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HomeMy WebLinkAboutTR-99-3-1 TRUSTEES John M. Bredemeyer, III. President Albert J. Krupski. Jr.. Vice President Henry E 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 COASTAL EROSION MANAGEMENT PERMIT Permit Number: 99-3-1 Name of Applicant/Agent: Name of Permittee: Virginia Meyran Address of Permittee: 175 Soundview Avenue, Mattituck Property Located: same DESCRIPTION OF ACTIVITY: to construct 106 1.f. of timber retaining wall plus 20' return on w/s. the e/s wall will connect to adjacent bulkhead. Approx. 375 c.y. of clean sand will be trucked in via Bailie Beach Road to west. A 3' wide stairway from west of bluff to beach will be repaired/replaced as appropriate. Date of permit issuance: June 24, 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 agreement is attached hereto and is a necessary special condition of this permit. NA A maintenance agreement is attached hereto andis a necessary special condition of this permit. John M. ~redemeyer, III President, Board of Trustees Board Of $outhold' Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 4198 DATE: ....~-ne Z-~.~..~:993 ISSUED TO Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952: and the Soufhold Town Ordinance en- titled "REGULATING AND THE PLACING 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 in accordance with +he Resolution of The Board adopted at a meeting held on 2June ~ 19. 9.3., and in consideration of the sum of $.. !SQl.0.0. paid by En-Consultants. pn behalf of V. Me~f.'~g: ............................. of N.Y. and subiec+ to the Terms and Conditions listed on the reverse side hereof, of Soufhold Town Trus'~ees authorizes and permits the following: ~o construct 106 l.f, of timber retaining wall plus 20' return on w/s. the e/s wall ~ill connect to adjacent bulkhead. Approx. 375 c.¥, of cleand sand will be trucked in. 3' wide stairway from west of bluff to beach will be repaired/replaced as approp. ail in accordance with the detalJed specifications as presented in the originating appJication. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these presents be subscribed by a majority of said Bo. gs~eL, as TRUSTEES John M. Bredemeyer. III. President Albert J. Krupski. Jr.. Vice President Henry P. Smith John B. Tu/hill William G. Albertson Telephone (5t6) 765-1892 Fax I516) 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 Eh-COnsultants, Inc. 1329 North Sea Road southampton, NY 11968 Re: Virginia Meyran sCTM g1000-99-3-1 Dear Mr. Haje: 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, Roy Haje on behalf of Virginia Meyran applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of southold, application dated April 26, 1993 and, application was referred to the Southold Town wHEREAS said Conservation Advisory Council for their findings and recommendations, respecu and, WHEREAS, a public hearing was held by the Town Trustees with 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 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 Eh-COnsultantS on behalf of Virginia Meyran to construct 106 1.f. of timber retaining wall pluS 20' return on w/s. The e/S wall will connect to adjacent bulkhead. Approx. 375 c.y. of clean sand will be trucked in via Bailie Beach Road to west. A 3' wide stairway from west of bluff to beach will be repaired/replaced as appropriate. permit will expire two years from the date it is signed. Fees must be paid, if a::licable 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 the following fees for work to be done below Mean High Water Mark: No fees Very truly yours, John M. Bredemeyer, III President, Board of Trustee JMB:jd Page 6 source via Anderegg parcel. Replace 3' wide stairway form top of bluff to beach. The CAC recommends approval provided the work is done in kind and in place and not placed in front of the existing bulkhead. Nassau Point Road, Cutchogue Vote of Council: Ayes: All Motion carried. Moved by Patricia Isaksen, seconded by John Holzapfel. it was RESOLVED to recommend to the Southold Town Trustees APPROVAL of Wet~and Application of THOMAS P. LOSEE. SR. 118-4-2 to remove and replace {in same location and configuration) 100 I.f. of retaining wall and 3~ wide stairway. Approximately 200 c.y. of clean fill will be trucking in from areas upland. 7425 Nassau Point Road. Cutchogue Vote of Council: Ayes: All Motion carried. Moved by Patricia Isaksen, seconded by John Holzapfel. it was RESOLVED to recommend to the Southold Town Trustees APPROVAL of the Wetland Application of JOHN TOBIN 118-4-3 to remove and replace (in same location and configuration} 100 .f. of retaining wall and 3' wide stairway. Approximately 200 c.y. of clean fill will be trucked in from areas upland. 