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HomeMy WebLinkAboutTR-8473 John M. Bredemeyer 111, President g�FFQ(,f.�o Town Fall,53095 Main Rd. Michael J. Domino, Vice-President �� Gym P.O. Box 1179 James F. King y Southold,NY 11971 Charles J. Sanders � �� Telephone(63 l)765-1892 Dave Bergen 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 / % constructed V Project complete, compliance inspection t +.f rt; I BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK i i i PERMIT NO. 8473 DATE: JULY 23, 2014 i i j ISSUED TO: EDGARD EL CHAAR i PROPERTY ADDRESS: 3765 STILLWATER AVENUE, CUTCHOGUE SCTM# 137-1-1 I I AUTHORIZATION i t Pursuant to the provisions of Chapter 275 of the"Town Code of the Town of Southold and in j accordance with the Resolution of the Board of Trustees adopted at the meeting held on July 23,2014,and in j consideration of application fee in the sum of$250.00 paid by Auberge Corp. c/o Edgard EI Chaar and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: I i I Wetland Permit to remove existing storm damaged pier and replace with new 4'x120' fixed pier, to begin 20-22 feet from seaward end of deck using only 2-pile bents, with the use of thru-flow decking over the wetlands and untreated decking on remainder; a 3'x12' aluminum ramp; and a 61x20' float; and as depicted on the site Plan prepared by Jeffrey Patan o, last dated May 20 2014 and stamped approved on fr July 23, 2014. IN 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. I I I John M. Bredemeyer III-Absent ,TIN co C* i i i 1 i I TERMS AND CONDITIONS The Permittee, E':d�ard ,] Chhaar, residing at 3765 Stillwater Avenue Cutchogue New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That tine 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 Permittee 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 Board will be notified 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. 10. 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. 0 �f SOVl Town Hall Annex John M. Bredemeyer III,President �� y� Michael J.Domino,Vice-President �O l0 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee Q Telephone(631) 765-1892 Charles J.Sanders,Trustee D�y`,oUNV ► Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 23, 2014 Mr. Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: EDGARD EL CHAAR 3765 STILLWATER AVENUE, CUTCHOGUE SCTM# 137-1-1 Dear Mr. Patanjo:- The Board of Town Trustees took the following action during its regular meeting held on Wednesday, July 23, 2014 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of EDGARD EL CHAAR 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 June 9, 2014, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policies 6 & 9 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit on the structure; and the proposed dock is within the existing pier line; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 23, 2014, at which time all interested persons were given an opportunity to be heard, and, 2 WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of EDGARD EL CHAAR to remove existing storm damaged pier and replace with new 4'x120' fixed pier, to begin 20-22 feet from seaward end of deck using only 2-pile bents, with the use of thru-flow decking over the wetlands and untreated decking on remainder; a 3'x12' aluminum ramp; and a 6'x20' float; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated May 20, 2014, and stamped approved on July 23, 2014. 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: $ 1,694.00 Very truly yours, Michael J. Domino Vice-President, Board of Trustees MJD/amn John M. Bredemeyer 111, President �,Sla Ot -C Town Hall Annex Michael J. Domino,Vice-President ��4 �Gy 54375 Route 25, P.O. Box 1179 a � Jaynes F. King y Southold,NY 11971 Charles J. Sanders C'y r► !� Telephone(63 1)765-1892 Dave Bergen Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - TO: ai—SZ, D4C Please be advised that your application dated has been reviewed by this Board at the regular meeting of 23 _ and your application has been approved pending the completion oft e f (lowing items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) % Constructed ($50.00) 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: F:7 (fi .( Tnspe-c-h'on —1S©.b0 Dock -(e6: 3 f-!2' r&tmp = 3 to sq_,'0-,n 3 tvlsq .4, bg • b b &'x ZD' P oaf- TOTAL FEES DUE: $ BY: John M. Bredemeyer III, President Board of Trustees • DEPARTMENT OF THE ARMY RECENED NEW YORK DISTRICT,CORPS OF ENGINEERS JACOB K26 JAVITS UILDING V`UL 17 2014 - NEW YORK,NEW YORK 10278-0090 ktTOW Qerk Regulatory Branch JUL1 0 2014 JUL 1 8 2014 SUBJECT: Permit Application Number NAN-2014-00611-EYR .. �, , by Edgard EI Chaar ""`' ar�' . T ��, The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Edgard EI Chaar 130 East 35th Street; New York, NY 10016 ACTIVITY: Replace an existing 85-linear foot fixed timber pier and extend by 35-linear feet; replace one 3-foot wide by 12-foot long ramp and one 6-foot wide by 20-foot long float. The replaced fixed and floating pier structure will extend 110-linear feet from the Spring High Water line into East Creek, Little Peconic Bay. The purpose of this project is to replace existing storm-damaged structures for access to navigable waters for recreational boating. WATERWAY: Little Peconic Bay LOCATION: 3765 Stillwater Avenue, Village of Cutchogue, Town of Southold, Suffolk County, New York As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c)(3)(A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. In order for us to better serve you, please complete our Customer Service Survey located at htt ://www.nan.usace.arm .mil/Missions/Re ulator /CustomerSurve .as x. ***PLEASE USE THE ABOVE 18-CHARACTER FILE NUMBER ON ALL CORRESPONDENCE WITH THIS OFFICE*** r • Regulatory Branch SUBJECT: Permit Application Number NAN-2014-00611-EYR by Edgard EI Chaar To allow for the timely processing of the subject application, your comments are requested within 20 days of the date of this letter. If you have any questions, please contact Robert Youhas, of my staff, at (917) 790-8715. Sincerely, Stephan A. Ryba Chief, Eastern Section Enclosures -2- 1lrMi-FIAT O�Ia10 GY9t EItM06 PROM FRED BMW MW 12D' 4' NDE X 12(' LIM ALL OEBMW 1N 10' eve=11M 00got=WR i 0 NiOP08ED Cur allyl F m8 MP.) � 8 --.-_.- —— -- PIaPOS®8 NDE X 1r Lm 6 —— - —- PIiOP0881 r WE X V LIM J—f wwww ROM WK 4 — '' -- —— _ MPIUMM WLR B. 2&- O 2 _ ___ o, 2 - -- __ -__-- _ - - _- _ _ •z,FILE TYPICAL SECTION S 0 H. 1"=2O' 4 LO C,07 '0'N SCALE: !"=2' V: REPRESENTS WATER DEPTH IN INCHE.. BELOW MEAN LOW WATER a NOTES 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM 2. LOT AREA: 16,987 S.F. / 0.389 ACRES tr j 0 0Nassau Poe 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: » � c � PECONIC LAND SURVEYORS SOUTHOLD, NYr .g SURVEY :RTES DATED JUN_ 18, 200 4.ALL DEMOtLSFD SFIALL B:lM-liEIOM PROPERTY OWNER: =e EDGARD EL CHAAR '�?ywa'er 130 EAST 35TH STREET Proposed Dock & Float Permits SCALE: Cove NEW YORK, NY 10016 AS NOTED PREPARED BY: TYPICAL SECTION & DATE: JEFFREY PATANJO LOCATION MAP 5-20-14 F 4' 06 HEWITT BOULEVARD CENTER MORICHES, Nti" :234 3765 STILLWATER AVENUE PROJECT LOCATION MAP 631-484-9332 CUTCHOGUE. TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEE: N.T.S. TAX YAP N0. 