HomeMy WebLinkAboutTR-5422Board Of Southold Town Trustees
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 40~ of the Laws of the
State of New York 1952; and the Soufhold Town Ordinance en-
titled ."REGULATINE~ AND THE PLACINC= OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, C=RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;!~. and Jn accordance with the
Resolution of The Bbard adopted at a meeting held on ..~.~p./~.,...!~h,
· 20nl..., and in consideration of the sum of $.....200.;.00 . paid by
Costello...Ma~ine Con~-rac,ti.ng on behalf-
of ........ Gr~enport, ...; .................... N. Y. and subject to the
Terms and Conditions listed on the reverse slde hereof,
~ ~n,,fhold Town Trustees authorizes and permits the followin¢~:
Wetland Penuit to replace existing I00 ft. bulkhead using 16 ft piling (.~ 6' cis. Series 4500 "C-
Loc" interlocking vinyl sheathing, with I'x 12' tie rods into a horlzoutal deadman secured in
place with 8 ft backing piling that the first bulkhead be removed and that the second bulkhead be
left in place with a ten foot non-disturbance buffer.
all in accordance with· the cleta~mcl specifications as presentea m
fhe odgJnaflng applicafion~
'IN WITNESS WHEREOF. The said Board of Trustees ~ere-
by causes frs Corporate Seal fo be affixed, and these p.resenf~ fo
be subscribed by a 'majority of fha sa,d Board as of tbs clara.
Trustees
TERMS and C~NDmONS
The Penaiecee
Alfred J. Amend
resldlag ac 380 Midway Road, Southold. N.Y. ss
part. of the consldersfioa for the is~,s,,ce of the P*~,~¢ does understsod tad pnncrJl~ to the roi-
1. That the said Boacd o/ Tm_o__,~__ ~ the Town o/ 8outhold ~e zeleased from say ami
~ ~ or .-~.i,,,~ tot a.,~o,s, o~ mia ~g dhectly or lndh'ecdy ss · ~ of ~ oper.
with respect thereto, m the complete'exx:huion of the Boaal of T _~*,~'-ee~-- o~ tbe Town d ~
2. That thls Permit ts valid for s perlod of 24 mor. wbld~ is eomtclel~d eo be d~e
estimated time' required eo camplete ~e wodc i~vol~d, bu¢ '~_d ~,,~a warrant, request
for an ,'re,-n~on may be made to the Bo~d
3. That dais permit should be r~dned indeFmltely, or as long ss the said p~rm[~Oee wishes
to mnlnf~in the structure or project involved, to provide evidence to anyone cot~emed that auth-
orization w~s originally obtained.
4. That the wodc .involved will be subject to d~ ~ and mppzx~d of the ~
its agen~ *md no~-complhmce with. the p~ovislom o~ the otigi~ati~ application, may be cause
t~vocariort of this p*~rai~ by ~lutlon o~ thc said ~
5. That there will be no uoreaco~able interference with t~vigatioo ss ·
hereh~ ~thorhed.
6. That there shall be no interfer~ce with the right o~ the public m pass and repass ~
the beach betvtm ~ tad low wirer mtrks.
7. Th~ if ~umre opcratJoos o~ the Town of Southold require the s~aovsl snd/o~ slcermtm~
the location of the ~nl~ berda utho~.ed, or if, In the ot~oL~ o~ the Bo~d o~ Trustees, the.
wodl sbell csu.~ um~somble obstrumon to f~ee navl~oa, the ssld Pem~tee will be required,
upoa due flo~ to l~nove or tlter this work or proje~ hereln stated without eXlm2Ses to the Town
8. '1"bat the said Boaz:d will be notified by' the Pennittee ot the completion. O{ the wodr mzth-
odzed.
9. That the Pexmittce will obtain all other p~mi~x and coose~ts dmt may be required
plemental m this permit which may be subject to tevok~ upon f~dut~ to ~ same.
Albert J. Krupski, President
James King, Vice-President
Hen .fy Smith
Artie Foster
Ken Poliwoda
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
September 28, 2001
Mr. John Costello
Costello Marine Contracting Corp.
PO Box 2124
Greenport, NY 11944
Alfred J. Amend
380 Midway Road, Southold, NY
SCTM#90-02-04
Dear Mr. Costello:
The following action was taken by the Board of Town Trustees during a Regular Meeting, held
on September 19, 2001, regarding the above matter.
