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Home My WebLink AboutTR-6095Board Of Southold Tom Trustees SOUTHOLD, NEW YORK DATE: .~.~.t ch... ~.~...2.o o 5 ISSUED TO ............... g:~.~ .r'....~9.~. ....................................................................................... Aulhorizalia. Pursuant to the provisions of Ohepter 615 of the Laws of the State of New YorE, 1893~ and Chapter ~0~ of the ,~.ws of fha ' State of New Yo& 19~2~ end the Southold To~n Ordinance titled ."REGULATING AND THE PLACING OF OBSTRUO~flO ~NS IN AND ON TOWN WATERS AND PUBLIG LANDS and the REIvIOVAL OF SAND, GRAVEL. OR OTHER LANDS .UNDER TOWN WATERS;t and in ac¢ordanca with the Resolution of The Board adopted et · meeting held on ...~ .'~.~.~.~ · ~.~.., and in ¢onsideretlon of the sum of $...~.~.~..~P. ..... paid by Dan~ei Fox of ................. ~.E.e..~.~.?~ ......................................... N. Y. and subject to the Terms and Conditions listed onthe reverse side hereof, of Southold Town' Trustees authorizes end permits the following: ~etland Permit to maintenance dred. ge existing canal to a depth of -4.0' to -6.0' below meaB low water. A total of 426 cy. of dredge spoil will be removed and deposited at an approved site, and all as depicted on the plan prepared by Costello all in accordance with the deta~d spedfioations as presented ia · the originating apprw, atioa. Marine Contracting Corp. dated June 23, 2004. IN WITNESS WHEREOF. The said Board Of Trustees here- by causes ifs Corporate. ~al ~o be a~xed, e.d these ~.resenfs fo b~ subsorlbed by ~'melorHy of the said Board .as of th~s darn. Peggy gickerson Artie F.oster - ABSENT -' Tms~es TER)4S and CONDmONS Daniel,Fox. ,470 Wiggins Lane, greenvort . .~ .... N, Y~ ~e t. Tht the s~d 13oatd e~ T~ and ~he Tc~. of Soq~otd are tef~__,~_ f~n tf~j, ~d That d~s t~,~t thould be mahed tndet'iof~y, oc is loag es the r,H Peanfttee ~ the stmm~ or pmiect involved, to pmv~ evidence to anyone mmemcd dm auth- w~ od~n.t!~ ebtdoed. 4. 'Ilar d~e wock hvotvcd wUlbc mbjea to d~e Ju Igea~ ~cl noz-.mmid;.~',- with d~e pmmds~om d ~ocatlon of d~s F,m~;t by ~:solution of the raid lathe Io~,~ d,~x_ o~.~he wo~t~ ~ or [/,fad~eot]fnto(tM'-iheB(~td o/Tms~ee~dlo. 9. Tht the 'i~,~tu~ ~11 e~r,l~ .all od~r pmnits ,~4 co,~_,elm nay be mpked m~ I, iemenal to this ~ ~ n~y 'be subj~ to tev~ ulx~ fdl~e to ebedn mae. 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 March 23, 2005 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Mr. John Costello Costello Marine Contracting Corp. P.O. Box 2124 Greenport, NY 11944 RE: DANIEL FOX 470 WIGGINS LANE, GREENPORT SCTM#35-4-28.28 Dear Mr. Costello: The Board of Town Trustees took the following action during its regular meeting held on Wed., March 23, 2005 regarding th'e above matter: WHEREAS, Costello Marine Contracting Corp. on behalf of DANIEL FOX applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated February 1,2005 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 23, 2005, 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 standards set forth in Chapter 97 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 approve the application of DANIEL FOX to maintenance dredge existing canal to a depth of-4.0' to -6.0' below mean Iow water. A total of 426 cy. of dredge spoil will be removed and deposited at an approved upland site, and all as depicted on the plan prepared by Costello Marine Contracting Corp. dated June 23, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: None Very truly yours, Albed J. Krupski, Jr., President Board of Trustees AJK/Ims Telephone (631) 765-1892 Town Hall 53095Route 25 P.O. B6x 1179"' Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., March 15, 2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Jack McGreevy, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of DANIEL FOX to maintenance dredge existing canal to a depth of -4.0' to -6.0' below mean Iow water. A total of 426 cy. of dredge spoil will be removed and deposited at an approved upland site. Located: 470 Wiggins Lane, Greenport. SCTM#35-4-28.28 The CAC recommends Approval of the application with the Condition of a 10' non-tun' buffer landward of the bulkhead. Vote of Council: Ayes: All Motion Carried New York State Department of Environmental COnservation Division of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www.dec.state.ny.us Janua~ 5,2005 EdnM. Crotty Commissioner Daniel Fox 470 Wiggins Lane Greenport, NY 11944 Re: Permit #1-4738-01917/00003 Dear Mr. Fox: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. ,P...!ease carefully read all permit conditions and special permit conditions contained in