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Home My WebLink AboutTR-4828 Michael J.Domino, President �QF so(/ry Town Hall Annex John M.Bredemeyer III,Vice-President ,`OOl0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 COUN N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1586C Date: July 8, 2019 THIS CERTIFIES that the construction of 1- 40' low Qrofile groin that will begin at the highest vertical point which is at the whaler of the bulkhead and no pre-filling with permission to use fill when constructingrg oin; At 200 Cleaves Point Road, East Marion Suffolk County Tax Map #1000-38-2-33 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 3, 1997 pursuant to which Trustees Wetland Permit#4828 Dated November 18, 1997 and Coastal Erosion Permit#5068 Dated September 22, 1999, Amended on September 22, 1999 was issued 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 construction of 1-40' low profile groin that will begin at the highest vertical point which is at the whaler of the bulkhead and no pre-filling; with permission to use fill when constructingrg oin. The certificate is issued to Anthony Napolitano owner of the aforesaid property. • &tau. Authorized Signature _ r Michael J.Domino,President ��OE SOUTyO Town Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 11 Glenn Goldsmith J Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 7 0 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: T, �lCU COMMENTS: 41 6 J` CERTIFICATE OF COMPLIANCE: Board Of $outhold Town Trustees SOUTHOLD, NEW YORK DATE:. 11/18/97 ISSUED TO ANTHONY NAFOLITANO 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 meetincj held on 11/18/9.7 19 9?, and in consideration of the sum of $150.0.0 . paid by ANTHONY NAPOLITANO ...... o~: East Marion . N. Y. and subiect to the Terms and Conditions listed' on the reverse side hereof, of Southold Town Trustees authorizes and permits the followincj: Wetland Permit to construct 1- 40' low profile groin that will begin at the highest vertical l~oint which is at the whaler of the bulkhead and no pre-filling. all in accordance with the detailed specifications as presented in the oricjinatincj application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this daf, e. Albert J. Krupski, President James King, Vice-President Attic Foster Ken Poliwoda Peggs' A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Febmary2l, 2002 Mr. Anthony Napolitano 200 Cleaves Point Rd. East Marion, NY 11939 RE: 200 Cleaves Point Rd., East Marion SCTM#38-2-33 Dear Mr. Napolitano: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, February 20, 2002: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit #4828 and Coastal Erosion Permit #5068 to construct one (1) 40' low-profile groin that will begin at the highest vertical point, ~vhich is at the whaler of the bulkhead and no pre-filling. Permits amended 9/22/99 to reinstate permission to use fill xvhen constructing groin. Permits will expire on November 21, 2002. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms DEC ACE Dept. of State Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Po]iwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (6311 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION M.~kNAGEMENT PERMIT Date: September 22, 1999 Permit# 50(5~ SCTM#38-2-33 Name of Applicant/Agent: ANTHONY NAPOLITANO Name of Pem~ittee: ANTHONY NAPOLITANO Address of Permittee: 200 Cleaves Point Rd., East Marion, NW Property Located: 200 Cleaves Point Rd., East Marion, NY DESCRIPTION OF ACTWITY: To construct 1 - 40' Iow profile groin that will begin at the highest point which is at the whaler of the bulkhead and reinstate permission to use fill. Date of Permit Issuance: September 22, 1999 This Permit is valid through NoYember 21,200l, which is concurrent with the Tidal Wetlands Permit. SPECIAL CONDITIONS: (apply if marked) N/A Bluff restoration through a re-vegetation plan is a necessary special condition of this permit. N/A A relocation agreement is attached hereto and is a necessary special condition of this permit. N/A A maintenance agreement is attached with application and is a necessary special condition of this permit. Albert J. Krupski, Jr. President, Board of Trustees / DEPARTMENT OF STATE George E. Pataki Randy A, Daniels Division of Coastal Resources 41 State Street Albany, NY 12231-{1001 September 12, 2001 Mr. Anthony Napolitano 200 Cleaves Point Road East Maion. New York 11939 Re: F-2001-0610 U.S. Army Corps of Engineers/New York District Anthony Napolitano - Jetties and Beach Fill - Orient Harbor Town of Southold, Suflb[k Count~ Reouest for Necessary Data and Information Dear Mr. Napolitano: The Department of State received ~our Federal Consistency Assessment Form and consistency certification, supporting information, and additioual requested information regarding tbe above matter on August 22, 2001. Pursuant to 15 CFR Part 930.58, the following data and information are necessary to enable the Department of State to adequately assess the coastal zone effects of this proposed activity: A copy of the permit purportedly issued for this project by tile Town of Southold Town Trustees does not appear to be executed and includes three special conditions for additional agreements regarding re-vegetation, relocation, and maintenauce. Please provide a cop3' of these additional local permit conditions to the Department of State together with an full)' execnted copy of the permit. The Town Trustees permit for this project is valid for a period of two )'ears and will expire on September 22, 2001. Please indicate whether or not this local authorization to condnct the proposed activities on Town-owned lands been extended or re-issued. Your stated purpose for tim proposed activities is the "[r]estoration of beach to origiual social, economic, recreational, environmental and protective status." Please elaborate on this statement, particularly with regard to "social" and "economic" status. Tbe upland at the proposed activity is purported to be entirely privately owned. Other than the Public Trust Doctrine lands and ~aters of the intertidal area, please indicate if any other area of this property publicly accessible. You should assess tile viabilit) of removing the existing rock groin and adding beach nourishment material to the shoreline instead of building new structures in the pnblicly owned intertidal area. Please provide a thorongh ¢~aluation of alternative measures to the Depamnent of State, partlcnlarl) placing beach-nourishment material along the project shoreline, for erosion protection. Please provide the information requested above as soon as possible. If this necessary informatiou and data are not provided ~Gthin thirt) days of the date of this letter, the Department of State may close the file regarding thi~ proposed acti~ it). [f the Department closes the file aud does not concur x~ ith the consistenc) certification provided t'or this proposed activity, the consistency provisions of the federal Coastal Zone Management Act prohibit federal agent) authorization ol-the proposal. Albert J. Krupski, President James King, Vice-President Henry. Smith Artie Foster Ken Polbvoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 22, 2000 Anthony Napolitano 200 Cleaves Point Road East Marion, NY 11939 RE: SCTM#38-2-33 Dear Mr. Napolitano: The following action was taken at the Southold Town Board of Trustees Regular Meeting on September 20, 2000 RESOLVED, that the Southold Town Board of Trustees grant a one year extension to Permit #4828, to construct 1-40' low profile groins that begin at the highest vertical point which is at the whaler of the bulkhead and no pre-filling. Permit amended 9/22/99 to reinstate permission to use fill when constructing groins. This will be the final extension allowed on this permit. Located: 200 Cleaves Point Road, East Marion. If you have any questions, please contact our office at 765-1892. Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (51611 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 28, 1999 Anthony Napolitano 200 Cleaves Point Road East Marion NY 11939 RE: SCTM #38-2-33 Dear Mr. Napolitano The following action was taken by the Southold Town Board of Trustees at their Regular Meeting on October 27, 1999: RESOLVED, that the Southold Town Board of Trustees grant a one year extension to Permit #4828 to expire November 21, 2000, to construct 1- 40' low profile groins that begin at the highest vertical point which is at the whaler of the bulkhead and no pre-filling. Permit amended 9/22/99 to reinstate permission to use fill when constructing groins. Located: 200 Cleaves Point Road, East Marion. However, other agency. If you have any questions, Sincerely, this determination is not a determination from any please call our office at 765-1892. Albert J. Krupski, Jr. President, Board of Trustees AJK/djh Albert J. Krupski, President James King, Vice-President HemT Smith Artie Foster Ken Poliwoda To~vn Hall 53095 Main Road P.O. Box 1179 Southold. New Ym'k 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 22, 1999 ANTHONY Napolitano 200 Cleaves Point Road East Marion NY 11939 RE: SCTM #38-2-33 Dear Mr. The following action was taken by the Southold Town Board of Trustees at their Regular Meeting on September 22, 1999: RESOLVED, that the Southold Town Board of Trustees grant an Amendment to Permit #4828 to reinstate permission to use fill when constrOcting groins. Located: 200 Cleaves Point Road, East Marion. However, this determination is not a determination from any other agency. If you have any questions, please call our office at 765-1892. Sincerely, Albert a. Krupski, Jr. President, Board of Trustees AJK/djh THE REV. CANON JOHN R. EDLER P.o. BOx 23g (631) 4'77 - 0111 September 12, 2000 Southold Town Board of Trustees Southold Town Hall Main Road, Southold, NY 11971 Dear Town Trustees: Please extend the following