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HomeMy WebLinkAboutTR-4238 Glenn Goldsmith,President ®� SO Town Hall Annex �0� ®�® 54375 Route 25 A. Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® a® Fax(631) 765-6641 UNTV,��° BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 20, 2023 Robert Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: RONI JACOBSON & DAVID FELDMAN 4680 WUNNEWETA ROAD, CUTCHOGUE SCTM# 1000-111-14-36.6 Dear Mr. Herrmann: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 19, 2023: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#4238 from Helen & Robert Rust to Roni Jacobson and David Feldman, as issued on October 1, 1993 and Amended on May 22, 1996, and Amended again on February 19, 1997. 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. 4iereIy, Glenn Goldsmith, President Board of Trustees /Goldsmith,President y �� G -town Hall Annex O G gas Krupski,Vice President y� 54375 Route 25 CO Eric Sepenoski »z P.O.Box 1179 Liz Gillooly Gy • O!NV Southold,NY 11971 Elizabeth Peeples �Ol �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report --II Date/Time: /10/73 Completed in field by: % En-Consultants on behalf of RONI JACOBSON & DAVID FELDMAN requests a Transfer of Wetland Permit #4238 from Helen & Robert Rust to Roni Jacobson and David Feldman, as issued on October 1, 1993 and Amended on May 22, 1996, and Amended again on February 19, 1997. Located: 4680 Wunneweta Road, Cutchogue. SCTM#: 1000-111-14-36.6 Typ of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: V Chapt.275 Chapt. 111 other Typp of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No V- Not Applicable Info needed/Modifications/Conditions/Etc.: \ Present Were: G. Goldsmith V N. Krupskt E. Sepenoski L. Gillooly E. Peeples EN-CONSULTANTS PERMIT TRANSFER REQUEST Town of Southold Board of Trustees Post Office Box 1179 Southold,New York 11971 Attn.: Elizabeth Cantrell Re: Wetland Permit#4238 4680 Wunneweta Road, Cutchogue SCTM#1000-11-14-36.6 Dear Board of Trustees: Please accept this letter as a request to transfer Permit#4238 from Helen&Robert Rust to the current owners, Roni Jacobson and David Feldman, whose address is 175 West 73`d Street,Apt. 2JK,New York, NY 10023. An Application for Transfer of Permit, transfer fee of$50, and a copy of the deed are attached. Sincer y, Robe errmann Coastal Management Specialist /khs APR - 7 2023 , 1319 North Sea Road Southampton,New York 11968 p 631.283.6360 f 631.283.6136 www.enconsultants.com environmental consulting Michael J.Domino,President Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski Telephone (631) 765-1892 Greg Williams d Fax (631) 765-6641 evutM BOARD OF TOWN TRUSTEES APR - 7 2023 TOWN OF SOUTHOLD r. APPLICATION FOR A TRANSFER OF A WETLAND PERMIT and COASTAL EROSION MANAGEMENT PERMIT DATE March 1, 2022 OWNER Roni Jacobson & David Feldman PHONE 917-386-5983 MAILING ADDRESS 175 West 73rd Street, Apt. 2JK, New York, NY 10023 AGENT En-Consultants PHONE 631-283-6360 ADDRESS 1319 North Sea Road, Southampton, NY 11968 PROPERTY LOCATION 4680 Wunneweta Road, Cutchogue — TAX MAP NO. 1000-11-14-36.6 I/We-En-Consultants for Roni Jacobson & David Feldman request a Transfer of Permit 44238 from Robert& Helen Rust Signed By: Robert E. He\4ann, Coastal Management Specialist APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Toam of Southold's Code of Ethics prohibits conflicts of interest on the hart of towniifHcers and employees.The pyoose o this form is to provide infornmafion which can alert the town_ of ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Jacobson,Roni (Last name,first name,Middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X 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,parcnl or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,remarriage,or business interest"Business interest"mearisa business; including a partnership,in which the town officer or,employee has even a partial ownership of(or employment by)a corporaiion in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agcnt/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a-corporation); B)the legal of tenefidial'oVmer of any interest in a non-corporate entity(when the applicant is_n-ota corporation); C)an officer,director,partner,or erimgloyee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this e of 20_,,,! Signature Print Name_ 4Tacobson Form TS 1 .:.>ard of Trustees Applicatio__---' AFFIDAVIT Roni Jacobson BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS,REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. N/A Si ature of Property Owner Signature of Property Owner Roni Jacobson SWORN TO BEFORE ME THIS 2-1 s� DAY OF M AV-CkA , 20 23 Notary Public KENDAL JAIMAL FISHER Notary Public-State of New York NO.01 F16420592 Qualified in New York County My Commission Expires Aug 9,2025 _ward of Trustees Applicatic ._ ' AUTHORIZATION (Where the applicant is not the owner) I/We, Roni Jacobson owners of the property identified as SCTM# 1000-. 111-14-36.6 in the town of Southold ,_New York, hereby authorizes En-Consultants to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. N/A Property Owner's Signature Property Owner's Signature Roni Jacobson SWORN TO BEFORE ME THIS Z-I SF DAY OF Mav-0i , 20 2 _ Notary Public KENDAL JAIMAL FISHER Notary Public-state of New York N0.01 F16420592 Qualified in New York county My commission Expires Aug 9,2025 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Solithold's Code of Ethics prohibits conflicts of interest on the Rart.of town officers and employees.Digp—R Aose of this form is to provide inforniation which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: Feldman, David (Last name,first name,giiddle 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 relationshipavith any officer or employee of the Town of Southold? "Relationship''includes by blood,niarriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation. in which the town officer or employee owns more than 50/c f the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)die owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(wheat 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 of 20_ Signature Print Name David Feldman Form TS 1 ], - ,rd of Trustees Applicatic, AFFIDAVIT David Feldman BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 4 N/A Signature of Pr6perty Owner Signature of Property Owner David Feldman ti SWORN TO BEFORE ME THIS DAY OF a °�� , 20 Z Notary Public Notary Public,state off N w York No.02BE6119787 commisQuasion Exfied in pires Co n 20 t Pi Lrd of Trustees Applicatic AUTHORIZATION (Where the applicant is not the owner) I/We, David Feldman owners of the property identified as SCTM# 1000- 1000-111-14-36.6 in the town of Southold New York, hereby authorizes En-Consultants to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. N/A Property OwnerISlinature Property Owner's Signature David Feldman SWORN TO BEFORE ME THIS �- DAY OF , 20 Z3 Notary Public FRD Notary Public,staY . te o®New York No.02BE6119787 Commission Expires 12 06 20 i IIIIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII IIIIIII IIIII IIIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 4/22/2020 Number of Pages: 4 At: 9,:32:.00 PM Receipt Number: 20-0063697 *ELECTRONICALLY RECORDED* Transfer Tax Number: 19-27570 LIBER: D00013056 PAGE: 514 District: Section: Block: Lot: 1000 111.00 14.00 036.006 EXAMINED AND CHARGED AS FOLLOWS Deed Amount $2,137,500.00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20.00 NO Handling $20.00 NO COE $5.00 NO NYS SRCHG $15.00 NO Notation $0.00 NO Cert.Copies $0.00 NO RPT $200.00 NO Mansion Tax $0.00 NO EA-CTY $5.00 NO EA-STATE $125.00 NO TP-584 $5.00 NO Comm.Pres $39,750.00 NO Transfer Tax $0.00 NO Transfer Tax Number: 19-27570 Fees Paid $40,145.00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL Judith A. Pascale County Clerk, Suffolk County RECORDED Number of pages 4 4, r2020 9:32:12 PM JDITH. A_ PASCALE CLERK OF This document will be public SUFFOLK COUNTY record. Please remove.all L D00013056 Social Security Numbers P 514 prior to recording. 19-27570 Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording I Filing Stamps . 31 FEES Page/Filing Fee 20.00 Mortgage Amt. 1. Basic Tax _ Handling �• 00 2. Additional Tax _ TP-584 5.00 Sub Total Notation 0.00 SpecJAssit. or EA-52 17(County) 5.00 Sub Total 50.00 Spec.JAdd. — EA-5217(State) 125.00 TOT.MTG.TAX — RP.T.S.A. 200.00 Dual Town Dual County— Held for Appointment Comm.of Ed. 5• 00 - Transfer Tax 0.00 — ' Mansion Tax 0.00 Affidavit � — •v The property covered by this mortgage is Certified Copy 0.00 or will be improved by a one or two NYS Surcharge 15. 00 345.00 family dwelling only. Sub Total YES of NO Other 395.00 Grand Total If NO,see appropriate tax clause on page# of this instrument. 4 1 Dist. Section Block Lot 5 Community Preservation Fund Real Pro art 20013325 1000411.00-14.00-036.006 Prop arty �r s Consideration Amount$2,137,500.00 Tax Service Agency R RAK CPF Tax Due $ 39,750.00 Verification Improved x 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address, RECORD&RETURN TO: Vacant Land Fidelity National Title - Riverhead, NY TD 10 24 Commerce Drive Riverhead NY 11901 TD TD Mail to:Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffolkeounlyny.gov/clerk Title# g Suffolk Count Recording & Endorsement Page This page forms part of the attached DEM made by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of SOUTHOLD In the VILLAGE or HAMLET of BOXES 6 THRU S MUST BE TYPED.OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12-010LIN08kk (over) cOc m to P, 3o, 4-o r? BARGAINAND SALE DEED with Covenant against Grantor's Acts THIS INDENTURE,made the /r� day of October in the year 2019, BETWEEN RUST FAMILY PARTNERSHIP 1, LTD (also known as THE RUST FAMILY PARTNERSHIP 1, LTD), with an address of 1430 South Dixie Highway, Suite 315, Coral Gables,FL 33146,party of the fast part and RONI JACOBSON and DAVID FELDMAN, residing at 175 West 73`d Street,Apt 21,New York,NY 10023,party of the second part. WITNESSETH,that the party of the first part in consideration of ten dollars and other valuable consideration paid by the party of the second part, does.hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part,forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected,situate, lying and being in the (see attached schedule"A"). BEING AND INTENDED TO BE THE SAME PREMISES CONVEYED TO THE PARTY OF THE FIRST PART AND DESCRIBED IN A DEED MADE BY HELEN RUST FAMILY PARTNERSHIP DATED 18t6 DAY OF NOVEMBER, 2003,AND RECORDED 213'DAY OF.NOVEMBER,2003, IN LEBER D00012285, PAGE 315,AT THE OFFICE OF THE COUNTY CLERK, COUNTY OF SUFFOLK, STATE OF NEW YORK. TOGETHER with all right,title and interest,if any,of the party of the first part of,in and to any streets and roads abutting the above described premises to the center lines thereof;TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises;TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants.that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatsoever,except as aforesaid. AND,the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the parry of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. FIDELITY NATIONAL TITLE INSURANCE COMPANY TITLE NO. 7404-006671 SCHEDULE A (Description of the Land) For Tax Map ID(s): 1000-111.00-14.00-036.006 ALL that certain plot, piece or parcel of land, situate, lying and being at Cutchogue, in the Town of Southold, County of Suffolk and State of New York,more particularly bounded and described as follows: BEGINNING at a monument on the Southwesterly side of Wunneweta Road at the Northerly comer of Lot 221 as designated on the Amended.Map A of Nassau Point as filed in the Suffolk County Clerk's Office as Map No. 156 being the Northerly comer of the premises about to be described; RUNNING THENCE along the Southwesterly side of Wunneweta Road,the following three(3)courses and distances: 1. On a tie line South 52 degrees 24 minutes 20 seconds East, 97.49 feet; 2. On a tie line South 68 degrees 00 minutes 20 seconds East, 177.63 feet;and ' 3. On a tie line South 71 degrees 12 minutes 15 seconds East, 10.0 feet to a point; THENCE through other land of the party of the first part,the following two(2)courses and distances: 1. South 66 degrees 51 minutes 10 seconds West 224.29 feet; and 2. South 81 degrees 01 minute 50 seconds West 140.00 feet to a wood bulkhead and the ordinary high water mark of Wunneweta Pond; THENCE along a wood bulkhead and the ordinary high water mark of Wunneweta Pond the following two(2)courses and distances: 1. North 08 degrees 55 minutes 50 seconds West 91.35 feet;and 2: North 42 degrees 29 minutes 15 seconds West,28.16 feet to the Westerly corner of the premises being described herein; THENCE North 44 degrees 34 minutes 20 seconds East 179.97 feet to a monument on the Southwesterly side of Wunneweta Road and the point or place of BEGINNING. END OF SCHEDULE A The word "party" shall be construed as if it read "parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. Signed, sealed and delivered in the presence of. Seller; RUST FAMILY PARTNERSHIP I,LTD Print name: tt�� , a Florida limited partnership, by its sole general partner: RUST FAMILY ENTERPRISES,LLC a Florida limited liability company, Print name:LOUA by its sole member: 2�E�� A " 3144- Randall D.Rust STATE OF FLORIDA ) ss: COUNTY OF LEON ) On the ((7` day of October, 2019, before me, the undersigned, personally appeared RANDALL D.RUST,personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to .me that he/she/they executed the same in his/her/their capacity(its), that by his/her/their signatpre(s) on the instrument, the individual(s) acted, executed the instrument before notary in Leon County and State of Florida. Notary stamp/official seal: Notary Pub ' ( ' a as commissioned) $hu,�rc� PrQs-kn SHANICE PRESTON Commis W#GG 227025 - y Expka ho 1T,2rd •�'•P:!,'�c'' BonordThru7MrFftnMnur�ceE00SE�101i Michael J.Domino,President OF SOUT Town Hall Annex John M. Bredemeyer III,Vice-President O 54375 Route 25 O P.O. Box 1179 Glenn Goldsmith lx[ [ Southold,New York 11971 A. Nicholas Krupski G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 olyCOU�`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1613C Date: August 27, 2019 THIS CERTIFIES that the existing 104' of timber bulkhead; construction of additional 120' of bulkhead 5 1/2'x50'walkway 131' walkway with 13'x32' deck an 8'x24' float with a 3'x16' ramp, a 6'x30' float with a 3'x8' ramp a 6'x40' fixed dock,with a 5'x6' attached lower platform,with the addition of a 12'x24' boat ramp; At 200 BUberiy Road 4680 Wunneweta Road, Cutchogue Suffolk County Tax Map#1000-111-14-36.6&36.7 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 27, 1993 pursuant to which Trustees Wetland Permit#4238 Dated October 1, 1993,was issued and Amended on May 22, 1996 and Amended again on February 21, 1997 and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the existing 104' of timber bulkhead; construction of additional 120' of bulkhead, 5 Wx50'walkway, 13 V walkway with 13'x32' deck, an 8'x24' float with a 3'xl6' ramp a 6'x30' float with a 3'x8' ramp a 6'x40' fixed dock, with a 5'x6' attached lower platform, with the addition of a 12'x24' boat ramp. The certificate is issued to Helen&Robert Rust owners of the aforesaid property. Authorized Signature Michael J.Domino,President �'�'rjf SOUT Town Hall Annex 25 John M. Bredemeyer III,Vice-President �� l0 P.O. Route P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski • Telephone(631) 765-1892 Greg Williams yCOU Y Fax(631) 765-6641 � NT`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Vdo�`I Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: Kcfsk. COMMENTS: - �Ueedl Flew pew of w f- ,s 4ar� l - 4te .}a cQ,,,¢ link dl- yPP-t y✓al I v,J SO-6 F'(T s rd¢, dlsv to sLpW 4.-sA 5fatow. W gMdnw f. :w fIi t s.L Ok. /' a7 — y: 1.sSue or A� �� c. c9 M 1� vinn� . CERTIFICATE OF COMPLIANCE: Michael A. Kimack ATTORNEY AT LAW P.O. Box 1047 Southold, N.Y.11971 Cell No. 516-658-6807 E-mail: mkimack2@yeriZpn.net August 25, 2019 Re: Permit No. 4238 200 Bayberry Road: SCTM 111-14-36.7 4680 Wunneweta Rd. SCTM 111-14-36.6 To: Southold Town Trustees: On August 20, 2019, an on site compliance inspection ( see attached) was conducted by Nick Krupski, Trustee for the purpose of determining whether the structures are in conformance with the issued permit with amendments. Mr. Krupski found that an upper retaining wall and 8' x 27' timber walkway had not been installed. That structure is not intended to be constructed. In addition, a fishing station was present which had not been previously approved. The fishing station has been removed ( see attached photo). The as built structures are now in conformance with permit No. 4238 w/amendments . The project is now complete and I respectfully request a compliance certificate at your earliest convenience Sincerely. e. Michael A. Kimack, Esq. �= ' AUG 2 201� �_ Se1001,l Town Boar of Trustees _ i p i I j OF i ' i f�v 1 / L �If� g-,/Yluj- w� 4v lk G�SS s x 33 SX33 as k�J BRAWN NN I MCO NU I DATE AUCU51'2019 1 DR4W I@ k JOB W 19-0155 Wun newetUNAUTHORIZED ALTERATION OR ADDITION THE EXISTENCE OF RIGHTS OF WAY /1 TO THIS SURVEY IS A VIOLATION OF AND/OR EASEMENTS OF RECORD IF �/y/o SECTION 7209 OF THE NEW YORK STATE ANY, NOT SHOWN ARE NOT EDUCATION LAW GUARANTEED coley SJ�. COPIES OF THIS SURVEY MAP NOT BEARING LOT baSq �Z, EMBOS SED ED SEAL SHALL INKED OT BSEAL DERED AME DED MAP REFER T THE OR OF NASSAU POINT r"�.$�'Sryf FILED AUGUST 16, 1922 AS FILE NO 156 �'+c TO BE A VALID TRUE COPY Curb GUARANTEES INDICATED HEREON SHALL RUN Premises known as 29 f ONLY TO THE PERSON FOR WHOM THE SURVEY st '0095 IS PREPARED, AND ON HIS BEHALF TO THE 200 Bayberry Road, Cutchogue f re��"m9 "�'Ir /�,�j,04 TITLE COMPANY, GOVERNMENTAL AGENCY AND `or LEDING INSTITUTION LISTED HEREON,AND aF TO THE ASSIGNEES OF THE LENDING INSTI— rea n = 47,952 s.f. "� F,� O TUTION GUARANTEES ARE NOT TRANSFERABLE rl G S�oKoV� so 11ry FO n pC� PI30 � S 0 — s P� �66 O osd „ae 40Lor uo .• rn wP� - � 8 pYYe�� m N+flaLv � � m�79 © a L,?3 t Na1'01'S0"� �w �. re�lt Koine 55 sa°kW� H ^� obek°9 ramp 1 it RS de e � 712 c AIC ' o` �spbaR 1 ramp ' w,y�� 5 dmrexay /Cyr q�p ozv'e�� j ��V QQ(p PISa OF'on 2t9 YJ h c�i b aow urr= '4Q"Vl dram � V'�e 1\b00 q R' /aG.J I? screened steps 'S I Slotyg deck 119' aeA 1ga.89 conf>1tst00e wrb Fran I75N stied m r1� u46ty Survey of Described Property R d �vase e � �°• �' & oa ati�ti° Bayberry situate Ot c Found Found Pµr OF LOT 218 Cutchogue °yf N6j. ldanument — }lanam� a.21�•L°"w °+e 3-84, It' N89.38'20"W 80j6 s� Town of Southold 60.00' wu=" 01fow-<LWE "UIZ Michael W. Min to, L.S.P.C. Suffolk County, New York PART OF LOT 219 LICENSED PROFESSIONAL LAND SURVEYOR NEW YORK STATE LICENSE NUMBER 050871 District 1000 Section 111 Block 14 Lot 36.7 87 Woodview Lane Scale 1"= 40' Surveyed August 21, 2019 Centereach, N.Y. 11720 PHONE FAX: (631) Certified to: �r" 580-1202 GRAPHIC SCALE � / KEVIN JAMES MODICA AND MELISSA CATENA MODICA f• 1 CELLULAR: (631) 766-9714 1 a zo .a e1 W TRADITION TITLE AGENCY(TRAD 19-6740) / ">'- •r EMAIL: rnikemintolspc®gmad coin WFG NATIONAL TITLE INSURANCE COMPANY ( IN FEET ) 1 mch = 40 ft 3 i a) -'•;.. ��1. ji :ra ,. u✓/ ti ♦ - � � .. ,rr !i .�1�' +s>+_K�.a."in"'Gam:�'�"e:• x.7Ya�''A'r '•.1,.��p+t+' .���y�br -'i'"'�"�"'�^pmss.,Y'4M / 1 Board Of Southold Town Trustees SOUTHOLD, NEW YORK C � PERMIT NO. ..42.3.8..._ _ _... DATE: ..Q.ctober...1,._.1993 ` ISSUED TO .........Helen....& Robert. Rust . ._.. ... ...... .. .tt Pursuant to the provisions-of Chapter 615 of the Laws of , `J 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- . 3' titled REGULATING AND THE PLACING OF OBSTRUCTIONS �r I' IN AND ON TOWN WATERS AND PUBLIC LANDS and the i l REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM 1 " LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on Sept. 100.00 19 ..9.3.., and in consideration of the sum of $... -_ paid by .Coste11o.,Mar ne,_on._behalf of Helen & Robert Rust ....... N. Y. and subject to the a Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Grandfather permit to replace approx. 104` of existingimber ' ? ` bulkhead inkindlinplace and to back£ill with 20 c.fir. of clean fill. 1 „ all in accordance with the detailed specifications as presented in j the originating application. ` IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to iJ be subscribed by a majorit of th aid Board as of this date. � Ln S Trustees i YID A , A �, A r.. cgs YS A • A >3 Albert J. Krupski,President ,may, y Town Hall John Holzapfel, Vice President o= 53095 Main Road Jim King P.O.Box 1179 Martin H. Garrell Southold,New York 11971 Peter Wenzel TelephoneTelephone(516)765-1892 Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 21, 1997 Costello Marine Contracting P.O. Box 2124 Greenport, NY 1,1944 RE: Helen Rust SCTM #111-14-34 Dear Mr. Costello: The following action was taken by the Southold Town Board of Trustees on Wednesday, February 19, 1997: RESOLVED that the Southold Town Board of Trustees. grants an Amendment to permit #4238 to add a 1.2' X 24' Boat ramp to be reconstructed and an upper retaining wall, including a 81 X 27' timber walkway between the upper retaining wall and lower bulkhead.. The Board suggests that a 15 ' buffer be placed behind the bulkhead. This is not an approval from any other agency. If you have any further questions, please do not hesitate to contact this office. Sincerely, Albert J. President, Board of Trustees AJK:jmd COSTELLO MA1112"INE CONTRACTING CORPORATION DOCK BUILDING•JETTIES ® BULKHEADING•STEEL & WOOD PILING • FLOATS 423 FIFTH STREET,P.O. BOX 2124 • GREENIPORT, NEW YORK 11944 (516)477-1199/4-77-1393/477-0682 February 10, 1997 Albert J. Krupski, Jr. , President Board of Trustees P.O. Box 1179 Southold, NY 11971 Re: Helen & Robert Rust SCTM #1000-111-14-34 Permit #4238 Dear Mr. Krupski: Enclosed please find copy of project plans that were approved by the Board of Trustees at the regular meeting, of May 22 , 1996. Please note that the 121 x 24' boatramp and' 27' of upper retaining wall was excluded from the description when we submitted our amendment to include all structures on the property. As a result, we are requesting an amendment to reconstruct the boatramp and upper retaining wall. I am enclosing photographs which hopefully will eliminate the need for your Board to make an on-site inspection. Also enclosed is the application fee in the amount of $40. 00. I 1 trust you will find the above information and my enclosures satisfactory to issue the amendment as applied for. Thank you for your time and consideration.' Very truly yours, Susan E. Loner g Permit Manager Enc. J fJA53AU i n 3k SAV plavD 4dVNNt3G! -7'A PDtNT ReWecr n Winn x 401 A ftwo X 6�ry 1`Uf9lX G�l*Q7'T.rx/ �Ur�F4L CL0l1rSr7Yt1T44� o ibo eac a Eamy ,/.ocso PIr fir. L�r✓�. /4E.5 a2al� dr NA53 tv f'o. tfacz24 6 er4 r ✓) irA�4 LlT-rLG PtGDN(C- SAY 7LaL.576-477-�'yq ��rT C Pv C fjEC6N STgU CT Q o laX qy ' 6qT RAMP fNeos ti A7/VPP" RE7Ai1v1iVc ALC G °` 41 � —se' n �RoPoSED; SOuT4E0Lh 76WN `rRUsTFE CAE-RMIT #Y�3� To REcoHSTRUe"T la' X ALF� 136A7 lEkAMf.AN O a? U15° PP K �(ep RF-TAINENC �l 1�r�r � � GUlZ+fr�J6tlt-'"� 7T✓dt�'GY-' SCG7R�/�2'l� !-!..✓-!/V `' �._ COU,c.T)'G.G'JUr�r r^Xrt' ,ar e"r2Mq � 8 � -SANVARY ao, (777 I t td} . � L(Z65SUl �1!l1 Bof�,T1z/� N1P, UPPED. R-ETA#NI NC WALL. 6� : .• AND L1111J � I2 BrsLIzHEAh A (}. ep ti SCALE:( = g z, L rF ;1 REPLACE EXls'rtNC. t p /-- �UPPER ME-rAINING WALL �xtsrrrv6 $ULK HEA D = ' tAl LW 2 y ; L O 0 4i1= bT D A ' € RECatt S rRUUr xrr � r BOAT R p PREPARE)1 ) K-Y; R b P US E-D C bSTE LI-6 NIARI N E CtATR, AMEIND EJYT Td 50UTHN-D 'P, U. 130X <IIaq Tov.�NT- //a3 8-, r r 9REENPbRT, N"Y IN"O TD PLC-ON .ST?>,IJCT #.`X R� (510 BbATRAH P, IN-STALL R X a7 JMF)FR wALkWAI LANDWARi-) PREPArvEb F6P, r bF F-X#STING EUUHLA'D, -- ---_ RPCI� NStRUCT �7 ` �IPP1=tz H ELEN M, � P(APr- P-V W. INST ROTA# W N [, WALL. WUNNtWErR RnAP ` NEW YORK , SUFFM-K CmiNTy SIfF-ET -Z OF �:YANut)Rvo � 1 ROOK BUILDING m JETTIES®BULKHEADING® STEEL & WOOD PILING® FLOATS 423 FIFTH STREET, P.O. BOX 2124 * GREENPORT, NEW `IORK 11944 • (516)477-1199/477-1393/477-0682 January 16, 1997 Albert J. Krupski, Jr. , President Board of Trustees P.O. Box 1179 2 7 Southold, NY 11971 Re: Helen & Robert Rust SCTM #1000-111-14-34 Permit #4238 Dear Mr. Krupski: Enclosed please find copy of project plans that were approved by the Board of Trustees at the regular meeting of May 22 , 1996. Please note that the 12' x 24' boatramp and 27' of upper retaining wall was ,excluded from the description when we submitted our amendment to include all structures on the property. As a result, we are requesting an amendment to reconstruct the boatramp and upper retaining wall, including a 8' x 27" 'limber walkway between the upper retaining wall and lower bulkhead. I am enclosing photographs which hopefully ,will eliminate the need for your Board to make an on-site inspection. Also enclosed is the application fee in the amount of $40. 00. I trust you will find the above information and my enclosures satisfactory to issue the amendment as applied for. Thank you for your time and consideration.: Very truly ours, Susan E. Long Permit Manager Enc. PAC PA E-D 13 1�U MARtNE LEN N, RaBE2T Wt FZUST UJU NIV p,p. BoX clay b `a8 �W ETH ROAD GRIGN PaRT , NV NASS/-tU POINT � e r � h� 3a 1A15Acr U ��nou +++ 7 P i r 1� Z PAD � W UNNt�idCYp O PQ rrUT Lwn n 2 x ( UP ETA PDXO D (A A tOC47TOiC/�+y�� VICJN/TY /-;W � �"t1�M F�cG3�'J N�6s�M ,�a,��x U.rf,�Yr x,+� Sriff©�,C�ous'�Y•�v,�.g5 o �co [ca a tGmD .PoM L.l'.T LL7Y6. NA55AV Coma saes cavrr rrrv� cac� —� f' AT LtTTLB PLTGONIC- [SAY 7-&Y.37,c-477-&W a �5� 2;� hPXlsravckNe `" t�ECaNSrRUc1' -17 - k� 7 _ UPPER RETAINING WALL ANlENDMEt/7" To 56UTH6/-I) EX15TlyC TOWN TRusTCE Pr- [zMt i t ©EC15 4P `/02.5? —r'o REccsr SIRoO-T 12!X.7-q! VdbOh'rN -ROATRAI4P, TNs-MH L 9"X U " Tr M gEI�,' WAL*Ld4y '0 L-ANDWARD OF -E}X/5TING 6L441)i LiGc©NSTr2UC-f a`7' LJPPCR jZETftth(1tYC WAL/- s Al RflSSUIEVU BOAT7ZAMP, Y3Y C,� UPPER. RETAINING WALL r f ,{ AND LAwErI SrlLk- HE'-AD ScALE a 1 1� T REPL.ACP— CKiS7 iN6 e— uppEtt pETAIN/NG WALL EX[ST11v �BUL k h EA p 2 i 'fib; to RECOMS� Ruc.T n ` ',i BOAT' TRAM P Sq f PREPARED -RY; 1�Rbi�bS ED; LbsTELL6 f4AR1NE C- MTR. AgFI\ID 1EmT TO SOUTR6LD P. D. I30K a► '4 T�Ala39- EE PL [ZMi � GiZF-ENF(JRT, Ny 1/ 9 To XLCONSTRUCT I xa C510 �77 - 1199 BbATRAM P, TSTALL q x a,7 TIMBER WALkWA'\l LANDWAR17 PREPAKEI) Fb R r bF Ex1ST1N G EULkHLAD) RM NS7RUCT Z7I UPPE2 HCLEttl M. � RbPERT inl, TRUST RETAfNIf�1G WALL, WUNNtWE``A RbAb NMSSAU 'P6jNi, CUTcNosUE: NEW YORK , SUMOLK Cnw-0 SKEET ;- CE J NUAR� MI'l s •ii a • � • _as6O 30 Rsqg I �tk� lrth° II �l� �iJl� J lr y+: 5 ; 9tk 1"� I 1 sL °r1 :a9•i•r �; � — ':an',,:� ..I w...` {_{ 3 i 1 m s t.a.-�'4, �. S n'f z•a t Alp u a$ Kati s°'' /,/ n 1 r t{ 1 I �r s( `' ri F, nab 4 " � x r Y R ~�h✓: t a u _ a n - r x DUDb�� OFk�Y / F ' ATO FjXE �gSi` r' '•� ' goy r tL �4 . aaS�c6 WTI W0005 TiMBER $UL;Kf3.EAD . � Amp RAMP S w +p 1L« 1 WALii WA s . t� �•- w t-r rlda vx/5'RAMps� ZWA1�ILX WAY J be v V -Z ;1 :j Gxi-srIN� SIR0LIURrS �y , FtfZNlt-r yang tA 1 eh Q � o� � .�,• r �,° (�?Nr1M� ya38 INS �'• , � .