Loading...
HomeMy WebLinkAboutTR-5144 Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ISSUED TO . S/4'l DATE: ..Mar. 22, 20.00 8ARBARA S.. KELSEY Autl1nrilatintt 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 Mar· 22,...2000 1'r 2 0 09 and in consideration of the sum of $. 150.,.00 . paid by 8ARBARA S. ..j;:ELSEY of Milttit).!ck. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: ~ Wetland Permit to repair and replace a bulkhead within 18" in 1 front of old bulkhead and approx. ~c.y. of dean fill from up-' ~ land source placed behind bulkhead with condit. that a re-calcu- . . lation of fill be sent in and that this is the last time óulkhead- can all in accordance with the detailed specifications as presented in be the originating application. 'bumped out'. IN WITNESS WHEREOF, The said Board of Trustees Mre- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. . . 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 (516) 765-181f2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 24, 20.0.0. Barbara S. Kelsey 3790. peconic Bay Blvd. Mattituck NY 11952 Re: BARBARA S. KELSEY SCTM #128-6-4 Dear Ms. Kelsey, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on March 22, 20.0.0., regarding the above matter: WHEREAS, BARBARA S. KELSEY, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated February 22, 20.0.0. 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 March 22, 20.0.0., 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 BARBARA S. KELSEY to repair and replace a bulkhead within 18" in front of old bulkhead and approx. ~c.y. of clean fill from upland source placed behind bulkhead with on re-calculation of fill and that this is the last time bulkhead can be 'bumped out'. Located: 3790. Peconic Bay Blvd., Mattituck. 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 pro;ect 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. DEC Dept. of State ACE . ~~ <i~ ~". ~.v~ ~~ :::. 'J" 'I:) =-~ ,< <iO 2: ,~ "'ð. ~{¡ '.i . i',,-v~ r' 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 (516) 765-18'!2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Onl ___Coastal Erosion Permit Applicatio ___Wetland Permit Application Grandfather Permit Application - -Waiver/Amendment/Changes Received Application: ~r #-0 D Received Fee:$/tJO .,." ( 0 Completed Application 'I. Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date sent) ---- CAC Referral Sent: óL - ~~. 0 Ù Date of Inspection: .'~ - 00 Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: ,3-.2eJ..·UÙ Resolution: o ~. LU,fnì ~~2 2 íIDJ :æJ TOV',\! U'Ii:' /. 'i;H~OlD ~ I .. J "-.....,...J f ~ Name of Applicant ßliI<ßI1f(,A S K £.1-5e:f '3790 p£ CONI'" /Yl'í SJ,.VD Po ßDX ....- / Address 40) ) /YIfl77/jVti( AJY JJ952. Phone Number: (Sib) 2. 9'8 ?t:,37 Suffolk County Tax Map Number: lo.o.o. - J2..~ -Or;. -04- Property Location: '37 '7 0 "Pe.CONIC £14 y ß/.. I/O. /YI117T/lv C K . /J/1f¡£f.-7L.'r' AU os. S r-I/O'" D£/...rn~ Dft./ vtf' (provide LILCO Pole #, distance to cross streets, and location) AGENT: WIJ...J...lfJm R- XELSr!1- (If applicable) Address: tJ"'"8 W. ~PRINGï(JfAJN f1.D /-"ONc:' VIU.l.n o7~S3 NJ 1 ,o~- 87' -Y~'9 Phone: 9 73 FAX#: 97 3 C. 51ø 8'2.3<:' b~~ «1.lJì - tlrrd of Trustees APPlicati~ / ' L'.-' GENERAL DATA Land Area (in square feet): 3g,4<;& I Area Zoning: R&.'JJÐQV7/AL. Previous use of property: 51t1"11C Intended use of property: 'SßrrJ/£ Prior permits/approvals for site improvements: Agency Date 7< No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? Á-NO Yes If yes, provide explanation: Project Description (use attachments if necessary): CON$7.tUCTJO,J OJ=- ¡qI'P/lD){II"!IITt£1.. 'r' /00 t.1 J~ F-tæ:T OF 7/fYlßETl. I3VI.K.J.iIf.1:1f) Tð fl6/'l.l9v¡;: GX1:5T IIVG ßOI.!<.J-ItdJD, !vËVJ 8vLJ<.j/tfflþ wlH ß/E iNSTl9ht...¡£f) /\JO Y'f>O/?/S 7HltN /8 INCJ (;5 IN J-=/i'ONï (If I2XISTIN0. ßVLkH~, jlL...4CŒmI:ßJT oP ßI'I'~OXJrf)"7'CL'( /C,~ C-v ~1'!~05 f)F t:..J..J£Y>rN vPt./-tND FIl.l-. (SANa ßI'}~KFJ'-I.) f]EJ-/IAJÐ Il()L~H(l"JI)- sa- I}TTIH.Jí!/Q) fMf"I'( Cù~P5 oP- ØJC/NE'€/lS JðJWï' Pð?fVl1j r+ pPU<;;frnolV- 2 02/28100 MON 10:06 FAX 516 i65 1366 . Ioard of Southo1d Town ACCOUDiìÞg Trustees Application ~002 WETIJ\J;fD/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations; COAJSÎAu ~ ÎJoN 0/:' ¡:¡ Wðf;{) ílfY)!J¡£f1. I3Ut-.K Ht...r-Äb /8 INClt-t!S hI /'!I?';'NÎ (If L£'i.IS TINC ,ß1/L.J<J+.otb. ßII~J<FJI../" I/OJð WITI~ c:..t../:.rtN v,PI./tNf) PI../.. (SfiN/J.). Area. of wetlands on lot: o square feet Percent coverage 0: lot: - % Closest distance be'twe~~nea.rest existing structure and upland edge of 1.;'etlands:. +-.'/J feet Closest d,istance bc:tweeq nearest proposed struc1:ure and upland edge of ',¡etlands: __ IItfh feet Does the project involve excavation or filling? No v Yes If yes, h.ow much m",-terial will be excavated?