permits Permit # 4825 Permit # 4826 Permit # 4827 New owners Paul Permit # 4828 2000 for one year John Edler Norman Taylor Frank Tomaslnl .. Lieblich & Candida Harper /~) Anthony Napolitano Thank you. Sincerely, ~o~h~ R. Edler Albert J. Krupski, President John Holzapfel, Vice President Jim King Mardn H. Garrell Peter Wenczel Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 19, 1997 John H. Geideman 355 Osprey Nest Road East Marion NY 11939 Re: ANTHONY NAPOLITANO SCTM #38-2-33 Dear Mr. Geideman, The following action was taken by the Board of Town Trustees during its Regular Meeting held on November 18, 1997, regarding the above matter: WHEREAS, ANTHONY NAPOLITANO, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated April 3, 1997 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 November 18, 1997, 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 structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT~ RESOLVED, that the Board of Trustees approves the application of ANTHONY NAPOLITANO to construct 1- 40' low profile groin that will begin at the highest vertical point which is at the whaler of the bulkhead and no pre-filling. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is sig~ed. 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. FEES: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC ACE Dept. of State Albert J. Krupski, President John Holzapfel. Vice President Jim King Martin H. Garrell Peter Wenczel Town Hail 53095 Main Road P.O. Box 1179 Southold. New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Juae 30: 1997 Ms. Darleen M. Gerbino N~SDEC Bldg. 40 Stony Brook, NY 11790 Re: ANTHONY NAPOLITANO SCTM g38-2-33 1-4738-01611/00001 FRANK TOMMASINI SCTM #38-2-34 1-4738-00734/00004 NORMAN TAYLOR SCTM ~SCTM #38-2-35 1-4738-00735/00007 JOHN EDLER SCTM #38-2-32 1-4738-01609/00001 Dear Ms. Gerbino, The Southold Town Board of Trustees received your Lead Agency Coordination Request form and has agreed that we do not wish to be lead agency for these 4 application~ pem~ng. If you have any questions please contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh New York State Department of Environmental Conservation Building 40 - SUNY, Stony Brook, New York 11790-2356 Telephone (516) 444-0365 Facsimile (516) 444-0373 JUN I 2/997 , .'I r, Job. P. Cahil, '" ~ :-~ ' Acting Commissioner June 9,1997 Town of Southold Board of Trustees Town Hall 53095 Main Road, PO Box 1179 Southold, New York 11971 Dear Sir/Madam RE: LEAD AGENCY COORDINATION REQUEST The purpose of this request is to determine under Article 8 (State Environmental Quality Review - SEQR) of the Environmental Conservation Law and 6 NYCRR Part 617 the following: 1. Your agency's interest in acting as lead agency; 2. Your agency's jurisdiction in the action described below; and 3. Issues of concern which your agency believes should be evaluated. Enclosed is a copy of the permit application and a completed Part 1 of the Environmental Assessment Form to assist you in responding. Project Name: Anthony Napolitano Groin Construction Project Location: 200 Cleaves Point Road, East Marion, NY 11939 DEC Project Number: 1-4738-01611/00001 DEC Permits: Article 25, Tidal Wetlands Article 15, Protection of Waters 401 Water Quality Certification SEQR Classification: [ ] Type I [ X ] Unlisted DEC Contact Person: Dadeen M. Gerbino, Environmental Analyst Division of Environmental Permits DEC Position: [X ] DEC has no objection to your agency or another agency assuming lead agency status for this action, but reserves the right to comment on this action if a positive determination of significance is made. [ ] DEC has no objection to your agency or another agency assuming lead agency status for this action, but we have the following concerns regarding this project (see "comments" below). [ ] DEC wishes to assume lead agency status for this action. [ ] The proposed action has been identified by DEC as occurring wholly or partially within or substantially contiguous to a cdtical environmental area (CEA) that was designated by . It is the position of this Department that your agency, if it has a jurisdiction over the action, should assume the lead agency role based on the existence of the CEA and the fact that the anticipated impacts are primarily of local significance. [ ]Other. (See comments below) Comments (Optional): Response: Please respond to this request within 30 days of the date of this letter. If no response is received within 30 days, we will assume that you have no objection to DEC or another agency assuming the role of lead agency, and have no comments to offer regarding the proposed action at this time. If neither your agency nor any other involved agency, including DEC, has indicated a willingness to serve as lead agency within 30 days of this letter: [ ] We will petition the Commissioner of DEC to designate a lead agency for this action. [ ] We will petition the Commissioner of DEC to