�j � ------ -�.. n �' h t. j( ! c v i C ¢ n �r� ` n �1 �Tt r O hl C int ? . , v. c � t, tt'is �� �. '►x C, r,t to t _ �•� ,�1��q �� �a�' j j� �� �j ,j•.a l� 1 , I tp to ^� t is tt S •-t t , tv p S � s�, ut t� `✓ � t .ry , ti t rpm 1xt 5 15 �• AUTHORIZATION FORM tJll if z► �' - � p!a t?S* owner of VVI `t tv , 7,4 X t9A1° Nvrl6Ef2 Business/ roperty name located at; t9 3/f W VQ 55— f> � do herby give .Costello Marine contracting Corp. the authority to act as agent in my behalf in applying for all of the necessary permits in order for work to be done on my property described above. Sag tore _ y i i i >'I 1 { O��SpFFO(,Yco Albert J. Krupski,President ti� Gy Town Hall John Holzapfel, Vice President c �4 53095 Main Road W = P.O. Box 1179 Jim King Martin H. Garrell y �� Southold,New York 11971 Peter Wenzel ��( �a0 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ma.v 22 1996 Costello Marine Cont. Sue Long P.O. Box 2124 Greenport NY 11944 RE: HELEN & ROBERT RUST SCTM #111-14-34 The following action was taken by the Board of Trustees at their regular meeting of May 22, 1996 : RESOLVED that the Southold Town Board of Trustees. approve the request for an Amendment to Permit #4238 to add 120' of bulkhead to already existing Grandfathered bulkhead, 5 1/2' X 50 ' walkway, 131' walkway with 13' X 32' deck, an 8' X 24' float with a 3 ' X 16' ramp, a 6' X 30' float with a 3' X 8' ramp, a 6' X 40' fixed dock with a 5' X 6' attached lower platform. Located: Wunneweta Road, Nassau Point, Cutchogue. This does not constitute any other permits from any other agencies. If you have any questions, please call our office. Sincerely, Albert J. Krupski, Jr. President, Board of' Trustees AJK/djh cc. CAC O Town Hall, 53095 Main Road to P.O. Box 1179 Telephone ♦ `� (516) 765-1801 h Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, May 20, 1996, the following recommendation was made: CF-22 Moved by Robert Keith, seconded by Allan Connell, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Grandfather Permit request of HELEN & ROBERT RUST 111-14-34 to amend grandfather permit to add the 120' bulkhead and the dock not included in the original grandfather application. Wunneweta Road, Cutchogue The CAC recommends disapproval because it feels this is not a Grandfather Permit but should be treated as a Wetland Permit which the CAC would approve. Vote of Council: Ayes: All Motion carried. ® .STEEL & WOOD RILING ® FLOATS COSTELLO MARINE CONTRACTING CORPORATION DOCK S�JILIJII�G JETTIES 131SLICI°iEADlS�G 423 FIFTH STREET, R.O. BOX 2124 . GREEVRORT, NEW YORK 11944 . (516) 477-11991477-13931477-0662 April 17, 1996 Albert J. Krupski, Jr. , President Board of Trustees P.O. Box 1179 Southold, NY 11971 Re: Helen & Robert Rust Wunneweta Road, Nassau Point Grandfather Permit #4238 Dear Mr. Krupski: Enclosed please find photocopy of the above referenced grandfather permit which allows for the reconstruction of 104, of existing bulkhead in-kind, in-place. Please note that we did not include the 120' northerly section of bulkhead in our original application. Presently, this section needs replacement and we would like to request an amendment to the grandfather permit to allow reconstruction in-kind, in-place. The total footage of bulkhead on this property is 2241 (104' of which is already grandfathered) . Please advise if you require additional information. Thank you for your review and assistance. Very truly yours, Susan E. Long Permit Manager Enc. 2 Moved by Robert Keith, seconded by Patricia Isaksen, it was RESOLVED to recommend to the Southold Town Trustees APPROVAL WITH REQUEST of the Wetland Application of HELEN M. AND ROBERT W. RUST 111-14-34 to replace approximately 104' existing bulkhead in-kind, in-place. Backfill , with 20 c.y. clean fill from approved upland source. The Council recommends approval but request the applicant maintain a 10' natural vegetative buffer behind the bulkhead. Wunneweta Road, Cutchogue Vote of Council: Ayes: All Motion carried. Moved by John Holzapfei, seconded by Robert Keith, it was RESOLVED to TABLE the Wetland Application of HIRANT AND AYDA CANDAN 44-1-18 to construct a bulkhead 38' front , 24' return, CCA materials, 3 x 10 x 8 sheating, 5 x 6 stringers, round pilings 8" every eight feet apart, penetration 4 1/2 ' galvanized hardware, with filter cloth on back. The application was tabled until the CAC receives better plans and applicant need to clarify his intent. Vote of Council: Ayes: All Motion carried. 55955 North Road, Southold Vote of Council: Ayes: All Motion carried. Moved by Bruce Loucka, seconded by Stephen Angell, it was RESOLVED to recommend to the Southold Town Trustees APPROVAL WITH STIPULATIONS of the Wetland Application of RUSSELL McCALL 116-6-7 to remove approximately 2000 c.y. of fill, concrete and other debris dumped in marsh by previous owner. Present owner seeks to install disturbed area to former condition as a marsh and to re-establish tidal flow via presently blocked drains to marsh to east. He does NOT intend to develop or otherwise build upon this property. All material removed will be disposed of in Town of Southold landfill or other suitable location. The Council approves the project provided the applicant does not leave a "hole in the ground". The CAC recommends the applicant contact the Cornell Cooperative Extension or an environmental consultant to provide assistance and knowledge to reestablish the marsh quickly and in an environmentally sound way. New Suffolk Avenue, New Suffolk Vote of Council: Ayes: John Holzapfel, Bruce Loucka, Stephen Angell, Betty Wells, Patricia Isaksen Abstain: Robert Keith Motion carried Moved by John Holzapfel, seconded by Bruce Loucka, it was RESOLVED to recommend to the Southold Town Trustees_ APPROVAL AS IS of the Wetland Application of MARY LAND BAIZ 56-5-1.2 E 2 to resheath approximately 102' existing timber jetty, extend inshore i NEW YORK STATt ?ARTMEHT OF ENVIRONMENTAL CONSERVATION PERMIT NUMBER / ® EFFEC VE D TE FACILITY/PROGRAM NUMBER(S) PIT EXPIR#AON DATECS) (TWSP2) Under the Environmental Conservation Lau , O 6' TYPE OF PERMIT a New ❑ Renewal 0 Modification ❑ Permit to Construct ❑ Permit to Operate I Article 15, Title 5: Protection Y 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR 360: of Waters' - Certification Solid Waste Management _ I Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPOES ❑ Article 27, le (�; Supply Hazardous W M�E'sa U 0 Article 19: Air Pollution I Article 15, Title 15: Water Control ❑ Article 34: at Erosion Transport Management I OB ❑ Article 23, Title 27: Mined Land J Article 15, Title 15: Long Reclamation 0 Article 36: Flo plain Island Wells nti U Management 9 N �+(°�I THOL� ❑ Article 24: Freshwater Wetlands � a ] Article 15, Title 27: Wild, ❑ Articles 1, " , , 7; Scenic and Recreational Rivers B Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control i Other: i PERMIT ISSUED TO TELEPHONE NUMBER Hde4,t )1?aL,t Uuur If I ADDRESS OF PERMITTE �a CONTACT PERSO FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY LOCATION OF PROD CT/FA ILITY COUNTY VILLAGE WATERCOURSE HYTM COORDINATES tla DESCRI ' ON OF AUTHORIZED ACTI TY Remove and replace in the same location /D!�/ linear feet of existing functional bulkhead and place�2 o u. yds. of backf Ut. NOTE: Additional activities described on page three (3) of this permit are also approved under this permit if the adjoining box js checked and th¢/ proposed work is shown on the approved plan. -e z ✓uR ��__e 11/11 S 19 Z= C /.116,:,_. 91319•S F By acceptance of this permit,-the permittee agrees that the permit is contingent upon strict compliance with the Environmentat Conservation Law (ECL), all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of this permit. PE I ADMINISTRATOR: ADDRESS Bldg. 40, SUNY, Stony Brook, New York 11790-2356 AUTHOORI �SIGHAAT®URE DATE �/3/>--3 Page 1 of (o GENERAL CONDITIONS Instructions 1. The permitted site or facility, including relevant records, is subject to in- spection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such represen- tative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3) . A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Renewals 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regula- tions is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or, applicable law or regulation have materially changed since the permit was issued. 3. The permittee must submit a separate written application to the Department for renewal ; modification or transfer of this permit. Such application must include any forms, fees or supplemental information the Department requires. Any renewal , modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES) , Hazardous Waste Management Facilities (HWMF) , major Air. Pollution Control (APC) and Solid Waste Management Facilities (SWMF) ; and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of this permit does not an modify, P Y supersede or rescind order or determination perviously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. Other Legal Obligations of Permittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from this project. 7. This permit does' not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required for this project. ,II i Page 2 of 6 .1-2ic - iIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 23, 33 and 6 NYCRR Part 608 ( ) i 9 That if future operations by the State of New Yor6 require an al- other environmentally deleterious materials associated with the teratiori in the position or the structure or work herein authorized, or protect if, in the opinion or the Department of Envirobmental Conservation 13 Am material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the tree nax igation of ,aid ;hall be removed evenly,without leaving large refuse piles.ridges across eaters or flood flocs or endanger the health, safer or %%elfare of the bed of a waterway or floodplain or deep holes that may have a the people or the State. or cause loss or destrucuon of the natural tendencc to cause damage to navigable channels or to the banks of resources or the State.the owner may be ordered'ow the Department to a %%atenxaV sremove or alter the structural work. obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or 14 There shall unreasonable interference with navigation by the work S herein authorized. ed. revocation of this permit. the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be com- 15 if upon the expiration or revocation of this permit,the protect hereby pleted, the owners, shall. without expense to the State, and to such authorized has not been completed,the applicant shall,without expense extent and in such time and manner as the Department of Environmental to the State. and to such extent and in such time and manner as the Conservation may require.remove all or any portion of the uncompleted Department of Environmental Conservation may require,remove all or structure or till and restore to its former condition the navigable an portion of the uncompleted structure or fill and restore the site and flood capacity of the watercourse.No claim shall be made against to Its former condition. No claim shall be made against the State of the State of New York on account of any such removal or alteration New fork on account of any such removal or alteration. 1U That the State of New York shall in no case be liable for any damage 16 If granted under 6 NYCRR Part 608, the NYS Department of Environ- 'or injury to the structure or work herein authorized which may be caused mental Conservation hereby certifies that the subject project will not by or result from future operations undertaken by the State for the contravene effluent limitations or other limitations or standards under conservation or improvement of navigation,or for other purposes.and Sections 301, 302, 303. 306 and 307 of the Clean Water Act of 1977 no claim or right to compensation shall accrue from am such damage (PL 95-217) provided that all of the conditions listed herein are met. III Granting of this permit does not relieve the applicant of the responsi- 17 All activities authorized by this permit must be in strict conformance Ibility of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant or his agent as part the U.S. Army Carps of Engineers, U.S Coast Guard. New York State of the permit application. y' Office of General Services or local government which may be required. Such approved plans were prepared by �12 All necessary precautions shall be taken to preclude contamination on _1f/ . ? of any wetland or waterway by suspended solids, sediments. fuels, ,o r cam.D 1 3 solvents, lubricants,epoxy coatings, paints,concrete.leachate or any SPECIAL CONDITIONS �l ' Additional Approved Activities (if box checked) ❑ Dredge to 4 . ft. elow mean low water no greater than 10 ft off shore of the repl cement bulkhead with resultant cu.yds. of dredged materia to be used as back fill or trucked to an appropriate upland te, (see special conditions 7 and 8) ❑ Construct - nnw bulkhead return(s) a ❑ Construct a bat slip or ramp (dimensions: by ) ,1 ❑ - Install Aboat lift or davit ❑ Construct an attachd parallel (capping) boardwalk up to 4 ft. i width (dimensions: `` by ) ❑ Install up-- to four (4) mooring piles (see special conditions 9 and 10) ❑ Construct a boardwalk or footpath up to four feet in width to access the bulkh d (see special conditions 11 and 12) Important:Refer to Special Conditions on the following pages which apply to any additional activities checked. DI.0 PER.v1tT �l-'•1titR 1 y -o PRnGRAnt t aCtEIT'i <C.x16ER Page 3 of �' NENV YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION _ SPECIAL CONDITIONS 25 Tidal Wetland I For AftiCle t 1. All repairs to existing structures are confined to replacement of existing structural elements with no change in design; dimension or materials unless specif- ically authorized herein. 2 . Any bulkhead constructed directly adjacent to vegetated tidal wetlands must be jetted in with minimal distur- bance to tidal wetlands. Trenching is strictly prohib- ited. 3 . Construction of bulkhead and return walls must be completed prior to placement of any fill materials behind such structures. 4 . All fill must consist of clean rock, gravel, sand and soil. Use of asphalt, slag, fly ash, broken concrete or demolition debris is prohibited. 5 . All fill must be graded to match the elevation of the land immediately adjacent to the bulkhead. 6 . Any debris or excess material from construction of this project must be immediately and completely removed from the adjacent area and disposed of at an upland site. Disposal of debris in tidal wetlands is prohibited. ' Dredctincr 7 . Dredged materials must e placed directly behind the bulkhead or into the co eyance vehicle. Side-casting or temporary storage of d edge materials is prohibited. 