WHEREAS, Costello Marine Contracting Corp.. on behalf of Alfred J/Amend applied to the
Southold Toxvn Trustees for a permit under the provisions of the Wetland Ordinance of the Town
of Southold, application dated August 23, 2001
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
September 19, 2001 at which time all interested persons were given an opportunity to be heard,
and,
WHEREAS, the Board members have personally viewed and are familiar xvith 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,
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 Costello Marine
Contracting Corp. on behalf of Alfred J. Amend for a Wetland Permit to replace existing 100 ft.
bulkhead using 16 fi piling ~,, 6' cis. Series 4500 "C-Loc" interlocking vinyl sheathing, with
l"x12' tie rods into a horizontal deadman secured in place with 8 fi backing piling that the first
bulkhead be removed and that the second bulkhead be left in place with a ten foot non-
disturbance buffer.
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 project xvill 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.
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 when project is started and on
completion of said project.
FEES: NONE
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
x/cjc
cc: DEC
Army Corp.
Dept. of State
Telephone
Tov~ Hall. 5;,'1095 Main Road
P.O. Box 11'1~9
~outhold, New Yixk I1~7~.
.q OU'THOLD TOWN
CONSERVATION ADVISORY COUNCH,
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
September 11,2001, the following recommendation was made:
Moved by Scott Hilary, seconded by Melvyn Morris, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit Application o~ ALFRED J. AMEND to replace
existing 100' bulkhead using 16' piling @ 6 cts, Series 4500 C-Loc interlocking vinyl
sheathing, with I"X 12' tie rods into a horizontal deadman secured in place with 8'
backing piling.
380 Midway Road, Southold. SCTM#90-2-4
The CAC recommends Approval of the bulkhead inkind/inplace with the condition that
the applicant establish and maintain a new 10' non-turf buffer.
Vote of Council: Ayes: All
Motion Carried
property
boundary
AHW at bulkhead
exist.
wood platform
exist, stairs
existing jetty
AHW at
bulkhead
PHOTO LOCATIONS
Approx.
N
PREPARED BY:
COSTELLO MARINE CONTRACTING CORP,
PO BOX 2124, GREENPORT NY 11944
(631)477-1199
APPLICANT I SITE ADDRESS:
ALFRED J AMEND
380 MIDWAY ROAD, SOUTHOLD NY 11971
SCTM 1000-090-02-04
18 July 2001 PHOTOS I of 2
PHOTOS
' ;' ;'e-'"'",,,. 4TI~) ROAD
ACCESS FOR
MACHINERY AND
MATERIALS FROM
Y, ,D N
_+,~ 2 STY.
~,12 FR. HOUSE
SCALE' 1":40'0"
0 10 20 30 40 50ff
Property of
Austin
444 Miry R~d
EXIST
JP~%%"" SITE PLAN
N. ?0°28, 20" W. 99.98'
REPLACE m
EXIST. I~ULKH.EA~D ~ --I HIGH WATER
ALW --I'='' ..,. __ __.~ .=.,,-- ALW
exist, jelly
PREPARED BY:
COSTELLO MARINE CONTRACTING CORP.
PO BOX 2124, GREENPORT NY 11944
(631) 477-1199
18 July 2001
APPLICANT / SITE ADDRESS:
ALFRED J AMEND
380 MIDWAY ROAD, SOUTHOLD NY 11971
SCTM 100(%0g~02-04
SHEET 2 of 3
Albert d. [~rupski, President
dames King. Vice-President
Henry Smith
,~'tie Foster
Ken Pollwoda
Town Hall
5.3095 Route 25
P.O. Box 1179
.qot~thold, New York 11971-0959
Telephone (631 } 765 18112
Fax (681) 765-1366
BOARD OF TOWN TRUSTEEB
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Applic. at. jon
~Wetland Permit Application i/ _ Major
Waiver/Amendmen~Chan~es
Rec~ved Applica~on: ~-~J O /
Received Fee:$ ,,-ff0-t '~ ~
~Completed Application ~/~0 /
Inc~omplete
SEQRA Classification:
Type I Type I1 Unlisted
~,C~. ,rdination: (date seml) ~ z
CAC Referral Sent: ~r/~/0 /
-_ -Date of Inspection: ~'Y/0 / .
_ Receipt of CAC Report:_
Lead Agency Determination:
- Technical Review: _ ~l[t~[O[[l"[[ -
Public Hearing Held:
Resolution:
Minor
Name &Applicant ALFRED J AMEND
Address
100 Hilton Ave, Garden City NY ~1530
............. Phone Number: ($1~) 741
Suffolk County Tax Map Number: 1000 - 90 - 02 - 04, ~/-
~ t
Property Location: 380 MiSsy Road ~ , ~
(provide LILCO Pole ~, distance 1o ~oss stre~s, and lo~tion) ..... ·
AGENT: ~stello Maline Con~ctino Co~.
