .E[tl m " 1 � `�C,// Cam"" • a6 nAF�6 SW1M3e S D \°Ll ® 121L` . vo•o°` ' SECTION NO COUNTY OF SUFFOLK © a 1o1n6 SOUTHOLD cnw` lis NOTICE T Red Property TEX NY ll nl\1L Oi 070 Service Agency L"�"r• 1211 a 2O —_,—_ ra.•nom.l Y. r*-- a`nn'"` s�.aTiwcamn inrmim t< ¢ ` 1'an1Y 0°AtYDr¢r � 171 y Y` E o-m. --z— ` - tonrsc •nxsur•mrtr rtm°ssnl o<il5 a®eo P mmcl to SUOO PROPERTY NIAP�saa..�.wln ----- ` Y. --� -- -- ""'o...,Y. ••-- Tsn vlammn i.x vavrz uon. ua,,. - I r 1 OFFICE LOCATION: OF.SOUI,yo MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G Q Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM f{~ E C E � 14 E L,1 r�' MAY - 9 2012 To: Jim King, President Town of Southold Board of Trustees Sotithhold Tovan From: Mark Terry, Principal Planner Board of Trustees LWRP Coordinator Date: May 9, 2012 Re: Proposed Wetland Permit for AUDREY ROTHMAN SCTM#1000-70-4-1 Melrose Marine Service, Inc. on behalf of AUDREY ROTHMAN requests a Wetland Permit'for the inkind/inplace replacement of existing deteriorated fixed pier with an extension of the pier seaward 12' to reach greater water depth and removal of 112' of existing catwalk. Located: 3995 Wells Ave., Southold. SCTM#70-4-1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action 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 1 Office Use Only astal Erosipn Permit Application etland Permit Application Administrative Permit Amendment/Transfer xtension ^Received Application: j I�' . /keceived Fee:$ L-1(:!;—Mpleted Application - Incomplete —_SEQRA Classification: APR 2 5 2t712 Type I_Type lI Unlisted _Coordination:(date sent) a�:WRP Consistency Assessment Form I a�1►,2, - _CAC Referral Sent: _✓Date of Inspection: ?-.- _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: [Public Hearing Held: Resolution: Name of Applicant Audrey Rothman Address 3995 wells Ave. Southold, NY 11971 Phone Number:( ) 631-765-3903 Suffolk County Tax Map Number: 1000- 70 - 04 - 01 Property Location: 3995 Wells Ave. Southold, NY (provide LILCO Pole#,distance to cross streets,and location) AGENT: David Melrose/Melrose Marine Service Inc. (If applicable) Address: 123 Huron St. #2 Brooklyn, NY 11222 Phone: (347) 742-7791 �`" Opt -d of Trustees Application GENERAL DATA Land Area(in square feet): 22,396 sq.ft. Area Zoning: Residential Previous use of property: Private Residential p Intended use of property: Private Residential Covenants and Restrictions: Yes XNo If"Yes",please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes X No If"Yes",please provide copy of decision. Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): Proposed in kind and in place replacement of existing deteriorated fixed pier with an extension of the pier seaward 12' to reach greater water depth and removal of 112' of existing catwalk as per NYSDEC request. E 'd of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To repair of storm damage and deterioration to the existing fixed dock in-kind and in-place for continued access to water related recreation and — to the existing mooring area. Area of wetlands on lot: +/- 1,000 square feet Percent coverage of lot: +/- 4.5 Closest distance between nearest existing structure and upland edge of wetlands: 85 feet Closest distance between nearest proposed structure and upland edge of wetlands: 35 feet See Pains Does the project involve excavation or filling? x No Yes If yes,how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/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 (use attachments if appropriate): This proposed project will have a minimal effect upon a wetland area during the implementation of the support piles only and no addition and _ or residual effects beyond that. The extent of this construction disturbance is likely to consist solely mild turbidity in the direct vicinity of _ the construction and in its tidal tract. P' _d of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Proposed in kind and in place replacement of existing deteriorated fixed pier with an extension of the pier seaward 12' to reach greater water depth and removal of 112' of existing catwalk as per DEC request. Are wetlands present within 100 feet of the proposed activity? X No Yes Does the project involve excavation or filling? X No Yes If Yes,how much material will be excavated? N/A (cubic yards) How much material will be filled? N/A (cubic yards) Manner in which material will be removed or deposited: N/A 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) This proposed project will have a minimal impact on both the subject and neighboring properties during the implementation of the support piles only and no addition and or residual effects beyond that. The extent of this construction disturbance is likely to consist solely mild turbidity in the direct vicinity of the construction and in its tidal tract. The proposed is a repair in- kind and in-place of an existing fixed pier and poses no additional impact adversely or otherwise to the immediate surroundings. ® o . • • --,COMPLETE THIS SECTIONON I • .:, Complete items 1,2,and 3.Also complete $ign re I item 4 If Restricted Delivery is desired.,. ' [3 Age kss rW, ,: ❑Add ssee I EN S '© `� ] 0 ^ 6 $ ' ■`Print your name and address on the reverse . � 3 ) 1, • so that we can return the card to you: Receive (Printed Name) C. Date of D livery l I Postage $ $1.30 0321 -z Attach this card to the back of the mailpiece; ` f or on the front if space permits. I Certified Fee D. Is delivery address different from item 1? ❑Yes $2.95 14 1'. Article Addressed to: If YES,enter delivery address below: ❑No i I Return Receipt Fee P Here \ e (Endorsement Required) $2.35 Here GO�1 111 111 � I Restricted Delivery Foe e (Endorsement Required) $0.00 \ ' Total Postage&Fees I q V V i I` l $ $6.60 05/07/2012 ` 3. SS ce Type I I YP Sent To JCertified Mail ❑ ress Mail I d D 7 GC/i?f it i Gl a la, p, " l A(T 0�� ❑Registered Retum Receipt for Merchandise I street,Apt.No.; r ❑Insured Mail ❑C.O.D. I or PO Box No. City'-siai..... G 7 DI 4. Restricted Delivery?(Extra Fee Yes q12,i 1-7I ; t 2. Article Number : i 7p11 2,970 •0000 6225 '7373 (transfer`from service la!_,' ` ` ' 1 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 .. . SENDER: COMPLETE THIS SECTION 7 Signa re t �• • ■ Complete items 1,2,and 3.Also complete A w item 4 if Restricted Delivery Is desired. X p Addressee I RI C'��ItT � .z o + �, ■ print your name and address on the reverse so that we can return the card to you. ecer ed by noted Name) C. ate o Delivery f Postage $ $1.30 0321 ■ Attach this card to the back of the mailpiece, C o�'r'I ,`I 1 or on the front if space permits. Certified Fee •�$2.95 14 s delivery address different from item 1? ❑Yes ] Postmark 1• Article Addressed to: If YES,enter delivery address below: ❑No 3 Return Receipt Fee (Endorsement Required) $2.35 Hero '6 LA C-Lek Restricted Delivery Fee (Endorsement Required) $p.00 li Q/1 f I 4 y-ai i I Total Postage&Fees $ $6.60 05/07/2012 1�� �Q-C p ,�'Io k( ( P '�] 3. Se Type Sent To rOS Z-e �_ I ,��eL GI/ �� j��( 7 / Certified Mail ❑Retums Mail Sireef,ApENo. _ \ V 1 9 -- -- Z ❑Registered Retum Receipt for Merchandise 3 or PO Box No. S( O M o ❑insured Mail ❑C.O.D. City State, 1 `, I 4. Restricted Delivery?(Extra Fee) [3Yes 2. Article Number; i; �p1112>972' 0�20j 16225 7366i (transfer from servici • Domestic Return Receipt 102595 02-M-154( PS Form 3811,February 2004 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY . SOL N 117 " ,`1 ` ■ Complete items 1,2,and 3.Also complete A. Signature L. [3 Agent 1 E" item 4 if Restricted Delivery is desired. ° ressee . d Postage $ $1.30 0321 1 ■ Print your name and address on the reverse B. eceived by(Printed Name) C., ate of Delivery 3 so that we can return the card to you. ; Certified Fee I ■ Attach this card to the back of the mailpiece, 3 $2.95 14 Postmaq or on the front if space permits. [IYes 3 Return.Receipt Fee D. Is delivery address iifferent from item 3 (Endorsement Required) $2.35 Here 1 Article Addressed to: If YES,enter del' ery adds below::�Q No 3 Restricted Delivery Fee ]•(Endorsement Required) $0.00 • Total Postage&Fees $ $6.60 05/07/2012 r e r? '0s � ` ��e Sent T� r✓I�`� J(; / C Y I 3. Se ceType �t Street,ApCNo:;; --------------- '' /� / t 3 or PO Box No. Z j �D )O G t°y r ` I n fj �� I ( //� Certified Mail ❑ ress NSa�I E. !l ff re P�L ...VVV J ✓✓ll 66 ( 0 ----------------- O vt ❑Registered Return eceipt fort Merchandise City, -- -Z1P+ y j rl 1 1 �f 7 ( I El'Insured Mail ❑C.O.D.MEM t TME32= 4. Restricted Delivery?(Extra Fee) ❑-Yes j 2. Article Number t t1 t .i lit , i ; 7t112;97L10 �0 {6225 •' 3Pi9 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-154o A PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Co v1..) C) I ►`a T:�11_11 k STATE OF NEW YORK o.l c� 1( l 7 C COUNTY OF SUFFOLK . x�l C Q` residing at 0✓1 `�jr����`� /X r -2 -Z Z� being duly sworn, deposes and says that on-the day.of 20_7 ,deponent mailed,a true copy of the Notice set forth the Board of stees 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 ld; that said Notices were mailed at.the.United States Post. assessment roll of the.Town of Southo . Office at DI /yo�1 V✓1 _, that said ices ere mailed to.each ofsaid.persons by (certified) (registered)'mail: /I Sworn to be r me this Day of , 20 THERESA LaRQSA Notary Public,State of New VA No- 1LA6172298 Qualified in Queen u � No M VLlc n ires Au st 0 o�ogv�Fo�,�ca James F. King,President ' Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President P.O. Box 1179 Dave Bergen 'F y Southold,NY 11971 John Bredemeyer O ��' Telephone(631)765-1892 Michael J. Domino y' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of AUDREY ROTHMAN COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING / c I, ly#r'-�residing at/dba ! j'D_(4_ 1-1 Son ?