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Home My WebLink AboutTR-4194Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 4194 DATE: .~gne 25, .~993 ISSUED TO ........George..]~r~ ............................. Pursuant fo fha provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the L.aws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACINC= OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a r~eeting held on ~t~e 2.~_ ..... 19 ~ , and in conslderafion of the sum of $ ~:~.00 paid by ........... George Br~!~ of N.Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: To rebuild storm damaged lawn retaining W~LU (approx. 3~ Wall To be ir~ line with neigl~bors big all in accordance with fha detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees kere- by causes ifs Corporate Seal to be affixed, and these presents fo be subscribed by a maiority or__the said~B~°ard as of this dat,e. TRUSTEES John M. Bredemeyer, III, President Albert J. Krupski, Jr., Vice President Henry P. Smith John B. Tuthill William G. Albertson Telephor~e (516) 765-1892 Fax (5~6] 765-~823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 Office Use Only: .DATE REC.: ~oastal Erosion Permit Application ~oastal Erosion Variance Application etland Permit Application ~. ~ ~ ~ ~ ~Waiver from Chapter 97(Application/permit': ~--~rustee Lands P~rmit Application ~ ~nB_ 78 ~andfather Permit A~plication J~ ~ V~C~mpleted Apps..Date~ ~bq2AC Comments-Date: Sent~ Rec. ~ ~ IU~ ut ~u~.,,~ ~ariance Required. (Y/N! ~_~eighbors notified-Date. SEQRA Type ~.~_~_~ Coord.: Date ~ent~ , ----sEQRA Determin./da~e:~/iA ~g~ ~Jo~n ~l~-~s~ ~ublic Hearing/date: ~'-~ ~6a ~-c c2?/~D Findings: Approved (Y/N) (~ Special Conditions: (Y/N) [" (see file) Application ~ee: __Permit(s) issued-date: Application Number;SCTM~1000- ,~- ~/~ Applicant: ~ ~ ~/ Address: ~ ~~_~7 ~ Interest: (owner, Owner of Property: ~ff0f ~J~ ~ consultant,lessee,etc.) Address Phone Subject Property Location: ~mmS" ~VJWd~a~ (Provide LILCO Pole #, Distance to cross Streets if not on ~3 33 location map) THIS IS NOT A PE~IT Page 1 Yds. to be excavated: O Yds. to be filled: Manner in which material will be removed or~ Width of canal, creek or bay fronting property: ~J~ Depth at low tide: ~/~ Aver. rise ~n tide: Distance to nearest channel: ~/-70~ ~;~istance project extends beyond similar projects in area: ~--t~ ~ ~;~.~ Area zoning: ~i~/~ Land area in acres: ~¥ Is project for private or business use: Intended use of property: ~£~ ~,~ Describe known prior operations conducted on premises: Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: ~ Has any license or permit ever been revoked or suspended by a Governmental Agency: Project Description The project description must also include plans for reclamation of land disturbed during construction of the principle and accessory structures and underground structures (i.e., pipeline and septic system; make additional a=tachments if necessary). THIS IS NOT A PERMIT Page 2 Authorization (Where the applicant is not the owner) (Pri~t~owner of subject property) (Mailing address-phone) do hereby authorize ~.~;~/~2 to apply for Coastal Erosion permit(s) from the Southold Town Trustees THIS IS NOT A PERMIT Page · · ~ I P~JECT LD, NUMBER ApRendix C State Environmental Quality Review SHORT E~Vi~ONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only P/~RT I.--~PROJECT INFORMATION (To be completed by Applicant or Proiect sDansor~ SEQ~ 5. iS PROPOSED A~-'T]ON: 7 AMOUNT OF ~ND AFFECTED: 8. WIL PROPOSED ACTION COMPLY WITH ~ISTING ZONING OR OTHER EXISTING ~ND USE RESTRICTIONS? es ~ No If No. describe briefly --9. WHAT IS PRESENT LA~D USE tN VICINITY OF PROJECT? 