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HomeMy WebLinkAboutTR-4196Board Of $outhold' Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 4196 DATE: ~une 25, 1993 ISSUED TO Stzffolk County Water Authority Authorization Pursuant to the provisions of Chapter 615 of the Laws of 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- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on Sune 19 93 , and in consideration of the sum of $ 150.00 paid by SCWA of N.Y. and subiect to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: install water main in the Laurel area to provide domestic water and fire protection for public use. Peconic Bay Blvd. up Bay A' to approx. 250' north of Bartley Road, Matt. Applicant must work with Town Engineer and place hay bales on southside of all in accordance with the detailed specifications as presented in the originating application. Husing Pond perminatly. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, end these presents to be subscribed by · majority of the said Boerd as of this dat.e. Permit will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the 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 v~,~ruly~s, John M. Bredemeyer, III President, Board of Trustee JMB: jd cc: Jamie Richter, Town Engineer Ray Jacobs, Superintendent of Highways TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. lohn L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 COASTAL EROSION bI3~AGEMENT PEtYMIT APPLICATION TOWN WETLANDS PER14IT APPLICATION TRUSTEE LTd~DS PEP~IIT APPLICATION office Use Only: ~oas%al Erosion Permit Application etland Permit Application rustee Lands Permit Application rand father ~'~ompleted ~pps. Date: 3~--~/~ ~Variance R=quired, ~ Neighbors notified Date: ~Ts'pe ~ , ~?lsp. comp./date: S l~-~5 ~EQRA Determin./date: Public 8earing/date: ~-~g$3 Findings: Permit Vote: (Y/N): ~& ~}6nC Special Conditions: {also see file) [OWN OF SOUTHOLD w~ne ~.ec. by Office Application Fee: Application Number; SC%~ ~1000- Project Il&me (If any) Date Prepared: 1/4/93 Applicant: Suffolk County Water Authority Address: 4050 Sunrise Hiqhway~ 0akda]e~ N.Y. Interest: Owner of Address 12"~ 8" & 6" Water Main Extension 11705 Phone (516 ) 563-020~ (owner, consultant,lessee,etc.) Property: Iown of Southold Phone { ) Subject Property Location: See Attached Print (Provioe LILCO Pole ~, Distance to cross Streees if not on location map) %'HIS IS NOT A PERi.lIT Yds. to be excavated: N/A Yds. to be filled: Manner in which material will be removed or deposited: any excavated soil back in same trench. Width of canal, creek or bay fronting property: N/A Depth at low tide: N/A Aver. rise in tide: N/A Distance to nearest channel: v~es Distance project extends beyond similar projects mn area: Area zoning: N/A Land area in acres: N/A Is project for private or business use: Intended use of property: N/A Describe known prior operations conducted on premises: N/A Has any prior license or permlt been issued to erect.structures, dredge, or deposit fill on said premises: Has any license or permit ever Deen revoke~ or suspended ~y a Governmental Agency: N/A Projecu Descriotion 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 DescriDtinn Authorization (Where the applicant is not tile owner) N/A I residing at (Print-owner of subject property) (Mailing address-phone) do hereby aunhorize to apply for Coastal Erosion permit(s) from the Southold Town Trustees Signature THIS IS NOT A PERMIT TRUSTEES John M. Bredemeyer. III. President Albert J. Kmpski, Jr., Vice President Henry P. Smith John B. Tuthill William G..~benson Telephone (516) 765-1892 Fax (516) 765-1.823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road EO. Box 1179 Southold. New York 11.971 June 30, 1993 Steven Burns Suffolk County Water Authority 4050 Sunrise Highway Oakdale, NY 11705 Re: Water Main Extension Southold Town Dear Mr. Burns: The following action was taken by the Board of Town Trustees during its regular meeting held on Thursday, June 24, 1993 regarding the above matter: WHEREAS, Steven Burns on behalf of Suffolk County Water Authority applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 20, 1993 and, WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a public hearing was held by the Town Trustees with respect to said application on Thursday, June 24, 1993 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, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 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 approves the application of Steven Burns on behalf of Suffolk County Water Authority to install water main in the Laurel area to provide domestic water and fire protection for public use. Peconic Bay Blvd. up Bay Ave. to approx. 