Loading...
HomeMy WebLinkAboutTR-4258Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~ '~'~'"'~"' DATE: ...]~2./6~9~ ISSUED TO DAVID FRENGH ul'horizalion Pursuant to the provisions of Chap)er 6t5 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of )he State of New York 1952: and the Sou)hold Town Ordinance an- titled "REGULATING AND THE PLACING 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 ResoluHon of The Board adopted at a meeting held on .12/6/9:t. 19 9~.., and in consideration of the sum of $ 200.00 paid by ~ o s ~ell o. M ar)ne_.., f~r. DAVID. ~ R E ~ q.~ of .... Qrie~% N.Y. and subject to )he Terms and Conditions Jisted on the reverse side hereof, of Sou)hold Town Trustees authorizes and permits the following: To construct 4' X 100' of fixed timber dock and (4) 2-pile dolphins. Orient Harbor all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate S.e. al to be affixed and these-presents to be subscribed by a maiorffy of the said Board as of this dat,e. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO B6~2r8 DATE: . .Jan, 28, 1993 ISSUED TO .............. Da.~i~t ,Fr,e.~ch ....................... - Pursuant '+o +he provisions of Chapter 615 of'the Laws of the S~afe of New York, 1893~ and Chap+er 404 of +he Laws of S+afe of New York 1952; and the So~+hold Town Ordinance en- titled "RE~U~TIN~ AND THE PLACIN~ OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:" and ~n acCordance with the Resolution of The Board eaop+ed a+ a meeting held on 19 93., and in consideration o{ the sum of $ e~em~ paid by of N.Y. ~nd subi~+ +o the Terms and Conditions lis~ed on the reverse side hereof, of Sou~hold Town Trustees au+horlzes and permits the following: all in accordance wi~'h the detailed specifica')ions as presented in +he originating application. IN WITNESS WHEREOF, The said Board of Trustees h~ere- by causes its Corporate. Seal to be affixed, and these presents to be subscribed by a malority of the said Board as of this dat,e. ,, TRUSTE~ES ~ SUPERVISOR John M. Bredemeyer, IH, President SCOTT L. HARRIS Albert J. Kmpski, Jr.. Vice President Henry P. Smith %~ll~-~.ll Town Hall John B. Tuthill 53095 Main Road William G. Albenson '~ .,p,d~li P.O. Box 1179 Telephone (516) 765-1892 ~:~ Southold. New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMEbF~ PERMIT Permit Number: 26-2-8 Name of Applicant/Agent: Costelio Marine Contracting Name of Permittee: DAVID FRENCH Address of Permittee: 196 Willow Terrace Lane, Orient Property Located: Same DESCRIPTION OF ACTIVITY: To construct a 4' X 100' of fixed timber dock and (4) 2-pile dolphins. Date of permit issuance: December 6, 1993 This permit is valid for a period of two years from the date of issuance. SPECIAL CONDITIONS: NA Bluff restoration through a re-vegetation agreement is attached hereto and is a necessary special condition of this permit. NA A relocation agreemen~ is attached hereto and is a necessary special condition of this permit. xxx A maintenance agreement is attached hereto and is a necessary special cOndition cf this permit. John M. Bredemeyer, III President, Board of Trustees JMB:jmd cc: Building Dept. Attachments TRUSTEES ~ SUPERVISOR John M. Bredemeyer, III. President SCOTT L. HARRIS Albert J. Krupski. Jr.. Vice Presidem Henry P. Smith Town Hall John B. Tuthill ~, ~ ,~_~ 53095 Main Road William G. Albertson ~kL,~?~ P.O. Box 1_179 Southold. New York 11971 Telephone (516~ 765-1892 Fax (516~ 765-1823 B OARD~OF TOWN TRUSTEES TOWN OF SOUTHOLD S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000- 26-2-8 Chapt. 97 - Wetlands NAME: David French Chapt. 37 Coastal Erosion DATE: October 29, 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 II DESCRIPTION OF ACTION: Costello Marine on behalf of David Frence request permit to construct 4' X 100' fixed timber dock and (4) 2-pile dolphins. Located Willow Terrace Lane, Orient. LQCATION:SCTM ~1000-26-2-8 REASONS SUPPORTING THIS DETERMINATION: i. An on 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 project be implemented as planned. cc: CAC Motion carried. ~loved by Bruce Loucka. seconded by Robert Keith. it was RESOLVED to recommend to the Southold of Trustees APPROVAL of the Wetland ApE install a 4' x 100' fixed timber dock and four 2-pile dolphins. 