(If applicable)
Address:
PO Box 2124
Greenport NY 1f944
Phone: ~030 477- 1199
Fax: (831) 477 - 0005
Board of Trustees A~plication
GENERAL DATA
Land Area (in square feet):
Area Zoning:
Previous use of property:
Intended use of properly:
26,633 sq. ft
Residential Waterfront
Residential Waterfront
Residential Waterfront
Prior permits/approvals for site improvements:
Agency Date
-- As shown on survey plan:
1. House & garage, fence.
Town of Southold Date of approval unknown
__ 2. Two lines of bulkhead, stairs to beach, jetty.
NYS-DEC, NYS-DOS, ACOE, Town of Southold
. No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency ? X No Yes
If yes, provide explanation: _ _
Project Description (usc attachments if necessary):
Replace existing 100 ft bulkhead using 16 ft piling ~ 6' cts,
Series 4500 "C-Loc" interlocking vinyl sheathing, with 1" x 12'
tie rods into a horizontal deadman secured in place with 8 ft
backing piling.
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: .......
Replace existing 100 ft bulkhead using 16 ft piling ~ 6' cts,
Series 4500 "C-Loc" interlocking vinyl sheathing, with 1" x 12'
tie rods into a horizontal deadman secured in place with 8 ft
backing piling,
Area of wetlands on lot:
0
square feet
Percent coverage of lot: .__~0 ...... %
Closest distance between nearest existing structure and uvland
edge of wetlands: _ 30 ft +/- feet (from exist, bulkhead to house)
Closest distance between nearest proposed structure and upland
edge of wetlands: ~_ 30 ft __ feet (replace exist, bulkhead)
Does the project involve excavation or filling?
Reinstate backfilling behind bulkhead only
If yes, how much material will be excavated? 0 cubic yards
tlow much material will be filled? < 10 cubic yards
Depth of which material will be removed or deposited: N/A feet
Proposed slol~ throughout the area of operations:.
0-2%
Manner in which material will be removed or deposited:
Existing materiel from behind existing bulkhead will be used.
- Any necessary gravel and topsoil for backfilling and
reinstatement of surface will be brought onto the site by truck
-- and placed by mini-loader and/or by hand. ---
Stalemenl ofthe effect, if any, on the wetlands and tidal waters ofthe town that
may result by reason ot'such proposed operations (use attachments if appropriate):
No negative Impact
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
Replace existing 100 ft bulkhead using 16 ft piling ~ 6' cts, Series
4500 "C-Loc" interlocking vinyl sheathing, with 1" x 12' tie rods into
a horizontal deadman secured in place with 8 ft backing piling.
Are wetlands present within 100 feet of the proposed activity?
No X Yes
Does the project involve excavation or filling7
__ No
Yes Reinstate backfilling behind bulkhead only
If Yes, how much material will be excavated? 0 (cubic yards)
How much material will be filled?
< 10 (cubic yards)
Manner in which material will be removed or deposited:
Existing material from behind existing bulkhead will be used.
-- Any necessary gravel and topsoil for backfilling and
reinstatement of surface will be brought onto the site by truck
-- and placed by mini-loader and/or by hand.
Describe Ihe nature and extent ofthe environmental impacts reasonably anticipated
resulting from implementation of the project as proposed.
(Use attachments if necessary)
No negative impact
41
I
$OUTHOL D
BAY ~
H
VICINITY MAP (NTS)
see Hagstrom Suffolk County Atlas
Map.29 ref. J-42
HOG
BAY
PROJECT LOCATION
J
LOCATION MAP (NTS)
PROJECT SITE
1000-90-02-03
1030 W Lake Drive, Southold
Preston M Harrington
256 Valley Rd,
Montclair NJ 7042
1000-90~02-05
444 Midway Rd, Southold
Austin Power
68 Huron Rd,
Bellerose NY 11426
PROPOSED WORK:
Replace existing bulkhead 100 fl using 16 It piling @ 6' cts, Sedes 4500 "C-Loc" interlocking vinyl sheathing, with 1" x
12 It tierods into a horizontal deadmen secured in place with 8 It becking piling.
PREPARED BY:
COSTELLO MARINE CONTRACTING CORP.