-O cubic yards How much material ",ill be filled? ~ /CoCo cubic yards Depth of which matE'rial will be removed or deposited:70 70P ap rvlFW ß"'t.XHrf/I1) feet Proposed slope thraughout the area of operationn: Aç~ l'~oP¡:flTY VSIN~ sr>'IlHI.. removed or deposited: éJvt:!fl. u/'t..fiND I.!v~ I... DO-¿I£/l I'f1-NO IS T HðIllD. Manner in which ma1cerial will be 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 att:achments if appropriate): AioAJ¿ 3 ~ · . STEPHEN M. PAWLIK P.O. Box 1611 Mattituck, NY 11952 51 298-5412 Retaining Walls Decks Bulkheads J>b:"t:l ~~~ å ~ ~ ~ ~ 1\ ~\ "'i.ï' " " ) ~ -I -K ;S c. ~ 0- ~ I" -..¡ SJ ~I ö:. ~ c: U> r- '4 ~ ~ ~ '" ~ G') ~<:::> I: ~ -.. o -... '(" ~ ~ï ~ t'\ ~ ~ ~. ~ ~~ 8 " ~ ð.- ~~ ~o_ Brick Walkways Beach Stairs Docks \ --í 0<> __r " I, ~ ~ ~ ~ I ~ '" I '\ "- ...-::. i\' ~ ),,:0 l' ~~ ~ ,.. .(:. ~ ~ ~ ~ G ...¡ .. ~ i ~~ t~~ , ~ ~ i , ~ 'ï".\ h ~ ~ ~ ~ ). ("<, ~ i1\' 0 G'\ ~ ~ . 14-16-4 (12197)-q rROJECT 10 NUMBER . SEQR 617.20 APPENDIX C STATE ENVIRONMENTAL OUAUTY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME BRRßN</'1 S. K£L.St:.7' I? e.P¡" /J~r£/Y) 1ö.7v! OF- 7'lrnßð1. ßVLI<Ht;7ð-D 3. PROJECT LOCATION: MunicinalilV 7 f'I(V IV ("))= $,O!,/THOI--i:! County .'-. U PPVI-J< 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide mr NY 3'790 ¡')G..CONJc" M)- 13).. VD) rn~TTI TUC AcROS.S P.R'O¡Y\, DE:L('I')13f/. {)IÇJ Vé: 5, I.;';-~OPOSEO ACTION, New 0 Exnansion o Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: c.ONSTnvc..T TIrt'J 13 i=.7I. 13L7t.KJ-t£ltfJ /6 I NC l+é.> JW P lPòN î OP 21.1'>7 /N~ TI /'I!IJ, t:.7I. !3vl.!<Jftd1/) ~ ¿:YI57'1NG ßvt..J<#Y1t) IS !3é."YO/vf'.J USê.J~VI..- sê:7?VJc.r;: ¡:}¡.J!J ¡( 661 /./1 rN:5. /?1::.-PLl~r;, t rr')IDvÌ'. 7. AMOUNT OF LAND AFFECTED: Initially .003 acres Ultimately _003 acres B. Will PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? XVa. o No If no, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~eSidential o Industrial D Commercial D Agriculture D Park/Forest/Open Space. D Other Describe: fIOVs ,¡: OJJ ¿PtECON I" 13 /j-- 'í . 10. DOES ACTION INVOLVE A PERMIT APPROVAl, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or Local)? )It Va. o No If yes. list agency(s) and permit/approvals 70WJJ OF SovÎ}jO"l> Wt!T<..A1v ()S /> Q1¡Y) I /'.. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes XNO If yes. list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION Will EXISTING PERMIT/APPROVAL REOUIRE MODIFICATION? DYes ~o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE "J ~ /tfD Applicant/Sponsor Name ?J/J ¡{ l:5L£é "'r /Jc.éJJ/ Pc/! ß'Yi'BMÆ Xt:l.Sèbate I.Á Jßr-PL...! d I J SIgnature /' / // If the~tlon Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 02/28/00 ~ION 10: 07 FAX 516 765 1366 . Board Southold Town Accounting . of Trustees Application 141005 County of Suffolk State of New York WIJ.J./Mh A Xéls<r"r (JI GtÐvÎ r-tl1/ (JWNa) _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 Q,e' HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS Mi~Y BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGRE,gS TO HOLD TB:E TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR Bï~ VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS AP::?LICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT (S) OR :"!EPRESENTATlVES C S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PRENISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS / sr DAY OF mÆf(cff rfÆ~~~dYV{mD 01 mAR. Cú TIIOMASJ. ROMANO NOTARY PU8UC OF NEW JERSE\' CcmmlSllon Expim 2I6I"Jt1J3 7 02/28/qO MON 10:07 FAX 516 764iÞ366 Southold Town ACCOun~ @] 004 l'ROOF OF MÄILING OF NOTICE A'TTACH CERTIFIED MAIL RECEIPTS Name: Address: PS Form 3800, April 1995 ~ Õ ¡¡zæ ~æ ~ ~ ~-4!"§oË~ o. ~~~D333:e!.. ~ "tI ~¡I! 00:JJ:1 0 Q~<i3.[~~.o" .æ. g¡ CD~· ri :. m-i ~~ J -; ~ ~ ~ ;r g: s: c..<.c CD ¡; -,..... N r\J ... IT" .z= .z= .... "IJ I:J ..D STATE OF NEW YORK COUNTY OF SUFFOLK " (AG.ŒNT rot{ eJ'-JNt£P..J lvll../...JA,trI ~ Kêi"St:."Y , residing at '5"8 W S¡DI?IIIJÇ."tOv" tJ {If) LON' N L 07851 , being duly sworn, deposes and says that on th,O! / fi'da:y of l'YIMci+,";l.o(}r), deponent mailed a true copy of the N()tice set forth ~the Board of Trustees Application, directed, to each of the above ,named persons at the addresses set opposir:e there respective ,names; that the addresses ¡;;et opposi I:e the names of said persons are the address of said persons as s''!own on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Posl: Office a I: t..ONG. v/ft.t.L'r IV T, that said Notices were mailed to each of said persons by (certified) (registered) mail. ',' vlkLé'1 .'" ç"- Sworn to before me this / J day of /I?~c.¡,+ ,"J!II 2.000 rf-lurm*1P([rrl@rK") 01 /'f\Moo No .~~c NOT:;:S~ :ERSEY Ccmmls$ion Expires 216!'J!XJ3 úÜJ-i4cDJ Q ÞL;¡ 6 02/28/00 MO~ 10:07 FAX 516 765...66 Southold Town Accounttlf I?J oo~ PROOF OF MÄILING OF NOTICE A'J.'TACH CERTIFIED MAIL RECEIPTS Name: Address: PS Form 3800, April 1995 o z:Dc ~ d UH '" f :;;> ~ "'CJ~ ~~o~(þcn ~ ~ " ~ .... g.. 3 ~ 3 s, ~ O--m. -::I::In""O .. "- .. i!. ~ 3~~g.oõg,cncþg w .- !iil'''''' . - c: c: _ .. ~ i!. 0 ~ ~ o¢z - (I ti! _.~ Q~ ~~n 0 .. . . c: {'"\ CD::I"'O ~' . en 3--- _n...cn .. ë! ~i T'" Q CD....~ N ¡¡>ø ~' '" !'< '!' ~ ~ ' :;-go ñ· -. '" ~ Qoo "'0 ë\' CD (ß ... (D ru ~, ~ .