250' north of Bartley Road, Mattituck SUBJECT to working with the Southold Town Engineer during all phases of this project. Hay bales are to be perminatly placed on the southside of Husing Pond. County of Suffolk ) State of New York ) Steven T. Burns BEING DULY SWORN DEPOSES AND AFFI~4S THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PER,lIT(S) AND THAT ALL STATEM~qTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER ~IOWLEDGE AND BELIEF, AND THAT WOP/~ WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TO%~N BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAS~GES 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 I}I CONJUNCTIO}I WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS SIGNATURE NOTARY PUBLIC Suggested space for location Map ~{IS IS NOT A PERMIT 617.21 Appendix C State Environmental Quality Review ..' SHORT ENVIRONMENTAL ASSESSN1ENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFOR~tATION ('Fo be completed by Apolicant or Proiect sDonsor) SEQE $. APPLICANT /SPONSOR 2. PROJECT ~AME Suffolk County Water Authority 12", 8" & 6" Water Main Extension 3. PROJECT LOCATION: uuniclo~mv Laurel county Suffolk See Attached Sheet 5. 15 PROPOSED ACTION: [] New E] Exoans,on ~ Mod,ficmtlon/a.era.on * * 6. DESCRIBE PROJECT BRIEFLY: Install 12", 8" & 6" Water Mains See Attached Map for Locations. [] Res,~em,a, [] !naus,nal [] Commerc,al [~] Agr,cullure [] Park/ForesuO~en spruce [] OI.er STATE OR LOCAL)? [] Yes [] t~o ;! ye~. iisi agcncy(s) and oermll/al3DrOValS Town of Southold - Road 01~ening Permit N.Y.S. DEC - Wetlands Permit Town of Southold - Road Opening Permit DEC #1-4738-00582/00001-0 A.¢.:~.'~O.~o, .am~: Steven T. Burns I! the action is in tho Co,~stal Area, and you are a state agency, complete Ihe Coastal Assessment Form bolero proceeding wilh this assessment OVER 1 PART III--OETERMINATIOI',I OF SIGNIFICANCE (TO be completed by Agency) [] Check this box if you have idenlifieo one or more. Potentially large or Significant adverse impacts w~ic~ MAY ~ Check this box ~ you have determined, based on the information and analysis aDove and any supDorting 4d*,-_ [2 91}--7c 617.21 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM SEQR Purpose: The tull EAF ~s designed to help applicants and agencies determine, in an orderly manner, whether a prolect or actlonmavbes~gnlf~cant The quest~on of whether an act~on mav be sigmficant is not alwavs easv to answer. Frequent- Iv, there are aspects of a prolect that are subjective or unmeasureab[e. It is also understood that those who determine slgmricance may have little or no formal knowledge of the environment or may not be technically expert m environmental analvs~s, in addition, many who have knowledge ~n one particular area may not be aware of the broader concerns affecting the question of s~gnificance The full EAF is intended to prowde a method whereby applicants and a§enc~es can be assured that the determ~nanon process has been orderly, comprehensive in nature, vet flex,hie enough to allow introduction of mtormat~on to tit a prolect or action Full FAF Components: The full EAF is compnsed of three parts: Part 1: Prowdes obiective data and information about a gwen prolect and its site. By identifying basic project data, it assists a reviewer m the analys~s that takes place m Parts 2 and 3. Part 2: Focuses on ~dent~twng the range of poss~ble~mpacts that mavoccur from a prolect or action. It provides gmdance as to whether an ~mpact is hkelv to be considered small to moderate or whether it ~s a potentially- large ~mpact. The form also idennhes whether an ~mpact can be m~tigated or reduced. Part 3: It any ~mpact m Part 2 ~s identified as potentially-large, then Part 3 is used to evaluate whether or not the ~mpact ~s actually ~mportant DETERMINATION OF SIGNIFICANCE--Type I and Unlisted Actions Identity the Portions of EAF completed for this project: ~ Part I ~ Part 2 -_Part 3 Upon rewew of the informat~on recorded on this EAF (Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magnitude and importance of each impact, it is reasonably determined by the lead agency that: A The prolect wdl not result in any large and important impact(s) and, therefore, ~s one which will not have a significant ~mpact on the enwronment, therefore a negative declaration will be prepared. B. Although the prolect could have a significant effect on the environment, there wd[ not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, theretore a CONDITIONED negative declaration will be prepared.* C The proiect mavresult~n one or more large and important impacts that may have a s~gmficant~mpact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions 12"~ 8"~ 6" Water Main Installation Name of Action Suffolk County Water Authority, Name or Lead Agency Steven T. Burns Supt. Distributi~n-Enn~tructinn Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer ~,,,n~tt,.,~ r~f g'o~non~lhte r~fficer m I pad Agency Signature of PreparerHf different frnm rpcnons~ble officer) Date PART 1--PROJECT INFORMATION Prepared by Project Sponsor '~OTICE: This document~sdes~gnedtoass~st~ndeterm~nmgwhether theact~on proposed may havea 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 rewew. Provide any additional reformation you believe will be needed to complete Parts 2 and 3. It ~s expected that completion of the full EAF wdl be dependent on mformat~on currendv avadable 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 12"~ 8", 6" Water Main Extension LOCATION OF ACTION (Incluae Street Ad~ress, Mumcipalit¥ aha County~ Laurel - See Attached Sheet NAMEOFAPPUCANTIBPONSOR Suffolk County Water Authority ADDBEBS 4050 Sunrise Highway 0akdale BUSINESS TELEPHONE ~516t 563-0205 STATE ZIP CODE N.Y. 11769 NAME OF OWNER (If different) I BUSINESS TELEPHONE ADDRESS CITY/PO STATE ZIP CODE DESCRIPTION OF ACTION See Attached Description Please Complete Each Question--Indicate N.A. ii not applicable A. Site Description Physical setting of overall proiect, both developed and undeveloped areas. 