HomeMy WebLinkAboutTR-4198 Glenn Goldsmith,President tF so�Ty Town Hall Annex
Michael J.Domino,Vice-President ,`O� Ol0 54375 Route 25
P.O.Box 1179
John M.Bredemeyer III [ Southold,New York 11971
A.Nicholas Krupski G Q Telephone(631)765-1892
Greg Williamsa0 Fax(631) 765-6641
00UM`I
BOARD OF.TOWN TRUSTEES
TOWN OF SOUTHOLD
July 16, 2020
W. Jonathan Fabb .
Twin Fork Landscape Contracting, Inca
P:O. Box 460
Cutchogue; NY°,11935
RE: , GLENN,MEYRAN IRREVOCABLE TRUST
175-S.O.UNDVIEW AVENUE, MATTITUCK
SCTM# 1000-99-3-1
Dear Mr. Fabb:
The following action was.taken by the..,Southold,Town Board of Trustees at their Regular
Meeting held on Wednesday,.July 15, 2020:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Coastal Erosion Management Permit 99-3-1 from Virginia-Meyran to Glenn
Meyran Irrevocable Trust, as issued on June 24, 1993; and Wetland Permit#4198 from
Virginia Meyran,to Glenn Meyran Irrevocable Trust, as issued on June 25, 1993..
Any other activity within 100' of the wetland boundary requires a permit,from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
Glenn Goldsmith, President
Board of Trustees
GG/dd
Glenn Goldsmith, Prent o��StFfD(,�Cp ' Town Hall Annex
Michael J. Domino, Vice+ite ident ,�� ��, _, 54375 Route 25
John M. Bredemeyer III o '` P.O. Box 1179
A. Nicholas Krupski o Southold, NY 11971
Greg Williams ti, � Sr Telepho e (6 92
Fax ) 765-6641-1
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
'Date/Time: 3/q�,��o 6 JS Completed in field by: G, G„lalsr.► �,
Twin Fork Landscape Contracting, on behalf of GLENN MEYRAN IRREVOCABLE TRUST requests
a Transfer of Coastal Erosion Management Permit 99-3-1 from Virginia Meyran to Glenn Meyran
Irrevocable Trust, as issued on June 24, 1993; and Wetland Permit #4198 from Virginia Meyran to
Glenn Meyran Irrevocable Trust, as issued on June 25, 1993. Located: 175 Soundview Avenue,
Mattituck. SCTM#: 1000-99-3-1
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 •✓ SEQRA Type: 1 II Unlisted Action
Type of Application: Pre-Submission Administrative Amendment Wetland
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line
Additional information/suggested modifications/conditions/need for outside
review/consultant/application completeness/comments/standards:
I have read & acknowledged the foregoing Trustees comments:
Agent/Owner:
Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski
G. Williams Other
_ 1
-J.
DiSalvo, Diane
From: TFLC, INC <twinforklc@optonline.net>
Sent: Monday, February 03, 2020 2:52 PM
To: DiSalvo, Diane
Subject: RE: Letter concerning Trust for 175 Soundview Ave.
Yes that is correct please transfer the permits#99-3-1 &4198 into the Glenn Meyran Irrevocable Trust.
Thankyou
Best,
Jen
TWIN FORK LANDSCAPE CONTRACTING, INC
From: DiSalvo, Diane<diane.disalvo@town.southold.ny.us>
Sent: Monday, February 3, 2020 9:46 AM
To: 'TFLC, INC'<twinforklc@optonline.net>
Subject: RE: Letter concerning Trust for 175 Soundview Ave.
Yes,that will do it.
I just now need from you an email that says that you would like to transfer the permits#99-3-1 &4198 into the Glenn
Meyran Irrevocable Trust.
Diane
From: TFLC, INC [mailto:twinforklc@optonline.net]
Sent: Friday, January 31, 2020 4:01 PM
To: DiSalvo, Diane
Subject: FW: Letter concerning Trust for 175 Soundview Ave.
Hi Dianne
Attached provides the verification of the Trust for Glenn Meyran from his attorney.
Will that work to transfer those permits?
Ok let me know, thank you
Best,
Jen
TFLC, INC
631-734-6643
From: Glenn Meyran <Rmi5384@aol.com>
Sent: Friday,January 31, 2020 2:31 PM
1
s.
COMERFORD & DOUGHERTY, LLP
1122 FRANKLIN AVENUE, SUM 406
GARDEN CITY,NEW YORK 21530
MICHAEL J.COMERFORD,P.C. 516-248-2424 OF COUNSEL
MAUREEN DOUGHERTY* FAX:516-246-1302 REGINA A.MATEJKA
MARYANN CATALANO www mcmdlaw com
ADRIANNE HOPPER*
*ADmnmm IN NY AND Cr
Janaury 28, 2020
Mr.Glenn Meyran
53 Morris Avenue West
Malverne, New York 11565
Re: 175 Soundview Avenue,Mattituck,New York
(Dist. 1000, Section 099,Block 3.0 Lot 001.00)
Dear Mr.Meyran,
As requested the following recorded deeds reflect the chain of title for the above
referenced property.
* Deed dated August 13,2009,recorded in the S1lffolk County Clerk's office on August
20, 2009,Liber D00012597 at page 263. Virginia S. Mcyran-to- Glenn R. Meyran and Mary
Jane Meyran,his wife.
Deed dated July 30,2018,recorded in the Suffolk County Clerk's Office on February
5,2019,Liber D00012999 at page 670. Glen Meyran and Mary Jane Meyran-tozMichael-j-,
Meyran;Tivstee=of the`GIenn-Meyran Ifrevocable=Trust:`dated-July-10,:2018,L=
Ve ly,yours,
MAU EN'DOUGAERTY
MD/ka
encl.
Glenn Goldsmith,President �QF SO(/1y Town Hall Annex
Michael J.Domino,Vice-President ,`O� ��� 54375-Route 25
P.O.Box 1179
John M.Bredemeyer III [ Southold,New York 11971
A.Nicholas Krupski G Telephone(631)765-1892
Greg Williams '� i0 — � -
U
� U
BOARD OF TOWN TRUSTEES I JAN 17 2020
TOWN OF SOUTHOLD
Sautliold Tovvn
APPLICATION FOR TRANSFER OF WETLA ' dot Trustees
DATE: JIG
S
PROPERTY OWNER NAME:
MAILING ADDRESS: 5:3 AWWS AVC µ'v-51 AQ-IV1P_V^ , ta
PHONE:
AGENT:
PHONE : —+73q --b lP4 3
ADDRESS. PO Bby- ly(0D /
PROPERTY LOCATION: 1-75ouetyj4.oj _
TAX MAP NO.:
[Me
request a Transfer of Permit#41 Q1 Q$ OcGI_.#e_ Co/ZS1 q 3 ArrAel4eV
D *4_111 �IZS'21111 37 - Se-e-from V�� �� 1-4L til-Gc,��T�c./t
Signed by:
• L
&AVIV BEING DULY SWOW' '
)IDEPOSEWAN]D AI+FI ` H AT IHE/SHIE IS'TIHE APPLICANT FOR THE ABOVE,
(DESCRIBED PEAMIT(S)AND TFHAT.ALL STATEMENTS CONTAINED IIIERI IN
ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BE LIEF,AND THAT
ALL WORK WILL BE DONE IN THE MANNER SET FOR'T'H.IN THIS APPLICATION
AND AS MAY BE APPROVED BY.THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THEAPPLICANT AGREES TO HOLD THE TOWN
O� SOYTTROI,I)AND THE
ROARID OF TRUSTEES HARMLESS AND)FREIE 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,INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATIONS
INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO IINSURE
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PER-MIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THE PERIMIT.
Signature of Property OwneV ISenture o Pro rty�Owner���
SWORN TO BEFORE,ME,THIS��DA`s OF� ..20-2.0
,.
Notary Public ('
l Notdrykqjj��
k
N q• e
s46,FkpaSSaU 76'3 York
res OcC23 tJ
(Where the applicant is not the owner)
ll�lve, r4j4 yspinrr M� � Gt,L'q Fti P, M k-y,2A, J
owners of the property identified as SCTM# 1000---q-2--3 -1 in the town of
/Y!&TrrU C, New York,hereby authorizes
C _fs tnrr.to act as m} agent and handle all
necessany work involved mith the application process for pen-nit(s) from the Southold Town
Board of Trustees for this property.
AAA, X-LA AZAProperty Owner's Signature �- Property O 's Signature
SWORN TO BEFORE IME THIS DAY OF_' , ,20�
Notar=;Public
Nota YkA�jVA. B�p&
No.0 y LI ate Of
Qualified BU61, 3e�Yor
My Commission� paeSau County k
Oet 23,2p?
NAME t1F ATOP' fd(?Al:jUteck all that apply.)'