196 Willow Terrace Lane. Orient Vote of Council: Ayes: Bruce Loucka. Robert Keith. John Holzapfel, Patricia Isaksen. John Hagerty. Betty Wells Nays: Stephen Angell Motion carried. ~]oved by Robert Kelth. seconded by Patrlcia lsaksen, it was RESOLVED to recommend to the ~outhold Town Board of Trustees APPROVAL of the Wetland Applicati6n of BRUCE AND BARBARA BEANY 103-3-5.1 to replace It'. x 30' fixed timber dock. 30" x 14' ramp. 6' x 20' float docl~' w|l~h pipe support pilings, 1750 Beebe Drive. Cutchogue Vote~of Council: Ayes: All Motion carried. Moved by Robert Keith. seconded by Patricia Isaksen, it was RESOLVED to recommend to [he Southold Town Board of Trustees APPROVAL of the Wetland Application of JOHN J. CONFORTI 107-7-5 to obtain a permit for an existing floating dock [5' x 70') with 3' x 16' ramp. 1935 Westview Drive. Mattituck Vote of Council: Ayes: All Motion carried, TRUSTF_J~S ~q~ SUPERVISOR John M. Bredemeyer. III. President ~," SCOTT L. HARRIS Albert J. Krupski, Jr.. Vice President Town Hall Henry E Smith ~ John B. Tuthill ~ 53095 Main Road William G. Albertson ~ EO. Box 1179 Southold. New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 8, 1993 Costello Marine Contracting P.O. Box 2124 Greenport NY 11944 Re: DAVID FRENCH SCTM ~26-2-8 Dear Sue, The following action was taken bythe Board of Town Trustees during its regular meeting held on December 6, 1993 regarding the above matter: WHEREAS, Costello Marine Contracting on behalf of DAVID FRENCH applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated October 15, 1993, and, WHEREAS, said application was referred to the Southold To%rn 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 Monday, Decen%ber 6, 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 question 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 DAVID FRENCH to construct 4' X 100' of fixed timber dock and (4) 2-pile dolphins. Permit will expire two years from the date it is sighed. Fees must be paid, if appticablef and permit issued within six months of the da%e 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 the following fees for work to be done below Mean High Water Mark: Fees: ~o~,: ~'~ 90'~ ~0 s,~. ~ ~.oo = ~0~60. oo ~ John ~. Bredemeyer III President, Board of Trustees JMB/d3 h cc. CAC TRUSTEES t John M. Bredemeyer, III, President SUPERVISOR Henry P. Srrfith, Vice President SCOTT L. HARRIS Albert J. Krupsld, Jr. lohn L. Bednoski, Jr. Town Hall lohn B. Tuttfill 53095 Main Road P.O. Box 1179 Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971 Fax (5161 765-1823 TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION W Office Use Only: ~ ~ Coastal Erosion Pe.rmit. Application D[r~ etland Permit Application J~ ~Trustee Lands Per~it Application ~ ~Grandfather ~A JU Completed Apps. Date: f ~ A Variance Required, J~ ~' ~0~!;~'O~t~ ~ Neighbors notified Date: ~ - SEQRA ~e Insp. comp. /date : -~ SEQRA Determin./date: Public Hearing/date: Permit Vote: (Y/N): Special Conditions: { also see file) [ Ap~ication Fcc: Application N~ber; SC~4 ~lOOe- 0 ~ ~- 002~ Project N~e (If any) /~,~ .~ /~ ~/~o/~ Address: ~ ~ /7? /~.~Ff~/~ ~ ~ /0 7~ Phon.e (f/~) 3~7 7/7/ Interest: (owner, consultan[,lessee,erc.) Owner of Property: D~ / / /~ . Address Phone ( ) / Subject p~oCerty Location: ~4 / ~/ ~C// ~/ {Provide LILCO Pole ~, Distance no cross Streets if not on location map) THIS IS NOT A PE~IT Yds. to be excavated: Yds. to be filled: Manner in which material will be removed or deposited: Width of canal, creek or bay fronting property: Depth at low tide: Aver. rise in tide: Distance to nearest channel: Distance project extends beyond silica( projects in area: Area zoning: ~~ Land area in acres: Is project for private or business use: ~ ~ Intended use of property: ~f~£ Describe known prier operations conducted qn premzses: Has any prior license or permit been issued to erec~ structures, dredge, or deposit fill on said premises: Has any license or permz~ ever been revoked or suspended by a Governmental Agency: Project Description The project description musm also include plans for reclamation of land disturbed during construction of the principle and accessory snruc~ures and underground s~ructures (i.e., pipeline and septic system; make additional attachments if necessary). Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address7phone) do hereby authorize to apply for 1 Ero~ion~ermit(z~) from the Sounhold Town Trustees Signature THIS IS NOT A PERMIT · '. I P~[OJECT I.D. NUMBBR 617.~ SEQ R I Appendix C State Environmental Quality RevieW '-- SHORT ENVIRONMENTAL ASSESSMENT FORM '"-- For UNLISTED ACTIONS On y PART I--PROJECT INFORMATION ~o be completed by ADrHicant or Project sDonsorl L. ,c ,o 4 I .FRO EOT.AME /ooo- o Z[- oo ~ -oo~ O New ~ Expansion 0 Modiflcation/aReration ~ ~ep ~; 7. AMOUNT OF NO AFFECTED: WHA IS PRESENT LAND USE IN VICINITY OF PROJECT? Bes:dential [] !ndu~tr,al [] Commercial [] Agr,culture [] pafklForesIlOgen s~ace [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY FEDERAL, ,, jOCJt% h"~'~ CJ I $. DOES ANY ASPECT OF THE ACTIOt4 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No I! '/es. list ,~gency name and 2erm~tlaooroval 12. {~Yes ~]No AS A RESULT ~3F~BOPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? I CEDTiFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE \~1 Signature: ' / If the actJon is in the CoaBtal Area, andyouarea state agency, comp,e,ethe I Coastal Assessment Form before proceeding with this assessment OVER 1 [] Yes ~No - ' ' O. IS THERE, OR I[~TH~TH 'RE _ KELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENV RONMENTAL ] PACTS? PART III--D~ERMINATION OF SIGNIFICANCE ¢o be completed by Agency) INSTRUCTIO~iS: For each adverse effect identified above, determine wqether it is substantial, large, impo~ant or Other~vlse significant. Each elfec! should De assessed m connectmn with its ia) setting tee. ardan or rural): (b) prooabddy Ot occurring; lc) ddrafion: rd) irr6vers~bHif¥; re} §cograohm scope; and if) magmtude. It necessary', add attachments or reference supporting materlals. Ensure that explanations commn sufficient detad to show that all relevant adverse impacts have Been idemil'ied and adequately addressed. [] Check this box if you have identii~[ed one or more cotentialJy large or significant aoverse irepacts which occur· Then proceeo directly fo fne FULL EAF anoror prepare a positive declaration· [] Check this box if you have determined, based on thc information ann analysis above and any supporting documantaNon, that the urooosed action WILL tJOT result ~n any significant adverse envlronmentat impacts AND prowoe on attachments as necessary, the reasons supporting this determination; County of Suffolk ) State of New York ) BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN' THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(s) OR REPRESENTATIVE(s)~ TO ENTER ONTO .MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~ S I GNATURE JO¥CE M. WILKINS Notary Pubfic, State of New York No. 495'246, Suffolk Cou nj(y_ Term ExpimsJune 12, 19_'.'.'.'.'.'.'.'~3 Suggested space for location Map THIS IS NOT A PERMIT TRUSTEES i SUPERVISOR John M. Bredemeyer. III. President SCOTT L. HARRIS Albert J. Krupsld. Jr.. Vice President Henry P. Smith Town Hall John B. Tuthill 53095 Main Road W'flliam G. Albenson P.O. Box 1179 Southold. New York 11971 Telephone .(516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 year Maintenance Agreement Erosion Protection Structures Chapter 37 Southotd Town Code Southold Trustees as Administrator I (we) type or print name(s) the owners of record of property at: (type or print street address) SCTM ~1000- in applying for a Coastal Erosion permit for an Erosion Protection Structure do hereby agree to a 30 year maintenance program for a structure cormuonly known as a ~]~ of ~Y as shown on the attached feet of length licensed survey of the 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 structur~ and that for any maintenance which involves more than 5% in length of this structure we are to give prior written notice to the administrator, waiting for their approval in all but true emergency situation's which would seriously endanger life, property and important coastal natural resource features such as bluffs or wetlands. We further understand that failure to maintain ~he structure could result in a requirement to post a bond and or have the repairs ordered as a lien against the property upon a finding by the Trustees that said lack of maintenance would risk life, property or important natural resources features including protected, rare or threatened animals and plants. Notarized Siqna~ture of ow~m~ of record sw0 To SS OaZ ME VAZ Or ~A~Y PUBLIC No. 4952246, Suffo~ Court_ Please submit three cop~es of a licensed land survey made within one year of the original construction. This maintenance agreement shall only be valid upon the final approval of the administrator. Subsequent owners may~ apply to the Southold Town Trustees to re-authorize this maintenance agreement. TRUSTEES ~ Jolm M. Bredemeyer, III, President ~ SUPERVISOR Hem-y P. Smitl~, Vice President SCOTt L. HARRIS Albert J. Krupski, Jr. John L Bednoski, Jr. Town Hall loire B. Tuthill 53095 Main Road P.O. Box 1179 Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Souhhold, New York 11971 Fax (516) 765-1823 ToWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS P~T APPLICATION TRusTEE 'LA~DS PERMIT APPLICATION Office > Use Only: ;tal Erosion Permit Appli6a~tion ~C~ ~ ,~ Land Permit :ApPtica~i6n. '~i0!~ ~ '~ --~rustee Lands Per~t ~pplication . H ~ >le d s. ate: ~3~ ~Q ub~ .te App D [~ ~ ~ ~ ~ Required, ance Ca mand. Da~e Rec. bv Office SEQ~ Dekermin,}/da~e: ~- 0~ D V/e3 ~ --Public Hearing/date: Findings: 7OCT I 5 ] Permit Yoke:: (Y/N): Special Cond~kions: (also see ~ile) Ap311eat~on Fee: Application Number; SC~5 ~1000- O~=-O~- Project Name (If any) ~AVID L. Date Prepared: IO/l{/C/,_3 Phone (s/~)~7~ //~ Interest: (owner, consultant,lessee,etc.) ~ ~ner of Proper%y: 5~) ID k. ~ub ect Phone j Property Location: ~,D ,~0% (Provide LILCO Pole ~, Distance to cross Streets if not on location map) ~IS IS NOT A PE~IT / Yds. to be excavated: ;{//4 Yds. to be fille.d: ~//~ Manner in which material Hill be-removed or deposited: /, Width of canal, creek or bay fronting property: io~of~- Depth at low tide: Aver. rise in tide: Distance to nearest channel: /~/~ Distance project extends beyond similar projects in,rea: Area zoning: '~ESlD~'r, JTIAL Land area in acres: Is project for private or business use: Intended use of property: E~I~T I~ 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: ~5 ~ ~uh<~F~Ah Has any lic se or permit e'ver been revoked or suspended by a Governmental Agency: ~ o Project Description The project description must also include plans for reclamation of !~d_.~k~.~r~.d_&ur!~g construction of the principle and acces.,~r,y structures and underground structures (i.e., pipeline and sept'lc system; make additional attachments if necessary). Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) do hereby authorize to apply for Coastal Erosion permit(s) from the Southold Town Trustees Signature THIS IS NOT A PERMIT County of Suffolk ) State of New York ) ~.~OH¢ ,~- CD~T~( ~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/S~E IS THE APPLICANT FOR THE ABOVE DESCRIBED PEP~IT(s) AND T~TALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DoNE iN THE MANNER SET FORTH IN THIS APPLICATIO~ AND AS MAY BE APPROVED HYTHE SOUTHOLD TOWN BOARD O~ TRUSTEES. THE APPLICANT SOUTHOLD AND THE TOWN TRUSTEES DAMAGES AND CLAIMS ARISING IF GRANTED. IN AUTHORIZE THE TRUSTEES, ONTO MY PROPERTY TO,] REVIEWOF THIS SIGNATURE SWORN TO BEFORE ME THIS ATM DAY OF (~70.~ ,19~,~ SUSAN E. LONG ~luMlfied m Suffo,~ C~unty ~on E~ires Novem~ SUggested space for location Map THIS IS NOT A PERMIT t~-~ [~--T~xt 12 PROJECT I.D. NUMBER ~ 617...21 SEQR 'J Appendix C Stat~ Environmental QUality R6,/I~W SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLisTED ACTIONS Only ~ART i--PRoJECT iNFORMATION (To be completed by Appllcan~ of Pr0J~ct sp0nbor) f. APPLICANT-/SPONSOR . ~ 2. PROJECT NAME 3. PROJ~ LOCATION: &. PRECISE LOCA~ON (Street address and road intersections, orom~nent landmarks, etc.. or orovlde map) 5. IS PROPOSED ACTION: [] Expansion [] ModIIIcation/alteratfon 6. OESCRIEE PROJECT BRIEFLY: Y. AMOUNT OF LAND AFFECTED: Infllally © acres Ultimately ~ acres 8, W~LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] No If No. describe briefly WHAT IS PRESENT LAND USE IN V{CINITY OF PROJECT? ~-Resldentlal [] Industrial [] Commercial [] Agriculture [] ParklForsstlOpen space [] Other Describe: t0. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY IFEDERAL, STATE OR LOCALI? ~-Yes [] No II yes, list age,cy{s} and permit/approvals o~' f t I1 DOES ANY ASPE~ OF THR ACTION MAVE A CURRENTLY VALID P~RMIT OR APPROVAL? ~ ~o It yes, Iisi age.cy .ame and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL ~ISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ~ CERTI~ THAT THE INFORMATION ~ROVIDED A~OVE I~ TRUE TO THE BEST OF MY KNOWLEDG~ It {h~ actlo~ le I~ the coastal Area, and yo~ are a Ooaet~l Assessment Fo~m betore proceeding wtlh thl~ assessment OVER ~ART II~ENVIRoNI~IENTAL ASSESSMI~ ~ro be comple[ed by Agency) A. DOES ACTION EXCEED ANY TYPE f ~HRESHOLD IN 6 NYCRR. PART 617.127 N yes. coordinate the review process and use the FULL EAF B, WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.67 II No. a negative declaration may be superseded by another Involved agency. C. COULD AOTIOH ~ESULT IN ANY ADVERSE EFFEOTS ASSOCIATED WITH TH~ FOLLOWING: (Answers may be handwrtllen. R legible) C1. Existing alt quaely, ~urfgce or groundw~e~ aualily or a~anlSy, noise levels, existing ~raf~Jc patterns, solid waste production or disposal, potential ~or erosion, drainage or flooding problems? Explain brielfy: ~. C3. Vegetation or fauna. Ilsh. shellfish or wildlUe species, significant habitats, or threatened or endangered Species? Explain I~rlefly: C4. A community's existing plans or goals as officially adopted, or a change Jr~ use or JnlensRy of use of and or o her natural resourcee? Exptaht br el y. C§. Growth, subsequsnt devdlopmenL or related actlvities likely to be inddced by the proposed action? Explain briefly. Long ierm. short term, cgmulatlve, or other effects not identified in C1-C57 Explain briefly, CT& Other Impacts (Including changes In Use of either quantity or type o[ energyl? Explain briefly. D. IS THERE. OR IS THERE LtKELY TO BE. CONTROVERSY RELATED TO PO:TENTIAL ADVERSE ENVIRONMENTAL fMFACTS? [] YeS [] No It Yes. explain briefly PANT Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS; For each adverse el)ecl Identified above, determine whether It ts sbbstantlal, la[ge, lmportaa! or otherwise slgntflcant. Each ~f~ec{ shoLItd be assessed in connection wlt~ its Iai setting (t.e. urban or rural); (b) 13robablllty of occurring; {c) duration; (d) itrev~rsibillty; (e) geogi-aphlc scope; end (t) magnitude. It necessary, add attachments or reference supporting materta s Ensure Ihat ' explanations contain sufiicien{ detail to show Ihai all reievani adverse Impacts hav~ been Ided~lhed and adequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse Impacts whicti MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive decla[atlon. [] Check this box it you have determined, based on the Information and enalysi~ above and any supporting do~:umentatton, that the proposed action WILL NOT result in any significant a~verse environmental i~npacts AND provide on attachments as necessary, the reasons §upportlng this determination: NEt/ YOR,~%ATE DEPARTMENT OF ENV[RONHENTAL cONgERVAT~ ~ EFFECTIVE~ TYPE OF PERMIT a Ne~ D Eene~e[ O M~iffcat{~ 0 Pe~it to C~str~t 0 Pe~ft to O~rate of gaters' Certification SoLid ~aste ~a~g~nt ArticLe )S, TitLe 15: ~eter O Article 17, TJttes 7, 8: SPDES ~ APtic[e 27, TitLe 9~ Artic[~ 15, TitLe lS: ~ater Controt ~' ArticLe 34: Coastal Erosion D ArticLe ~, Titte 27: Ni~ La~ ArticLe 15, TitLe 15~ Long Rec[~tf~ D 'Art~cte ~= ~s[a~ Ue[ ts Na~g~nt 0 ArticLe 2~= Fresh~ateP ~et[a~ ArticLe 15, T~t[e 27= ~i[d, D Artfctes I, 3, 17, 19, Scenic e~ Recreatf~a[ Rfve~s a A~tlcte 25= TJ~[ ~et[a~ 6~YCRR 3aO: R~fatf~ Control Other.' CONTACT PERSO~ FOR PERHITTED ~K - t - TOWN OF Sb LOCAT[O~ OF P~OJECT/FAC[LITY E~ ~IPTION OF AUTHORIZED ACTIVITY NOTE: A~itiona[ activities descP}~ on page (3) are atso a~rov~ ~er this ~rm{t if the adjoining ~x is check~ a~ the pro~s~ work is shown on the a~rov~ o[an. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict cemptfance with the ~vironmenta[ Conservation Law (ECL), a[t applicable regulations, the general Conditions specified (see page 2) and aL[ ~[fcab[e Spec[aL Conditions incLuded as part of this permit. PERMIT ADMINISTRATOR: } ADDRESS f { BEdg. 40, SUNY, Stony Brook, New York 11790-2356 Page I of 6 GENERAL CONDITIONS InstrUctions 1. The permitted site or facility, including relevant records, is subject to in- spection at reasonaDle hours and intervals by an authorized representative of the Department ?f Environmental Conservation (the Department) to determine whethe~ the permittee is complying with this permit and the ECL. Such represen- tative may order the work suspended pursuant 'to ECL 71-0301 and SAPA 401(3). A copy of this permit, including all referenced maps~ drawings and special conditions, must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Renewals ~ 2. The Department reserves the right to modify, suspend or re~oke this permit when: a) the Scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regula- tions is 'found; b) the permit was obtained by misrepresentetion or failure to disclose relevant facts; c) new material information is discovered; or d} environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. 3. The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms, fees or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least: a} 180 days before expiration of permits fbr State Pollutant Discharge Elimination System (SPDES}, Hazardous Waste Management Facilities (HWMF}, major Air Pollution Control {APC) and Solid Waste Management Facilities (SW~F); and b} 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination perviously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. Other Legal Obligations of Permittee 6. The permittee has accepted expressly~ by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from this project. 7. 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. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required for this project. Page 2 of ~ )[i~JDI'~'IONAL GI~N£RA[ CONDITIONS FOR ARTICLES 15 (Tiile 5), 24, 25. 34~ and 6 NYCRR Part 608 ( ~ t) That if future operations by the State of NeW York r/~ctuire an al- Uther environmentaJly deleterious materials associated with the teration in the position of the ~tructure or work herein authorized, or project. if, in the opinion of the Deoartment of Environmental Conservation 13 Any material dredged in the Prosecution of the x,'ork herein oermitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across x~aters or flood flows or enoanger the health, sat~tv or welfare of the bed of a water~vav or floodplain or deep holes that may have the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State. the owner may be ordered by the DePartment to a waterxvav remove or alter the structural work. obstructions, or h~zards caused 34 There shrill be no unreasonable J,tarleeence with navigation by the work thereby wit~but exaense to the State. ~nd if, upon the expiration or herein aPthorized revocatton of this permit, the structure, fill excavation or other -- modification of the watercourse h~rebv authorized shall not be com- 15 If upon the expiration or revbcatibn of this [~ermlt. the project hereb~ plated, the owners, shall, without expense to the State. and to such authorized has not been_co .mp[eted, the applicant shall, without exoense extent and in such time and manner as the Deoartment of Environmental to the State. and to such e~ent and in such time and manner as the Conservation may require, remove all or any ~ortlon of the uncompleted Deoartment of Environmental Conservation may require, remove all or structure or fill and restore to its former condition the nawgable any portion of the uncornp[eted structure or fill and restore the site and flood capacity of the watercourse. No claim shall be made against -f~o its former condition. No claim shall be made against the State of the State of New York on account of an' such removal or alteration New York on'account of any such removal or alteration. 10 That the State of New York shall in no case be liable for an~ damage 16 If granted under 6 NYCRR Pa~t 608, the NYS Department of Environ- or Inlury to ~he structure or work herein authorized wl~ich may be caused mental Conservaticn hereby certifies that the subject proiect svill not by or result from fut6re ooerations undertaken by the State for the contravene effluent limitations ar other limitations or s~andards unde~ conservation or imorovement of navigation, or for other purposes, and Sections 301. 302. 303. 306 and 307 of the Clean Water Act of 1977 no claim or right to compensation shall ~ccrue from an~ such damage. (pl_ 95-2'17) orovided that all of the conditions listed herein are met 11 Granting of this permit does not relieve the applicant of the respons*- 17 All activities authorized by this ~erm~t must be in strict conformance bilit~ of obtaining any other oermission consent or approval from with the approved plans submittedbv the applicant or bis agent as part the U.S Army Corps of Engineers. U.S. Coas~ Guard. New York State of the uermit application. Office of General Services or local government which may be reoulred. of any wetl~nd or waterway by suspended solids, sediments, fuels. ' on SPECIAL CONDITIONS Additional APProved Activities (if box is checked) [] Install up to four (4) mooring piles (see special conditions 8 and 9). [] Construct a boat lift or davit. Construct a board walk or footpath up to four (4) feet in width to access the dock (see special conditions 10 and I1). Important: Refer to Special Conditions on the following pages which apply specifically to any additional activities checked. SPECIAL CONDITIONS For Article 1. The use of wood treated with pentachorophe~0~ in the constructior of structures that will be in contact with tidal waters is strictly prohibited° 2. Those portions of docks, catwalks and ramps Which extend over Vegetated tidal wetlands shall have a maximum surface width of 4 feet and.shall be a minimum of 3 1/2 feet above grade, as' measured from the ground surface.to the bottom of the planking. Floating docks shall not rest on vegetated tidal wetlands at any tidal stage. Docks and floats shall not: (a) extend laterally beyond property lines, (b) be placed so that docked boats extend over adjacent property lines, (c) interfere with navigation, (d) interfere with other landowners' riparian rights. 4. Dock reconstruction or replacement or seasonal installation shall not involve expansion or substantial modification of existing structures or facilities. 5. Installation of additional docks at marinas, boat basins, or other commercial facilities is not authorized by this permit. 6. No dredging, excavating or other alteration of shoreline or underwater areas is authorized by this permit, nor shall issuance of this permit be construed to suggest that the Department will issUe a permit for such activities in the future. Any debris or excess materials from clearing or construction activities performed under this permit must be immediately and completely removed from the wetland adjacent area and disposed of at an upland site. Disposed of debris in tidal wetlands is prohibited. FACILITY ID NUMBER J PROGRAM NUNIBER J Pa~e ~ qf b ~r~/,~'~ J'~._~:~ N~.~RK STATE DE~ART,k'II~NT OF EN%'J£ON,%IENTAL CONStiPATION $1'JEcIAL COMD JTJOIN$ For Article Mooring Piles (if approved, see page 3) = 8~ No structures are to be constructed on piling~ without fUrther aut/~orization of the Department~ 9. Pilings shall not: (a)' extend beyond proper~y lineS, (b) be placed ~ ~hat docked boats extend over Property lines, (c) interfere with navigation; (d) interfere with other landowners, riparian rights. Access paths, boardwalks (if approved, see page 3) 10. The ground area cleared for construction of a path or boardwalk is limited to a maximum width of six (6) feet. The path or boardwalk itself is limited to a maximum width of four (4) feet. 11. Cover material~Used for footpath i~ ~limited to natural wood/bark chips, stone, gravel or sand~ SUPP~[.