8 . Dredged material not used a backfill must be disposed of at an upland site, and s 'tably retained to prevent it from reentering any water ody or tidal wetland. i t DEC PER..11T ti UMBER F.�CILITI 10 NUMBER PROGRAM NU.mBER Page of i 5 1 y �SSe NEW YORK STATE DEPARTMENT OF ENVIROMMENTAI, CONSERVATION SPECIAL CONDITIONS For Article 25 Tidal Wetland Moorinct piles (if appro\dked page 3) 9 . No structures are tstructed on pilings without further authorizatie Department. 10. Pilings may not- ( beyond property lines, (b) be placed so th boats extend over property lines, (c) interfenavigation,• (d) interfere with other landowneian rights. Access paths boardwalks oved, see page 3) 11. The ground area cleared for construction of a path or board walk is limited to a maximum width of six (6) feet. The path or boardwalk it elf is limited to a maximum width of four (4) feet. 12 . Cover material used for footpath \,s limited to natural wood/bark chips, stone, gravel or and. i - j EC PERMIT NUMBER I - ? _ 7 ICIUTY 10 NUMBER PROGRAM NUMBER �ge6 of 6 SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply to all permits$ A. A copy of this permit, including all conditions and approved plans, shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit shall be protected from the weather and posted in a conspicuous location at the work site until all authorized work has been completed. B. The permittee shall require that any contractor, project engineer, ' or other person responsible for the overall supervision of this project reads, understands, and complies with this permit and all its general, special, and supplementary special conditions. Any failure to comply precisely with all of the terms and conditions j of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation.Law. If any of the permit conditions are unclear, the permittee must contact the Division of Regulatory Affairs at the address on page- one or telephone (516) 444-0365. 1 Is C. If project design modifications become necessary after permit issuance, the permittee shall submit the appropriate plan changes ` for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submission of a new application for permit. D. At least two days prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully ' aware of and understand all terms and conditions of this permit. Within 30 days of completion of the authorized work, the bottom portion of that form shall also be signed and returned, along with photographs of the completed work and, if required, a survey. t E. For projects involving activities to be undertaken in phases over a period of more than one year, the permittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. F. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, office of General Services, Tower Building, Empire State Plaza, Albany, NY 12242 (518) 474-2195, which may be required for any encroachment upon y. State-owned lands underwater. f. �f7 DEC Permit No. 7 3 v cy "6 Page &of b- #4 4'- N 4PP$OSxE[7 AS PER TERMS AND CONTIITIONS OF. p ; DT A 5 3 A U tkcr ��h� 3� i1 A S S A U LIYAnoa III, ram' PDINT- �A Z fib. If Ila Or PO 114T R s upK elA k; POKD Ip fp Loc,�snoly�,,� _V�c�.ViTY � Fir F2oM f/.46sT,��f f`Ur�FfllX�lX/ j'T x.+�{/' �Ur�FOL f'LOUrY7y.9T1.95 o /00 rep C wev .4OPO �- i �9snap,Byy GaT LcW6. 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Er'/6E)jr,E �it/.4kj/✓,6�p"1.�3%7�p r�,t-!A•aPLfG(X/T 2 COU�I�fj SU7A.tGcO_=6.,IJC�C,SrEj/ ,PD. 4/5S9UPT. farrf/o6d�/TbW.s/pr io//TNO/� fra rc aF',d�ia yogic fr5'EE7-2 qr 2 AUGv57"//J/�3 TRUSTEES �� 1�� L� SUPERVISOR John M. Bredemeyer, III, President (+� SCOTT L.HARRIS Albert J. Krupski, Jr.,Vice President -Z Henry P.'Smith Town Hall John B. Tuthill 53095 Main Road William G. Albertson �'''��� '�� P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 1, 1993 Mr. John Holzapfel, Chairman Southold Town Conservation Advisory Council Southold Town Hall Main Road Southold, NY 11971 Dear Mr. Holzapfel: Transmitted herewith are the following applications for a wetland permits: Francis X. Smith 71-1-13 Patricia Guinan 86-7-5 Helen Rust 111-14-34 Please prepare a written report of findings and recommendations with respect to this application. _ Very truly yours, John M. Bredemeyer, I I President, Board of Trustees JMB:jmd � _ t 2r.r <6lMwo- �� 2 � INE C0NTRACTIN CC)RPO . Q r 8 1E�DfNC µJETTIES•BtJLKNEADiNG r STEEEriNwl}F NG� -10K7 s ..+� .. .fi � Cx' xrl's'+%s. ! ` su*sr � -.s + � ., k'txtk. 42�FI STREEF,P,D BOX2124 • GREENPORT,'NE OR.4" (516y 477 7189/477 i383 4"."-0 ° lvanUary 16 r`r 1997 , i ta, �•J U �Albert.-Jw 4K_rugski, Jr. , President >• Board o TLUSteeS 'W11-9 3+' �t u ear ` THOLD e �xe obertRust TOWN OF"SOU 3 SCTMIOdQ Ill-14-34 yWl WRE T 423$,7i,i - ,ter N'' ,-*_Z4 A `t'3',+r�r..Et 3 `. 3"✓`.s, "` ' Y '�'v_�, t't5,�C Qe o " � �lii�.�-'" rti'.lbit.• G1. - a f v` g' `" . Ydv1'Sh- - r. E'rsclosec please find copy of project plans that were approved , theBoara of Trustees at the m regular eeting of May 22, 1956 at a Pease note that `the 12' "x 24 boatramp and 27` of uppe yretininga1l was_,excluded from the description when we�s ubmtte3t e amenam t�to­include all;structures- on 'the' property.esultMwre araIrequesting an .amendment to reconstruct the boatram}uy f a uPP? pta-inIng ,,wall, E including a 8' _x,27' timber wal wa Y eet?? upper retaining wall and lower bulkheads "r ter+-.... � `'°`� a -' s,.r= ^2's c+, -' ✓� ,x,�,8�-}•- ,,, k`��-�' . en osngphotogzaphb whichhopefull wi e]siaina ee o olirSgard,to '^make�an on"sit��ins ection also ! ti 4 5 a i'catso�f , xri th ammountr'of $4Q:Q0''tt , e�, � ecnformations�an 3,m� �enal°osures sate - su q .;dy xi- .-0 -4 r3 ..a rt ]k 1 f f'' ,YTkarik ourlfor .,your�tiiedvand ion considerat r} o- u ? # d9tt, e 't GAS �LY,K x" �, El y w�^S, � 'Rig'm gg X R _ it e 'Y k u Susan E Lonc , Q �IMV�itManage.r-. t z` — }�e 4 14 r .y� `+VI ;i r fJA53AU Z r � 3k n1 ,455AU ' I N T- Z 'D PO N k/G7A © FkNE- PDKq o. Q L4G4770�//�y9P I//C/N/TY its � F20/11 AIA65T iy �a,�.�xU�,fayrrx��w 5Uffa�•�CoU�sr7Ytv.�4s woo ��. LG7Sr6. NA55Av Gosr�✓Go Yroei�/e C�xrle x7r r6 r � s�� R Po. rraczrz� G r iy. .rQ� LITrI.c- APFc014rc 15AY 7r-L.576-477-I(W �UEr7- 4 Q a O �' Lft NO O F fNEOf d el 27p h Q JF 7- _ �aX15TO ULICll e-4 P iBc� (04 - v t-K6Pooc`� GRAND FATE{E R '?" ���F�v .�E?.G9CEAf3y2/7X.lO¢aFEX/ST9c�6 'h� �J�y� y��v T/vBt aGYrfriCO,a✓C-4VV res 4cg C,r ID 40, 77WWf-K rV6,7711-W PG4�/ SG�LE 5a� / ✓r � AHffN3 AM'L!N ���Q ,p �'Z 2x r2 cyo 4A'z• /4X6 n,8trt CACArfLL 314 x/4 T/E RAC Gx6 �LFlLJ�9 � Dc-,aoy,Qv ip eau rx 20 AEu�-sTinv/ / ZH/N. .fit[<c!��1sr7F,P/r7L5' <G4 �Eat>�p AZZ f6gA,=WOWc y� 6olYq///ZEv p�°��SA�/lE/J 7IJ.IG,�/Jd/C770N.4L �9�:V1/E5,447z.�y. .4.yvw 2 Ca�c ,r SGZ4 u�i 6. A/2--z. Y/V �i 550�'//,l/y,E/U�T4.�1�,C//71y06G�;�J/.y///�.35 .. /�U/✓i!