& ~ .,,~ ,- ~D10 "" " ()? '5 =~ CD IT" ~~. r§. ::. g "tJ;::¡' ~ (It >-~o~ or .... ~ s. ¡¡" or ..... e.c.g" "" "'=> (""""0 -~ e, en' !!: CJ .. ~ -< .. !!!. ru "" .... '" "" w ;¡¡ "" C> .... ¡;¡ -' .. STATE OF NEW YORK COUNTY OF SUFFOLK " (AGGNT rOJl.. ()"'No:.7<j i.vII..I..IIVr¡ /'¡ Kéi.St:.-r , residing at 5"8 W S,PI?JIJ(,,7TI"',J (ljJ LONt;. N L 07851 , being duly sworn, deposes and says that em the /~ída.y of TYlMci+, 111I7.(}~1 deponent mailed a true copy of the Notice set forth In,the Board of Trustees Application, directe~ to each of the above named persons at the addresses set opposir:e there respective ,names; that the addresses set opposite the names of said persons are the address of said pe¡~sons as s"'1own on the current assessment: roll of the Town of Southold; th.3.t said Notices were mailed at: the United States Post Office at L..ONG. vflL.l..&r N:r, that said Notices were mailed to each ,:>f said persons by (certified) (registered) mail. v/kr...{''1 /' 51 Sworn to before me this I day of rnMCH , S 2.0dD dL~j~1£òYY)OIYkJ 01 mARoo N ry ub.~~ fHOMAS J. ROMANO NOTARY PUBUC Of NEW JEI/SEY CommIsIIcn ExpIIN 2/61'JffJ3 ~(j7 6 02/28/00 MON 10:0i FAX 516 i65~66 Southold Town Account4li I4i 004 PROOF OF MAILING OF NOTICE A'J.'TACH CERTIFIED MAIL RECEIPTS Name: Address: ~ PS Form 3800, April 1995 ~ !Ilf I I II ';; ~~..¡¡¡ i!. " " o i~ ~_oo CD ao Ii! RI.g·![ ~ <1) -'J~¡gl ~ B Š~· if m O~ õ ru .... IT" ... N C' _\:\ ..c ....t. 1/., o<Q c""'" ~ ~ .... ru o [þ STATE OF N:E:W YORK COUNTY OF SUFFOLK ,) (AG.61.JT FO¡¿' ðWNC"'Py ivlt..L.IIVYI If Kët.Sê'r , residing at'5"S W S'p/?IA,jI;,7TJv<tJ (If) L.ot-" N L 07851 , being duly sworn, deposes and says that on the / Si'da:.y of l71I'r1rCl+ ',1B7.or;p, deponent mailed a true copy of the Notice set forth!n,the-šõird of Trustees ApplicatiOll, directed. to each of the, above named persons at the addresses set opposi~;e there respective.names; that the addresses set opposite the names of said persons are the address of said persons as s:'10wn on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office a I: L.,ONG i/1fL.1.£ì N 'J", that said Notices were mailed to each of said persons by (certified) (registered) mail. vlk<-<'1 , çj Sworn to before me this I day of /hl'fl ((f ,:IIJ: 2(121) tffc~tfYJ¡a'YQ ~,~ LX) NOTARY I'U8IJC Of NEW JERSt; CommIsIIan Exø/IN'l/6/'Jl1J3 Ál,ßAuw, (2 f;k;;/ 6 02/28/00 MO~ 10:0i FAX 516 i6541Þ66 Southold TOlvn ACCount4lj I4i OO~ PROOF OF MAILING OF NOTICE A'l'TACH CERTIFIED MAIL RECEIPTS Name: Address: PS Form 3800. April 1995 '0 a ~~~, '" ~;;:-"~~3~' ;. ~ !' g.:D i g ~ m~ ~~ " N ~ 'i ~.§' ¡¡>~ t ~ ¡jo ¡ f. ~ ~ ê5' ~ær ~ 0- .. .c .c ... VI ~,~ '....J -l '.' ... o STATE OF NEW YORK COUNTY OF SUFFOLK " (AGGNT FoR. ()WN"--P..J ivlL.L.,IIY" IJ Kéi..$ê'r '. , residing at, '5'ß W S'p/?IIJÇ"77JV'I,,J {I/) LOt'''. N L 07851 , being duly sworn, deposes and says that on the / ~i' da:y of l'Y1Mctf , ,1B;r.oCc,' deponent mailed a true copy of the If()tice set forth in, the Board of Trustees Applicatiol'l, directed, to each of the above named persons at the addresses set opposi~:e there respective ,names; that the addresses set opposite the names of said persons are the address of said pe¡~sons as s-'lown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office al: L.ONG. vht.t..£r tV:r, that said Notices were mailed to each ()f said persons by (certified) I registered) mail. 1'/9<..I"C'1 ?J~ 0/7' --- / :II Sworn to before me this day of /1'I/tI?CN ,9?~ ~ ~~Æ~arv 0 I fY\AR.cp ~t'l %'1 RtOMASJ,ROMANO NOTARY PUBlIC OF NEW JERSEY Commission ExpIIes 2/6/2f1J3 6 . . A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NVCRR PART 617.4? o Ves o No If ves, coordinate the review nrocess and use the FULL EAF. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NVCRR PART 617.6? o Ves o No If no a net'latlve declaration mav be sUDerseded bv another Involved aaencv. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing atr quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal; potential for erosion, drainage or floocling problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significanl habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, çr related activities likely to be induced by the proposed action? Explain briefly: ce. Long term. short term, cumulative, or other effects not identified in C1-C5? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D, WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABUSHMENT OF A CEA? o Ves o No E, IS THERE. OR IS THERE UKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? o Ves o No If yes, explain briefly PART II-ENVIRONMENTAL ASSESSMENT (To be completed by Agency) PART II-DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identifled above. determina whether it Is subslãntial, large, Important or otherwise significant. Each effect should be assessed in connection with its (a) setting (I.e., urban or rural); (b) probability of occ:urrlng; (c) duration; (d) Irreversibility; (e) geøgraphic scope; and (f) magnitude. If necessary. add anachments or reference lupporting matenals. Ensure that explanations contain sufficient detail to show that art relevant adverse Impacts have been