the permit to insure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Mark Carrara Deputy Permit Administrator CC: Costello Marine Contracting Corp MHP file DEC PERMIT NUMBER 1-4738-01917/00003 FACILITY/PROGRAM NUMBER(S) PERMIT Under the Environmental Conservation Law EFFECTIVE DATE Janua~ 5,2005 EXPIRATION DATE(S) Janua~ 5,2010 TYPE OF PERMIT · New [] Renewal [3 Modification [] Permit to Construct E] Permit to Operate · Article 15, Title 5: Protection of Waters [] Article 15, Title 15: Water Supply [] Article 15, TiUe 15: Water Transport [] Art,cie 15, T~tle 15: Long Island Wells [] Article 15, T~tle 27: Wild, Scenic and Recreational Rivers [] Article 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation [3 Article 24: Freshwater Wetlands · Article 25: Tidal Wetlands [] Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management [] Article 34: Coastal Erosion Management [] Article 36: Floodplain Management [3 Articles 113, 17, 19, 2'~, 37; 6NYCRR 380: Radiation Control · '.~YCRR 608: Water Quality Certification PERMIT ISSUED TO Daniel Fox [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management TELEPHONE NUMBER (631) 477-3241 ADDRESS OF PERMI3-rEE '470 Wiggins Lane, Greenport, NY 11944 CONTACT PERSON FOR PERMI3q'ED WORK Costello Marine Contracting Corp., PO Box 2124, Greenport, NY 11944 NAME AND ADDRESS OF PROJECT/FACILITY Fox Property, Same as above. S~M #1000-035-4-28.28 TELEPHONE NUMBER (631) 477-1199 SrUffOIk Southold Fordham Canal DESCRIPTION OF AUTHORIZED ACTIVITY: MAINTENANCE DREDGE A 26' X 197' AREA OF THE CANAL TO A DEPTH OF -4 FEET BELOW APPARENT LOW WATER, TRUCK DREDGE MATERIAL TO AN UPLAND ~ITE. ALL WORK SHALL BE DONE IN ACCORDANCE WITH THE ATTACHED PLAN PREPARED BY COSTELLO MARINE CONTRACTING LAST REVISED ON DEC. 17, 2004. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all pplicable regulations, the General Conditions specified (see page 3 & 4) and any Special Conditions (see page 2) included as part of this-permit. · DEPUTY PERMIT ADMINISTRATOR: I ADDRESS "": I Region 1 Headquarters Mark Carrara Bldg. #40, SUNY~ Stony Brool~,.NY 11790-2356 ,~UTHORIZED SIGNATURE ..~'..,~/' I DATE ¢'"','~ ~ I January 5, 2005 Page 1 of 4 NE~ ~'' STATE DEPARTMENT OF ENVIRONMENTAL CONS, ION SPECIAL CONDITIONS 1. 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. 2. 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. 3, Dredging ~s prohibited from June 1 - September 30 of each year to protect spawning shellfish and/or spawning finfish, 4. Material approved to remain on-site and or within the Department's Tidal Wetland jurisdiction must be retained so as not to re-enter any water body, tidal wetland or protected buffer area. Off-site upland disposal of dredge material beyond the Department's Tidal Wetlands jurisdiction requires the approval of the Division of Solid and Hazardous Materials (631) 444-0375 and is not covered by this permit. 1-4738-01917/00003 PAGE 2 OF 4 NOT~ATION OF OTHER PERMITTEE ~NS 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 attribufable to the permittee's acts or omissions in connection with 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 er 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 c~vil 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 comply with this perm[t, 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 Environmental 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 [o 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 pedorm 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). T~e 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 permit1 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 Determinations 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 Permit 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) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APO) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission ct applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg #40, Stony Brook NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: ': a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terms or conditions of the permit; cl exceeding the scope of the project as described in the permit application; .. d) newly discovered material information or a material change in environmental odnditions, relevant technology : or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-01917/00003 TATE DEPARTMENT OF ENVIRONMENTAL CONS~ION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 16 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS ) 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 natural 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. 