Tax grievance• B. IlAng
Variance Thistee
Change of Zara Coastal Erosion
Approval of plat. - Mooring
Exemption from plat or official map Pinning
Other
(if"Other'•name-the activity,)
Do youpersoi lij+;fur:thmagh}aurcompany iist,sibling,patartl,orch'ltd}huvcax�lauon tli:ttnyofficeroccnipioye`
sou
of tho f tswn 6f Tisftilh�id7:"1teLn;innsltip"inrtodes by blootf�°Hiatt ape or 6irsmossltitrtxst 13usiness!vWt"means a bisirz s,
inchwing ich the tSs*icrn ofltecror empioyec ta€.Gvett o pastint:aiv2i tsltip of(or ettl iuyment by)a cotpontian
in which the towis ofriwr of employee owns mom than 506 of the shares
YES NO
lfyou amsmmd"-YES'.completetit balance of this fornt tmd.date snd 4go..wt re it:diented,
Name of paean=pioyed by the.Town of Southold _
Titin ar posift6n o'ritiatPerson
j Describe the rt latfimship.between youmetf(the;applicantlngenthepiesstitative)and tlie.tnwn officeror.employec..Hither cheek
the apptnpriate tine A)thraagis D)andtor describe in the space p ovidett The town nffii cr ar wtployce or his or her spoust;sibiing,parcnt,.or child is(cheep all tttat apply);
' A)tt�niimer"af g{etider than 59�eiiFthwshares of tbe-eot'poiatt stock oYthtrvi:pp9Tcdtni- ,
r (sYhiro;the arpiicmnt iS a eutpiirefinct).- - -
B)the 2t galdr Fienefictal:otviter, of any interest in a
nosrctisIs4rttte entigy.(zYha t6s
f appl c,20 is not a comot. ion);
C)an ofl�ei*i,dic=Wr,}siidw.or employte of the applicant;or
l Dj ttie;actio!applicant.
L}i?S R1F t}il+E7F:RELA`t'IONSHTP
Subm fted this.��day of 2t3
Pciiiii3�ititn4min 141 QP,
4 GLEN tJ R• M E/AhA/
f
f ..
i
APPLICANT/AGENT/RE'PRE'SEI►7TA'�'I'VE
TRANSACTIONAL DISCLOSUTRE FORM
The Totem of Southold'":Code of Ethics prohibits conflicts of interest on=the part of town officers andempiovees.The purpose of
this-form is to provide inforination which can alert the town of possible conflicts of intarest and allow it to take wliatevcr action is
necessary to avoid same. —y�
YOUR NAME: �_ N�` Iyl t� CN��Ill�''�F'" o � .
(Last name,first name,apiddle initial,unless you are applying to 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 Totten 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 olficer or employee owns more than 5%of the shares.
YES NO X —
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 ofgreater than 5%-of the shares of the corporate stock of the ap"ptiekint
(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 off cer-director,paitner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this day 20�0
Signature
Print Name ' N
Fonn TS 1
Glenn Goldsmith,President DoE so�ly Town Hall Annex
Michael J.Domino,Vice-President ,`OO0
0 54375 Route 25
John M.Bredeme er III Pd, Box 11 k
Y � � Southold,New York 11971
A.Nicholas Krupski G Q Telephone(631)765-1892
Greg Williams Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 16, 2020
W. Jonathan Fabb
Twin Fork Landscape Contracting, Inc.
P.O. Box 460
Cutchogue,-NY- 11935
RE: GLENN MEYRAN IRREVOCABLE TRUST
175-SOUNDVIEW AVENUE,,MATTITUCK
SCTM# 1000-99-3-1
Dear Mr. Fabb:
The following action was taken-by the,Southold Town Board�of Trustees at their Regular
Meeting held on Wednesday, July 15, 2020:
RESOLVED, that the Southold-Town Board,of Trustees APPROVE the request for a
Transfer of Coastal Erosion Management Permit 99-3-1 from Virginia,Meyran to Glenn
Meyran Irrevocable Trust, as,issued on June 24, 1993; and Wetland Permit#4198 from
Virginia Meyran.-to Glenn Meyran Irrevocable Trust,-as issued on June 25, 1993..
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
Glenn Goldsmith, President
Board of Trustees
GG/dd
DiSalvo, Diane
From: TFLC, INC <twinforklc@optonline.net>
Sent: Monday, February 03, 2020 2:52 PM
To: DiSalvo, Diane
Subject: RE: Letter concerning Trust for 175 Soundview Ave.
Yes that is correct please transfer the permits#99-3-1 &4198 into the Glenn Meyran Irrevocable Trust.
Thankyou
Best,
Jen
TWIN FORK LANDSCAPE CONTRACTING, INC
From: DiSalvo, Diane<diane.disalvo@town.southold.ny.us>
Sent: Monday, February 3, 2020 9:46 AM
To: 'TFLC, INC' <twinforklc@optonline.net>
Subject: RE: Letter concerning Trust for 175 Soundview Ave.
Yes,that will do it.
I just now need from you an email that says that you would like to transfer the permits#99-3-1 &4198 into the Glenn
Meyran Irrevocable Trust.
Diane
From: TFLC, INC [mailto:twinforklc@optonline.net]
Sent: Friday, January 31, 2020 4:01 PM
To: DiSalvo, Diane
Subject: FW: Letter concerning Trust for 175 Soundview Ave.
Hi Dianne
Attached provides the verification of the Trust for Glenn Meyran from his attorney.
Will that work to transfer those permits?
Ok let me know, thank you
Best,
Jen
TFLC, INC
631-734-6643
From: Glenn Meyran <Bmi5384@aol.com>
Sent: Friday,January 31, 2020 2:31 PM
1
COMERFORD & DOUGHERTY, LLP
1122 FRANKLIN AVENUE,SUITE 406
GARDEN CITY,NEW YORK 11530
MICHAEL J.COMERFORD,P.C. 516-248-2424 OF COUNSEL
MAUREEN DOUGHERTY* FAX:516-248-1302 REGINA A.MATEJKA
MARYANN CATALANO wwwmcmdlaw com
ADRIANNE HOPPER*
*ADM 7M IN NY Arm Cr
Janaury 28,2020
Mr.Glenn Meyran ;
53 Morris Avenue West
Malverne, New York 11565
Re: 175 Soundview Avenue,Mattituck,New York
(Dist. 1000, Section 099,Block 3.0 Lot 001.00)
Dear Mr.Meyran,
As requested the following recorded deeds reflect the chain of title for the above
referenced property.
Deed dated August 13,2009,recorded in the Suffolk County Clerk's office on August
20, 2009,Liber D00012597 at page 263. Virginia S. M.eyran-to- Glenn R. Meyran and Mary
Jane Meyran,his wife.
* Deed dated July 30,2018,recorded in the Suffolk County Clerk's Office on February
5,2019,Liber D00012999 at page 670. Glen Meyran and Mary Jane Meyran-to Michael
Meyran,_Tru§tee of the-Glenn Meyran Irrevocable Trust.dated July 10,2018.
Ve ly yours,
MAU EN DOUGHERTY
MD/ka
encl.
S
Glenn Goldsmith,President �QF so1/ry Town Hall Annex
Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25
P.O.Box 1179
John M.Bredemeyer IIIc[ Southold,New York 11971
A.Nicholas Krupski G Q Telephone(631)765-1892
Greg Williams
BOARD OF TOWN TRURIPEES � JAN 17 2020
TOWN OF SOUTHOLD n
Southold Town
APPLICATION FOR TRANSFER OF WETLA • dot Trustees
DATE: Q�',
e �
PROPERTY OWNER NAME: _�ILI' ' ` old
�
d
MAILING ADDRESS: �3 N)aa S �'��/ AL4.jV�fr�. � If 5—&,'5
PHONE: qj-1
AGENT: kw
PHONE :
ADDRESS: P® BbX ,q100I �-q itct4r
PROPERTY LOCATION:
TAX MAP NO.: ®l
I/We AW-4J ��N-�Y� 12. 1
Iles
request a Transfer of Permit# OCAS 0/7,57/4 ':!? AT 7-AC1+9V
from V i e&el . !!t-4-1 25- . /&110 se-e—
Signed by:
v
h
P-V r A'E-17L ftt 64►N R 1 BEE%DULY SWORN,"
DEEPOSE ASID A + I T 4,T HE/SHEI�s `APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HERHIN
A-RE TRUE TO THE BEST OF HIISIHER 104OWLEEIDGE AND BELIEF',AND THAT
ALL WORK WILL BE DONE I THE MANNER SET FORTH IN'I"IIEIIS APPLICATION
AND AS MAY BE APPROVED BY'THE SOUT HOLEID TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES €O HOLD TBE TOWN OF SOUTHOI D AND THE
BOARD OF TRIUS`~<'EES HARMLESS At TD FREE FROM ANY AND.ALEI..,DAMAGES
AND CLAIMS ARISING UNDER OR BY VIRTUE TE"OF SAID F +RMIT(S),Its
GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHO ZE iI`IE�E
TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,-INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO Ems'PROPER'I Y TO
INSPECT THE PREMISES IN CONJUNCTION ION WITH THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FUIUFHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPER1Y AND AS REQUIRED TO ELNSL
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF PERi�i'IT.