IdenUfled and adequately addressed, If question D of Part II was checked yes, the determination and sig- nificance must evaluate the potential impact or the proposed action on the environmental characteristics 01 the CEA. o Check this box if you have identified one or more potentially large and significant adverse impacts which may occur, Then proceed directly to the FULL EAF and/or prepare a positive declaration. o Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name or Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Prepare, (If different from responsible officer) Date l 1IJrd of Trustees APPlicati9IÞ County of Suffolk State of New York ~~ð'I~ ~ - ~IS€ DEPOSES AND AFFIRMS THAT HE HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND~ LL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN TH ER 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 ~USTRES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT ( S) OR REPRESENTATIVES ( S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. BEING DULY SWORN ó3J~~ .!. t(JAO.x Signature ~ SWORN TO BEFORE ME THIS L DAY OF r~ )4" 20D I '- h~~1\i\'0 JÍn~ Notary Public MElANIE V. BP.O"",1/ Notary PItJIic, SIal. 01 New YOlk No. 4908712 CuaIfied In &lU CouIq Commlalon Expiree Oc:I, II, Z aD I 7 . . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P,O.Box1179 Southold. New York 11971 Telephone (516) 765-1~ Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of NfJ.!__~_ßttMdM--~f.'=---~-~t COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I , w/YJ. IJ KI!£LSr:'r , residing at ~ ¡.,) ~I?INr:..Tm-.t>J /{!) J..."",c:, ..l1qJ..!.~ ^.J ~"')".,~ (¡:¡r~<PvT·=>t:T€ o.....Nl£Þ.) being duly sworn, depose and say: I>/- T" WK '2.(0) That on the @ day of fV\Pc{(cij 1»9" , I personally posted the property known as 3?90 /lG.c.o':'·.. ßAT 8J..1I1,) /I'I'HT"U'" NY 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 seven days prior to the date of thq puJ;Jlic hearing. (date of hearing noted thereon to be held IN IHI'JÆ.. tJ.o1 fJ.~ DfL A(JrJUT 7: IS- ~.1'Il . ^~' Dated: OÝ tJ~ a/l (signature) S\oior.n to before me this oq day of IV\Af<.C. 1'\ ~ 2.000 Ni-f¡~ 1:1 ~æmJ J. ROMANO NOTARY PUBlIC Of NEW JEISEY Commbllon EJcpIIII 'lI612'1J3 i Telephone (516) 765-18<12. .. Town Hall. 53095 Main Road P.O. Box 1179 Southo1d. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 20, 2000, the following recommendation was made: Moved by Bret Hedges, seconded by Bill McDermott, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit Application of BARBARA S, KELSEY 128-6-4 to construct approx. 100 linear ft, of timber bulkhead to replace existing bulkhead, New bulkhead will be installed no more than 18 in, in ITom of existing bulkhead, Placement of approx, ~ of clean upland fiil (sand backfill) behind bulkhead 8-s- 3790 Peconic Bay Blvd" Mattituck Vote of Council: Ayes: All Motion Carried 95-19-3 (10/981-q NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION OFFICE OF GENERAL SERVICES UNITED STATES ARMY CORPS OF ENGINEERS JOINT APPLlCATÎON FOR PERMIT* * If.iiIf.i ~ APPLICATION NUMBER DISTRIBUTION 1 S1 COPY 2ND COPY 3RD COpy 4TH COPY 5TH COPY Permit Administrator Corps of Engineers Program NY5 Agency Applicant US ARMY CORPS OF ENGINEERS 1. Please read ALL instructions on bock. Check permits applied for. Attach additional information as needed. o FRESHWATER WETLANDS 0 TIDAL WETLANDS 0 WATER SUPPlV 0 lONG ISLAND WEll o PROTECTION OF WATERS FOR, o A. Construction or placement of docks and moorings 0 B. Construction, reconstruction, or repair of a DAM or other impoundment structure Dc. Disturbance oto STREAM BED or BANKS or excavation in or fill of NAVIGABLE WATERS 0 401 WATER QUALITY CERTIFICATION o COASTAL EROSION CONTROL 0 LAKE GEORGE PARK COMMISSION (Docks and Moorings) 0 WILD, SCENIC OR RECREATIONAL RIVERS o AQUATIC PEST CONTROL FOR: 0 A. Aquatic Vegetation Control 0 B. Fish Control 0 C. Insect Control o LEASE, LICENSE, EASEMENT, or other real property interest in state-owned lands under water 0 UTILITY EASEMENTS (Pipelines, Conduits, Cables, etc.) 2. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES (If any) 3. IF OTHER THAN INDIVIDUAl, PROVIDE TAXPAYER 10 NUMBER 4. APPLICANT IS AlAN: DOwner 0 Operator 5. NAME OF APPLICANT {use full name) 4J/~h/~m 17 MAILING ADDRESS o Lessee X£1.5é. y ~D o Municipality/Governmental Agency (Check os many os apply) Agent w S PRIN c.. TOWN ZIP CODE 5~ POST OFFICE LONG 'vALL¿y 6. NAME OF OWNER (if different than number 5 above) I8J Owner 0 Agent/Contact Penon MAILING ADDRESS o POST OFFICE 80')( J. .OS- m;:tTT I Îur:.K 07'853 S !<£t...SE.Y /IJ'J' 8AR.B.I1IU3 3'7 '10 jJ~C ON Ie NY ß-9-y TELEPHONE NUMBER (Daytime) 'tt:..3 7 ZIP CODE 7. PROJECT/FACILITY LOCATION (mark location on map, see number 10 on revene side) County J.. K. I Town/City/Village S ADDRESS (including street or rood) ",¿CONI c.. 3790 POST OFFICE ¡r¡lfrrl Tf.J CK I-.D 8~'r NYTM-N 4 ZIP CODE / I 7 ::1'2. DEC USE ONLY NYTM-E 9. Nome of USGS QUAD MAP B.NAME OF STREAM OR BODY OF WATER (on or near proiect site) ,P~C.O It, 84'r' (G/ŒPtT 10. HAS WORK BEGUN ON PROJECT? (If YES, a~explonotion on starting work without permit, include dates) Shaw work on mop or drawing 0 Yes .