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HomeMy WebLinkAboutTR-3992 GF Of $outhold To n Trustees SOUTHOLD, NEW YORK PERMIT NO. 3.992 .... DATE: .Maz'ch 22,,_1992 ISSUED TO ...........~rie....G~i~.d Pursuanf fo fhe provisions o~ Chapter 615 the S+afe of New York 1893; and Chap+er 404 of fhe L~ws of the Sfa+e of New York 1952; end the Soufhold Town Ordinance en- titled "RE~U~TING AND THE PLACIN~ OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LA~DS and REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" a.d b accordance wff~ ~e Resolufion o{ T~e Boar~ a~op~e~ afa mee+ing ~eJ~ on ..[~c5 .~.. 19...~ , and in consideration o~ ~he sum o~ $ 50.00 paid by g~...~f oE ~K~.e .G~[[]~ ................. of N.Y. and subject Terms and Condffions listed on fha reverse s~de hereof, o~ 5oufhoJd Town Trustees authorizes and permits fha ~oJJowJng: Grandfather permit to reconstruct 5' X 58' dock damaged by Hurricane "Bob". Dock must not go further seaward than existing docks. a[~ in accordance wffh the detailed specifications es pre.hied in fhe or~gbafing applicafbn, IN W~TNESS WHEREO~, The said. Board of Trustees ~re- by causes ifs Corporate Sea] fo be affixed, and these presents be subscribed by a m~jorffy of the seid Board as of fhis W~stees TRUSTEES SCOTT L. HARRIS John M. Bredemeyer, III, President Supervisor Hemy P. Smith, Vice President Town Hall. 53095 Main Road Albert J. Knrpski, Jr. P.O. Box 1179 John L. Bednoski. Jr. Southold, New York 11971 John B. Tuthill BOARD OF TOWN TRUSTEES Fax (516) 765-1823 Telephone (516) 765-1892 TOWN OF SOUTHOLD Telephone (516) 765-1800 GRA1TDFATHER APPLICATION 1. Name of Applicant: Marie Gaillard 2. Mailing address: Bell Hill Avenue, Fishers Island, NY 06390 Tel. No: 516 788 7438 3. Address of Property: Bell Hill Avenue, Fishers Island, NY 4. Tax Map Number: 1000- 009 - 3 - 15 Approx.yr.of construct:15-20years 5. Prior owner if known: 6. Diagram of existing structures, including all dimensions, must be included with this application: See attached application package. 7. Indicate on attached map: Location, ie; reference point, telephone pole number, adjacent property owners, etc. Signature of applicant: ~~~ .1'~,~ Date: ~;~}~ * Please note, there is a one time fee of $50.00 for filing this application. Docko, Inc. P.O. Box 421. Mystic. CT 06355 203~ 572-8939 Fax: 203 572-7569 Mr. John Brede~eyer, President Southold Board of Trustees ~ ~ ............ t ; PO Box 728 uthold, 11971 ,TOkeN OF $0UTH0[D Re: Marie Galliard, Fishers Island Dock Reconstruction Permit Dear Mr. Bred~eyer: On behalf of our client, we request a "Grandfather" Permit and Coastal Erosion Permit for the reconstruction of an existing fixed wood dock damaged by ~urricane "BOB", on the Marie Gaillard property on Fishers Island. We enclose the following documents in support of this permit application: - Two prints of application drawings titled: Project: "Dock Reconstruction" Location: Fishers Island, Town of Southold Suffolk County, New York Waterway: Hay Harbor Applicant: Marie Gaillard Hate: December 31, 199] - Two copies of the Southold Board of Trustees "Grandfather" application, Corps and DEC applications, Tax Assessor' Map and location map. t trust that you will find this application package complete and acceptable; please let me know if the need for more information arises. Yours truly, DOCKO, INC. Keith B. Ne±lson, PE Enclosures cc Marie Gaillard Jim Haggerty, CE Christine Costopoutos, DEC John Clavin, Fishers Island Harbor Master File 91-08-240 LOCATION MAP / Project: DOCK RECONSTRUCTION /' - Location: FISHERS ISLAND, TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK Waterway: HAY HARBOR Date: DECemBER 31, 1991 Applicant: MARIE GAILLARD )0 ~ 2 540 000 FEET (N. Y.) ~50 1 MILE ROAD CLASSIFICATION 4000 50~0 6000 7000 FEET Primary highway, Light-duty road, hard or ~ hard surface _ -- improved surface 1 KILOMETER Secondary highway, IT PROJECT: ~ LOCATION: ~S WA~WAY: DATE: AP~ICANT: DOCKO, INC. ~ ~, ~[~ON. P.