Signature of Property Owne Sign lure o Prorty Owner
SWORN TO BEFORE ME THIS ��DAY OF t1l l 20 2D
0a A
Notary Public f
l �R
rotary pL�/i���•
/y Co Qua��e0 01$Stafe �R)'
fim�ss%(y�Na 61. 4r�L }.
res Oct �Y
(Where the applicant is not the neer)
owners of the property identified as SCTNI# 1000- in the town of
New York,hereby authorizes GiJ _r0 Al P+7Z7
AS �,,,�, �K�4��seA� co ffin6 arv�.to act as my agent and handle all
necessary work involved-vxith the application process for permits)from the Southold Town
Board.of Trustees for this property.
Property Owner's Signature Property O 's Signature
SWORN TO BEFORE MME THIS -DAY flP�+C vl'' ,202-0
Notary Public
tvotaiYKA EI�!� BURYNo.07 State of Ne
Qualified• BU6154163 Fork
My Cornnnission"NassP_kpesau County
.n ci:23,202�Z
NAME OF AM" ` IQNt;(Check all ttat apply)
Tax Crievanik• $DIlding
Variance Tntstw �C
! Change ofZone'. Coastaj'Erosion
Approval of-pie,, - laboring
aemptioa from plat or official map Planning
Other
(if"Other•,name the activity,) _
Do you per lV,(or-.through)vur compaiWvjiousa,sibling,ggcni,or child}haya aveWonr hip QIte#y officer or cniptoyf
( ofthc'i's�witjot Ws .thdld4_"Re nsbip"inctudes'by bloom it e,of bus x353 esG"Dusind+sc t"intens o t&dwss,
including o partnership.in-Aich the tswttof bir`or employee bas dven a partial gnIhftship of(orenlpl)yment by)a coq ration
in which the town otlacer or employee owns MGM than 50,6 of the shares.
f - Y135 _...._,. NO
i f yo*a aramwed-YES".complete the balance of Ibis form and date and sign where indicated.
Name of person crnplayed by the.Town of Southold
Title br position of that person y
Describe:the cela6anship betm-een yourself(the applicant/agentJrepresentaiw and tm town otftceror eatpJoyec Either cheek
the- prjitdlilns A)ttiroug-h D)andlor desddbe in the apoce provided
l j; Tlic,totvri tifflier br empleyet or his or heir spouse,sibling,parent;of child is(che* 1114atajipty).' s?
Aa tttcawr r ofgr a r than,i°�n€tJ shahs of the ct}rgaor3tt slick of"a�i�nt
-
I _ _ {ier7ieti-tl!re agpt(catttu'awr{xiistiQtij; � - -- _- - .
s '-` - i3)ihcle lor6enekicial otvae of interest in a nos. rate a dlytn(tiizItOft-ft -
°�, - - � -•_��i�} is n0i.a eorpitu�iorix _ '
i 2', Gj-ania ti,di char;pRctrte;,orempkyeeoftheapplicant or -
l 1, '' . ' �)'t�t"t3;'ectttst'•agplicanj., . - _ `:�
DE3CRIk'TiON:t)F:1tJEI.ATIONSI-]tP
Submitted this-��day of _20 ,
1 signatiut;_. =
ff
GLEN R mE RAN
I �
{
-•� l ,. `" rsx..._«i.,, u....w..a........«..r...-.,.n...r,� �,.--...,.<-.-__.. s-,....,_n.,.,,_s�,+e>1.w,..,....--..,:......�..�a,�..,._._�...+..�..r.....«...+..-»..-.._.....,..n.�.r.,..v+_-wen w-+....m— .w..
(SSS
I
1 '
...... ,-.../ ......... .,.-.a ... .__.-.._._ .:,.. , � .., .. d»..-.-_ .-.e. - •-.. .-...--`r...,> r:- ns,.T--. _� ,.ww.�.-.,.,..-�s-a�..,...,-.,.u..�w..�.-v».na--e�.,..yvemn�m m--..
APPLYCANUAGENUREPRE'SENTATIVE
TRANSACTIONAL DISCLOSURE.FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on-the part of town officers and employees.The qui-ose of
'this fbirm is to provide information which can alert the town of possible conflicts sof interest and allow it to take whatever action is
necessaty'to avoid same,
YOUR NAME: . • L P}fill �, 1/ 156,Nt U7VU� � •
(Last name,first name,4iiddle 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 oremployee
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;•n 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 br 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 die applic int
(when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when-the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this day 20P-0
Signature
Print Name N
Form TS I }
J
OW
.11 ;.. �,Y`?!�,'j/ g.��t,*%4i�i� ter✓'\..
-... -' f ♦ ► k ,� dfrK.� `\� 4 4 f;. <�D Y. 5 ff•u 3;�a•M�. ;'
• r !� .. —� � �'; �'�a•:�''. �,-t2i�s.��d'r" ss'�,�•�,i�i�r,„;y:�•-.��•`^.'T7rr"�i7r r , .!
11 Board Of Southold''
outhold Town Trustees
ti ;
SOUTHOLD, NEW YORK �` .
3 ••
41 June 25, 1993 F
PERMIT NO. .......9$........... ......... DATE: ............. ....................
ISSUEDTO ..............Virginia...Meyran.......................................................................
Pursuant to the provisions of Chapter 615 of the Laws of I`>
the State of New York, 1893; and Chapter 404 of the Laws of the
' State of New York 1952; and the-Southold Town Ordinance en-
I
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
�I REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM f
LANDS UNDER TOWN WATERS;" and in accordance with the ily
Resolution of The Board adopted at a meeting held on ...June..24.... l ;
I 19.....9.3., and in consideration of the sum of $ 150.00 Paid by
s
.......En-.Consultants..,on..behalf of V.. Meyran f '
of .. ....... ..... N. Y. and subject to the '
�
Terms and Conditions listed on the reverse side hereof,
�\ sya of Southold Town Trustees authorizes and permits the following:
p ;
' f to construct 106 1.f. of timber retaining wall plus 20' return `
ri on w/s. the e/s wall will connect to adjacent bulkhead. Approx.
a:
375 c.y. of cleand sand will be trucked in. 3' wide stairway
a� from west of bluff to beach will be repaired/replaced as approp. jk
1 all in accordance with the detailed specifications as presented in
the originating application, z. "
IN WITNESS WHEREOF, The said Board of Trustees here-
'• °,�; by causes its Corporate Seal to 6e affixed, and these presents to E :`
�. k
} .,,.... a be subscribed by a majority oft said Bo as of this date.
.......... ........................... Ik
• Off, G ,:.
C Z
.......
j
. ., ... ...... ...1.�A.,.,. _....................../.. ,
Tru
�- i t ^<.a.! ��:� a r M1,. t a -n �f q'd 4Y w:..?+rM1'�1•:f!__-vs� :[':i -' -+`SI• Jr'. "•
���,•k � �sb•-..,�••.o :;� �.3W.��W..c,�.trt;.r�...:.- mod" .r - +v� *�•�•+�,is�a,�.e�;a�.:� - ��
r '
SUPE
ISOR
TRUSTEES ��OS�FFU(,�CD SCOTT LRVHARRIS
John M. Bredemeyer, III, President �y� Gy
Albert J. Krupski, Jr., Vice Presidents
Henry P. Smith y = Town Hall
John B. Tuthill O f'' 53095 Main Road
William G. Albertson 'f4J �a0�� P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
COASTAL EROSION MANAGEMENT PERMIT
Permit Number: 99-3-1
Name of Applicant/Agent:
Name of Permittee: Virginia Meyran
Address of Permittee: 175 Soundview Avenue, Mattituck
Property Located: same
DESCRIPTION OF ACTIVITY: to construct 106 l.f. of timber
retaining wall plus 20 ' return on w/s. the e/s wall will connect
to adjacent bulkhead. Approx. 375 c.y., of clean sand will be
trucked in via Bailie. Beach Road to west. A 3' wide stairway
from west of bluff to beach will be repaired/replaced as
appropriate.
Date of permit issuance: June 24, 1993
This permit is valid for a period of two years from the date of
issuance.
SPECIAL CONDITIONS:
NA Bluff restoration through a re-vegetation agreement is
attached hereto and is a necessary special condition of this
permit.
NA A relocation agreement is attached hereto and is a
necessary special condition of this permit.
NA A maintenance agreement is attached hereto and is a
necessary special condition of this permit.