ðI No 11. PROPOSED STARTING DATE /T)~"" 00 / 12. APPROXIMATE COMPLETION DATE 13. PROPOSED USE: 14. Will PROJECT OCCUPY STATE LAND? ~I 1711+'(' 00 ~P,;vate 0 Publ;c 0 Camme,dal 0 Ves Na 15. PROJECT DESCRIPTION AND PROPOSED PURPOSE; (e.g. quantity and type of material to be excavated, dredged or used to fill or riprop; location of disposal sites; type of structure to be installed; height of dam; size of impoundment; capocities of proposed water saurces; edent of distribution system; size of marina and types of docks and maa';ngstabe;nstall"",.tc, C-ONS7¡¿Vc:..TJON OF flPtI'//'O)(Jm¡9Tf,I..'f' 100....F' oS: TJf'T)ßa 13,,"I<#EflÞ 7'0 /:6Pl..lIC-e ~X'Sr/Nt;. SOJ.. ('HIERD. NE.'W 81.J1..J<ji£AÞ 41'.... & JIJ~T.e¡'I../iJ) /JO rn01'.1!f. THftw If 1/oJCJ<1!5 II.J I"K""r OF eXiSTJNr;. 8VJ..KrJ.€»b. PJ../f~"'e-wT' oP- flJ>PlI.o'tIIYlIJ7êc.Y '''6 c.Vß,~ r¡(/j~ or- t.J-..EJ'TN (JPJ.fi/V/) PII-.J.. (SI9ND IYHXI=,I..L) 13ß./iINO I3vht<H~Þ. 16¡WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL, STATE AND/OR LOCAL PERMITS? rsiirYes 0 No If YES, please list: To... tJ 0 ¡: SOll7 HOt../) GAAAJDFArJ1Ell. fJ<="tVnlT' I hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. Folse statements mode herein ore punishable os 0 Closs A misdemeanor pursuant ta Section 210.45 of the Penal low. Further, the applicant accepts full responsibility for 011 damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every nome and description resulting from soid project. In addition, Federal low, 18 U.S.C., Section 1001 provides for 0 fine of not more thon $10,000 or imprisonment for not more than five years, or both, where on opplicant knowingly and willfully falsifies, conceals, or covers up 0 material foct; or knowingly makes or uses 0 folse, fictitious or fraudulent statement. ~ I hereby authorize the agent named in Number 4 above to SUbmit!iS application on my behalf. Dot. 1/~.s-lt)O SignotureafOwner ó:j C?~(J'V""l'l, ' \~~ Title OWN€n. Oute JIse.SIt/Þ SignalureafAgent/ConlaclPenon ~<2b.c.G"'7"'" /JJ{.;z.f.S- Titl. /9(;.PJJ -- - - -- -- -- --- - --_.----- -~-----_... ..: " . . . ENVIRONMENTAL QUESTIONNAIRE This is, intended to supplement ENG Form 4345, Application for Dèpartment of the Army Permit, or the Joint Application for Permit used in the State of New York. Please provide complete answers to àll questions below which are relevant to YOur - project. Any answers may be continued on separate sheet(s) of paper tå be attached to this form. '. .' PRIVACY ACT STA TEMENT The purpose of this form is to provide the Corps of Erigineers with basic information regarding your project. Thif information will be used to facilitate evaluation of your permit application and for public dissemination as required by regulation. Failure to provide :col1?plete Information may 'result in your application being declared incomplete for processing, therl?by delaying processing of your application. . GENERAL-APPLicABLE TO ALL PROJECTS , 7. Explain the need for, and purpose 'of, the proposed work. TO !?U¡..ß.CE: £XI5T Jlvc. Ih?i"I<íHtYJl) /JIvD AIf074H.Ï I3/JIVJ<. ,19"': HOtlS¡;', £XI57/¡.,JG ,6VLRfltm-f) /'1M .8<!:'..7,f ,f€P/JJllt.7J ornE J /fN/) ¡S. fJIJß':1 /T' S 'fìCRVI,fl~L-~ LIP-€,. 2. Frovide the names ;;nd ;;ddresses of property owners ;;dj;;cent to your work site (if not shown on the ;;pplication form Dr project drawings). Sfiow tV oN ;:>';'07 PL./lI,J /11ft. 'r' I1!fi S ::rOS¡; P}J lieGf;.JE£ J ml?. H/M~E... /3, POt..t..P.K /YII? .... rn/?':: H, 'vON ¡£tJh '15' GRltO£t-J S7 '1/7..'& fA) ¡>f¡t..fYI AJÆi£ DR. i 92. woo.DßV¡¿y ¡¿D ;?OSt..Y/'\J HTS ,4PT 'J.i'ð-ß HUNIIN6TOrV . pomp;9/oJO BEAcH IVy 115'77 PI... 330~9 N Y InLf3 (PleEse note that depe.7ding upon the nature and extent of your project, you may be requested to provide the n;;mes and addresses of additional prDperty owners proximate to your project site to ensC!re proper coordination.) . . ' 3. Photographs of the project site should be submitted. For projects in tidal ;;reas, photographs..ofthe waterway viciniry,should be taken at low tide. Uiing a separate copy of your plan view, indicate the ·10 cation and direction of each photogr;;ph as we!1 as the date ;;nd time at which the photograph was taken. Provide a sUf,ïcient number of photographs so as to provide a clear understanding of conditions on and proximate to your project site. S EF It IT iJ Co- H t:fD . , . 4. Provide a copy of any environmental impact sta;eJent, of..rny other environmental report which was prepared for your project. fI)¡'A ._ (continued on next p;;ge) Page 7, '.. ". . ~ . . . 5. Provide a th,orough discussion of alternatives to your proposal. This discussion Sfïould include, but 'not necessarily be limited to, the, "no action" alternative and alternative(s} resulting in less disturbance to waters of the United States. For filling projects in waters of the United States, including wetlands, ,your alternatives discussion shou./d demonstrate that there are no practicable alternatives to your proposed filling and that your project meets with current mitigation policy (i.e. avoidance, minimization and compensation}. . © NO fI<:"ìJO¡J - Ç:()A¡'/Jf'sc Or 2>(/S7'JNG ~L)i.