PO BOX 2124, GREENPORT NY 11944
(631)477-1199
APPLICANT / SITE ADDRESS:
ALFRED J AMEND
380 MIDWAY ROAD, SOUTHOLD NY 11971
SCTM 1000-090-02-04
18July2001 SHEET I of 3
ES FOR
MACHINERY AND
MATERIALS FROM ~.
j2+_~STY'
FR. HOUSE
N. 70°28' 20" W. 99.98'
REPLACE EXIST. BULKHEAD
exist. Jetty
PREPARED BY:
COSTELLO MARINE CONTRACTING CORP.
PO BOX 2'124, GREENPORT NY 11944
{631) 477-1199
~18 July 2001
SCALE' 1"=40'0"
0 10 20 30 40 5Oft
Property of
Austin Powers
444 Midway Road
SITE PLAN
AHW
BULKHEAD AT ORDINARy
HIGH WATER'
,,~,~J ....,.~ ALW
APPLICANT / SiTE ADDRESS:
ALFRED J AMEND
380 MIDWAY ROAD, SOUTHOLD NY 11971
SCTM '1000-090-02-04
SHEET 2 of 3
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Attic 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
BOAHD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ~1~ ~IID ~l~c~ , residing at ~ ~~ j A~. ~
G. ke- N Y II 270
being duly sworfl, depose and say:
That on the 7 day of ~ , 200~ , .I personal~y posted the
property known ~as ~.~2~) ~[~"[~[ '~. ~¢~F~I[C-~ ~
by placing the ~oar~ 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 or, the.
Rublic hearing. Date of hearing noted thereon to be held~
Dated:
Sworn to befor~e me this
/~) day of~~200
Notary Public /
Alfred Amend
~ ostmg 9/6/01
COSTELLO MARINE CONTRACTING CORPOI{ATIOI i
DOCK BUILDING · JETTIES · BULKHEADING · STEEL & WOOD PILING · Ft O.,\TR
· 1.'~ FIFrt4 S'f'REET. PO BOX 2124 · GREENPORT. NEW YORK 11944 · (5161,177.11~4q 4;,' I.?~ ·1·' ,,, ...
FAX - (516)477-0005
Date:
AUTHORIZATION FORM
located at ~' ~"C" /L~/(~_ 4~, (~ ~ ~.j~
of /~-
Business/Property
do hereby give Costello Marine Contracting Corp,
act as agent in my behalf in applying for all of
permits in order for work to be done on my
above.
the authority
the necessary
property described
~ignature
t o
Applioation for:
Project Site:
Board of Trustees Application
WETLANDS PERMIT
Alfred J Amend
308 Midway Road, Southold NY ~1197f
County of Suffolk
State of New York
of Costello Marine Contrac~fng Corp. BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND TI/AT Al 2. STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF H1S/IIER KNOWLEDGE AND BELIEF, AND TI-LAT ALI. WORK
WiLL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOm BOARD OF TRUSTEES. TIlE APPI.ICANT
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 AUTIIORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION
Signature
SWORN TO BEFORE ME THIS .2- I DAY OF /dF~d~u3'~ ,20 O /
~:~otary Public
SUSAN K TOOKER
NOTARy PUBLIc, S~ate of New York
No 0'~ T05078120
QuaJihed m Suffolk Cou
Commissmr,
EXpires
Name:
PROOF OF ~AILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Address:
CERTIFIED MAIL RECEIPT
FU Postage $ ~:),6"7
U3
~ Certified Fee ~ ' I 0
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
CERTIFIED MAIL RECEIPT
(Domestic -~fail Only: No Insurance Coverage Provided)
~ Rn~-~ ~'~', belng duly sworn, deposes and says
that on the {~ da~ o~ ~U~*. ~mo~ , de~onen=
mailed a true copy of the Notice set ~orth in the Board of
Trustees Appllca=lon, directed to each of the above named
persons at the addresses set opposite there respective names;
that the addresses se~ opposite the names of said persons are
~he address of said persons as shown on the current assessment
roll of the Town of Southold; that said Notices were mailed at
the United States Post Office at ~-.~T}~q'~ , that
said Notices were ma~led to each of sa~d persons by (certified)
(registered)
Signature
Swot. to before =o this /(~ day of
Notary Public
~o.~:L'~
~.~-
HOTICE TO ADJACENT PR()PERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
Itl the matter of applicant: ALFRED J AMEND
YOU ARE HEREBY GIVEN NOTICE:
I. That it l.~ tile Intention of the
Permit from the Board of Trustees to:
undersigne¢l to request a
I~eplace existing 100 ft bulkhead using 16 ft pili;fg ~ 6' cts,
Series 4500 "C-Loc" Interlocking vinyl sheathing, with l" x 12'
tie rods into a horizontal deadman secured in place with 8 ft
backing piling.