designate your agency as lead, presuming you have jurisdiction. Please feel free to contact this office for further information or discussion. Sincerely, Dadeen M. Gerbin0 Environmental Analyst Enclosures George E. Pataki Alexander E Treadwell Secretary of State Ms. Darleen M. Gerbino Environmental Analyst NYS Department of Environmental Conservation Region 1, SUNY Stony Brook Stony Brook, NY 11790 June 3, 1997 .... OF SOUTHO D jf.,',~ I, Re: S-97-035/036/037/038 Taylor/Edler/Napolitano/Tommasini Construction of Groins Town of Southold, Gardiners Bay Dear Ms. Gerbino: Thank you for sending the Department of State (DOS) copies of the Coastal Assessment Form (CAF) and supporting information regarding the proposed groin construction activities in the Town of Southold. We have reviewed the submitted information as well as information on file at this office. The following comments and enclosures are provided for your consideration. In accordance with Executive Law Article 42 and implementing regulations in 19 NYCRR Part 600.3 (c)., (copy attached), when the Secretary has identified State agency actions which are likely to affect the coastal area, those State agency actions are required to be undertaken in a manner consistent to the maximum extent practicable with the coastal management program (or approved Local Waterfront Revitalization Program). Pursuant to 6 NYCRR Part 617.14(f)(10)(i), when an action is not in an approved local waterfront revitalization program area, an identification of the applicable coastal policies of Executive Law, Article 42 as contained in 19 NYCRR 600.5, and a discussion of the effects of the proposed action on, and their consistency with such policies, must be produced. Since permits from the New York State Department of Environmental Conservation (NYSDEC) may be required for various portions of this project, NYSDEC must make its own determination regarding the consistency of its action with the policies and purposes of the state's coastal management program. No State agency involved in an action shall carry out, land or approve the action until it has complied with the provisions of Article 42 of the Executive Law. Ms. Darlene Gerbino Page 2 The following items should be addressed within your policy analysis. Questions and comments are listed with regard to each of the applicable policies of 19 NYCRR 600.5. Flooding and Erosion Hazard Policies: (1) Whenever possible, use of nonstructural measures to minimize damage to natural resources and property from flooding and erosion. Such measures shall include: (i) the setback of buildings and structures; (ii) the planting of vegetation and the installation of sand fencing and drainage systems; (iii) the reshaping of bluffs; and (iv) the flood-proofing of buildings or their elevation above the base flood level. (2) Mining, excavation or dredging in coastal waters shall not significantly interfere with the natural coastal processes which supply beach material to land adjacent to such waters and shall be undertaken in a manner which will not cause an increase in erosion of such land. (4) Activities or development in the coastal area will be undertaken so as to minimize damage to natural resources and property from flooding and erosion by protecting natural protective features, including beaches .... (5) Activities and development, including the construction or reconstruction of erosion protection structures, shall he undertaken so that there will be no measurable increase in erosion or flooding at the site of such activities or development or at other locations. Our comments are included within the attached copy of correspondence from Fred Anders of our office to Albert Krupski Jr. of the Town of Southold. In his letter, Mr. Anders discusses a variety of issues pertaining to construction of groins within this area of Gardiners Bay. The letter also contains alternatives to construction of the groins which if implemented, may provide protection that results in fewer detrimental impacts to the existing natural protective features. Please consider these suggestions in your evaluation of the proposed groin projects with respect to the goals and objectives of the New York State Coastal Management Program. We hope that this information will assist you in your review of this proposed project. If you have any questions regarding this letter or any other aspect of New York State's Coastal Management Program, do not hesitate to call me at (518) 474-6000. Coastal Resources Specialist WFM/wfm c: COE/NY - James Haggerty Town of Southold ~ Albert Krupski Jr. file Albert J. Kmpski, President John Holzapfel, Vice President .