-J<Jfé'flo 0JITH ..A.ESCfi-7I'NT . Lose; ()P 8JIJifNKmfOlT ftNÐ HoV5E:. . ._ T OF ShtJ~ !>1?c-¡-(w)6N - l..uovt..{) ¡¿£é)VIRÆ Pt..l'KJflfIf!1o'T ® 1'J.,19c.t:f'f)t!!V _"k' j'"' )¡,JtH~ FPtrr> 6'iIS'7JN6 I1Vl-Kj-féfrX)/¥J GltØ!Tot f~ -0 , c./'.£t!-]II¡1. co S J . @ O "''''f¿ve'r',otO . G~HJ JO 1£'Y./.P,tV c.. ~VL¡: I+fO}{:J .. <",' ~ L> ~ (!. N~, 'T7< "......X ,~1J 4~ ¡::¡,.,¡; 'Clt~ ÐJs'TvR.ßM.,¡u ~"'~mv, , DREDGING PROJECTS Gr?~ P'lJ.fvtJfl-, t..o So Î Answer the following if your project involves dredging. 1. Indicate the estimated volume of mårerial to be dredged and the depth'lbe!ow mean low water) to Which dredging would occur. Would there be overdepth dredging? '. 2. You can apply for ,e ten-year permit for maintenance dredgir¡g. If you wish to apply for a ten-year permit, please provide the number of additional dredging events during the tim-year life of the permit find the ,amount of marerial to be removed during future events. .' 3. Indicate of yoúr drawings the dewatering area (if applicable} and disposal site for the dredged material (except landfill sites}. Submit a sufficient number of photographs of the dewatering. and disposal sires as applicable so es to provide e clear indication of existing conditions. For ten-year maintenance dredging permits, indicate the dev.:atering/disposal sites for futl!re dredging events, if known. , . 4. Describe the method of dredging (Le. clamshell, dragline, etc.} and the expected duration of dredging. '> 5. Indicate the physical nature of the material to be dredged (Le. sand, silt, clay, etc.) and provide estimated percentages of the various constiW.ents if available. For beach nourishment projects, grain size analysis data is required. .- (continued on next page} Page 2 " "" .. ,-.' ... ~ ¡ --- . . . 6. Describe the method of dredged material containment (i.e. hay bales, embankment, bulkhead, etc.) and whether return flow from the dewatering/disposal site would teenter any waterway. Also indicate If 'there would be any barge o~~ . . MOORING FACILITIES . Answer the fol/awing if your project includes the construction or rehabiiitation of recreational mooring facilities. 1. It is general/y recommended that any fixed piers and walk ramps be limited to four feet in width, õnd that floats be'limited to eight feet in width and rest õt least two feet õbove the waterWay bottom at mean low water. Terminal floõts õt privõte, non- colTimerciõl facilities should be 'Iimitedto .20 .feet in length. If you do' not believe your propOSõl cõn meet with these recommendations, pléase provide the reason(s}. ",", 2. Using your plan view, show to scale the location(s}, posirion(s} õnd size(s} (including length, 'besm õnd drõft) of_vessel(s} to iJe moored õt the proposed facility, induding those of trõnsient vessel(s} if known. " ,. ',.. 3. For commerciõl mooring sites such as marinas,1ndicõte the cõþacity of the faciiity õnd indicõte on the plan view the locQtion(s} of any proposed fueling and/orsewage pumjJout fsciiities. 'If pumpout facrïities are not planned, please discuss the rationõ/e below õnd Indicate the distance to the nearest av;;ilable pumpout station. "\ 4. Indicate on your plan view the distance to adjacent marine structures, if õny õre proximõte and show the locations and dimensions .of such structures. ..: 'r. -, '~ (continued on nèxt page) Page 3 . . .. - ...- ;..". .... . \, . '.. . . 5. Discuss the need for wave protection at the proposed facility. Please b~ advised that if a permit is issued, you would be ;equired to recognize that the mooring facility may bè subject to Wave action from wakes of passing 'vessels, whose '. operations would not be required.to be modified.,../ssuance of a permit would nòt ' relieve you of,ensur/ng the integÌ'it}iöf,the ¿"'othor/zed structure(s) and the United ., States would nåt be, held responsible for 'damages to the structure(s) and vessel(s) moored thereto from, wakes from' þãssing vessels. , . . BULKHEAD lNG/BANK STABllIZA TION/FllllNG 'ACTIVITIES Answer lthe¡following ;if.your.;projec~ .includescconstr~ction of bUlkheading, (also retaining wålls and seawalls). with 'backfill, :'filling of waters/wetlands¡ or any other bank stabilization fills'such as riprap, revetments, gabions¡ etc. '.. . .' 1. indicate the total volume of fill (includina backfill behind a structure such as a bulkhead) as well as the volume of fill to be placed into waters of the United Sta,tes. The amount of fill in waters of the United States can be deteTmined by calculating . the ,amount ,of/iIUq,be.placed below tn.e p!ane of spria!! lilgli tide in tlda! areas End belov/ordin'åiY- high. water in non-tidal areas. /BJ}cj( F J L.L tJlJL Y ,.'.:;:·<::':Ït(Wf-0{J./Y}·fH~~,'·:~:) ~~ "'. "e-u-BJ£/·. .YMtJ s " . . . -; .. -..' .' ..... .... ..":';.' ':.. ;.. R.... ........ . ... . ·2.'lndicàie the source(s) anâ,typ.e(sr~f fill ïnátËriaf.' . 'n '. . :~:.=-. ~ :~·_;.\::';~~~·/o: ., . -' ..- .- . . ,.- '- u_ ~.._.:. ,,.;, ;'. .' . -- . ~ ';'. . . '. . . CLLrnN (' SßtJD) \,.;P L/j7VD riLL,. .. ... - ":. -,. ~ ..:--. 3. 'Indicate the method of .fill placement fi.e, by h~nd, bulldozer, clane, etc.]. Would ..,?ny,temporary fills be 'required in waterways or wetlands-to provide access for . construction equipment? /f.so,:please indicate ,the area, of such waters arId/or wetlands to be filled,-and show on the plan and sectional views. -A..£>'" "-~ I. f!. /.,)0 TE.('f)jJ FJ t-.L. S. ¡:¡C.C-~5 TI:JRovrol1 "f¡'#<lU PIV"'¡CJ'..... 1\J8G.H~1è . , P'L.,4C, e",l£NT' . /37' Hl!NIJ /TNO' :S/P~ 13 VLL.JJO'ûm . :.'.. .' The foregoing requests basic information on the most common ,types of projects requiring Departme!1t of the Army permits. It is intended to obviate a/reduce the need for requesting additional information; howevér, additional Information m,ay be requested above and bèyond whà't is requested in this form.. '.' .... -- . ~... .' . ........ . ~.:.... Flease feel free to add any additional information regarding youi' project, which you believe may facilir~te our review. Page 4 ., . .' 0'\ :o~v ~~Ìt)\ «' 'I) \ .; '!. - \ \ ... \ \\ ". \ ~:\ § 41 ~14j o bg ~ ~. f)¡ ~ ~t. J ~?' + ~ ~ ~ C( " ,"11' ..,~_ ,.ii;' J " i ~ < ". ,~ .~ ,ti~ '~1 " .. , tJ ~ ~ SURVEY FOR AUGUSTUS KELSEY AT LAUREL TOWN OF SOUTHOLD SUFFOLK COUNTY, N r 7000 - 128 - 06 - ().f. Scale: 1'~ 40' Feb. 20,1992 , . . " ~ /ì -:L- 0...... ~~ ~ 1 c '- , "- > ',-, , ,Ù\. -0 '~ -:s=- ~ " -", j c, , ~ / ~ ' ~ G' C' ... ~1' .... -, "- -, p ¿ " ~ á ~ .,. ... , ~ - ... J >-> ";;:y i'-' ~ --> ~ - '" ~ ~-r. .L L. ~ ~ '? -J --J => - ~ ~\t. , ~~\~ ~ i,,- 0 '. ~ "" '" C J >t. _ >< 3 %' ~ ~ fIQ ~ ~ ~ ~ 1- => ~ u '2 - \IS ' .,¡ r:,."'¡ -< ~ " ~ C x =l ~~ ~ ~ <:t, 'Ii. <c '-U "" It: 112 <>::- AREA = 38,468 sq. ft. ~- o -::;( NEW YORK ST~ OEPARTMENT OF STATE COASTAL .AGEMENT PROGRAM . Federal Consistency Assessment Form' An applicant, seeking a permit, license, waiver, certification or similar type of approval from a federal agency which is subject to the New York State Coastal Management Program (CMP, shall complete this assessment form for any proposed activity that will occur within and/or directly affect the State's Coastal Area, This form is intended to assist an applicant in certifying that the proposed activity is consistent with New York State's CMP as required by U,S. Department of Commerce regulations (15 CFR 930.57). It should be completed at the time when the federal application is prepared. The Department of State will use the completed form and accompanying information in its review of the applicant's certification of consistency. A. APPLICANT 1. Name: /3/1RßI9R/9- S. KUSE'r (please print) ,PfE..CONIC If/) Y ¡n1J7Ï1 ,""Ck: 3. Telephone: Area Code (5'U,,) 29 í? - 9&:5? PO ß 0/< 40{ 2. Address: 3190 l3t.vD N'r' 119..5'2 B. PROPOSED ACTIVITY /(JO /"'/NêlJ1( P(£'ð 7'/:J/TrJ /8 I fY "If<] Brief description of activity: CONS7HvcTIO¡.) Or- 11I'/'/?vX//YI/:¡ïoë:Z. '>' OF ì J/??ßG:P. gUI..,KlI~j) , 7 0 ß IE J'~,I)r:: Q) /IQ /J'>oAtr / IAJ ¡WON'" 1) P. EX/STING !5V/.-f(IfEYtO, I3/9C.?I'IL'- INn H <::l..,t:1IN ul'LAN() I=¡(.l.. . Purpose of activity: To I/¿J'L/Jce £'X /5JJ.IJG 1Je. T'=.IUð!?/JTél) 8vLKHetl) 19/VtJ /'~t!Yf:!}JT .oAfr!~G-ß: 7'0 !:lIJNJ( /J-tvD /7ai/5rs 1. 2. 3. Location of activity: suPPô/....!< County SOv7HoLÐ City, Town or Village '3790 ¡:>ecONIC 111} Y' /kvf).. Street or Site Description 4. Type of federal permit/license required: fie Ot: 70J/V'I 5. Federal !3Pplication number, if known: 6. If a state permitJIicense was issued or is required for the proposed activity, identify the state agency and provide the application or permit number, if known: 'J'o)),rr- /leo¡£' fiND N'1'5 /Je"C C. COASTAL ASSESSMENT Check either "YES" or "NO" for each of the following questions, The numbers following each question refer to the policies described in the CMP document (see footnote on page 2) which may be affected by the proposed activity. 1 , Will the proposed activity result in any of the following: a. Large physical change to a site within the coastal area which will require the preparation of an environmental impact statement? (11,22,25,32,37,38,41,43) . . . , . . , . , . , , . . , . , . . , . . b. Physical alteration of more than two acres of land along the shoreline, land under water or coastal waters? (2, 11, 12, 20, 28, 35, 44) .....,...,........,..,...........,.".,...,.. c. Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1) . . . . . . . . . . . . . . d. Reduction of existing or potential public access to or along coastal waters? (19, 201 ............ e. Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10) .. . . . . . . . f. Siting of a ficility essential to the exploration, development and production of energy resources in coastal waters or on the Outer Continental Shelf? (291 . . . . . . . . . . . . . . . .. ...... g. Siting of a ficility essential to the generation or transmission of energy? (271.................. h. Mining, excavation, or dredging activities, or the placement of dredged or fill material in coastal waters? (15, 351 ............,.......,........,...,..,.,.....,."