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TR-8246
James F.King,President D.rOgFQ('I.c Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President a� �Gy P.O.Box 1179 Dave Bergen y Southold,NY 11971 John Bredemeyer �y �� Telephone(631)765-1892 Michael J.Domino 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 ,IV'w) 111%rr _ :'„,`11/ 1//jrr.. .it / /�/r•• .'14f /rr .YV,N ' 4.. Aal' 1 11/%jr - •'lll /%//rr BOARD.OF SOUTHOLD TOWN TRUSTEES � p4iv SOUTHOLD,NEW YORK PERMIT NO. 8246DATE: JULY 17,2013 =... ISSUED TO: ALBERT & BARBARA REIBLING s PROPERTY ADDRESS: 75 ISLAND VIEW LANE, GREENPORT SCTM#57-2-32 •• AUTHORIZATION — 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 July 17,2013,and in 11, consideration of application fee in the sum of$250.00 paid by Jeffrey&Loriann Patanio and subject to the N Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to remove and replace 151 linear feet of existing bulkhead with new vinyl bulkhead; replace 30 cubic yards of clean fill; replace existing 271x9' deck r and 4 x8 stairs to beach; establish and subsequently maintain a.10 wide non-turf buffer on landward side of bulkhead; with the condition stairs to beach are retractable, and as depicted on the site plan prepared b Jeffrey Patan o last dated.Ma 11 2013 / P� P P P Y Y J � Y, � and stamped approved on July 17,2013. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, "E and these presents to be subscribed by a majority of the said Board as of this date. - 1116111104 w iI{ ( i. .,,"r+/r 1 1 iV�. .-. '•Twill IV i'`�-......�..�-•^"'��I 10�-.r ..d// w,a �I 11,e.: i11 0 .•e.•.' ,;,�' :._. �...y,. - "J - .e.lr:li:' :P:' -,.. rr1:14,••• ....Cr.l„1 /��ti. r.111,1�4i.•1,1,. �� s.�w�r�4...-:-.V . 1.,.. 'wry,(.,..., _ .:.r__ _. .:.._,, _• .r>:.�w - -- 'z':e:.:_ ,, :''. Ra{ ` ISLAND SLAND VIEW LANE el.4.4 rf+ ryc r — _ E I PROPOSED 32 LF VINYL BULKHEAD el.43 S 85'4000 107.52' (IN SAME ALIGNMENT AS EXIST.) emcn +e CH. LNK. FENCE K WOOD BULKH °l 1 l ' p cil co tt O ? a c 1 ' Saba E 4 . 1 rn O ~ra � e1.4.3 el.4.5 r r*+ ' ~^♦ t o APE' ;. _ ,9 `O ' /26.5 a' 1. `� PROPOSED 77 LF VINYL BULKHEAD E" (IN SAME ALIGNMENT AS EXIST.) . PROPOSED\LINE OF 10' NON—TURF BUFFER F OF CAFAR� 1 9' REPLENISH')fPROX. 30 CY OF FILL LOST �N� N� WOOD DESK \ DURING STO 1.M PROJECT LOCATION MAP m w•2 STORY FRAME oo s m RESIDENCE Y' wooD wry \ \ tir N.T.S. F.FL.=1o.0 1 �6712�LTaQ , E C E � V E N REPLA E WOOD DECK (27'X9') AND STAIRS 1 J (4'X8')) ST DURING STORM . —••�• • WOOD JE>� \: 265� — — JUN 2 2013 PROJECT Cl .'' Southold Torun LOCATION U,K ONCE WOOD i Beard of Trustees WOOD PROPOSED 42 LF VINYL BULKHEAD el.3.9 CH• DECK Q' / g4.2 /,• (IN SAME ALIGNMENT As IXlsr.) ` APPROVED BY MEAN HIGH WATER — — o S ig•-5 ' W ' 60ARD.OF TRUSTEES To. OF.SOUTHOLD of RE1DY ;:. DATE . `I '17- 13 NOTES: PROPERTY OWNER: SCALE: 1. ELEVATIONS REFER TO NGVD 1929 ALBERT REIBLING BULKHEAD. PERMIT PLANS 1"-20' 2. LOT AREA: 9,111 S.F. / 0.209 ACRES 2928 MEADOWCREST DR. 3. PORTIONS OF SITE PLAN FROM SURVEY PREPARED BY: YORKTOWN HEIGHTS, NY 10598 PROPOSED PLAN DATE: PECONIC SURVEYORS PREPARED BY: 5-11-13 1230 TRAVELER STREET, SOUTHOLD, NY JEFFREY PATANJO 75 ISLAND VIEW LANE DATE SURVEYED: APRIL 29, 2004 106 HEWITT HEBLVD. NY 11934 GREENPORT, TOWN OF SOUTHOLD CENTER SUFFOLK COUNTY, NY SHEET: 631-484-9332 TAX MAP NO. 1000-57-02-32 1 of 2 PROPOSED TIMBER TOP CAP NOTE: REMOVE EXISTING REMAINING STRUCTURE IN ITS ENTIRETY PROPOSED 3"X6" PROPOSED 14' LONG 10" BUTT AND INSTALL NEW BULKHEAD REAR WALE CCA TREATED TIMBER PILE, 6' IN THE EXACT SAME POSITION O.C. LOST D AS STORM DAMAGED BULKHEAD SAND RAISE TOP ELEV. APPROX. 1 FT. LOST DURING STORM i i .� in -------- ---------------------------------------- ------------------- APPROXIMATE M.H.W. REMOVE REMAINING ! \ \\ \\ DAMAGED BULKHEAD LAY PROL OG PILE SED 8" TIP CCA TIMBERS \ APPROXIMATE M.L.W PROPOSED 6"x6" CC\A PROPOSED 8" TIP CCA PIA6' TOP & BOTTOM WALE O.C. 8' LENGTH. BOLTED LAY-LOG WITH 3/4" PROPOSED 12' LONG CLOC GALVANIZED THRU-BOLTS. 9000 VINYL SHEETING PROPOSED 16' LONG 1 " DIA. GALV. TIE ROD, 6' O.C. TYPICAL SECTION N.T.S. PROPERTY OWNER: BULKHEAD PERMIT PLANS SCALE: Noted ALBERT REIBLING 2928 MEADOWCREST DR. YORKTOWN HEIGHTS, NY 10598 PROPOSED SECTION DATE: PREPARED BY: 5-11-13 JEFFREY PATANJO ITT BLVD. 75 ISLAND VIEW LANE 106 HEW NY 11934 CREENPORT, TOWN OF SOUTHOLD CENTER ITT BLVD. D. CEN T484-93C SUFFOLK COUNTY, NY SHEEP: TAX MAP NO. 1000-57-02-32 2 OF 2 TERMS AND CONDITIONS The Permittee Albert& Barbara Reibling,residing at 75 Island View lane, Greenport,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 stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. 