~. 203 572 8939 F~ 572 7569 ? Docko, Inc, P.O. Box 421. Mystic. CT 06355 f203 572-8939 Fax: (203) 572-7569 ABO~E: May 1990 aerial photograph of the site looking southeasterly from a 500 foot altitude; Marie Gaillard's deck is in the lower left corner. BELOW: View frc~ the water at high tide in November 1991 looking east. Visible d~m:~ge includes.brokan pile attachraoants and destroyod landing at shore. Docko, Inc. P.O. Box 421. Mystic. CT 06355 [203) 572~8939 Fax: (203~ 572-7569 ABOUE: Dock as viewed from the shore facing westerly showing primarily the dock's aligr~ent and debris scatterad along ~h~ shore to the south. BELOW: Focus on the amount of debris and nature of the destroyed components from the landing section of the dock, now laying to the east. Oocko, Inc, P.O. Box 421. Mystic, CT 06355 (203) 572-8939 Fax: (203) 572-7569 December 31, 1991 Ms. Christine Costopoulos NYS DEC, Regulatory Affairs SUNY, Building 40, Roc~ 219 Stony Brook, NY 11790-2356 Re: Marie Ga±llard, Fishers Island Dock Reconstruction Permit Dear Ms. Costopoulos: On behalf of our client, we request a Tidal Wetlands Penmit, including Water Quality Certifications, as necessary, for reconstruction of a fixed dock damaged by Hurricane "BOB", at the Marie Gaillard property on Fishers I.sland, New York. We enclose the following in support of this ~mit application: - Four prints of application drawings titled: Project: "Dock Reconstruction" Location: Fishers Island, Town of Southold Suffolk County, New York Waterway: Hay Harbor Applicant: Marie Gaillard Date: December 31, 1991 -Four copies of the DEC Joint Application, including the Short Environmental Assessment Form, SAAF, site photographs, Tax Assessor's Map and location plan, Corps and Town applications. -Application Fee, in the amount of $210, payable to the NYS DEC. I trust that you will find this application package complete and acceptable; please let me know if the need for further information arises. Very truly yours, DOCKO, INC. Ke~th B. Noilson~ P.E. Enclosures cc: Marie Gaillard Jim Haggerty, ~' John Bredemeyer, Town of Southold John Clavin, Fishers Island Harbor Master Tcxn Law, Sandy McGugan File 91-08-240 954g-3 (B/Bg)--7e DEC APPLICATION NUMBFR NEW YORK STATE DEPAJ~MENT OF ENVIRONMENTAL CONSERVATION ~OINT APPLIOATION FOB PERMIT U.S.A.~ COR~ O~ ENGINeeRS APPLICATION ~ARTIC~ 15, ~TLE 3 CAQUAT lC PESTICIDES CONTROL} ~YCRR 327 {AQUATIC VEGETATION} ~6NYCRR 328 {FISH} ~6NYCRR 32~INSECTSl ~ARTICLE 1S, TIT~ S ~YCRR ~ {PROTECTION OF WATERS} ~r'~e di~bance of a STREAM B~D OR ~NKS or. ex~vati~ in ~ fill of NAVIGABLE WATERS. ~q WATER QUALITY CERTIFICATION ~ne ~ ~11 ~11 ~516 ~ 78~-7~38 POST OFFICE j ST*T~ j ZmCODE Fishers Isled ~ 06390 ~ko, Inc., Kei~ B. Neil~n PE ~ ~x 421 Mystic ~ 06355 County Suffolk J Town or city ~11~ho]d Village ~ ~h~r$ Islend ~11 ~11 A~. POST OmC~ STATE ~ Zm COD~ Fish~s Isled ~ J N~E OF STR~A~ OR BODY O~ W*TEe ~y H~r ~ Public ~ Commercia~J Feb--, 1992 6 w~ ~ 2~0 R~o~ct 58 +/- LF ~ fix~ ~ ~k, of w~ch 50 +/- ~ is ~te~d of the High ~ Line. US ~ of ~gin~rs, ~s a~ ~rs Act of 1899, S~on 10 ~ of ~u~old, "~a~er" Pe~t. ~/ ; J~ ~ ~~'~ ~er ~RM~ ADMINIS~ATOR 14-16-4 (2/87)--Text 12 PROJECT I.D. NUMBER 617.21 SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION fro be