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Home My WebLink AboutSPDES - Southold Town Animal Shelter,~ RESOLUTION 2012-535 ADOPTED DOC ID: 7966 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2012-535 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 3, 2012: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Notice/Renewal Application/Permit in connection with the State Pollutant Discharge Elimination System (SPDES) permit regarding the Southold Town Animal Shelter Facility, which is required by the NYS Department of Environmental Conservation under the terms of our SPDES Permit #NY-027- 3821, subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED IUNANIMOUSI MOVER: Jill Doherty, Councilwoman SECONDER: William Ruland, Councilman AYES: Ruland, Talbot, Doherty, Krupski Jr., Evans, Russell MARTIN D. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer.andaloro@town.southold.ny.us LORI Mo I{ULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD July 30, 2012 RECEIVED New York State Dept. of Environmental Conservation Environmental Permits, Bureau of Environmental Analysis 625 Broadway Albany, NY 12233-1750 Southold Town Re: Southold Town Animal Shelter SPDES Permit #NY027382t DEC No: t-4738-03908 Due Date: October 3, 2012 To Whom It May Concern: With respect to the referenced matter, I am enclosing an original, executed Notice/Renewal Application/Permit form and Questionnaire, which form has been executed by Supervisor Russell. The Questionnaire has been completed with the exception of the issue date of the current permit. We have not been able to locate our copy of the current permit and, therefore, have left this date blank. If you have any questions regarding the enclosed, please do not hesitate to call me. Very truly yours, Secretary to the Town Attorney /Ik Enclosures J cc: Ms. Elizabeth A. Neville, Town Clerk Mr. James Richter, Engineering Inspector 91-20-5 (4/98) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION State Pollutant Discharge Elimination System (SPDES) NOTICE / RENEWAL APPLICATION / PERMIT Please read ALL instructions on the back before completing; this application form. Please TYPE or PRINT clearly in ink. PART1- NOTICE Date: 06/14/2012 Permittee Contact Name, Title. Address Facility and SPDES Permit Information TOWN OF SOUTHOLD JAMES RICHTER 53095 MAIN RD PO BOX 1179 SOUTHOLD NY 11971 Name: SOUTHOLD TOWN ANIMAL SHELTER Ind. Code: 8999 County SUFFOLK DEC No,: 1-4738-03908/ SPDESNo.: 027 3821 Expiration Date: 04/01/2013 Application DueSy: 10/03/2012 Are these name(s) & address(es) correct? if not, please write corrections above. The State Pol!utant Discharge Elimination System Permit for the facility referenced above expires on the date indicated. Submit this application by the "Application Due By" date listed above in order to keep continuous coverage under your permit. CAUTION: This shod application form and attached questionnaire are the only forms acceptable for permit renewal. Sign Part 2 below and malt this form and the completed questionnaire using the enclosed envelope. Effective April 1, 1994 the Department no longer assesses SPDES application fees. tt them are changes to your discharge, or to operations affecting the discharge, then in addition to this renewal application, you must also submit a separate permit modification application to the Regional Permit Administrator for the DEC region in which the facility is located, as required by your current permit. See the reverse side of this page for instructions on filing a modification request. PART 2 - RENEWAL APPLICATION CERTIFICATION: I hereby affirm that under penalty of perjury that the information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief False statements made herein are punishable as a Class A misdemeanor pursuant to section 210.45 of the Penal Law, $i§~et~re ~ Title Date PART :3 - PERMIT (i~~ this line - Official Use Only) Effective Date: / /__ Expiration Date: Permit Administrator Address: NYSDEC - Division of Environmental Permits Bureau of Environmental Analysis 50 Wolf Road, Albany, NY 12233-1750 Signature Date This permit together with the previous valid permit for this facility issued __ / __ / __ and subsequent modifications constitute authorization to discharge wastewater in accordance with all terms, conditions and limitations specified in the previously issued valid permit, modifications thereof or issued as part of this permit, including any special or general conditions attached hereto. Nothing in this permit shall be deemed to waive the Department's authority to initiate a modification of this permit on the grounds specified in 6NYCRR §621.14, 6NYCRR §754.4 or 6NYCRR §757.1 existing at the time this permit is issued or which arise thereafter. Attachments: General Conditions dated / NEVi/YORK STATE DEPARTMENT OF'ENVIRONMENTAL CONVERVATION ~omP~ea'~ er~eryo~ ~ DEC ID~- ~q3~-O~08 '/ ,,,~ SPDESNumborNY 02q 3g~l QUESTIONNAIRE for SPDES PHvate, Commercial & Institutional (PCI) Renewal Applications Please answer the following questions about your discharge and return this form with your SPD ES Application form. 