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HomeMy WebLinkAboutTR-7580 0 • John M. Bredemeyer III,President *Qf SU(/rTown Hall Annex Michael J. Domino,Vice-President '`� l0 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold, New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J. Sanders,Trustee yCOUNN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 21, 2014 Ms. Joanne Burr 116 Roosevelt Ave. Hasbrouck Heights, NJ 07604 RE: JOANNE BURR PENINSULA ROAD, FISHERS ISLAND SCTM# 10-4-7.2 Dear Ms. Burr: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, May 21, 2014: RESOLVED that the Southold Town Board of Trustees.grants the Last One-Year Extension to Wetland Permit#7580, as issued on June 22, 2011. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, John M Bredemeyer I President, Board of Trustees JMB/amn John Bredemeyer, President OF F94 Town Hall Annex Michael J. Domino, Vice-President °� cOay 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanders Southold, NY 11971 Dave Bergen f�41 ,� �a°! Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: &d Z / / `y el JOANNE BURR requests the Last One Year Extension to Wetland Permit#7580, as issued on June 22, 2011. Located: Peninsula Road, Fishers Island. SCTM# 10-4-7.2 Type of area to be impacted: �� '/Saltwater Wetland Freshwater Wetland Sound Bay l Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed: Modifications: Conditions: �� sr �X TF o 1 L1 Present Were: J. Bredemeyer -"M. Domino ✓J. King C. Sanders It. Bergen Bay Constable Other Form filled out in the field by J, IeIA16­1 Mailed/Faxed to: Date: _•l ':' [,.'� 'f " '.i:�L'N�t_L �F'I_=lt �. �:7G. tai .._ . � � i, ya- R -► , 7 � : MAY 1 7 2013 4 &WW At APR 14 214 f al Ft �A-J 3 47 6 � �. c 0 0 James F. King,President DF S0Town Hall Annex Bob Ghosio,Jr.,Vice-President QlyOl 54375 Main Road O P.O. Box 1179 Dave Bergen # 11 Southold,New York 11971-0959 John Bredemeyer Co Michael J. Domino • 44Z-) Telephone(631)765-1892 QlyCO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 19, 2013 Ms. Joanne Burr 116 Roosevelt Ave. Hasbrouck Heights, NJ 07604 RE: JOANNE BURR PENINSULA ROAD, FISHERS ISLAND SCTM# 10-4-7.2 Dear Ms. Burr: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, June 19, 2013: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit#7580, as issued on June 22, 2011. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, )JKJ.-" 0.�5r James F. King President, Board of Trustees JFK:amn • _ v MAY 1 7 2013 DIV Ila 17 d t c5 317S! �w/4 Al Rao-A �C o ,r d C9 1 R UL-,e ee -s Po �3r �x J � 79 S � �- � � � 9 '7 1 - °lsg i iS—,—.5M-71= lIIIIIIIII�IIiII"fl1,SII'I�Ipd��1f',�I'��',A,I��ui��ll�lfi�� Jill M.Doherty, President ��OF soyo/_ Town Hall Annex Bob Ghosio,Jr.,Vice-President h0 `0 54375 Main Road P.O.Box 1179 James F. King Southold, New York 11971-0959 Dave Bergen G Q John Bredemeyer '�0 �� Telephone(631) 765-1892 um, Fax(631) 765-6641 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 '/z constructed X Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 7580 DATE: JUNE 22, 2011 ISSUED TO: JOANNE BURR PROPERTY ADDRESS: PENINSULA ROAD, FISHERS ISLAND SCTM# 104-7.2 AUTHORIZATION L Pursuant to the provisions of Chapter 275 and/or Chapter 1 I I of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 22,2011,and in consideration of application fee in the sum of$250.00 paid by Joanne Burr and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to reconstruct the existing 41x58' timber dock and extend to 70' and using grated materials on the first 25' of the fixed dock; relocate piles to a min. 10' apart; replace existing ramp,8'xl6' float and 12'x12' float in a"T" configuration; and as depicted on the site plan prepared by CME Associates, Inc.,last dated May 11, 2011, and stamped approved on June 22, 2011. i" JN WITNESS WHEREOF,the said Board of Trustees hereby.causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. �0��,1►Ef(k�.�Q� )A me h Cr r TERMS AND CONDITIONS The Permittee Joanne Burr,residing at Peninsula Road,Fishers Island,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages,or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Pennittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved,but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said$oard will be]totified by the Permittee of the completion of the work authorized.' 9. That the Permittee will obtain all other permits and consents that may,be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. i �► Jill M. Doherty, President -``��v sooTyo Town Hall Annex Bob Ghosio,Jr.,Vice-President �� l� 54375 Main Road James F. King P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen 4 C John Bredemeyer 'Ol'COU `�� Telephone Fax(6316 31) 892 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 22, 2011 Ms. Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: JOANNE BURR PENINSULA ROAD, FISHERS ISLAND SCTM# 10-4-7.2 Dear Ms. Moore: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, June 22, 2011 regarding the above matter: WHEREAS, Patricia C. Moore, Esq. on behalf of JOANNE BURR applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated May 20, 2011, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 22, 2011, 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, 2 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 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JOANNE BURR to reconstruct the existing 4'x58' timber dock and extend to 70' and using grated materials on the first 25' of the fixed dock; relocate piles to a min. 10' apart; replace existing ramp, 8'x16' float and 12'x12' float in a "T' configuration; and as depicted on the site plan prepared by CME Associates, Inc., last dated May 11, 2011, and stamped approved on June 22, 2011. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, WIJil . Doherty President, Board of Trustees JMD/eac Jill M. Doherty,President ��Of S�f'/jyO Town Hall Annex Bob Ghosio,Jr.,Vice-President e�0 - l0 54375 Main Road y P.O. Box 1179 James F. King 4 T Southold,New York 11971-0959 Dave Bergen G _ Q John Bredemeyer %� �� Telephone(631)765-1892 l`COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: J 00 c1(1� &"r Please be advised that your application dated 020 owl/ has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 15i Day of Construction ($50.00) '/z Constructed ($50.00) X Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: r �r TOTAL FEES DUE: BY: Jill M. Doherty, President Board of Trustees 0 Jill M.Doherty, OgUFFiCt,President �QV COG P.O.Box 1179 Bob Ghosio,Jr.,Vice-President 'l2 Southold,NY 11971 James F.King ti Telephone(631 765-1892 Dave Bergen ,y Fax(631)765-6641 John Btedemeyer p !� Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: JOANNE BURR requests a Wetland Permit to reconstruct the existing 4'X 58' timber dock and extend to 70' and using grated materials on the first 25' of the fixed dock; relocate piles to a min. 10' apart; replace existing ramp, 8'X 16' float and 12'X 12' float in a "T" configuration. Located: Peninsula Rd., Fishers Island. SCTM#10-4-7.2 Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 _Chapt. 111 _other Type of Application: —Wetland _Coastal Erosion _Amendment —Administrative—Emergency_Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: J. Doherty_B. Ghosio J. King D. Bergen, J. Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: • �gpFFO(,� • Peter Young,Chairman - Town Hall,53095 Main Rd. Lauren Standish,Secretary y. P.O. Box 1179 O Southold,NY 11971 �y01 � Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., June 15, 2011, the following recommendation was made: JOANNE BURR to reconstruct the existing 4'X 58' timber dock and extend to 70' and using grated materials on the first 25' of the fixed dock; relocate piles to a min. 10' apart; replace existing ramp, 8'X 16' float and 12'X 12' float in a "T" configuration. Located: Peninsula Rd., Fishers Island. SCTM#10-4-7.2 The CAC did not make an inspection, therefore no recommendation was made. low a� k, x 7 —�Y �1 �.�+ C � • 'S- ,tea rI aa r t, y ® I 0 • ���� ,• ` Print - Maps Page 1 of 1 Bing Maps f` Peninsula Rd, Fishers Island, NY 06390 My NotesFishem4s�orid Sound Hs Ai <tl�` nd • FREE! Use Bing 411 to Find movies, Ol businesses & more: 888-BING-411 Y �; ` � ♦! ,rte roti Jy� r � v ay crosoft Bird's eye view maps can't be printed, so another map view has been substituted. http://www.bing.com/maps/print.aspx?mkt=en-us&z=18&s=b&cp=41.263 590,-72.004928... 