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 F SQU,. Town Hall Annex Bob Ghosio,Jr.,Vice-President OVA y�l 54375 Main Road O P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer G Q Telephone(631) 765-1892 Michael J.Domino �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 17, 2013 Mr. Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: ALBERT & BARBARA REIBLING 75 ISLAND VIEW LANE, GREENPORT SCTM# 57-2-32 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, July 17, 2013 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of ALBERT & BARBARA REIBLING applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 20, 2013, 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 July 17, 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 ALBERT & BARBARA REIBLING to remove and replace 151 linear feet of existing bulkhead with new vinyl bulkhead; replace 30 cubic yards of clean fill; replace existing 27'x9' deck and 4'x8' stairs to beach; establish and subsequently maintain a 10' wide non-turf buffer on landward side of bulkhead; with the condition stairs to beach are retractable; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated May 11, 2013 and stamped approved on July 17, 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 Very truly yours, v� James F. King President, Board of Trustees JFK/amn James F.King,President y - Town Hall Annex Bob.Ohosio,Jr.,Vice-President w ni 54375 Route 25,P.O.Box 1179 Dave Bergen �.��i �► a� Southold,NY 11971 John Bredemeyer 'r/j3 Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ) t-C—�4?y Pa- an �`b 4 y- A b z(+ + 6a r nna e ill i h Please be advised that your application dated. 12-6 hS has been reviewed by this Board at the regular meeting of 3 and your application has:been approved pending the completion-of t a 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) % Constructed ($50.00) Final Inspection Fee $50.00 . Dock Fees($3.00 per sq. ft j 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: $ SCE• O C� BY: James F. King, President Board of Trustees Peter Young,Chairman co Town Hall,53095 Main Rd. Lauren Standish, Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1892 y' Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 10, 2013 the following recommendation was made: Moved by John Stein, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the application of ALBERT & BARBARA REIBLING to remove and replace 151 If. of storm damaged bulkhead with new vinyl bulkhead. Replace 30 cy. of clean fill lost during storm. Replace 27'X 9' deck and 4'X 8' stairs to beach lost during storm. Located: 75 Island View Lane, Greenport. SCTM#57-2-32 Inspected by: John Stein The CAC Supports the application with the Condition the beach stairs are retractable. Vote of Council: Ayes: All Motion Carried >Z I � I• Y _ l •1 • _ T—�LRY.. �G �� —`� � �•.'we i� ter~ - -♦ � ti kn S! jW r .. Ibert& Barbara Reibling and View Lane, Greenport R,,•,_ CTM# 57-2-32 7 gUFFO(�- lames F.king,President P.O.Box 1179 Bob Ghosio,Jr.,Vice-President �� Gy a Southold,NY 11971 Dave Bergen Telephone(631 765-1892 John Bredemeyer ,+. 1 Fax(631)765-6641 Michael J,Domino G Southold Town Board of Trustees Field InspectionlWork Session Report , s" Date/Time: ��� /D , S Jeffrey Patanjo on behalf of ALBERT & BARBARA REIBLING requests a Wetland Permit to remove and replace 151 linear feet of existing bulkhead with new vinyl bulkhead; replace 30 cubic yards of clean fill; replace existing 27'x9' deck and 4'x8' stairs to beach. Located: 75 Island View Lane, Greenport. SCTM# 57-2-32 Type of area to be impacted: _Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Park of Town Code proposed work falls under: _Chapt.275 Chapt. 111 other Type of Application: Wetland _Coastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: -,to 9915C -�VP 2J/' 70 /3 Conditions: Present 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: ECEI1\7w 2013 PAO "'' + � L.a, �s •'+der. r ! rm.� Ji � ���. �'� +i 5�� � .�� gyp- '�`'� .