John M. -Bredemeyer, III
President, Board of Trustees '
TRUSTEES SUFFO(,r SUPERVISOR
John M. Bredemeyer, III, President p�0 COG SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President
Henry R Smith y z Town Hall
John B. Tuthill 1-� 53095 Main Road
William G. Albertson y p�� P.O. Box 1179
��j
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 30, 1993
En-Consultants, Inc.
1329 North Sea Road
Southampton, NY
1968
Re: S�TM #ia Meyran
1000-99-3-1
Dear Mr. Haje:
owin action was taken by the Board of 1993 regardingn Trustees the
The foll g June 24,
its regular meeting held on Thursday,
above matter: lied to the
WHEREAS, Roy Haj a on behalf of permit re thenp PP. ions of the
Southold Town Trustees fora P application dated April
Wetland Ordinance of the Town of Southold, Southold Town .
26, 1993 and,
cation was referred to the o
Conservation
Advisory Council for their findings and recommendations,
WHEREAS said appli
and, the Town Trustees with respect
WHEREAS, a public hearing was he1Ju a 24, 1993 at which time all
to said application on Thursday, opportunity to be heard, and,
interested persons were given an ersonally viewed and are familiar
WHEREAS, the Board members have p and,
question and the surrounding area,
documentation
with the premises in
WHEREAS, the Board has considered all the testimony
submitted concerning this application, proposed will
WHEREAS, the Board has determined nd gat theIal are Drojectofsthe people of
not affect the health, sa Y
the town,
THEREFORE BE IT
NOW, roves the application of
RESOLVED that the Board of Trustees approves The e/s wall will
-Consultants on behalf of Virginia Mer raon to construct 106 l.f.
En wall plus 20 re
of timber retaining Approx. 375 c.y. of clean sand will
connect to adjacent bulkhead. APP ro riate.
ay
be trucked in via Bailie Beach Road repaired/replaced assapproP
from west of bluff to beach will b
Permit will expiust
re two years from the ate it is ssixemonthseofmthe
Per licable,. and permit is
suedbe paid, if apt
date of this notification. Two inspections are required and the
Trustees are to be notified upon completion of said project.
Permit will be issued upon payment of the following fees for work to
be done below Mean High Water Mark: ,
No fees
Very truly yours,
John M. Bredemeyer, III
President, Board of Trustee
JMB:jd
Page 6
source via Anderegg parcel. Replace 3' wide stairway form top of
bluff to beach.
The CAC recommends approval provided the work is done in kind and
in place and not placed in front of the existing bulkhead.
Nassau Point Road, Cutchogue
Vote of Council: Ayes: All
Motion carried.
Moved by Patricia Isaksen, seconded by John Holzapfel, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
of Wetland Application of THOMAS P. LOSEE, SR. 118-4-2 to
remove and replace (in same location and configuration) '100 I.f. of
retaining wall and 3' wide stairway. Approximately 200 c.y. of .clean
fill will be trucking in from areas upland.
7425 Nassau Point Road, Cutchogue
Vote of Council: Ayes: All
Motion carried,
Moved by Patricia Isaksen, seconded by John Holzapfel, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
of the. Wetland Application of JOHN TOBIN 118-4-3 to remove and
replace (in same location and configuration) 100 I.f. of retaining
wall and 3' wide stairway. Approximately 200 c.y. of clean fill will
be trucked in from areas upland.
7525 Nassau Point Road, Cutchogue
Vote of Council: Ayes: All
Motion carried.
Moved by Stephen Angell, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Trustees
DISAPPROVAL of the Wetland Application of VIRGINIA MEYRAN
99-3-1 to construct 106 l.f. of timber retaining wall plus 20'
return on west side. On east side, wall will connect to adjacent
bulkhead. Approximately 375 c.y. of clean sand will be trucked in
via Bailie Beach Road to west. A 3' wide stairway from west of bluff
to beach will be repaired/replaced as appropriate.
The Council recommends disapproval because the retaining
wall/bulkhead is' not warranted. Also there is no established policy
concerning the bulkheading of property along the Long Island Sound,
the long range effect on the Sound must be considered.
The Council approves the repair of the stairs.
175 Soundview Avenue, Mattituck
Vote of Council: Ayes: All
Motion carried.
SOUTHOLD TRUS.TEES
Issued To-- V'l rm DateJ�:� "
Address- �►��r�, tLq� &
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFPICE,TOWN OF SOUTHALD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
L _
TRUSTEES y0 �G
John M.Bredetneyer,III,President o SUPERVISOR
Henry P. Smith,Vice President y Z SCOTT L.HARRIS
Albert L Krupski,Jr., O
John L.Bednosld,Jr. 'y;J O� Town Hall
John B.Tuthill Ol �'a 53095 Main Road
P.O.Box 1179
Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971
Fax(516)765-1823 TOWN OF SOUTHOLD
COASTAL EROSION MANAGEMENT PERMIT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
TRUSTEE LANDS PERMIT APPLICATION
Office Use Onl O
oastal Erosion Permit Application D
etland Permit Application
rustee Lands Permit Application APR 2 61993
randfather
Completed Apps. Date: S tt�;13
ariance Required, TOWN OF SOUTHOLD
_aANeighbors notified Date:
SEQRA Type
l—Coord. Review-opt. ,mand. a Office
Insp. comp./date:,gyp Q/ a �]
SEQRA Determin./date: S;�d/13
Public Hearing/date: 1_�AV4 1&3 AAR,2 a
Findings:
Permit Vote: (Y/N) : ��
Special Conditions:
(also see file) Applcati
Application Number; SCTM #1000-99-3-1
Project Name (If any)
Date Prepared: ._April 16, 1993
Applicant: EN-CONSULTANTS, INC.
Address: 1329 North Sea.Ro.ad, _
i
outhamA -on, NY 11968 Phone _C16 ) 283-6360
Interest: (owner, consultant,lessee,etc. ) Consultant
Owner of Property: VIRGINIA MEYRAN
Address 175 Soundview Avenue
Mattituck, NY 11952 Phone D16 ) 298-5139
I
Subject Property Location: 175 Soundview Avenue
Mattituck, NY 11952
(Provide LILCO Pole #, Distance to cross Streets if not on
location map)
THIS IS NOT A PERMIT I
Yds. to be excavated: 0 Yds. to be filled: 375 cy
Manner in which material will be removed or deposited:
Trucked in, dumped & graded
Width of canal, creek or bay fronting property: 15 miles
Depth at low tide: 0 Aver. rise in tide: 2'-6"
Distance to nearest channel: N/A Distance project
extends beyond similar projects in area: N/A
Area zoning: R-40 Land area in acres: 1.13
Is project for private or business use: private
Intended use of property: no change
Describe known prior operations conducted on premises:
None known
Has any prior license or permit been issued to erect .structures,
dredge; or deposit fill on said premises: Unknown
Has any license or permit ever been revoked or suspended by a
Governmental Agency:
Project Description
The project description must also include plans for reclamation
of land disturbed during construction of the principle and
accessory structures and underground structures. (i.e. , pipeline
and septic system; make additional attachments if necessary) .
See attached
Authorization (Where the applicant is not the owner)
I VIRGINIA MEYRAN residing at 175 Soundview Avenue
(Print-owner of subject property) (Mailing address-phone)
Mattituck, NY 11952
do hereby authorize En- Consu1tanfk, Inc to apply for
Coastal Erosion permit( s) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT
County of Suffolk• )
State of New York )
ROY L. HAJE
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 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 REPRESENTATIVE(s) , TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
s
S GNATU
SWORN TO BEFORE ME THIS �; �DAY OF ,19
P0
TARY 'P;0bL RAY M. DOUGHERTY
NOTARY PUBLIC,-StMe of New York
No.O1D04901601,Suffolk County
;r;nf TOM EOhN Jalp 20;
Suggested space for location Map
THIS IS NOT •A PERMIT
TRUSTEES r � ". �' SUPERVISOR
John M. Bredemeyer, III, President j��: SCOTT L. HARRIS
Albert J. Kru ski, Jr., Vice President .
p j'
Henry P. Smith Town Hall
John B. Tuthill �,. x• �
�" _y' 53095 Main Road
�:, ��,°`' `�
William G. Albertson `'pj , ;§S ,;� P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
30 year Maintenance Agreement
Erosion Protection Structures
Chapter 37 Southold Town Code
Southol Trustees as A i.
nistrator
(Lf LLI P " �
type or print name(s) /r
the owners of record of property at: �ej d N do p"61 U�
A-/T, u cR
(type or print reet address) SCTM #1000- —3—
in applying for a Coastal Erosion permit for an Erosion
Protection Structure do hereby agree to a 30 year ma/i tenspce
program for a structure commonly known as a 13 v LfC �N-d
of b y as shown on the attached
feet of length
licensed survey of the as-built structure.
It is my/our understanding that we are to maintain this
structure with materials designed to endure 30 years and or
equivalent to the original approved structure and that for any
maintenance which involves more than 5% in length of this
structure we are to give prior written notice to the
administrator, waiting for their approval in all but true
emergency situation's which would seriously endanger life,
property and important coastal natural resource features such as
bluffs or wetlands. We further understand that failure to
maintain the structure could result in a requirement to post a
bond and or have the repairs ordered as a lien against the
property upon a finding by the Trustees that said lack- of
maintenance would risk life, property or important natural
resources features including protected, rare or threatened
animals and plants.
Y
Notarized Signature Of owner of record
SWORN TO BEFORE ME THIS DAY OF ed
MELANIE V.SROWN
rkdAAv�D Notary Public:State of Now York
No.4908712
NOTARY PUBL C d AWW in&fth cm* G�
Commission Eon Od.19,19
Please submit three copies of a licensed land survey rude within
one year of the original construction. This maintenance
agreement shall only be valid upon the final approval of the
administrator. -Subsequent owners may apply to the Southold Town
Trustees to re-authorize this maintenance agreement.
<< . � �_ ` ,� Ire�J /*=!///•.�y .�°� ...-water
- MAP OF P�20PIE'i�FT)1'
WILLIA-M . .12.
)��EYPAIV-
/-/:c//y W47
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AT yabi
_ bc,rl�f►egd
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fi'li�gpj1V8�mzf,.,, _ _ _~ \ / W°pq• ✓ \ �"- --�_
u va or's tiCc�
aoas��( - - ' L _ I/
i ...�d sar31 Stair not Fa 0.,r_ <r vaiid trur,copy, ftv (1
indicatsd ter
hazard
gJ-
';o'Ytess 't �
person
l 60
e
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-'-anY,govarnmenla!- �.
r'uticn ir8t2,j
ri 1►P� �y j ��
titivll {� dCc(: -�
EN-CONSULTAN INC. , -6• wn� it hour if !
1329 NORTH A RD,
SOUTHAMPT N, Y. 1196 ho �'
C 516-6283-6
'�• Gerafulof�ecf f'O �$4tr7r'�/.��9 ►�t1`b!!•�-e�s• � c°a��"'•� � ._,_,.._.,.,_ 1
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t
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eevisad Dec. e, 1986;April <?a 19?3
f� = rttr�rrU�nCnt
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L
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PROP/06�RET.[.)A COuYtx t
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�tG PRO Fig E OF
Ll RE TA/NirVG 4-�A L L
F-N-CONSULTANTS INC.
O -7 S S° M9 NORTH SEA RD,.
SOUTHAMPTON N. Y. 11968
516-283-6360
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,8.4(2/87)—TSxt 12
PROJECT I.D.NUMBER 61 SEQR
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
VIRGINIA MEYRAN by En-Consultant
3. PROJECT LOCATION:
Municipality Town of Southold County' Suffolk
4. PRECISE LOCATION(Street address and road Intersections,prominent landmarks,etc.,or provide map)
175 Soundview Avenue
Mattituck, NY
SCTM: 1000-99-3-1
S. IS PROPOSED ACTION:
❑New ❑Expansion ❑Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
SEE PROJECT DESCRIPTION
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
13 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)and permiUapprovals
DEC, DOS, COE
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? q r
❑Yes 9No If yea,list agency name and permitlapproval
12. AS A RESULT
YyO--F�� PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes 'tJ No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: VIRGINIA MEYRAN by En-Consultants
Date: A,pr i t 19,' 1993
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
1
�. ., o........ .,. 74V.n.nfys��.
14-16-2 (2187)-7c L
617.21 SEAR
Appendix A
State Environmental Quality Review
FULL ENVIRONMENTAL ASSESSMENT FORM
Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project
or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent-
ly, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine
significance may have little or no formal knowledge of the environment or may be technically expert in environmental
analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecting
the question of significance.
The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination
process has been orderly,.comprehensive in nature,yet flexible to allow introduction of information to fit a project or action.
Full EAF Components: The full EAF is comprised of three parts:
Part 1: Provides objective data and information about a given project and its site. By identifying basic project
data, it assists a reviewer in the analysis that takes place in Parts 2 and 3.
Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides
guidance as to whether an impact is.likely to be considered small to moderate or whether it is a potentially-
large impact. The form also identifies whether an impact can be mitigated or reduced.
Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the
impact is actually important.
DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions
Identify the Portions of EAF completed for this project: ❑ Part 1 ❑ Part 2 El Part 3
Upon review of the information recorded on this EAF(Parts 1.and 2 and 3 if appropriate), and any other supporting
information, and considering both the magitude and importance of each impact, it is reasonably determined by the
lead agency that:
❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not
have a significant impact on the environment, therefore a negative declaration will be prepared.
❑ B. Although the project could have a significant effect on the environment, there will not be a significant
effect for this Unlisted Action because the mitigation measures described in PART 3 have been required,
therefore a CONDITIONED negative declaration will be prepared.*
❑ C. The project may result in one or more large and important impacts that may have a significant impact
on the environment, therefore a positive declaration will be prepared.
* A Conditioned Negative Declaration is only valid for Unlisted Actions
at
Name of Action
Name of Lead Agency
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)
Date
1
PART 1—PROJECT IN RMAN
Prepared by Project Sponsor
NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect
on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered
as part of the application for approval and may be subject to further verification and public review. Provide any additional
information you believe will be needed to complete Parts 2 and 3.
It is expected that completion of the full EAF will be dependent on information currently available and will not involve
new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify
each instance.
NAME OF ACTION
LOCATION OF ACTION(Include Street Address, Municipality and County)
NAME OF APPLICANTISPONSOR , BUSINESS TELEPHONE
ADDRESS
i#1P TGN N. Y. 11468
CITY/PO ,. STATE ZIP CODE
NAME OF OWNER If different) BUSINESS TELEPHONE
��►'� !h i 5 W�/�ikAl / (,!_,�c ram_..
ADDRESS /1-7S �64 h d vi %J +-`c
CITY/PO STATE ZIP CODE
DESCRIPTION OF ACTION
Construct 106 l.f. of timber retaining wall plus 20'
return on w/s. on e/s wall will connect to adjacent
bulkhead. Approximately 375 cy of clean sand will be
trucked in via Bailie Beach Road to west. A 3' wide
stairway from west of bluff to beach will be repaired/
replaced as appropriate. Project is necessitated by
damage caused by 12/11/92 storm.
Please Complete Each Question—Indicate N.A. if not applicable
A. Site Description
Physical setting of overall project, both developed and undeveloped areas.
1. Present land use: ❑Urban ❑Industrial ❑Commercial FResidential (suburban) ❑Rural (non-farm)
❑Forest ❑Agriculture. ❑Other
2. Total acreage of project area: acres.
APPROXIMATE ACREAGE PRESENTLY AFTER CQMPLETION
Meadow or Brushland (Non-agricultural) y5 acres `f 1 acres
Forested acres acres
Agricultural (Includes orchards, cropland, pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres
Water Surface Area acres acres
Unvegetated (Rock, earth or fill) • 3 acres 3_ acres
Roads, buildings and other paved surfaces '0S_ acres .b 5 acres
Other (Indicate type) �yti" s'_rt `OP ` y y acres •�G acres
3. What is predominant soil type(s) on project site?
a. Soil drainage: ®Well drained d % of site []Moderately well drained % of site
- ❑Poorly drained % of site
b. If any agricultural land is involved how many acres of soil are classified within soil group 1 through 4 of the NYS
Land Classification System? NSA acres. (See 1 NYCRR 370).
4. Are there bedrock outcroppings on project site, ❑Yes []No
a. What is depth to bedrock? Ya0 � (in feet)
2
5. Approximate percenti )f prc ad project site with slopes: 10% 5 % 210-15% a � %
1615% or greater oZ f %
6. Is project substantially contiguous to, or contain a building, site, or district, Listed on the State or the National
Registers of Historic Places? []Yes 0640 1.
7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? Dyes E]No
8. What is the depth of the water table? 3 (in feet) r S,/`C)
9. Is site located over a primary, principal, or sole source aquifer? G Yes ❑No
10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ®Yes ❑No
11. Does project site contain any species of pl t or a4im4l life that is identified as threatened or endangered?
❑Yes [PNo According to �'� f
Identify each species
12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations)
®Yes ❑No Describe
13. Is the project site presently used by the co unity r rr��ighborhood as an open space or recreation area?
4Yes ❑No if yes, explain Qgeac� 'hr-
14. , Does the present site include scenic views known to be important to the community?