1 Present land use: ~_Urban ~lndustrial ]Commercial ~]Res~dentiaJ (suburban) ~Rural (non-farml L~ Forest ~Agnculture []Other 2 Total acreage of proiect area: N/A acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION 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 acres Unvegetated (Rock, earth or fill) acres acres Roads, buddings and other paved surfaces acres acres Other (indicate type)_ acres acres 3. What ~s predominant sod type(s) on prolect s~te? Sand & Loam a. Soil drainage: ~Well drained % of site ~'lModeratetv welt drained 100 % of site L~Poorlv drained % of site Land Classmcat~on System? N/A acres. (See 1 NYCRR 370). 4 Are there bedrock outcroppings on proiect site? ~Yes ~lNo a. What ~s depth to bedrock? (in feet) 2 PART 1--PROJECT INFORMATION Prepared by Project Sponsor >~OTICE This document ~sdes~gned toass~st~n determmmgwhether the action prooosed ma,/ i~a~e as~gnit~canteffect on the enwronment Please complete the entire form. Parts A through E Answers to these quesuons wdl be considered ahpartof theappllcat~onrorappro~alandmavbesublecttofurther~er~f~catlonandpubllc rev~e~ Pro~deanvaddltlonal mrormauon you beheve wd[ be needed to complete Parts 2 and 3. It is expected that compleuon or the full E&F wdl be deoendent on ~nformaclon currently avadable and will not involve new studies, research or mvestlgal:lon, if information reQu~nng such additional work is unavadable, so indicate and specdv each instance NAMEOFACTION 12", 8", 6" Water Main Extension LOCATION OF ACTION ~lnctuOe Street Address, Mumcioalny ane Countyl Laurel - See Attached Sheet NAME OF APPLICANT/SPONSOR Suffolk County Water Authority ADDRESS 4050 Sunrise Highway CITYIPO Oakdale BUSINESS TELEPHONE r516 ' 563-0205 STATE i Z]P CODE N.Y. 11769 NAME OF OWNER tlf (]ifferentl ~USINEES TELEPHONE ADDRESS CITY/PO I STATE ZIP CODE DESCRIPTION OF ACTION See Attached Description Please Complete Each Question-Indicate N.A. ii: not applicable A. Site Description Physical setUng of overall proiect, both developed and undeveloped areas. 1 Present land use: ~Urban m-Industrial ~Commerclal ~Res~dentlal (suburbanl --~Rural (non-~arml L~ Forest ~Agriculture ]Other 2. Total acreage ct prolect area: N/A acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) acres acres Forested acres acres Agricultural (lncludes 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 IRock. earth or fill) acres acres Roads, buddings and other paved surfaces acres acres Other (Indicate type~ acres acres J. What ~s predominant sod type[s) on prolect site? Sand & Loam a. Sod drainage: ~Well drained % of site '~Moderatelv well drained 100 % of site ~Poorty drained % of s~te Land ClassJticauon System~ N/A acres. [See 1 NYCRR 370L 4 .Are there bedrock outcroppings on prolect site? ~Yes ~No a. What ~s depth to bedrock? [in feet) 2 Approximate percentage or proposed project s~te w~th slopes: ~:~0-10% 100 % ~10-15% % E~15% or greater % Is prolect substanuaJJv contiguous to. or contain a building, s~te, or district, listed on the State or the National Relg~sters or Historic Places? ~?fes ~No ]~ prolect substantially contiguous to a site listed on the Re§~ster pt National Natural Landmarks? _-Yes ~No ;~ What is the depth of the water table? 6' +- (in feetl 9 Is ~te located over a primary, pnnc~paJ, or sole source aquifer? ~Yes 10 Do huntm§, fishing or shell fishing opportunities presently ex~st in the proiect area? :k~Yes ~No 11 Does prolect s~te contain any speoes of plant or ammaJ life that ~s ~dent~fied as threatened or endangered? :Yes -~(No According to Identity each species 12 Are there any umque or unusual land forms on the prolect s~te? (ie. cliffs, dunes, other geological formations) [:-Yes ~No Describe 1~, I, the prolect s~te presently used by the commumtv or neighborhood as an open space or recreation area? _--Yes ~[No If ,,,es, explain 13. Does the present $~te include scemc views kno~n to be ~mportant to ~he commumty? ~Yes )~No 15. Streams w~thin or conuguous to prolect area: James Creek. and Horton Creek a. Name of Stream and name of River to which it ~s tributary Great Pe¢onic Bay 16 Lakes. a. Name N/A 17 Is the s~te served by existing public utilities? ~Yes ~No al If Yes, does sufficient capacity exist to al)ow connection? b) If Yes. wdl improvements be necessary to allow connecuon? ponds, wet)and areas w~th~n or contiguous to prolect area: b Size (In acres~ ~Yes ~No ~Yes ~No 18. Is the s~te located in an agricultural district certified pursuant to Agriculture and Markets Law. Arhcle 25-AA, bect~on 303 and 304? =Yes ~No 19 Is the site located m or substantially contiguous to a Critical Enwronmental Area designated pursuant to Article 8 or the ECL. and 6 NYCRR 617~ ~Yes [:No 20 Has the s~te ever been used for the d~sposal of solid or hazardous wastes? ~Yes ~No B. Project Description Physical d~mens~ons and scale of project (fill in dimensions as appropriate; a. Total contiguous acreage owned or controlled by prolect sponsor N/A b. Prolect acrea§e to be developed: N/A acres initially; c Prolect acreage to remain undeveloped N/A acres. d. Length of prolect, m redes: N/A (If appropriate) e if the prolect is an expansion, indicate percent of expansion proposed N/A acres. acres ulumately f Number pt off-street parking spaces existing g. ,~,tax~mum vehicular trips generated per hour h. If residential: Number and type of housing umts: One Family Two Family [mt~aJJt N/A Ultimately Dimensions Hn feeU of largest proposed structure N/A height: Linear feet of frontage alon8 a public thoroughfare prolect will occupy · proposed N/A (upon compleuon of project)? Multiple Famdy Condominium width; length 220' ft.