�f•' *°- '' � F 4 T ,,t 'ram, t } e iy • 'U11 s ro Photo 2 r � � "fir k''�« ���^•4 s ri• a• �• P * Y4 y� r r� June 17, 2013 NYS Dept. of Environmental Conservation SUNY @ Stony Brook D E C E V E 50 Circle Road Stony Brook, New York 11790-2366 JUN202013 Attention: Duty Analyst RE: 75 ISLAND VIEW LANE,GREENPORT, NY southold Town Boar of lnistees SCTM No. 1000-57-02-32 APPLICATION FOR PERMIT Dear Sir/Madame: We hereby submit four(4) copies of the proposed plans, applications, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332 or e-mail at jpatanjo@optonline.net. Very truly yours, c Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 cc: Town=of-Southold.;— Albert& Barbara Reibling 30INT APPLICATIOM [FORM For Permits/Determinations to undertake activities affecting streams,waterways, .i'k7lY�"sY waterbodies,wetlands,coastal areas and sources of water supply. US Army Corps of New Mork You must separately apply for and obtain separate Permits/Determinations from Engineers(USAGE) State each involved agency prior to proceeding with work.Please read all instructions. APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart- General Services ment of State Check all permits that apply: Check all permits that apply: ❑Coastal Erosion ❑ Section 404 Clean Water Act Check all permits that Check if this ❑ Stream Disturbance apply: applies: ❑ Excavation and Fill in Management ❑ Section 10 Rivers and Harbors _ ❑ State Owned Lands ❑ Coastal Navigable Waters ❑Wild,Scenic and Act Under Water Consistency ❑ Docks,Moorings or Recreational Rivers Nationwide Permit(s)-Identify Concurrence ❑Utility Platforms ❑Water Supply Number(s): Easement ❑ Dams and Impoundment ❑ Long Island Well 3 (pipelines, Structures ❑Aquatic Vegetation Control conduits, cables,etc.) ❑401 Water Quality ❑Aquatic Insect Control Certification Preconstruction Notification- ❑Docks, ❑ F eshwater Wetlands El FishN Fish Control Moorings Vor ❑ / ❑ Platforms Tidal Wetlands El Incidental Take of Endan- gered/Threatened Species � ❑ I am sending this application ❑ I am sending this ❑ I am sending L�I am sending this application to this agency. to this agency. application to this this application a enc . to this agency. 5. Name of Applicant(use full name) Applicant must be: 6. Name of Facility or Property Owner(if different than ❑Owner Applicant) A I Wort �a r ba ra Qe�bl,� ❑Operator Mailing Address ❑ Lessee Mailing Address (check all that apply) 14er. lbw cre6-r Post Office City Taxpayer ID(If applicant Post Office City 1/a{ is NOT an Individual): State � Zip Code �p gp�$ State Zip Code Telephone(daytime) Email Telephone(daytime) Email qrq . aNs a6 t3 as �b-r1 &✓e�riron•,nJ e-1- 7. Contact/Agent Name 8. Project/ Facility Name Property Tax Map Section/Boc k/Lot Number --s- P -IS ?Sla...A vte— �anC 1,900 - 1- rc a'�"a n a Company Name' Project Location-Provide directions and distances to roads,bridges and bodies of waters: 5� c Mailing Address Street Address,if applicable Post Office City State Zip Code NY 1 oG I-(ewl-t-f (vLvcQ �S z,&l kru2 View IAAle Gactev)P7r-1- 9Yy Post Office City A r LL /City County �G/I�'PiC s+/�n f tGi�lcs l d- Sv �-�ro(.- State Zip Code Quadrangle Map Stream/Water Body Name �., H13`� al & Pe Conk. Telephone(daytime) 6 31• ,1��1,! a,32 inates: Enter NYTMs in kilometers,OR Latitude/Longitude Email '/ NYTM-N Latitude Longitude =` USAGE'Number For Aaenev Use Unty DEC Application Number _ JOINT APPLICATION FORM 09/10 This is a 2 Page Application Application Form Page 1 of 2 Both Pages Must be Completed JOINT APPLICATION DORM e PAGE 2 OF'2 Submit this completed page as part of your Application. 9. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose. Attach additional page(s) if necessary. Include: description of current site conditions and how the site will be modified by the proposed project;structures and fill materials to be installed; type and quantity of materials to be used (i.e., square ft of coverage and cubic yds of fill material and/or structures below ordinary/mean high water) area of excavation or dredging,volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource impacts; and where applicable,the phasing of activities. ATTACH PLANS ON SEPARATE PAGES. �CrnoJG Lt/l.K ,ft�ll.Gt /S/ .L-¢ S-r t( @e,-Jl LA-1 New vin.� f✓ �ti S cc ih c (A�Gt T��N �S e-01 5541la7 , 1Z.? (�w� F= !� Cost cep✓l.v� �to��-, ll��� �� X 9 ' GL Proposed Use: Private ElPublic ❑Commercial Proposed �� Estimated ya�_ 3 Start Date: 3 Completion Date: Has Work Begun on Project? ❑Yes ETNo If Yes,explain. Will Project Occupy Federal,State or Municipal Land? ❑Yes 19<o If Yes,please specify. 10. List Previous Permit/Application Numbers(if any)and Dates: 11. Will this project require additional Federal,State,or Local Permits including zoning changes? Yes ❑ No If yes,please list: 12. Signatures.If applicant is not the owner, both must sign the application. I hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said project.In addition,Federal Law, 1B U.S.C.,Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies, conceals,o c ers up a material fact; or knowingly makes or uses a false,fictitious or fraudulent statement. nature ofApplican Printed Name /� Title Date IN q 5-3c)—l.; Sign re of Owner Printed Name Title Date §Wnajere of Agent 0 Printed Narbe Tie Date 'For Aaenib tlse:,Onlx QETERMINATi ION OF iV0 PEf3f�lIT REQUY6tED - PQePdY project Number determined that.Na Perm is required front this Agency for the project described m (Agencj,Nane) apphca r t this t10n i ::Agency Representative Name(printed)• _ Tftle •' 3 : Sigrtature ete i I S l JOINT APPLICATION FORM 09/10 Application Form Page 2 of 2 New York State Department of Environmental Conservation oboe PERMISSION TO INSPECT PROPERTY By signing this permission form for submission with an application for a permit(s)to the Department of Environmental Conservation("DEC'),the signer consents to inspection by DEC staff of the project site or facility for which a permit is sought and,to the extent necessary, areas adjacent to the project site or facility. This consent allows DEC staff to enter upon and pass through such property in order to inspect the project site or facility,without prior notice,between the hours of 7:00 a.m.and 7:00 p.m.,Monday through Friday. If DEC staff should wish to conduct an inspection at any other times,DEC staff will so notify the applicant and will obtain a separate consent for such an inspection. Inspections may take place as part of the application review prior to a decision to grant or deny the permit(s) sought. By signing this consent form,the signer agrees that this consent remains in effect as long as the application is pending, and is effective regardless of whether the _ signer,applicant or an agent is present at the time of the inspection. In the event that the project site or facility is posted with any form of"posted"or"keep out"notices,or fenced in with an unlocked gate,this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further agrees that during an inspection,DEC staff may, among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soils and vegetation(taking samples for analysis),and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s)sought by the application. Permission is granted for inspection of property located at the following address(es): By signing this form, I affirm under penalty of perjury that I am authorized to give consent to entry by DEC staff as described above. I understand that false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.' AuBECI- I�i t.I/s'[. ;t /�1teJnl & F Print Name and Title Signature Date ' The signer of this form must be an individual or authorized representative of a legal entity that: owns fee title and is in possession of the property identified above; maintains possessory interest in the property through a lease,rental agreement or other legally binding agreement;or • is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in the property for the purpose of consenting to inspection of such property. Permission to Inspect Property Application Supplement 12/08 617.20 _ Appendix C State Environmental Quality Review SHORT EHVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION To be completed b TV !cant or Project S onsor1. APPLICANT/SPONSOR PROJECT NAME Al ber-1- �e�rbu« �2et b) -75- Ss-1ewyr9 -✓!<w 3. PROJECT LOCATION: Municipality �/G�i1 f2 + County 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) -7 ,�' 7s14,vu9 f/lec > Lkn eevl (.2 4 , ►�"� -See- C-eli.-f/end inkP 5. PROPOSED ACTION IS: ❑ New ❑ Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: �lk Ge�e-71,e.y -A b..clGh«40- 7. AMOUNT OF LAND AFFECTED: _ d ( Initially . o l acres Ultimately acres 8. WILL PRgPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ElNo If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? residential Industrial Commercial Agriculture11 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 permittapprovals: To ,-, .0 F Is * .