5/20/2011 �gUFFO( Jill M. Doherty,President QV CO P.O.Box 1179 Bob Ghosio,Jr.,Vice-President Southold NY 11971 James F.King ti Telephone(631 765-1892 Dave Bergen ,y M Fax(631)765-6641 John Bredemeyer p V'F Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: g-l�' Patricia C. Moore, Esq. on behalf of JOANNE BURR requests a Wetland Permit to construct a 4'X 50' fixed dock, 4'X 8' ramp, 6'X 16' floating dock and 12'X 12'floating dock in a "T" configuration, constructed a min. of 3' above grade over tidal wetlands. Located: Peninsula Rd., Fishers Island. SCTM#10-4-7.2 Tyof area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part own Code proposed work falls under: hapt.275 Chapt. 111 _other Type of Application: �tland _Coastal Erosion _Amendment _Administrative_Emergency Pre-Submission Violation Info needed: F1 Modifications: &I Conditions: Prese Were: Doherty Ghosio J. King D. Bergen, J. Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: 1 s FIII III, o N f z y • ,prt m t� dY I. rauYr v MISE ( 4W \ 3Y la W B s 22 Z 'i � I �� u' ,u ♦3 t.o. �� wa turn • � 'i it I y O `. T I • I TI I .4 V wESt xMdM as ' a�i � ' ryHF[I nK9lR1 s i 5����� I O I - � 15 fo - NY s <�� I ��m r •7 ,� - �. nazi e... e4' �a �� 1 i1 uI .z t w1 \ z.,Y r• oR� �,.a .ter s.ra a. ,ee ss�ro.�e o%r: ¢xrnt ��-J-1 wl- /3T 'I J c ` _— iz11 Q — -- —_, •. .. xonce COUNTY Of SUFFOLK x --- .-- _ .r«— _ �� .• .. Aed h t f E ' SOUiNOLO secTrory uo ____ -- -- —.•-- Wer y ax Service Agency r s u� OFFICE LOCATION: �QF SO(/lMAILING ADDRESS: Town Hall Annex �0� Ol0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Cn Telephone: 631 765-1938 Fax: 631765-3136 �1y00UNT'1,�� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 22, 2011 Re: Proposed Wetland Permit for JOANNE BURR SCTM#1000-10-4-7.2 Patricia C. Moore, Esq. on behalf of JOANNE BURR requests a Wetland Permit to reconstruct the existing 4'X 58' timber dock and extend to 70' and using grated materials on the first 25' of the fixed dock; relocate piles to a min. 10' apart; replace existing ramp, 8'X 16' float and 12'X 12' float in a "T" configuration. Located: Peninsula Rd., Fishers Island. SCTM#10-4-7.2 The proposed action has been reviewed to Chapter 268, 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 CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney r Office Use Only _Coastal Erosion Permit Application X_Wetland Permit Application Administrative Permit Amendment/Trans eZ tension ✓Received Application: iJ ✓Received Fee:$ Completed Application _Incomplete _SEQRA Classification: Type IType 11 Unlisted Coordination:(date sent) _ � RP Consistency AssessVment Form t(��J'rl1 MAY 2 2011 ,trate Referral Sent: �e of Inspection: / --- Receipt _Receipt of CAC Report: _Lead Agency Determination: Technical Review: —,f'u—blic Hearing Held: l Resolution: Name of Applicant n Ar- j�jy r( � `'Jna me W1-0 Address 1 �c �o_C'eQr Ci5br.0 cls 4 tc NS- O-7(o D! Phone Number:( ) o�)O I — a S-k I 1 S 7 Suffolk County Tax Map Number: 1000 - ( y - y — -7. - Property Location: P-e n o t n s TS 1 cvr�cl (provide LILCO Pole#, distance to cross streets, and location) AGENT: �Gl 1Y[ (If applicable) Address: 5 10-zo fnQtn QvGc, � LSpLO-tp ) j p v �. 1 ( 9 -7( - Phone: l s' y 33C2 Ord of Trustees Application* GEN`ERAL DATA Land Area(in square feet): 1. 94 Inc - Area Zoning: 2- qo Previous use of property: �/s((5 �OU}e 4 LfCr L Intended use of property: r6Cbn5V4Uc crc i5( i rtct c�oG1c v�kin i 2' P/t�et�scolJ Covenants and Restrictions: Yes __)�___No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes _,oN_No If"Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date 1p,; � N Co K? I �( QD 3 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): recons\ Qct- 50' -l-Im6v/ C10CIc _ a,t 4fMd dock +0 70' ( l z'„[,x+rwscoro) to b✓a1e v ae(74 ti 2 Frain Ghon �ao � 6r 5o 0sT2S' of eel d�l�) C�fuicc[ M��xc . f��crrd��[iile5 i7� rn1ri,rnUm to, nrznNi- annA off- p �IPS � Sem-son a-1 T f [octet �5 n� c�QQ Qs Sh ,rn C MLk duns Ord of Trustees Application• WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: (lam CoAcSf uc;' P/ f ✓1 CL)CA . NF1 Via %v Area of wetlands on lot: square feet Percent coverage of lot: � A Closest distance between nearest existing structure and upland edge of wetlands: 5- feet Closest distance between nearest proposed structure and upland edge of wetlands: $ feet Does the project involve excavation or filling? No Yes ( b y �✓�e- i les If yes, how much material will be excavated?cubic yards How much material will be filled?_NA cubic yards Depth of which material will be removed or deposited: N(A feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: SVrannAoa.,r A d ny t_ cc vl.�tvu r ove Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): PA I V) ( r/l cO d (5h-) r (a',� — PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNUSTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1,APPLICANT/SPONSOR 2.PROJECT NAME Jocjnn-e iJvl-r' y^Zca7,5JYUc — dock -"h°rr/ &PROJECT LOCATION: ey1 nt n suA cL 2� MunicipalityCounty 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc •or Drovitle maD �-If_0/1 r n S rJJCt R e c A 5.IS PROPOSED ACTION: © New ®Expansion Modification I alteration 6.DESCRIBE PROJECT BRIEFLY: l voo icrsd>tic� r5 S6 r C)ocjG 1:T 14A a­�}eivtd f-kTo" YNa Fey rclQ 00 7.AMOUNT OF LAND AFFECTED: Initially .O/ acres A Ultimately acres �• 9 S.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? NYes ❑ NO It no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as marry as apply.) riqlRealdenflal ❑mdustrial ❑Commercial F]Agnwlture ❑Park/Forest I Open Space FjOther (describe) 1o. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stats or Local) ©Yes R)Jo If yes, list agency name and permit l approval: 4'j--A4 D�Br#g o,lTe-t Ito ""r,/w7 p�Ck 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? myes El 11 yes, list agency name and permit / approval: PiX'-S/z� Sv` of bye 1 . ASeaRE A ULT OF PROPOSED ACTION WILL EXISTING PERMIT! APPROVAL REQUIRE MODIFICATION? No I CERTIFY T__T THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantonsor/ SpNem Date: Signature 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. 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. ❑ Yes 0✓ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) Cl. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Longterm,short tens,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If yes,explain briefly: ❑ Yes ❑✓ No 17, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Ii es a Iain: ❑✓ No F- PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether itissubstantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(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 determination of significance mustevaluate the potential impact of the proposed action on the environmental characteristics of the CFA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL 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 adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees Name of Lead Agency Date Jill M. Doherty President Print or*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) �9UFFDIA Jill M.Doheny,President - Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President P.O.Box 1179 James F.King 'F Southold,NY 11971 Dave Bergen y .,a Telephone(631)765-1892 John Bredemeyer 1 # �' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of JOANNE BURR COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING ./ I, k186Rr^3vy2 residing at/dba O bb,-3Y filS/r�74M Z4� y�m63Yr being duly swom,depose and say: That�o/qn the/, day of Z&W 2011, I personally posted the property known as /Y.0 'e 92r /,� Zl 6* 9wrt io-t.yw6 ,2 dve �e /'Z)c& Lw pr by placing the Board of Trustees official poster where itas' y be seen, and that I have checked to be sure the poster has remained in place for eight d s prior t the date of the public hearing. Date of hearing noted thereon to be held Wed Jun 22 2011 n or about 6:00 PM. Dated: (signature) Sworn to before me this day of /6"4 20// Notary Public /ATRICIA J. CRISANTI NOTARY PUBLIC MY COMMISSION ELAPID-O U4P 31,2m: Ad of Trustees Application* County of Suffolk State of New York BEING DULY SWORN DEPOSE ND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(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 REVIE OFTHISAPPLICATION. Signature SWORN TO BEFORE ME THISDAY OF 20 4-Notary BETSYA.PERKINS Notary Public,State of New Yank 8l Ainr se dx3 uoisslwwooNo.01PE6130636 /(IunoC�� ui pagllenp Qualified in Suffolk Coun 9C90S t d l0'oN Commisslon Expires July 18, 3 „ioA Marl Io a 'oll4nd AWN SNIN8 d' AS138 04/11/2011 23: 49 120128 57 1JOANNE PAGE 02 -_...