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 shall accrue from any such damage. All necessary precautions shall be taken to 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. 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. 7. The[e shall be no unreasonable inter[erence with navigation by the work herein authorized. 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 structure 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. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations 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. 10. 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 and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 11. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Costello Marine last revsied on Dec. 17, 2004. DEC PERMIT NUMBER 1-4738-01917/00003 PAGE 4 OF 4 400' .z:~,~/,~/_ ,wo)c o ~o 4.01rf 0 ~ l & 4eeo' .... · saaisnJ1 jo pJ~o8 .j 0 ~0 4.0 FT / il/IJJllllll ~'1111 I I o ~ ~ Albert J. Krupski, President James King, Vice-President Henry Smith Axtie Fester Ken Poliwoda Town Hail 53095 Main Road P.O. Box 1179 $outhold, New York 1 ! 971 Telephone (516) 765-1882 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~Wetland Permit Application Grandfather Permit Application Waiver/Amendment/Chang~ ,-~eceived Application: ~;~ ~Received Fee:$~' ,Completed Application~41~ Incomplete SEQRA Classification: · Type I .Type II Unlisted Coordination:(date seBt) --w~fAC Referral Sent:~ ,,-Date of Inspection:~..~~ . Receipt of CAC Repor' . Lead Agency Determination:__ Technical Review: .-t~/blic Hearing Held:~~___ Resolution: Beard of Trustees Name of Applicant _'"~[~1 ~X Address ~"TD ~1~ _[](["~--3 I i~_. , Phone Nmber:(~[) cou t 000 Property Location: ~]0 ~]~l~5 (provide LILCO Pole (If appIicable) .... Address ['"~ ~J~ distance to cross streets, and location) of Trustees Ap~ Land Area (in square feet): Area Zoning: 21~ _~ ~/[~ Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: Agency j Date i 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): Trustees Application WETLAND/TRUSTEE LA~D$ i~PL~CAT~ON D~TA Purpose of the proposed operations: ~[a~d~_ Area of wetlands on lot: ~ square feet Percent coverage of lot: ~ % closest distance between nearest existing structure and upland edge of wetlands: (Q feet Closest distance between nearest proposed structure and upland edge of wetlands: O feet Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated? 4 ~ ~ cubic yards How much material will be filled? ~ ~ cubic yards Depth of which material will be removed or deposited:~_4~- feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: S. tatement 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): of Trustees Ap~ County of Suffolk State of New York DE~O~SVAND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMEI~S CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOLVCHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOtPI"HOLD AND THE TOWN TRUSTEES HAi{MLESS AND FREE FROM ANY AIFD 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 P, EPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~ _ ~, //- ~i~na~t-u~e ' ~ swo TO HEFORE ME THIS mU . DAY ~-~' % 'N'dtary Puibl~d .... /~ ,.,¥NTHIA M, MANWARING · -,RY PUBLIC, STATE OF NEW YORI, NO:01 MA6100507 QUALIFIED IN SUFFOLK COUNTY ?OMMISSION EXPIRES OCT, 20 ~ COSTELLO MARINE CONTRACTING CORPORATION DOCK BUILDING · JETTIES · BULKHEADING · STEEL & WOOD PILING · FLOATS 423 FIFTH STREET · P.O. BOX 2124 · OREENPORT, NEW YORK 11944 · (631) 477-11991477-1393/477-0682 · FAX (631) 477-000-~ AU'I~ORIZ~kTION l~ORbl behalf in applying for all of lbo necessary permits for work to be completed at my above referenced property. 617.20 Appendix C State Environmental Quality Rev;ew SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by A 1. APPLICANT/SPONSOR COSTELLO MAR. INE CONTRACTING COP.-P (CMCC) )plicant or Project Sponsor) 2. PROJECT NAME DAN~L FOX 3. PROJECT LOCATION: Municipality SOUTHOLD TOWN County SUFFOLK 4. PRECISE LOCATION (Street address and road intersecfiona, promine, ,[ landmass, etc., or provide map) 470 WIGGINS LANE, GREENPORT, NY I 1944 5. PROPOSED ACTION IS: [] New [] Expansion [] ModJficaUon/artera~on 6. DESCRIBE PROJECT BRIEFLY: MAINTENANCE DREDGE TO -4.0' AND -6.0' BELOW MEAN LOW WATER. REMOVE APPROXR,,IATELY 426 CUBIC YARDS OF SPOIL AND TAKE TO AN APPROVED SITE 7. AMOUNT OF LAND AFFECTED: Initially --- ~cres Ultimately --- acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes LJ No If No, desQ'~be briefly 9. WHAT IS PRESENT LA!: ~JSE IN VICINITY OF PROJECT? [] Residential ~] ;,,dustdal [] Commercial PRIVATE RESIDEIx :: .L WATEILFRONT E~Agdcultem [] ParidForest/Opan Space [] Ol~er 10. DOES ACTION INv. £ A PERMIT APPROVAL, OR FUNDING, tlOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE ,?, L3CAL)? [] Yes [ I No If Yes, list agency(s) name anP permit/approvals: ACOE, NYSDOS, NYSDEC, SOUTHOLD TOWN 11. DOES ANY ASPEC ~ ,- THE ACTION HAVE A CURRENTLY VALIO PERMIT OR APPROVAL? 