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Home My WebLink AboutTR-44-1-15Board Of $outhold Town Trustees SOUTHOLD, NEW YORK Emergency Storm Damage (12/24/94) PERMIT NO. 44-1-15 DATE: ...4127/95 ISSUED TO . . ROBERT DIETRICH Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter 404 of the Laws of the State of New York 1952: and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:" and in accordance with the Resolution of The Board adopted at a meeting held on . 4/27/95 19 95, and in consideration of the sum of $ 200.00 paid by Costello Marine lnG., for ROBERT DIETRICH ...... of ...Southold. N.Y. and subject to fha Terms and Conditions listed on the reverse side hereof, of Soufhold Town Trustees authorizes and permits the following: Install 5 batter piles, extend easterly return 12' landward place 10 c.y. of clean fillj all as per DEC plan dated 2/6/95 all in accordance with the detailed specifications as presented in the originating 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 maiority of the said Board es of this date. Trustees Albert J. Kmpski, President John Holzapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 April 27, 1995, Robert Dietrich 55755 County Road 48 Southold NY 11971 Re: SCTM #44-1-15 Dear Mr. Dietrich, The following action was taken by the Board of Town Trustees during its regular meeting held on April 27, 1995 regarding the above matter: WHEREAS, En-Consultants Inc., on behalf of JOSEPH ST. PIERRE applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of So~thold, application dated February 22, 1995, 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 April 27, 1995, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members familiar with the premises and, have personally viewed and are in question and the surrounding area, 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 37-18 of the Southold Town Code, which will be listed on a separate page, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of ROBERT DIETRICH to repair storm damage by lnstallimg 5 batter piles, extend easterly return 12' landward and place 10 c.y. of clean fill, all in accordance with NYSDEC approved plan dated 2/6/95. Located: 55755 County Road 48, Southold. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. CAC Albert J. Kmpski, President John Holzapfel, Vice President William G. Albertson Martin H. Gan'ell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southoid, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-44-1-15 NAME: Robert Dietrich DATE: March 31, 1995 Chapt. 97 - Wetlands Chapt. 37 Coastal Erosion RESOLVED that pursuant to Article 8 of the Environmental Conservation Law, State Environmental Quality Review and 6NYCRR Part 617, Section 617.10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Trustees,'as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. TYPE OF ACTION: Type: I DESCRIPTION OF ACTION: Applicant requests a Wetland Permit to repair storm damage by installing 5 batter piles, extend easterly return 12' landward and place 10 c.y. of clean fill, all in accordance with NYSDEC approved plan dated 2/6/95. Located 55755 County Road 48 Southold. ' LOCATION: SCTM #1000-44-1-15 REASONS SUPPORTING THIS DETERMINATION: 1. An on site inspection has been conducted by the Board of Trustees. 2. An environmental assessment, submitted by the applicant and reviewed and.completed by the Board of Trustees, has indicated that no significant adverse effects to the environment are likely to occur should the project be implemented as planned. cc. CAC ISL Nb R£P~,~CE L~,$T FILL _J' I0 c% ~ 05, N APPRo¥. IT..*' LAHBWARB PREPARED FOR: Robert & Virginia Dietrich 55755 County Road 48 Southold, NY 11971 SCTM~1000-44-1-15 PREPARED BY: Costello Marine Contr. P.O. Box 2124 Greenport, NY 11944 516) 477-1199 PROPOSED: Storm Damage Repairs Install 5 batter piles for reinforcement, Extend easterl return approx. 12 landward Replace approximately 10 cu. yds. lost fill January 26, 1995 Sheet 1 of 2 Prepared For Robert & Virginis Dietrich 55755 County Rd. 48 Southold, NY 11971 Prepared By: Costello Marine Contr. P.O. Box 2124 Greenport, NY 11944 (516) 477-1199 Janurary 26, 1995 Sheet 2 of 2 AUTHORIZATION FORM ,/ '¥/¥, -/- ~, '-. ~ ~ .,,.,~ ', ~-~.', ~w.~ o~ , ~ ~.,~ 'Business/Property N~me located at .~.~-~.5' ~-~.~t~. ~ ~?~, ~. //~/~/ do hereby give Costello Marine Contracting Corp. the authority to act as agent in my behalf permits in order for work above. in applying for all of the necessary to be done on my property described Signature DEC PERI'lIT NUMBER 1-4738- 01072/00001-0 STATE DEPARTNE#T OF ENVIRONI4ERTAL CONSER~ON FACILLTY/PROGRAH NUMBER(S) TYPE OF PERMIT · Ne~ D Rc~e~eL 1 I EFFECTIVE DATE February 8f 1995 PE IT EXPIRAT log DATE(S) iq Nod.fic.t.on iq Penait to Construct ,Perm, t to Oper.te Article 15, Title 5: Protection D 6NYCRR 608: Uater Quality D of Waters Certification SuRely O Article 19: Air Pollution Article 15, Title 15: gater Cmtro[ D Article ~, Title 27: NI~ L~ Article 15, Title 15: L~ D Article 2&: Freshaater getLa~ Article 15, Title 27: gild, D Sc~lc ~ R~r~tl~[ Rivers Other: PERHIT ISS~D TO R~rt Oletrlch Article 27, Title ?; 6NYCRR ~60: Solid Waste Nauagement ArticLe 27. TitLe 9; 6NYCRR 373: Hazardous Waste Management Article 3~: Coastal Erosion Management Article 36: FLoodplain Management Articles 1, 3, 17, 19, 27, 37; 6NYCRR ~80:Radiation1 Control I TELEPHONE NUMBER ~UKCaS OF PERNLTTEE 55755 County Road ~8. Southoid, NY 11971 CONTACT PERSON FOR PERMITTED gORK I TELEPHONE NUMBER Costa{to Marine P.O. Box 2124, Gree~part, NY 11944 I (516) 47T-1199 NAME AND ADDRESS OF PROJECT/FACILiTY Dietrich Property - 557~5 County Road &8, SouthoLd LOCATION OF PROJECT/FACILITY COUNTY J TO~IN Suffolk Southotd k~ATERCOURSE NYTN COORDINATES InstaLL 5 better piles, extend easterly return 12' tandaerd ~nd place 10 cubic yards of clean fill. Ail tmrk sbe[i be in accordance Ntth the attached NYSOEC approved plan dated 2/6/95. By acceptance of this permit, the perlaittee agrees that the permit Is contingent upo~ strict compliance Ylth the ECL, all applicable regulations, the General Coodttfo~ specified (aec pa~e 2) and any Special Candltf~ns included as part of this perelt. REGIONAL PERMIT ADMINISTRATOR: ~ ADDRESS RobertA,~, Greene I BLdg. 40, SU#Y, Roam 219. Stony Brook, #Y 11~90-2356 AUTHORIZED SIGNATURE' ~ I DATE I Page I of 5 Q~PAL (33H31TI(3~ Inspect ions 1. The permitted site or faci ity, including relevant records, is subject to in- spection at reasonable hours and intervals by an authorized representative of the DeperlJ,~nt of Envirc~.f~ntal Conservation (the DepertJ,~nt) to determine v%hether the permittee is Go,plying with this permit and the ~ . Such represen- tat ive rray order the work suspended pursuant to ECL 71-O301 and S~°A 401 (:3}. A copy of this permit, including all referenced flaps, dra~vings and special conditions, rrust be available for inspection by the DepariJ,~nt at all tirres at the project site. Failure to produce a copy of the permit upon request by a DepariJ,ffnt representative is a violation of this permit. Pem3it Changes and REnewals 2. The Depar~f~nt reserves the right to m3dJfy, suspend or revoke this permit v~en: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ~ and pertinent regula- tions is found; b) the permit v~s obtained by misrepresentation or failure to disclose relevant facts; c) ne~vflaterial inforrration is discovered; or d) envJro~H~ntal conditions, relevant technology, or applicable I~v or regulation have rraterial ly changed since the permit v~s issued. 3. The permittee must sub-nit a separate vw J tten application to the D~perlrmnt for renewal, rrodification or transfer of this permit. Such appl icatJon mJst include any fo.~, fees or supplu~ntal infonTation the Deparbf~nt requires.. A~/ renewal, rrodification or transfer granted by the Deparb~unt trust be in writing. 4. The permittee must sub3~it a reneu~l application at least: a) 180 days before expiration of pen-nits for State Pollutant Discharge El imination System (SPCES), Hazardous V~ste IVanege~nt FacJ l ities (I-W,4:), flajor Air Pollution Control (APC) and Solid V~ste IVanageT~nt Facilities (~1:); and b) 30 days before expiration of all other permit types. 5. L~less expressly provided for by the Deparb,~nt, issuance of this permit does: not m3dify, supersede or rescind any order or determination perviously issued by the Departn~nt or any of the te~¥~, conditions or requira~nts contained in such order or determination. :)ther 6. Legal C]31igations of PenTittee The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all da~uges, direct or indirect, of whatever nature and by wJ-~d[uver suffered, arising out of the project described in this permit and has agreed to inda~[Hfy and save harmless the State frc~ suits, actions, da~uges and costs of every na~u and description resulting frcrn this p roj ect. 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 irrpairrrent of any rights, title, or interest in real or personal property held or vested in a person not a party to the permi t. 8. The permittee is responsible for obtaining any other permits, approvals, lands easufunts and rights-of-v~y that n-ay be required for this project. Page 2 of 5 ADDITIONAL GENERAL CONDII'IONS FOR ARTICLES 15 (Tide 5), 24, 25, 34, 36 and 6 N¥CRR Part 608 ( Tidal Wetlands Ih· people of the S ale. or cause Ios~ or de~ru£Hon of Ih· natural lend·ney, to cause damage to navigable channel5 or to the bank5 of a.dtloodcapacil¥of th·watercourse No claim shaU be madeagainsl to i 5 fornler condition No · a m ~haH be made a§ainst Ih· State 10 Thai Ih· 5Iate of New York ~haU in no ca~. be I}able for any damage that Ih· proiect ~ill be free from on 1/26/95 6e SPECIAL CONDITIONS During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. All fill shall consist of "clean" gravel and soil (not asphalt, slag, flyash, broken concrete or demolition debris). No excavation of the beach is authorized for the purpose of obtaining fill or stone materials. All peripheral berms, cofferdams, rock revetments, seawalls, gabions, bulkheads etc. shall be completed prior to placement of any fill material behind such structures. Equipment operation below apparent high water is strictly prohibited. 1-4738-01072/00001-0 Page 3 of 5 25 For Article SPECIAL CONDITIONS Tidal Wetlands There shall be no discharge of runoff or other effluent over or through any bulkhead or shoreline stabilization structure or into any tidal wetland or adjacent area. Supplementary Special Conditions (A) thru (F) attached. 1-4738-01072/00001-0 Page_.4 of ~ 5 The following cond~ions apply to all Tidal nds; Freshwater Wetlands; Coastal Erosion Management; and Wild, Scenic, and Recreational Rivers Permits: 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 wizh 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. The permittee shall rec~/ire that any contractor, project engineer, or other person responsible for the overall supe~;ision 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 of this permit, %lnless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. If any of the permit conditions are unclear, the permittee shall contact the Division of Regulatory Affairs at the address on page one or telephone (516) 444-0365. If project design modifications become necessary after per~it 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. At least 48 hours prior to conunencement 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 per-~it. Within 30 days of completion of the per~mitted 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. For projects involving activities to be undertaken 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 subsecfuent years. in The granting of this permit does non relieve the permittee of the responsibility of obtaining a grant, easement, or other necessa~ approval from the Division of Land Utilization, Office of General Se~xices, Tower Building, Empir~ State Plaza, Albany, ~[Y 12242 (516) 474-2195, which may be required for any encrcacb_ment upon State-owned la~ds under, at er. DEC Permit No. 1-4738-01072/00001-0 Page 5 of 5 I s i~NSTALL ~" B^~rTE~ ~- FY F'tTN b PREPARED FOR: Robert & Virginia Dietrich 55755 County Road 48 Southold, NY ]1971 SCTM~1000-44-1-15 S c,~e: 30'z" PREPARED BY: Costello Marine Contr. P.O. Box 2124 Greenport, NY 11944 (516) 477-1199 PROPOSED: Storm Damage Repairs Install 5 batter pil. es rot reinforcement, Extend easterly return approx. 12 landward Replace approximately 10 cu. yds. lost fill January 26, 1995 Si]eeL 1 of 2 Prepared For Robert & Virginis Dietrich 55755 County Rd. 48 Southold, NY 11971 Prepared By: Costello Marine Contr. P.O. Box 2124 Greenport, NY 11944 (516) 477-1199 Janu~ary 26, ]995 Sheet 2 of 2 ? ' ' Albert J. Krupski, President John Holzapfel, Vice President William G. Albeflson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 ~_Coastal Erosion Permit Applicatig~,~ ~_Wetland Permit Application Grandfather Permit Application Trustee Lands Permit Application Waiver ~_Rece~ved Applicat>p~:~_~j~ ~_Clerical Review: ~__Completed Applic~tic~l --Incomplete SEQ~Classification: e I~T~e II__Unlisted. Coor~ination:(date CAC Referral Sent: ~~. Date of Inspection:"~~ Receipt of CAC Reportf(dafe) LeadAgency Determinati~/ Technical Revi~w:(date)~/~ Public Hearing.(dat~~ Decision: Approved ~Application Fee:$~O. Name of Applicant ~5~K~]- Address ~J~7 ~C COU NT~ Phone N~ber: Suffolk County Tax Map N~ber: 1000 Property Location: (provide LILCO Pole ~, distance to cross streets, and location) Agent: ~O~ T ~LLo {If applicable) Address: Phone: q 77-// 7 B~d of Trustees ApplicationO GENERAL DATA Land Area (in square feet): _~ Area Zoning: ~E$1DE ~TI ~ h Previous use of property: ~/~ Intended use of property: N~ C~E 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): i ~ I FILL Bo~d of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: ?~6~ECq- ~Ot]5~_ ~6~. Are wetlands present 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) 1R u LK ~ F---A_D EY,.TE..NSIt,,k3 OF RET',,.)'P,N ts~l_g. ~'~6""FE.¢"-r ~OusF__ .,Ak..~ ..b 5 B~d of Trustees ApplicationO WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~0Si~ ~ $?~-r~f~'J~l; Area of wetlands on lot: ~//~ square feet Percent coverage of lot: ~ % ~ Closest distance between nearest existing structure and upland edge of wetlands: A//~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~/~ feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? ~/~ cubic yards How much material will be filled? ~ cubic yards Depth of which material will be removed or deposited: feet. C&~A~ ~(kk P~O~ O~4A~D ~Ou~c ~ Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: .'~,ACKHO F' q~'D FLACP-- FILL, Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate): 6 County of Suffolk Stake of New York ~EO~E ~. C03TEL~o 5~. BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITIs) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER K~IOWLEDGE 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 AbREES TO HOLD THE ToWN OF SOUTHOLD AND THE TOWN TRUSTEES HJ~RMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMITIS}, IF GRANTED. IN COMPLETINd THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(s) OR REPRESENTATIVE{s)~ TO ENTER ONTO MY PROPERTY TO INSPECT TIlE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS NOTARY PUBLIC 8USAN E. LONG Notary Public, *qtgte of New York No, 01L04958343 Oualified ir~ Suffolk County ,., ~. Commissioct Expires November 6, 1~,~ Suggested space for location Map Tills IS NOT A PERMIT ./ AUTHORIZATION FORM Date: Business/Property N~me I do hereby 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 above. on my property described J. IL., ~ x(,, ~,..,( Sign~'ture · 14-1~'3 |2~3 ~ - Taxi t2 I~'ROJECT I.D. NUMDEa 6t7..21 Appendix C Slate EnvlronmentsI Qustlly Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) t. APPLICANTotSPONSOR [ 2. PROJECT NAME Costello Marine Contracting Corp. I ~6~E~T ¥ ~IR~INIA 3. PeOJEOT LOCATION: Uu.~c~p*.ly ,~O{3T ~ L ~ County Suffolk &. PRECIS~ LOCATION {~freel addfega and to~d lnletsecllons, ptomlnenl 8ndm~rks. elc..or provide map) See Attached area map. SEQR 5. IS PROPOSED ACTION: [] NeW [] Expansion ?. AMOUNT OF LAN(~ AFFECTED: g. WHAT IS PRESENt LAND USE IN VICINITY OF PROJECt? WATERFRONT NYS DEC, ACOE ~ TO~/y'~ (DF ~OO~HO~-]~ DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL7 [~1o If yes, IIsi agency name and permit/approval ' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THF DEBT DP A~llca.llsoon~or .am.: COSTELLO MARINE CONTRACTING If Ihs action Is In Ihs Coastal Area, end you are a slate agency, complele the Coaslal Assessment Form belore proceeding with.this sssessmenl OVER 1 ?ART II.-~-ENVIRONMENTAL ASSES TNT (Tu t)e. coH~pleted I~y Age,my) B. WILL ACTION RECEIVE COOROIIqATED REVIEW AS PROVI[JED FUll UNLISTED ACiFOrlS Itl It tl'~CRR, PARi-.6t 7 6? II No, a negative declafalion may be superseded by aflolher involved agency [] Yes [] No C. COULD ACTION RESULT IN ANY AOVERSE EFFECTS ASSOCIA[ED wHn TRE FOLLOWING. (A.swe~s m~y be handwrlUen, ii legible) Ct. Existing air quallly, surlace or g~oundwatef quality of qua.ltly, noise levels, exlsllr~g t~alllc patle~ns, solid waste ptoducllon or disposal. potential for e~oslon. Walnage or tloodl,]g ptoblem$? E~ptain bHelly: Long lerm, shorl lerm, cumulallve, or olhe¢ 9flecls nol IdenUIled in CI-CST Explain bristly. D. IS THERE. OR IS THERE LIKELY TO SE. COi'ITROVERSY RELATED TO POTENrlAL ADVERSE EtiVIRONMENTAL IMPACTS? [] Yes [] No It Yes. explain brlelly PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse ellect Idenlllled above, determine whether II Is substanUal,'large. Important or olherwlss significant. Each effect should be assessed in connection with Its (a) setllng (I.e. urban or rural); (b) p~obablllty o! occurring; {c) dul'allon; (d) irreverstblllly; (e) geographic scope; and (t) magnllude. II necessary, add allachmenls or re[erence supporting materials. Ensure thai explanallons conlaln sutflclenl detail 1o show Ihal all relevant adverse Impacls have been Idenllfled and adequately addressed. [] Check this box It you have IdentlUed one or more potentially large or significant adverse Impacts which MAY occur. ]'hen proceed directly to the FULL EAF aDd/or prepare a positive decla~'atlon. [] Check this box It you have determined, based on the Inlormatlon and analysl~ above and any supporllng documentation, Ihat the proposed action WILL NOT result In any slgnlflcan! adverse environmental Impacts AND provide on altachmenls as necessary, the reasons supporllng this delermlnatlon: Name 2