—c(, Zee�-� L)o V, being duly sworn, depose and say: V. That on the 7--day of /1�aY , 201';4personall posted the property known as 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. May 16 2012. Dated: (signature) Sworn to before me this of otary bli THERESA LaROSA Notary Public,State of New York No.O1LA6172298 ed i Qu s Coun mission i s gust O6 1 MEPROSE U l7 LFU MARINE SERVICE, INC. 500 ROBINSON ROAD GREENPORT,NY 11944 www.melrosems.com (631) 477-1546 Date: June 13, 2012 To: Board of Trustees Town of Southold P.O. Box 1197 Southold,New York 11971-0959 From: David Melrose, Melrose Marine Service Inc., Authorized Agent Re: Permit Application set for review: June 20, 2012 Audrey Rothman, 3995 Wells Ave. Southold,NY 11971 Suffolk County Tax Map: Dist. 1000, Sect. 070, Block 04. Lot 01 To Whom it May Concern, To complete the requirements for Mrs. Rothmans application included please find: • Notarized Proof of Mailing Form • Certified Mail Receipts • Affidavit of Posting Please let me know if there is anything else required. Thank You, David David Melrose Environmental Consultant Melrose Marine Service Inc. 123 Huron St. #2 Brooklyn,NY 11222 347-742-7791 dmelrose(a,,melrosems.com 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. APPLICANT/SPONSOR 2. PROJECT NAME David Melrose/Melrose Marine Service Inc. Rothman Residence Dock Repair 3. PROJECT LOCATION: Municipality Southold County Suffolk 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 3895 Wells Ave.Southold,NY 11971 5. PROPOSED ACTION IS: New Expansion ❑✓ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Proposed in kind and in place replacement of existing deteriorated fixed pier with an extension of the pier seaward 12'to reach greater water depth and removal of 112'of existing catwalk as per NYSDEC request.. 7. AMOUNT OF LAND AFFECTED: Initially N/A acres Ultimately N/A acres 8. WILL 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? ❑✓ 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 (FEDERAL,STATE OR LOCAL)? �✓ Yes No If Yes,list agency(s)name and permit/approvals: USACE Nationwide,US Dept of State Consistency Assessment and NYSDEC Wetlands permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes I No If Yes,list agency(s)name and permit/approvals: 12. AS A RESULT 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/sponsor name: Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER I =�l�eset`:ptl� PART 11- 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 EAR ' Yes a 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) 'Cl. 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,shel fish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as ofridaiiy adopted,or a change in use or Intensity of use of land or other natural resouroes7 Explain bdefly: 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 quantity or type of energ Explain briefly D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If es,explain briefly: a Yes. Q No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes lain: Yes Q No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agencyy . INSTRUCTIONS: For each adverse effect identified above,detemtine whetherit is substantial,large,important arotherwise 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 suflident detail to show that all relevant adverse Impacts have been Identified and adequately addressed. If question d of part fi was checked yes,the determination ofsignihcance mustevaluate the potential impact ofthe proposed action on the environmental characteristics ofthe CEA. Check fhis box Ifyou have Identified one or more potentially largeor s(gnfficafit adverse Impacts which NAY occur Then proceed directly to the FU LI EAF and/or prepare a positive declaration. Check this box if you have detemilned,based an the Information and analysis above and any supporting documentation,that the proposed aetio WILL NOT result in any signifitcant adverse environmental impacts.AND provide,on attachments as necessary,the reasons supporting thi determination. Board of Trustees kh/Al B /Z Name of Lead Agency 1 � //� Date `�/1 PCs � /\Al/1-1 President Print or Type Name of Responsible Officer in Lead Agency rifle of Responsible Officer S" nature of Responsible Officer in Lead ericy Signature of Preparer(If different from responsible officer] Board of Trustees Application County