------ -- 0411212011 10:31 MOORE LAN S 7851643 P.001I001 taoard of Txuataas Application AUTHORIZATION (where theapplicantis not the owner) f371d4�at1 03e,U I`r FIBoard p (mailing address))/ tcu Lit, te do hereby authorize (Agent) JJ2 _ to apply for permit(s)from the Southold wn. steba on my behalf. ( Rld''a81$natUre) ii i i 0 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Vc)ctnnC 6(iff' P4,+'c cu C Mco-rcj coq c4,:t (Last name,first name,middle initial,driless you are applying in the name of I 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 7C Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? `Relationship"includes by blood,manage,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 X 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 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(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this yof1_20¢�L Signature ( �r/��� Print Name C [702f Form TS 1 Iau.'/�IG utiL� Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF 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 Area. 2. 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). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent 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 shall not be undertaken. A copy of the LWRP is available in the following 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 SCTM#— le -V- 7,;71-- The Application has been submitted to(check appropriate response): �7f Town Board El Planning Dept. E Building Dept. 0 Board of Trustees 1�9 1. Category of Town of Southold agency action(check appropriate response): / (a) Action undertaken directly by Town agency (e.g. capital construction,planning activity,agency regulation, land transaction) E (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval, license,certification: 0 Nature and extent of action: l��ot�7Ll �1�NC/I � �TL�"I/ ✓'tCe�s/'rLC-fz�'�_ X 7o 2,5 of 6K«l clock oee� der_K�.ta / tt Location of action: n S CI& IC,,d r Site acreage: 7 4-4 Present land use: &F u S'G ,[ C*'a c/G Present zoning classification: 440 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: ��6?19//C 16 U/�e- (b) Mailing address: l//,, �oy�y e-1/- 14j e . /yit a X,-. v �/-{^' / J � Al �i 7�n b (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No Mp If yes, which state or federal agency? 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. Yes No [] (Not Applicable - please explain) �S � S CL✓ Joe Z �c� PNrs/r�nc. rJ�.�c /2 ' r a Li d�� lti of Wa-IF-r in Z.- 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 IE Yes 0 No �X (Not Applicable-please explain) 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 0 No � (Not Applicable-please explain) 1,t/a d-, (isr &S ' ' F�rf of 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 0 No ® (Not Applicable-please explain) 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 11 Yes E No �] (Not Applicable-please explain) 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. 71 Yes D No (Not Applicable-please explain) /t O P)Z fi,- $�v �LtrL✓ r:n /��_�/C(l �jr"/c//{'/o���D p�/S � / 6riS ._.. /h.n.rn✓/n q� sf-Lv{�a�cc< :fq�J�i`Y� 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. See Section III — Policies Pages; 34 through 38 for evaluation criteria. ❑ Yes ❑ No X (Not Applicable—please explain) 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 1:1 No LA (Not Applicable—please explain) 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. IR YeSE] No❑ (Not Applicable—please explain) /)Md'e i r,« /J v -Gc�� ,cC� �,D rnor D- a4c'-s n� Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's wo dependent uses and promote sitinlf new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No �6 (Not Applicable—please explain) 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— please explain Gen4,t&cA_ er7v'ir'canme,r/W/ 41GutCL&&77S, 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 X, Not Applicable— please explain 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 fbl Not Applicable—please explain PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel: (631)765-4330 Fax: (631)765-4643 May 20, 2011 by hand Board of Trustees Town of Southold Main Road Southold NY 11971 RE: JOANNE BURR PREMISES: PENNISULA ROAD, FISHERS ISLAND SCTM: 1000-10-4-7.2 Dear President Doherty and Board members: On April 12, 2011, our office submitted an application for a wetlands permit to repair/reconstruct the dock, in kind in place. At that time we were waiting for the updated plans. We are now submitting a new application since we have changed the plan and we respectfully request that you replace this application with the one previously submitted and apply the $250.00 filing fee paid to this application. Thank you for your courtesies in this matter. e truly yours, Patricia C. e PCM/bp encls. IN�ST HAR50R LOCUS D,4RBIE5 COVE SCALE: 1"=400' NOM 1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT. 2.) IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. 3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYORS SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF THE LAND SURVEYOR. 4.) A PORTION OF THE SITE IS LOCATED IN FLOOD ZONE AE, ELEVATIOy tt -- AND ZONE VE ELEVATION 13 PER FIRM (FLOOD INSURANCE RATE MAP) ftk SUFFOLK COUNTY, NEW YORK- COMMUNITY NUMBER 36103C, MAP, UMfB€R >y 36103CO019H MAP REVISED SEPTEMBER 25, 2009. 5.) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TA)(MAP 1000, SECTION 010, BLOCK 4, LOT 7.002 6.) TOTAL AREA = 1.94t ACRES. 7.) SITE IS LOCATED IN R-40 ZONE. i 8.) BASE FOR LEVELS: MEAN LOW WATER 1i R E V I S 1 0 N S PLAN OF PROPOSED DOCK REPAIR PREPARED FOR CME Associates, Inc. JOANNE BURR CMEn -- 32 Crabtree Lane,Suite 340Wdstock,Non CT 06281 55 Maln Street Sulte 300 NorwlM,CT 06380 PENINSULA ROAD, FISHERS ISLAND 333 East River Drive,East Hartford,CT 06108 Phone 888-291-3227 50 Elm Street,Southbridge,MA 01580 vmw.cmeengineedng.wm DATE: 05/11/11 1 SCALE: AS NOTEDI SHEET: 1 OF 5 JOB #2011811 DEED LINE N Battu 47• 38.82' W N 08'0112' W \ 118.14' WEST I \ � DEED LINE HARBOR 3.2 - \ GJ IlI_il \ PILE �N -1.4 x �(TYP.) �q ITI inl rl ,29 It it FLOATS 1 O _oI \ 8' X 16' & 12' X 12' \ / Ili RAMP 0.7 x w Ox�O p&e • EDGE OF GRASS -0,2 " Op LIMITS OF WETLANDS VEGETATION DECKJ 1I i_I J AT BASE OF WALL- ELEV. 3.0i APPROXIMATE MEAN ^' n xSy 'OFOx -0.4 x -0.8 x LOW WATER (ELEV.=0.0') 0.6 � EXISTING �li it y� —G. STONE JETTEE RESIDENC E� o �� \l it 1 `� p�� APPROXIMATE MEAN HIGH WATER (ELEV.=2.6') I � DECK \ � �z- N 64'04'12' W w ° 80.23' EDGE OF LAWN U I .a 'r BOULDER RETAINING q WALL \p it Apr m, %1 \ A .PRO ED BY I EXISTING CO DIS OF TRUSTEES LEGEND TOWN OF SOUTHOLD 4 EXISTING CONTOUR WJE ry��„� -4.3 EXISTING SPOT GRADE ELEVATION �p- G PILING TO BE REMOVED ,. • PILIING TO BE RELOCATED AS NE SSARY j 30 0 30 R E V I S 1 0 N S GRAPHIC SCALE IN FEET PLAN OF PROPOSED DOCK REPAIR PREPARED FOR CME `'_ CME Associates, Inc. JOANNE BURR 32 Crabtree Lane,Woodstock,CT 06261 65 Main Street,Suite 340 Norvdch,CT 06360 PENINSULA ROAD, FISHERS ISLAND 333 East River Drive,East Hartford,CT 06108 Phone 888-291-3227 DATE: 05/11/11 SCALE: 1" = 30' SHEET: 2 OF 5 JOB 02011811 50 Elm Street,SouMbdtlge,MA 01650 viww.cmeengineedrg.wm DEED LINE —4.6 N 80 1111 47• > 38.82• W N 08'01'12' W \ 118.14' \ WEST qq• DEED LINE HARBOR OD \\ x —3.2 —4.7 x ml =i l O /ry 1.4 x � IITII li II �4 /II II IFi1 1 f �� RMV Kp yy� lit O Y p0 ,2.9 f1.0AlS SEE NOTE I71' �1 -G.7 x —1.9 z EDGE OF GRASS _0.2 LIMITS OF WETLANDS VEGETATION DECK J �I -I Qom• AT BASE OF WALL— ELEV. 3.0i i APPROXIMATE MEAN 04 x —O.b ' LOW WATER (ELEV.=0.0') '01O 0.6 EXISTING / / ua LTJ —03 x ;0 STONE JETTEE t, RESIDENC j p0 \IA APPROXIMATE MEAN HIGH WATER (ELEV.