/E.Cr/EIT r2p. �SS4UPT. CUTf/06dE 7bW.V pl �OUlHOIO f 74 7�- 5f,EEr 20,= � EEBRUARtf iZr 1996 f 4 tk, s .dam ° �' .""' '�• MI IN AM '•.n: 1 4 �' i i �f._' 3 4 t�kjau��l�� iifN - Ez I -42 _ t 4 xw -fi all aii �. jp tie1r % �1 4� 4t1t} `7ey41Y � > eCry P.. 4 ry. 6s"'re�t°i, / `8Sr JO � Ae rt� �i� �i�/� lrpr Y.f'� ►nj! i1IrrMPa Ms �'� '•'•iir �r�'' IT r , Aps d` AUTHORIZATION FORM en Date. I, L0,.0.) aA owner of TA)< nAt° Business/ roperty name �vT�Nt �vf� . l lg3s located at . �yl� 19 �N W +y. ��� �� j�-sy O V09,� do herby give Costello Marine Contracting Corp. the authority to act as agent in my behalf in applying for all of the necessary permits in order for work to be done on my property described above. �,( ! S S g ture M 41) x� ,4�UEFO�,�c TRUSTEES ®� OG John M.Bredemeyer,III,President o �!� SUPERVISOR Henry P. Smith,Vice President SCOTT L.HARRIS Albert J.Krupski,Jr. " John L. Bednoski,Jr. Town Hall John B.Tuthill 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 Only: Coastal Erosion Permit Application Wetland Permit Application Trustee Lands Permit Application Grandfather Completed Apps. Date: 7 Variance Required, Neighbors notified Date: SEQRA Type N OF SOUTHOLD Coord. Review-opt. ,mand. Date Rec. by Office Insp. comp./date: ��� .,.�. SEQRA Determin. /date: L/-r J Q Public Hearing/date: Findings: Permit Vote: (Y/N) : Special Conditions: (also see file) pp ica ion ee: Application Number; SCTM 41000- Ill - - 3� Project Name (If any)_ ELEM fix} , RUST Date Prepared: SIa3 b3 Applicant: CnST—F L LbTM P_ s I3 C 0k}?2ACrt I QC Coe t3 Address: (E•C) , Zox oiloZ�( 6421-a=t\)t'02T o tJ� IIa << Phone (51(, ) V77 11?7 Interest: (owner, consultant,lessee,etc. ) .A (g E hid Owner of Property: [1.6G-F IM, M , `t h6Z F P-T W U S l Address (]0NJ N GWETA Roa n MAS5At Pe% 1 ),37 vj i Phone (SJ ) Subject Property Location: LAI U Kj N r W F •r/,k 120A j (Provide LILCO Pole #(, Distance to cross Streets if not on location map) THIS IS NOT A PERMIT Yds. to be excavated: - o - Yds. to be filled: cu, us, Manner in which material will be removed or deposited: ACk Ho E Width of canal, creek or bay fronting property: !u� Depth at low tide: Aver. rise in tide: Distance to nearest channel: Distance project extends beyond similar projects in area: N /A Area zoning: RESIDgNJT/6L Land area in acres: a+- Is project for private or business use: -PP-10A-=c� Intended use of property: EXoSTINsC. REs1 >1tNcF: Describe known prior operations conducted on premises: Nbn1E Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: No Has any license or permit ever been revoked or suspended by a Governmental Agency: NO . 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) . KEPI #CEO'° " PPS®L 1 ;f 91.u__ C> r.xrsT It�i kiN1� zN- PLAC.E BNCY, F)LL w crH aD CU, 4ps• C' t EA K� FILL F- R(M APPRol rzh u P c WEN C0U2eE _A\JT h0z(zATlo -ATTACh0D Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) do hereby authorize 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 ) (2EO Kr.E fl • OSTF LLb S P 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. SIGNATURE SWORN TO BEFORE ME THIS _cP, a DAY OF A l)6 l!S-F , 19 ct3 SUSAN E LONG NOWY Public.State of New York Nm QuIllifisd�in Suffo*Chou NOTARY PUBLIC � e5�w=r44 Suggested space for location Map THIS IS NOT A PERMIT i 617.20 Appendix C Slate Environmental Ouallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART l Project Inlormatton (To be completed by Applicant or Project sponsor) i Applicantrsponfor 2 ProleCl Name COSTF-LLO E Co + T Project location. Municipality -TnW N 6F 41�-- tvrAbLh County SU F F 61LK. J it proposed action: ❑ New ❑ Expansion ❑ Modificalionralleration REFAIRS REPLACt= MEQ-r 5 Describe prolect bnetly. , 1'iFP.LACE APPROXIW41TEl4 IOy. EXI.ST)WG T4MBEK $ULKtFEAb �X}, kl WD 'iTJ "PLACE - TB_A(!,rflL+, .16 cu.y ps• OI..EA7 Q FILt_. b Precise location Iroad intersections, prominent landmarks, etc or provide map] KIFA HA-P ,ATTA•cIHED 7 Amount of land aiiecte& - v__._._. In " acres -"Ultimately --� acres. -- - - - - - - tt Will pr osed action comply with existing zoning or other existing land use restrictions? Er Yes ❑ No It No,describe briefly 9 Whhat�r present land use in vicinity of proiectl U Residential ❑ Industrial ❑ Commercial... ❑ Agnculture ❑ Parktandropen space ❑ Other Describe: W(ATE R F QbtJ T 10 Does acti involve a permit.approval, or funding, now or ultimately,from any other governmental agency(Federal, state or local)? Yes ❑ No It yes, list agency(s)and permitlapprovals "TOvJ 0 OF 5p0- `li0 ,U AR"y CO(ZWS d r- lR OG I N LE E,$ N3.5 ' btrG 111 Does any aspect of the Action have a currently valid permit or approval? r ❑ yeto If ses, list agency name and permu,approval h'pe 11 At result of proposed coon will existing permit approval require modification? ❑ yet No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST Of Xil KNOWLEDGE ' Appbcant:sponsor name. GoSTE.LL6 ,�A R)M G COX)-TR}�CT I IJ G Dale Signature. It 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 r~ B PART it Envlronmenial Assessmeti. ;to be completed by Agency) A Does action exceed any Espe I threshold m.6 NYCRR. Part 61712r If vet.Coordinate the tevsew process and use the rust EAF 'L J Yes ❑ .'..' R Will Actfoo-receoye coordinated rEvrew as bt8vided for Unlisted Actions in 6 NYCRR,Part 61771 If No, a negative declatabon may be superceded bs another involved action ❑ yet ❑ No C. Could Action result in ANY adverse effects on, to. or arising from the following (Answets miv be handwritten, of legible) C1 Existing air quality. surface or groundwater quality or quantity,noose levels,exdring tralnc patterns.solid waste production or disposal,potenlrai for etosrnn. drainage or flooding problemst Explain briefly - C2. Aesthetic. agricultural,archeological, historic, or other natural or cultural resources.or community or neighborhood characters Explam briefly. r CT. vegetation or iauna,:movemens of fish or wdd6le species, significant habitats. or threalened or endangered species? Explam bnelly Ca. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land of other natural resources? Explain briefly. CS. Growth, subsequent development, or related activities likely to be induced by the proposed action! Explain briefly. r C6. Secondary. cumulative.or other effects not identified in C1•C6? Explain briefly, l� V. A change in use of either quantity or type of energyl Explain briefly PART III Determination of Significance (To be completed by Agency) INSTRUCTIONS! For each adverse effect identified above, determine whether it is substantial. large. important or otherwise significant, Each effect should be assessed in connection with its(a) setting(i.e. urban or rural); (b) probability of occurring; (c)duration;(d)irreversibility; let geographic scope; and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur, Then proceed directly to the FULL EAF and;or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation. that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide here, and on attachments as necessary, the reasons supportng this determination, ' Agency Name rgencv Preparer's Name Preparers Sognature.Tale _. Darr 2