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY [FEDERAL, STATE 0~ LOCAL)? [] Yes '~]o If yes, list agency(s) and permit/apProvals /- 11. DOES ANy ASPECT OF THE ACTIOt4 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? / I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE the action is in the CODD~al Area, and you are a state agency, complete the Coastsl Assessment Form before proceeding wilh this assessment OVER 1 D. IS THERE. OR I$ THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIA~ ADVERSE ENV RONM[NTAL h', PACTS? FART liI--DETERi'~IINATION OF SIGNIFICANCE [To be completed by Agency) INSTRUCTIONS: For each adverse etfecl identified above, determine whether il is substantial, large, important or other, vise significant, Each ellect should be assessea in connection with ifs (al setting (Lo. uman or rural); (b) probability O~ occurring; (c) duration; (d) irrEvers~bility; (el geographic scope; and (~} magnitude. I~ necessa~, add Attachments or reference supporttng me,tennis, Ensure :hat explanal~ons co~lain sut/icient Oelail to Show that all relevant aoverse impaczs have been /dentition and aaequately aaoresse:. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF anco/or prepare a positive decl~-r3l~on. Check this box it' you have determined, eased on the information and analysis above end any supporting documentation, that ti~e eroeosea action WILL NO'[ result in any stgnifican! a~verse environment, al impactS AND erowoe on a~tacnmen[s as necessary, fhe reasons supporting this determmafiom County of Suffolk ) State 'of New York ) ~"<C~F~~ ~i~J BZ~ DUL~ SWO~ OEPOSSS ~S ~,mT SS/SHE ZS mS ~nZC~ ~o~ ~ ~ow P~IT(S) ~ ~T ~L STAT~S CO~AIN~IN ~E ~UE TO BEST OF HIS/H~ ~OWL~SE ~ BELi~, ~ ~T WO~ WILL BE ~NE IN ~E ~ER SET FOR~ IN ~IS APPLICATION ~AS ~YBE APPRO~D BY ~ SO~O~ TO~ BO~OF ~US~S. ~ ~PLI~T TO~ OF SO--OLD ~ ~ ~ ~U~EES ~ ~ D~GES ~ ~AIMS ~IS~G OR BY;~R~E OF SAID P~T[S), IF G~D. A~L~CATION, I HER~Y AU~RIZE ~ TRUSTEES, SES IN ~NJ~CTI~ WI~R~I~ OF SWORN TO BEFORE METHIS 2~ DAY OF ~ ,19~ NOTARY PUBLIC PALll-INE L. SMITH Notsry Pub;lc, State of N~ Ymk NO. 81-4653734 Suggested space for location Map THIS IS NOT A PERMIT 01 N~3~ £ ~ 3A~qS-NO3 ~0~-~ WdSC :~T ~66I-E0-~0 TRUSTEES John M. Bredemeyer. ITl, President Alber~ .L Krupski. Jr., Vice Pres/cleat Henry P. Smith John B. TutMll %qlliara G. Alb~nsen 'l%lephone C516) 765-i892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 y.ear Maintenance Agreement Erosion Protectibn' structures Chapter 37 SouthOl~ Town. Code Southold Trustees as Aclministrav_or SUPERVISOR SCOTT L. HARRIS ~wn Hall 53095 Main Road Re. Box 1179 Southoid. New York 1197] #1000~ in applying for a coastal Erosion permit for an Erosion Protection Structure do hereby agree to a 30 ~ear maiptenance program for a structure commonly k~.own as a (&~ %"LAT~,I~ of ~O as shown on the attached feet of length licensed survey of t_he as-built structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and or equivalent to the original approved structure and that for any maintenance which involves more than 5% in length of this structure we are ~o give prior written notice to the administrator, welting for their approval in ail but true emergency situatioN's which would seriously endanger life, property and important coastal naturalresource features such as bluffs or wetlands. We further, understand that failure to maintain the structure could result in a requirement ~o post a bond and or have the repairs ordered as a lien a~ainst the property upon a fln~tng by the Trustees that said lack of maintenance would risk life, property or i~portant ~atural resources features including protected, rare or threatened animals and plants. Notarize~n~ture of owner of record SWORN TO BEFORE ME THIS ~- DAY OF agreement s~ll only be valid upon the final approval of the a~inistrator. S~se~ent ~ners may apply to the Scuthoid To~ Trustees to re-authorize t~s mainten~ce agreement. STATE Of NEW York DEPARTMENT Of STATE: ALBANY. NY ,TOWN OF SOUTHO/D July 18, 1995 Mr. Kenneth Homan Braun Oyster Company, Inc. Box 971 Cutchogue, NY 11935 Dear Mr. Homan: Re: F-95-270 U.S. Army Corps of Engineers/New York District Permit Application #95-04280-L2 and U.S. Coast Guard Permit Application Braun Oyster Company, Inc. Town of Southold, Suffolk County The Department of State has completed its evaluat/on of your Federal Consistency Assessment Form and certification that the above proposed permit activity compl/es with New York State's approved Coastal Management Program. and will be conducted/n a manner cons/stent with th/s program. Pursuant to 15 CFR Section 930.63, and based upon the project information submitted, the Department of State concurs with your consistency certification. This concurrence is without prejudice to, and does not obviate the need to obtain all other applicable licenses, permits, and approvals required under existing State statutes. The U.S. Army Corps of Engineers is being notified of this decision by copy of this letter. Sincerely, C_~orge R. Stafford / /} Director Division of Coastal Resources and Waterfront Revitalization GRS/DM/jtb cc: COE/New York District - Douglas Price Coast Guard - Bill Smith DEC/Reg/on 1 - Robert Greene NYS OGS - Alan Bauder Town of Southold - Albert Krupski New York State Department of Environmental Conservation Building 40--SUNY, Stony Brook, New York 11790-2356 TOWN OF SOUTHOLD Notice Thomas C. Jorling Commissioner As required by law, the Department of Environmental Conservation is hereby providing you with notice of an alleged violation of the Environmental Conservation Law which occurred within your municipality. THIS NOTICE DOES NOT REOUIRE ANY RESPONSE OR ACTION BY YOU. Please be advised that the Department has sufficient evidence to commence an enforcement action against '~c3~ P~,5~- ~ ~e~f. ~,~. for a violation of Article(s) 25 and/or 15 of the Environmental Conservation Law of the State Of New York. NOTICE PROVIDED TO: Nanle: The Honorable Albert KruDski, Jr. Address: President, Board of Trustees Town Hall P.O. Box 1179 NY Southold, NOTICE PROVIDED BY: Na/ne ~ Title: Date: 11971-0959 Louis A. Chiarella Regional Manager - Bureau of Marine Habitat Protection Building 40 - SUNY, Stony Brook. New York 11790-235~' ~J~t~ '"'" - ~ Phone (516] 444-0295 ~ F,,x # 444-034s TOWN OF SOUTHOLDI Notice of Violation July 29, 1994 Langdon Marsh Commissioner Mr. Richard Mautner 60LenoxAvenue Lynbrook. NY 11563 Mr. George Braun 7 Huron Rd. Betlerose Village, NY 1100t Date of Violation: on or before July 29, 1994 Location of Violation:2005 Bayshore Rd., Southold Permit # (if applicable) Tax MaplD# 1000-53-4-11&12 Dear Mr. Brann: Records of this Department indicate that you are in violation of the Environmental Conservation Law (ECL): Article 15. Protection of Waters Section 6NYCRR Article 15, Wild, Scenic and Recreational Rivers Act Section 6NYCRR Article 23, Mined Land Reclamation Law Section 6NYCRR Article 24, Freshwater Wetlands Act Section 6NYCRR Article 25, Tidal Wetlands Act Section 25-0401.1 6NYCRR Part 661 Article 19, Air Pollution Control Act (Restricted Burning) Section 6NYCRR In that you caused, or permitted to be caused: construction of approximately 100' of rail road tie retaining wall in the area adjacent ro a regulated tidal wetland without the necessary NYSDEC permit. Contravention of this/these Article(s) of the ECL is a violation and/or a misdemeanor punishable by a fine of no more than/a day. Penalties may be assessed for each day that the violation continues. Please be further advised that violations of the ECL which are not resolved may be the subject of an admiulstrative hearing pursuant ~o Tide 6 of the Official Compilation of Codes, Rules & Regulations of the State of New York (6NYCRR, Part 622). You are hereby advised to cease your operation at the referenced location immediately. Please contact the following office within thirty (30) days of receipt, of this letter, so that we may attempt to re~olve this matter. Failure to contact this office within this time period will result in this matter being referred to the Department's Regional Attorney for further enforcement action. To schedule an appointment for a compliance conferer~e in this matter, please contact Ms. Kay Worker at (516) ~A...