=2.5') PROVIDE OPEN - 'n'1 �z- N 8404'12' W DECK O 0 ft M 80.23' STA. 0+ODt TO ° �\ SI'A 0+26& o� „ EDGE OF LAWN BOULDER RETAINING _ Q-0 WALL �I LEGEND - 4 - EXISTING CONTOUR x —4.3 EXISTING SPOT GRADE ELEVATION NOTE: REPLACE RAMP AND o NEW PILE LOCATION FLOATS AS NECESSARY MAINTAIN EXISTING DIMENSIONS PROPOSED DOCK RECONSTRUCTION 8' X 16' & 12' X 12' 30 15 0 30 R E V I S 1 0 N S GRAPHIC SCALE IN FEET PLAN OF PROPOSED DOCK REPAIR = PREPARED FOR CME CME Associates, Inc. JOANNE BURR 32 Crabtree Lane,Woodstock,CT 06281 55 Main Street,Suits 340 NorvAch,CT 06360 PENINSULA ROAD, FISHERS ISLAND 333 East River Drive,East Hartford,CT 06108 Phone 888-291-3227 DATE: 05/11/11SCALE: 1" = 30' SHEET: 3 OF 5 JOB �J2011811 50 Elm Street,Southbridge,MA 01550 v .cmeengineenng.00m NOTE PILINGS TO BE DRNEN 25' MINIMUM OR TO REFUSAL 70't PROPOSED FIXEDDOCK NOTE ALL PILES & 10 58't EXISTING FIXED DOCK FRAME MATERIAL TO BE CCA TIMBER— DECKING TO BE DOUGLAS FIR OR OPEN RAMP GRATE (SEE DETAIL) PROPOSED PILE SEE DETAILS EXISTING STONE 4' WIDE RAMP - SEE NOTE RETAINING WALL '^�r SHEET 3 FLOATS - SEE NOTE 5 SHEET 3 m, I APPARENT HIGH WATER a, LIMB OF TIDAL WEIWiDS " BASE OF WALL 3.0t MEANHIGW WATER 2.5 ) qll I� m Idl 0 SII II I ` _ WATER ZoII q I� II IIII I II ��� II II III I}I III\II II X � II h II III ISI IIII II IIS � \ w II IIII I�I IIII �� i� II DATUM ELEV II III II II -5.00 to O N M I I I 0+00 0+25 0+50 0+75 1+00 1+20 PROFILE SCALE HORZ: 1'-30' VERT: 1"-3' R E V I S 1 0 N S PLAN OF PROPOSED DOCK REPAIR w.. PREPARED FOR CME §e` CME Associates, Inc. JOANNE BURR 32 Crabbae Lane,Woodstock,CT 06281 PENINSULA ROAD, FISHERS ISLAND 55 Main Street.Suite 340 Norwich,CT 06360 333 East River Drive,East Harford,CT 06108 Phone 888-291-3227 DATE: 05/11/11 SCALE: AS NOTED SHEET: 4 OF 5 JOB #2011811 50 EIm Street Southbridge,MA 01550 www.cmeenginee ng.can WOOD PILE (TVP) V w w STRINGER CROSS MEMBER u _ _ WOOD PILE (TYP) * o w DECKING I' I• _ z v - CROSS MEMBER UM 1" SPACE (TYP)—iF— 6*44441 10't (TYP) a STRINGER (• CENTER TO CENTER '1 DECKING PLAN )AEW- V WIDE DOCK WITH 2" X 8" DECKING LM La 1" SPACE (TYP):II-- NOT TO SCALE1D' (TYP) CENTER TO CENTER PLAN VIEW- DOCK WITH OPEN GRATE DECKING 12" DIA " x 8" DECKING 12" DIA PILING PILING IIII IIII ELEV 7.0t I 3" x 10" STRINGER I I ELEV 7.Ot Li CENTERi0 Y x 8" SPLIT CLAMP M.H.W. T M.H.W. M.L.W. 3" x 8" CROSS BRACE FFF M.L.W. 0CENTER NEW PILES 10 Fr. MINUMUM CROSS SECTION SIDE VIEW 4' WIDE FIXED DOCK WITH 2" X 8" DECKING NOT TO SCALE 8' OR 12' 16' OR 12' DECKING DECKING (Tzz YP) STRINGERS (TYP) MHW FLOAT MHW FLOAT MHW MLW MLW MLW END VIEW SIDE VIEW TYPICAL ELOATING DOCK NOT TO SCALE REVISIONS DETAILS PLAN OF PROPOSED DOCK REPAIR PREPARED FOR CME ,..� CME Associates, Inc. JOANNE BURR 32 Crabbea Lana,Woodstock,CT 08281 PENINSULA ROAD, FISHERS ISLAND 33355 Easaint Rle.,OwSule,340Norwor CT 06360 333East Rivar Ddve,East,MA015 CT 08108 Phone glnee 3227 DATE: 05/11/11 SCALE: N.T.S. SHEET: 5 OF 5 JOB #2011811 50 Elm Sreel,Sau hb dga,MA 01550 www.cmeangineed g.cam DEED LINE N BOTi'b" W N 38,62 p1ygOR AL N 08'01'1' W 11e.14' F _ e HIGH WATER UNE (TYP.) ; OOi FLOAT 34Q00 0 61'S7,48•• W 5 04'5548" W S 10262 peas Co p cJl 136.D0' A RIP-RAP ALONG E 100'4 O HIGH WATER LINE 0 STDNE WALL 0000000000 DECK 0 m EXISTING O DOCK TRANSFORMER EXISTING DRIVE '•' —^e RESIDENCE N 64'04'12" W p a 3+ DECK 80 23' rn , LOT 6 n o ry LOT 7 & e z AREAY = 14,750 sq.fl. IN \ i io c \ LOT 9 / N 2702.as \AREA = 30,720 q.ft. 0 N 1520'48" E 0 76,72' gE 1150.02p e0.0z o N 2H 24 NOTES- G n 5 85'04'1 ry E 1199.94100. 199.94 0 j IOO. p E � 1.) COORDINATE DISTANCES ARE MEASURED FROM LLS. COAST & GEODETIC SURVEY TRIANGULATION STATION 3 I N 65'0412" W 86.11 S ✓1+"04'12"E "PROS" 100.00 n 2_) TAX REFERENCE: N 65'0412 W 185.8)' 20 RICHT OF WAY DISTRICT 7000, SECTION 010, BLOCK 4, LOT 7.2 & LOT 9.4 o I y \ a LOT 10 -pmo AREA = 18,540 aq.ft. UNITS OF MARSH (T)P.) MAP R F RAN F• LOT 22 \ M o LOT 18 & 20 w 1.) PLAN OF PENINSULA AT FISHERS ISLAND; o AREA 15,000 sq.ft. OWNED BY CHARLES W. HEDGE & FRANCES G. THORP; n = \ w SCALE 50' TO THE INCH, CHANDLER & PALMER, ENGRS. IRDry PIPE NOg NORWICH, CONN. 1973; REVISIONS 2 TO JAN. 29, 1976. N 3551.69 O E 1169.63 \ o 2 5 85'04'12 E 165 IRON PIPE IN g .00' 20' RIGHT OF WAY 73.53 2 N 2533.59 A PIPE TO PENINSUTA ROAD 5 85'04'17• E100.00' E 1165.41 OT 11 EXISTING DRIVE N e5roa9z" SURVEY MAP w IIDoo IRON vIPE 2 PREPARED FOR LOT 17 & 19 LOT 21 n� AREA - 11,325 sq.ft. -i IRON PIPE m 5 59'49'45" w ss E ;?�:;; JOANNE MONTGOMERY BURR 27.70' b 40 20 0 40 p0 CNnv�CALE IN FEET l FISHERS ISLAND, DARBIES COVE , NEW YORK LOT 16 REVISIONS OATS DESCRIPTION 097 mmm -,r CHANDLER, PALMER de KIND IRON PIPE N 2=0 arpiitecbrq En9ineern9 ontl Sur.eYn9 GUARANTEED m Im e9wP....Nu.PN.Pr aro wo-en-vw r.�aaa-gee-Tml NATIONAL CITY MORTGAGE, COMPANY. JOANNE MONTGOMERY BURR COMMONWEALTH LAND TITLE INSURANCE COMPANY IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR DATE: JUNE I, 1999 TITLE SURVEYS OF THE NEW YORK STATE LAND TITLE ASSOCIATION. SCALE: 1" 40' SHEET 7 OF I JA + 1. �r . b STATE OF NEW YORK DEPARTMENT OF STATE ANDREW M. CUOMO CESAR A. PERALES GOVERNOR SECRETARY OF STATE NYS DEPARTMENT OF STATE DIVISION OF COASTAL RESOURCES D J2011JI MEMORANDUML'LIJULTo: Mark Terry, LWRP Coordinator, Town of Southold Board Cc: Jill Doherty, President, Southold Town Trustees From: Jennifer L. Street, Coastal Resources Specialist, Consistency Un(; Re: F-2011-0563 U.S. Army Corps of Engineers/New York District Permit Application—Ms. Joanne Burr —proposed dock replacement in place with a 12' extension, West Harbor, Penninsula Road, Fishers Island, Town of Southold, Suffolk County. Date: July 20, 2011 Enclosed is a copy of the Federal Consistency Assessment form and permit application for the above- referenced project for your information and preliminary review. Please contact Jennifer L. Street, the DOS reviewer assigned to this project, at (518) 474-6000 (e-mail at: Jennifer.Street(g dos.state.ny.us) to discuss applicable LWRP policies and concerns, and any additional information which may be necessary to assist you in reviewing this project. Any comments you may have will assist the Department in reaching a decision as to the consistency of the proposed action with the approved Town of Southold LWRP. We would appreciate hearing from you on this proposed project within 30 days (by August 19, 2011). If we do not hear from you by that date, we will presume that you have no objections to the proposed project. Enclosures Cc: NYSDEC—Matthew Penski (1-4738-00394/00005)— via e-mail, no encl. COE/New York— Frank Tangorra—via e-mail, no encl. ONE COMMERCE PLAZA,99 WASHINGTON AVENUE • ALBANY,NY 12231-0001 • (518)474-0050 WVVVV.DOS.STATE.NY.US E-MAIL:INFO@DOS.STATE.NY.US PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold, New York 11971 Tel (631) 765-4330 -- - • . . -,� Fax: (63 1) 7654643 July 6, 2011 NYS Dept. Of State 99 Washington Ave. Albany NY 12231 RE: JOANNE BURR SCTM: 1000-10-4-7.2 RESIDENTIAL DOCK; PENINSULA ROAD, FISHERS ISLAND, NY Dear Sir or Madam: Enclosed please find a copy of the application submitted to the New York State Department of Environmental Conservation. Thank you and please advise if you should have any questions. V ryr tpuly yours, Patricia C. Moore PCM encls. =coastal . ur�gS NEW YORK STATE DEPARTMENT OF STATE Pf°s� �pSO COASTAL.MANAGEMENT PROGRAM JUl 9 R X011 Federal Consistency Assessment Form An applicant,seeking a permit, license,waiver,certification or similar type of approval from a federal agency which is subject to the New York State Coastal Management Program(CMP),shall complete this assessment form for any proposed activity that will occur within and/or directly affect the State's Coastal Area. This form is intended to assist an applicant in certifying that the proposed activity is consistent with New York State's CMP as required by U.S. Department of Commerce regulations(15 CFR 930.57).It should be completed at the time when the federal application is prepared. The Department of State will use the completed form and accompanying information in its review of the applicant's certification of consistency. A. APPLICAANTT (please print) 1. Namey,) C)F� woe 2. Address: �I �Q (Zoo At-y— YA a 2,10a1)1,lJr— UP ,e,h„ __� d)Lp 04 3. Telephone: Area Code f c?, - I IS . B. PROPOSED ACTIVITY 1. Brief description of activity: Ce C Cn,;VrU G{- � ± »d doC r-- I cc o ,, �y�-� a' J3,�x-- 6,xcL ` CLQ - ,p + QS ,1e etoe d F c' Dcr- It t--4-1 PCti`o fir? 69�' ArtI ATS= L-jjiZ-)tDr�''+� 2. Purpose of activity: 3. Location of activity: nn Su. . f�sr,�rS fslanct . County A City,Town,or Village Street or Site Description 4. Type of federal permN it/license required: 11 13 '0 C 5. Federal application number,if known: N�W (Z 6. If a state permit'license was issued or is required for the proposed activity,identify the state agency and provide the application or permit number,if known: G 0?nU n — J C. COASTAL ASSESSMENT Check either"YES"or"NO" for each of these questions. The numbers following each question refer to tate policies described in the CMP document (see footnote on page 2) which may be affected by the proposed activity. 