of Suffolk State of New York L BEING DULY SWORN DEPOSES 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. �u- )"t'k m. Signature SWORN TO BEFORE ME THIS DAY O -P ,20 j\ CONNIE D. BUNCH Notary Public,State of New York No.01 BUS185050 Notary Public Qualified in Suffolk County Commission Expires April 14,2�(o Bo''- of Trustees Application County of Suffolk State of New York David Melrose BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE 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 AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH RE W OF THIS APPLICATION. Sj6ature SWORN TO BEFORE ME THIS DAY OF G i'C " ,20 Notary ublie FBRITTANY A.GENOINO' t"kbory public,state of New York No.01GE6245154 Quai'ified in Suffolk ff lk 18,ty o r commission Exp Ho-___ of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Audrey Rothman residing at 3995 Wells Ave: (print owner of property) (mailing address) Southold, NY.11971 do hereby authorize David Melrose (Agent) of Melrose Marine Service inc. to apply for permit(s) from the Southold Board;of Town Trustees on my behalf. (Owner's si ature) 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: David Melrose for Audrey Rothman (Last name,first name,middle 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.) X 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 5%of the shares. YES NO y 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 t ' d y of f' �1 k-, 204 Signature Print Name Form TS 1 i x Town of'Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAFks r proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. assessment is intended to supplement other information used by a Town of Southold agencl in making a determination of consistency. *Except minor exempt actions including Building Per its 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 ex pt minor action list, policies and explanations of each policy contained in the Town of Southoldal Waterfront Revitalization Program. A proposed action will be evaluated as to its signint 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",then the proposed action may affehe achievement of the LWRP policy standards and conditions contained in the consistency review Thus, the action should be analyzed in more detail and, if necessary, modified prior to maki a determination that it is consistent to the maximum extent practicable with the LWRP poi icy standards and conditions. If an action cannot be certified as consistent with the LWRP poi icy 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, ill local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 70 _ 04 _ 01 The Application has been submitted to(check appropriate response): Town Board © Planning Dept. 0 Building Dept. E Board of Trustees l^ 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: A Nature_and extent of action: Proposed in kind and in place replacement of existing deteriorated fixed pier with an extension.of the pier seaward 12'to reach greater water depth and removal of :112`of existing catwalk. I r r x �I Location of action: 3995 Wells Ave. Site.acreage: 22,396 sq. ft. Present land use: Private Residential j Residential Present zoning classification: I 2. If an application for the proposed action has been filed with the Town of Southold agency, the follo (" g information shall be provided: (a) Name of applicant:NIA (b) Mailing address: N/A I (e) Telephone number:Area Code( ) N/A (d) Application number,if any: N/A i Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes L^ No❑ If yes,which state or federal agency? NYSDEC, USACE and DOS DEVELOPED COAST POLICY I Policy L.Foster a pattern of development in the Town of Southold that enhances community characte'i, preserves open space,makes efficient use of infrastructure, makes beneficial use of a coastal location,2i'nd minimizes adverse effects of development. See LWRP Section III—Policies;Page 2 for evaluation criteria., ❑Yes ❑ No © Not Applicable �j I� I Attach additional sheets if necessary I Policy I. Protect and preserve historic and archaeological resources of the Town of Southold. I ee LWRP Section III—Policies Pages 3 through 6 for evaluation criteria No n Xes I" 1 Not Applicable I;I � 7 K 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 ill Attach additional sheets if necessary NATURAL.COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See WRP Section III-Policies Pages 8 through 16 for evaluation criteria X i f � Yes.Ed No u Not Applicable N Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Sec on III —Policies Pages 16 through 21 for evaluation criteria Yes El No t"' 1Not Applicable ill .I Attach additional sheets if necessary I 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; P �gg 22 through 32 for evaluation criteria. Yes E] No LJ Not Applicable i i I i i IIIII YI Attach additional-sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — ) olicies Pages 32 through 34 for evaluation criteria. Yes No l" 1 Not Applicable FX � I II BI . N! ill Attach,additional sheets if necessary Policy.8., ,.Minimize environmental degradation in Town of Southold from solid waste and haz' rdous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation critex ia. 121 Yes, El No 0 Not Applicable i i IIIII u PUBLIC COAST POLICIES Policy 9:. 'Provide for public access to, and recreational use of, coastal waters, public lands, and Ipublic resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for eva 'uation criteria: Yeo No X❑ Not Applicable �I �I I Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependentuses in suitable:locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. � I 0 Yes El No L^ i Not Applicable I d III I Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the IIieconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation cr teria. I' Yes No 0 Not Applicable I Ili I' Attach additional sheets if necessary Policy 12: Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies�i Pages 62 through b5-for evaluation criteria. - [] .Yes .0 No[^ 1 Not Applicable Attach-additional sheets if necessary I I Policy. .13..-Promote appropriate use and development of energy and mineral resources. See LWRP Section III-Policies; Pages 65 through 68 for evaluation criteria. E. Yes 0 No I^ J Not Applicable i i �I I i Created.on 511510511:20 AM MEAROSE A o 0 U MARINE SERVICE, INC. 500 ROBINSON ROAD GREENPORT,NY 11944 www.melrosems.com (631) 477-1546 Date: April 24, 2012 To: Board of Trustees = - Town of Southold P.O. Box 1197 APR 2 5 2012 Southold, New York 11971-0959 From: David Melrose, Melrose Marine Service Inc., Authorized Agent- Re: Permit#4148- Date: 4/29/1993 Issued to: Robert Rothman, 3995 Wells Ave. Southold,NY 11971 Suffolk County Tax Map: Dist. 1000, Sect. 070, Block 04. Lot 01 Ladies and Gentlemen of the Board, On behalf of Mrs. Audrey Rothman, Melrose Marine Service Inc. has been authorized to apply for a permit to replace elements of her deteriorating fixed pier. This pier has been in existence in this location prior to documentation dating from the 1960's and was granted a Grandfather Permit from the Southold Board of Trustees on 4/29/1993 to replace the dock in-kind and in-place. The dock still stands in the permitted configuration and was severely damaged in a March 2010 storm and subsequent weather events. Our original submission to the New York State Department of Environmental Conservation for an in-kind and in-place repair and a replacement of the pier was denied due to the objection of the existing catwalk that runs parallel to the bulkhead (because of its proximity to the wetlands). It was suggested by the DEC that this section of catwalk be removed completely and in lieu of the sacrificed be allowed to transfer the same square footage to another portion of the pier. On behalf of Mrs. Rothman, we ask the Board for permission to replace this deteriorated structure with a new pier consisting of materials, size and configurations reflecting current town codes. We also ask for a 12 foot extension to the existing pier to ensure adequate water depth for moored vessels and to minimize the lost property incurred by the NYSDEC and The Town of Southold mandates. This exchange will compensate my client with 48 square feet of dock space for the approximately 112 square feet sacrificed. The proposed will consist of 10 new treated timber piles with like underpinning and a Town approved hardwood or composite decking. All materials are to be brought in by truck via Oaklawn Avenue. All work is to be done from land and from a floating crane barge where necessary. All machinery is to be stored upland when not in use and secured on the crane barge moored at the site. This project will take no more than one month to complete. ,I. n Included please find: • Trustees Application • LWRP Consistency Assessment Form • Short Environmental Assessment Form • Project Plans (two copies) • A Copies of a Recent Survey • Current Photos of Structure • A Copy of Permit# 4148 and Original Application Forms The required Application Fee, Transactional Disclosure Form and a signed and notarized page of the Board of Trustees Application Form will be hand delivered on April 25, 2012. Please notify of how to proceed and if there is any further information you may require. Thank You, 4ae��� David David Melrose Environmental Consultant Melrose Marine Service Inc. 123 Huron St. #2 Brooklyn,NY 11222 347-742-7791 dmelrose(,melrosems.com