~im King Martin H. Garretl Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May ~ 1997 Fred Anders N.Y.S. Dept. of State Coastal Management 162 Washington Ave. Albany, ~f 12231 RE: Proposed Groins at SCTM ~38-2-32,33,34,35 Dear Mr. Anders: Enclosed are copies of the above referenced applications to place a series of six groins in the bay. The Board is currently reviewing these applications and would like 'four commenus. Also enclased are _~uestions the board asked the applicant and their reply, if 'you have any questions, please do not hesitase to call us. Sincerely, Albert Krupski, Jr. President, Board of Trustees AJK:jmd cc: Louis Chiarella, DEC Telephone (516) 765-1801 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 SOUTffOLD TOWN CONSERVATION .LDVISORY COUNCIL The following recommendation was adopted at the April 28, 1997 meeting of the Southold Town Conservation Advisory Council: No. 1~38 Moved by Bruce Loucka, seconded by Scott Hilary, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Application of ANTHONY NAPOLITANO 38-:2-33 to construct one I~0' groin where old stone jetty was destroyed. Foot of Gillette Drive, East Marion. The Council recommends disapproval because there is no need shown. Vote of Council: Ayes: All Motion Carried Albert 1. Krupski, President John Holzapfel, Vice President 3'im King Martin H. Gan'ell Peter Wenczel Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD .Xpril 25, 1997 Larry Tuthill 1215 Inlet Lane Greenport, NY 11944 RE: Proposed Groins at SCTM~38-2-32,33,34,35 Dear Mr. Tutbill: The Board of Trustees have the following questions with respect to the above referenced applications: 1. What is the net uni-directional movement of the sand? (where and when does it move). 2. What is the amount of the material in the net? 3. What is the zone of transport - Breaker Zone? 4. What is the percentage of sand the groins will alter? 5. What is the anticipated down drift of impact? 6. What is the overall objective? 7. Where is the fill coming from? Please submit the answer to these questions as soo as possible so the Board can continue its review. Thank you. Sincerely, Albert J. /~' President, Board of Trustees AJK:jmd cc: CAC John Geidemen 511~-477-2421 JOHN H, GEIDEM_AN Lond Surv~V, oe P.O. Box 416 ~a~t Marion, N~w York 11~39 &lC, Z2~4~ Albert J. Kmpski. President John Holzapfel. Vice President Jim King :Ma~in H. Garre[l Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold. New York t 1971 Telepho ne (516) 765 - 1892 Fax (516~ 765-1823 Office Use Only Coastal Erosion Permit Application ~etland Permit Application Grandfather Permit Application Waiver / Amc ndme nt / Chap~ s ~eceived Application: ."~'1~. ~F~eceived Fee: $ ~;.~ -- ~ompleted Appli~a%ion Incomplete SEQ~ Classification: ~e I__~e II Unlisted Coordination: (date sent) CAC Referral Sent: Date of Inspection: ~Receipt of CAC Report: ~Lead Agency Determination: ~ ..... Technical Review: ~P~lic Hearing Held: Resolution: Address ZO¢ ~;le,~r5- / Phone N~er:(~L ) ~77- Suffolk County Tax Map N~er: 1000 - Property Location: ~ ovide LILCO Pole g, distance to cross streets, (If applicable) and location) Phone: FAX~: Board of Trustees AppliO:ion Land Area Area Zoning: Previous use of property: Intended use of property: GENERAL DATA (in square feet): ~i~m,c~ ~ Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): 2 Board of Trustees Applic of the proposed operations: ~. /~ >2.~-~ wetlands on lot: - ~ square feet coverage of lot: ~ % distance between nearest existing structure and upland wetlands:~ ~ ~.g-feet ~ ~-~..,~.~,~-~,~...~.,~. distance between nearest proposed structure and upland wetlands: feet involve excavation or filling? Yes cubic yards cubic yards Purpose Area of Percent Closest edge of Closest edge of Does the project If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriase): Board of Trustees ApplicOion COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands Dresent within 75 feet of the proposed activity? ~ No Yes Does the project involve excavation or filling? ~ No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 4 Board of Trustees Appli~.on County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEFfE~VfS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORT~ 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 REPRESElqTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF ,19 Notary Public PROJECT r.D, NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMFNT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION ('Fo De completed by Applicant or Project s~onsor~ SEC 5. IS PROPOSED ACTION: ,~New r~ Expansion [] Mooificatlontalteralion 6. DESCRIBE PROJECT BRIEFLY: WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LANO USE RESTRICTIONS" ,~Yes [] No If NO. describe orlefly I ~, I~Res,~entJal ~,!nauszna~ ~' Commercial 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~No I! ,/es. list aqency name ana permit/approval If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a~.s, essment OVER 1 Civil Marine (5t6) 477-2421 JOHN H. GEIDEMAN Consulting Engineer P.O. Box 416 E. Marion, L. I. New York 11939 on my property at ~uthori ze For permits Including: 516-477-2421 JOHN H. GEIDEMAN P.O. Box 416 East Marion, New York 11939 z-AXG. V. :.:[ -T