1. Will the proposed activity result in any of the following: YES/NO a. Large physical change to a site within the coastal area which will require the preparation of an environmental impact statement? (11,22,25, 32,37, 38,41,43). ... . . . . . . . . . . . . . El VJ' b. Physical alteration of more than two acres of land along the shoreline, land ® _/ under water or coastal waters? (2, 11, 12,20,28, 35,44). . . . . . . . . . . . . . . . . . . . . . . . . . c. Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1) . . . . . . Q d. Reduction of existing or potential public access to or along coastal waters? (19,20) . . . . . . a e. Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10) . . . Q �� f. Siting of a facility essential to the exploration,development and production of energy resources in coastal waters or on the Outer Continental Shelf! (29). . . . . . . . . . . . . . . . . . . a g. Siting of a facility essential to the generation or transmission of energy? (27) . . . . . . . . . . . a h. Mining,excavation,or dredging activities,or the placement of dredged or fill material in coastal waters? (15, 35). . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . a .J i. Discharge of toxics,hazardous substances or other pollutants into coastal waters? (8, 15,35) a j. Draining of stormwater runoff or sewer overflows into coastal waters? (33) . . .. . . . . . . . . Q R" k. Transport,storage,treatment, or disposal of solid wastes or hazardous materials? (36,39) . a �- 1. Adverse effect upon land or water uses within the State's small harbors? (4) . . . . . . . . . . . . a 2. Will the proposed activity affect or be located in,on,or adjacent to any of the following: YES/NO a. State designated freshwater or tidal wetland? (44) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Federally designated flood and/or state designated erosion hazard area? (11, 12, 17,) . . . . . Q 1J c. State designated significant fish and/or wildlife habitat? (7). . . . . . . . . . . .. . . . . . . . . . . . 0 d. State designated significant scenic resource or area? (24). . . . . . . . . . . .. . . . . .. . . . . . . . Q _' e. State designated important agricultural lands? (26). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Beach,dune or barrier island? (12) . . . .. . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. — — g. Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3). . . . . . . . . . . . . . . It. State,county, or local park? (19,20). . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i.Historic resource listed on the National or State Register of Historic Places? (23) . . . . . . . . Q 3. Will the proposed activity require any of the following: YES/NO a. Waterfront site? (2,21,22). . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . b.Provision of new public services or infrastructure in undeveloped or sparsely populated sections of the coastal area? (5). . . . .. . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . c.Construction or reconstruction of a flood or erosion control structure? (13, 14, 16). . . . . . . d.State water quality permit or certification? (30,38,40). .. . . . . . . . . . . . . . . . . . . . . . . . . . ] e.State air quality permit or certification? (41,43). . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . .. Q 4. Will the proposed activity occur within and/or affect an area covered by a State approved local waterfront revitalization program? (see policies in local program document). . . . . . . . .. . . .. a P-0051005 D ADDITIONAL STEPS 1.I2 4 ofthe questions in SOC6011 C are answered"NO",then the applicant or a;enoy shall complete Section E and submit the docurner"talion required by Section F. 2.If any of the questions in Section C are answered"YES",then the appbcantor agent is advised to consult the CMP,or where appropriate,the local war mrfroarre"itatizationprogramdocument•, Theproposedacti;+itvntustbeanalyzedinmore detail wilt respect to the applicable state or looa,coastal policies. On a separate page(s),the applicant or agent shall: (a) identify,by their policy mlmbets,which coasM1 policies are affected by the activity,(b)briefly assess the effects of the activity upon the Palley; and,(wi state how the activity is consistent with each policy. Following toe completion of this wri"011 aasesartent,the applicattt or agency shall complete Section E and submit the documentation required by Section F. i=. CIiRTtFICATION The applicant or agent must MrdFi that the proposed activity is consistent w:tr.the State's CMP or the approved focal waterfront revitalization program,as appropriate. If this certification cannot be made,the proposed activity shall not be undertaken. If this certification can be made,complete,this Section. "The proposed actir'ty complies with New York State's approved Coastal Management Program,or with the;q.,piicablo approved local watei*ont revitalization program,and will be conducted in a manner cemeistent with such program:. n Appi ic„t(ir/.4genr "Namne:- — -----_.—. Address: \ �IC�O�( vep�-4 tSy�DtC�C _i � Talephane: Area Code}n�p- - ,�Q --- j ApPlioaraiAgenes S.gnature: !/dr-,p iV1/L(D /�L gJ�C(„h Date:_ P.SUBMISSION REQUIREME"N7"'5`- 1.The applicant or agent shall submit the following documents to the New York State Department of State,Office of Coastal,Local Government and Community Sustilaebility,Attn:Consistency Review Unit,1 Comin Piaza,99 Washington Avenue-Suite 1010,Albany,New York 12,231. erve a..Copy of original signed form. b.Copy of he completed federal agency application. c.Other available information which would support the certification of consistency. 2.The applicant or agent shall also submit a copy of this completed form along with hislher application to the federal agency- 3,If there are any questions regindicg the submission of this form,contact the Department of State at (Sig) 474.6000. 'These state and local doeumeacs are available for inspection tit the offices of many federal agencies,Deparmrent of environmental conservation one Department of State regional offices,and the appropriate regional and county planning agencies. Local program dccumeuta an also available for inspection at tho offices of ds,appropriate local government. `nn. �s a e} .,a �.,4Y �•+ ."-3' � " �'c i, ,z fF l,i y::C>H 30. z r (j s a c r V II e JOANNE BURR . PENINSULA ROAD, FISHERS ISLAND SCTM: 10 * F, 00-10-4-7.2 k �•€, ,z �yL, fM1"� ��as t _.y�iq E�.��.✓a`rr� � az','k,� w� � J�+�+, w :+nh Se ✓" nm' �Y P fi ' � 4 a PP t y nl i1. }} r ✓ Y yfl r- {��i n r x; ��� x � x v � � a f.. 4 �� f _ �v � h ..A �� �'•. H } 7,17 'et, JokNNEBURR ROAD, PENINSULA SCTM: 1000 FISHERS ISLAND Y .+* + ' f '., S .:.t+a T ldA,•:. +.x 7 y�g� '' .,� •'}� �,�..."•:..F ,n'." -.d,. , w. q .v .:.✓"�> �" z•. =+ t< � > ��, :t � �.,�.� =eliP '.s q a...�s "jix5 �, � a`.. a Jai'•.. i � as s;r w'� �t'�a-xY.'. F A F'y k m e .-1 d lit n Ammm M � " •tx# * nu r a a �. .,7" r' _ :�,6£ 'v� .,f� � ' �,."ti ILF�,yp �g111ffi�fi 1 8 J r JOANNE BURR BURR PENINSULA ROAD, FISHERS ISLAND SCTM: 1000-10-4-7.2 w �0 S w F T s Are,„„• �_: Ly * �� ' x .` y � y� �s Nrva Pe q6 n jp 4 6 { �� ➢ 'fit *». •,k& r awl' � ��'+ fP '!� :. £ RN a rtFy H # }... 1 •j 4 '..:a' N k er s S J k�� �'.v SII hII®�,• yg � I '��� L LJW� .^ �i .F�Y•'� � � `1a W�'� Y P 'iry fy& fY Ly"yC , Ip e 014 -" o z xS `'1" IIIIIIIrt� w' i F' g irS 1" "" 4 �------------ • � .•h r-Ya} �,':1 '�.` ;dif ��� �i�'t 2.yT s x'q" Yyr `.