~.E~I]ENTARy SPEC'~q~., CONDITIONS The followlng conditions ap~ly to all permitst A. · A copy of this perm%t, including all condi~i0n~ and approved plans; shall be available at the project ~te Whenever authorized work is in progress. The permit Sign enclosed with the permit shall be protected from the w~ather and posted in a ~onspicuous location at the work site until all authorized Work has been completed. C. If proj~ct~esign modifications become necessary.after permit issuance, the permit%eS.shall sUbmat the appropriate plan changes for approval by the Reaional Permit Administrator prior t~ ~ndertaklng any Such m~dific~tions, The permittee is advised that SUbstantial modification may require submission of a new application for permit~ D. At least two days prior to commencement of the project~ the permittee and contractor shall sign and return the top portion of the enclosed ~otification form certifying that they are fully &War~ Of and ~nderstand all ~ermS and conditions of %his permit& With%n 30 days Of completion of the authorized work, the bottom por~on of that form shall also be Signed and returned, along with pho~ographs of the completed work and, if required, a Survey, For projects involving activities to be undertaken in phases over a period of more than one year, ~he psrmittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. : F. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, office of General Services, Tower Building, Empire State Plaza, Albany; N~ 12242 (5~8) 474-2195, which may be required for any encroachment upon State-owned lands underwater. AUTHoRiZATiON FORM BUsine~s/prop~rty nam~ do herby give Cost,ilo Martn~ coh~ra~tn~ corp. %h~ authority ~o au% as agent 1n my behalf tn applying for all of %he necessary perm~Es ~n order for work %o be done ~ my~tope~y~e~bed ~ TRUSTEES SCOTt L. HARRIS John M. Bredemeyer, III. President Supervisor Henry P. Smith~ Vice President Town Hall, 53095 Main Road Albert J. Kmpski. Jr. P.O. Box 1179 John L. Bednoski. Jr. Southold. New York 11971 John B. Tuthilt BOARD OF TOWN TRUSTEES Fax (516) 765-1823 Telephone (516) 765-1892 TOWN OF SOUTHOLD Telephone (516) 765-1800 GRANDFATHER APPLICATION 2. Mailing address: ~ 0 ~5o~ /77 ~o~ v/ //~ /F ~ ./~P ?0~ Tel. No: ~/,~ 337 3. Address of Property: ] ~ ~ ~/~ ~cf 4. Tax Map N~ber: 1000-OZ~-O0Z-o0~ Approx.yr.of construct: /~ 5. Prior owner if k~o~: ~ ~f~f ~ 6. Diagr~ of existing structures, including all dimensions, must be included with this application: 7. Indicate on attached map: Location, ie; reference point, telephone pole number, adjacent property owners, etc. Signature of applicant: ~-~ ~ ~//~-~ Date: / ~ ' * Please note, there is a one time fee of $50.00 for filing this application. The Southold Town Trustee office has determined that your application for a q~oasta± erosioD~~=+~ -~-~~ ~'- is no~- j ~zi~diuhi~:~al~incomplete,Q please consider the following information in this regard for any re~gired return s~missicn: Trustee RepresentX~tive cc: ~ui~ding Dept. ~cnin~ Do=id of A~pc&lz Plannil~ D~ar~ Co~=~va~ion Advisory Counc~i~l This nosice makes no claim with respect to other jurisdictions within or o~Itside the Town of Southold with respect to permits, permission required. 4/92 ' Town Hall, 53095 Main Road I~I,'PZABETH A. NEVILLE f/~, j~ P.O. Box 1179 TOWN CLERK o~ I Southold, NewYork 11971 P,~GISTRAR OF VITAL STATISTICS ~ k, ~ Fax (516) 765-t823 NLARRIAGE OFFICER Telephone (5-16) 765-1800 RECORDS MANJ%GEMENT OFFICER ~_'ff~j Q ~ - FREEDOM OF INFOR/VIATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPUCATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of Information Officer}. One copy will be returned to you in response to your request, or as an interim response. ....... SECTION I. TO: TO ,~ {Department or Officer, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: {Describe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.} Printed Name: _Address: ~_~ Mailing Address (if different from above): Telephone Number: [ ] APPROVED [ ] APPROVED WITH DELAY* [ ] DENIED* Nevi lie " tOW~ Fr~m of lnfomation Offl~r * If delayed or denied see reverse side for explanation. Consultant Pre ject Name 000- Date The Southold Town Trustee office has deter~ined that your application for a ~?ast~± erosio~7~'~nn~ ~,~mit-is no~-j uiiadicti~nal~ncomplet~Q- please consider the following information in this regard for any required return s~mission: Trustee Represen~tive cc: Buit~ing Dept. ~ning Po~.~d of Appcgtz Planni~ Doar~ Con~rv&tion Advisory ~u~i~l This notice makes no claim with respect to other jurisdictions within or outside the Town of Southoid with respect to permits, permission required. 4/92 LONG ISLAND Orlen{ Y.C. HARBOR GAROINERS R/O/W off Willow Terrace Orient, NY