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Home My WebLink AboutTR-5757 ~ ,,, Board Of Southold Town Trustees SOUTHOLD. NEW YORK PERMIT NO. S1S'l DATE: ..!.lay 21.?QQ3 ISSUED TO ........ ... ....ANDREWNlKOLICH . Aut~nr¡i!atinu pursuant to the provisions of Chapter 615 of the Lam of the State of New York, 1893: and Chapter 404 of the Lam 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 ..May...21r··.. .2()(H..... and ·in consideration of the sum. of $..2()()..()().·.· paid by Andrew·..Nikolich··· . . .. .......................... ..................... of ..Garden-..Gity.... N. Y. and subject to the Terms and Conåitions listed on the reverse side hereof, of Southokl Town Trustees authorizes and permits thè foUowing: Wetland Pennit to Maintenance Dredge 10 foot x 80 foot area long side existing bulkhead _ Refurbish existing 6'x4O' float. Replace deteriorated styrofoam flotation with vinyl floaters and replace existing CCA hoards with 5/4" lrex decking - Reconstruct existing deck. aM in accordance with the detailed specifications as presented in . the originating appftCation. IN WITNESS WHEREOf, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscnoed by a· majority of the said Board as of this date. ~._'-~,-'-',:~,..,':"":'-':'" :._:...~.:....:..:...:...:....:~:._~-~._~.,.:.....~.--~....~", '.' . . . '." . . . . .. . ," TERMS and CONDITIONS The Permittee Andrew Nikolich ~~~'l residiog at 850 Budd's Pnnn Rn::ar1 ~t"\nf-hQld N. Y., as put. of the coosideøtioa for the ss,"nr# of die Permit does uødcnw><Í and prescribe to the fot- lowåøg: 1. 'Iõat the said Board of. Trustees and the Town of. SooICbol<l .... rdeosed &om IlJ'f and aU damages, oe claims foc damages, of suits arisiøg ditccdy or iDditecd7 as a rauIt of IlJ'f oper- adoo perf~ pursuaøt to this permit, and die said p.... ~........m, at his oe bcr own :sf 1M'. <iefend IlJ'f and ill such _IS· ¡,.;.I.tooI by Ibitd parties, .... the said p.o. I......., -- fall IiobUit7 with. respect d1ereto. to the .........- adusion of the Baud of. T~ of. the Town of. So ..I old 2. That this Permit is· ftIid for a pèriod of 24 mos. wbirh is co...' .'!Id to be the esc;-wI time· re.quired 110 complete the -wod< in~ but should CÏtc.'aIiISW>CC warraøt, ~ for an exœm/.on ma7 be made. to the Board at . btu daIie. 3. That this Pennit should be reWoed indefmitel.y, or as loog as the said Pc:rmime wisbes 10 ....¡....in. the sttuCtUte or project involvec!, to provide eñdence to anyoae conœrnecI that aach- .orization was origiøal17 obtained. 4. That die work åm>1.ed ..m be subject to the ~ .... approval of. the Board (t its agents, and noc>-OO'"'P"''''''' with. the provisions of. the orIsI""lI..g applicatioø. -7 be canse foe revocation of this Permit by resolution of. the said Board. 5. 'Iõat there ..m be no unreaSOC'.bI~ inteefen:øœ with. naYigatioo as . rauIt of the 1VOdr betein aÜchorize<l. 6. That there shaU be no interference with the right of. the public to pus ..... repøs aIœg the beach between high and low _tee marks. 7. That if future opendoos of the Town of SoutboId rec¡uúe die JaIIOftI aad/<x o1œradoos in the loco""" of. the -wod< betein ~h.e<I, or if. in the opinion of. die Board of Tnuœes, the . wod< sbaII cause unreasoaabIe obsuua>oo to free ...~ the said p.-.I.... ..m be required. upoo due notice, to remove or dter this work or project betein stated witbouc e.<per'W:s to the Town of. Souchold. 8. That the said Board will be notifie<l by the Permittee 01 the ccllOf'kdoo of. the work oudJ.- orized. 9. That the permittee will obcain aU ocher permilS and cooseolS that tD&'f be required sop- plemental to this permit wbic:h -7 be subject to reYOIœ upoa failure to obtain same. . . Albert J. Krupski, President James King, Vice~President \ Artie Foster Ken Poliwoda Peggy 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 May 27, 2003 Mr. Andrew Nikolich 89 Kingsbury Road Garden City, NY 11530 RE: SCTM#56-05-15 850 Budd's Pond Road Southold, NY Dear Mr. Niko'Jich The Board of Town Trustees took the following action during a Regular Meeting, held on May 21, 2003 regarding the above matter WHEREAS, Andrew Nikolich applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated April 17, 2003 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 May 21,2003 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 projecl as proposed will nol affect the health, . 