completed by Applicant or Project sponsor) I APPLICANT/SPONSOR I 2. PROJECT NAME Marie Gaillard I Dock Reconstruction 3. PROJECT LOCATION: Municipality Fishers Island, Town of Southold County Suffolk 4 PRECISE LOCATION ~Street address and road intersections, prominent landmarks, eEc., or Dro¥ide map) 100 yards +/- North of Equestrian Ave. on ~ell Hill Ave. 5. IS PROPOSED ACTION: [] New [] Expansion ]~ Modification/alteration Reconstruction 6. DESCRIBE PROJECT BRIEFLY: Reconstruct 58+/- LF of 5 Foot wide fixed wood dock, 50 Foot of which is waterwa~d of the High Tide Line. 7 AMOUNT OF LAND AFFECTED: Not Applicable Initially acres Ultimately acres 8 WiLL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~] Yes [] No ~f No. describe briefly 9. WHAT IS pRESENT LAND USE IN VICINITY OF PROJECT? ~ Residential [] Industrial [] Commercia [] Agriculture [] Park/Forest/Open space [] Other Describe: The property adjacent to Ms. Gaillards site is moderate density residential. 10. DOES ACTION INVOLVE A PERMit APPROVAL. OR FUNDING NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? J~"Yes [] No If yes, list agency(s) and permit/approvals US Army Corps of Engineers, Nationwide Permit Town of Southold, "Grandfather" Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] ?es [] NO If yes, list agency name ana permit/approval Tidal Wetlands Regulations effective in 1977; the current dock pre-exists state regulations and is considered "Grand fathered". 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? FJy.$ ~J~] No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Marie Galliard, Applicant/Owner Date: ~'-~; / ~ ~ Signature: ~)~-~[ 1:3t~ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II--ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 {f yes, coordinate the ~wew process and use the FULL EAF. [] Yes [] No B. W~LL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS tN 6 NYCRR. PART 617.6? if No. a negatwe declaration may be superseded by another involved agency. [] Yes [] No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: ('Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantiiy, noise tsvets, existing traffic patterns, solid waste production or disposal, 3otential for erosion, drainage or flooding probtsms? Explain briefi~ C2. Aesthehc, agricultural, archaeological, historic or other natural or cultural resources; or commun ty or ne ghborhood character? Explain briefly: C3. Vegetation or faunA, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of laed or other natural resources? Exotain briefly. C5. Growth. subseauent develoDmem, or related activities likely to be induced by the proposed action? Ex~[ain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explain briefly PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large; important or otherwise signific;nt. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. [] 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 and/or prepare a positive declaration. I-'1 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 AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Signature of Responsible Officer in Lead Agency SigPature of Preparer (If different from responsible office~) Date 2 Marie Gaillard 95-20-.7(10/90) Dock Reconstruction New York State Department of Environmental Conservation Supplement to Application for Permit STRUCTURAL-ARCHEOLOGICAL ASSESSMENT FORM (SAAF) PART I - APPLICANT COMPLETES Applicant Information l. Applicant Name Marie Gaillard 2. Applicant Address Bell Hill Avenue, Fishers Island, New York Project Information 3. Project/Facility Name Dcx~k Reconstruction 4. Project/Facility