+ *Amount, if a · will not be known until excav on begins. How much natural material U.e, rock. earth, etc.j will be removed From the s~te? * ,'~11 disturbed areas be reclaimed? ,~Yes _--No _~N,'A a Ir ~e~. for what intended purpose ~s the s~te being reclaimed? b Will topsod be stockpiled for reclamation? EYes ~_No c ~,%;11 upper subsod be stockpded for reclamatton? ~¥es ~No [ons~cubic yards Restored to 0riclinal condition How many acres or vegetation ~trees. shrubs, ground coversJ wdl be removed from site? N/A acres. Wdl any mature forest (over 100 years old) or other Iocal[y-~mportant vegetation be removed bv this prolect? ~No b Ir single phase proJect. Anticipated period of construction N/A - If multi-phased: a Total number of phases anticipated N/A InumberJ b Antic~pated date or commencement phase 1 c. Approximate completion date of final phase d. Is phase 1 functlonal(y dependent on subsequent phases) 8 \%'ill blasting occur during construcuon~ ~es X~No 9 Number of lobs generated: dur,ng construcuon N/A , 10 Number or lobs eliminated by th~s prolect N/A I1 Will prolect require relocation or anv prolects or racdltle~/ months, (~nc[ud~ng demohtion). mon[h nlon[h - year, (including demolition). - year. ]No after prolect is complete -~es ~NO If yes. explain 12 Is surface liqmd waste disposal involved? ~Yes ~No a If yes, indicate type ot waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent wdl be discharged 13. Is subsurface liquid waste disposal revolved? ~Yes ~No Type 14 Will surface area of an existing water body increase or decrease by proposal? Explain ~Yes )~No ~Yes 15. Is project or any portion of project located in a 100 year flood plain? 16 Will the Drolect generate sohd waste? ~Yes ~No a. It yes, what ~s the amount per month tons b If yes. ~ll an ex~sting sohd waste facility be used? ~Yes ~No ,:. It yes, g~ve name location d WdJ any wastes not go into a sewage disposal system or into a samtary landfill? e If Yes, explain ~No ~Yes ~No 17 Wdl the prolect involve the disposal of solid waste? ~Yes ~No a. If yes, what is the anticipated rate of disposal? tons/month b. If yes, what is the anticipated site life? years. 18. Wdl prolect use herbicides or pesticides? ~Yes )~No 19 Will prolect rouUnely produce odors (more than one hour per day)? ~Yes )~]No 20 Will project produce operating noise exceeding the local ambient noise levels? ~Yes 21 Will prolect result ~n an increase m energy use? ~¥es ~No If ves, indicate type(s) 22 If water supply is from wells, indicate pumping capacity N/A gallons/minute. 24. Does project involve Local. State or Federal funding? E~Yes ~No Ir ~es, explain ~No *Amount, if any, wi be known until excavation .',dl disturbed areas be reclaimed? ~Yes )No ]N/A b Vvill topsod be ,tockpded for rec]amatmn~ ~]Yes ~No · ~,~,d[ upper subsod be stockpded for reciamauon~ ~'~es Restored to oriqinal condition ]No 4 tqow many acres or vegetation Itrees ~hrubs. ground coversi will be removed from s~te? N/A acres ~ ',%dl any mature forest {over 100 years oldi or other locally-important vegetation be removed by th~s protect? ~No o It single phase prolect: qnt~c~pated per~od of construcuon N/A ~ If multi-phased: a Total number of phases anticipated N/A /numberJ b Anticipated date of commencement phase I - c Approximate completion date of final phase - d. Is phase 1 functionally dependent on subsequent phasesi ,~ Will blasting occur during construct~on~ ]Yes ~No 9 Number of lobs generated: during construction N/A l0 Number or lobs eliminated b~ th~s prolect N/A 11 Will prolect reqmre relocation or any prolects or [aClllties( months. (including demol~t~onJ month ,,.ear. Hnciud~n~ demol~tlom. month s ear. _-~es ]No . after nrolect I) complete ]'~es ~.No It ~,es, exolmn 12 Is surface liquid waste d~sposal ~nvolved? ]Yes X~No a. If yes, indicate type of waste tsewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liqmd waste d~sposal involved? ~.Yes ~No Type 14 .Will surface area pt an existing water body increase or decrease by proposal? Explain ©Yes 15 Is prolect or any poruon of prolect located in a 100 ,/ear flood piton? ~Yes ~No 16 Will the oroiect generate solid waste? ~zYes ~No a If yes. what is the amount per month tons b It yes. wdl an ex,sung sohd waste facditv be used? ~]Yes ~_No ¢ If ,,'es. gwe name location d Will any wastes not go into a sewage d~sposa] system or into a samtarv landfdll e If Yes. explain _--Yes ~No 17 Wdl the prolect ~nvoJve the disposal of solid waste? L~Yes ~No a. If ves, what is the anticipated rate of disposall tons/month. b. If yes. what is the antm~pated site hfe,~ years. 18 Wdl prolect use herbicides or pesticides? -iYes )(]No 19 Wdl prolect routinely produce odors (more than one hour per dav)? ~ZYes ~]No 20 Will prolect produce operating noise exceeding the local ambient noise levels? ~;'es 21 W.II prolect result m an increase m energy use/ If yes , indicate type(s) 22. If water supply is from wells..nd{cate pumping capacity N/A gallonslmmute. 24 Does prolect revolve Local. State or Federal funding? ~Yes ~_No It ~es. explain ~]No 4 25. Approvals Required: Type Submittal Date City. Town. Village Board OYes L~No City. Town, Vi!lage Planning Board ~Yes L~No City. Town Zoning Board ~Yes L~No City. County Health Department E~Yes [No Other Local Agencms []Yes L]No Other Regional Agencies [~Yes E~No State Agencies [}Yes ~No Federal Agencies L~Yes ,~No ~own ot bou~hold Ro~d ODeninq Permit N.Y.S. DEC 8/92 1/93 C. Zoning and Planning Information 1 Does proposed action involve a plannmg or zonmg decision,~ ~Yes ~No Ii: Yes. ad.cate decision required ~_zomng amendment ~zomng variance ~spec~al use permit ~subd~vision ~new~revision of master plan _~resource management plan ~other What ~s the zoning cJasslticat~onts)of the site? N/A ~site plan What ~s the maximum potenbal development of the s~te if developed as permitted by the present zoning? N/A What is the proposed zoning of the site? N/A What ~s the maximum potential development of the s~te ii: developed as permitted by the proposed zoning? N/A 6 Is the proposed action consistent with the recommended uses m adopted local land use pJans? ~Yes 7 What are the predominant land use(s) and zoning classifications within a ~,~ mile radius of proposed action? Residential ~No 8 Is the proposed action compatible w~th adjoining/surrounding land uses within a '/. mde? X~Ye~ I~No 9 If the proposed action ~s the subdivision of land. how many lots are proposed? N/A a. What is the mm~mum tot s~ze proposed? N/A 10 Will proposed action require any authorization(s) for the formauon of sewer or water districts? ~Yes Will the proposed action create a demand for any community provided services (recreation. education, police, fire protecbon)? ~Yes L~No a. Ii' yes, ~s existing capacity sufficient to handle projected demand? ~Yes -~No 12 Will the proposed action result in the generation of traffic significantly above present levels? ~Yes [~No a. If yes. ~s the existing road network adequate to handle the additional traffic? ~Yes E~No D. Informational Details Attach any additional information as may be needed to clarify your proiect. If there are or may be any adverse ~mpacts associated with your proposal, please discuss such impacts and the measures which you propose to m~tigate or avoid them E. Verification I certify that the information prowded above ~s true to the best ot my knowledge. ~ppucant, bpon>or ,'~ ame Date Signature Title If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 Part 2--PROJECT IMPACTS AND THEIR MAGNITUDE Responsibility of Lead Agency General Information ~Read Carefully) · in completing the form the rewewer should be guided by the question: Have my responses and determinations been reasonable.~ The rewewer ~s not expected to be an expert environmental analyst. · Identifying that an ~mpact will be potentially large [column 2/ does not mean that ~t is also necessarily significant. .&nv large impact must be evaluated in PART 3 to determine significance. [dent~rwng an ~mpact ~n column 2 simply asks that it be looked at further. · The Examples prowded are to assist the rewewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific prolect or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. · The ~mpacts of each proiect, on each site. m each locality, will vary. Therefore. the examples are illustrative and have been offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to answer each question. · The number of examples per question does not indicate the ~mportance of each question. · In identifying impacts, consider long term. short term and cum[atwe effects. Instructions (Read carefully) a. Answer each of the 19 questions m PART 2 .&nswer Yes ~f there w. II be any ~mpact. b. Maybe answers should be considered as Yes answers. c If answering Yes to a question then check the appropriate box [column 1 or 21 to indicate the potential size of the *mpact. If impact threshold equals or exceeds any example provided, check column 2. l i: impact w~ll occur but threshold ~s lower than example, check column 1. d If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. if a potentially large impact checked in column 2 can be mitigated bv change(s) in the prolect to a small to moderate impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This must be explained m Part 3. IMPACT ON LAND 1 Will the proposed action result in a physical change to the prolect site~ ~NO ~,YES Examples that would apply to column 2 · Any construcuon on slopes of 15% or greater. [15 foot r~se per ~100 foot of length), or where the general slopes m the prolect area exceed 10%. · ConstrucUon on land where the depth to the water table is less than 3 feet. · Construction ot paved parking area for 1,000 or more vehicles. · Cons[ruction on land where bedrock is exposed or generally within 3 feet of ex~sting ground surface. · Construction that wdl continue for more than 1 year or involve more than one phase or stage. · Excavation for mining purposes that would remove more than 1,000 tons of natural material (i.e.. rock or soil) per year. · Construction or expansion of a sanitary landfill. · Construction in a designated floodway. · Other ~mpacts 2 Will there be an effect to any unique or unusual land forms found on the site? (i.e., cliffs, dunes, geolosical formations, etc.)l~NO [qYES · Specific [and forms: 6 I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change ~ -~ []Yes FqNo L~ [] [~Yes ~]No ~ [] [-]Yes [-'1No [] [] []Yes [-~No [] ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~tes ~No ~ ~ ~ Yes ~ No ~ ~ ~Yes ~No ~ ~ ~Yes IMPACT ON WATER 3 Will proposed acuon affect any water bodv designated as protected? I Under Article) 15, 24.25 pt the Enwronmental Conservauon Law, ECLI []NO ~YES Examples that would apply to column 2 · Developable area of s,te contains a protected water body. · Dredging more than 100 cubic yards of material from channel of a protected stream. · Extension of utility distribution facilities through a protected water body. · Construcuon in a designated freshwater or t~dal wetland. · Other ~mpacts: 4 Will proposed action affect an,/ non-protected existing or new body of waters ~_NO ~YES IExamples that would apply to column 2 · ^ 10% increase or decrease m the surface area of any body of water or more than a 10 acre increase or decrease · Construcuon or a body of water that exceeds 10 acres of surface area. · Other ~mpacts: 5 Will Proposed AcUon affect surface or groundwater quality or quantity? E~NO []YES Examples that would apply to column 2 · Proposed Action wdl require a discharge permit. · Proposed Action requires use pi a source of water that does not have approval to serve proposed (proiect) action. · Proposed Action requires water supply from wells with greater than 45 gallons per minute pumping capac~tv. · Construction or operation causing any contamination of a water supply system · Proposed Act[on w,ll adversely affect groundwater. · Liqu,d effluent wdl be conveyed off the site to facilities which presently do not ex,st or have inadequate capacity. · Proposed Action would use water in excess of 20,000 gallons per day. · Proposed Action wdl likely cause s,ltation or other discharge into an ex,st,ns body of water to the extent that there will be an obvious visual contrast to natural cond,tions. · Proposed Action will require the storage of petroleum or chemical products greater than 1,100 gallons. · Proposed Action will allow res,dential uses in areas without water and/or sewer services. · Proposed .&ct~on locates commercial and/or industrial uses which may require new or expans,on of existing waste treatment and/or storage fac,Jities. · Other impacts:. 6 Will proposed action alter drainage flow or patterns, or surface ~ater runoff? ENO ~YES Examples that would apply to column 2 · Proposed Action would change flood water flows. ? I 2 [ 3 Small to Potentiat Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] ~ []Yes f"~ No [] [] [-[Yes [] [] [] Yes [] No [] [] []Yes ENo [] [3 []Yes []No ~ ,_~ E2Yes Z]No ~ E2 ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ [] ~Yes ~No ~ ~ ~Yes ~No G [] GYes GNp ~ G ~Ves ~No ~ [~ ~Yes ~No ~ G ~Yes ~No ~ E5 ~Ves ~No ~ [] ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ E2 ~Yes ~No · Proposed Action may cause substantial erosion. · Proposed Action is incompahble with ex~sting drainage patterns. · Proposed Action will allow development m a designated floodway. · Other ~mpacts: IMPACT ON AIR Will proposed action affect a~r quality? ~NO I~YES Examples that would apply to column 2 · Proposed Action wdl induce 1,000 or more vehicle trips ~n any 8~ven hour. · Proposed Action wdl result in the incineration pt more than I ton or refuse per hour. · Emission rate of total contaminants wdl exceed 5 lbs. per hour or a heat source producing more than 10 million BTU's per hour. · Proposed action wdl allow an increase m the amount of land committed to industrial use. · Proposed action wdl allow an increase m the dens~tv of industrial development within existing industrial areas. · Other impacts: IMPACT ON PLANTS AND ANIMALS Will Proposed Action affect any threatened or endangered species~ ~]NO ~YES Examples that would apply to column 2 · Reduction of one or more species listed on the New York or Federal list. using the s~te, over or near site or found on the site. · Removal of any portion or a critical or significant wildlife habitat. · ~,pphcation of pesticide or herbicide more than twice a year. other than for agricultural purposes. · Other Impacts:. 9 Will Proposed Action substantially affect non-threatened or non-endangered species? [~NO ~YES Examl~les that would apply to column 2 · Proposed Action would substantially interfere with any resident or migratory fish, shellfish or wildlife species. · Proposed Action requires the removaJ of more than 10 acres of mature forest (over 100 vears of age) or other locally important vegetation IMPACT ON AGRICULTURAL LAND RESOURCES 10 Will the Proposed Action affect agricultural land resources? ,~NO ~YES Examples that would apply to column 2 · The proposed action would sever, cross or limit access to agricultural land (includes cropland, hayfields, pasture, vineyard, orchard, etc.) 8 I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] ,~ ©Yes ~]No [] ~. [~Yes E~No [] ~ I-]Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No · Con~rructlon activity would exca,,ate or compact the soil profile of dgrlcultural land · The proposed action would irreversibly convert more than 10 acres pt agricultural land or if located ~n an Agncultuta] District. more than 2 5 acres or agrmultural land. · Tile propoCed action would d~srupt or prevent installation or agricultural land management systems le 8.. ~ubsurface dram hnes. outlet ditches. ~trlp croppings: or create a need lot ~uch measures [e ~. cause a farm t~eld to dram poorly due to increased runoff) · Other ~mpacts IMPACT ON AESTHETIC RESOURCES 11 Wdl proposed acuon affect aesthetic resources~ _NO ~-YES ~lr necessary, use the \~sual E-~F ,\ddenqum m ~ecr~on b1721. ,\ppend~x B '1 [~amples that would apply to column 2 · Proposed [and uses, or prolect components obwouslv ddferent from or m sharp contrast to current surrounding land use patterns, whether man-made or natural · Proposed land uses, or prolect components ws~ble to users of aestheuc resources whmh wdl ehm~nate or s~gnfficantlv reduce their enloyment pt the aesthetic qualities of that resource. · Prolect components that wdl result ~n the elimination or s[gmficant screemng of scemc wews known to be important to the area. · Other ~mpacts: IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES i2 Will Proposed ~CtlOn impact any site or structure or Mstonc. pre- historic or paleontological ~mportance? L~NO ~YES £~amples that would apply to column 2 · Proposed Action occurring wholly or partially w~thin or substantially cont~uous to any facd~tv or s~te hsted on the State or National Register · Any ~mpact to an archaeological s~te or fossil bed located w~thin the archaeological s~tes on the NYS Site Inventory · Other ~mpacts IMPACT ON OPEN SPACE AND RECREATION 13 Will Proposed Action affect the quantity or quality of ex~st~ng or future open spaces or recreational opportumties? Examples that would apply to column 2 _~NO ~YES · A malor reduction of an open space important to the community. · Other ~mpacts' I 2 Small to Potential Moderate Large Impact Impact 3 Can Impact Be Mitigated By Project Change ~Yes ~No --]Yes L~,No ~'res ~.No ~Yes ~No ~'(es ~No [~Yes ,rmNo [~Yes [--rNo F-lYes E~No ~Yes ~No I~Yes [~]No ~Yes ~No [~Yes I~No ~Yes [--]No ~Yes [~No 9 IMPACT ON TRANSPORTATION 14 Wdl there be an effect to ex.sting transportation ~?stems? -~NO [~YES Examples that would apply to column 2 · Mteration of present patterns of movement pt people and/or goods. · Proposed Action wd[ result in malor traffic problems. · Other ~mpacts: IMPACT ON ENERGY 15 Wiil proposed action affect the commumty's sources pi: fuel or energy supply? ~NO [~YES Examples that would apply to column 2 · Proposed Action will cause a greater than 5% increase in the use of any form or energy m the mumc)pality · Proposed Action will require the creation or extension or an energy transmission or supply system to serve more than 50 stogie or two family residences or to serve a major commercial or mdust~ia] use. · Other ~mpacts: NOISE AND ODOR IMPACTS 16 Will there be obiectionable odors, noise, or wbrat~on as a result of the Proposed Action? [~NO EYES Examples that would apply to column 2 · Blasting w~thin 1.$00 feet pt a hospital, school o~ other sens.tive facility. · Odors wd[ occur routinely (more than one hour per day). · Proposed Action wd[ produce operating noise exceeding the local ambient no~se levels for noise outside of structures. · Proposed Action wdl remove natural barriers that would act as a noise screen· · Other u'npacts: IMPACT ON PUBLIC HEALTH 17 Will Proposed Action affect public health and safety? E]NO ~YES Examples that would apply to column 2 · Proposed Action may cause a risk of explosion or release of hazardous substances (i.e. o~l, pestmides, chemicals, radiauon, etc.) in the event of accident or upset conditions, or there may be a chronic Iow level discharge or emission. · Proposed Action may result in the burial of "hazardous wastes·' in any form (i e. toxic, poisonous, highly reactwe, radioactive, irritating, mtectlous etc.) · Storage facilities for one m~llion or more gaJJons of hquified natural gas or other flammable liquids. · Proposed action may resuJt in the excavation or or, her disturbance · ,t~:n ' ~",q ;~et of ~ -t '_.red for the disposal : !:~: ~, :,azardous waste. · Other impacts: 10 I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By impact Impact Project Change L~ ~ [~Yes []No ~ ~ E3Yes []No [] ~ [~Yes [~No ~ [] ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes GNp ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~N0 ~ ~ ~Yes ~No IMPACT ON GROWTH AND CHARACTER OF COMMUNITY OR NEIGHBORHOOD 18 Wdl proposed action affect the character of the ex,sting commumtv? _--NO EYES Examples that ~ould apply to column 2 · The permanent population of the c~ty, town or w[lage ~n which the prolect ~s located ~s likely to grow by more than 5°,/o · The mumc~pal budget tor capital expenditures or operating services will increase by more than 5*,/* per year as a result of this prolect. · Proposed action wd[ contiict w~th officially adopted plans or goals. · Proposed action wd] cause a change m the dens~tv of land use. · Proposed ,Action wdl replace or eliminate existing facilities, structures