..... i. Discharge of toxics, hazardous substances or other pollutants into coastal waters? (8, 15. 35) ..... j. Draining of stormwater runoff or sewer overflows into coastal waters? (33) .................. k. Transport, stroage, treatment, or disposal of solid wastes or hazardous materials? 136, 391 . . . . . . . . I. Adverse effect upon land or water uses within the State's small harbors? (41 ................. 2. Will the proposed activity affect or be located in, on, or adjacent to any of the following: a. State designated freshwater or tidal wetland? (441 ................................... b. Federally designated flood and/or state designated erosion hazard area? (11,12,17,1 .',.,.,.,.. c. State designated significant fish and/or wildlife habitat? (71 ............................. d. State designated significant scenic resource or area? (24) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e. State designated important agricultural lands? (26) ......,..."............'.'........ f. Beach, dune or barrier island? (12) ........,...,................,......,.....".. g. Major ports of Albany, Buffalo, Ogdensburg, Oswego or New York? (3) ..................... h. State, county, or local park? (19, 20) ...................,......."............... i. Historic resource listed on the National or State Register of Historic PJaces? (23) . . . . . . . . . . . . . . . -,-\ YES NO x.. f x... L 2L -.:::'L X t ~ L 1- .x. .L A::. L * YES NO 3. Will the proposed activity reauire any of the following a. Waterfront site? (2, 21, 22) . . ' . . . , . . . . . . . . . . , . ' , , . . . , . . . . , . . . . ' . . ' , , . , , , ' , b. Provision of new public services or infrastructure in undeveloped or sparsely populated sections of the coastal area? (5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . c. Construction or reconstruction of a flood or erosion control structure? (13, 14, 16) . . . . . . . . d, State water quality permit or certification? (30, 38,40) . , . . . , , , . , , , , . . . , . ' , e. State air quality permit or certification? (41, 43) .. . ' , , , , , , , , . , . . ' , , , , , , , , . , 4- Jr t 4. Will the proposed activity occur within and/or affect an area covered by a State approved local waterfront revitalization program? (see policies in local program document') . . . . _--:L D. ADDITIONAL STEPS 1. If all of the questions in Section C are answered "NO" I then the applicant or agency shall complete Section E and submit the documentation required by Section F. 2. If any of the questions in Section C are answered "YES", then the applicant or agent is advised to consult the CMP, or where appropriate, the local waterfront revitalization program document'. The proposed activity must be analyzed in more detail with respect to the applicable state or local coastal policies. In the space provided below or on a separate pagels), the applicant or agent shall: la) identify, by their policy numbers. which coastal policies are affected by the activity, (b) briefly assess the effects of the activity upon the policy; and, (c) state how the activity is consistent with each policy. Following the completion of this written assessment, the applicant or agency shall complete Section E and submit the documentation required by Section F. E, CERTIFICATION The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved local waterfront revitalization program, as appropriate. If this certification cannot be made, the proposed activity shall not be undertaken. If this certification can be made, complete this Section. "The proposed activity complies with New York State's approved Coastal Management Program, or with the applicable approved local waterfront revitalization program, ane will be conducted in a manner consistent with such program." ApplicantJAgent's Name: /1/91{ b'j/l/t s, K S'>t!T ;00 .Box c.¡Oç J'JI197/1ÏuCj( IV)')J h-2.. Applicant/Agent's Signature: /'6:Lo/.J( c 9foT7 !ß c, .~f H".~. ßA'r ßLI//J ) "''7 r" Address: ...> 7'-' Telephone: Area Code ({)b) 29-¡¡ ,~ l(¡¿~ '\ Date: ) /1--7/()J / ' F, SUBMISSION REQUIREMENTS 1. The applicant or agent shall submit the following documents to the New York State Department of State, Division of Coastal Resources, 41 State Street· 8th Floor, Albany, New York 12231. a. Original signed form. b, Copy of the completed federal agency application. c. Other available information which would support the certification of consistency. 2. The applicant or agent shall also submit a copy of this completed form along with his/her application to the federal agency. 3. If there are any questions regarding the submission of this form, contact the Department of State at (518) 474-6000. "These state and local documents are available for inspection at the offices of many federal agencies, Department of Environmental Conservation and Department of State regional offices, and the appropriate regional and county pla-nning agencies. Local program documents are also available for inspection at the offices of the appropriate local government. FCAF revised 7/9197 ·2·