HomeMy WebLinkAboutAdriano, Ernesto James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Applicati/
Wetland Permit Application g Administrative Permit
AmendmentJTl'ans f. er/Ext ~nslon
eceived Applicati_om ,7/tctb~
mpleted Application
__Incomplete
__SEQRA Classification:
Type I Type II Unlisted
__Coordination:(date sent) _
--./~'~WRP Consistency A~sessment Form
~'~AC Referral Sent:
__Date of Inspection:
Receipt of CAC Report:
__Lead Agency Determination:
Technical Review:
~-~Public Hearing Held:
Resolution:
Name of Applicant ~z~/Z ~/e ~j~ 2~/~/g2
Address 7',2-3 d~:kYe"'b'xJ~I£/-tr~?D/dW/
Phone
Suffolk County Tax Map Number: 1000
Property Location: -4 ! ?,ff ,(~1~M,4£~$
(provide LILCO Pole #, distm~ce to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
of Trustees Applicatioe
Land Area (in square feet):
Area Zoning: ~tY
GENERAL DATA
Previous use of property:
Intended use of property:
Covenants and Restrictions:
If "Yes", please provide copy.
Yes V No
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
i,' No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
of Trustees Applicatio0
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: ~-Y/,/f square feet
Percent coverage of lot: %
Closest distance between nearest__ existing structure and upland
edge of wetlands: ~, ,~v ~"/at feet
Closest distance between nearest proposed structure and upland
edge of wetlands: /~ ~L~.~ feet
Does the project involve excavation or filling?
No v Yes
If yes, how much material will be excavated? .~ D ~" cubic yards
How much material will be filled? 2-3 C cubic yards
Depth of which material will be removed or deposited: 7
Proposed slope throughout the area of operations: ~ ,~¢,,~
Manner in which material will be removed or deposited:
feet
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):
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
County '~'~'~-~'~
SEQR
1. APPLICANT / SPONSOR
3 PROJECT LOCATION:
PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map
5 IS PROPOSED ACTION: [] New [] Expansion [] Modification ! alteration
7 AMOUNT OF LAND AFFECTED:
initially .~j- 0 acres Ultimately ,7~" acres
8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
[~Yes [] No if no, describe briefly:
9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply)
[~Residential E~]lndustrial E~commercial r~lAgriculture I'~Park/Forest/OpenSpace E]Other (describe)
10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
E]Yes F1No If yes, list agency name and permit / approval:
11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
E~JYes E~]No If yes, list agency name and permit / approval:
,2 AS ^ RESULT OE PROPOSED ACTION W LL EXlSTINO PERM T APPROVAL REOUlRE MODIFICATION?
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Appficant / Sponsor Name ~-g"~ ,f)~)/~/~'7~//-) 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 617.47 If yes, coordinate the review process and use the FULL EAF.
~-~ Yes F'"-] No
B. WILLACTIONRECEIVECOORDINATED REVIEWASPROVIDEDFORUNLISTEDACTIONSIN6NYCRR, PART617-67 ]fNo, anegative
declaration may be superseded by another involved agency
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 paitem, 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 communit_¥ or neighbor_h~od character? Explain briefly:
I ' ' ' ' ' ' ..... ' briefly:
C3 Vegetahon or fauna fish shellhsh or w~ldllfe species s~gn~ficant habitats, or threatened or endangered species? Explain
C5
C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly:
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:
Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
C70lher impacts including changes in use of either quanti[y 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 xes, explain briefly:
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~/es explain:
E:] Ye' I--1N°I
PART Ill - DETERMINATION OF SIGNIFICANCE {To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each
effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibilRy; (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 must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur, Then proceed directly to the FULl
EAF and/or prepare a positive declaration,
Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio~
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi
determination.
Name of Lead Agency
Date
Tifle 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 Applicati~
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: /3//~
Are wetlands present within 100 feet of the proposed activity?
No V Yes
Does the project involve excavation or filling?
No c/ Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
County of Suffolk
State of New York
qoard
of Trustees Application
~-'7~/k~/7--~ ~ ,/~ ~D BEING DULY SWORN
DEPOSES ,MNI) 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 TO,TN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TO~FN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
Signature
SWORN TO BEFORE ME THIS / 5/'v~h DAY OF ~ ,20 O/f
CONNIE D. BUNCH
NotmT Public, State of New York
.N..o. 01BU6185050
uualifie~_ n Suffolk County
ssion txpires April 14,
Notary Public
of Trustees Applicati~
AUTHORIZATION
(where the applicant is not the owner)
(print owner of property)
residing at
(mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(Owner's signature)
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 emnlovees. The rmranse of
~tlais form is to provide information which can alert the town of r~ossible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: ~"~ ~X~ ?~/'/'~/L/(~ ~)
(Last name, first name, middle initial, unless yoo 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
(If"Other", name thc activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
oftbe Town of Southold? "Relmionship" includes by blood, marriage, or business interest. "Business interest" means a business,
including a partnership, in which the town officer or employee has even a partial ownemhip of(or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
YES NO
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agenffrepmsentative) 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
Form TS I
Submitted this,-./ff
Signature
Print Namd
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
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.
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 answered "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-
suoDortin~ 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 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.
JUL
DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# /j> ,.~ ,5' /2_
PROJECT NAME
The Application has been submitted to (check appropriate response):
TownBoard ~ Planning Board [~ Building Dept. [-~ BoardofTrustees
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)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action: ,, .~ h~,,O/_/,.4/_.?~///~.,,O
/
Location of action:
Site acreage:.
Present land use:
Present zoning classification:
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: ~-'W~O~/~' ~'~/"'/3'/0
//7¢/
(b) Mailing address:
(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 ~-~ If yes, which 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.
V-~Yes ~ No [-~ Not 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
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 1'/I Not Applicable
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
Yes [] No I~/qNot Applicable
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 App'[liable
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 [] Not 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. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria.
~-~ Yes [] No [-~ 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
TITLE /~ ~A~ ~7~ DATE
~ v~Crol~
~g~.~vo ta
I~/1~ lwl
CONCRET~
FOUN1)AHON
T.F.=58.6
DEPARTMENT OF ENVIRONMENTAL
DEC PERMIT NUMBER
1-4738-03545/00001
FACILITY/PROGRAM NUMBER(S)
PERMIT
Under the Environmental
Conservation Law
EFFECTIVE DATE
March 15, 2006
EXPIRATION DATE(S)
March 14, 2011
TYPE OF PERMIT · New [] Renewal [] Modification [] Permit to Construct [] Permit to Operate
[] Article 15, Title 5: Protection of Waters [] 6NYCRR 608: Water Quality [] Article 27, Title 7; 6NYCRR 360:
[] Article 15, Title 15: Water Supply
[] Article 15, Title 15: Water Transport
[] Article 15, Title 15: Long Island Wells
[] Article 15, Title 27: Wild, Scenic and
Recreational Rivers
Certification
[] Article 17, Titles 7, 8: SPDES
[] Article 19: Air Pollution Control
[] Article 23, Title 27: Mined Land
Reclamation
· Article 24: FreshwaterWetlands
[] Article 25: Tidal Wetlands
Solid Waste Management
[] Article 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
Ernesto A. Adriano
ADDRESS OF PERMITTEE
723 Greenbelt Parkway West, Holbrook, NY
CONTACT PERSON FOR PERM[TrED WORK
11741
NAME AND ADDRESS OF PROJECT/FACILITY
Adriano property, 2195 Edwards Lane, Orient
TELEPHONE NUMBER
(631) 472~4148
TELEPHONE NUMBER
COUNTY
Suffolk
TOWN
Southold
WATERCOURSE
NYTM COORDINATES
E:726.63 & N:4558.98
DESCRIPTION OF AUTHORIZED ACTIVITY:
Construction of a paved driveway, and installation of a potable well. This regulated activity is in association
with the construction of a single family dwelling and appurtenant structures which are outside the
jurisdiction of the Article 24 (NYSDEC Freshwater Wetland Regulations) of the NYS Environmental
Conservation Law. All regulated activity must be done in accordance with the attached plan prepared by
Lamberto C. Fernando, AIA, last revised on 2/9/06 and stamped NYSDEC approved on 3/13/06.