or areas of h~stonc importance to the commumtv · Development wdl create a demand for additional community services (e 8. schools, pohce and fire, etc. I · Proposed ?,CtlOn wdl ~et an important precedent for ruture prolects. · Proposed Action wdl create or ehmlnate employment · ()that ~m0act) I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [3 [] [3yes ~o [~ [] ~]Yes [3No [] [] []Yes l-~No [] [] 13Yes C]No [3 ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Y~s ~No ~ ~ ~Yes ~No 19 Is there, or is there likely to be. public controversy related to potential adverse enwronmental ~mpacts~ ~NO EYES If Any Action in Part 2 Is Identified as a Potential Large Impact or If You Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3--EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact ~dentified in Column 2 of Part 2: 1 Briefly describe the ~mpact. 2 Describe (u: applicable) how the impact could be mmgated or reduced to a small to moderate impact bv prolect change{s). 3 Based on the information available, decide if it is reasonable to conclude that this impact ~s important. To answer the question of importance, consider: · The probability of the impact occurring · The duration of the impact · Its ~rrevers~bilitv, including permanently lost resources of value · Whether the impact can or wiU be controlled · The regional consequence pt the ~mpact · its potential divergence from local needs and goals · Whether known objections to the prolect relate to this impact. I'F'ofltlnue on attachments) 11 LOCATION OF ACTION: i. Great Peconic Bay Blvd. at Birch Drive. 2. Great Peconic Bay Blvd. across from Town Beach (e/o Sigsbee Road}. 3. South end of Sigsbee Road. 4. East end of Old Salt Road. 5. East end of Rochelle Place. 6. 8ay Avenue m 250' north of Bartley Road. PROJECT DESCRIPTION ~he purpose of this project is to install water main in the Laurel area o provide domestic water and fire protection for public use. The new main will be installed in the asphalt traveled way of Great Peconic Bay Boulevard, Sigsbee Road, Old Salt Road. Rochelle Place and Bay Avenue, approximate)y 4 feet from the grass edge. The trench will be approximatel? J'-O" wide and 4'-?" deep. ~ll excavateO material, sand and loam, will De piaceo on the asphalt traveled way. A hay bale and silt screen barrier will be installed as shown on the attacheO erawings prior to any construction. In the event groundwater is encountered, a trench pump with a capacity of no more than 30 gallons per minute will be used. The water will be pumped behind hay bale and silt screen barrier to eliminate infiltration of sediment into stream water. A Water Authority inspector will be present at all times to oversee the installation of the water main and that all specifications are adhereO to. Also, if rain should occur, all work will cease. All trenches will be backfilled, stabilized and returned to their original condition. Excess fill will be removed from site anU disposed of in a legal manner. TRUSTEES John M. Brederneyer. IlL President Albert J. Krupski. Jr.. Vice President Henry P. Smith John B. Tuthill William G. Albertson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD 30 year Ma±ntenance Agreement Erosion Protection Structures Chapter 37 Southold Town Code Southold Trustees as Administrator I (we) the owners of type or print na~e(s) record of property at: SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road Ed. Box 1179 Southold. New York 11971 (type or print s~reet addressl SCTM $1000- in applying for a Coastal Erosion permit for an Erosion Protection Structure do hereby agree ~o a 30 year maintenance program for a structure commonly known as a of 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. Notarized Signature of owner of record SWORN TO BEFORE ME THIS DAY OF ,19 NOTARY PUBLIC Please submit three copies of a licensed land survey made within one year of the original construction. This maintenance agreement shall only be valid upon the final approval of the adminisurator. Subsequent owners may apply to the Southold Town Trustees to re-authorize this maintenance agreement. SUFFOLK COUNTY WATB AUTHORITY Od~XDaal, IL Y. ~ I-1 ~LAIN INSTALI, ATiON I"] HYDRANT INSTALLATION AUTHOIIZAI'IONI ONly N.Y. ~:ele N.o.~ ~_ CempleM Drawn By ~..~ t~ Plant Fl~ld I~mp. Sh~t of ImpM:ted By _ Auth. COUNTY OF SUFFC~t.K ~c.~ce $OUTHOLD Properly Tax Service Agency pf.GOtgG COUNTY OF SUFFOLK ~o.~. $OUTHOLD I ~ -, , t3 ,0 ~3 C, ,// t3 .............. ::'~ ........ ' .......................... !t 'F I/ E:! ~3 £1 /' C1 I.'? l:2 [_2 Cl l:71 ,' U C] o l:1 / < ['.2 I.:1 t::l .... CI /l:l '7:/ / l.:l /:' L'] ii El / ! , ! '; / ~'7 /// /L7 L:~ /// ' I.:.I //:/ ' ./ [..7. ~;~ ,/!~0// C-~1 ........................... ~._~ ........ :::=": ...... "~;: ........ m. ~, ~;. .................. .................... ...,, ~"~ :'~ ~:.~ [:] ~ [1 ,'1'°1 / _:.: ;..., /: C, /I [7/ U / / !.2. LAureL/I,,,1A, TT~TO ~1<' ::'l LOT' I'~'~'~J~=--~T· SUFFOLK COUNTY WATER AUTHORITY oAKDAL~, N. Y. :::::::::::::7:::::::::::::::::::::::::::::::::::::::::::::::::::::: ;:::: ~ :;~;~.,, ~"~;, REFEREncE ~ ~IN INsTALLATIoN INsTALLATI():j AUrH~iZAri~S E] ;~'r'DRA~4~ ONLY ::::::::::::::::::::::::::::: PI, Y, ..............................Mop Ref, No. Cor, tract,,? ' Field Prep. Sheet ~'