�,'-.G� i r � RoyAllRit y • .3 r � � p i ^+- �v I F � M � bi Y � II S tt Ta..,1 r4 "w 4. a #Srr xa S m � x i ttt �b'S $ 5 Y -0� •,*-A '"tel it Y. JOANNE URR PENINSULA ROAD, `' FISHERS ISLAND SCTM: 1000-10-4-7.2 „ - JOINT APPLICATION FORM 'Ui_ i ? For Permits/Determinations to undertake activities affecting streams, waterways, waterbodies, wetlands, coastal areas and sources of water supply. New York You must separately apply for and obtain separate Permits/Determinations from US Army Corps of State each involved agency prior to proceeding with work. Please read all instructions. Engineers (USACE) APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart- Check all permits that apply: Check all permits that apply: General Services ment of State ❑ Stream Disturbance ❑Coastal Erosion ❑ Section 404 Clean Water Act Check all permits that Check if this ❑ Excavation and Fill in Management apply: applies: ❑ Section 10 Rivers and Harbors. Navigable Waters ❑ Wild,Scenic and Act ❑ State Owned Lands ❑Coastal • Recreational Rivers �yI Under Water Consistent Docks, Moorings or `t”' Nationwide Permit(s) - Identify Concurrence Platforms Water Supply Number(s):• Utility Dams and Impoundment ❑ Long Island Well - Easement(pipelines, Structures ❑Aquatic Vegetation Control conduits, ❑ 401 Water Quality ❑ Aquatic Insect Control �+,cables, etc.) Certification Preconstruction Notification - Ira Docks, Freshwater Wetlands El Fish Control - ElY / 11N r Moorings or `Tidal Wetlands ❑ Incidental Take of Endan- Platforms gered/Threatened Species ❑ I am sending this application to this agency. 111 am sending this application G I am sending this 'W I am sending to this agency. application to thisthis application agency. to this agency. S. Name of Applicant(use full name) Applicant must be: 6. Name of Facility or Property Owner(if different than i)✓Afirz10wner Applicant) ❑ Operator Mailing Address ❑ Lessee Mailing Address y L (check all that apply) Post Office City Taxpayer ID(If applicant Post Office City is NOT an individual): tate Zip Code State Zip Code Vii.- f,•. Telephone(daytime) Email Telephone(daytime) Email 7. Contact/Agent Name 8.. Project/7Facility Name, l Property Tax Map Section/Block/Lot Number r' Yrc.c(d C /� C,f,r c: 1 1 C(21i . d� Company Name Project Location- Provide directions and distances to roads, bridges and bodiesof waters: Mailing Address Street Address, if applicable Post Office City State Zip Code llipt1.c. '.<�_TC( - - NY 5 Post Office City Town/Village/City CountyY. {' State Zip Code Name of USG S Quadrangle Map Stream/Water Body Name 4-=�3 i- -7 "t 37:acs we-'t }�L✓ Telephone(daytime) Location Coordinates: Enter NYTMs in kilometers, OR Latitude/Longitude. Email Mr,r+('C q c NYTM-E NYTM-N Latitude Longitude For Agency tlise only DEC AppRkagon Number: USACE Number: JOINT APPLICATION FORM 09/10 This is a 2 Page Application Application Form Pagel of 2 Both Pages Must be Completed JOINT APPLICATION FORM -PAGE 2 of 2 Submit rtes tomalated page as part et year Appllcatiun. 9. proJact Description and ptrrpeaa: Provlde a cornplate rarrative dascrlptlon cf the proposes Z14 arj hs purnaee. Attach eddni^r•.al nage,s, If necessary.Inciooe: description O`current site eundafons end how M!site will be modlpld b/the P-�,ppsEG Project;StrU(tur25 antl i17 rnattr as;tU Z lnStalfetli type and Baan tf cf materials to oe used il.o„ sq,lin ft of mvaragt a ornG v:>it YJs o1 materiel andi cr sir.^,ares herobe;,,dinary/-. an 'ogh rva(er}area M exCevedon or dredg:rg, vai„mes cf rnotariel to be romovad ane Inxtian of draG;,trG r+attrlai dlaposai or uss; Work :T.ebrods and type of eauipmenc to be -read; ; .iiutlon c0nb&4 metmods and mtigation a t.Vtles proposed tc rnmc+anea:e For ms..arca inrac.,s}; and when. llpolit&e,tf!a phashg of actiotiee. gTj ,}J of Gila 7N gEPAR_ a�E pAGF� 1 Vloc,rl Accic �. rcxn` p c v1,4 to;e1 �•xr� cf,�er_ cox 4r�°r-tdc d �u-i ri.�p✓'o�',r/��.�e 4vt��%r r)c�.f;tLt� 1 r k E Frcp�saC Use' Pdvuta Q Puhlk. QCommerclai Proposed Fstlma[ed --_--" , Start Date: CCm��eVor DacaY Has Work Began Cn Oro+ect4 Q Yea Y5..No If Yee,explain. Wlii Pro}ex OCCUPY Fadt:al,State or Mur:idpal Land? Q Yes FaNo If Yes,please specify. %,,fGy_.— 10. Fist PYAWeus'ermtt[Appacetion Numbz v Of any;end Dates: Lo t: Will this project.4quire additional Fckiaf,state,or W(al Pem,its Ircfudlny ZVrnngctianges7 IM Yes ,Mrs N yes, please I:St: I 12. Sfgnatarn.It eppgnt is not the owner,both roust sign the appflcatlon. I hereby affirm that Information provided On tMs form and Ali attachments submitted herewith ie tr,te to tee be o}nh knowledge and 041101. Fa1sa 6tatattent6.made herein are punishable as a Glass A mlademeanor pursuant to Section he be of;he know ne Law, Pcithar,the applicant accepts foll reaponslbiN(Y for all damage, dire ct or Mdlract,of whatavar nature,and by whomever suffered, arisieq out of tlw project described harem and apreee to Indemnify and save harmless the State front sults, actions, damages and Costs OF Iver r Hanle antl.deecri0tton resUtung f,roit�said Wcject. In addltkn,Federal Law,IS t i.S.G,SeG:on no,"vtde3 fora ore Of net more tTan$10,000 Jr�mp-tsonment,or net more than 5 years, ,path wlere an appScard• t,owingly end wllSingly falsgae,. conceals,cir tavtrs up a materlaf,'set;or knowingly maRes or oats a raise,ncutlous or ffaud4 ent stetement. !_ cY�tnl lei F/-Lar` __C �rt,�e •� — 3— lI fdnergrA of APMleant PN,ttxd Name TMe — Oat. ttA NemA Title azure bf'A ant Meted Name — — Datt Fer Arrancy Wa Onhr OMMMIN/tRON OF NO POtN1Y Raeox RO Agency PnMCNNUVW _ —, has datermnad that No Plmt$le reyViYed ltvtn this At7enty for the proJECt described N (AgeACy Namx} this appacaran.. AgenCF NepneSentadve; Name(printed)._-----_-- Tnie Signature Date IOMT APPLICJIT10kMRK 09/20 Appitmucin Foam Page 2 oP 2 l4ew York State Department of Conservation Aki PERMISSION TU INSPECT PROPERTY I+ I By signing this permission form for submission with atm application for a permits) to the Department of Environmental Conservation("DEC'),the signer consents to inspection by DEC staff of the project site or facility for which a permit is sought and,tc the extent necessary, areas {{ adjacent to the project site or facility, Tltis consent aiu w T)EC staff to enYwr upon and pass !i it through such property in order to inspect the project site or facility,tvithout prior notice,between the houars of 7 00 a.m.and 7:00 p.m.,*donday through Paday. l_`DEC staff should wish to conduct an inspection at any other times, DEC staff will so notify the applicant and, will obtain a separata consent for such sr.inspection. [nspections may take place as part of the application review prior to a decision to grant or deny the permit(s) sought. By signing this consent form,the signer agrees that this consent remains in effect as long as the application is pending,and is effective regardless of whether the signer,applicant or an agent is,prescrmt at the time of the inspection. In the event that the project site or facility it posted with any form of"posted" or"keep cut'notices,or fenced in with fin unlocked gate,this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further agrees that during an inspection,DEC staff may,among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soil and vegetation(taking samples for analysis), and may Crake drawings sad take photographs, Failure to grant consent for au inspection is grounds for, and may result in, denial of the pennit(s)sought by the application. Permission is granted for inspection of property located at the following address(es): oZ h1tiJ 1 1:3 til i, f h � 1.�1� S t.LV1a. Q%' C By signing this form,I affirm underpenlally of perjury that I am authorized to give consent to entry by DEC staff as described above. .1 understand that false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.* Print Name and Title Signature Date «tLo aper of this form must be an iadividuai or-authorized raMwntafve of a legal ot%,ty titer. • owns tea title end Ps W poseesvk n of the prep"tdeatifmd above; • matn'ems posesastay intW-01t in the property trough a leaee-rental agremout or other legally binding agreateemk or • to provided permission to act on behalf of an indivichtet o.Wgai entity pcesessing fee title or other possessory interest m the properly for the ptupoee of consenting to inspeotion of such propoity, Pertadseton to laspeet Property Application Supplement nbUs ENVIRONMENTAL QUESTIONNAIRE This is intended to supplement EMG Form 4345, Application for Department of the Army Permit, or the Joint Application for Permit used in the State of New York. Please provide complete answers to all questions below which are relevant to your project Any answers may be continued on separate sheet(s) of paper to be attached to this form. PRIVACY ACT STATEMENT The purpose of this form is to provide the Corps of Engineers with basic information regarding your project. This information will be used to facilitate evaluation of your permit application and for public dissemination as required by regulation. Failure to provide complete information may result in your application being declared incomplete for processing, thereby delaying processing of your application. GENERAL--APPLICABLE TO ALL PROJECTS 1. Explain the need for, and purpose of, the proposed work. 2. Provide the names and addresses of property owners adjacent to your work site (if not shown on the application form or project drawings). 1 o�, t O- L1-- 1. _3 Elt3E,r'L +� as (3; + z : qq le L3 dg i 1c;2 �-t 5 ko1 c :"3 " icy iL 1 J (Please note that depending upon the nature and extent of your project, you may be requested to provide the names and addresses of additional property owners proximate to your project site to ensure proper coordination.) 3. Photographs of the project site should be submitted. For projects in tidal areas, photographs of the waterway vicinity should be taken at low tide. Using a separate copy of your plan view, indicate the location and direction of each photograph as well as the date and time at which the photograph was taken. Provide a sufficient number of photographs so as to provide a clear understanding of conditions on and proximate to your project site. 4. Provide a copy of any environmental impact statement, or any other environmental report which was prepared for your project 5. Provide a thorough discussion of alternatives to your proposal. This discussion should include, but not necessarily be limited to, the "no action" alternative and alternative(s) resulting in less disturbance to waters of the United States. For filling projects in waters of the United States, including wetlands, your alternatives discussion should demonstrate that there are no practicable alternatives to your proposed filling and that your project meets with current mitigation policy (i.e. avoidance, minimization and compensation). dE c' ,k- 1 tL• a Lc',�A G%E /� JGl 1lei ft'1 i✓t'Z-7}�`/' -, t � .%�-:l C,C 2{' - fi7OCt.j' L 16L? �' Ai,f zLt l DREDGING PROJECTS Answer the following if your project involves dredging.L 1. Indicate the estimated volume of material to be dredged and the depth (below mean low water) to which dredging would occur. Would there be overdepth dredging? 2. You can apply for a ten-year permit for maintenance dredging. if you wish to apply for a ten-year permit,please provide the number of additional dredging events during the ten-year life of the permit and the amount of material to be removed during future events. 3. indicate of your drawings the dewatering area (if applicable) and disposal site for the dredged material (except landfill sites). Submit a sufficient number of photographs of the dewatering and disposal sites as applicable so as to provide a clear indication of existing conditions. For ten-year maintenance dredging permits, indicate the dewateringfdisposal sites for future dredging events, if known. 4. Describe the method of dredging (i.e. clamshell, dragline, etc.) and the expected duration of dredging. 5. Indicate the physical nature of the material to be dredged(i.e. sand, silt, clay, etc.) and provide estimated percentages of the various constituents if available. For beach nourishment projects, grain size analysis data is required.. 6. Describe the method of dredged material containment (i.e. hay bales, embankment, bulkhead, etc.) and whether return flow from the dewatering/disposal site would reenter any waterway. Also indicate if there would be any barge overflow. MOORING FACILITIES ,�G71` 64, Answer the following if your project includes the construction or rehabilitation of recreational mooring facilities. 1. It is generally recommended that any fixed piers and walk ramps be limited to four feet in width, and that floats be limited to eight feet in width and rest at least two feet above the waterway bottom at mean low water. Terminal floats at private, non- commercial facilities should be limited to 20 feet in length. If you do not believe your proposal can meet with these recommendations, please provide the reason(s). 2. Using your plan view, show to scale the location(s), position(s) and size(s) (including length, beam and draft) of vessel(s) to be moored at the proposed facility, including those of transient vessel(s) if known. 3.For commercial mooring sites such as marinas, indicate the capacity of the facility and indicate on the plan view the location(s) of any proposed fueling and/or sewage pumpout facilities. if pumpout facilities are not planned,please discuss the rationale below and indicate the distance to the nearest available pumpout station. 4. indicate on your plan view the distance to adjacent marine structures, if any are proximate and show the locations and dimensions of such structures. 5. Discuss the need for wave protection at the proposed facility. Please be advised that if a permit is issued,you would be required to recognize that the mooring facility may be subject to wave action from wakes of passing vessels, whose operations would not be required to be modified. Issuance of a permit would not relieve you of ensuring the integrity of the authorized structure(s) and the United States would not be held responsible for damages to the structure(s) and vessei(s) moored thereto from wakes from passing vessels. BULKHEADING/BANK STABILIZATiON/FiLLING ACTIVITIES /�A1p7- t _r Answer the following if your project includes construction of bulkheading (also retaining walls and seawalls) with backfill, filling of waters/wetlands, or any other bank stabilization fills such as riprap, revetments, gabions, etc. 4. indicate the total volume of fill (including backfill behind a structure such as a bulkhead)as well as the volume of fill to be placed into waters of the United States. The amount of till in waters of the United States can be determined by calculating the amount of fill to be placed below the plane of spring high tide in tidal areas and below ordinary high water in non-tidal areas. 2. Indicate the source(s) and type(s) of fill material. 3. Indicate the method of fill placement(i.e. by hand, bulldozer, crane, etc.). Would any temporary fills be required in waterways or wetlands to provide access for construction equipment? If so, please indicate the area of such waters andlor wetlands to be filled, and show on the plan and sectional views. The foregoing requests basic information on the most common types of projects requiring Department of the Army permits. It is intended to obviate or reduce the need for requesting additional information; however, additional information may be requested above and beyond what is requested in this form. Please feel free to add any additional information regarding your project which you believe may facilitate our review. WEST HARBOR LOCUS D�R,BIES COVE SCALE: 1"=400' NOTES 1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT. 2.) IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. 3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF THE LAND SURVEYOR. 4.) A PORTION OF THE SITE IS LOCATED IN FLOOD ZONE AE, ELEVATION 11 Y AND ZONE VE ELEVATION 13 PER FIRM (FLOOD INSURANCE RATE MAP) F01�,` SUFFOLK COUNTY, NEW YORK. COMMUNITY NUMBER 36103C, MAP NUMBER• `-� 36103CO019H MAP REVISED SEPTEMBER 25, 2009. 5.) SITE IS IN THE TOWN OF SOUTHOLD. COUNTY OF SUFFOLK TAX MAP 1000, SECTION 010, BLOCK 4, LOT 7.002 6.) TOTAL AREA = 1.941 ACRES. 7.) SITE IS LOCATED IN R-40 ZONE. _ 8.) BASE FOR LEVELS: MEAN LOW WATER R E V I S 1 0 N S PLAN OF PROPOSED DOCK REPAIR PREPARED FOR CME' CME Associates, Inc. JOANNE BURR 32 Crabtree Lana,Woodstock.CT 06281 PENINSULA ROAD, FISHERS ISLAND sS Main StreK Suits 340 Norwich,CT 06960 333 Ess'ftim t)&e East HaCnd.CT 06106 Phcnsm"91-329 )ATE: 05/11/11 1 SCALE: AS NOTE SHEET: 1 OF 5 J08 #2011811 50 Elm Sbest,Southbridge.MA015M www.cmeengin°em°.corn DEED LINE x -4.6 N 80.11 47, W > 38.62• N 08'01'12' W 118.14' \ WEST �• DEED LINE \ HARBOR IiJI I_il x -3.2 -4.7 x O \ 1.4 x \ PILE III IIa II •(TYP.) �4 rl \ m III II_il FLOATS pp -29 x 8' % 16' & h� 12" X 12' RAMP 1y / -0.7 x \ \\ 11_il n-1 I I • -1.9 �. 1 I px OV_6' • EDGE OF GRASS -0.2 x CPO��. LIMITS OF WETLANDS VEGETATION DECK J 1I yl 1 �� AT BASE OF WALL- ELEV. 3.0t v APPROXIMATE MEAN -0.4 -0.8 x LOW WATER (ECFV-=0.0") y y0 0 6 EXISTING j / �ILu i K -0.3 x 1 _ _O x STONE JETTEE /RESIDENCE N.`� / p�0-1. APPROXIMATE MEAN HIGH WATER (ECFV.=2.5") DECKI N 64'04'12 W ``'� ��° �• 80.23' EDGE OF LAWN—//, AWN BOULDER RETAINING WALL � ,xl LEGEND EXISTING CONDITIONS — — 4 — — EXISTING CONTOUR x —4.3 EXISTING SPOT GRADE ELEVATION C PILIING TO BE REMOVED PILIING TO BE RELOCATED AS NECESSARY 30 15 0 30 R E V I S I O N S NOWNENQ TT --------- - __-GRAPHIC SCALE-IN FEET----.... PLAN OF PROPOSED DOCK REPAIR PREPARED FOR CME CME Associates, Inc. JOANNE BURR 32 Cra*"LIIM.W00dst0:K CT06281 PENINSULA ROAD, FISHERS ISLAND BB Main Seest,Sdte 340 Nw*ich.CT 06W0 333 East aver Odve,East LlaBad,CT 06108 Ptw "8-2913227 \TE: 05/11/11 1 SCALE: 1" = 30'1 SHEET: 2 OF 5 JOB—i-2-0 1-1-8-1711 SaeeL B-'Mdge.MA 015M vl xmeengYmerhVg DEED LINE -4.6 N gp 11 47- W 38.62' N 08'01'12" W 118.14' 1�1 WEST DEED LINE \ HARBOR 9 h�ry -4.7 x U_l O I N w/ 1-4 un 1 RAMP nl AND x FLOATS SEE NOTE \\ IT ( -1.9 X % iiI n_el � ox EDGE OF GRASS'I I -D2 x \' yq M LIMITS OF WETLANDS VEGETATION DECK j 11 I_I J r/ AT BASE OF WALL- ELEV. 3.OY -0.4 x -0.8 APPROXIMATE MEAN j °x �/ \ X LOW WATER (ECFV.=0.0') 0.6 / EXISTING // ndl �Y, -o3 X \0_ STONE JETTEE RESIDENCE APPROXIMATE MEAN HIGH WATER (ECFV.=2.5') DECK / P " OPEN I '` /���I` f `�2_ N 6404'12" W Siw o+ost To %° 80.23' STA 0+251 0. EDGE OF LAWN BOULDER RETAINING WALL OI \ i1 �I LEGEND - 4 - - EXISTING CONTOUR -43 EXISTING SPOT GRADE ELEVATION NOTE: REPLACE RAMP AND e NEW PILE LOCATION FLOATS AS NECESSARY MAINTAIN EXISTING DIMENSIONS PROPOSED DOCK RECONSTRUCTION 6• X 16' & 12' X 12' 30 15 0 30 R E V I S 1 0 N S T---T -_ _. -._ __. _.._-- -..-___._-- _ .__ -. __ _.... .. _ ___.-_ -GRAPHIC_SCALE-IN-FEET.__.-_._ . . PLAN OF PROPOSED DOCK REPAIR _ PREPARED FOR CME CME Associates, Inc. JOANNE BURR 32 CraNree Lane,Woodstock,CTOB281 PENINSULA ROAD, FISHERS ISLAND Mein Street Su0e 340 NwML,CT 066 333 East Riwc Odm East Haft CT06106 Phone 8811491� )ATE: 05/11/11 1 SCALE: 1' = 30' SHEET: 3 OF 5 1 JOB #201j8_1 1 60 Elm SkBet SoulhGMge,MA01550 rnw.grlaaglneaYgmm NOTE PILINGS TO BE DRIVEN 25' MINIMUM OR TO REFUSAL 70't PROPOSED FIXEDDOCK NOTE ALL PILES do 10 56't EXISTING FIXED DOCK FRAME MATERIAL TO BE CCA TIMBER— DECKING TO BE DOUGLAS FIR OR OPEN GRATE (SEE DETAIL) RAMP PROPOSED PILE SEE DETAILS EXISTING STONE '=' RETAINING WALL 4' WIDE RAMP — SEE NOTE '�� w SHEET 3 FLOATS — SEE NOTE 5 1 SHEET 3 Ig, 'Pi APPARENT HIGH WATER LIMIT OF TIDAL WETLANDS BASE OF WALL (3.0t) MEAN HIGH WATER (2.5f) �I�I II i1 D91 it �I `il _ oyY WATER ao�1l I� I� II II (I I�I\ Illl�il II z w 'I �I II it II III II �I� it II II IrI IIII II II w II it iI i� IIII ii �� II I II I �� IIII II u DATUM ELEV —5.00 N N N n cc O N I I I 0+00 0+25 0+50 0+75 1+00 1+20 PROFILE SCALE HORZ: 1 0=30' VERT: 1'=3' R E V I S 1 0 N S PLAN OF PROPOSED DOCK REPAIR PREPARED FOR C E CME Associates, Inc. JOANNE BURR CMEl Cmbtme Lam. Woo&tockCTOW/ PENINSULA ROAD, FISHERS ISLAND 55 Main Sb*K Salta 340 Nan".CT 08380 333 East Ftl a Ddw,East Ha,dad,CT 08108 Pf m 88&2913127 ATE: 05/11/11 1 SCALE: AS NOTEDI SHEET: 4 OF 5 JOB #2011811 1 50 Elm Street,Smddxldga'MA 01550 vm -rmw, hmri,g-w WOOD PILE (TYP) II• �. w - - W STRINGER CROSS MEMBER U o WOOD PILE (TYP) m~ K r DECKING (• "[:j z CROSS MEMBER 1- SPACE (TYP)—iE- 10'} TYP * - - e CENTER TO CENTER DECKING STRINGER PLAN VIEW— 4' WIDE DOCK 6WTH 2" X 8" D KWr SPACE NOT TO TO SCALE Io' TYP CENTER TO CENTER PLAN VIEW- DO .K unTu nonl GRATE nc CKING 12" DIA " x 8" DECKING 12" DIA PILING PILING II � All, ELEV 7.0} II 3" x 10" STRINGELEV 7.Ot I 3" x 8" SPLIT CM.H.W. _ , M.H.W. M.L.W. + 3" x 8" CROSS 5'm M.L.W. 'CENTER 10 CENTER NEW PILES CROSS SECTION 10 Fr. MINUMUM SIDE VIEW 4' WIDE FIXED DOCK WITH 209 X 8" D EKING NOT TO SCALE 8' OR 12' 16' OR 12' DECKING DECKING (TYP) STRINGERS (TYP) MHW MLW FLOAT MHI FLOAT MHW MLW END VIEW SIDE VIEW TYPICAL FLOATWG DOCK NOT TO SCALE REVLS ISIONS DET PLAN Of PROPOSED DOCK REPAIR t1 PREPARED FOR CME CME Associates, Inc. JOANNE BURR 32 CrabNee Carie.Wood.,,*CT06281 PENINSULA ROAD, FISHERS ISLAND 55 Main Street.Suits 3a NarwN11.CT 06ffi0 333 East RWer Ori".East H"OaA.CT 06108 Phone 888-291,3W TATE: 05/11/11 SCALE: N.T.S. SHEET: 5 OF 5 JOB /2011811 50 Eua Suaac soumbnaye,MAa1s5° Www anee08irmoulm wrs • �•.. ... ^^ mem.... ., m.,w —_ _ �....u.� ._. .w� m >m�N rn.Nlr�u N � muoo A` lu w�uoi � j•duuu oe a] AV 0 Oe�N! (troy yv Y }0 Z N 1 4' fj M. A t ar i Lu'a� p WEST nMBOR ��y l - a.• a •••.._./// I v� " / " Ix u• !OBER HMB ) « u ay w4.e.m N DAR51ES n S .. xm O / J.3 ' yi ski' l!•_ _I If) • 11 /y �♦ LL'! K` e � 1"a I INNER SA♦ vab Ma le 115" f U� f n.l• IY --� ' •A}y � Y � .lig "" � c n � /T J •/ !• 1191 t4 191 • ]4r na] <� tl t�r r• / F.0.27 u5 u4A a • 115 ' jplttW_•Ik: ,I /®% ''ltl.l mQ !.) \\A .. m AA rw n.�o. axxrtn• WM]W \ eer-YC.w •YStl a J I fEgnr D.80 v L ......... �. u• (21) uunmew,ul em.eF PROJECT ID NUMBER 61720 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 •PROJECT INFORMATION (Tobe completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME Z, 2 J.PROJECT LOCATION: coJ t0,ti L.v. 4-CIA-0 Municipality S 1 ;2J 1 S U✓'t'/-} (J County % t,(,_r-foc_-it, 4 P ECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks gtc -or provide map 5.IS PROPOSED ACTION New Expansion I ill Modification I alteration 6.DESCRIBE PROJECT BRIEFLY. LT' II CCcx`3 �- rc.LL� �- 1 �5�, I � � S5 } WJo� Uhf Lc �l� I u , f 7.AMOUNT OF LAND AFFECTED c7 Initialry, acres I f q Ultknately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes 1:1 No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) RResldential D Industrial ❑Commercial OA911culture O Park/Forest/Open Space 0011ter (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stateor Local) N1 1:1Yes R71 No 8 yes, list agency name and permit / approval: t q��- ��C--! C�� ]— And 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? -Ulyes RNd 8 yes, fist agency name and permit / approval: 1 AS R ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ea 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Spans Name Date: Signature-- If natureIf the action Is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART If- IMPACT ASSESSMENT o be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.47 It yes.coordinate the review process and use the FULL EAF. 0 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. Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,it wgible) Cl. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage w flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,w other natural or cultural resources;Or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildilife species,significant habitats,or threatened OF endangered species?Explain briefly: C4. A wmmunil's ends y ffog plans or goals as officially adopted,or In change use or Intensity of use of land or other natural resources?Explain briefly. C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other adec4 rot identified In CI-05? Explain Miafly: C7. Other Impacts(Including changes In use of either quanuty or of arta ain brieti : D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If yes,ax lain briefly: Yes ❑No E. IS THERE,OR IS THERE LIKELY TO BE.CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yesa talo: E]Yes No PART III•DETERMINATION OF SIGNIFICANCE(To be completed by Atgency) INSTRUCTIONS: Foreach adverse effect ideMMed above,determine whether It is substantial.large,importantor otherwise significant. Each effect should be assessed In connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration:(d)kreversiblity;(e) geographicsoope;and(Q 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 A was checked yes,the deterrdnatton of significance must evaluate the potential impact of the proposed action on the environmental characteristics of theCFA. Check this box if you have Identified mew more potentially large or slgalfkaM adverse Impacts which MAY occur.Then proceed directly to the FUL FAF and/or prepare a positive declaration. Check this box It you have determined,based on the Information and analysis above and any supporting documentation,that the proposed acdor WILL NOT result in any significant adverse environmental Impacts AND provda, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Nam of Responsiblecar In LgWil ncy Tide of Responsible Officer Signature of Responsiblecern Load Signature of Preparw(if diffixentfrom responsible officer)