'Use additional sheets as necessary. When was.your current permit issueC (ie:signed by a Department representative)? Date__/ / Yes No [] · [] · Has the SPDES permit foi~ your facilily been mddified in the past 5 years? Have any. changes been made to your disPOsal system? If yes, please describe: [] · Has there been an increase in wastewater discharge c~uantities to or from your disposal system above what-was listed (see design flow) on your permit? If yes, explain: [] · Have Ihere been a physical expansior~or other modifimations'to your faculty? I[ yes, pi~ase descr~e: Has there been a change in the type, size or nature of the activity or business being conducted at your facility? If yes, please describe: New York State Department of Environmental Conservation Division of Environmental Permits, 4th Floor 625 Broadway, Albany, NY 12233-1750 Phone: (518) 402-9167 · Fax: (518) 402-9168 Website: www.dec.ny.gov RECEIVED James Richter Town of Southold SEP ] 7 20]Z 53095 Main Rd PO Box 1179 Southold, NY 11971 Southold Town Clerk SEP 1 3 2012 FACILITY INFORMATION NAME: Southold Town Animal Shelter LOCATION: Southold (T) COUNTY: Suffolk SPDES NO: NY 027 3821 DEC ID NO.: 1-4738-03908/00001 Joe Martens Commissioner Dear SPDES Permittee: Enclosed please find a validated NOTICE/RENEWAL APPLICATION/PERMIT form renewing your State Pollutant Discharge Elimination System (SPDES) permit for the referenced facility. This validated form, together with the previously issued permit (see issuance date of this permit in Part 3 of the NOTICE/RENEWAL APPLICATION/PERMIT form), and any subsequent permit modifications constitute authorization to discharge wastewater in accordance with all terms, conditions and limitations specified therein. The instructions and other information that you received with the NOTICE/RENEWAL APPLICATION/PERMIT package fully des. cribed procedures for renewal and modification of your SPDES permit under the Environmental Benefit Permit Strategy (EBPS). As a reminder, SPDES permits are renewed at a central location in Albany in order to make the process more efficient. All other concerns with your permit such as applications for permit modifications, permit transfers to a new owner, name changes, and other questions should be directed to the Regional Permit Administrator at the following address: Walter Hilbert Suffolk County Department of Health 360 Yaphank Avenue, Suite 2C Yaphank, NY 11980 (631) 852-5700 If you have already filed an application for modification of your permit, it will be processed separately through our regional office. If you have questions concerning this permit renewal, please contact Lindy Sue Czubernat at (518) 402-9165. Sincerely, Agency Program Aide Enclosure cc: RPA RWE BWP 91-20-5 (4/98) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION State Pollutant Discharge Elimination System {SPDES) NOTICE / RENEWAL APPLICATION / PERMIT Please read ALL instructions on the back before completing this application form, Please TYPE or PRINT clearly in ink. Permittee Contact Name, Title, Address Facility and SPDES Permit Information TOWN OF SOUTHOLD JAMES RICHTER 53095 MAIN RD PO BOX 1179 SOUTHOLD NY 11971 Name: SOUTHOLD TOWN ANIMAL SHELTER Ind. Code: 8999 County SUFFOLK DEC No.: 1-4738-03908/~ SPDES No.: 027 3821- Expiration Date: - 04 / 01 / 2013 Application Dueuy: 10/03/2012 Are these name(s) & address(es) correct? if not, please write corrections above. The State Pollutant Discharge Elimination System Permit for the facility referenced above expires on the date indicated. Submit this application by the "Application Due By" date listed above in order to keep continuous coverage under your permit. CAUTION: This short application form and attached questionnaire are the only forms acceptable for permit renewal. Sign Part 2 below and mail this form and the completed questionnaire using the enclosed envelope. Effective April I, 1994 the Department no longer assesses SPDES application fees. If there are changes to your discharge, or to operations affecting the discharge, then in addition to this renewal application, you must also submit a separate permit moditication application to the Regional Permit Administrator for the DEC region in which the facility is located, as required by your current permit. See the reverse side of this page for instructions on tiling a modification request. PART 2 - RENEWAL APPLICATION CERTIFICATION: I hereby affirm that under penalty of perjury that the information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to section 210.45 of the Penal Law Na~e ot ~~uctioa~ on l~ek) Signature ~/ Title PART 3- PERMIT (Below this line- Official Use On!y) Effective Date: 41~L! [~ Expiration Date: '~ ,~ /._~ NYSDEC- Division of Environmental Permits - ~7~ ~'~ .~" {)~ Address: Bureau of Enviromental Analysis Pe~it Administrator 625 Broadway, Albany, NY 12233-1750 SFP 1 3 2012 Signature ~ Date Thisperm~t~ether~hthepreviousvalid permit for this facil~ issued ~ / t / ~andsubsequentmodifica~ons constitute authoriza~on to discharge wastewater in accordance with all terms, condi~ons and limAa~ons specified in the pre~ously ~ued val~ ~rmA, modifica~ons thereof or issued as pad of this perm,, including any special or general condiBons a~ached hereto. Nothing in this permit shall be deemed to waive the Depadment's ~t~od~to i~ea mpdification of this permit on the grounds specified in 6NYCRR ~621.14, 6NYCRR ~754.4 or 6NYCRR ~757.~ '~xisflng ~t the Ume this permit is issued or which arise thereafter. NEW YORf( STATE DEPAR'~,~E~T OI- ENV~RO'N~ENTAI ~.zONYERVATION jPlease enter DEC;iD I - ~3~-0~08 / p.e~ ~%_ SPDES Number NY O~ g 3 8& J fo~- SPDES Private, Co:"n~ercJal & ~nstitutiof~Al (PCI} ~e~-~e~r~ Applications Please answer the following questions about your discharge and reJum this fo~ with your SPD ES Ap~Ji~tion ~or',:~. lise additional sheets as necessaW. VVhE:n was yoLIr current permit issued Cie:signed by a Depadment representative)? Date / / Yes [_~ J Has the SPDES permit for your facil~ been modified in ihe past 5 years? Have any, changes been made to your disposal system? If yes, please describe:' Ei I Has there been an increase in wastewater discharge quantities to or from your disposal system above what was listed (see design flew) on your permit? if yes, explain: D ~ Have lhere been a physical expansion or other modifications'fo your facility? If. yea. please describe: [_-J il. Has there been a change in the type, size or nature of the activity or business being conducted ~t your facility? If yes, please describe: