The URL can be used to link to this page

Home My WebLink AboutTR-6220 James F. King, presidt Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Je. . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0175C Date December 19. 2006 THIS CERTIFIES that the dock. ramD. and float. and non-disturbance buffer At 635 Waterview Drive. Southold Suffolk County Tax Map # 78-7-10 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 5/17/05 pursuant to which Trustees Permit # 6220 Dated 10/19/05 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a dock. ramD. float. and non-disturbance buffer The certificate is issued to 40 C LLC owner of the aforesaid property. r-07~ Authorized Signature . . . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: \)..II:1/oc. Name of Applicant: ~O ell c. Name of Agent: Property Location: SCTM# & Street ~35 'w c.+c cv.-<-vJ Suv<i\ol~ . 8LA'\-\-- doc..k w\fU'.......-\- re.'bV.:r;'2\ Brief Description of proposed action: b"'ff€(l.. . Typj of area to be impacted: ..0altwater Wetland _Freshwater Wetland Sound Front _Bay Front Distance of proposed work to edge of above: ParJ of Town Code proposed work falls under: ~hapt.97 _Chapt. 37 _other Type of Application: ~ W etIand _Coastal Erosion _Amendment _Administrative _Emergency hlfG ll.eedGd: Eu.w P",Ss<}. "'~ fCch." - 30- 1ev-..l"'",4 of- olG'(l:::-) n., \'<' u"""'~ i' I "'':)< (Lot. ~e ~ r{Q Modifications: Conditions: <, .. 10 OCJ):~'I '-I.;- a t/:/IJJ f{) ",.1/ ", (f\ / '{; 10 " " :~ v ",,", () " " ., '-l ~ 1 <lo4 .! I .1'1 ;14 "'A 1"1 'II 004- " ~ " , , " ~ , ~.l " ." c " " " h,t ~""';IO " ,,.: rJ- ," 0'/ :; (.1:8'1,' ....;,; ~B/.l. ::E 0.1:. :"( "'I '" ^' " " '^ .. " Plan View ~ Appllc.ant, Harlo Rlvelll Propo' ',d, Docok 4 Float PurpO~l" PrIvate Moorlnq LatlLude- N 41-02 -35 Lcmqltude- H 122532 SCrn IOOO-lB-1-IO Southold, NeH York Tide Ranqe, 2,3'+/- Da[um, A.L.H. SGALE 1"= 50' " w-t-E S , A. "vet;:::'lt -Y~.t:-""-<s o~ I,' /" . A'o+ 6:J~~/ ~ / '.;JaQte ~' "'0 C/ , 'II '. ;' / Proposed Timber , f' Walk (4' x 55') l< / (min. 3.5' abv. gr.) / 3' x!4' Ramp & . ,/ 6' x 20' Float I;'" ."j ), " " -' '" :.t r .I' ~ 4 31:) 1 2:;' .' j;J4 24 :;11_3 ;'1 ;'<4 "'.I ./.' .II .I' " :..- I ;,04 Ie 2+ .2 )4 ;tl \'1 II "~I " P'l,' It:.- I L ~ vt.,' If') ot'> ,'J. , .4 ')4,' . 1)4 ," ~ -' l< '" " '" ..1 1,0 (.t,"! '" ALH . Edge of ~ M'Q~5h" ";.. :ross Section SCALE 1"= 20' _Imlt of TIdal Vielland!:> as )ellneated by R 1'=0)( on 04-2B-04 - ~~. Proposed Timber Walk 4' x 55' (min. 3.5' abv. gr.) 3' x 14' Ramp - -lL__J__L L_'~_.J__J_ !il'l.kll)IH :;EA LEVEL \/lAPPING , ,1'1"'1' II' ., :, I . 0 ~ " AIHel I Of I 8" dia, Piles 12' o.e. 10' pcn. .(.~ '-,( '-/1--/1I </ '1_ ! / J, ' -'i--, (11 / ~. ( 1'1" ,),. ) . I 1 I /"; "'I " ' I ''', ~ ' 'r 1.'/,;/, - l/; , ( ~, ( . "Ie r 1/ ~I,. r II: . J. 'I; . 1"'1 I;. I .)/ (/ . 'I '~ 11'1 _ . 1,/ s,- /" /7- / :~:: + ; f-l,. 'I /,.; I,'''''' '~i 1:', ;"f I /, ; 1/1(.;" t'. '/(j. 'f' ,~\ _', 'f. '" '" I ;" l _" '.' " 6' x 20' Float HH LH ..- ~J ~:." -~ :"}# ,t ' . .. // ,;' _r~ " . ~ r'.-.. //. f ''': f." .; !~_' ~,:."'\ if 'q ", ~ ,;.. 1-'jo \~ f/"'..' '~,' '.', ' 11 ! . If. \ ~" '('.'lll~1-.""';~.."">f~ 'A 5 ~ 'f1/', .~jl,;j- >l ~, ~!I' . ..... II '.. '-c' . --J oQ- .' (, .h l \.< ,"" A. '\..0.; .' '; 'l:~, "0 0511"~ ~<.c, '\ .f'C)'---- 'j~ "....: ... l At'JD S'~ ,'~ -- - - ~ - ~ . - - ~ ~ ex. gr. _.-'/;',','1 Ic....-..f.'1 KEY MAP not to sGole \ \ ~ ~~ ~. ~ 7:- <0 ...... -1.. CO THIS PLOT HAS DEYELOPE[; FROH 5lJRVEr'S OF 04-22- 0" ROBERT H. FOX, NY5 licit ~,.. . '"'' d" ("","",'" ~ "H" 0' p. "I'" I "'I>,, ." . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Jolm Holzapfel , Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 24, 2006 Mr. Mario Rivelli 80 Franklin St. New York, NY 10013 Re: 635 W ATERVIEW DRIVE, SOUTHOLD SCTM# 78-7-10 Dear Mr. Rivelli: The above referenced property has been inspected for compliance with Southold Trustee Permit # 6220 for a dock, ramp, and float. A condition of the permit is a non disturbance, no mow buffer. The buffer extends 30' from the edge of the dock walkway, landward, to a large cedar tree. This area is very sandy, with salt marsh hay grasses, small Baccharis seedlings, and Phragmites reed, mixed in with the turf grasses. This area is seasonally flooded. The condition ofthe dock permit is that this area not be mowed and remain undisturbed. A four foot wide path may be mowed landward in the area ofthe wood dock/walkway. The area will be inspected again one month from the date of this letter. If the buffer has remained undisturbed a certificate of compliance will be issued for the dock. Please contact this office if you have any further questions. Very Truly Yours, James F. Kk;de: ~ Board of Trustees ~ -..........--.........~... u, J.>..l UjJl:j.lU, rreSloell't lames King, Vice-preside. Artie Foster Ken Poliwoda Peggy A. Dickerson /' I 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 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction /' Y, constructed / Project complete, compliance inspection.1\1~l)1o "1::>0t.."'- ~ .........lkwo..'\: eJ ~ . l-w"," ~ t~~ ~ ~ ~J<IL Io~ ~~\-o..,~ (1oW)W~ ~ ') . r:; C~-lu..\l \0 \i~?'.' '(: \ \. G ('>c.., ~V") Cew: ~ :SO/-/., ~ Cl4C'.tr-,J....... v fl.r~ '-.. 4>&~ (' '\ >0- u S Uo-...{c... "',,~ ---) . o ~I f1 i-{'~\ -;s J C) ~ <$' ~ 9> ) () . ,roes King, ¥ice-PresideO Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ~,'~ constructed V/' Project complete, compliance inspection. Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK PERIvflT NO....~...~..'~.~': ....... 40(3 1.Lei ISSUED TO ......................................... ~ ......................................................................................... Pur,uent to the pro~,i~Jon$ of Oh,,pier 61!i of the I-~ws of the Stele of New Yor~, 1893, and Oh~pfer ~ of the ,L~. ws of the ' Stele of New York 19,~2~ and the Southold Te~rn Ordmen~e eh- fflled ."R~TIN~ AND ~E ~PL&OlN~ OF~ OBtRUderS IN AND ON TOWN WATERS AND PUBLIC ~DS REMOVAL OF SAND, ~VEL.'O~ O~ER MATERIALS..~M ~NDS .UNDER TOWN WA~RS::.,, ,nd in ,~e~,nce w~h 'the Resol~lon of ~e Boerd edopfed et · meeting held on ..~.~.....~.~ ....... .2g.~.~.L., end 1n eonsider~fi~ of the sum of $.?.~.O,.~Q ........ peld by ~0 C ~C of Sou~floZd N.Y. end subject fo the of Southdd Town' T~es ~horizes end permi~ the We~nd Pe~it to ~nstruo~ ~ 4'x 55' ~mber ~lk~y 3.5' 3hove grade, ~ 3'x~ 4' r~mp, ~nd ~ ~'~( dook, wJ~h the ~ndltions o[ no m~ng ~e~ of the ~d~r bees ~h ~m ~re~ to be ~ non mmQv31 o~ the ~re fen~, ~e ~o~ m~y nm e~end beyond ~he pier line o~ the neighboring ~nd no OOA be~te~ lumber to be use~ for the ~nstm~ion, ~nd ~11 ~s depiote~ on the plans dr3~ by 8e~ Level M~pping d~ted ~5/05. a~ in a~mdance w~ the defa~d s~fflcaflons as ~nf~ in .~e ~gl~ting ap~fi~. .. IN WffN~S WHERe, ~e said ~ard Of Trustees ~re- ~u~s if~ ~r~afe ~al to be a~xed, and ~e~ ~se~ fo sub~ed by ~ '~j~ of fhe ~td ~rd .as of fh~s darn. DATE: ....°.?.~Pt?~...?.: 2005, 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 19, 2005 40 C LLC 80 Franklin Street New York, NY 10013 RE: 635 WATERVIEW DRIVE, SOUTHOLD SCTM# 78-7-10 Dear Mr. Rivelli: The Board of Town Trustees took the following action during its regular meeting held on Wednesday October 19, 2005 regarding the above matter: WHEREAS, 40 C LLC 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 May 17, 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 October 19, 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, RESOLVED, that the Board of Trustees approve the application 40 C LLC to construct a 4'x 55' timber walkway 3.5' above grade, a 3'x14' ramp, and a 6'x20' floating dock, with the conditions of no mowing seaward of the Cedar trees with that area to be a non disturbance buffer, removal of the wire fence, the dock may not extend beyond the pier line of the neighboring docks, and no CC^ treated lumber to be used for the construction, and all as depicted on the plans drawn by Sea Level Mapping dated 8/5/05. Inspections are required at a fee of $50.00 per inspection. (See attached schedule. This is' not a determination from any other agency. Fees: $50.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hct LU ocoO Ne~ 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 Edn M. Crotty Commissioner August24 2005 40C LLC 80 Franklin St New York NY 10013 OCT - 4 Sout~old Town Board of Trustees Attn: Mario Rivelli Dear Permittee: Re: 40C LLC Property, 635 Waterview Drive, Southold DEC No. 1-4738-03379/00001 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 and approved plans. Please read all permit conditions carefully. 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, and the dual Notice of Commencement/Completion of Construction. Please follow all instructions on the latter. Very truly yours, Karen S. Westerlind Environmental Analyst Enclosures: 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-03379/00001 FACILITY/PROGRAM NUMBER(S) PERMIT Under the Environmental Conservation Law EFFECTIVE DATE 24 August2005 EXPIRATION DATE(S) 31 August2010 TYPE OF PERMIT · New E~ Renewal [] Modification [] Permit to Construct [] Permit to Operate [] Article 15, Title 5: Protection of Waters [] Article 17, Titles 7, 8: SPDES [] Article 27, Title 9; 6NYCRR 373: [3 Article 15, Title 15: Water Supply [] Article 15, Title 15: Water Transport [] Article 15, Title 15: Long Island Wells [] Article 15, Title 27: Wild, Scenic and Recreational Rivers [] 6NYCRR 608: Water Quality Certifica- tion PERMIT ISSUED TO 40C LLC ADDRESS OF PERMI"~-EE 80 Franklin Street, NewYork, NY 10013 CONTACT PERSON FOR PERMITTED WORK Mario Rivelli NAME AND ADDRESS OF PROJECT/FACILITY 400 LLC Property, 635 Waterview Drive, Southold LOCATION OF PROJECT/FACILITY SCTM: 1000-078-07-10 COUNTY J TOWN Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY E3 Article 19: Air Pollution Control [3 Article 23, Title 27: Mined Land Reclamation [] Article 24: Freshwater Wetlands BI Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management Hazardous Waste Management [] Article 34: Coastal Erosion Management [] Article 36: Floodplain Management [] Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control TELEPHONE NUMBER 717-881-8189 TELEPHONE NUMBER 212-625-1114 WATERCOURSE Goose Creek NYTM COORDINATES E: N: Construct a catwalk measuring 55 feet long by 4 feet wide, a ramp measuring 14 feet by 3 feet and a floating dock measuring 20 feet by 6 feet. All work is to be done in accordance with the attached plans stamped NYSDEC approved. By acceptance of th~s permit, the permittee agrees that the permit is contingent upon strict comp ance w th the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: (KSW) ADDRESS George W. Hammarth, Region 1 Headquarters Deputy Permit Adminstrator Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE / Page 1 of 4 10. 11. 12. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the ~ermitted activity. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodology is stabilization of the entire disturbed area.with appropriate vegetation, such as grasses, etc. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than the existing lawn area 50 linear feet from the tidal wetland boundary. Dock or timber catwalk shall not exceed 4 feet in width and shall be a minimum of 3~ feet above grade* over tidal wetland areas (* as measured from ground to bottom of dock sheathing). The use of wood treated with pentachlorophenol in the construction of structures that will be in contact with tidal waters is strictly prohibited, Floats and ramps may not rest on or be stored in any vegetated tidal wetland. No dredging, excavating or other alteration of shoreline or underwater areas is authorized by this permit, nor shall issuance of this permit be construed to suggest that the Department will issue a permit for such activities in the future. No permanent structures may be installed on dock/catwalk/float without first obtaining written Department approval (permit, modification, or amendment). Docks/catwalks/floats may not (a) extend laterally beyond property lines, (b) be placed so that docked boats extend over adjacent property line, (c) interfere with navigation, (d) interfere with other landowners riparian rights. Pilings may not: (a) extend beyond property lines, (b) be placed so that docked boats extend over property lines, (c) interfere with navigation, (d) interfere with other landowners riparian rights. No structures are to be constructed on pilings without further authorization of the Department. DEC PERMIT NUMBER 1-4738-03379/00001 40C LLC Page 2 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS 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 attributable to the permittee's acts or omissions in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the 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 to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SARA 401 (3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and 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 of 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; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions, 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 40C LLC I Page 3 of 4 1-4738-03379/00001 I NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (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 necessaryprecautions shall be taken to preclude contamination of anywetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 4. 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. 5. There shall be no unreasonable interference 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 C on servation m ay 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. 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. 9. 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 Robert H. Fox, dated 04-22-05 and last revised 08-05-05. DEC PERMIT NUMBER 40C LLC Page 4 of 4 1-4738-03379/00001 Rb'TURN THIS FORM TO: COMPLIANCE Mmfne Habitat Protection Stony,Srook, NY t 1790-2356 PERMITNUMBER: I-N'-2 .~ ~- C~-~ ~ ~/~0000/ ISSUED'T.~ PROJECT LOCATION/ADDRESS: CONTRACTOR NAME: ~ OR FAX TO: 631.444-0297 ADDRESS: TELEPHONE: Dear Sic Pumuant to General Condition fl 9 of the referenced permit, you are hereby notified that the' authorized activity shall commence On · We ce~ that we have read the referenced permit and approved plans and fully understand the authorized pmjeot and all at~vedCrmdltlons. We have, Inspected the project slt,.e, and can complate.the p~ject a.s desc~_bed In the permit and as deploted on the plans. We can do so In full'compliance wrm all plan notaa ar~ perm~ conmaons: ~ .ne permit algn, permit and approved plans will be .v~lable at the ~e for Inspection In accordance with general Condition No. t. (Both slgn~ture~ required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE M~IST BE SENT TO THE ABOVE ADDRESS A T, LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT AND /OR ANY ASSOCIATED REGULA TED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE PER~ffr AND APPROVED PLANS A VA/I-ABLE A T THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE PEI~iII I ~ ,"~" AND/OR CONTRACTOR TO APPUCABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS. NOTICE OF COMPI. ETION OF COHSTRUC~ON RETURN THIS FORM TO: COMPLIANCE Marine Habitat Protection NY~DEC Building 40 - SUNY Stony Brook, NY 11790-2356 PERMIT NUMBER: /_ y 7 ~ PROJECT LOCATION/ADDRESS: (X)NI'RACTOR NAME: OR FAX TO: 631~.?.4-0297 ISSUED TO: ADDRESS: ~ TEL~?HONE~ Dear Sir. Pumuent to General Condition fl g of the referenced pemflt, you are hereby notified that the authorized aotlv~y was completed on · We have' fully complied with the terms arm conditions of the permit and approved plans· (Both signatures required) PERMrrEE DATE CONTRACTOR DATE THIS NOTICE, 'H,I'rH PHO TO~i~4PH$ OP ~ ffE COMFLE ~ =D ~VOKK AND/OR A COMPL= I t:D SURVEY, A S APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DA YS OF COMPf.~ON OF THE PROJECT. o All,err J. Ir~upski, President Jsmes King, ¥ice-President Artie Foster Ken Poliwods Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: /'~, ( '7r 2~£ has been O~..~- I '~ zoo ~ and the (____~) Application Approved (see below) ( )Application Denied (see below) ( ) Application Tabled (see below) if your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: S1GNEDf PRESIDENT, BOARD OF TRUSTEES Oct. 13 , 2005 Field InspecI -'--"lr ii", , 'I 1'1 I I II J .' J " ,( " ,J 1 . I ~ ,j,,,",! I 'll' _ I 1'1 I, 1.1', J '''~ ../1 ..... ~, --- . I. I Oct. 13 , 2005 Field Ins_on . Oct. 13 , 2005 Field Insp,on . Oct. 13 . 2005 Field InSPljon . Oct. 13 , 2005 Field Inspec. . Marine Helmet Pf~i~'"um~ c~. IVl~ Hf~8OUrOes, Region One Building 40 - SUNY, Stony BreOko New YOrk 11790.2356 Phone: (631) 4440296 FAX: {631) 444.0297 Fax Transmission Cover Sheet # Page~ + Cove~. I ~- .~ zoo~] ~1~ - ~HQS,,~T ~8~OFf~TC9 ~d ZT:~T'QOO~/T~/90 :'=Permit Tracking MARINE HABITAT BBOTECTION REGION 1 BLDG 40 SUNY STONY BROOK, NY ~'i790-2356 ~ 8U, ,=-,-,u ,';,:? MARINE':' ~00~ ~]~{G - D~SF,~ LGZOTttTC9 T¥~ ~T:gT 900~/T~/90 Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., June 14, 2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Alicia Marin, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH CONDITIONS of the Wetland Permit application of 40 C LLC to construct a 4'X 55' timber walkway 3.5' above grade, a 3'X 14' timber ramp, and a 6'X 20' floating dock. Located: 635 Waterview Dr., Southold. SCTM#78-7-10 The CAC recommends Approval of the application with the condition the dock is in line with the neighboring docks and the existing fence is removed. Vote of Council: Ayes: All Motion Carried I I( J PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON PLANNING BOARD OFFICE TOWN OF SOUTHOLD MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 To: Town of Southold Board of Trustees From: Mark Terry, Senior Environmental Planner LWRP Coordinator Date: July 18, 2005 Re: Proposed Permit to Construct a Dock for 40 C LLC in Goose Creek SCTM#1000-78-7-10 The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. This proposal is to construct a fixed open walkway 4 x 55', a 3' x 14' timber ramp and a 6' x 20' timber float in Goose Creek in Southold. Goose Creek is a listed~Critical Environmental Area. The action is located within REACH 8 in the R-40 zoning district. The 89~fgot length of the proposed walkway/dock is inconsistent with the size of the surro~ng open walkway/dbck structures within the area. The dock structure to thehorth of the property is avoroximately 35 feet in length (2004 Aerial photograph interpretation). Overall density of dock structures within the immediate vicinity of the parcel is low. The proposed structure is for private use and will not support a pattern of development that enhances community character nor preserves "public" open space. Additionally, the applicant has not prooosed sufficient mitigative design and construction best management practices that will minimize the adverse effects of the action on the environment to the greatest extent possible. Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. There is no opportunity to meet this policy Policy 3. Enhance visual qualiO~ and protect scenic resources throughout the Town of Southold. The Plan View indicates that the structure will be a minimum 3.5' above grade. Policy Standard 3.1 Enhance visual quality and protect scenic resources throughout the Town of Southold including: Minimize the introduction of structural design components (including utility lines, lighting, signage and fencing) which would be discordant with existing natural scenic components and character, The action does not meet this policy, conversely, the applicant proposes a structure that will affect the scenic quality of the area. B. Screen components of development which detract from visual quality, Using appropriate siting, scales, forms, and materials to ensure that structures are compatible with and add interest to existing scenic components. The scale of the structure is large and inconsistent with surrounding dock structures. The length should be evalauted dependent upon the establish need of the applicant. The construction material of the structure has not been identified and should be identified. Preserve existing vegetation and establish new indigenous vegetation to enhance scenic quality, and The action will result in a loss of high quality Iow and high salt marsh. The application states that damaged wetland vegetation will be replaced, however, no standard planting plan indicating the timing, species and specifications have been submitted to the Board. The Board should require a simple restoration plan for disturbed areas. Protect visual quality associated with agricultural land, open space and natural resources. The visual quality of natural resources (salt marsh) will be impaired as a result of the action. The Board should require a low profile structure to minimize visual impacts. Policy 4. Minimize loss of human life, structures, and natural resources from flooding and erosion. No loss of human life is expected as a result of the action. If approved the structure will be designed and constructed to tolerate flooding and minimize erosion. Policy 5. Protect and improve water quality and supply in the Town of Southold. The materials used to construct the dock are unknown and should be identified. In general, the elimination of the use of CCA-treated materials in marine waters is strongly recommended. Wood pressure-treated with a chromated copper arsenate (CCA) is the most commonly used material for pilings for small docks. There has been extensive study of the toxicity of these compounds in the marine environment that suggests that the degree of toxicity depends on the chemical form as it reaches the target organism. The forms will change over time and in response to sediment types, amounts of organic material present, oxygen levels and water movement (Luoma and Carter, 1991). Laboratory studies by Weis et al. (1991, 1992~ have shown that leachate from CCA -treated wood can be toxic to estuarine species. Leaching decreases by about 50% daily once the wood is immersed in seawater. Approximately 99% of the leaching occurs within the first 90 days (Cooper, 1990, Brooks 1990; in Sanger and Holland, 2002). If CCA is permitted, please implement the following Best Management Practices recommended by National Oceanic and Atmospheric Administration's (NOAA) to minimize leaching into the water: Where CCA-treated materials are to be used, soakine it in saline waters for 90 days prior to installation will allow leaching to occur in a controlled setting ,or Place a vinyl sleeve over the piling to prevent leaching. The project area demonstrates extremely shallow water depths. The installation of the proposed structures may promote power boat traffic and the possible following negative impacts may Occurl Impacts to submerged aquatic vegetation, Contamination from fuel discharges (if power vessels are proposed) Erosion on shorelines, and Re-suspension of bottom sediments and turbidity To further the above policy and to reduce turbidity in the event that the proposed action is approved, the following Best Management Practice is strongly recommended: The encirclement of the entire project area with a floating turbidity screen to remain in place a sufficient number of days to allow the settling of the suspended solids. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. The orooosed action is located within a DEC Critical Environmental Area. The orooosed detailed construction oractices of the dock have not been identified. It is recommended that the aoolicant identify the orooosed construction oractices. Activities during dock construction can destroy vegetation either above or below the tide line by pulling them from the substrate or destroying their root system. The peat beds underlying salt marshes can also be compacted through the improper use of heavy equipment. In sea grass beds, the installation of pilings may have immediate impacts as well as cause long- term changes. Installation through "jetting" with high-pressure hoses typically disturbs a surrounding area-- depopulating grasses there prior to construction. Once areas are depopulated, the presence of pilings may lessen chances of regrowth. Beal, Schmit, and Williams (1999) suggest that changes in seagrass communities in the vicinity of pilings may be caused by the modification of currents, sed'maent deposition, attraction of bioturbators, and leach'me from chemically treated wood. Both marsh grasses and sea grasses have adapted to living in extended periods of sunlight. Their photosynthetic pathways vary from many terrestrial plants allowing them to be highly productive in their natural sett'mgs. Shading can have significant impacts on the health and productivity of these plants. It is recommended that the Board min'unize shading fi.om dock structures to the greatest extent possible. Based upon the above the action is inconsistent with the following policy standards. Policy Standards 6.1 Protect and restore ecological quality throughout the Town of Southold. The proposed action does not propose a simple restoration plan identifying timing, species and planting specifications of areas that may be impacted (if any) during construction. Such a plan shall be required. 6.2 Protect and restore tidal and freshwater wetlands. The proposed action will result in a net loss of tidal wetlands. 6.3 Protect vulnerable fish, wildlife, and plant species, and rare ecological communities. The proposed action is located within a NYSDEC Critical Environmental Area. The proposed action does not propose a simple restoration plan identifying species and planting specifications of areas that may be impacted (if any) during construction. Such a plan should required. Policy 7. Protect and improve air quality in the Town of Southold. No significant impact to air quality will occur as a result of the proposed action. Policy 8. Minimize environmental degradation in Town of SouthoM from solid waste and hazardous substances and wastes. See Policy 5 response above. Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of $outhold. The proposed action will remain private and will not support a pattern of development that enhances community character nor preserves "public" open space. Policy 10. Protect $outhold's water-dependent uses and promote siting of new water- dependent uses in suitable locations. The proposed action is within a DEC listed Critical Environmental Area. The proposed action will not protect or enhance the physical, cultural and environmental attributes of Goose Greek. Based upon such, the proposed action does not meet the following policy standards to the greatest extent possible. 10.3 Allow for continuation and development of water-dependent uses within the existing concentration of maritime activity in harbors, inlets and creeks. A. Ensure that public actions enable these harbors, inlets and creeks to continue to function as concentrations of water-dependent uses. B. Protect and enhance the economic, physical, cultural, and environmental attributes which make up the character of these harbors, inlets and creeks. 10,4 Minimize adverse impacts of new and expanding water-dependent uses and provide for their safe operation. Limit the potential for adverse impacts associated with development of a new water- dependent use by promoting the location of new development at appropriate sites. Appropriate sites include: sites which have been previously developed, sites which require minimal physical alteration to accommodate development, sites that already possess public infrastructure or locational characteristics that would support a water-dependent use. B. Avoid development of new water-dependent uses at sites that are located outside of the traditional concentrations of water-dependent uses or at sites that exhibit imt~ortant natural resource values or where the proposed use will cause significant adverse affects on community character, surrounding land and water uses. or scenic quality. Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. The action is oroposed within Goose Creek, a listed NYSDEC Critical Environmental Area which entitles the area to a hei~_,htened level of orotection. The proposed action will not support the following policy standards. A. Ensure that commercial and recreational uses of living marine resources in the Town of Southold are managed in a manner that: C. Foster the occurrence and abundance of the Town's marine resources through: 1. protection of spawning grounds, habitats, and water quality, 2. enhancement and restoration of fish and shellfish habitat, 3. the prevention of over-fishing. 11.2 Provide for commercial and recreational use of the Town of Southold's finfish, shellfish, crustaceans, and marine plants. Maximize the benefits of marine resource use so as to provide: 1. a valuable recreational resource experience, Protect the public health and the marketability of marine and fishery resources by: 1. maintaining and improving water quality of fishery and marketable marine resources to protect public health. Policy 12. Protect agricultural lands in the Town of $outhold. This policy does not apply to this action. Pollcy 13. Promote appropriate use and development of energy and mineral resources. This policy does not apply to this action. Goose Creek is a listed Critical Environmental Area by The New York State Deoartment of Environmental Conservation, which entities the area to a heightened level of orotection. It is recommended that the Board of Trustees consider the below information and reauire the following outstanding items to further the oolicies of the Local Waterfront Revitalization Program: 1. The orooosed detailed construction practices and materials (aoolication indicates timber?) have not been identified and should be outlined in writing to the Board. 2. Although the aooHcation states that the disturbed areas will be restored, a restoration olan outlining soecies, timing and soecifications has not been submitted to the Board. Such a Dian must be submitted to the Board. 3. During construction of the structure, reauire the encirclement of the entire oroiect area with a floating turbidity screen to remain in oince a sufficient number of days to allow the settling of the susoended solids. Correspondingly, the potential impact of any Unlisted Action on the environmental characteristics of the Coastal Environmental Area is a relevant area of environmental concern and must be evaluated in the determination of significance prepared pursuant to Section 617.7 of SEQR. Please contact me at (631) 765-1938 if you have any questions regarding the above. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application --./(Vetland Permit Application __ AdminisU'ative Permit --AmendmenffTrans fer/Ex~nsion __Received Fee:$ ~/~1.) , - ~l/ot~ IF~~ -.Offmpleted Application ~ (~lO~ Incomplete ~o~ ~,~nc~on: Ill Tyre I T~e I1 Unlisted Coordination:(date s~nt) ~ i ~CAC Rel~al Sent: ,~]~ ~ate of Inspection: ~}~ ~Receipt of CAC Report: .rg Lead Agency Determina~ Technical Review: ~.~.c .e=~ng .e~:b Resolution: Name of Applicant 40 C~ [..LC IO01~ Phone Number:( )2~Z G26 1714 Suffolk County Tax Map Number: 1000- Prope~yLocation: ¢~ ~~ D~ [ S~C~/ ~) 500' (provide LILCOPole ~, distance to cross streets, ~d location) AGENT: ~.~f. (If applicable) Address: ~/. j{~ . Phone: Board of Trustees Application GENERAL DATA Land Area (in square feet): 3 gD, 0 24 5. Area Zoning: ~-~q'&l 0 ~d T~ ~ Previous use of prope~y: ~ ~ O~T~ ~ Intend~ use of prope~y: ~ ~ ~ ~ ~ Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? [,/'No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): ~Board of Trustees Application WETLANOfrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~ C.~'I'~' q'~-- ~ Area of wetlands on lot: Il ['2~. 5 square feet Percent coverage of lot: 3.53 % Closest distance between nearest existing structure and upland edge of wetlands: Oq,,O~ feet Closest distance between nearest proposed structure and upland edge of wetlands: :~ feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? How much material will be filled? 0 0 cubic yards cubic yards Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: e~{ Manner in which material will be removed or deposited: Statemem of the effect, if any, on the w~lands and tidal waters of the to~ thru may result by reason of such proposed opermions (use a~achments if appropriate): ~oard of Trustees Application COASTAL EROSION APPLICATION DATA Purposes ofproposed activity: ~006{ ~ ~ ~ ~I~C(/~~ ~e w~lands present within 100 feet of the proposed a~ivity? No ~es Does the project involve excavation or filling? ~No Yes If Yes, how much material will be excavated? How much material will be filled? ~) (cubic yards) Manner in which material will be removed or deposited: ~[-~ {~ Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 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, NewYork 11971-0959 Telephone (631) 765-1892 Fax(631) 765-~l BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ....... COUNTY OF SUFFOLK) STATE OF NEW YORK) I, ~r~O ~.,[v~,/,-k-I , residing at ~.~- t,~- leo t~ being duly sworn, depose and say: AFFIDAVIT OF POSTING That on the 4_ day of ~0 ~ ~-, 200~,, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Dated: Swom to before me this KIERAN M. CORCORAN ~.~'~°~ i~"~'~ _~ Commission Expires December 6, 20 PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1~ APPLICANT / SPONSOR 40 c 3.PROJECT LOCATION: Municipality 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by A3plicant or Project Sponsor) 2. PROJECT NAME County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map G~,~ kgltW'E~Vt~ DI~iV~--' I 5~d'T'~°C'OlNY 5. IS PROPOSED ACTION: ~New ~ ~pansion ~ M~ification / alteration 6. DESCRIBE PROJECT BRIEFLY: SEQR 7. AMOUNT OF LAND AFFECTED: ~--~.. Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY W~TH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe bdefly: ,~HAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential []Industrial []Commercial [~Agriculture E~Park/Forest/OpenSpace []Other(describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL ~NyCesY (Federal, State or Local, E~No If yes. list agency name and permit / approval~.DJ~.C..' I ~.~1.~, "[~_~",~ ~-~1~/ v 0F ,nS ,ee'v 11. DOES ANY.~.~SPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r~Yes ~v~INo If yes. list agency name and permit / approvak 12.[~YesAS A ~NoL''~'"E ULT OF PROPOSED~'~)ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/signature SP~Ti~lr Name . ,~Z~ ~ "~ 0 ~'~,.'~ Date: If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. B· W~LLACTI~NRECE~VEC~~RD~NATEDREV~EWASPR~V~DEDF~RUNL~~TEDACTI~N~~N6NYCRR~PART617~6? IfNo, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCrATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, 3otential for ems[on, drainage or flooding problems? Explain briefly: I C2. Aesthetic, agricultural, archaeological, histodc, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetatio~n o~ i~una, h~hl ~hellfish oT~iictiife speci;~i ~igniflcani habitats, ;r ihreste~d Or enc~hgered species? Expi~ih ~defly: C4· A community's existing plans or goals as of~cially adopted, or a change in useor intensity of use of land or other natural resources? Explain bdefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdefly: C6. Long ter~, short term, cumulative, or other effects not i~entified in Cl :C57 Ex~lain briefly':' C7. Other impacts (inCluding cha'ng~ in use (~'~iiber qua~iity or type ~l:energy? 'l~pla[n'br~efiy: D. WILL THE PROJECT HAVE AN iMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: i-i Yes r--]No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: [-I i--lNg PART Ill - D~=IFRNIINATION OF $1ONIFIC~IC£ {1o bo completed by .~en~) INSTRUCTIONS: For each adverao effect identffied above, determine whether it is au~tantial, large, important or otharwise sign~csnt. Each affect should be essessed in connection with its {a) setting (i.e. urban or rural); {b) prolmbiliht of occurring; (c) duration; {d) irmvorsibility: (e) geographic scope; and (f) magnitude· If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed, If question d of part ii was checked yes, the d eterrnination of significance must evaluate the potential impact of the proposed action on the environ mental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur· Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting doCumentation, that the proposed actio~ WILL NOT result in any significant adveme environmental impacts AND provide, on attachments as necessary, the reasons supporting thi.. determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Board of Trustees Application County of Suffolk State of New York ,40 C, El. Ca l',/,Iqttl'O0 t l.l,.I BErNGDt VSWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERIVIIT(S) AND THAT ALL STATEMENTS 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 SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS DAYO Notary Public BARBARA ANN RUDDER Notlp/Publio, State of New York No. Qul~f~ld in $~4folk County Comm~llon Expirel April 14, ~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of£thics nmhibits conflict~ of interest on thc vart of town officers and employs. Thc purpo~ of this form is to on)vide information which can alc~ thc town of possible conflict~ of interest ~md allow it to ~akc whatever action is nece*sarv to avoid same, (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, soeh as a company. If so, indicat? the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other', name the activity.) ~ ~"~ 4 ~ '~ ~-~~ 0~--~-. Do you personally (or through your company, spouse, sihling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or buginass interest. "Business interest'? means a business, including n partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold ' ~1~ ~1' , Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (cheek all that apply): __.A) the owner of greater than 5% of the shares of the corporate stock of thc applic0nt (when the applicant is a corporation); __.B) thc legal or beneficial owner of any interest in a non-corporate entity (when tha applicant is not a corporation); __.C) an officer, director, pasmer, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Town Of $ontbold ~ INSTRUCI tONS LWRP CONSISTENCY ASSESSMENT FORM All applicants for p~fi~its* includkig Town of Southold agenc/es, shall complete th/s CCAF for proposed actions that are subject to thc Town of Southold Waterfront Consistency Review iaea. T~is assessment is intended to supplement othcr information used by a Town of $outhold agency in ' making a deta'n'dnation of corlzistency. *Except minor exempt aetion.~ including Building Permitr and other ministerial permtts not located within the Coc~tal Erosion Hazard Area. Before armweting the questions in Sect/on C, the preparer of this form should review the ~xempt minor action list, policies and explenalions of each policy contained in the Town of Southold Local War,i-front R~vitali~ation Pwgram. A propesed action will bc evaluated as to its s/snifioam beneficial and adverse effects upon thc coastal area (which includes all of Southold Town), If/my question in Section C on this form is answered "yes", then the pwposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should b~ analyzed in more deta/1 md, if necessary, modified prior to ~naJdng a determination that it is congstent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it al-~ll_not be undertaken. A copy of the LWRP is available in the following places: online at' the Town ofSouthold's website (southoldtown.northfork.net), the Board of Trustoes Office, the Planning Department, all local libraries and the Town Clork's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION The Applicntfon bas been submitted to (check appropriate response): TownBoard [] Planning Dept. ~'] BoJldtngDept ~-~ BoardofTrnstees'~ 1. Category o£Town of Southold agency action (check appropriate response): (a) Action lmdettalom directly by Town agency (e.g. r_~pital construction, planning activity, agency regulation, la;Id transaction) (b) Financial azs/stan~e (e.g. grant', loan, subsidy) (¢) Pei'ihit, approval, license, cerl/ficatien: Nature and extent of action: . ' If'au application for tho p~posed action has been filed w/th the Town of Southold agency, the followin8 information shall b~ prov/ded: (a) Nameofapplicant: L~O C~ L.L,C.~ (cO Applic, zlion mumb~r, if any: Will tho a~tion be dir~tly undertakcn, r~quir~ landing, or.appw, v, al bll a state or f~deral agency? ¥~ [~_)SJ. No[-~ Ifyes, which stateor federal agency? ~)-~.C. ! ~J'~-S DEVELOPED COAST ~POI,ICY Policy 1. Foster a pattern of development in the Town of 8outhold that enhances community character, preserves open space, makes efficient use of infrastructure, makes benefleial use ora coastal location, and minimizes adverse effects of development. See LWRP Seetion III - Policies; Page 2 for evaluation eriteria. At/ach additio~a] sheets if nece~ary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southol& See LWRP Seetion III - Policies Pages 3 throttgh 6 for evaluation criteria Attach 'adStt~o~al sheets if nece~s~y0 Policy 3. ~han~ ~sual qun~ and pro~ scenic r~ourc~ ~roughout the Town of Southol~ 8~ L~ S~ofl ~- Poflci~ Pages 6 ~rou~ 7 for ~ua~on e~te~a ~ Y~ ~o ~ Not App,cable Attach addit~tmal sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section II! - ]Policies Pages 8 through 16 for e~'aluatlon criteria Yes [--~ No blot Applicable Attactt add,tin,mi sheets if'nec~sary Pulley 5. Protect nnd improve water quality and supply In the Town of Soathold. See LWRP Section ill -Policies Pages 16 through 21 for evaluation crlterin R Yes ~'~NO ~-~NotAppHcable Attach addilional sheets if n~cess~'y Policy 6, Protect and restore the qnslt~y and fe~on of ~e To~ of Soa~o]d ~osystems ~cludin~ Si~ifl~t Coast~ ~h and Wfld~e HabitaM ~d wefl~. S~ L~ S~flou I!I - Policies; Pngff 22 ~ugh 32 for evalua~on cfi~a. ~ Yes ~o ~ Not Applicable Policy 7. Protect and improve air quality in the Town of Southold, See LWRI' Section III .- Policies Pages 32 through 34 for evaluation criteria. ' ~-] Yes ~ot Applicable Aaevh edditioml sh~t~ if nvoes~ary Poflcy 8. Minimize environmental degradation in Town of Soulhold from solM waste and hazardous substances and wastes. See LWRP Section III- Policies; Pages 34 through 38 for evaluation criteria, [] Yes ~ot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section Eli - Pofleies; Pages 38 through 46 for evaluation criteria. ['--] Yes [] l'qo ~-~ Not Applicable At~gh additional sheots if neoe~0a~ WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See I,WRP Section Ill - PolicLes; Pages 47 through 56 for evaluation criteria. ['~ YeS [~No [] Not Applicable Attach ~dd~oa~l ~h~ts ~ necessary Pnlicy ].l. ~emo~e ~usmtnable use of~g ma~ne r~o~rces ~ ~o~g ~s~aed So~ ~e P~nic ~d To~ w~. S~ L~ $~on ~ - ~oli~; ~ag~ 57 throegh 62 for ~ua~o~ ~ Y~ ~o ~ ~ot Applicable At~tch ndditionn~ shects if necessary Policy 12. Protect agricultural lands in the Town of Southoid. See LW]RP Section ~I - Policies; Pages 62 through 65 for evaluation criteria. At-tach additions1 sheets if nct~ssery Policy 13. ]Promote apl~roprinte use and development of energy and mineral resources, Set: Section IH - ]Policies; P. ages 65 through 68 for evaluation criteria. [] Y., [-] ~o [-~ ~ot AOplicebl~ Created on.5/25/05 11:20