Location Bell Hill Avenue, Fishers Island 5. Is the proposed project adjacent to, or does it contain a building or structure listed in the State or National Register of Historic Places? Yes No x 6. Are there any buildings or structures built prior to lg40 adjacent to or within the proposed project area? Yes No x If the answer to question 5 and/or 6 is yes, provide the following information for each building and structure (use attachments if necessary): a. name of structure b. location c. type of structure (ex: house, outbuilding, barn, bridge, dam, ruins) d. approximate age or date of construction 7. Might the proposed project have any impact (physical/visual) upon any buildings or structures listed in the State or National Register of Historic Places o__rbuilt prior to 19407 Yes No x If yes, describe briefly (use attachments if necessary): 8. Provide photographs of every building and structure that may be impacted by the project as described in number 7, above. The following standards are recomsended: o minimum of two photographs o minimum size 4" x 4" prints from negatives preferred; polaroid photos awe acceptable o photos must be clear and focused o clearly label photos so it is obvious what is being illustrated; key photos tO map or plan, if possible o entire front and side of the structure in a the building as possible. Be sure the not partially or fully blocked by trees or other o relationship of building or structure to ~oadway or 9. Has the land w%thi~ the proposed project area been previously disturbed or altered {excavated, landscaped, filled, utilities installed)? Yes × No If yes, describe briefly, including depth of disturbance {use attachments if necessary): The site was previously disturbed during the original construction of the dock and subsequent mainteru%nce and repairs. 10. Approximate percentage of proposed project area with slopes: 0-10% % 10-15% % 15% or greater x % 11. Approximate percentage of proposed project site-with the following drainage characteristics: *NOTE: The dock originates at well drained 20* % on a steep section of moderately we~ed % the shore, the r~inder poorly drained % being in and beyond the inter-tidal zone, under water. Prepared by D0CKO, INC., Keith B. Neilson, PE Date ~ecember 31, 1991 SAAF1.LK/G lO/gO Marie Gaillard Dock Reconstruction STRUCll)RAL-ARCHEOLOGICAL ASSESSMENT FORM (SAAF) PART 2 - DEPARll4ENT OF ENVIRONMENTAL CONSERVATION (DEC) COMPLETES Applicant/Project Information l. Applicant Name' Marie Gaill~d 2. Project/Facility Name Dock Reconstructzon 3. DEC Number Buildings and Structures 4. Might the proposed project have any impact {physical/visual) upon any buildings or structures listed in the State or National Register of Historic Places oc built prior to lg40? Yes No If yes, DEC must consult with the Office of Parks, Recreation and Historic Preservation (OPRHP}. The DEC must request a determination of eligibility for the State Register of Historic Places and/or comments regarding project impact. Include information supplied by the applicant in response to questions 5, 6, ? and 8 of Part 1 of this form. Archeological Sites 5. Does the proposed project area coincide with a circle, square or stippled area on OPRHP's Statewide Archeological Inventory Map? Yes No 6. Is the proposed project area outside of a circle or square, but one for which information has been provided (ex: documented reports of known sites} that suggests the area is archeologically sensitive? Yes No If yes, what is the nature and source of information? 7. Is the proposed project area apparently undisturbed? Yes No B. Will the proposed action include a physical disturbance of the project area? Yes No 9. Is the slope in the area characteristically less than 15% (unless on li~mstone/flint escarpments)? Yes No 10. Is the proposed project area characteristically moderately well or well drained? Yes No If the answers to 5, 7-10 are yes, an archeological survey should be performed by the .applicant. Provid~ th~ applicant with a copy of Report FormatFfor Cultural Resource Investlqat~ons and list of archeological consultants. If the answers to 6-10 are yes, DEC must consult with OPRHP before requiring that theapplicant perform an archeological survey. Results of Evaluation No buildings, structures or archeological sites identified at the project location (SHPA-1) Buildings, structures or archeological sites identified, but no impacts will occur, no survey required. No further cultural resources review required (SHPA-2) Consultation by DEC with OPRHP required structures archeology Archeological survey required Prepared by Date SAAF2.LK/G 10/90 Marie Gaillard Dock ~econstruction 1 of 2 pages APPLICATION C~ECKLIST NOTE: APPLICATION MUST INCLUDE: x 1. STANDARD FORMS - Appropriate Application for Permit. Short Environmental AssesSment Form, Structural Assessment For.m. .NOTE: For all projects requiring Wild, Scenic & Recreational ~ivers Permits and for co~amercial, industrial or multi,residential pro- j~cts, submit a long Environmental Assessment Form. x 2. APPLICATION FEE: Refer to enclosed fee schedule $10.00 minimum, Check or Money Order payable to NYS DEC. You will be notified of additional fees, if any. x 3. Authorization letter from the owner where the applicant is not the owner. x 4. Staking and labeling of the seaward/wetland side of the proposed structure or fill area. x 5. Photogra.phs of the staked project area mounted on a separate and labeled page. x 6. County Tax Map Numbers: Photo of Tax Bill will suffice. Suffolk: Dist~000 Sect.009 Blk. 3 Lot 15 Nassau: Sect. Blk. Subblock Lot × 7. Project Plans (four copies) - Plans must clearly show the pro- posed project and include all appropriate dimensions, elevations and muse be at a scale of 1" to 100' or larger. x 8. Address of project location (if vacant land; telephone pole # or other identifying landmark). MINIMUM PLAN REQUIREMENTS (FOUR COPIES REQUIRED) PROJECT: Alterations and/or Extensions 1, 3, 5, 6, 7, & 8 New House Construction 1, 3, 5, 6, 7, & 8 Accessory Structures 1, 3, 5, & 6 Repairs to Existing Structures 2, 3, & 4 Dredging 2, 3, 4, 5, & 6 *Catwalks and Docks 2, 3, 4, & 5 S~bdivisions 1, 2, 3, 5, & 6 Bulkheads 1, 2, 3, 4, 5, 6, 9, & 10 Groins and Jetties 2, 3, 4, 5, 9, & 10 Filling 1, 4, 5, & 6 KEY: 1. Stamped Sealed Survey * 2. Plot Plan * 3. Location Map * 4. Sectional View * 5. Wetland Line or Mean High Water, as appropriate 6. Fill and Clearcut Area 7. Sanitary System Location Test Hole and Data 9. Profile View 10. Distances from fixed structures NOTE: IF YOU WISH CONFIRMATION OF RECEIPT OF YOUR APPLICATION, PLEASE SUBMIT A SELF-ADDRESSED, STAMPED POSTCARD. NOTE: TRE PERMIT PROCESS TAKES AT LEAST EIGRT (8) WEEKS. Docko, Inc, P.O. Box 421. Mystib, CT 06355 (203) 572~8939 Fax: (203) 572-7569 December 31, 1991 Mr. Jim Haggerty, Regulatory US Army Corps of Engineers Jacob Javits Federal Building, Room 1937 New York, NY 10278-0090 Re: Marie Gaillard, Fishers Island Dock Reconstruction Permit Dear Mr. Haggerty: On behalf of our client, we request a Department of the Army Nationwide General Permit for reconstruction of the fixed dock due to damage frc~ Hurricane "BOB", at property of Marie Gaillard On Fishers Island, New York. We enclose