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NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC APPLICATION NUMBER
DIVISION OF SOLID WASTE II
APPLICATION FOR A SOLID WASTE•MANAGEMENT FACILITY FACILITYCODE
PERMIT
Please read all instructions before completing this application
Please TYPE or PRINT ctearly
1. TYPE OF APPLICATION (Check All Applicable Boxes):
2. APPLICANT IS THE.
® Permit to Construct ❑ Initial (New) ❑ Renewal
® Facility Owner
❑ Permit to Operate ❑ Subsequent Stage (New) ❑ Modification
® Facility Operator
3. FACILITY OWNER'S NAME
4. FACILITY OPERATOR'S NAME
5. ENGINEER'S NAME AND P.E. LICENSE NO.
TOWN OF SOUTHOLD
TOWN OF SOUTHOLD
GEORGE
Address
Address
Firm Nam@ PE #NY -062442
53095 MAIN ROAD
53095 MAIN ROAD
City
City
Addroas
SOUTHOLD
SOUTHOLD
1;7q BRI71AD 11011019 ROAD
StateMp Code
Staliwzlp Code
CitylStatef<Ip Code
NEW YORK 11791
Telephone Number
Telephone Number
Telephone Number
( 631 ) 765-1800
( 631 ) 765-1800
( 631 ) 756-8000
FACILITY NAME AND LOCATION (Attach USGS Topo Map showing exact location)
7. SITE OWNER'S NAME
Name YARD WASTE COMPOSTING FACILITY
TOWN OF soUTHoT.n
Street
Address
COUNTY ROAD 48
53Q95.MATN ROAD
City, State, zip Code
City
CUTCHOGUE NEW YORK 11935
Town County
Stateop Code
SOUTHOLD SUFFOLK
Coordinates
Telephone
NYTM—•E 2,413.325 NYTM--N
( )
8. TYPE OF FACILITY (Cheep all appilcable boxes)
g. IS APPLICATION BEING FILED BY OR
10. FEE AMOUNT
❑ Landfill (Specify category)
ON BEHALF OF A MUNICIPALITY?
ENCLOSED
❑ Research, Development and Demonstration
CRYes ❑ No If yes, name.
❑ Land Application ❑ Transfer Station
❑ Solid Waste Incineration ❑ Medical Wast,
TOWN OF SOUTHOLD
$
❑ Refuse Derived Fu,l Processing ❑ West@ Tire Storage
11. NAME(S) OF ALL MUNICIPALITIES SERVED
® Composting ❑l.artdflif Gas Recovery
SOUTHOLD & HUNTINGTON
❑ Recyclables Handling and Recovery ❑ Waste Oil
❑ Other (Describe)
12 SOLID WASTE HANDLED
13. PROVIDE THE FOLLOWING INFORMATION WHERE APPLICABLE
a. Llai wastes to be accepted YARD WASTE
s. Facility area proposed In the application 17.2 acres
INCLUDING LEAVES, BRUSH WOOD CHIPS
L
17.2
D. Facility area ultimately planned acres
GRASS
15
c. Ultimate facility height above existing ground level feet
17.2
d. Total site area acres
b. Quantity (Specify Units)
Existing "approved design capacity"
Proposed "approved design capacity" 150 r 000 YD
e. Existing landfill area on this site and adjacent properties acres
14. IS A VARIANCE REQUESTED FROM ANY PROVISION OF 0 NYCRR PART 3607
❑ Yes ® No If yes, cite the specific provision(s)
I 15. CERTIFICATION:
I hereby affirm under penalty of perjury that Information provided on this form and attached statements and exhibits was prepared by me or
under my supervision and direction and Is true to the best of my knowledge and belief, and that I have the authority or am authorized as
SUPERVISOR (title) of TOWN OF gnrTTw1T.n (Entity)
I to sign this application pursuant to 6 NYCRR Part 360. 1 am aware that any raise statement made herein is punishable as a Class A misdemeanor
pursuant to Section 210.45 of the Penal Law.
�
1
' i I ` •,� / — o f a�A' , JEAN W. CocHRAN
Date Signature Print Name
REGIONAL DRA COPY