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? --~ Yes ICE . THAT ?HE INFOP, r T, SHPRO'.'L.£Q.,BOVEiSTRUETOTHEBESTOFMYKNOWLEDGE Applicant/sponsor name , JANE COSTELLO ",V-XLSIS, PERM I ~' I'.LA. NAGER ('~ CMCC Date: Signature: /., ~. If t~caoc. ' n is in the Coastal~Area, ar:ct you are a state agency, complete the : I Ass~ssme,', : ,, m b :' oroceed ng w th this a.~essment PART II - IMPACT ASSESSMENT (To"15'e completed by Lea, d Agency) A. DOES ACTION EXCEED ANY TYPE i THRESHOLD IN 6 NYCRR, PART 617.47 If yes, ooordinate the review process and use the FULL ~kF r~TM E~No , . WILL ACTION RECEIV~ COORDINATED REVIEW AB PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PAR-T 617-67 If No, a negative I--lYes I--1No COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING; (A. nswerI may be handwritten, if legible) C 1. Existing air quality, surface or groundwater quallIy or'quantity, noise levels, exilting traffic paItam, solid waste production or dispolal, po[ential for erosion, drainage or flooding probJemI? Explain briefly: C3. Vegetabor, or fauna, fish, shellfish or wilolife species, ilgnificant habitat, i. or ~hrestaned or endangered species? Explain briefly: C5. Grow[h subsequent development, or related activitieI likely to be induced by ~e proposed sction? Explain bde§y: C6 Longten~ shor[term, cumulative, orothereffectlnotidentlfledinCl.CS? Expislnbriefly: C70Iher impacts (including changes in use of either quantity ~- type of energy)? Explain briefly: D. WiLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? [] Yes. ~f~ No If Yes, explain briefly: IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No if Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (ii) setting (I.a, urban or rural); (b) probability of occ~Jmng; (c) duration; (d) irrevers~Oil~ty; (e) geograph,c scope, and (f) magnitude, if necessary, add attachmentli or reference supporting matanats. Ensure that explanations contain sufficient detail to snow that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of slgnlflcan~ must evaluet~ ~he pote~l~el Impa~t of the proposed action on the ~-nvironmental chai:ectedatics of the CEA. ] C~eck Ibis Pox if you have identified one or more I~o~ntistiy large or significant sdvems imp sc*-.I w'nich MAY occur. Then proceed directly to U3e FULL FAF and/er prepare a positive declaration. ] Check this box if you have detem~ined, based on the Informer/on and analyils above and any supporting documentation, that ~e propose0 action WILl NOT res~Jl[ in any sight§cant aciverse environmental Impacts AND pro?de, on attachments as necessary, ~ne reasons supporting this de[erminaDon Name of Lead Agency Pnn[ or Type Name of Responsible Officer in Lead Agency Signaa~re of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer (if different f~om rssponalbie off~cer) Albert J. Ph'upski, President JamesKing, Vice-President Artie Foster Ken Poliwoda Peggs'A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTtlOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING ~eing duly sworn, depose ~d say: That on the day of ,200 , I personally posted the property known as by placing the Board of Trustees official poster where it can easily b~seen, ~d that I have checked to be sure ~e poster h~ remained in place for ei~t days phor to the date of~e public hemng. Date ofhe~ng noted thereon to be held t~ ~ ~. ~ ' Sworn to before me this day o f~r.~2~00 l'~otary Publi~''~ Veronica F. Cidone Notary Public, State of New York No: 52-4661406 Qualified in Suffolk County j Commission Expires Dec.31, ~Z)O~, NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Daniel Fox S.C.T.M.# 1000-35-4-28.28 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. ~ Maintenance dredge existing channel to a depth of -4.0' to -6.0' below m~an low water level 376 cubic yards of spoil to be removed off the property to an approved upland site. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 470 Wiggins Lane Greenport, NY 11944 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on Wednesday, March 23, 2005 on or about 7:00 pm. You may contact the Trustees Office at 765- 1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAIVE: MAILING ADDRESS: Daniel Fox 470 Wiggins Lane Greenport, NY 11944 Enc.: Copy of sketch or plan showing proposal for your convenience. L c:)-cA 7'IOAIA/1A~, 0 ~0 4.0 I~ V o ~ ~T