the following in support of this permit application: - Two prints of the application drawings titled: Project: "Dock Reconstruction" Location: Fishers Island, Town of Southold Suffolk County, New York Waterway: Hay Harbor Applicant: Marie Gaillard Hate: December 31, 1991 - Two copies of Corps of Engineers, Town end DEC Application Forms - Two copies of site photos, Tax Assessor's Map, and location map. I trust that you will find this application package complete and acceptable; please let me knew if the need for further information arises. Very truly yours, Keith B. Neilson, P.E. Enclosures cc: Marie Gaillard Christine Costopoulos, DEC John Bredemeyer, Town of Southold John Clavin, Fishers Island H~rbor Master Tom Law, Sandy McGugan File 91-08-240 ~PPLICATIONFOR DEPARTMENT OF THE ARMY PER~ I OMa 4ppl:tOV~,L NO. (33 CFR 325) I Expires 30 June 1992 other aspect o! this collection Of ir~omtation, including suggastJo~ for mduciag b~s burden, te Washington Headqua.,lers Services, Di~ecterate for IoformatJon Operations and Repons. 1215 Jefferson Davis Highway, Suite 1204, Adiegton. VA 22202-4302; and to the Off)ce o~ kifon'nal~o~ and Regulatory Affairs, OIfK:e Of Management and Budget, Washington, DC 20503. T_~ Oe~t of the .Army 13e~t I~'og__ ram is au ~tho~ed_ b~ Section 10 of Ule Rive~s and Had)ors Act of 1899, Section 404 of the,Clean Water Act and pubticr.e~er.dth~..ou~., msuanceofapubticnObCe. D~isclo..s?. e~f~th~n~nn~b~x1mquasted~sv~uma~y;h~wever~b~edatarequaste~are~ecessarginCxder te commun~ae ruth,the a,opr~a'tt and to eva~uae the ~ al~icatien, it nece~_~,y information is not provided, the permit appear _,,m cannot be pr _a,~ecad not can a pem~ be issued. o~ ~t ~ .oCalna~ .~ra,ang$ ? ~ood ?pr .uduclb~ cotes ~ ~ the kr. aaoa and c~ast~ o~ the ~__~ act~ty mu~ be auacaed to ~ (_see. sa~p~e ~. ?q? a~ L,.~u~oas) a~ be a,~at~ to ~e Ok~t~ Engme~ haw iur~ o~ me ;oca~ of m propo~ act~ty. ~ ~ Is riot completed ~1 fu~ will be retemed. 1. APPLiORTlONNUMl~Rirrobeas$ignedb¥Corps) 3, NAME, ~DRES~ . AND TITLE OF ALrrHORIZED AGENT Docko, Inc., Keith B. Neitson, PE PO Box 421 Mystic, C~ 06355 z NAME AND ADORES~ OF APPMCANT A/C ( ) (Residence) Marie G~.illard ,,~c(203) 5'7~-Rg~q (off~) Bell Hill Avenue Fishers Island, NY 06390 Sta~t of ~.tech.iz~o.: I he.P. by de~,~gnam ,~ ~ocko, Inc. to act ~n my ~'c ( ) (office) ~]; ~__ P, econ~uct 58+/- ~ o'~ fixed ~ dock, of which 50+/- L~ is wate~wa~d of ~-e 4b. PURPOSE This dock is utilized for private recreational boating. Not Applicable ENG FORM 4345, AUg 89 Eomo. OF APe 86 ~S OeSO~ (p,,~.,..,,~ cz:-c'w.o.) North M/M George R. Furse South Old House, West Hoathly Peter S. Gaillard Sussex, England RH194RA 17 Mountain Peak Rd. Chappaqua, NY 10514 ~. WA~.~.~)DY AND ~ ON WAT~P. BODy %VI.~RE AO'iTViTY EXIb~T~ OR I~ ~ The Gaillards Dock projects into the far southerly end of the Hay Harbor from the E~st shore. Bell Hill Avenue, Fishers Island Suffolk New York 06390 Town of Southold, Board of Trustees LOCAL GOVERNING BODy %%tJTH JURISDICTION OVERSITE S. 1~ any poflion o~ the ict~vity Io~ which autho~izatio~ is sought now oomplete? {'1 YE~ :~J NO If answer is *yes' give reasons, mo~th and year the activity was complete(i indicate the e~--fing wink on the drawing- This project is the reconstruction of an existing dock system. NYS DEC Wetlands Pending December 31, 1991 Pending Southold "Grandfather" Pending December 3:1, 1991 Pending Coastal Erosion ~ie ~ll~d ~ko, Inc. Kei~ B. ~il~n PE ~e appli~ati~ ~st ~ signe~ ~ ~e ~ ~o desires ~ ~de~ ~e pro~se~ ac~ (applicant) or ~ m~ ~ s~ned by a ~ a~or~ed agent if ~e statement in ~o~ 3 h~ be~ filled o~ ~d signed.