1000-187-01-01 ,OF 1000-137-01-5.1 1 \{ LAND OF MORANDINA TRUST r+ P 0. BOX 1058 SOUTHOLD, NY 11971 EE aMNc w°BdMS Os MAL d ' PROPOSED FDO pL PER 1X 4 RmE `. SUPPORTED DO 6Y PIFS a e'O.C.ocOW X wm sus) K i LOT 20 y ROM DOW DRE,OED PER!RMT � �p350' (Tax MaP) +r Lm z�"ro o N 56°05'54"E m � = m ® $ ' �+ DR GRAVEL NEWAY J r� � ` •� \v� 0 � 2 Sty. LOT 19 .. (O �.. #376b PTIOPOSED 2D'L=z w®E nark DocN l t'- SUPPORTPD m+(2)O I PIES O RIO 0.6 N J 1.'N \ C o.s's -..H 8 S I TMM a N=LS.aMW ML9=i- MWO (O S 57° 21'01"W ,_87s 312.81' y AM"ON 5-15-14 t\ 1000-137-01-5.1 \ LARD OF 3flLDRED DAVID 3825 Stillwater Ave. Cutctwgue, A!Y 11935 i J REPRESENTS WATER DEPTH IN INCHES. BELOW MEAN LOW WATER N-�` PROPERTY OWNER: 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM EDGARD EL CHAAR pro sed DOCk & Float Permits scALE: 2. LOT AREA: 16,987 S.F. / 0.389 ACRES 130 EAST 35TH STREET NEW YORK, NY 10016 1"=40 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: PREPARED BY: PROPOSED PLAN DATE: SOUTHPECONC LAND SURVEYORS JEFFREY PATANJO 0-14 SURVEY L NY 106 HEWITT BOULEVARD SURVEY LATEST DATED JUNE 18, 2001 CENTER MORICHES, NY 1193,4 8766 STILLI►ATER AVENUE CU7ICEOGUE, TOWN 4. ALL DECKING USED SHALL BE UN-TREATED 631-484-9332 COUNTY, SOUTHOLD SUFFOLK COTY. NY HEEf: TAX YAP N0. 1000-137-01-01 i z NAN-2014-00611-EYR Mailing List NYSDEC-Region1 V. -' United States Post Office-­ Division ffice- .Division of Envr ental Permits 240 GriffinStrdetW SUNY@Stgray,. rook 50 Circle Road Cutchpgd6, NY 11935 Stony &d6k, NY 11790-3409 `'.-lease Post for Public View" NY State Departme Mate Jeffrey Patanjo Division of overnment—CZM 106 Hewitt Boulevard 41S treet Center Moriches, NY 11934 ny, NY 12231 Mildred David Town of Southold 3825 Stillwater Avenue 53095 Rte 25 Cutchogue, NY 11935 Southold, NY 11971 "P tease•° Rb4+r View" Morandina Trust Edgard EI Chaar P.O. Box 1058 130 East 35th Street Southold, NY 11971 New York, NY 10016 a 11 . P py,.. .. e � 1 w f �s w. y. Y Yp y r'A ��.s t Yt .•sr i �. w JF _t Edgard C-M Stillwater Aven2e,C2tchipe LCrM#136-2-12 /16/14 John Bredemeyer, President °�SIAF9jt Town Hall Annex Michael J. Domino, Vice-President �° 54375 Route 25 James F. King $ P.O. Box 1179 Charles J. Sanders . Southold, NY 11971 Dave Bergen yNv! �a°! Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionMork Session Report Date/Time: 7 tt,6 Jeffrey Patanjo on behalf of EDGARD EL CHAAR requests a Wetland Permit to remove existing storm damaged pier and replace with new 4'x120' fixed pier with the use of thru-flow, decking over the wetlands and untreated decking on remainder; a 3'x12' aluminum ramp; and a 6'x20' float. Located: 3765 Stillwater Avenue, Cutchogue. SCTM# 137-1-1 Typ�f 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 Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable ax"Iriit 4v fo needeo DAAI� I-c inKi '� ,1 e�e oP to r--� clot Modifications: Conditions: Present Were: J. Bredemeyer --W. Domino eT King meanders D. Bergen Bay Constable Other Form filled out in the field by e-4.C1 NJ Mailed/Faxed to: Date: i Albert J.Krupski,President '*0 so Town Town Hall 25 James King,Vice-President �O w P.O. Route 9 Artie Foster P.O.Bos 1179 Ken Poliwoda qr Southold,New York 11971-0959 CA Peggy A.Dickerson Telephone(631)765-1892 �►`,0 , Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 18,2005 JUN - 9 2014 i Mr. Edgard EI Chaar - - 3765 Stillwater Ave. card of Trustees te r Cutchogue, NY 11935 RE: 3765 STILLWATER AVE.,CUTCHOGUE SCTM#137-14 Dear Mr. EI Chaar. The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, May 18,2005: RESOLVED,that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit#1470 from Bruce R. Johnson to Edgar EI Chaar,as issued on January 7, 1981. If you have any questions, please contact our office at(631)765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims ' Albert J.KrupsK President ' FF Town Hall James King,Vice-President 53095 Route 25 Henry Smith P.O.Boz 1179 Artie Foster Southold,New York 11971-0959 Ken Poliwoda • Telephone(631)765-1892 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 30,2001 J U N - 9 2014 Mr.Brice Johnson af Tf- 3765 Stillwater Avenue r f Tr Cutchogue,NY 11935 RE: Corinne Boos—Bruce R Johnson SCTM#137-1-1 Permit#1470 - i Dear Mr:Johnson: The following action was taken at the Southold Town Board of Trustees Regular Meeting on July 25,2001 RESO v-ED,that the Southold Town Board of Trustees approve the request for a Transfer of Permit#1470 from Corinne Boos—.to--Bruce R Johnson.. If you have any questions,please contact our office at 765-1892. Sincerely, Albert J.&pf'Jr. Iy President,Board of Trustees Board Of Southold Town Trustees �.�. SOUTHOLD, NEW YORK PERMIT NO. 14.70 une 3 1 $, ISSUED TO ..:.....P9Ki a-..Boos....:..............._...._ ...:-.... _.... . ..... f Ala t4ortztt#tLai ON, -.-'g 2014 Pursuant to4e provisions of Chapte 615 e e ;af,the State of New York, 1893; and Chapter he La is es Y• ' State of New York 1952; and the Southold Town r mance on-titled "REGULATING AND THE PLACING•OF OBSTRUCTIONS ` IN•AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF--SAND; GRAVEL OR.OTHERMATERIALS.FROM. 'LANDS UNDER.TOWN WATERS;"-and in accordance with the Resolution of The Beard adopted at a meeting held on ..'Jan..7.1981 .....,.._.. ..... .....- 19..........., and--in consideration of the sum of-$...2.p,0....---• paid by• ' E ........Corinne.-.Jaoo :.• of 3765 .Stillwater Ave.,CutchNPand subject to .the Terms And- Conditions -listed on the reverse side hereof, of Southold Town'Trustees authorizes and.permits the following: `K To replace existing 6' by 9" floating dock with two ne ` floating docks 8' by 10' each. at private property of ap licant at East Creek with the condition that the' to al lnat� of the d ck& ainn flpatin clocks hall not exce��l�n accordance withf the°�eTailscT s�c�ticeions pro pFeesrerttd�nr'ers the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents.to' be subscribed'by a majority of the said Board as of AW date. 1 FF ......... .. lcui... e Al 1 �` �� . . . . . - " Photo JUN ■ 2014 a L I _ fir. r j'{. � I��• Photo yAaa..•b� i 4 i, V\" , � :AiJ-.. �.. �` �'�r Y r �.. 