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 page 2 & 3) and any Special
Conditions included as part of this permit.
PERMIT ADMINISTRATOR: ADDRESS
Region 1 Headquarters
Roger Evans (GWC) Bldg. #40, SUNY, Stony Brook, NY 11790-2356
(,/d~~ March 13, 2006
d
Page 1 of 4
NE_.[_E~K STATE D~L CONSOTION
1. 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.
2. 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.
3 Prior to commencement of any construction activities, a continuous row of straw bales shall be staked end to end
along the downslope edge of any areas of clearing, filling or ground disturbance. 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.
4. Straw bales shall be recessed two to four inches into the ground at all times.
5. 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.
6. 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 all 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.
7 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.
8 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.
DEC PERMIT NUMBER
1-4738-03545/00001
PAGE2OF 4
--NEW YORK~STATE DEPARTMENT OF ENVIRONME__ ~ONSERVATION;NYCRR PART 608
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5),
( 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 owner may be ordered by the
Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the
State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of
the watemourse 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 watemou rse. 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 orwaterway by suspended solids,
sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally
deleterious materials associated with the project.
Any material dredged in the conduct of the work herein permitted shah be removed evenly, without leaving large
refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause
damage to navigable channels or to the banks of a waterway.
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.
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.
All activities authorized by this permit must be in strict conformance with the approved plans submitted by the
applicant or his agent as part of the permit application.
DEC PERMIT NUMBER
1-4738-03545/00001
PAGE 3 OF 4
NOTIFICATION (~~~ONS
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 the State of New York, its representatives, employees, and agents ("DEC") for all claims,
suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with the permittee's
undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit
whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not
extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or
omissions, or to any claims, suits or actions naming the DEC and arising under article 78 of the New York Civil Practice
Laws and Rules or any citizen suit or civil rights prevision under federal or state laws.
Item B: Permittee's Contractors to Comply with Permit
The permittee is responsible for informing its independent contractors, employees, agents and assigns of their
responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect
to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental
Conservation Law as those prescribed for the permittee.
Item C: Permittee Responsible for Obtaining Other Required Permits
The permittee ts responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may
be required to carry out the activities that are authorized by this permit.
Item D: No Right to Trespass or Interfere with Riparian Rights
This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of
others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or
personal property held or vested in a person not a party to the permit.
GENERAL CONDITIONS
General Condition 1: Facility Inspection by the Department
The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an
authorized representative of the Department of Environmental Conservation (the Department) to determine whether the
permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL
71-0301 and 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 permit, including all referenced maps, drawings and special conditions, must be available for inspection
by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a
Department representative is a violation of this permit.
General Condition 2: Relationship of this Permit to Other Department Orders and Determinations
Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any
order or determination previously issued by the Department or any of the terms, conditions or requirements contained in
such order or determination.
General Condition 3: Applications for Permit Renewals or Modifications
The permittee must submit a separate written application to the Department for renewal, modification or transfer of this
permit. Such application must include any forms or supplemental information the Department requires. Any renewal,
modification or transfer granted by the Department must be in writing.
The permittee must submit a renewal application at least:
a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous
Waste Management Facilities (HWMF), major Air Pollution Control (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, Region 1, SUNY Bldg #40, Stony Brook, NY 11790-2356
General Condition 4: Permit Modifications, Suspensions and Revocations by the Department
The Department reserves the right to modi~, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds
for modification, suspension or revocation include:
a) materially false or inaccurate statements in the permit application or supporting papers;
b) failure by the permittee to comply with any terms or conditions of the permit;
c) exceeding the scope of the project as described in the permit application;
d) newly discovered material information or a material change in environmental conditions, relevant technology or applicable
law or regulations since the issuance of the existing permit;
e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental
Conservation Law or regulations of the Department related to the permitted activity.
DEC PERMIT NUMBER
1-4738-03545/00001 PAGE 4 OF 4
018
4,'
iI