MYes ❑No
15. Streams within or contiguous to project area:
a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland areas within,Or4ontigu�s to prpject area:
a. Name L°07 / 5 S�,c�► doh aL b. Size (In acres)
17. Is the site served by existing public utilities? ❑Yes 710
a) If Yes, does sufficient capacity exist to allow connection? []Yes ❑No
b) If Yes, will improvements be necessary to allow connection? Dyes ❑No
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA,
Section 303 and 304? ❑Yes E�SNo
19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8
of the ECL, and 6 NYCRR 617? ®Yes ❑No
20. Has the site ever been used for the disposal of solid or hazardous wastes? Dyes ITN
B. Project Description
1. Physical dimensions and scale of project (fill in dimensions as appropriate) t
a. Total contiguous acreage owned or control led by project sponsor ,' acres.
Ab. Project acreage to be developed: c�aa C . acres initially; acres ultimately.
c. Project acreage to remain undeveloped 66- ` ""S S acres.
d. Length of project, in miles: N 1/1 (If appropriate)
e. If the project is an expansion, indicate percent of expansion proposed /K %;
f. Number of off-street parking spaces existing AO ckKhs ; proposed
g. Maximum vehicular trips generated per hour `44 (upon completion of project)?
h. If residential: Number and type of housing units:
One Family Two Family Multiple Family Condominium
Initially
Ultimately
i. Dimensions (in feet) of largest proposed structure height; width; length.
j. Linear feet of frontage along a public thoroughfare project will occupy is? ft.
3
5 ..
2. How much natural rr .,ial (.rock, earth, etc.) will be remoi iron site? tons/cubic yards
3. Will disturbed areas be reclaimed? ❑Yes ❑No IN/A
a. If yes, for what intended purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? ❑Yes ❑No
c. Will upper subsoil be stockpiled for reclamation? ❑Yes ❑No
4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? acres.
5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
❑Yes IbNo
6. If single phase project: Anticipated period of construction / months, (including demolition).
7. If multi-phased: K M
a. Total number of phases anticipated (number).
b. Anticipated date of commencement phase 1 month year, (including demolition).
c. Approximate completion date of final phase month year.
d. Is phase 1 functionally dependent on subsequent phases? ❑Yes ❑No
8. Will blasting occur during construction? ❑Yes MNo
9. Number of jobs generated: during construction ; after project is completed
10.'Number of jobs eliminated by this project
11. Will project require relocation of any projects or facilities? ❑Yes �No If yes, explain
12. Is surface liquid waste disposal involved? ❑Yes Flo
a. If yes, indicate type of waste (sewage, industrial, etc.) and amount
b. Name of water body into which effluent will be discharged
13. is subsurface liquid waste disposal involved? ❑Yes Ej No Type
14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes TONo
Explain
15. Is project or any portion of project located in a 100 year flood plain? VYes ❑No
16. Will the project generate solid waste? ❑Yes QTNo
a. If yes, what is the amount per month tons
b. If yes, will an existing solid waste facility be used? ❑Yes ❑No
c. If yes, give name location
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No
e. If Yes, explain
17. Will the project involve the disposal of solid waste? ❑Yes 17lo { t
a. If yes, what is the anticipated rate of disposal? tons/month.
b. If yes, what is the anticipated site life? years.
18. Will project use herbicides or pesticides? ❑Yes VNo
19. Will project routinely produce odors (more than one hour per day)? ❑Yes 25No
20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes XNo
21. Will project result in an increase in energy use? ❑Yes JNo
If yes , indicate type(s)
22. If water supply is from wells, indicate pumping capacity gallons/minute.
23. Total anticipated water usage per day �M gallons/day.
24. Does project involve Local, State or Federal funding? ❑Yes 15No
If Yes, explain
4
25. Approvals Require(- • Submittal
Type Date
City, Town, Village Board ❑Yes ❑No
City, Town, Village Planning Board ❑Yes ❑No
City, Town Zoning Board ❑Yes ❑No
City, County Health Department ❑.Yes. ❑No _
Other Local Agencies WYes []No
Other Regional Agencies ❑Yes ❑No
State Agencies MYes []No �C A,-t a r y s3
-Federal Agencies ❑Yes ❑No
C. Zoning and Planning Information
1 . Does proposed action involve a planning or zoning decision? -®Yes ❑No
If Yes, indicate decision required:
❑zoning amendment ❑zoning variance ❑special use permit ❑subdivision ❑site plan
❑new/revision of master plan ❑resource management plan ❑other
2. 01 What is the zoning classification(s)of the site? R—yd
3. What is the maximum potential evelopment of the site if/devel9 ped as permitted by the present zoning?
�h O ivy \. A, Q 4.c��i 07
4. What is the proposed zoning of the site? NSA
5. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
6. Is the proposed action consistent with the recommended uses in adopted local land use plans? BTrs ❑No
7. What are the predominant nd use(s) and zoning classifications within a 1/4 mile radius of proposed action?
8. Is the proposed action compatible with adjoining/surrounding land uses within a '/4 mile? ®Yes ❑No
9. If the proposed action is the subdivision of land, how many lots are proposed?
a. What is the minimum lot size proposed?
10. Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes I�o
11 . Will the proposed action create a demand for any community provided services (recreation, education, police,
fire protection)? ❑Yes VNo
a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes []No 1
12. Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes ( lo
a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes []No
D. Informational Details
Attach any additional information as may be needed to clarify your project. If there are or may be any adverse
impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or
avoid them.
E. Verification
I certify that th informa 'o provided above is true to the best of my knowledge. U _
Applicant/Sponso me �' 'rc Date T/�S
i
Signature Title
If the action is in the Coastal Area, Ind you are a state agency, complete the Coastal Assessment Form before proceeding
with this assessment.
5
TRUSTEES Og�FFU�,�C SUPERVISOR
John M. Bredemeyer, III, President h��� CGy SCOTT L.HARRIS
Albert J. Krupski, Jr., Vice President o
Henry P. Smith � ,? Town Hall
John B. Tuthill O • 53095 Main Road
William G. Albertson 4,- P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
S.E.Q.R.A.
NEGATIVE DECLARATION
NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT
APPLICATION NO. 1000-99-3-1 Chapt. 97 - Wetlands
NAME: Virginia Meyran Chapt. 37 - Coastal Erosion
DATE: May 26, 1993
RESOLVED that pursuant to Article 8 of the Environmental Conservation
Law, State Environmental Quality Review and 6NYCRR Part 617,
Section 617.10 and Chapter 44 of the Code of the Town of Southold,
notice is .hereby given that the Southold Town Trustees, as Lead
Agency for the action described below, has determined that the
project will not have a significant effect on the environment.
Please take further notice that this declaration should not be
considered a determination made for any other department or agency
which may also have an application pending for the same or similar
project.
TYPE OF ACTION: Type II
DESCRIPTION OF ACTION: Applicant proposes to construct 106 l.f. of
timber retaining wall plus 20 ' return on w/s. On e/s wall will
connect to adjacent bulkhead. Approx. 375 c.y. of clean sand will
be trucked in via Bailie Beach Road to west. A 3 ' wide stairway
from west of bluff to beach will be repaired/replaced as appropriate.
Project is necessitated by damaged caused by 12/11/92 storm. Located.
175 Soundview Avenue, Mattituck.
LOCATION: SCTM #1000-99-3-1
REASONS SUPPORTING THIS DETERMINATION:
1. An on site inspection has been conducted by the Board of
Trustees.
2. An environmental assessment, submitted by the applicant and
reviewed and completed by the Board of Trustees, has indicated that
no significant adverse effects to' the environment .are likely to occur
should the following mitigation measures be implemented.
Cc: CAC
TRUSTEES c SUPERVISOR
John M. Bredemeyer, III, President ��. pG SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President �� yam►
Henry P. Smith y = Town Hall
John B. Tuthill 53095 Main Road
William G. Albertson y ��� P.O. Box 1179
Telephone (516) 765-1892 - Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 12 , 1993
Mr. John Holzaphel, Chairman
Southold Town Conservation Advisory Council
Southold Town Hall
Main Road
Southold, NY 11971
Dear Mr. Holzaphel:
Transmitted herewith are the following applications for a wetland
permits:
Robert Celic 123-8-29
George Buckley 71-1-8
Schuyler Bergen 119-1-2
Marian Ales 119-1-20
Aristedes Speres 119-1-76
Joseph Mandelbaum 119-1-75
Thomas Losee 118-4-2
John Tobin 118-4-3
Virginia Meyran 99-3-1
Please prepare a written report of findings and
recommendations with respect to this application.
Very truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB:jmd
REGULATORY AFFAIae
RMAON BUILD1114G
f;T/:'11: 77i•7Is'I;;:►Sl%3.' :7c P•tT;71TT 7:ORK
BT 01'7 Y 7 {;C47O1ti:, T'.M%V „'�;'+.'.c4 11790.2356
New York State Department of Environmental Conservation
B bG r l)-r-Tr-u a r v s Thomas C. Jorling
�eJ� q6 �/ Po �0)( Commissioner
Dear Srcak
RE: LEAD AGENCY COORDINATION REQUEST
The purpose of this request is to determine under Article 8 (State Environ-
mental Quality Review - SEQR) of the Environmental Conservation Law and 6 NYCRR
Part 617 the following:
1. Your agency's interest in acting as lead agency;
2. Your agency's jurisdiction in the action described below; and
3. Issues of concern which your agency believes should be evaluated.
Enclosed is a copy of the permit application and a completed Part 1 of the
Environmental Assessment Form to assist you in responding.
Project Name: Virg In rR 11h E v rah �ny,-
Project Location:
i
/�J- fov�c✓ vrw ��- , /�'►Q�x,���F Scr�'l /GAG-- �j��3�/
DEC Project Number:
DEC Permits: gICIV wM��V
SEQR Classification: [ ] Type I t4 Unlisted
AP71993
DEC Contact Person:
DEC Position:
[ ] DEC has no objection to your agency or another agency assuming lead agency
status for this action, but reserves the right to comment on this action if
a positive determination of significance is made.
[ ] DEC has no objection to your agency or another agency assuming lead agency
status for this action, but we have the following concerns regarding this
project (see "comments" below) .
DEC wishes to assume lead agency status for this action.
[ ] The proposed action has been identified by DEC as occurring wholly or
partially within or substantially contiguous to a critical environmental
area (CEA) that was designated by
It is the position of this Department that your agency, if it has a juris-
diction over the action, should assume the lead agency role based on the
existence of the CEA and the fact that the anticipated impacts are
primarily of local significance.
[ ] Other. (See comments below)
Comments (Optional ) :
Response•
Please respond to this request within 30 days of the date of this letter.
If no response is received within 30 days, we will assume that you have no
objection to DEC- or another agency assuming the role of lead agency, and have no
comments to offer regarding the proposed action at this time. If neither your
agency nor any other involved agency, including DEC, has indicated a will-
ingness to serve as lead agency within 30 days of this letter:
[ ] We will petition the Commissioner of DEC to designate a lead agency
for this action.
[ ] We will petition the Commissioner of DEC to designate your agency- as
lead, presuming you have jurisdiction.
Please feel free to contact this office for further information or
discussion.
° Sincerely,
Enclosures
cc: (see distribution list)
. -r W"v of souTtod>
•
EN-CONSULTANTS INC.
1329 NORTH SEA RD,
SOUTHAMPTON N, Y. 11968
516-283-6360
, t
:5
6•
1
a J��tS�I
J�
(n r4 tf �ji �r � , t
PART 1 . F<ROJECT INF%je, TION
Pre a'red by Project Sponsor.
P.
'\
ca
NOTICE: This docu
ment is designed to a's'sIist in,'determining whether the a nSWe proposed the a quest ons will be l tons ti ed
on the environment. Please complete the entire form, Parts A through E.
in par
t of the application for approval and may-be subject to further verification and public review. Provide any additional
information you believe will be needed to'complete Parts 2 and 3.
is ez ected that completion of the full EA will depend such additional lon currently available and will not involve
work is unavailable,
vailable, so indicate and pecify
p
new studies, research or investigation. If inforrrlation r requiring
each instance.
NAME OF ACTION
LOCATIO=���Address,�
pality and County)
BUSINESS TELEPHONE
NAME OF APPLICANTISPONSOR Egi-CONSULTANTS INC. ( )
4.,n
ADDRESS
e5Oru y HAM T N N, Y, I STATE ZIP CODE
CITYIPO r le-283-6360
• BUSINESS TELEPHONE
CRTsrs/3
NAME OF OWNER{If different) r
I ►" f r7 t,
ADDRESS J / Irk ZIP CODE h Q t/f �J � STATE
CITYIPO _�
DESCRIPTION OF ACTION
Construct 106 l.f. of stwall will rataining
adjacent
------ return on w/o. On e/
375 cy of clean sand will b
bulkhead. Approximatelye .
trucked in via Bailis Beach Road to west- A 3' wide
stairway from west of bluff -to beach is
necessitated be will
replaced as appropriate. Proj
damage caused by 12/11/92 storm.
Please Complete Each Question=Indicate N.A. if not applicable
A. Site Description
Physical setting of overall project, both developed and undeveloped are�Rcsidential (suburban) ORural (non-farm)
1. Present land use: ❑Urban ❑Industrial ❑Commercial
❑Forest ❑Agriculture. ❑Other
acres.
2. Total acreage of project area: -PRESENTLY AFTER Cs2MPLETION
APPROXIMATE ACREAGE `�5 acres 4 acres
Meadow or Brushland (Non-agricultural) acres acres
Forested acres acres
Agricultural (Includes orchards, cropland, pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres' acres
Water Surface Area acres 3 acres
Unvegetated (Rock, earth or fill) O.S acres •b S acres
Roads, buildings and other paved su faces , `� v acres �G acres
Other (Indicate type)_____--
3. What is predominant soil type(s) on project site? % of site
®Well drained d % of site ❑Moderately well drained
a. Soil drainage: % of site
OPoorly drained 1 through 4 of the NYS
b. If any agricultural land is involved how many
many acres of soil are(See 1 NYCRR 370).classified within soil group
Land Classification System. ONO
4. Are there bedrock outcroppings on project site? OYes
,. '1 a� (in feet)
What is depth to bedrock?
2 __
prox ate percentage roposed project site with slopes; �( 0 9 S! % aO-15% '? %
m
[615% or greater a %
6, Is project substantially contiguous to, or contain a`>building, site, or district, listed on the State or the National
Registers of Historic Places? ❑Yes E3f4o "
7. Is project substantially contiguous to a site listed on'the Register of National Natural Landmarks? []Yes J51No
8, What is the depth of the water table? (in.feet) ( `9
9. Is site located over a primary, principal, or sole source aquifer? ItYes ONo
10. Do hunting, fishing or shell fishing,opportunities presently exist in the project area? ®Yes ❑No
11. Does project site contain any species of pI t or a�im�F life that is identified as threatened or endangered?
❑Yes E�No According to • 6(( //77``
Identify each species
12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological.formations)
5IYes ❑No Describe /i F
13. Is the project site presently used by the con ra' unity r rr}}�eighborhood as an, open space or recreation area?
FpYes ❑No If yes, explain �4c�
14. . Does the present site include scenic views known to be important to the community?
( Yes ❑No
15. Streams within or contiguous to project`'area:
a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland are within or,contiguous, to prpject area:
a. Name Z.0 �5 ti� � 47 b. Size (In acres)
17. Is the site served by existing public utilities? 0Yes 1_7N0
a) If Yes, does sufficient capacity exist to allow connection? ❑Yes ❑No
b) If Yes, will improvements be necessary to allow connection? ❑Yes ❑No
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA,
Section 303 and 304? ❑Yes E6No
19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to.Article 8
of the ECL, and 6 NYCRR 617? FZYes ❑No
20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes [TNo
B. Project Description
1, Physical dimensions and scale of project (fill in dimensions as appropriate) 1
a. Total contiguous acreage owned or`con rolled by project sponsor , acres.
c14 " � acres initially; acres ultimately.
b. Project acreage to be developed:�r'
c. Project acreage to remain undeveloped N� �a" acres.
d. Length of project, in miles: k �/T (If appropriate)
e. If the project is an expansion, indicate percent of expansion proposed /Y 0 %;
44/i
f. Number of,off-street parking spaces existing/Io C__ ; proposed.
g. Maximum vehicular trips generated per hour (upon completion, of project)?
h. If residential: Number and type of housing units:
One.Family Two Family Multiple Family Condominium
Initially /
Ultimately
i. Dimensions (in feet) of largest proposed structure height; width; 16 length.
j. t,inehr fo(J of frontage! along t1 public thOr•CM91INire project will uc:Gul)y WC-8 _ fL
3
2. How much natural material (i.e., rock, earth, etc.) will be removed from the site? toiis/cubic yar��
S,
3. Will disturbed areas be reclaimed? ❑Yes ONO >UfNIA
a. If yes, for what intended purpose-is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? ❑Yes ONO
c, Will upper subsoil be stockpiled for reclamation? ❑Yes ONO
4, How many ��cres of yf�getation (trees, shrubs, ground covers) will be.removed from site? acres,
5. Will any mature forest (over 100 years'old) or other locally-important vegetation be removed by this project?
❑Yes 1:' No
6. If single phase project: Anticipated period of construction / months, (including demolition):
7. If multi-phased: N M
a. Total number of phases anticipated (number).
b: Anticipated date of commencement phase 1 Month year, (including demolition).
c. Approximate completion date of final phase month year.
d. Is phase 1 functionally dependent on subsequent phases? ❑Yes ❑No
8. Will blasting occur during construction? ❑Yes 7No
9. Number of jobs generated: during construction after project is completed
10. Number'of jobs eliminated by this project
11. Will project require relocation of any projects or 'facilities? ❑Yes JINo If yes, explain
12. Is surface liquid waste disposal involved? ❑Yes F�N0
a. If yes, indicate type of waste (sewage, industrial, etc.) and amount
b. Name of water body into which effluent will be discharged
13. Is subsurface liquid waste disposal involved? ❑Yes E�No 'Type
14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes T�]No
Explain
15. Is project or any portion of project located in a 100 year flood plain? ItYes ONO
16. Will the project generate solid waste? . ❑Yes I?fN0
a. 'If yes, what is the amount per month tons
b. If yes, will an existing solid waste facility be used? ❑Yes ONO
c. If yes, give name location
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes []No
e. If Yes, explain
17. Will the project involve the disposal of solid waste? ❑Yes fJo
a. If yes, what is the anticipated rate of disposal? tons/month.