1'F. deem-AL r • • JUN n,4 fi i y�y il. � June 2, 2014 NYS Dept. of Environmental Conservation SUNY @ Stony Brook 50 Circle Road Stony Brook, New York 11790-2356 Attention: Duty Analyst RE: 3765 STLLwATER AvE.CuTcHowE, NY SCTM No. 1000-137-01-01 APPucam FOR PERMIT Dear Sir/Madame: We hereby submit four(4) copies of the proposed plans, applications, check, Photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332 or e-mail at jpatanjo@optonline.net. Very truly yam, Je2yPatanjo 106 Hewitt Blvd. Center Moriches, NY 11934 cc: NYSDOS Army Corps of Engineers Town of Southold , Mr. EI Chaar 'UN - 9 2014 ar of I 30INT APPLICATION FORM For Permits/Determinations to undertake activities affecting streams,waterways, waterbodies,wetlands,coastal areas and sources of water withdrawal. US Army Corps of New York You must separately apply for and obtain separate Permits/Determinations from Engineers(USACE) State each involved agency prior to proceeding with work.Please read all instructions. APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart- General Services ment of State Check all permits that apply: Check all permits that apply: ❑Stream Disturbance ❑ Coastal Erosion 1:1 Section 404 Clean Water Act Check all permits that Check ifthis apply; applies: ❑ Excavation and Fill in Management ❑ Section 10 Rivers and Harbors ❑State Owned Lands ErCoastal Navigable Waters ❑Wild,Scenic and "E' Under Water Consistency ❑ Docks, Moorings or Recreational Rivers /Nationwide Permit(s)-Identify ❑Utility Concurrence Platforms ❑ Water Withdrawal Number(s): Easement ❑ Dams and Impoundment ❑ Long Island Well (pipelines, Structures 133 Aquatic Vegetation Control conduits, ❑401 Water Quality ❑Aquatic Insect Control cables,etc.) Certification Precon�st ion Notification- ❑.Docks ❑ Freshwater Wetlands ❑ Fish Control l� Y / El Moorings or ❑Incidental Take of Endan- Platforms 011dal Wetlands gered/Threatened Species ,.,/ 1 I am sending this application ❑ I am sending this I am sending I am sending this application to this agency. to this agency. application to this this application agency. to this a enc . 5. Name of Applicant(use full name) Applicant must be: 6. Name of Facility or Property Owner(if different than L7 Owner Applicant) , ¢s " t E a,rA EL C bAa►,r ❑Operator a — Mailing ddress ❑Lessee Mailing Addre (check all that apply) 13d Ews'f 3s �y s+�f�-•t' JUN - 9 2014 U1 Post Office City Taxpayer ID(If applicant Post 0flice Ci t,JC as 1,1 r IL is NOT an individual): 3L L/il"fiV,,ai State N-1 Zip Code On t State Telephone(daytime) Email Telephone(daytime) Email Q17 - 2t%4 a$ �9 elohA�re vr� .Oft 7. Contact/Agent Name 8. Project/Facility Name Property Tax Map Section/Block/Lot Number Ter!1(ri'1 ha-,,- 0sCA- / Ooo - 11 3-1 - v i - o1 Company Name Project Location-Provide directions and distances to roads,bridges and bodies of waters: 3? .5 s-r, IIW�. �r�..► 44410 Mailing Address Street Address,if applicable Post Office City State Zip Code NY l o b Hew i-t--t- QL v e2• 3-7 l9 S S?,/l v.-telt Aue C w t e, o y vc I t R 3 S Town/Village/City County Post Office City A / Ce,,-l-ef Msfl"CS 150V'rkot4 �vr%A,L State Zip Code Name of USGS Quadrangle Map Stream/Water Body Name 3 N Sr ..t g„ a rl a er&&- Telephone(daytime) q S Ll. 1313 7- Location Coordinates: Enter NYTMs in kilometers,OR Latitude/Longitude d31 Email NYTM-E NYTM-N Latitude Longitude J Qo�'tq ri o(94®h)��e,ns� y 6 son= M�N JOINT APPLICATION FORM 02/13 This is a 2 Page Application Application Form Page 1 of 2 Both Pages Must be Completed tNT APPLICATION FORM—PAGE 2 OF 2 Submit this completed page as part of your Application. 9. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose.Attach additional page(s)If necessary. Include: description of current site conditions and how the site will be modified by the proposed project;structures and fill materials to be installed; type and quantity of materials to be used (i.e., square ft of coverage and cubic yds of fill material and/or structures below ordinary/mean high water)area of excavation or dredging,volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource impacts;and where applicable,the phasing of activities. ATTACH PLANS ON SEPARATE PAGES. /�G2 q✓!r� F�ok 4 CG fh �e�►t.vG t�fSl'a,v1 S7�®�/r� v�tsrn..pa� !'� w, 7 W�c�e 3 X 1 '•1'.'W Pi r/L Proposed Estimated 30, f `f Proposed Use: GrPrivate ❑ Public ❑Commercial Start Date: g ' 1 y Completion Date. Has Work Begun on Project? ❑Yes Blo If Yes,explain. Will Project Occupy Federal,State or Municipal Land? ❑Yes GrNo if Yes,please specify. 10. List Previous Permit/Application Numbers(if any)and Dates: A 11. Will this project require additional Federal,State,or Local Permits Including zoning changes? Yes ❑No If yes,please list: A�.zt� C"wf l ti "t Oo S 'fow..► o� So.��-�.1rA —rhos 'tes 12. Signatures.If applicant is not the owner,both must sign the application. I hereby affirm that 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. Further,the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits,actions,damages and costs of every name and description resulting from said project. In addition,Federal Law,16 U.S.C.,Section 1001 provides for a fine of not more than$10,000 or imprisonment for not more than 5 years,or both where an applicant knowingly and willingly falsifies, conceals,or covers up a material fact; or knowingly makes or uses a false,fictitious or fraudulent statement. L_bcw a � o.-o-« S z 3 , th Signatu o Applicant Printed Name Title Da Signature of er Printed Name Title Da e -J�f�rGti �w 'rano f1 sys�T 5,s� • f n re of Agent Printed Nam TIM Date 30INT APPLICATION FORM 02/13 Application Form Page 2 of 2 MW New York State Department of Environmental Conservation _ game PERMISSION TO INSPECT PROPERTY By signing this permission form for submission with an application for a permit(s)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, to the extent necessary,areas adjacent to the project site or facility. This consent allows DEC staff to enter upon and pass through such property in order to inspect the project site or facility,without prior notice, between the hours of 7:00 a.m.and 7:00 p.m.,Monday through Friday. If DEC staff should wish to conduct an inspection at any other times, DEC staff will so notify the applicant and will obtain a separate consent for such an inspection. Inspections 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 present at the time ofthe inspection. in the event that the project site or facility is posted with any form of"posted"or"keep out"notices, or fenced in with an 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, soils and vegetation(taking samples for analysis),and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for,and may result in, denial of the permit(s)sought by the application. Permission is granted for inspection of property located at the following address(es): 37 !05 5-Ni!/wa-1'ct. Ayc . C..Ta /tioc�ve. t--+ y By signing this form, I affirm under penalty of perjury that I am authorized to give consent to entry by DEC staff as described above. I understand that false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.* -(�,u(jet, C A.%4 r —� Print Name and Title nature Date *The signer of this form must be an individual or authorized representative of a legal entity that: • owns fee title and is in possession of the property identified above; • maintains possessory interest in the property through a lease,rental agreement or other legally binding agreement;or • is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in the property for the purpose of consenting to inspection of such property. Permission to Inspect Property Application Supplement 12/08 6I Z20 Appendix B Short Environmental Assessment Form Instructions for Comaletins Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: EL Chws► rr ?ICA.. Project Location(describe,and attach a location map): 3-7to6' st,/lr✓4 �c Avc C✓r�hoq�-¢ N`Z ll � 3T Brief Description of Proposed Action: (1,L�►®✓G X-0c9 S'tJN2 51'oW41 ll..yi a'cgQ llliC- Ani /c.Gt Avr..V I Z O ` �...� le V 1 wad ?9 •+,l-rye ?'ki �' ,�a i�.•+�,�..,. Name of Applicant or Sponsor: Telephone: R l 2104- 8 8 69 6j' ala EG C,{.....r E-Mail: clCAA dL & vrr. o✓ Address: l so EasT 3 t. s T itcT City/PO: State: Zip Code: i--./ G' yox k- N y 1 1 DO!is 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ Z r'I SQ Cc- /'4 c,d-pt / 04SOPS !Tv•..r+ c-� S.�kk.ld2 T�,istees 3.a.Total acreage of the site of the proposed action? o t acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned o. �$ or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ,_.,,� [:]Urban ❑Rural(non-agriculture) ❑Industrial [:]Commercial 31 esidential(suburban) ❑Forest ❑Agriculture [I Aquatic []Other(specify); ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 2 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? Er ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? Z ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 0' ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Z ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: e-'2c'*� Cfl�IL �3� 14. Ide ify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: [Shoreline [I Forest [IAgricultural/grasslands 1­1 Early mid-successional Wetland ❑Urban 2Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? a ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, F-1a.Will storm water discharges flow to adjacent properties? ❑NO [:]YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? r i ❑ � w . If Yes,briefly describe: NO ❑YES Page 2 of 4 � s 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: CA et r'l E t G eaa{ Date: S 12- Signature: ZSignature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 - � No,or Moderate small to large impact impact may may 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ EJ problems? 11. Will the proposed action create a hazard to environmental resources or human health? 0 Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ECheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 NEW YORK STATE DEPARTMENT OF STATE COASTAL MANAGEMENT PROGRAM 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.APPLICANT (please print) 1. Name: Ect•e el 61 Ck-%-tf 2. Address: 13 n fa ST 3 s.y STr«T Ale,.-' V 6AXk, &),I t o a t fr 3. Telephone: Area Code( ) 9 o 7• ?t Y. a 6 6 9 B.PROPOSED ACTIVITY 1. Brief description of activity: Qcinevc anAltce 6Tolac �.Aea�a�1t �t/L , /1'��'+t° Flo•-� 2. Purpose of activity: Itrn.g �••ctGt'tl�t �,yslQe otA naIeA wwA 3. Location of activity: Sd-f t-ie-- C✓+C 1►rq ti c s plc 4 c County City,Town,or Village Street or Site Description 4. Type of federal permit/license required: Af m C-,z?'r 5. Federal application number,if known: >,%J 4 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: !-' `l eb C.COASTAL ASSESSMENT Check either"YES"or"NO"for each of these questions. The numbers following each question refer to the 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 IT of an environmental impact statement? (11,22,25,32,37,38,41,43) u 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) e. Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10) L1 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) ❑ Q g. Siting of a facility essential to the generation or transmission of energy? (27) ❑ [� h. Mining,excavation,or dredging activities,or the placement of dredged or fill material in ❑ ❑ coastal waters? (15,35) i. Discharge of toxics,hazardous substances or other pollutants into coastal waters? (8,15,35) ❑ 2Q_y j. Draining of stormwater runoff or sewer overflows into coastal waters? (33) ❑ L'1 k. Transport,storage,treatment,or disposal of solid wastes or hazardous materials? (36,39) ❑ 1. Adverse effect upon land or water uses within the State's small harbors? (4) ❑ 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) ErQ. b. Federally designated flood and/or state designated erosion hazard area? (11, 12, 17) Q C. State designated significant fish and/or wildlife habitat? (7) Q d. State designated significant scenic resource or area? (24) ❑ e. State designated important agricultural lands? (26) Q f. Beach,dune or barrier island? (12) g. Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3) a h. State,county,or local park? (19,20) ❑ Q i. Historic resource listed on the National or State Register of Historic Places? (23) 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 waterfronEl IT revitalization program,or State-approved regional coastal management program? (see policies in program document*) D.ADDITIONAL STEPS 1. If all of the questions in Section C are answered"NO",then the applicant or agency shall complete Section E and submit the documentation required by Section F. 2. If any of the questions in Section C are answered"YES",then the applicant or agent is advised to consult the CMP, or where appropriate, the local waterfront revitalization program document*. The proposed activity must be analyzed in more detail with respect to the applicable state or local coastal policies. On a separate page(s),the applicant or agent shall: (a)identify,by their policy numbers,which coastal policies are affected by the activity,(b)briefly assess the effects of the activity upon the policy; and,(c)state how the activity is consistent with each policy. Following the completion of this written assessment,the applicant or agency shall complete Section E and submit the documentation required by Section F. E.CERTIFICATION The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved local 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 activity complies with New York State's approved Coastal Management Program, or with the applicable approved local waterfront revitalization program,and will be conducted in a manner consistent with such program." Q Applicant/Agent's Name: EFrc 1"a'I s� n o Address: 906 Newt f-f' BI�cQ • Ct t-F,et n.Ancielie , N`f Telephone: Area Code( Applicant/Agent's Signature:Ao"����� Date: F.SUBMISSION REQUIREMENTS 1. The applicant or agent shall submit the following documents to the Nev York State Department of State, Office of Coastal, Local Government and Community Sustainability, Attn: Consistency Review Unit, One Commerce Plaza-Suite 1010,99 Washington Avenue,Albany,New York 12231. a. Copy of original signed form. b. Copy of the 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 his/her application to the federal agency. 3. If there are any questions regarding the submission of this form,contact the Department of State at (518)474-6000. *These state and local documents are available for inspection at the offices of many federal agencies, Department of environmental Conservation and Department of State regional offices,and the appropriate regional and county planning agencies. Local program documents are also available for inspection at the offices of the appropriate local government.Revised 1010411010 ENVIRONMENTAL QUESTIONNAIRE This is intended to supplement ENG 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. t<X!s,+J,_7 Q,t,L it G®SrT ol..l,,..7 52arM 2. Provide the names and addresses of property owners adjacent to your work site (if not shown on the application form or project drawings). See- P la,-6 (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 alternatives)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). -7hL Na ✓�'I� wd✓�� ^.�'� a l�e .. '�"� -r�►G VSA DREDGING PROJECTS Answer the following if your project involves dredging. 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 dewatering/disposal sites for future dredging events, N 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 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). 12'el V e r 6/J1C n-e s ^A e- 2. 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 mooned 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 Na 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 vessel(s) moored thereto from wakes from passing vessels. ?.J 'V'I.c ,,,eeA,,J0 . BULKHEADING/BANK STABILIZATION/FILLING ACTIMIES 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. 1. 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 fill 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 and/or 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. RPT„ 21 a�a i 4 P ! 1 CIr P , F t p C¢ 'd7 • 3i \ �� 1�r R t6yc) 'ee „ V., F�EPI y .os ro ', e NII /,o Baa 'o 'sets ' o f� apfl p e QS o , x i�r N P ,x, xe ems s G �` " e — Z —� --�'__ --c—— NOTICE COUNTY OF SUFFOLK © R a asuman secnori rw E -µms_ �e I Real Property Tax Service Agency r or N v.r r eW)rllu —__� r •-- weoreR+R�N.IR.aMY1,ip a 137 � taM OFFICE LOCATION: ��OF SO(/ryO MAILING ADDRESS: Town Hall Annex �O lQ P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G.c1 Q Telephone: 631 765-1938 Fax:631765-3136 couf 1,�'ct\1, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM RL E CSi.�,To: John Bredemeyer, PresidentTown of Southold Board of Trustees U[, 2 2 2014 From: Mark Terry, Principal Planner LWRP Coordinator Date: July 22, 2014 Re: Proposed Wetland Permit for EDGARD EL CHAAR SCTM# 1000-137-1-1 Jeffrey Patanjo on behalf of EDGARD EL CHAAR requests a Wetland Permit to remove existing storm damaged pier and replace with new 4'x120' fixed pier with the use of thru-flow decking over the wetlands and untreated decking on remainder; a 3'x12' aluminum ramp; and a 6'x20' float. Located: 3765 Stillwater Avenue, Cutchogue. SCTM# 137-1-1 It is my recommendation that the proposed actions are INCONSISTENT with LWRP Policy 6: protect and restore the quality and function of the Town of Southold ecosystem and Policy 9: provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold and therefore are, INCONSISTENT with the LWRP. A permit for the existing dock structure was issued on June 3, 1981 authorizing access to the public waters. The applicant is seeking an expansion (seaward projection) of the current dock structure further into public waters. The applicant fails to prove that the action meets the following requirements as outlined in § 275-11 Construction and operation standards C. 2 (d) of the Southold Town Code: (d) Review and approval of dock applications. Before issuing a permit for a dock structure, the Trustees shall consider whether the dock will have any of the following harmful effects: [1] Whether the dock will impair navigation or be located in areas of high vessel traffic or vessel congestion. [2] Whether the dock will unduly interfere with the public use of waterways for swimming, boating, fishing, shellfishing, waterskiing and other water-dependent activities; i . 0 f51 Whether the dock will cause degradation of surface water quality and natural resources; I'111 Whether the cumulative impacts of a residential and commercial dock will change the waterway or the environment and whether alternate design, construction, and location of the dock will minimize cumulative impacts; and [121 Whether adequate facilities are available to boat owners and/or operators for fueling, discharge of waste and rubbish, electrical service and water service. In addition, Chapter 275 requires that the determination of the length of the dock must include the dimensions of the vessel. The dimensions of a vessel are not specified. 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 • g{yFFOX,� NV CdG� Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary N.O.Box 1179 '�►` Southold,NY 11971 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 Thurs., July 17, 2014 the following recommendation was made: Moved by Keith McCamy, seconded by Peter Meeker, it was RESOLVED to SUPPORT the application of EDGAR EL CHAAR to remove existing storm damaged pier and replace with new 4'X 120' long fixed pier, 3'X 12' aluminum ramp and 6'X 20' floating dock, using thru-flow decking over the wetlands and untreated decking on remainder. Located: 3765 Stillwater Ave., Cutchogue. SCTM#137-1-1 Inspected by: Keith McCamy, Peter Meeker, John Stein The CAC Supports the application with the Condition gutters, leaders and drywells are installed to contain run-off from the dwelling and the installation of a 10' non-turf buffer. Vote of Council: Ayes: All Motion Carried L� rc � �..: _ _. J U L 1 8 2014 's__ L___ i . James F.King,President Qf SO�jy Town Hall Annex i O� 54375 Main Road Bob Ghosio,Jr.,Vice-President P.O.Box 1179 Dave Bergen 4 Southold,New York 11971-0959 John Bredemeyer Telephone(631)765.1892 Michael J.Domino Fax(631)765-6641 j Yt.'•5 i I .. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Office Use Only a r oastal ErosioPermit Application D Wetland Permn it ApplicationVgnsion Administrative Permit Am �. ReceivedAppl dine is JUN — 9 2014 I . Feceived Fee:$ ompleted Application w a _Incomplete Ow,rd u'Trusiees i _SEQRA Classification: Type I Type H Unlisted Coordination:(date sent) I-LWRP Consistency Asses went Form ' // I AC Referral Sent: 7 1 Date of Inspection: Receipt of CAC Rep r ___Lead Agency Determination: Technical Review:_ ' Public Hearing Held: Resolution: I Name of Property Owner(s) Cot J^ej l C b Aar- Address 13o C oet r 3 5"x' 5-r'r-ev_T �t N+ `l�tiK, n�`I ! v o f 6 Phone Number:( ) '1 r 7 'Pt y- 7'b61 Suffolk County Tax Map Number: 1000- 137- &I - t Property Location: 3 '7 6 5 r4 j I I wk r/L A va a te , C'�t l..S u c (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: ! °6 1-JeWL- + dL'0&b. oe"'ter n/1ot��hes, ti►`l t]93�I Phone: &,a,, W $4 3 3 a— I Ard of Trustees Application i GENERAL DATA Land Area(in square feet): 1 b ,,9 ? s F. Area Zoning: fL t S i. Previous use of property: �r-S t cf e 1-t►wC Intended use of property: f1.c s r tinkw(, Covenants and Restrictions on property? Yes ✓ No If"Yes",please provide a copy. i Will this project require a Building Permit as per Town Code? Yes No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review i. and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No j Does the structure(s)on property have a valid Certificate of Occupancy? ✓ Yes No i Prior permits/approvals for site improvements: i I Agency Date ,V,c t' pJO. &47p No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes,provide explanation: Project Description(use attachments if necessary): Q��o�c �c-r,.�ti ST�� d,.n•.3��- P��i'- 4'"� (ellacc a•y+", n.,tw q'wiAe � lao' Go.�g F•xs8 fleA, 3{{rrtOc ,e { a ' t"'.y q/�.n{,.��••z M� cleal -1-4- x �FI.'iC. ✓✓�/����'� �C tG.N�j i N �JiY1 M{N�bJ� I� I! 1 Bold of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA i Purpose of the proposed operations: s r. sr. of 4 M—I! a.,a ^,/t...� �1 X !7(s !✓.v� F's*L1� �le/LI 3xia .41�»,.,�.-h. lL..�rf� �'k7a� FI.w.T. �r.,I�- -E-.> h...t F1..ou - ?"h it, ,lictet!2,2 ^,,!/L wcYl•y»�tS a„Q ✓..��T��,r-t'<� Did Area of wetlands on lot: P coo square feet Percent coverage of lot: I t •-7 % Closest distance between nearest existing structure and upland edge of wetlands: o feet Closest distance between nearest proposed structure and upland edge of wetlands: o feet Does the project involve excavation or filling? ✓ No Yes 1 If yes,how much material will be excavated? NL, cubic yards How much material will be filled? N/g cubic yards Depth of which material will be removed or deposited: "J'q feet Proposed slope throughout the area of operations: N In Manner in which material will be removed or deposited: NtA 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): There wN 111 be G N",j/.�l'1 YG G FTLGT i n &—e f 14�f o2 § oc". �'� 4 h c IN Sr�.ItN�t"Io..! Ip A'clei n�k 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: Ec ChAwr PttIL Project Location(describe,and attach a location map): 37 tis N't It 43S Brief Description of Proposed Action: (l.t;~-e 'ColeoI..QMw'ad� lltiC- A,,J t t'c.tt wt•fl% Newt Lv ` L...� �( Y! &v4g log {!/Q A0 AN9 av►&a � ' kap ' F/•ter-t Name of Applicant or Sponsor: Telephone- 6-4,101 elephone:6-4 et t' t'L Gl•w..r E-Mail: �1el,.c��t� vrJ. o✓ Address: 30 6%%STT City/PO: State: Zip Code: t.i c,,� 1r'otiIL NY r Or/L 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ r7s0Ee,4^ / w),1SovS�Ta. #-b 01'e- S. kk.ILf T�✓st'ees 3.a.Total acreage of the site of the proposed action? 01 acres b.Total acreage to be physically disturbed? •ei acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) [:]Industrial ❑Commercial residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? 117 M M 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ./ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: R ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Z ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: e{fc1L 73' 14. 14e ify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Q horeline ❑Forest [IAgricultural/grasslands ❑Early mid-successional [Wetland ❑Urban 2guburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑' ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ❑NO []YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: []NO []YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO . YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? ❑ If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: E t G f ax,(- Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning © ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? LJ 5. Will the proposed action result in an adverse change in the existing level of traffic or (� ❑ affect existing infrastructure for mass transit,biking or walkway? LJ 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? ❑ b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, F] waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large XMI IF IIIA1111110411i 51111 impact impact . may may st;�. _t, occur occur filo. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? ❑ 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined it th t the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-teen and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental imp cts. D to Name of Lead Agency ' Print or pe Name of Responsible Officer in Lead Agency itle of Responsible Officer Signature of Responsi officer in Lead Agency Signature of Preparer(if different from Responsible officer) PRINT Page 4 of 4 Boa d of Trustees Application I County of Suffolk State of New York i BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)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. THE APPLICANT BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TR } AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES is 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. i Signatur f Property Owner i �G SWORN TO BEFORE ME THIS LE—DAY OF ,20_ Notary Public York :01P 150861 Commission Expires 08/07120 r' i e9d of Trustees Application I AUTHORIZATION (where the applicant is not the owner) c h o."r residing at r a o C...5r 3 5'4-3 s 4- (print owner of property) (mailing address) `A A4, NY folk, do hereby authorize e (Agent) Qa't"k^ala to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's si ) .i 'r f APPLICANT/AGENT/REPRESENTAlWE TRANSACTIONAL DISCLOSURE FORMThe Town of 1 1 rd i nfl' interest 0 the ' ` 1 0 this form is tole[ orination which can ertille town of nossibld conflicts of hte ad allow-it to take i j >l mgn to avoid same. YOUR NAME: E4 . (Last name,fust name,*id a initial,unless you are applying id the name of I someone else or other entity,such as a company.If so,indicate,the other person's or company's name.) j NAME OF APPLICATION: (Check all that apply.) I Tax grievance Building !j variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring i 1 Exemption from plat or official map Planning I, Other ' (if"Other",name the activity.) `1 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,marriage,or business interest."Business interest'means a business, j... including a partnership,in which the town officer or employee has even a partial ownersbip of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. i YES NO ✓ i Ifyou answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold I . Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check i I the appropriate line A)through D)andlor describe in the space provided. [. check all is child that apply): I The town officer or employee or his or her spouse,sibling,parent,or ( � . A)the owner of greater than 5%of the shares of the corporate stock of the applicont ' (when the applicant is a corporation); ! B) in anon-corporate entity(when the the legal or beneficial owner of any interest applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. �j DESCRIPTION OF RELATIONSHIP I . Submitted this _day of ' Z, Signature Print Name Form TS 1 f l f I r PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: M Adreg �a-rtd q Ti��4- QO �X, IO 5fl 5���hc1d i 1 q1 � STATE OF NEW YORK COUNTY OF SUFFOLK Fes- O , residing at V d m ley 54- , being duly sworn, deposes and says that on the 7 day of _, 20L+, deponent mailed a true copy of the Notice set forth in the Board of rustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold'- that said Notices were mailed at the United States Post Office at Center AXIC'If5 ,that said Notices were mailed to a ersons by CERTIFIED MAEURETURN RECEIPT. Sworn to before me this 7 Day of 20 I� _ i Notary Public Lodw Patsio Putilip ofNew York Wo 01 P 1 C 1unty Commission Expires OW7/20 4 John Bredemeyer, President guFFO( Town Hall Annex Michael J. Domino, Vice-President ��°�0 c°oy 54375 Route 25 James F. King ti P.O. Box 1179 Dave Bergen • Southold, NY 11971 Charles J. Sanders y'�o1 ,F �a°� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of EDGARD EL CHAAR COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, Je�rCW LT IRlfar1 IU , residing at/dba 100 H�J)tom E fd. G MDy c her N`I u zl34 being duly sworn, depose and say: That on the day of J U �/ , 2014 I personally posted the roperty known as 3-165 5-h 11 w 0LAC r AVC. Cw.+c�0q UC, N by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,July 23,2014. Dated: 04'�� s' na e Sworn to before me this day of JP� 20 biiw� Notary Public Pan �y P one a8�o Yak Qua County Commission Expires 06107/20f Y NOTICE OF HEARINGI NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold New York concerning s thiro er p p �h .' I Ch mar OWNER(S) OF RECORD. aid SUBJECT OF PUBLIC HEARING: Remove existing storm damaged pier and replace with new 4'x120' fixed pier with the use of thru-flow decking over the wetlands and untreated decking on remainder; a 3'x12' aluminum ramp; and a 6'x20' float. TIME & DATE OF PUBLIC HEARING: ;tolqw-aor 3OPM �3 If you have an interest in this project, you are invited to view the Town file(s) which are available for ins ection rior to the day of the hearing during normal business days between the ours o 8 a.m and 4. p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * 631 765- 1892 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM , PROPERTY LOCATION: s.c.TALS: THE FOLLOWINO ACTIONS MAY REQUIRE THE SUBMISSION OF A I•#o t b? '01 p 1 ST01MMATER,GRADING DRAINAGE AND EROSION CONTROL PLAN 'Disc cern '131oc"Tc— —W— CIIRT� BY A PIWFMBIONAL IN THE STATE OF NEW 70—M i� SCOPE OF WORK - PROPOSED CONSTRUCTIONITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? Will this Project Retain All Storm Water Run-Off (Include Tota)Area of all Parcels located within �rLr -1/0 3>69 Generated by a Two(2')Inch Rainfall on Site? the Scope of Work for Proposed Construction) ___ ❑ f (This item will include all run-off seated by site ✓ � . b. What is the Total Area of Land G (S.F.I Aeras)earing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed 686 p.p 1 y Site Improvements and the permanent creation of construction activity? impervious surfaces.) R I ACM) PROVIDE BRIEF PROJECT DIESCREMON Adawas Nowa/) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion Ota,_ 4.vla �2yel,r u c E y 't� t i�' and sediment control practices that will be used to ✓ ❑ control site erosion and storm water discharges. This t lr-0A., i;hr o r 12A-.8 .t-.,,aa- G'k�a' Item must be maintained throughout the Entire t Construction Period. �loaK"- 4 Will this Project Require any land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? § Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ❑ ✓ (5,000 S.F.)Square Feet of Ground Surface? i 6 Is there a Natural Water Course Running through the Ili Site? Is this Project within the Trustees jurisdiction F General DEC SWPPP Rsauiremerts: or within One Hundred(100')feet of a Wetland or I Submission of a SWPPP is required for all Construction activides involving sol Beach? disturbances of one(i)or more acres;hutiudhV disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to ❑ ./ including Construction activOks involving sol disturbances of fess than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES pemiit is required for storm water discharges. (SWPPP's shall meet the Nnimurn Requirements of the sPOEs General Penrdt 8 Will Driveways,Parking Areas or other Impervious for storm Water Discharges from Construction activity-Permit Na GP-0-i0401.) Surfaces be Sloped to Direct Storm-Water Run-Off � ✓ ! 1.The SWPPP shall be prepared prior to the submillial of the NOT.The NOI shall be Into and/or in the direction of a Town right-of wa)It submitted to the Department prior to the commencement of 00n3huctfon aceft. Will this Project Require the Placement of Material, ( 2.The SWPPP shall describe the erasion and sediment control pracdcsa and where / S regtdred,post-construcion storm water management pred des that will be used and/or Removal of Vegetation and/or the Construction of any ✓ constructed to reduce the polufaMs in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of fhis permit.in addtifon,the SWPPP shall Area?Inas rem wuNOT kwiumA the installation afDriveway Mron@4 1 Won*potential sources of pollution which may reasons*be expected to affect the qualgr of storm water discharges. NOTE: IfAnyt Answerru Quetion aloin One through bete a Answered S.F.with A Chock area, 1 3.All SWPPP9 that requhe the post-construction storm water management PrOadoe a ■cox ander.Grading, Drainage sib&Erosion k between a,00e S. ti i Ace in area, component shell be prepared by a quid Design Professional Licensed in New York a utholdlVa d Grading Submitted o Erosion Comrol Pisa k e of Any by the Tawe of that is knowledgeable in the principles and practices of Storm Water Management Southold and Must be autanetad for Review Prior to issuance of My Bolding Permit (NOTE: A Check Mark(4)and/or Answer kr each Quee6on Is Required for a complete Apgialon) r SPATE OF NEW YORK, /r COUNTY ..............SS 'That I,........... ................................. ... ...................being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual elgning—D 1) I And that he/she is the ................ !..Jl!4rl1............. ............................................................... (Owner,Contractor,Agent,Corporals Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief,and that the work will be performed in the manner set forth in the application filed herewith. Sworn vt4�before me this; ...........•......,,'-.. (� � ...... ... ...d IV�. ,2U.� I , NotaryPublic:. .................................... ............----..... ,/................................... V i .. �Applant) II FORM - 06/10 Yolk Coi* wtai­ !I, Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS IAll applicants for permits* including Town of Southold agenc.ies 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 si ipn f cant 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!'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. listine both suuuortins and non- :_id 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. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM## I3 PROJECT NAME E( G�aar ILe�•cP�.+ce The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 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) ❑ (b). Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: ten owe -•nuyrw�, s�•r v� .�k n+�+?s.�2 (��t.�- de4014 a &-(44 •t•<w N't+a•� �c' to n 6or� h�rc2 PaL , 3�X 1� il�...n{N++nti �rA'►l� �.r.R b'X 70F1•+rr: -P)C2 �"•. '�.u.v� ��rrv�Gl a...� <Ptc lL•.v svciL w c t�,,,..p 5 a•.j11 �.., -art..-�f'� ��IGt,••+f s..� /Lain A-44elL, • i . I Location of action: 3 7 b S s r, it 4 v-c . c.,-tc 6•u Site acreage: Present land use: 4-1 wL Present zoning classification:_ Q c j I 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:_ E4 q a r- 151 Ck,.-*r I. (b) Mailing address:_ i 3 o E-,s r S S a0 '54. x1 c w '4-'Cr, tj Y / oal b (c) Telephone number: Area Code( ) -t l-7 . 1-1`1 - 3 S 6 1 ! (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes R No❑ if yes,which state or federal agency? 4,c s o OS f i 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. Faster 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. [aYes ❑ No ❑ Not Applicable k Pii�ee���aeeS a �ie�- ,,tib Fl•a+ Losr GQ..liti5 4-4e STo�,.. w•►cSL (� 4+e wa7r6 w r�'Li s., t>t S✓.. �+� irr/p6A�/^'�) /"ee✓ 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 1:1 Yes 1:1 No [ Not Applicable i I i Attach additional sheets if necessary Polis 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See Y LWRP Section III—Policies Pages 6 through 7 for evaluation criteria �-� U( I Yes ❑ No❑ Not Applicable Plr�tc-} tt la.•-sis-t'.c��t' ,,.,t�� i✓tcy�tbori�s �r�r�+G!-1' c1 , f • 3 I Attach additional sheets if necessary i NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP I . Section III--Policies Pages 8 through 16 for evaluation criteria ❑ N Yes 1:1No � 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 �— Not Applicable f 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. F] Yes No Not Applicable I,. i, 1 ,ctA writ r.t%Are- I • 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 l substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluatiotp criteria. ❑Yes ❑ No U 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. �Ye� No❑ Not Applicable ------------ �oG ��,.✓ v� �lsQTs Attach additional sheets if necessary i i I 7 I ._ WORKING COAST POLICIES 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 &clic-E �tlowS Fs ft- a�ccSS -!'• w�'tci . •.�, o. . Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic j 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 Q Not Applicable PREPARED BY �_T �w fiN^► a TITLE n—t' DATE s" a o• `y I i June 2, 2014 Town of Southold Trustees LLJUN ,�Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 - 9 2014Southold, New York 11971 RE: 3765 STILLWATER AVE. CUTCHOOUE, NYs""`r'` SCTM No. 1000-137-01-01 rd of Trustees APPLICATION FOR PERMIT Dear Sir/Madam: We hereby submit one original and three (3) copies of the proposed plans, application, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, 0 1 Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 BOARD OF .,RUSTEES TOWN OF S41t DATE PROPOSED OPCKNG TO BE EN--GRATE EPANELS OR EQUAL A � PROPOSED � iAelLONG X n LOT 20 wrrH irPILES i ' o. MPIC eoSIDE) K C— O 1� MOVE EXISTING DAMAGED PIER R FLOAT CO Q 00 . 350 ' (Tax Map) J7127' D Y WIDE T�"'� o o N 56 05 54 E Q 15 _ 1g' 130GRAVEL DRIVEWAYCA 2 Sty. LOT 19 F.Res 23r •� Q R/0 NC. SUPPORTED PROPOSED 2WTH(2)g'/ PILES 6' WIDE FLOATING DOCK Q 1.0'N O.TN 0.6'N J Q 4' .L.F. EDGE OF TIDAL WETLANDS AS IDENTIFIED Q 0.9'S s�/ / TAT [I H _ O BDG- [I MICHAEL K WICKS, L.S. ON 2-25-13 k rp S 57* / '0/ "►/ 8.4�S 9 5 5 3'2.81 ' :rZi JEFFREY PATANJO ON 5-15-14 I � 3.1 �•91F�•. � 1000-137-01-554 \ LAND OF MILDRED DAVID 3825 Stillwater Ave. Cutchogue, _NY 11935 i f]D ,1 U N - 2014 3s° REPRESENTS WATER DEPTH IN INCHES BELOW MEAN LOW WATER 4 iY ii 34:ii ., NOTES: PROPERTY OWNER: 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM EDGARD EL CHAAR Pm sed Dock & Float Permits SCALE: 2. LOT AREA: 16,987 S.F. 0.389 ACRES 130 EAST 35TH STREET NEW YORK, NY 10016 1"=40° 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: PREPARED BY: PROPOSED PLAN DATE: PECONIC LAND SURVEYORS JEFFREY PATANJO 5-20-14 SOUTHOLD, NY 106 HEWITT BOULEVARD SURVEY LATEST DATED JUNE 18, 2001 CENTER ITT BO ES, R 11934 3765 STILLWATER AVENUE 631-484-9332 CUTCHOCUE, TOWN OF SOUTHOLD 4. ALL DECKING USED SHALL BE UN—TREATED SUFFOLK COUNTY, NY SHEET: TAX MAP N0. 1000-137-01-01 1 OF 2 THRU-FLOW DECKING OVER WETLANDS PROPOSED FIXED ELEVATED CATWALK 4' WIDE X 120' LONG ALL GREENHEART TIMBER 120' 45' 4"x4" CCA POSTS 10 OVER WETLAND LIMITS PROPOSED 6"x6" CC POSTS (TYP.) g -- --- - - - PROPOSED 3' WIDE X 12' LONG -- -- - --- -- —ALUMINUM HINDGED RAMP I 6 - - PROPOSED 6' WIDE X 20' LONG GREENHEART FLOATING DOCK --APPROXIMATE- M.H.W. EL. 2.5±-- 2 _ _ --- -- -- - - O EXISTING GRADE APPROXIMATE M.L.W EL. O.Of - - - -- CCA (TOTAL OF 2) ___-_ ___ PROPOSED 8" 0 PILE - t fi- - - - - _. . - 2 -- —4 TYPICAL SECTION LOCEN )1 SCALE: H: 1 =20 V: 1"=2' 36,. REPRESENTS WATER DEPTH IN INCHES BELOW MEAN LOW WATER t� NOTES: 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM ' 2. LOT AREA: 16,987 S.F. / 0.389 ACRES w R� 4D Nassau Poi AN 2014 3. PORTIONS OF PLAN FROM SURVEY PREPARED BY: 0PECONIC LAND SURVEYORS SOUTHOLD, NY SURVEY LATEST DATED JUNE 18, 2001 T 7o r Tru- 0 q� 4. ALL DECKING USED SHALL BE UN-TREATED s _ b PROPERTY OWNER: 4'a EDGARD EL CHAAR Haymter 130 EAST 35TH STREET Proposed Dock & Float Permits SCALE: Cove NEW YORK, NY 10016 AS NOTED - f+ '"1O0dRa PREPARED BY: TYPICAL SECTION & DATE: a JEFFREY PATANJO LOCATION MAP 5-20-14 106 HEWITT BOULEVARD CENTER MORICHES, NY 11934 3765 STILLWATER AVENUE PROJECT LOCATION MAP 631-484-9332 CUTCHOCUE, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: N.T.S. TAX MAP NO. 1000-137-01-01 2 OF 2 \ \ -LINE OF PROJECTION TO NEIGHBORING DOCKS \ AND PARALLEL TO EXISTING SHORELINE 1 `? � ADJACENT DOCK TO NORTH WITH POSSIBLE INSUFFICIENT WATER DEPTH AT LOW TIDE BASED { \ \ ON RECENT BATHYMETRIC SURVEY nC IIA ADJACENT DOCK TO SOUTH APPROVED AT y ` PRIOR TOWN OF SOUTHOLD TRUSTEE HEARING • #3825 STILLWATER AVENUE, CUTCHOGUE « I �. 0 im r. �. cl a ASSUMED LOCATION OF ADJACENT DOCK THAT IS ON SHORELINE AND REMOVED DUE TO STORM OR SEASONAL USE. I ILINE OF PROJECTION TO NEIGHBORING DOCKS AND PARALLEL TO EXISTING SHORELINE � I i I « I x i .. I d'� I «r I