- lti®l e-- T✓ ice' cl 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes to If Yes,list agency(s)name and permitlapprovals: 12. AS A RESULT OF PROP D ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes M No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 07 —3 c> -f Signature: Ylz , If the action is in the Coastal Area, d you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 _ _Reset ` PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. 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 energy)? Explain briefly, D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? Yes No If Yes,explain briefly: E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 11 Yes No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural); (b)probability of occurring; (c)duration;(d)irreversibility; (e) geographic scope;and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and anysupporting documentation,thatthe proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) °°&iosm x,ndrzw y xTARpON --�ENE y s♦ 0&t6°) Q' F_ d S n b '�fe P ♦ Et • FOR PCL NO. 6EE SEC.N0. T• �0.1 ay d ♦' ' sEE ssu xo. rcamws.e ♦�e ae' .. R .',$ a♦Qsi . m a,,,,,,��, "' F Poe F 10 m1 yi � �/ sxiwtze ae. •. �-�� ae,a9,ao`` 'v' � . �QO w, �H .' ♦ y ss.d ` 'r �'az;as szd 5 'as _e�xsda ' ad P� � s ss.a c � ..�... _.�..� I ♦.d a1 g 20 a 18- roF m d >3♦ Z `, E � O u �BACO/7' n rqz` rs1F `m �� L°="`- \ .dz.e � p a •a F o '�♦ ..._--_ Z a� a sa a n,xr✓� '' � 0 � 37.1 �• ,•BLUE ,� a ./' _._i. / NE 9 Pam:_ SOUND ISLAND SHELTER — a— ,•,� Nonce COUNTY OF SUFFOLK © g soumoln I El R9NMI Agency. E ' - a ._�. ..m1.—_•rLa.+.�• '2. �—^ •r-o..�ss.- +.a.. r_u..�w K. K: OFFICE LOCATION: OF S0(/ryO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &YoungsAve.) Southold, NY 11971 G Q Telephone: 631 765-1938 a� Fax: 631765-3136 �OlyCOU0,�� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM E C .E � VU E J U L 1 1 2013 Southold Town To: Jim King, President Boar ofTru e s Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 9, 2013 Re: LWRP Coastal Consistency Review for ALBERT & BARBARA REIBLING SCTM#1000-57-2-32 A permit (6517) for the actions was issued by the Board in 2007. Jeffrey Patanjo on behalf of ALBERT & BARBARA REIBLING requests a Wetland Permit to remove and replace 151 linear feet of existing" bulkhead with new vinyl bulkhead; replace 30 cubic yards of clean fill; replace existing 27'x9' deck and 4'x8' stairs to beach. Located: 75 Island View Lane, Greenport. SCTM# 57-2-32 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 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 Nle FTM -; Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit , C E I R „ E Amendment/Transfe/Ext nsion v /Received Application:�3 , keceived Fee:$ Z50 :�7completed Application 3 J U N 2 0 2013 Incomplete _SEQRA Classification: Type I Type H Unlisted Southold Town �oordmation:(date sent) 3 Boar of Trustees LWRP Consistency Assessment Form ✓CAC Referral Sent4* W-3 ate of Inspection:Receipt of CAC Re Lead Agency Determination: Techru Review: ✓Public Hearing Held: _TW5 Resolution: Name of Applicant A I b e r 4 it Address aqa g qr• %Ioek4vwn/ hl el744S, N y /p T i Phone Number:( ) °� 1 ` Z y S- 2 6 1 3 Suffolk County Tax Map Number: 1000- 3 7 Property Location: -75 Z e1wnd View LuH a Gir{cnPoff (provide LILCO Pole#,distance to cross streets,and location) AGENT: -3-e f F sre �a +Q .► (If applicable) Address: I v6 Hc,..wt-4 Ceoi+ee AAar 1Chee- 11431 Phone: 6 3! y$y• 9 3 3 a- �I Board of Trustees Application GENERAL DATA Land Area(in square feet): 9� 119 Area Zoning: R-e 5 Previous use of property: 1ze—s Intended use of property: I?t5 Covenants and Restrictions: Yes ✓ No If"Yes",please provide copy. 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? No Yes If yes,provide explanation: Project Description(use attachments if necessary): Kr n-v vc arse- rcp lac c Is-1 ei- v F s-1-ofM etkm.►�eek 6Jcac {, «t. ReRt&ec d-el"2 5-tef 2c P'A cc a �c q' oert 4-k u`X $ 5Za.rS -f® bc,,G4 57' eQ�iu.y 51mi.h - Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 112emawe *nS rcpltce 15-1 t-f - du MayccP b�ucrz�.� ►.✓�-l-k ti�� ✓�,�� L h�C.IGh taco. /l�Pl�c� 3 0 c7 vf- clew., 60 Area of wetlands on lot: square feet Percent coverage of lot: 1 % Closest distance between nearest existing structure and upland edge of wetlands: /d-P feet Closest distance between nearest proposed structure and upland edge of wetlands: to o 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? 30 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: I Z Manner in which material will be removed or deposited: e*ee-ya 4-0 r 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): !, etc id be ,vv eCfecj c,J Board of Trustees Application COASTAL EROSION APPLICATION DATA )Ren►ove anrQ I'ePtaet /S/ [F di 5T�� �r4rnes9at� Purposes of proposed activity: b.,LKheaet wt+,h Llc L b�c,���w� • /Ze/'lacc �v c,1 vF Gte,-m A,/1 t,st 5Q'ortir Qt�lkee 2� ,q Xs' S74lrs -E. he-cl- G,ST LV/ztiy STa rm . Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? 3n (cubic yards) Manner in which material will be removed or deposited: E,'rc a V e,+o e 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) Pr vie c•1 v !f �r o c cQ e fv.r .cr ��,..G-'/o wL 5✓�IGGt� anlS� Ohs -��ctig.✓ •� �rrai0ce4.7 - 617.20 Appendix C State Environmental Quality Review SHORT EWRONMENTAL ASSESSMENT! FORM For UNLISTED ACTIONS Only PART I -PROJECT INFORMATION To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Al bec-1- 3. PROJECT LOCATION: Municipality C>re`,7�'l County 5•� �� 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) �� Sew Vl�w C<cne ire evl -f' d�s� S�G (P GGa 5. PROPOSED ACTION IS: New Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: S��!� �� 4 y�� j)d Lk,6`4,612 fLe,o v¢ .ter, Q lee,,oIk ee !st 7. AMOUNT OF LAND AFFECTED: Initially . V t acres Ultimately acres 6. WILL PR9POSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes F1 No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential Industrial Commercial El 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)? EaYes No If Yes,list agency(s)name and p /ermit/approvals: Tvw � - F So—kWoIl� `+ 1/L !--f-et,1 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes to If Yes,list agency(s)name and permittapprovals: 12. AS A RESULT OF PROP D 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/sponsorvame: Date: •7 --.3c / c a Signature: �, A If the action is in the Coastal Area, d you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 . Reset j PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ❑Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? Yes El No If Yes,explain briefly: E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e. urban or rural); (b)probability of occurring; (c)duration;(d)irreversibility;(e) geographic scope; and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ElCheck this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and anysupporting documentation,thatthe proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination /) ©F re of 7- ff►/ L ff Name of Lead Agency Date �Y1wl f IIA Print or Type Name of Respo40icer Lead AgencyTitle of Responsible Officer ignature of Responsible Agency Signature of Preparer(If different from responsible officer) PROOF OF MAILING OF NOTICE ' ATTACH CERTIFIED MAIL RECEIPTS Name: Address: r �eru.Q� eosemQr� —TI QNr STATE OF NEW YORK COUNTY OF SUFFOLK (� , residing at r t , being duly sworn,deposes and says that on the day of L& , 20 , deponent mailed a true copy of the Notice set forth in the Board of 71rustees 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 06difer MM 01 9,S , that said N ces were mail each of said persons by CERTIFIED MAIL/RETURN RECEIPT. i Sworn to before me this Day of UI 20 l i Not Public Loriann Patan* Notary Public State ofv York Qualified in Suffolk County Commis�si n Expires�07/20 j James F.King,President �4 - Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President u.- �t P.O.Box 1179 �Dave Bergen S '�' Southold,NY 11971 John Bredemeyer '�j� Q�` Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ALBERT & BARBARA REIBLING COUNTY.OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, jC4&q f1a+gn•O , residing at/dba lo(o 1-l�w i f 3)Vd being duly sworn, depose and say: That on the 7 day of J(A)v , 2013, 1 personally posted the property known as 1� t,5Lar-vi V 1 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,July 17, 2013. Dated: Sworn to before me this 7day ofJ012013' otary Public L' ' n Paton10 Public a ofNew York Qualified.in S lk Cdunty No:01PA6150861 Commission Expires 08/0i/2Qj NOTICE OF HEARING 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. ber+ Barbo-ro.., OWNER(S) OF RECORD: • SUBJECT OF PUBLIC HEARING: Remove and replace 151 linear feet of existing bulkhead with new vinyl bulkhead; replace 30 cubic yards of clean fill; replace existing 27'x9' deck and 4'x8' stairs to beach. TIME & DATE OF PUBLIC 'HEARING: &��anyTtAl r If you have an interest in this project, you are invited to view the Town file(s) which are available for ins ection rior to the day of the hearing during normal business days between the ours o 8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631. ) 765- 1892 Board of Trustees Application County of Suffolk State of New York Albc-,f G;" ",f 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. P Signature SWORN TO BEFORE ME THIS DAY OF II/�CL. ,20La Notary Public Loriann Pataniio Notary Public State ofNew York Qualified,in Suffolk County No:01PA6150861 Commission Expires 08/07/201'1 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Aldcv+ >?cihl:cy residing at ?gag N�eacQo�cres? D2. (print owner of property) (mailing address) yo ry-4.9 . -Ne-t yk45/ N4 10 sI8 do hereby authorize -j-e- FC-rety (Agent) Qa-r-t 1 o to apply for permit(s)from the Southold Board of Town Trustees on my behalf. Marl P6 4'�__ (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 pumose 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: Q« l v n A C bs r-r' (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.) 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 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 qs 3 0 day of M 200 /3 Signature Print Name — _ Form TS 1 Town - of Southold two Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM z o PROPERTY LOCATION: S.0 T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Ol�y�a level S 7 Oa 31- STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN str ct sectionBlock of CERTIFIED BY'A DESIGN PROFESSIONAL IN THE.STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION PTEm# / WORK.ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? ' ' I Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within 4 111 0•am 9 Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) (s /Acres) (This item will include all run-off created by site ✓ ❑ b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed -3 D.0to$ Site Improvements and the permanent creation of construction activity?.? (S. ./Acres) impervious surfaces.) 2 Ddes the Site Plan and/or survey Show All Proposed ✓/ PROVIDE_)31tIE.F 1'ROJEGT DFSCRIPT'ION (provide AddltianalPa9esasNeeaed) Drainage Structures indicating Size$Location?This Item shall include all Proposed Grade Changes and Slopes Controlling Surrace Water Flow. �nt o�L 6sn s f l p 3 Does the Site Plan and/or Survey describe the erosion / ❑ and sediment control practices that will be used to ~—" control site.erosion and st6nm water discharges. This p �iGe ;L-7 rh 9 f 12c e,1L u n.�_ item must be maintained throughout the Entire /I Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural slwm . ee Existing Grade Involving more than 200 Cubic Yards — of Material within any Parcel? G(!wh �c l �"5 �'`;5 �'�°!� ' 5 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 or within One Hundred(100')feet of a Weiland or El General DEC SWPPP Requirements: Beach? Submission of a SWPPP Is required for all Construction acUtles involving soil Well there be Site preparation on Existing Grade Slopes disturbances of one(1)or more acres;Inducting disturbances of less than one acre that 7 ❑ ✓— 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(109)of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. other Impervious El / (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or ✓ for Storm water Discharges from Construction activity-Permit No.GP-010-001.) Surfaces be Sloped to Direct Storrs-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the NOI.The NO)shall be into and/or in the direction of a Town right Df-way. . submitted to the Department prior to the commencement of construction activity. W{II this Project Require the Placement of Mateda{, r2.e The SWPPP shall describe the erosion and sediment control practices and where ❑ — required,post-construction storm water management practices thathat will bill be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants h storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder comprrance with the terms and conditions of this permit In addition,the SWPPP shall Area?(This)tam will NDTInclude the Installation of Driveway Apra=) Identify potential sources of pollution which may reasonably be expected to affect the NOTE: If Any Answerto Questions one through Nine is Answered with a Check Mark quality of storm water discharges. in a Box and the construction site disturbance is between 6,000 S.F.&1 Acre in area, 3.All SWPPPs that require the post-construction storm water management practice a Storrs Water,Grading,Drainage&Erosion Control Plan is Required by the Town of component shell be prepared by a qualified Design Professional Licensed in New York Southold and Mustbe Submitted for Review Prior to Issuance of Any Building Permit. that is knowledgeable In the principles and practices of Storm Water Management. (NOTE; ACheck Mark(J)and/or Answer for each Question Is Required fora Complete Appllcarion) SPATE OF NEW YORK, ,,,,,,SS COUNTYOF..................................... That I,.i l..�-•••••1.�5.9L!v v��......••"""being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of Individual signing Do�c/u')m�fent( \11y^,rry,t1�/ And that he/she is the ..................."a^Y•�•,•••Y' •:toWne�;Contracic�agent.CorporateOffce�etc j. ............ ...... 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; day of.. �. ..........20.0 ....... ................ ..... ... ....... Nouay Public: //t�.l.....e� ••• Applicant) ••• "••••"'�"""" (Signature of FORM - 06/90 Loriann Patanio, Notary Public State ofNew York Quallo 01 PA6f 150861uniy Commission Expires 08/07/20���' Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its 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",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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# S 7 - o a - 39- The Application has been submitted to(check appropriate response): Town Board 0 Planning Dept. D Building Dept. 0 Board of Trustees l. 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: I�LKlrc4.eQ Rtin�vc *Ark rep Lee /s! C F of S f'•r•,► iwuyGdl w[4'�i NG.✓ V[N G Svc-lLticc�.dP . Ate- 3o cy %4r1 ,�./l G•Sf d,/wy S�"-��, /gyp It e-& ;Z-7 'A y`X 'rJ Sd'��✓S �-� �tccGG, G�S� c�v/c,.J� Sfe�M Location of action: -7 S v( ` L� vi { per Site acreage: o S 0,9 Present land use: f-� 5'ej en 4l AC Present zoning classification: �R-s 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: A L bee+ 0 ar (b) Mailing address: Pga'b 1A,-eJv ocrams-�- d�!'• 1�vrll-f-ow� dC t 1h 4-s pi� lO 59 43 (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 10 No❑ If yes,which state or federal agency? 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. 9Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes 0 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 ACTION PROVIDES FOR IMPROVED VISUAL COMPONENTS. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ® Yes © No © Not Applicable RECONSTRUCTION OF BULMUM WILL PROTECT LOSS OF PROPERTY DUE TO EROSION. 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 through 21 for evaluation criteria 0 Yes © No [;]Not Applicable ACTIN HAS NO EFFECT ON WATER QUALITY. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies;Pages 22 through 32 for evaluation criteria. 0 Yes Q No® Not Applicable ACTION HAS NO EFFECT ON ECOSYSTEMS. 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 Q No® Not Applicable ACTION HAS NO EFFECT ON AIR QUALITY. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies;Pages 34 through 38 for evaluation criteria. ❑Yes ❑ No Not Applicable ACTION HAS NO EFFECT CAUSED BY SOLID AND HAZARDOUS WASTE. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section in—Policies;Pages 38 through 46 for evaluation criteria. ❑' YeD No® Not Applicable ACTION IS LOCATED ON PRIVATE PROPERTY. Attach additional sheets ifnecessary WORKING COAST POLICIES Policy 14. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies;Pages 47 through 56 for evaluation criteria. 0 Yes ❑ No ® Not Applicable ACTION IS LOCATED ON SINGLE FAMILY RESIDENCE AND UTILIZED FOR RECREATIONAL BOATING ACTIVITIES. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters.See LNVRP Section III—Policies;Pages 57 through 62 for evaluation criteria. ®Yes ❑ No 0 Not Applicable ACTION WILL PROMOTE RECREATIONAL RESOURCE FOR LANDOWNER BY WAY OF BOATING ACTIVITIES. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. 0 Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies;Pages 65 through 68 for evaluation criteria. Yes ❑ No ® Not Applicable Created on 5125105 11:20 AM f June 17, 2013 Town of Southold Trustees Town Hall Annex Building D ECEIVE 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 JUN 2 0 2013 RE: 75 ISLAND VIEW LANE,GREENPoRT,NY Southold Town SCTM No.1000-57-02-32 T u e APPLICATION FOR PERMIT Dear Sir/Madam: We hereby submit one original and four(4) copies of the proposed plans, application, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. V truly yours, effrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934