__..b.' If yes, what Is the anticipated site life? years.
18. Will project use herbicides or pesticides? ❑Yes rNo
19. .Will project routinely produce odors (more than one hour per day)? ❑Yes 95No
20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes XNo
21. Will project result in an increase in energy use? ❑Yes JNo
If yes indicate type(s)
22. If water supply is from wells, indicate pumping capacity ��� gallons/minute.
23. Total anticipated water usage per day ��//' gallons/day.
24. Does project involve Local, State or Federal funding? ❑Yes I5No
If Yes, explain
4
' Approvals Required submittal
Type Date
City Town, Village Board ..DYes Ell No
III. II�`, n ?'ill ij �� I'I�Inllll Illa,uFl nl'13a Fll`IF�
City, Town Zoning Board L IYes I__INo
City, County Health Department ❑Yes. ❑No �p��
Other Local Agencies VYes ❑No �°`'r� 7/w.5h'-5
Other Regional Agencies ❑Yes ❑No _
State Agencies ®Yes ❑No �C Art oZ( W S3
-Federal Agencies ❑Yes ❑No
C. Zoning and Planning Information
1 . Does proposed action involve a planning or zoning decision? 'EYes ❑No
If Yes, indicate decision required:
❑zoning amendment ❑zoning variance ❑special use permit ❑subdivision ❑site plan
❑new/revision of master plan ❑resource management plan ❑other
2: �W-hat_is the zoning classification(s)of the site?
3. What is the maximum potential evelopment of the site if/devel9 ped as permitted by the present zoning?
A r d'c. r���n.
4. What is the proposed zoning of the site? N0,
5. What is the maximum potential'development of the site if developed as permitted by the proposed zoning?
6. Is the proposed action consistent with the recommended uses in adopted local land use plans? HYLes . ❑No
7. What are the predominant nd use(s) and zoning classifications within a '/4 mile radius.of proposed action?
8. Is the proposed action compatible with adjoining/surrounding land uses within a '/4 mile? tffYes ❑No
9. If the proposed action is the subdivision of land, how many lots are proposed? (A
a. What is the minimum lot size proposed?
10. 'Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes t*0
11 . Will the proposed action create a demand for any community provided services (recreation, education, police,
fire protection)? ❑Yes VNo
a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes ❑No J
12. Will the proposed action result in.the generation of traffic significantly above present levels? ❑Yes 17�I0
a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yese ❑No
D. Informational Details
Attach any additional information as may be needed to clarify your project. If there are or may be any adverse
impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or
avoid them.
E. Verification
I certify that th informa 'o provided above is true to the best of my knowledge. �/
Applicant/Sponso me Cf (`�" � � Date T//
Signature Title
If the action is in the Coastal Area, Jnd you are a state agency, complete the Coastal Assessment Form before proceeding
with this assessment.
5
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
`r JOINT , PLICATION FOR PERMIT U.S.ARMY CORPS OF ENGINEERS APPLICATION NO.
Please read ALL instructions on back before completing this application. Please type or print clearly in ink.Attach additional information as needed.
❑ARTICLE 9, TITLE 1,ARTICLE 43 6NYCRR 646(LAKE GEORGE RECREATION ZONE)
❑ARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) 1:16NYCRR 327(AQUATIC VEGETATION) 116NYCRR 328(FISH) 1:36NYCRR 329(INSECTS)
S ❑ARTICLE 15, TITLE 5 6NYCRR 608(PROTECTION OF WATERS)
T ❑For the construction, reconstruction,or repair of a DAM or other impoundment structure.
A
T I��❑For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS. 0401 WATER QUALITY CERTIFICATION
E IXARTICLE 15, TITLE 1S ❑6NYCRR 601 (WATER SUPPLY) ❑6NYCRR 602(LONG ISLAND WELL)
❑ARTICLE 15, TITLE 27 6NYCRR 666(WILD, SCENIC AND RECREATIONAL RIVERS)
I❑I_ARTICLE 24 6NYCRR 662, 663(FRESHWATER WETLANDS) ❑ARTICLE 36 6NYCRR 500(FLOODPLAIN MANAGEMENT)
L�FARTICLE 25 6NYCRR 661 (TIDAL WETLANDS) ❑ARTICLE 34 6NYCRR 505(COASTAL EROSION)
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E ❑SECTION 10(RIVER AND HARBOR ACT OF 1899)for structures and work in navigable waters of the U.S. ❑COASTAL CONSISTENCY CERTIFICATION.
E ❑SECTION 404(CLEAN WATER ACT OF 1977)for disposal of dredged or fill material in waters of the U.S.
D
❑SECTION 103(MARINE PROTECTION, RESEARCH AND'SANCTUARIES ACT)for the transportation of dredged materials for dumping into ocean waters.
1. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES(If any)
2. APPLICANT IS A/AN ISI��+,
Owner ❑Operator ❑Lessee ❑Municipality/Governmental Agency (Check as many as apply)
3. NAME OF APPLICANT(Use Full Name)
VIRGINIA MEYRAN
MAILING ADDRESS 7(516)
PHONE(Where can be reached during day)
175 Soundview Avenue 298-5139
POST OFFICE Mattituck STATE ZIP CODE
NY 11952
4. NAME OF ❑Owner
®Agent/Contact Person (Check'.one)
Roy L. Ha e En-Consultants, Inc
MAILING ADDRESS TELEPHONE(Where can be reached during day)
1329 North Sea Road (516) 283-6360
POST OFFICE STATE ZIP CODE
Southampton NY 111968
5. PROJECT/FACILITY LOCATION(Mark location on map,see Number 1B on reverse side)
County Suffolk I Town or city Town Of SOutholdl Village
STREET ADDRESS(If different from applicant)
Same
POST OFFICE _ t )Q f
NNK STATE 1', ZIP CODE
6. NAME OF STREAM OR BODY OF WATER bong Island Sound
..1 L.1 ..
7 HAS WORK BEGS pp BEGUN ON PROJECT? If YES• attach explanation on starting work without permit,includes dates!U 8. WILL PROJECT UTILIZE STATE LAND?
❑Yes Li No Show work on map and/or drawings. ❑Yes liiNo
® Private
9. PROPOSED USE: 10. PROPOSED STARTING DATE: 11. APPROXIMATE COMPLETION DATE: 12. FEE OF(NYS Permit Only)
❑ Public ❑ Commercial ASAP ASAP S
Enclosed
13. PROJECT DESCRIPTION: (e.g. quantity and type of material to be excavated, dredged or used for fill or rip rap, location of disposal sites: type of
structure to be installed; height of dam; size of impoundent;capacities of proposed water sources;extent of distribution system; etc.)
SEE ATTACHED
14. WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL,STATE AND/OR LOCAL PERMITS? Yes ❑ No If yes, please list:
TOWN OF SOUTHOLD, DOS, COE
15. CERTIFICATION:
I hereby affirm that under penality of perjury 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 projo(t
described herein and agrees to indemnify and save harmless the State from suits, actions• damages and costs of every name and description resulting from said
project. In addition, Federal Law, 18 U.S.C. Section 1001 rovides for a fine of not more than $10,000 or imprisonment for not more than five years, or both.
where an applicant knowingly and willfully falsifies,con a s,or cov s up a material fact;or knowingly makes or uses a false, fictitious or fraudulent statement
❑1 hereby authorize the agent named in Number ove to bm' is application on my behalf.
April 12, 1993 President
DATF R IG.ArL;RE -- -- ---------
rl n l
PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE
PROJECT DESCRIPTION
Re: VIRGINIA MEYRAN
Construct 106 l.f. of timber retaining wall plus 20 '
return on w/s. On e/s wall will connect to adjacent
bulkhead. Approximately 375 cy of clean sand will be
trucked in via Bailie Beach Road to west. A 3 ' wide
stairway from west of bluff to beach will be repaired/
replaced as appropriate. Project is necessitated by
damage caused by 12/11/92 storm.