-0295. Office of Legal Affairs Attn: Gail Hintz Assistant Regional Attorney Regional Attorney Dr. Christopher S. Mallery, ACOE Very truly yours, Charles T. Hamilton Regional Supervisor of Natural Resources Stony Brook ECO Enright CerfifiedMail# f' Oa? ~-~ 7/~ ?/~ NOV//94LC132 TRUSTEES John M. Bredemeyer. HI. President Albert J. ICmpski, Jrt, Vice President Henry P. Smith John B. Tuthill William G. Albertson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 June 30, 1993 George Braun 2005 Bayshore Road Greenport, NY 11944 Re: SCTM ~1000-53-4-11 Dear Mr. Braun: The following action was taken by the-Board of Town Trustees during its regular meeting held on Thursday, June 24, 1993 regarding the above matter: WHEREAS, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated April 7, 1993 and, WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a public hearing was held by the Town Trustees with respect to said application on Thursday, June 24, 1993 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in q~lestion and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW, THEREFORE BE IT RESOLVED that the Board of Trustees approves the application of George Braun to rebuild storm damaged lawn retaining wall ('approx. 3' high). Wall to be in line with neighbors. Permit will expire two years from the date it is signed. Fees must be paid, if applicable~ and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Permit will be issued upon payment of be done below Mean High Water Mark: the following fees for work to TRUSTEES John M. Bredemeyer. III. President Albert J. Krupski. Jr.. Vice President Henry R Smith John B. Tuthill William G. Albenson Telephone (516' 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-53-4-11 Chapt. 97 - Wetlands NAME: George Braun Chapt. 37 - Coastal Erosion DATE: May 26, 1993 RESOLVED that pursuant to Article 8 of the Environmental Conservation Law, State Environmental Quality Review and 6NYCRR Part 617, Section 617.10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. TYPE OF ACTION: Type DESCRIPTION OF ACTION: Applicant proposes to rebuild storm damaged lawn retaining wall (approx. 3' high) and move this wall to be in line with contiguous walls (approx. 6' out). Located 2005 Bayshore Road, Greenport. LOCATION: SCTM ~1000-53-4-11 REASONS SUPPORTING THIS DETERMINATION: i. Anon site inspection has been conducted by the Board of Trustees. 2. An environmental assessment, submitted by the applicant and reviewed and completed by the Board of Trustees, has indicated that no significant adverse effects to the environment are likely to occur should the following mitigation measures be implemented. cc: CAC Telephone (516) 765-1801 TO: FROM: DATED: RE: SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL Southold Town Board of Trustees Southold Town Conservation Advisory Council May 24, 1993 Recommendation of Applications Town Hall. 58095 Main Ro~d P.O. Box 1179 Southold. New York 11971 1993 TOWN ,OF SOUTHOLD. At the May 20th 1993 meeting of the ~outhold Town Conservation Advisory Council. the follow recommendations were made: Moved by Bruce Loucka, seconded by Betty Wells, it was RESOLVED to recommend to the Southold Town Trustees APPROVAL of Wetland Application of GEORGE BRAUN 53-4-11 {o rebuild storm damaged lawn retaining wall (approximately 3' high) and move the wall approximately 6' out to be in line with neighboring property walls. 2005 Bayshore Road, Greenport. Vote of Council: Ayes: All Motion carried. Moved by Bruce Loucka, seconded by Betty Wells, it was RESOLVED to reco.m, mend to the Southold Town Trustees APPROVAL of Wetland Applicatmn of RICHARD MAUTER 53~4-12 to rebuild storm damaged lawn retaining wall (approximately 3' high) and move wall to match existing wall of adjacent neighbors. 2055 Bayshore Road, Green port Vote of Council: Ayes: All Motion carried. Moved by John Holzapfel. seconded by Bruce Loucka. it was RESOLVED to recommend to the Southold Town Trustees APPROVAL of the Wetland Application of NUNAKOMA WATERS ASSOCIATIONS. INC. 87-2-[t0.1 ~; 40.2 to construct a timber retaining wall 170 +/- I.f. overall [including returns) generally at or above line of apparent high water and backfill with 170 +/- c,y. of clean sand to be trucked in from upland source. Wall is necessary to prevent TRUSTEES John M. Bredemeyer, III. President Albert J. Krupski. Jr.. Vice Presidem Henry P. Smith John B. Tuthill William G. Albenson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 May 10, 1993 Mr. John Holzaphel, Chairman Southold Town Conservation Advisory Council Southold Town Hall Main Road Southold, NY 11971 Dear Mr. Holzaphel: Transmitted herewith are the permits: · ~George Braun Dick Mautner Nunnakoma Waters Assoc. John Doroski Cleaves Pt Village Frances McLaughlin William Edgett Sheldon Salzman Arthur Toan Strongs Marina Sandra Zatarian following applications for a wetland 53-4-11 53-4-12 87-2-40.1 &40.2 34-1-3 38-7-4.2,8 94-1-3 115-12-3 71-1-5 52-2-22 122-9-6.2 31-16-8 Please prepare a written report of findings and recommendations with respect to this application. Very truly yours, John M. Bredemeyer, III President, Board of Trustees 3MB: jmd Whipple Pi .............. M 50 White Bi'ch Dr ........ L White Pirie Rd ......... M 48 Wh~tehorse Tpk ...... 0 46 Wh~ney La .............. P 46 New York State Department 'of Environmental Conservation RE: LEAD AGENCY COORDINATION REQUEST The ourpose of this reauest is to determine under Article 8 (State Environ- mehtal Quality Review - SEQR) of the Environmental Conservation Law ano 6 NYCRR Part 617 the following: t, Your agency's in:eres~ in acting as lead agency; 2. Your agency's jurisdiction in the action described below; and 3. Issues of concern which your agency believes should be evaluated. Enclosed is a copy of ~ne permit application and a comoleted Part 1 of the Environmeqtal Assessment Form to assist you in resoonding. Project Name: Project Location:~ DEC Project Number: DEC =evmS~s: SEQR Classification: [ ]~e I [ ] unlisted DEC Contact Person: DEC Position: [] DEC qas no objection to your'agency or another agency assuming lead agency sta%us for this action, but reserves ~ne right to comment on this action if a oositive oetermination of significance is made -2- .;~' EC has no objection co your agency or anothe" agency assuming lead agency status for this action, but we have the following concerns regarding this project (see "comments" below). [ ] DEC wishes to assume lead agency status for this action. - ] The proposeo action has been identified by DEC as occurring wholly or - o~rtially within or substantially contiguous to a critical environmental area (CEA) that was designated by It is the position of this Department that your agency, if it has a juris- diction over the action, should assume the lead agency role based on the existence of the CEA and the fact that the anti'cipated impacts are primarily of local significance.- [ ] O~ner. (See comments below) Comments (Optional): Response: Please respono to this reoues~ within 30 oays of the date of this letter. If no response is received within 30 days, we will assume that you have no objection to DEC or another agency assuming the role of lead agency, aha have no comments to offer regarding ~ne ~roposeo action at this time. If neither your agency nor any other involved agency, including DEC, has indicated a will- ingness to serve as lead agency within 30 days of this letter: We will petition the Commissioner of DEC to designate a lead agency for this action. [ ] We will petition one Commissioner of DEC to designate your agency as lead, oresuming you have jurisdiction. Please feel discussion. Enclosures free to contact this offic~/~or//further information or Sin~_~ cc: (see distribution list) JOINT APPLtC/~tON FOR PERMIT ' $ T T [] For the disturbance of a_~ST~,~_~ ~BED OR BANKS or excav~itJon ,, [~] ARTtCLE 15, TITI~E iS ~6N~OY ~WATER SUPPLY) ' [ ~A"~CLY ~5. ~]TLE ~ 6~C~ ~6~ILD. S~ENIC AND R~CREATI( ~ARTICLE 24 6~CRR 662 663 FFRESH~A~ER WETLANDS) ~ ~ARTICLE 25 6N~RR 661 [Ti~ ~ET~NDS) ......................... z~z ............................... or fiI[ of NAVIGABLE WATERS. [~401 WATER QUALITY CERTIFICATION qYCRR 602 (LONG iSLAND WELL} [LE 34 6NYCRR 50~ [CC~A~TAL EROSi6N] ' [] SECTION 10 (RIVER AN? HARBC~ ACT OF 18991 for sLructures and, ~iin ~a~igable ~'al~rs of the U.S. [~]COASTAL CONSISTENCY CERTI~ATION. ~SECTION ~ {CLE~ WATER ACT OF 1977l for di~sal of dredged LIST P~EVIOUS PERMIT/A~LI~Y~ON~MBERS AND DATES {lf ~ny]. APPLICANT IS A~AN ~ner ~Operator ~Lessee ~Munidpality/Governme~tal Agen~ ~Check as many as apply) NAME OF ~O~ner ~AgengContact Person (Check ~Y~s ~O ' Sh ..... k'on mag and/or drawings. ~: ~ I ~Yes ~No PROPOSED USE ~ Public g C~mercial 3}g~ J ~/~ . S Enclos~ ' ~x WILL THI5 PROI~T REQUIRE ADD[TI~NAE FEDERAL STATE AND/OR LOCAL PER~I~} ~ Ye¢ ~ No I~ yes please list' PERMIT ADMINISTRATOR State Environmental Quality Review lT ~'~ / /, FULL ENVIRONMENTAL ASSESSMENT FOR~~ Purpose: The full EAF is designed to help appJicants and agencies determine, in an orderly manner, whether a pr~ or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- [y, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may be technically expert in environmental analysis. In addition many who have know[edge in one 3articular area may not be aware of the broader concerns affecting the ouestion of significance. The full EAF is intended to provide a method whereby appbcants and agencies can be assured that the determination process has been orderJy, comprehensive in nature, yet flexible to allow introduction of information to fit a project or action. Full EAF Components: The.full FAF is comprised of three oarts: Part 1: Provides objective data and information about a given project and its site. Bv identifying basic project data. it assists a reviewer in the analysis that takes place in Parts 2 and 3 Part 2: Focuses on identifying the range of possible impacts that may occur from a prolect or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether K is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: f any ~mpact in Part 2 is identified as ~otentially-[arge, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE--Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: [] Part 1 [] Part 2 []Part 3 Upon review of the information recorded on this EAF [Parts 1 and 2 and 3 if appropriate), and any other suppor[ing information, and considering both the magitude and importance of each impact, it is reasonab|v determined by the lead agency that: [] A. The project will not result in any large and important impact(s) and, [herefore, is one which wilt have a ~ignificant impact on the environment, [herefore a negative declarati(m wi~ fee prepared. [] B Although the proiect could have a sigmificant effect on the environment, there w~ll not ~e a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been reouired, therefore a CONDITIONED negative declaration will be prepared.* [] C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive ~eclaration will be prepared. ' A Conditioned Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agencv 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) Date 1