2. That tho property which ts the .qubJect of Envlronme~ltal
Review ts located adjacent to your property and is descri, bed a~
follows:
380 Midway Road, $CIM # 1000 - 90 - 02 - 04
Southold NY 11971
3. That the project whlch Js subject to Environmental Reviow
u~lder Chapters 32, 37, or 97 of tile Town Code Is open to pub]it
comment on: ~-J~A You may contact the Trustees Offlce at
765-1892 or in writing.
The above refere~ced proposal is under review of the Bo~rd of
Trustees of the Town of Southold and does not reference any
other agency that might }lave to review same proposal.
OWNERS NAME:
MAILING ADDRESS:
PIIONE #:
MR ALFRED J AMEND
100 Hilton Ave,
Garden City NY 11530
(516) 741 541~
Enc.: Copy of sketch or plan ~howlng proposal for your
convenience.
617.20
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be completed by Applicant or ProJect sponsor)
I. APPLICANT/~PONSOR Corp. 2. PROJECT NAME
COSTELLO MARINE CONTRACTING ALFRED AMEND
3. PROJECT LOCATION: TOWn of Southold Suffolk
Munl¢lpalUy' C~unt¥
4. PRFClSE LOCA?ION (~treel add,ess and mad Intersections, I~omlnent landmarks, etc., or pro~lde map}
380 Midway Road, SCTM # 1000 - 90 - 02 - 04
Southold NY 11971
(Map A#ached)
SEQR
$. IS PROPOSED ACTION:
X~] New [] Expansion [] Modlflcallol!/altm'ation
6. DESCRIBE PROJECT BRIEFLY:
Replace existing 100 ft bulkhead using 16 ft piling @ 6 ft cts, Series 4500 "C-Loc"
interlocking vinyl sheathing, 1" x 12 ft tie rods into a horizontal deadman secured
in place with 8 fl backing piling.
7. AMOUNT OF LAND AFFECTEO:,
tRill, fly NIL ac~es um~at.*y NIL a,:.ro,
a. YeLL PROPOSED AclrIeN COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE REETRICTIONS?
[] No ff No, describe briery
9. WHAT IS PREEEN~ LAND USE IN VICINTTY OF PROJECT1
[X~ Residential [] Indu$1dal [] Commercial
Describe:
Private residential waterfront
[] Agriculture
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOC~L]~
~] Yes [] No If yea. list agencyt9) lind pem~it/lpprovaJa
NYS-DEC, ACOE, NYS-DOS, Town of Southold
! 1. DOES ANY ASPECT OF THE AOTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[] Yes [X] No If yes, Iisi agency nome and permit/approval
12. AS A RESULT OF PROPOSEC ACTION WILL I:XlSTINO PERMIT/APPROVAL RECUIRE MODIFICATION?
E]Ye, FX]No
I CERTIFY THAT THE INFORMATION PROVIDEG ABOVE 19 1RUE TO THE BEET OF MY KNOWLEDGE
I! the action is in the Coastal Ama, and you are a slate agency, complele the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART II--ENVIRONMENTAL ASS ,. be completed by Agency)
I~ ¥. I'-I .o
C COULD ACTION- ~E~-U-L~ IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE F~L~wI~.I~ (Answe,~ may be handwHtlen, d Ic.g,blu)
PART Ill--DETERMINATION OF SIGNIFICANCE (To be compleled by Agency)
INSTRUCTIONS: For each adverse affect identified above, determine whether it is subslsnlial, large, Important Or olherwise significant.
Each eflacl should be assessed )n connection wllh Ils (a} setting (i.e. urban or rural); (bi probabiflly of occurring: (c) dural/on; Idl
irreversiblllty; (e) geographlo scope; and (fi m~agnlluda. If necessary, add atlechments or retarence supporting malarIMs. Ensure that
explanations contain sufficient detail Io show that all relevant adverse Impacts have been identified and adequately addressed. II
quasllnn D of Part Il was checked yes, the determination and significance must evaluate the potential Impact of the proposed action
on the environmental characlarlsllcs of the CEA
[] Check Ibis box if you have identified one or more potentially large or significant adverse Impacts which MAY
occur. Then proceed dlreclly Io the FULL EAF and/or prepare a positive declaration.
(---~ Check this box ti you have determined, based on the information and analysis above end any supporting
documentation, Ihat the proposed action WILL NOT result in any slgnlficanl adverse environmental ImDacts
AND provide on attachments as necessary', the reasons supporting Ihls determination: