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HomeMy WebLinkAboutTR-7007AAPFROVED BY LOARD OF TRUSTEES TOWN OF SOUTHOLD 3 ./ / / BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-79-04-24 SCALE FEBRUARY 11. 1999 MARCH 31. 1999 ADDED PROPOSED HOUSE MAY 28, 1999 REVISED PLOT PLAN AREA = 40.259.90 sq. ft. 0.924 ac. CERTIFIED TO: CHICAGO TITLE INSURANCE COMPANY WILLIAM KELLY SANDRA SIKORSKI SURVEY dF LOT 57 j K~EY MA_P MAP , OF ~ ~'~ "'"~' HARBOR LIGHTS ESTATES ~</%~?. SECT[ON THREE ~ ~.~ FILE No. 5,47 FI~D AUGUST 7. ,968 ~~ ~ APPROVAl, OF CONSTRUC-i~O WORK~ A $ING.[~ FAMILy RESIDENCE Thc sc~ge dls~ ~d ~ ~ly f~iliti~ ~ ~ts Jura ingegno Surveyor (651)727-2090 Fox (630727-1727 SURVEY OF LOT 57 MAP OF HARBOR LIGHTS ESTATES SECTION THREE SITUATED AT BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-79-04-24 SCALE 1 "=40' SHOWING NEW SUFFER AREA k ;RAP!NC PLAN ( JUNE 22. 2000 R~4~SED SEPTIC %'fSTE~J ~ ~ROP WELL AREA = 40,259.90 sc rt. CERTIFIED TO CHICAGO TITLE INSURANCE COMPANY WILLIAM KELLY ,~, SANORA SIKORSK[ Minimum distance between well and cesspool is to be 150 fe~t. r TEST HOLE DATA ~ PROPOSED SEPTIC SYSTEM DETAIL NOTES 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS: do.o EXISTING CONTOUR LINES ARE SHOWN THUS: .... PROPOSED ELEVATIONS ARE SHOWN THUS: ~ 2. !F CLAY OR BOG IN THE LEACHING POOL AREA IS FOUND, tT MUST BE EXCAVATED AND REPLACED WITH CLEAN SAND. [<~'~ PROPOSEO EXPANSION POOL ~'-{~;~ PROPOSED LEACHING POOL ~ PROPOSED SEPTIC TANK 4E LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD BSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. Joseph A. Ingegno LaDd SurveYor I,OT 57 HaRPIOR LI£;H?$ E>'TATI4:~ APPROV~rb BY !'OV;'N OF $OUII'[ James F. K/ng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road 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 # 0389C Date: December 11, 2008 THIS CERTIFIES that the existing 8'x12' shed located outside the approved buffer At 1840 Brigantine Drive, Southold, New York Suffolk County Tax Map # 79-4-24 Conforms to the application for a Trustees Permit heretofore f'fled in this office Dated 11/21/08 pursuant to which Trustees Permit # 7007A Dated 12/10/08 and 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 the existing 8'x12' shed located outside of the approved buffer area The certificate is issued to WILLIAM KELLY owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7007A Date of Receipt of Application: November 21, 2008 Applicant: William Kelly SCTM#: 79-4-24 Project Location: 1840 Brigantine Drive, Southold Date of Resolutionllssuance: December 10, 2008 Date of Expiration: December 10, 2010 Reviewed by: Board of Trustees Project Description: To permit the existing 8'x12' shed located outside ofthe approved buffer area. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the application prepared by William Kelly, received on November 21, 2008. Special Conditions: None. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. King, President Board of Trustees JFK:eac James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 F~x (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application -~/Administrative Permit g Amendment~Transfer/~xJ,ension eceived Application: i/Received Fee:$ '~)~4 SS~ -/r~ ~'-~I ~1.~ .,,,"Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) t.--LWRP Consistency Assessment Form CAC Referral Sent:~ p,,-'Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ../Yublic nearing Held: i Resolution: Name of Applicant Address UhoneNumber:( ) &~l~ T~- 2q 5<'~- Suffolk County Tax Map Number: 1000- 'Tq - Oq ~ ~// Property Location: ]~)/'~0 ~[~'/~.,~"~'~_~ ~ ~rovide LILCO Pole ~, dist~ce to cross s~eets, ~d location) AGENT: [~,~~ ~ (If applicable) Address: Phone: ~rd of Trustees Applicatic Land Area (in square feet): Area Zoning: GENERAL DATA Previous use of property: ~7-~:f2:~C_~_._ Intended use of property:. ~->~-~,~O6n~--- Covenants and Restrictions: ~ Yes No If"Yes", please provide copy.~ __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by X a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): ]Sf~.~ ~ Board of Trustees Applicati, WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~->'~12D~ ~ ~ Area of wetlands on lot: ]~_: ;~"-7 square feet Percent coverage of lot: ,~ % Closest distance between nearest existing structure and upland edge of wetlands: ~7 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? lkJ/~- cubic yards How much material will be filled? /~l~ cubic yards Depth of which material will be removed or deposited: ~ I~'~ Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet Statement of._t)e' ~ffect, !f any~ 0_n th~' wetl~ds and tid~al wa_t~rs of t:h~ t°wn tha_t.._may Le_s_ult reason of such proposed operations (use attachments if appropriate): 617.20 SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only P,,~T--J--4aR~ECT INFORMATION ( To be completed by Applicant or Project Sponsor) (. AP,.EI-ICANT/~ONS OR 2. PROJECT NAME 3.PROJECT LOCATION: 4. PRECISE LOCATION: Street Addess and Road Intersection~ Prominent landmarks etc -or provide mad 5. IS PROPOSED ACTION: [~New j'~ Expansion r~] Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF =CT LAND AFFE TED: Initially ~w--) acres~ Ultimately ~ acres ~ 8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No if no, descdbe briefly: W_9~HAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) esidentia, J---]industrial []Commercial [~Agdculture [~ Park l Forest / Open Space E~Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL A~G~NCY (Federal, State or Local) Yes [] No If yes, list agency name and permit / approval: 13. UUE5 ANY A~HECI ~ IHE ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ~No If yes, list agency name and pe~it / approval: CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO TH~ BEST OF MY KNOWLEDGE Date: -' / If tl~e 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 FAF. []Yes []--] No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C'I r--iNo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED 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, potantJal for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agdcufiural, archaeological, histadc, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as o/ficially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. G owth subsequent development or related acbwt~es likely to be induced by the proposed acgon9 Explain briefly C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain bdefly: C7 D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAl E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If },es explain: [] Yes [-'-]No ! I PART 111 - D~ ~ t::I<MINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~Ve~determinewhetheritissubstan~a~~~arge'imp~rtant~r~therWisesignificant~ Each effect shoutd be assessed in connection with its (a) setting (i.e. urban or rural); (b) pmbabitity of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (t) 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 · ~,'e~, ~h-~ determ!n_.t!o~ of s[gn!~c, ancc must evclucte thc pcte~tiaHmpcct c. fthc prc, pcc. c.d-:ctlo r, c.r, t,hc c. nv~,rc.~,m~n~r.l ch&r&cterlsticz, c,f the CEA. Check this box if you have identified one or more potenfially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Che~ ~his b~-}'o~ t~/~ d~rm~d~ b~e~ oh {h~ ~r~f~)rmaiion a~d ~alysis ~b0ve a~d ~ny ~u~p0rtin~' document~io~ tt~¥~he pr0p~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessaPj, the reasons supporting thi determination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) of Trustees Applicat~n County of Suffolk State of New York ~0'gL~S"~]5[D/)(F]'~f~H T HIHAT ~/Sm Ig ?~ ~PLIC~T FOR ~ ~O~ STaTeS.TS TR~ TO T~ BEST OF ~S~R ~O~EDGE ~ BEL~F, ~ T~T ~L WO~ ~L BE DO~ ~ T~ ~R SET FORTH ~ T~S ~PLICATION ~ AS MAY BE ~PRO~D BY T~ SOUTHOLD TO~ BO~ OF TRUSTEES. T~ ~PLIC~T AG~ES TO HOLD T~ TO~ OF SOUTHOLD ~ T~ TO~ TRUSTEES ~ESS ~ F~E FROM ~Y ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY VIRT~ OF SA~ PE~T(S), ~ G~TED. ~ CO~LET~G T~S ~PLICATION, I ~BY AU~O~E T~ ~US~ES, T~ AGENT(S) OR ~P~SENTATI~S(S), TO EN~R ONTO ~ PROPERTY TO ~SPECT T~ P~SES~CON~CTION~TH~,~;~~ ~CATION. ' r,'. /~at SWORN TO BEFORE ME THIS ~:~ [ ,54 DAY OF ~x,.~%X~X'k~a.q ,20 0~ Notary Public CONNIE D. BUNCH Notary Public.State of New York No. 01BU6185050 Qualified in Suffo k County ,. Commission Expires April 14, 20 I~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the naa of town officers and emnlovees. The purpose of this form is to vrovide information which can alert the town of~ossible conflicts of interest and allow it to take whatever action is (Last name, first name,~aida~ initial, tmle~ you are applying :in the name of someone else or other entity, such as a company. If so, indicate 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 (lf"Otber", name the activity.)_ Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of thc Town of Southold? "Relationship" includes by blood, toarriage, or business interest. "Business interest'~ means a business, including a 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 lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Soathold Title 0r position o f that person ~l Describe the relationship between yourself{the applicanl/ageaffrepresentative) and the town officer or employee. Either check the line A) through D) and/or describe in the space provided. The is (check all that apply): ___A) the owner of hah 5% of the ~ of the applicant (when the apl: B) the legal or'beneficial o t interest in a non-corporate entity (when the applicant is not a ___C) an officer, the applicant; or )llcant. DESCRIPTION OF RELATIONSHIP Form TS 1 200 ~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCA. F for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard A rea. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is ans~vered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail, listing both supporting and non- suvvortine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the folloxving places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION 7q -C q - PROJECT NAME ~LCq ~t'~ The Application has been submitted to (check appropriate response): TownBoard [~ Planning Board [--~ Building Dept. [~ BoardofTrustees Category of Town of Southold agency action (check appropriate respot~se): (a) Action undertaken directly by Town agengy (e.g. capital [--] construction, planning activity, agency regulation, land' transaction) [---] (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: Present land use: [~~.~-- Present zoning classification: If an application for the proposed action has been filed ;vith the Town of Southold agency, the following information shall be provided: (a) Name of applicant: ~4C~L~,/k (b) Mailing address: ~), ~). C cty7Mc)tx5 Met 115-71 (c) Telephone number: Area Code ( ) (d) Application number, ifany: ~ Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] N~ If yes, ~vhich state or federal agency?. ( C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY 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. See LWRP Section III - Policies; Page 2 for evaluation criteria. ~N []Yes [] No ot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria Yes No [~] Not Applicable f Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [] No~ NotApplicablc Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not A Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No CNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [~ Yes [~] No ~ Not 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 III - Policies; Pages 38 through 46 for evaluation criteria. ~-] Yes~ No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations~.ee LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~ Yes [] No L~Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [-~ Yes ~] No ~Not Applicable /- Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. [~Yes [~ No[~Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. Yes [] No [~ Not Applicable DEC PERMIT NUMBER 1-4738-02289100003 FACILITY/PROGRAM NUMBER(S) NEW YORK STA~EPARTMENT OF ENVIRONMENO CONSERVATION PERMIT Under the Environmental Conservation Law EFFECTIVE DATE March 28, 2008 EXPIRATION DATE(S) March 27, 2013 TYPE OF PERMIT · New [] Renewal [] Modification E] Permit to Construct [] Permit to Operate [] Article 15, Title 5: Protection of Wa- ters [] Article 15, Title 15: Water Supply [] Adicle 15, Title 15: Water Transport [3 Article 15, Title 15: Long Island Wells [] Article 15, Title 27: Wild, Scenic and Recreational Rivers [] 6NYCRR 608: Water Quality Certification [] Article 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation · Adicle24: FreshwaterWetlands [] Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management [] Adicle 27; Title 9; 6NYCRR 373: Hazardous Waste Management [] Article 34: Coastal Erosion Management [] Article 36: Floodplain Management [] Articles 1, 3, 17, 19, 27.37; 6NYCRR 380: Radiation Control PERMIT ISSUED TO William Kelly TELEPHONE NUMBER (631) 766-2435 ADDRESS OF PERMITTEE P.O. Box 1680, Southold NY 11971 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Kelly Property, 1840 Brigantine Drive, Southold LOCATION OF PROJECT/FACILITY SCTM # 1000-79-4-24 COUNTY I TOWN Suffolk Southold Description of Authorized Activity WATERCOURSE FWW SO-39 NYTM COORDINATES E:718.1 N:4546.9 Construct an in-ground swimming pool, pool equipment, pervious stone patio, 8 foot by 12 foot shed, 24 foot by 26 foot garage, pervious driveway, and install three (3) dr/wells. All work shall be performed in accordance with the plans prepared by Nathan Taft Corwin III last revised on 2/25/08, and stamped NYSDEC approved on 3/28/08. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see pages 2 - 4) and an)/Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS SUNY @ STONY BROOK, 50 CIRCLE ROAD, STONY BROOK, NY 11790-3409 John A. Wieland (MRP) AUTHORIZED SIGNATURE DATE Page 1 of 4 March 28, 2008 RK STATE DEPARTMENT OF ENVIRONMENT~AL CONSI SPECIAL CONDITIONS 1. Prior to commencement of any construction activities, a continuous row of straw bales shall be staked end to end as shown on the approved plans. The bales shall be maintained, repaired and replaced as often as necessary to ensure proper function, until all disturbed areas are permanently vegetated. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are removed. 2. Straw bales shall be recessed two to four inches into the ground at all times. 3. The limits of clearing, grading and ground disturbance line is equal to the staked hay bale line as shown on the approved plans. 4. Any work, disturbance, and or storage of construction materials shall be confined to within the limit of clearing and ground disturbance shown on the approved plan. 5. Any demolition debris, including excess construction materials and or excess excavated materials, shall be disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland by the close of business on the day such material was generated. 6. All fill shall consist of clean soil, sand and gravel that is free of the following substances: asphalt, slag, flyash, broken concrete, demolition debris, garbage, household refuse, tires, woody materials including tree or landscape debris, and metal objects. 7. There shall be no draining of swimming pool water directly or indirectly into freshwater wetlands or protected buffer areas. 8. All roof runoff and or pool discharges shall be directed to drywells located a minimum of 75 feet from the freshwater wetland boundary. 9. All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or waterbody at the end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. Fuel or other chemical storage tanks shall be contained and located greater than 100 feet landward of the regulated wetland or waterbody at allk times. If this requirement cannot be met by the permittee, then the storage areas must be designed to completely contain any and all potential leakage. Such a containment system must be approved by NYSDEC staff prior to placement of equipment, machinery or tank storage within 100 feet of the regulated wetland or waterbody. 10. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass and mulched with straw immediately upon completion of the project, within two (2) days of final grading, or by the expiration date of this permit, whichever is first. Mulch shall be maintained until a suitable vegetative cover is established. If seeding is impractical due to the season, a temporary mulch shall be applied and final seeding shall be performed as soon as weather conditions favor germination and growth. 11. Suitable vegetative cover is defined as a minimum of 85% area vegetatively covered and no unvegetated areas larger than one (1) square foot in size. 12. The permittee shall incorporate the attached Covenant (or similar language) to the deed for the property where the project will be conducted and file it with the Clerk of Suffolk County within 30 days of the effective date of this permit. This deed covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to: NYSDEC, Bureau of Habitat Regional Manager, SUNY @ STONY BROOK, 50 CIRCLE ROAD, STONY BROOK, NY 11790-3409 DEC PERMIT NUMBER 1-4738-02289/00003 PAGE 2 OF 4 Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee~ excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of thc State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittce's acts or omissions in connection with the pcnmttec'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 thc terms and conditions of the penrfit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DECks own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of thc 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 thc permittee's agent with respect to the )crmitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittcc. Item C: Permittee Responsible for Obtaining Other Required Permits Thc pcrmittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to catxy 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 w/th the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this pem~it, 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 permirlee 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 (APC) 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, SUNY ~ Stony Brook, 50 Circle Road, Stony Brook NY 11790-3409 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Deparlmcnt reserves the right to modify, suspend or revoke this permit in accordance xvith 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 envirornnental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) nonco~npliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environn~ental Conservation Law or regulations of thc Department related to the pemxitted activity. DEC PERMIT NUMBER [ PAGE 3 OF 4 I 1-4738-02289/00003 NE K STATE DEPARTMENT OF ENVIRONMENTAL CONS TION (FRESHWATER 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 oyvner 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. 4. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across or along the bed ora waterway or floodplain, deposits within any regulatory floodway, 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 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. 8. 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 their designated agent as part of the permit application. Such approved plans ~vere prepared by: Nathan Taft Corwin III last revised on 2/25/08, and stamped NYSDEC approved on 3/28/08. DEC PERM1T NUMBER 1-4738-02289/00003 PAGE 4 OF 4 95-20-1 (11/03) -gd New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of the approved work and any DepartmE,'nt conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit numb~ shown when contacting the DEC. · ~r/ P, eg~ona~ Permit Administrator ilrp~itt~i ~ba~i ~ ROGER EVANS / / NOTE: This notice is NOT a permit ~OTICE COVENANT TO THE DE~ DECLARATION THIS DECLARATION, dated __ day of _, 200 , is made by (hereinafter the "Declarant"), whose address is WITNESSETH WHEREAS, the Declarant is the owner of certain real property located in the Town of Southold, County of Suffolk, State of New York, Tax Map # District 1000, Section 79, Block 4, Lot(s) 24 which real property is more particularly described in Exhibit A annexed hereto (hereinafter referred to as the "Property"); and WHEREAS, the Property is situated in or adjacent to regulated freshwater wetland SO-39 of the Southold Quadrangle which has been inventoried and mapped by the New York State Department of Environmental Conservation (hereinafter "Department"), pursuant to Environmental Conservation Law (hereinafter "ECL") Article 24 (also known as the "Freshwater Wetlands Act") and Part 664 of Title 6 of the New York Code of Rules and Regulations (hereinafter "6 NYCRR"); and WHEREAS, various activities conducted both in and adjacent to freshwater wetlands are regulated by the Department pursuant to ECL Article 24 and Part 663 of 6 NYCRR and require written authorization from the Department prior to being conducted; NOW, THEREFORE, in recognition of the Department's jurisdiction as set forth above, it is the responsibility of a party having any right, title, or interest in the Property, to obtain from the Department or any successor organization, a current description of all activities which are regulated pursuant to ECL Paticle 24 and Part 663 of 6 NYCRR, and to obtain written authorization from the Department prior to such regulated activities being conducted on the Property. Regulated activities include, but are not limited to clearing of vegetation; application of chemicals; excavation; grading and filling; and erection of any structures. By: STATE OF NEW YORK ) )SS. COUNTY OF ) On the__day of. in the year 200 , before me, the undersigned, a Notary Public in and for said state, personally appeared , personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the person or entity upon behalf of which the person acted, executed the instrument. NOTARY PUBLIC NOTICE OF COMMENCEMENT OF CONSTRUCTION RETURN THIS FORM TO: Bureau of Habitat NYSDEC 50 Circle Road - SUNY PERMIT NUMBER: /- ,~7,,'~2'- St-°nY Br~°k' N)( 11790-3409 - PROJECT LOCATiON/ADDRESS: OR FAX TO: 0272 ISSUED TO: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to General Condition fi 9 of the referenced permit, you are hereby notified that the authorized activity shall commence on · We certify that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions. We have inspected the project site and can complete the project as described in the permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions. The permit sign, permit and approved plans will be available at the site for inspection in accordance with general Condition No. 1. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS A T LEAST TWO DA YS PRIOR TO COMMENCEMENT OF THE PROJECT AND /OR ANY ASSOCIATED REGULATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE PERMIT AND APPROVED PLANS AVAILABLE A T THE WORK SITE FOR THE DURA TION OF THE PROJECT MA Y SUBJECT THE PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENAL TIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS. Cut along this line ~ ~ ~ NOTICE RETURN THIS FORM TO: PERMIT NUMBER: PROJECT LOCATiON/ADDRESS: COMPLIANCE Bureau of Habitat NYSDEC 50 Circle Road - SUNY Stony Brook, NY 11790-3409 OR FAX TO: 631-444-0272 ISSUED TO: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to General Condition # 9 of the referenced permit, you are hereby notified that the authorized activity was completed on · We have fully complied with the terms and conditions of the permit and approved plans. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE, WITH PHOTOGRAPHS OF THE COMPLETED WORK AND/OR A COMPLETED SURVEY, AS APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DA YS OF COMPLETION OF THE PROJECT.