2 . Safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Andrew Nikolich for a Wetland Pennit to Maintenance Dredge 10 foot x 80 foot area long side existing bulkhead - Refurbish existing 6'x40' float. Replace deteriorated styrofoam flotation with vinyl floaters and replace existing CCA boards with 5/4" trex decking - Reconstruct existing deck. BE IT FURTHER RESOLVED that this detennination should not be considered a detennination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and pennit issued within six months of the date of this notification. Inspections are required at a fee of$5.00 per inspection. (See attached schedule). FEES: None Very truly yours, ~frt~s&~9<l.-~ . ~ . President, Board of T stees AJK/cjc cc DEC .tote of Council: At: All Motion Carried . Moved by Don Wilder, seconded by Bill Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of SAMUEL & ANNE DELUCA to reconstruct existing fixed timber dock and stabilize existing shoreline. 4'X 47' of fixed timber catwalk is proposed to be reconstructed in-kind and in-place. The 4'X 38' portion of the catwalk parallel to the east property line is proposed to be removed and reconstructed in-kind on the west side of the existing facility adjacent to the existing concrete block ramp. An area of eroded shoreline to the east of and adjacent to the existing boat ramp (50 sf.) is proposed to be augmented with 10+/- cy. of clean fill from an approved upland source and planted with Spartina Alterniflora on 18" centers. A 67+/-linear ft. of 20-50 lb. stone is proposed to be placed by hand along eroded scarp and fill area and along cut bulkhead to the east of the ramp. 11 +/- If. Of one row and one block high precast concrete block wall is proposed on the west side of the ramp landward of the existing cut bulkhead. Located: 1350 Glenn Rd., Southold. SCTM#78-2-31 The CAC recommends Approval with the Condition that all areas, except the boat ramp, be re-vegetated with natural plantings. Vote of Council: Ayes: All Motion Carried Moved by Bill Cook, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of ANDREW NIKOLICH to maintenance dredge 10'X 80' area along side of existing bulkhead, refurbish existing 6'X 40' float, replace deteriorated Styrofoam floatation with vinyl floaters and replace existing CCA boards with 5/4" Trex decking, and to reconstruct the existing deck. Located: 850 Budd's Pond Rd., Southold. SCTM#56-5-15 The CAC recommends Approval with a Condition that the proposed 6'X 40' float is reduced to a 6'X 20' float and the dredge spoil location is specified. Vote of Council: Ayes: All Motion Carried Moved by Bill Cook, seconded by Melvyn Morris, it was RESOLVED to recommend to the South old Town Board of Trustees APPROVAL of the Wetland Permit application ofTHE LAGOON ASSOCIATION for a 10-Year .. N YORK STATE DEPARTMENT OF ENVIRONME. CONSERVATION ... DEC PERMIT NUMBER 1-4738-02966/00004 FACILITY/PROGRAM NUMBER( ·PERMIT EFFECTIVE DATE A ri117, 2003 EXPIRATION DATE(S) Under the Environmental Conservation Law April 17, 2008 TYPE OF PERMIT. New 0 Renewal 0 Modification 0 Permit to Construct 0 Permit to Operate . Article 15, Tltie 5: Protection of Waters o Article 17, Titles 7, 8: SPDES o Article 27. Title 9; 6NYCRR 373: Hazardous Waste Management o Article 15, Title 15: Water Supply o Article 19: Air Pollution Control o Article 15, Title 15: Water Transport o Article 23, Title 27: Mined Land Reclamation o Article 34: Coastal Erosion Management o Article 15, Title 15: Long Island Wells o Article 15, Title 27: Wild, Scenic and Recreational Rivers o Article 24: Freshwater Wetlands o Article 36: Floodplain Management . Article 25: Tidal Wetlands o Articles 1. 3, 17, 19, 27,37; 6NYCRR 380: Radiation Control . 6NYCRR 608: Water Quality Certifica- tion o Article 27, Title 7; 6NYCRR 360: Solid Waste Mana ement PERMIT ISSUED TO TELEPHONE NUMBER Andrew Nikolich ADDRESS OF PERMITTEE Road, Garden Cit , New York 11530 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Nikolich COUNTY ert , 850 Budds Pond Road, SDuthold TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY: Budds Pond Dredge 10ft. seaward of the existing bulkhead to a maximum depth of 3 % feet below mean low water. Resultant 55 cubic yards of dredged material to be trucked off-site. Replace 6' x 40' float. Relocate existing jacuzzi and reconstruct deck, All work must be done in acè'ordance with the DlEc¡ea~ o stamped NYSDEC approved. By acceptance of this permit, the permittee agrees that the permit is contingent u applicable regulations, the General Conditions specified (see page 2 & 3) and a of this permit. ·th the ECL all as part PERMIT ADMINISTRATOR: ADDRESS Gear e W. Hammarth DMG AUTHORIZED ~~ATURE ~ P'/~ A ri117, 2003 J Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTA SERVATION . SPECIAL CONDITIONS 1. 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. 2. The storage of construction equipment and materials shall be confined landward of the bulkhead. 3. All dredged material shall be disposed on an approved upland site and be retained so as to not re-enter any water body, tidal wetland or protected buffer area. 4. During the dredging operation, the permittee and his contractor shall prevent spillage of sediment during excavation and haulage. Dredging shall be accomplished with a clam shell or other closed "bucket" equipment. 5. Excavated sediments shall be placed directly into the approved disposal site or conveyance vehicle. No sidecasting (double dipping) or temporary storage of dredge material is authorized. 6. Dredging is prohibited from June 1 - September 3() of each year to protect spawning shellfish and/or spawning finfish. fõ)1ê a: ~ ~ \YJ IE 0 U11 APR 28 . Southold Towt Board of Trustees DEC PERMIT NUMBER PAGE 2 of 4 1-4738-02966/00004 EWYORK STATE DEPARTMENT OF ENVIRONMENTA SERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the naturai resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shail accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken 10 preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted slructure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitalions or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 9. At least 48 hours 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 an conditions of this permit. Within 30 days of completion of project, the bottom po signed and returned, along with photographs of the completed work and, if requi en ,. d ~ ~l8nillOOl<by the 10. All activities authorized by this permil must be in strict conformance with the a applicant or his agent as part of the permit application. Such approved plans were re ared b Andrew Nikolich on 3/10/03 and last r ised 3/24/c&uth )Iò '0\' oar,I," . DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-()2966/00004 NEW YORK STATE DEPARTMENT OF ENVIRONMENTA SERVATION TIFICATION OF OTHER PERMITTEE lGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributabie to the permittee's acls or omissions in connection wilh the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to compiy with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmenlai Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights 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. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection 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 representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. 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 or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Detenninations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. . General Condition 3: Applications for Penn it Renewals or Modifications 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 or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 18() 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 Mooagement Facilities (SWMF); and . b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitte NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg #40, Stony B General Condition 4: Permit Modifications, Suspensions and Revocations by the The Department reserves the right to modify, suspend or revoke this permit in accordanc for modification, suspension or revocation include: aj materially false or inaccurate statements in the permit application or supporting aper; b) failure by the permittee to comply with any terms or conditions of the permit: c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental con law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commi-s8ioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 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'" i c " - " o . c: -<I . EI ... t " !! ::I .s.cti 0" ::I ..." ... õa..ti "'... .:of -d ]~~ 5 E::SO ~ .:::::¡ Q - 0 ~ .¡: In- :; ~ 'E .S : ~!! 13 = G.I.c:3 .: ~ -< ~ .a ~ - U'" G.I;S~Uþ£ Þl/- ... - 1:1 = 0:;...·:: .s "" '" 8 ,~ " Q,I 0 «= G.I " .. "" " so bII..:.c= ~ .. = '" .. " G.I ".C 0 ... 4:: ... CQ "'CI 0 =~.§] ~ QOo¢::~Y loII':o5~ ¢:.:!..'c.:e '=' t ~ ~ CJ _......G.iCII G,I,=,-"'C"C ~ e \C Go) ÞlI ~~ :~.~ "0 ~ ~ ë.. ·a !i ~·a ~ " I:I"C G.I "r::I - 5 ~~ ~ Ë .... ,t¡rn- .. = =' ... ~ is ~ .¡ CJ cS .... 0 !5:;;~C::~~ ;z; . . . - Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . . 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 SOUTH OLD Office Use Only _Coastal Erosion Permit Applic~n _Wetland Permit Application _ Major - Minor _ Waiver/ Amendmen~hiles _Received Application: t.f 7 O.?> _Received Fee:$ &/11- " J I . _Completed Application ...¡ /17/ ð!J _Incomplete ~ ~ A~R ~ ,~ ~"~ ~ SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) ~ I CAC Referral Sent: -!J!¡ 7 /O!J Date ofInspection: If! D!:J Southold Town _Receipt ofCAC Report: Board of Trustees _Lead Agency Determination: Technical Review: _Public Hearing Held: ·'JJ.1:J-¡/D~ _Resolution: r i .t ~y Name of Applicant ß¡.; Dlu'-vv' NIJ~Dt.i CII Address JJ'1 /L'¡NGS ßUp. '/ ,R oA D GAÆ () é tV C F7. ¡././. 11.~::Jo PhoneNumber() (516) 71;6- 3Y37 Suffolk County Tax Map Number: 1000 - .!I-6 - 05- /.s- Property Location: 19.5Õ BUDDS PONf) /<OAÒ {Å.O/1 1.¡¡'CDfJ./C¡ fo ~"''T ¡.!orne,Rd :::;:: 300 F-I- (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~ard of Trustees ApPlicati~ GENERAL DATA Land Area (in square feet): /(;,720 Area Zoning: R cSldew-h;' / Previous use of property: ,Reo..J' ìcleVlh 'ø / Intended use of property: Ke.r r"c/eu'¡,,"o / , Prior permits/approvals for site improvements: Agency Date DIE~1E1 APR 1 I 2003 E ~ f~ll.l'ilr IÞ 16.rI.S' ß,)/I(/.{) of T~vsrð:,f 1'1:""'7 it 5t¡ !J'e¡ ðOhlð r>,o r/lvJr££J Southold Town Board of Trustees 2. 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): /. Ivfc:"n-lerrc"'c~ cIred¡e. ¡oO.x,fo F-f art"Q. Qloa;rS/d~ ~x/s6;J b,-/kht:::æ=1 2~ KeÆw¿,,;¿ ey,,f 707'1 6 'yl¡o' /1001. ¡?e-µbce de!er'orofeoJ , 1 slrro-k::cll->-l ß/C,./tO'7,wlllt v/f7yII7cQfe.,r.r ,:lad rephce.. e'n-IWn'v CCA I I board./" L<J, It, -% "+~^ dec{¿¡;7'1' 3. Keccpn.r-lvuc..-I- e->c/.r..,4·~7 c/~ck:., Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda ,. . 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 ----------------------------------- ,~ E ~ BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application Q of _~_ðLL(I2£_I..~______ COUNTY OF SUFFOLK) STATE OF NEW YORK) _\4 10WI :14 0\11llS1III I, 4,''/)flEw Mii.t.J':";£i-l , AFFIDAVIT OF POSTING .P't ¡¡"'rS [W] ( , residing at ''7 , I'd é:" (/yde./ {~-I'1- ¡V-'7' being duly sworn, depose and say: That on the 311.° day of 1111'( , 20(),J, I personally posted the property known as t'SG ßudd's f>l;.,·,d Rd by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the ~bliC hearing. Date of hearing noted thereon to be held ~~I ~ ~ 0. ~ '7{J~f)¡n - '/ Dated: Sworn to befo e me this ~ day of 200~ l LA.:>.J:. ¿ J., Notary MARYBETH PASCALE SCISCENTE Notary Pubhé." State of New York No. 02SC5043553 ...___9ualified in Nassau Counry _nmlSlSlon Expires Maya. ~ ~ard of Trustees ApPlicati~ WETLANDrrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: pro µe.r/-"'1 { I I¡/Vÿ'ðve"",~vt-I· / Area of wetlands on lot: /030 GO square feet ..111X13 E~ Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: .::J- feet Town laanl of Trustees Closest distance between nearest proposed structure and upland edge of wetlands: 5 feet Does the project involve e~YJltion or filling? No /' Yes :þL~.D(;.¡£D If yes, how much material will be en:1 1I;§? -6-:;- cubic yards How much material will be filled? o cubic yards Depth of which material will be removed or deposited: 3...£ 2.- feet + 2<0 Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: La,.",: TO ð""LGê'- /D l/''¿/CO''''ð",IG JI¡I(£;A. ])~<ÕÙt;.IIVC HFTµcD ~UI¿L «o::c c:~,;".J"EL 13L1clLf:r. 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 appropriate): ¡VO/Ú':- 1-1.16.4. 121B7)- fext 12 I PROJECT 1.0. NUM8EH . . 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLlSïED ACTIONS Only PART I_PROJECT INFORMATION (To be completed by Aoplicant or Project SDonSOr) SEa 1. APPLICANT /SPONSOR ,1./ 1I1I.D1(£vV /v/¡.!.O/.-tc.# 3 PROJ ECT LOCATION; d . Municipality S O(j-/I, of, County 4. PAEC:SE LOCA nON (Street aodress and road tntersections. prominent landmarks, e[c., I· 2. PROJEC7" NAME .A"'DIfl~ N,w.OL.Ic..u PI(O¡>£R. ry ¡r·fI::Wc·Jc~~o,£~ Jl/H=õ Ii::. ,g.so 13udd's /1r7d j?d IV~"'C IE I W ~ rñì U APR t-7" l!dJ - 5. IS PROPOSED ACTION: o New 0 Expansion gMoClificationlalleratlon 6. DESCRIBE PROJECT 8RIEFL Y: ,. /"fAI"n;Ñ"I'ICC J)L.i:I>Gè< ,O{fXJ't:;>ff- area é7k-l..r,oIe Z . Keku·6ult e"ct.r-/rPlJ I/e::a-f C Gy ~') ;3. !2e=rl.rIrLl c"¡" €»é,..,.lm J de c ~ . Board .01 Trostees e)q.r"''''7~ ÐC/O<Head '. AMOUNT OF LAND AF¡=¡::CTED: o !rollially acres Ultimatelv o ac~~s 3. \fIlL:'" ;:;qO?IJSEO ..\CTrON CQMPL':' 'NITH ~:<IS7ING ZONING OR OTHEFI EXISTING I...;"ND USE =:eS¡¡::¡IC710NS? y¡:.,.,Yes 0 No If ~Jo, descnOe briefly '3. '/.HAf jS ?RESENT :...A/"~Q !;::c IN 'IIC1NITY OF ?~OJECr: ~ ResldenlJal rï.!ncus¡nal 1- C.Jmmerclal ~~!be: 1---1 ':"gncUlture ~ ParklFQrest/Ooen soace ~ Other 10. DOES ACTION INVOLVE A PSRMIT ..\PPRQVAL OR ¡:UNDI~~G, ,\jQW OR ULTIMATELY !=NOM ANY OTHER GOVEP..NME~ïAL AGENCY \F:::iJERAL, STATE CN LOCAL)? )"1 Yes CJ No If yes. !isl agencYIS! aM permilfaoprovalS /, .J)EC 2 . ))cfCirl"",evì-f 0-( ~t'/dlY/( ". DOES ANY ASPECT OF THE AC¡10r~ HAVE A CURRENTLY VAUO PERMIT OR APPROVAL? 0" Yp.s ~~o I' 'I~S, list agency name ana permIt/approval 12. AS A RESULT OF PROPOSED ..\CTION WILL =XJSTING ?ERMITlAPPRovAL MEQUIRE .\IIOOIFICAïION? o Yes No ! CEiiTrFY THAT THE ¡NFORMATION PROVIDED ,.I..eOvE IS TRUE :0 ':""!-iE 3ES, OF MY KNOWL'::OGE ;VI tL c. L I C-t-L Applicant/sponsor O..ue: I¡ !t6 jzt:lD3 I ' SIgnature: -.J. , J/") , If the action is in the Co::>stal Area, and ·¡OU are a state agency, complete the Coastal Assessment Form beiore proceeding with this a~~essmem OV!::R I' ,. I ':OE3 :..C7:":.~ ":'N'( .~-"~'I- ......:II(t:.. I , I';S . 7M:=ìE3¡-:CLJ :) Je ,:::.r.-.:::,e~2'J ~'I .l:;e!;C" :..\.....:::;;... :tl -) :¿·~S:=.;::. ;¡ :..,;;7 -5'ì.·::~ ~ I "fes. :.nar9 :ne r~vlI~w :rQCe5:3 ana 'JSi! ~re =:....L_ ';:,J; ~ PAñ.T 1!_==:NVIRC~JME:'J¡~' ::. NIL~ ..:..C:":C:-¡ ~E':::':'.¡= :::C?DINA-;-ë.;J ::¡EV¡EW ....5 '::Q.C'/ICEJ =.:;¡::¡ 'JNL.S7:::J .:,::7:C~S.N :5 'nC::::.R. :1",,:;-;- -;:;".37 may :Ie sucerse~eC :.y 3.nc¡~er ,nvalVee açenc'¡. . '~a5 ."0 ,f ·~o. 3. ,'eç~r:'¡B :~C:31:; 1...-:"<>" :- :'-.10 C. C':ULD ":"C7lCN .:IE.5UL7":N ),NY J..DvE:=.SE ~:==~,:73 ASS':'C;;..7=:J N17~ -:~=. .=·JL:....:'NI~G. :~ns.....ers ~Q'{::e iancwrlt:ef'l. I ,eO:;I~lè! ::,. =-'1:1511(19 .aIr ':U3I1t"{. ~urraC2 Jf ,¡rot.;nawa!e~ -:ual;ty Jr :t.:antJty, ,1015e e'/"!IS. :x:s:lng '~a;fic ;aner:1s. :;olle .vas:e :¡r¡;Ct;c::::n ':H ~Is:: :Jo!enual !cr :!fOSion, :::ra,na(je.:Jr "loo<:mq JrOClems; -:"-:c!aln ::!nefly: C2. ...I.estnettc, ac:;nc:Jltural. uC:1aeclogIC.3.t, ;'lstCrlC, Jr ::Itner 1at'..J{al ::Ir C:.Jltur:11 ;esourr:~s: .jr :::¡mmunlt'( :lr .1e!C:;;"IccrnOad .:::ã.rac::!r? ~:::Ia!o' ~. '-.... '/ec:;~[aI10n or :auna. 'Isn_ 5~ellf¡sn ::Ir ·....llaHre 5ûec:es. 5lgnliic~nl 1aD.tal~. Jr :nre3Ie!'1ea .jr ~ncançere~ ~::ec:es] SClam ':Jrlerly: C.!.. A. c:::mmunlty's eXls~lng ;J!ans or ¡oats as of[c:aJlY acootec. ,::Ir a cnange In use or Intensity aT use of ~ana or other natural resourcss7 :xplam :::; _.:i_ '_c:ng :erm. :;nor~ :erm. '::.Jrnul'W'/e. ::Ir 'JlMer !!Ifec~s not .cen ,!ctovlEe ~c~.o~" \~ . lalM :me!Jv. ':5. Growrn. 5ucseouenr ::evelocmen!. ::II retatea aC::Vltles likel t. Õ I '~oJ......... c:-..:af :.\;:)Ialn ::Irle!!'!. - :t::~~ ï.JoaC:3 Inc:.....c:nç ::-:ançes .n 'Jse ::It ~!!ner ~l!anll[Y ?r SOUIMld 10"" Board 0\ 1ruslees , laIn :rren·/. ...J. .s -'-!~:::E. :A:S -:-¡...,E::¡¡::: _:K:::!.:~:-C 3E. :::,'-¡-::¡cve:::s'( ::¡E~7:::::J ':"0 ;:¡0T=':IT!;.,i... .:.8IfS.::J.SE :':I\¡\RCNMeJï;'L .,',!Po\(;73? _ '~es _ ~o .f ·~es. ~):.claln ::Ine!lv ';)AR7 !11_0ËÏë:~MINAï1CN ~F SiGNI¡::¡CANC:= l¡"O Je camOleted -:JI( Agency) INSïRUC-;10NS: For ~3C:1 acverse ~rfec~ Identified at:cve. determine whetner It is substantial, [arge, ;mcortant or otnerNlse signlfic :,aC:1 ~ílec~ Si10Uid tJe 3.ssesse<:J ,n c::Jnnec~lon with Its (ã 3etting ¡Î.i!. urban or ~ural): (b) ~rooacllity at oc::~g; (c1 auration' jrre'¡erSlollity; :et geograonic 3c~ce: ana (f) magmtuce_ If ~ecessary, acd attachments or reference supporting matenals. =:1sun:~ ~xClana[ions ccntaln suttic:ent JeIa11 to snow that ail ~e!e'¡ant adverse impacts i1ave oeen identified and adeClJately 3.ccressec. C:'ecx: ~h1S jox if '.IOU i1ave identifiea one 'Jr ,"TIare :Jotemlally larçe Qr srgnlficant 3.G'Iersa jr.10ac:s "t¡tlic:1 ,'.tA'~ oc:::;r_ Then 'Jrcceea airec:!'.I ~o :ne ,=Ul!... ::AF' :ma/or prepare a positive· declaration. _ C;'ec:< :nis =ox it you (¡ave de!ermlned, based on the information and analysis 5bove and any siJODor:i:"'.c coc:Jr.:.entatlcn, :nat :r.e JroQosea ac:ion WIL!... ~~OT result in~r:y sIgnific3nt adverse anvlrcnment3.[ im:ac:: '"'-NO :Jro'lICe ::n 5.i.i.3.C:1ments 3$ necessar'l, the ~easons 5uccorring !nIS determInation: ..."".... H _.:..,¡ ~,\:n<'¡ ~"n! Jf ,¡;t:: ....,rT'IP. JI ",c·,;;;cn\.QLt:: ~II¡c::r n ~"...o ~~cn" ,(It:: :JI "'<:'oonuo"~ ....Jr"c~r ).-:n,¡::,,¡r\: )f ""':':J.Jf¿r '!f ..:":,,,·..nl ;rom ,~~oon\.o'" Jr",~n ;'o.;n.J!\.:fl' ,. ~..'con',ou!' '::r:"èr n ~':-.JQ ~\;.:-n'·1 j...(C o . APPLtCANT - TRANSACTIONAL DISCLOSU~FORH The Town of Sou~hold's Code of &bhics rohibibs conflicbs of nberesb on bhe parb of town off cers and employees, The purpose of this form is to provide information which can alert the town of possible conflicts of in~ereBt and allow it to take whatever action is I\ecessarv to avoid same. TOUR NI\.HB. r / .. ¡..".' "R"·' Nj),z.¿Vv 1'-I.I¡'¿êLIC~·'·¡;:"'''''-'·'!'·~· Last name, [1rat name, m ddle n tal, unle8B you are applyIng in the name of Bo~eone elsB or other entity, suell ~s a company. If BO, indicate the other person's or company's name.) ... ;:·..~~,.·::;~·.t::.:-0f.'.:!..-'¿' NATURB ot APPLICATION. (Check ali thab spplY,) Tax \lrisvanc. Variancs Change of zone ^p'p~QNal of plat ~ Ex.~pbion from plab~r official map other /" (If "other," name the activity.) ..~ (:.~ ~.-.I'. ,...¡ f,,1f' _~.I~::tJJ,..:./f -/<;:-.1 I Do you perøona11r (or ~hrough tour ~b.pa"y, øpouøe, ølb1tng, parent, or chi1d) hDve II relat.ionøhlp wit.h any officer 0[' enaployee of the Town of Southold1 -Relationship· includes by blood, .arriage, or business interest. ·Uusiness in~eres~' ..eand . businens, including a par~nerdhip. in which ~he ~ovn officer or employee has e~en a par~ial ovnership of (Dr empl"r..en~ by) a corporation in vhich the tovn of ricer or eMployee ovns More than 5% of ~he Bha.re8~ TES NO ./' If you ansversd "TBS," comple~e the balance of ihid tor. and date and sign where indicated. Name of person employed by bhe Town of Soubhold Titla or ponibion of thab psrson Oescrlbs tha relabionshlp bsbwaen yournslf (bhs applicanb) and the town officer ør employee~ El~her check the appropriate line ~) through D) and/or. describe in the space provided. _A) bhs 0 corp L lIi a _B) bhe 1 non co r employee Dr his or her npousø, nibllng, a (check all bhat apply). of graBber bhan 5% of bhs shares of the sbock of ths applicjnb (vhen the applican~ rabion) I gal Dr beneficial ownsr of any inbereøb in a por te'entity (when the appllcanh is not a ati n), SOllthold ~w office direcbor Parbner or employss. ot bhe rUI~te ' t . or _D) ths acbual applicant, .... , .., .';";:_' DESCRIPTION O~ I1ELflTIONSIIIP '.- ~ ~ .. .. .... ... ,~w·.._ !.I. -." ...~.~.;~.~:. . , .~ .~,. \ ¡..'\., ,...,t~~~ -::..1]J;' ;-. ",:.~'fllf:,""'~~ri'f~i ~ . "'J: ·,f¡·!~.t1!' sUb,.i t~ed ~his ll.. day of:)(1,-; ~]CL' ~ r. i ' "f'. slghabure /'f.:1F~l:.~.' '~t--........:..~~~i::'~ I A " , ..~. - .Þ04.. ·pdnb nsme Hi:<",'-If{ ...,. CR . ., ~, >:.\?:>,,;A!1~:!t~~~;;¡;" i,,;,. ..(...~)... .~.".:' --., ,,:.J~J11h~¡A~m!ii·.'r:,fJ. I - ~~ard of Trustees ApPliC~n f\J ú- Ssau.. County of SIrifeIk State of New York )"'t>lI.ëV'-I Ail ¡,¿ 0 t- C>H 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 HlSIHER 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 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 REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~J~~ / ¥gnature SWORN TO BEFORE ME THIS /5 T'- DAY OF A-p¡¿;L ,2003 ~~ Notary Public MAR'I1IETH~ N....., Public. YIn No. Qualified In _ CountY ~m;..ion EJopI_ M.r" ., o<GV3 . . 1.1_16_4 (Van-Text 12 I PROJECT 1.0. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISíED ACílONS Only PARí I_PROJECí iNFORMAílON [ío be completed by ADplicant or Project sponsor) 1. APPLICANT ¡SPONSOR L / 2. PROJEC7 NAME rtrlOtlc!:'VV ¡V/lLG>l.IC'-# ¡/¡/þ/C':vV IV f "C:>~fc.¡J P"Of'ER. ry ¡r1I'11lo'''~''tS'<",- 3. PROJECT L.OCATION: d Municipality Soul/¡ 0/ County ..J"l/¡::¡CÕ /1::. 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks. etc., or provlae mao! SEQ .G'.so 13C/dd's /bad ¡?d 5. IS PROPOSED ACTION: o New 0 Expansion 6. DESCRIBE PROJECT BRIEFLY: /, ¡v(,,/I<NC"ÑArlCC J>Jt.':"G~ loIlXJ'C;{f- area ab'J./""'ck eK....r.¡,...:...? 6..../RhC!~e/ Z . ¡Z~.fUrb(.r¡' ",,,cN..4-PlJ I/':C$f- C Gy ~c>') 3, ¡2.e=..,..r'¡"'C/ c'¡' e)c¡..rlml de c k.. . 7. AMOUNT OF LAND AFr=eCTED: Initially 0 acres Ultimately 0 a 3. IfJIL~ ?!=IO?OSED ;"C'íIQN COMPL':" WITH ëXlSïtNG ZONING OR OTHER EXISTING XYes 0 No If ~o. c!esc~lbe orief!y MOQificatlon/aJterallon [E(C;[E r-: .i; ; . i: ,dJ Soulhold fawn Board of g. 'tJHAT IS PRE:ENT LAr~D I;::ë IN VICiNITY OF PROJECT" )c:1 ;::¡esldenllat r-;.~naus:rlal C C,Jmmercial ~~'be: Q Agriculture .--.:. Park./Forest/Ocen scace '- atner 10. DOES ACTION INVOLVE". PERMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY !=ROM ANY OTHER GOVERNMENïAL AGENCY (F::DERAL. STATE CM LOCAL)? )?JYes DNa If yes. ~ist agency(s\ and cermit/acprovals /, .bEC 2. 1>c:: fori THe vt-( 0-( :&¡ld'Yt7 .Or- 11. gOES ANY ASPECT OF THE ACTlO'~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? o Yes' ~o If yes, list agef'\cy name and permll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING ?ERMITfAPPAQVAL MEQUIRE .\IIODIFICA7ICN? o Yes No I CEiUIPf THAT THE INFORMATION PROVIDED A80VE [5 TRUE 70 THe 3ES7 OF MY KNCWL:ùGE Signa lure: IV} ¡¿c. lot c.~ O<1(e: f!t6/Z003 / I ADPllcanllsponsor . J J , ~ J I"') [f the action is in the Cons tal Area, and you are a state agency, complete the Coastal Assessment Form beiore proceeding with this a.~~essment OVSR 1 · PAñ.ï !1_=NVIRO~JM~;'rï')" .ëS3MENï ,70 ~e c:)r.-,:;:~~ac J'I I .... JOE5 .J..C7:C,o,,¡ ::;":CS=.0 :'N'f 'L';:' :-;-':::.E5i-:CLJ 'N -) ~~'!':;::¡:" .~ .:.':.1 '5, i.':, .-\çe!1C" . :1 yes. ~~ rOIf1iit8 :na reV11!W :rocess ana 'JS8 ~I'!e .=:JL:... ::~'=. I~,:,.u ¡-.'O 3. 'NIL:" .:..C7:CN ;:¡E':~:V= :::CRCIN..:..ïëa .~EV[E'N':'S i=lRC'/IOE::J =.:~ UNL.S72:J ..;::7iCN$ iN:) ,\I'(C::;'R. ~.~;¡ï '5;i.57 :T\ay oe sucer$e~ec ::y i!nctr:er ;nvOlvea a¡;ency. :1 .·~o. iI .1eO;;3.I:-/e :ec:;ar:; - - I I C. I ~ Yes '-- :-40 (:~ULQ ":'C7iCN .~ESUL-; iN .Jr.NY ,.\DVE:='S¡;; :F:=;,·:7S ASSCC:..:.íE:J '.vIiI-! -~E F·'JL:..·.:v'JING: :A.nswers :~av:e ,anC:wtll:en../ :e;J~f~t C'. =';(15I1n9 3.lr CU31.ty. ~urtac!! ::If 1rOl..:nawa[e~ ::ualily 'Jr "::t.:anllty, ,1015e ,e'lels, ~x:s:¡ng :~ãific :al'erns. ~oic ,v3Sie JrCCL.;c:::::n Jf Jfs;;:: :;IOlenU31 rc: ~ros¡on. :ralnage ar :looc:inq .:Jroolems? S.~olam :Jnelly: - C2.. ..),estl\e!c, ac;ric:Jllutal, uc~aeologlc3J. ~ISiO(lC, .)r :)tner .'a(~ral :)f cultural :esourc~s: ~r ~:Jmmunt['( :Jr ,'eU;:1~crnOOd ':~Qrac:er? :.xolaLn .' ~. 'feçerõtlan .:Ir :auna. :Isn. sroellfisn or 'NLlallle soecies. ':iIC;¡:miicanr :J,aoltal!õ. :Jr :nre3lene<l or ~ncançerea ~;::ec:es? Stclam :Hlell'/: - - - C":'. A .::::mmunl{'·s e;a::is:~nç ;:Itans or .~oaIS as oflc:..!!,! iOooted.af a cnange in use Of intensity at use at Land Of :Jlher natural resources? =:.'tpJaln ::: -0 c_. Growl". suoseauent :::eVetoomenr. :Jr related aC:lvltles likelY to ~e Induced :JV the .:rcOdsea aC:lon? Ë.'tolaln oriel Iv. ~ ~.,~..~ ~ ,w ~ ¡~ . ':3. '_cnç :erm. :¡nort :o!r,~. :::.:mUlauve, :)( '3IMer ~¡fec:.s nor ,ce!"luliea in -. . ~- '::I:-:er :moac:s oinC:.Jc:nç ::-:ançes ,n 'Jse of ~!tMer ~~anuly ?r :~/~e 0 ~nerg"l? "-,,,.JìøuillQjd,{gwn Board of Trustees - ..J. S ::",!!::=:e. ::A :5 ":"¡...,E;:;iE '_:!<2:",::r 7"0 5E. ::~NT::;ove:=$"( ;:.E!..,),7:::::¡ 70 ?OT~:-ï!;'L ":'8'fË.:::Së ::'NV!RCNMeJ7;'L ..'.~P~C":"'.s? - - _':'e5 _~o 'f ·~es. ~xClaln :JneIJ:-, .~;.\Rï III_OET~~MINATICN OF SiGNIF1C;'NC=: ITo :Je c~mDleted 'JY Agency) JNS7RUCiIONS; For ~3C:1 aaverse ~rtec: identified at:ove. determine wnetner it is suostantia, large, ;mcon:ant orotnerNlse siçnlfic. :ach :!ífec: silould ~e assessed in connection 'Nlln Its (a) setting tLe", urcan or ~ural); (b) ;lrocacility of oc:;~-Wg; (C! duration' irre'¡erslbllity: :e geogracnic .3c:Jce; ana (I) magOltuCle", It necessary, add aUachments or reference supporting malerlals", ::1sur.c: ~xclanaticns c::;n(aln suitic:ent l3e.tail to snow that all ~e!e'lant adverse impacts have been ideotifiea and aCeCU3(ely aCCressec. I - , - I , I - , - , ; , i , CleCK :his :,CX iÝ 'IOU have iCemiiieQ one or ,-nore .::otentiaJly larçe or significant aG'Ierse imoac:s wnic:1 ~.1;"·~ oc=~r. Then :Jrcceea airec:Jy 10 :he ;=ULL :AF 3.naJar ¡::reoare a positive" declaraticn. C~ec:< :his ~ox if you have determined, ~asad on the information and analysis above and any SUDDor~¡í':ç coc:J~entarlcn. :hat :t:e Jrocosed ac:ion WILL ~JOT result in--*r.y signiÍicant adversa envlrcnmenral ¡mcac:: AND ;JfOv1ce ::n a¡t3.c:1ments as necessary, ¡he ~easons 5upconing mls determlnarion: """",\." ~I ...,...u "'\;1:"'" J"nl .)r . ~~.: "...n.. )1 «,',;:;on"OI'" ·...;II'c-.:r n ;........c ....."'''c·, :'IL~ ::II ..(..:~ccn\oOI~ WII'Ctt ;.\;n.Jlurt' )I -<..\con..QI'" ':;I:,(.:or.n .("..10 ....'Õ..ru:;y j.'(n.,¡;u'''' )f ""0::).)'("' ~II .;'I:...·("nt ;ram ,,:,)oon\oo,o: :)",,~n J..u;: o . . U.~6.J. (2la7l-reXI 12 I PROJECT 1.0. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I_PROJECT INFORMATION (To be complered by Applicanr or Project sponsor) SEa 1. APPLICANT ¡SPONSOR L I AIfJ:JIt,.:vV IV f¡¿.O/-fc.¡.J 3. PROJECT LOCATION: -/,'1 Id Municipality SOU 11 0 County S l./ ~ / i::. 4. PAEC:Se LOCATION (Street address and road intersections. prominent landmarKs. elC., or prevlce map) I 2. PROJEC7 NAME ,¡4"'DIZ~ ¡.J'~l.IC-li PIt.Of'~1I.TY Ir1FWo"'/e:"'':N~ g.so Bc./dd's !1::,r7d f? d - - 5. IS PROPOSED ACTION: o New 0 expansion 6. DESCRIBE PROJECT BRleï=L Y: /, ¡.1AI"""""'Af'/CC J)A!.':"G~ IOf(.X.;orf- area olc.'J..r..~ exr.r'¡"";f' hu/Rhead Z X<=!ûrb'J'h e¡c;.r~"'J I/~c:d- C 6'y ~D') ¡:::;;o Ie ~ 'W \E F:\ ;3. ¡l!.e=..,.r!rc./ c..¡. e)£NI,,? de c k. . . if: \E ~ \.Ç. ", \ \ \Ij !leC' 'LUUU ¡,~ \ .NMoaification/alteralion 7. AMOUNT OF UNO AF;:ëCTED: InlHally 0 acres Ultimatelv Ü 3. WIL~ FRO?OSEiJ ACTION CQMPL':' WITH EXISilNG ZONING OR OTHER EXISTIN t1-'-A, Xves 0 No If ~o. describe oriefty use: ::1ESTRICTIQNS7 Sout\1Old lown Board oIlrusteoS 9. 'UHAT IS ?RESENT ~t~D I;::ë IN VICiNITY OF PROJECT? ~ Resldenllal r-;.!ncus:nal C CùmmerClal ~:lbe: o Agriculture ~ ParK/Forest/Qcen scace '_Otner ~o. DOES ACTION !NVOLVE A P'E:RMIT APPROVAL OR FUNDlr~G. NOW OR ULTIMATELY FROM ANY OTHER GOVe¡::¡NMENTAL AGENCY (FEDERAL. STATE Ort LOCAL)? )?J' Yes 0 No If yes, list agenC'{(s) and permit/approvals ,. .DEC 2 . Ì)cfClr/"..,evl-( 0-( ~¡ldlY/r ·r ". DOES ANY ASPECT OF THE ACTlQU HAVe A CURRENTLY VALID PERMIT OR APPROVAL? dYes ~o II y~s. list aQeC'lcy name and permil/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL ¡::¡eaUIAE .'vIOOJFICAïICN? o Yes No I CEñTIFY THAT THE INFORMATION PROVIDED AeOVe IS TRUE -:"0 THE 3EST OF MY KNOWLEDGE ¡VI IL Q L I c.1-L SIgnature: . J ,~..-") Q.,Ue: It hG /Z003 / I Applicant/sponsor If the action is in the CO"$tal Area, and '{au are a state agency, campi ere the Coastal Assessment Form bet ore proceeding with this a.~~essmen: OVSR 1 ?Añ¡ !1_::NVIRO:'JMENï,).,' .::::-""'1- -') . -' re" "{ .\ -o"'c· ...,:)L' C, I ", 'Je C::)(';"',...I'=. ...... .....':::t-., . il yes. ::>crClnaI9 :ne rg~I~'H :rOCe:53 ana 'Jse '.r.e .=:...L:.... ::'A'= .... -::CE5 ;.ç:;C~ ::~C::::=::: ;.,'¡y ",::S. 7¡.,:=:E:s¡,;ûLJ:N -} .'~~G:::.¡::;. ~.:.F.ï j:7:Z'" 3. 'NIL!... ..:..C7:CN .:;E.:~:\i= :::CRCIN,:..7ë.iJ =1EVIE'N"'5 ?P.C'J'CE~ =.:r:\ UNL.S72C> ..;::'7iCNS iN 5 .\·rC:='R. ~.o\ñ7 j~ ;-.5, may oe sucerseC:e'= :<Y ~not~er ;nvQ'~ea a¡;enc'f. :=·~,u 1_:-10 :1 .·~O. 1 .1eo;;;¡t'Ve ':~C:.H::; ~Yes ~:-IO c. ::':ULO ..:..C7iCN .:;,ESUL7 ,1'1 ..Ir.NY ~OVE:=.SE =':=?Ë·:7S ASSCC:;.iEJ 'NliH -;-'E. ::'JLL":WING; :).nswerS ;":"Iay::e 'anc:wrlt:e!'l..I .e~~I~1 C1. ::,;ustJng ¡Lr ':ualit'(, :iurfaCS ,Jr Qro~nawate~ ::ualiiv ~r ,::t:anIlIV, ;"IOlse ;e·{eI5. ~X!S~lnq ::aific :anarn5. sOlic: .vas:e JrOCL;C::::;"I ::Ir ~Is::: potentIal fcr U05Lon. :ralnaçe or :toocinq :Jroclems? ~":DlaLn ::H!erly: C2. ~eslnel!c. a¡;r1c~Jltural. HC:'IaeologlcJ.l. :'Is;onc. Jr :~Hner ia¡:.Jral ::Ir cUlfuraJ ;esourc~s: ::Ir ::::Immun,ty ::Ir .iel!;ilccrnOoo C~ã{ac:er? ="";claln - C:. 'e¡;elatton or :auna. ·Isn. sr.ellflsn or 'Nllolife scec.es. :ugnli¡cant ~acltal~. or :nre3.teneO or !!ncanc;ereo :;cec:es? SIelaln Jrlall'l: C~. A c=mmunLt'('S axis.ing ;¡tans or ~oals as otlc:.Uly adooteo. or a cnange Ln use or intensity ot u.:se ot !an<3 or olher natural resoun:es? ::tpJa¡n ::; ':5. Growth. suoseauem :evetooment. ;Jr relatea ac::V¡Ues likelY to ~e ,nouceo 'JY the ::rcoosea ac:ion? ::.x;:¡laln Jrleily. ':5. '_cnt; :erm, ::inort :er:TI. '::.JmuJau~e. ::Ir <;.liner gtfec:5 nOI ,c:enlliieCl in C~-':57 =x;:)laLn Jrlell'(. -:t:-:e~ mcac:s .inc:.,¡c:nç ::-:ant;es ,n ·Jse ::It ~:tner qt:anwy ~r :yçe or ~nerç-n? :,:(:::11';'10 :;r:elly. :;. S ':""!-!E:::e. :A ,5 ·~ï.....E~E :..:!<2!.::- 7'0 ;e. :::Nïi10VE?S'( ::I.E!..A7::::J 7'0 ?f'JTË:'IT!':".. ":'~'=:;!.Së =:-IVIRCNME~í':'L ;..,~P"C7.s? _~es !- No .f ·~es. ~xclaln :Jnelly ?.o.Ri 111_OEiE?\MINAiICN OF SiGNI¡:¡C,o.NCE (To "e comoleled "y Agency) INSïRUC710NS: ror ~3C:1 aaverse 2ifec: identIfied at:ove. aetermine wnetner It is sucstantial.large. :mcariant or olnerwlse siçnrfic ::3.C:1 ~ílec: siloula tJe ;,ssessed in connection witn Its (a) setting tl.e. urcan or rural); (èJ ¡:Jrobao1Iity of occ~-Wg; (c duration irreversibIlity; reI geogracnic 3ccce: ana (f) magnltuae. If necessary, add attacnments or reference supoarting matenals. =:1sun~ ~xc'anaricns ccnt3Jn suftic:ent delali (0 snow !tlat all :e!e'¡ant adverse impacts have been identitiea a.nd adeQUately accressec. C:-teck :his box d 'fou have identifieo cne or ;TIore ;:::otenrially larçe or significant aC'Ierse imcac:s whiC:1 ~,1;"'~ OC:::.Jr. Then ;Jrcc22å airec:ly to ~ne ;:ULL =Ar an%r prepare a positive- declaraticn. C:'ec~ ~his ~ox :t you have determined, ~asad on the information and analysis above and any SiJooon,::-:ç coc:.JrnentðOcn. :nat :t':e ;Jrocosea ac:ion WILL ~lOT result in....-,1.ny significant adverse anvircnmenraJ imcac:.: AND :Jrovice 'In ;,;,t..ac:1ments :as necessary, the reasons supconing this determlnãtion: "'"",~ 11 .~...o.J "''õ.:nc·¡ "'''1\1 Jf ~~..: "'..rn.. :)1 -(,',;;;01\\101": ....:,c~r n __......0 ...~.:fIC·' :'11": ::)1 {\:~oonUO1! VIl'C.:r ".;nJIUrl! )1 {",~conUOI~ '':I:'c~r ,n _",JO ....-.,:I!ncv )'OCnol:U(1! )I r'·~~.Hl!r ~Ir ..:u:e~l!nl ;ro"" ,,,,)oon"o'~ 'Jrr,co!rl .)...!C 2