7525 Nassau Point Road. Cutchogue Vote of Council: Ayes: All Motion carried. Moved by Stephen Angell, seconded by Bruce Loucka, it was RESOLVED to recommend to the Southold Town Trustees DISAPPROVAL of the Wetland Application of VIRGINIA MEYRAN 99-3-1 to construct 1(16 l.f. of limber retaining wall plus 20' return on west side. On east side. wall will connect to adjacent bulkhead. Approximately 375 c.y. of clean sand wilt be trucked in via Bailie Beach Road to west. A 3' wide stairway from west of bluff to beach will be repaired/replaced as appropriate. The Council recommends disapproval because the retaining wall/bulkhead is not warranted. Also there is no established policy concerning the bulkheading of property along the Long Island Sound. the long range effect on the Sound must be considered. The Council approves the repair of the stairs. 175 Soundview Avenue. Mattituck Vote of Council: Ayes: All Motion carried. lohn M. Bredemeyer, m~ p~.. ident I4,nry P. Smith, Vice President Albert I. K_mpski, Sr., lohn B. Tuthill Telephone (5 I6) 765-1892 BOARD OF TO~VN T~v-JST]~ES Fax ($16) 765-1823 TOWN OF SOUTHOLD SUPI~RVISOR SCOTT L. HARRIS TownHall 53095 Main Road P.O. Box 1179 Southold, New York 11971 COASTAL EROSION MANAGE~m~T PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION /eO:i l Office Erosion Permit Application Permit ApplicatiOn ~rustee Lands Permit Application ~Grandfather Completed Apps. Date :' ~ 1%%1~3 ~,,L ~ariance Re~ired, ~ ~eig~ors notified Date: SEQ~ ~e ~ ~Coord. Revlew opt.,m~d. ~ SEQ~ Dete~n./date. ~/~ P~lic Hearing/date: ~ - ~ Findings: Permit Vote: ~N): ~ Special Conditions: ( also see file ) OWN OF SOUTHOLD Application Numbe~ SCTM %1000-99-3-1 Project ~aro. e (If any) Date Prepared: ~April 16, 1993 Applicant: EN~CONSULTANTS, INC. Address: 1329 North sea. Road, SouthamPton. NY 1196R Phone ~]6 ) 2~3-6368 Interest: (owner, consultant,lessee,etc.) Consultant Owner of Property: VIRGINIA MEYRAN Address 175 Soundview Avenue Mattituck, NY Subject Property Location: (Proviae LILCO Pole location map) 11952 Phone 516 ) 298-5139 175 Soundview Avenue Mattituck~ NY 11952 Distance to cross Streets if not on THIS IS NOT A PERMIT Yds. to be excavated: 0 Yds. to be filled: 375 cy__ Manner in which material will be removed or deposited: _ Trucked in, dumped &qraded Width of canal, creek or bay fronting property: 15 miles Depth at low tide: 0 Aver. rise in tide: 2'-6" Distance to nearest channel: N/A Distance project extends beyond similar projects in area: N/A Area zoning: R-40 Land area in acres: 1.13 Is projeet for private or business use: private Intended use of property: no change Describe known prior operations conducted on premises: -- None known Has any prior license or permit been issued to erect .structures, dredges or deposit fill on said premises: Unknown 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 attachments if necessary). See attached Authorization (Where the applicant is not the owner) I VIRGINIA MEYRAN residing at 175 Soundview Avenue (Print-owner of subject property)-- (M~g address-phone) Mattituck, NY 11952 ~o hereby authorize En-cnn~,]]~nts. Inc. to apply for Coastal EroSion per~it(s) from the So~thold Town Trustees ~ Signature ~ THIS IS NOT A PERMIT County of Suffolk') State of New York ) ROY L. ~AJE BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED h~IN ARE TRUE TO THE BEST OF HIS/~RR KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE FiA1TNER 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 F/gTEK ONTO MY PROPERTY TO INSPECT TEE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. swoRN To BEFO THIS OF ~p~. - - ~ KAY M, ~UOH~R~ ~ [ ': U NOTARY PUBLIC, St~ of New York ~ No. 01~q~1, Suffotk Oou~ Suggested space for location Map · £nIS IS NOT'A PERMIT TRUSTEES John M. Bmdemeyer, III, President Albert J. Krupski, Jr., Vice President Henry P. Smith John B. Tuthill William G. Albenson Telephone (516) 765-1892 Fax (516) 765-1823 SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 year Maintenance Agreement Erosion Protection Structures Chapter 37 Southold Town Code - S, outholcl~Trustees as Administrator type or print name (s) the owners of record of property at: /7~%/~Jc/~y (type or print-~reet address) SCTM 1000- in applying for a Coastal Erosion permit for an Erosion Protection StruCture do hereby agree to a 30 !~ear maintenance program for a structure commonly known as a of / 0 p 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 structure 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 the structure could result in a requirement to post a bond and or have the repairs ordered as a lien against the preperty 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 Signature ~f owner of record SWORN TO BEFORE ME THIS NOTARY PUBLEC i,~.ANIE V. N~. 4908712 Commission Expires Ocl. 19,19~ Please submit three copies 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. !' ~t " ' ~ ~'" ' ' ~ ~'~ I C ~ ~'t~ - -~' --~ /A I~ / ? -' ~ ,/ ,~ 1, SULTA ? ~ -I EN-CONSULTANTS IN(:;. 1329 NORTH SEA RD, SOUTHAMPTON N, ¥. 11968 516-283-63,80 ,e4(2167)—Tbxt 12 PROJECT I.D.NUMBER 61 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only w, PART I—PROJECT INFORMATION (To be completed by, Applicant or Project sponsor) 1. APPLICANT/SPONSOR2. PROJECT NAME VIRGINIA MEYRAN by En-Consultant 3. PROJECT LOCATION: Municipality Town of Southold County Suffolk 4. PRECISE LOCATION(Street address and road Intersections,prominent landmarks,etc.,or provide map) 175 Soundview Avenue Mattituck, NY SCTM: 1000-99-3-1 5. IS PROPOSED ACTION: ❑New ❑Expansion ❑Modlficationlalteration 6. DESCRIBE PROJECT BRIEFLY: SEE PROJECT DESCRIPTION 7. AMOUNT OF LAND AFFECTED: , Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? l_TYea ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial ❑A riculture Describe g ParklForeat/Open space ❑Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ®Yes ❑No If yes, list agency(s)and permit/approvals DEC, DOS, COE 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? 44 1 ❑Yea 9No If yes,flat agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? C1 Yes 'U No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE VIRGINIA MEYRAN by En-Consultants Applicant/sponsor name: Date: APri 1 19;, 1 9 3 Signature: 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 14-16-2 (2/87)-7c 617.21 SEAR Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project. or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, 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 knowledge in one particular area may not be aware of the broader concerns affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature,yet flexible to allow introduction of information to fit a projector action. Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By 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 project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, 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 supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead agency that: ❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, 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 declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions to Name of Action Name of Lead Agency 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 PART 1—PROJECT INFORMV_:()N Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any additional information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable,so indicate and specify each instance. NAME OF ACTION LOCATION OF ACTION(Include Street Address, Municipality and County) NAME OF APPLICANTISPONSOR ,,o BUSINESS TELEPHONE :�'rANIS INC. ADDRESS °•ifs �-:_�.,�itS7-?`dP�I NV. 11468CITY/PO ,_., STATE ZIP CODE 283-6360 NAME OF OWNER If different)� BUSINESS TELEPHONE► r !tii 4 W���i�w c ra-i� (Slee, ) o2S�r57/3 ADDRESS CITY/PO STATE ZIP CODE DESCRIPTION OF ACTION Construct 106 l.f. of timber retaining wall plus 201 return on w/s. on e/s wall will connect to adjacent bulkhead. Approximately 375 cy of clean sand will be trucked in via Bailie Beach Road to west. A 3' wide stairway from west of bluff to beach will be repaired/ replaced as appropriate. Project is necessitated by damage caused by 12/11/92 storm. Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas. 1. Present land use: ❑Urban ❑Industrial ❑Commercial 5IResidential (suburban) ❑Rural (non-farm) ❑Forest ❑Agriculture ❑Other 2. Total acreage of project area: ;L acres. APPROXIMATE ACREAGE ,PRESENTLY AFTER QQMPLETION Meadow or Brushland (Non-agricultural) �5 acres y 4 Acres Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) • 3 _ acres acres Roads, buildings and other paved surfaces '�5 acres .b S� acres Other (Indicate type) 4"0,0 s`q Yy acres `EG acres 3. What is predominant soil type(s) on project site? a. Soil drainage: ®Well drained d % of site []Moderately well drained % of site ❑Poorly drained % of site b. If any agricultural land is involved how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? Ni/+ acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site, ❑Yes ❑No a. What is depth to bedrock? 'Y'60f (in feet) 2 5. Approximate percentage of prc,, -A project site with slopes: (n0-10% S� % 12110-15% a % 1615% or greater o? r % 6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the National Registers of Historic Places? ❑Yes 13f4 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes JE1No 8. What is the depth of the water table? 3 (in feet) r ��-►Grk 5�f`c� 9. Is site located over a primary, principal, or sole source aquifer? G6Yes ❑No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ®Yes ❑No 11. Does project site contain any species of-pl t or animal Life that is identified as threatened or endangered? ❑Yes ErNo According to - Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) EVYes ❑No Describe Eli 1CP 13. Is the project site presently used by the co unity 9righborhood as an open space or recreation area? 4Yes ❑No If yes, explain QT<et �rd7i r 14. , Does the present site include scenic views known to be important to the community? MYes ❑No 15. Streams within or contiguous to project area: a. Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland are s with in,or4onti pus to,pr ject area: a. Name �Dij 5 �`' Z aA4/' "' b. Size (In acres) 17. Is the site served by existing public utilities? ❑Yes 710 a) If Yes, does sufficient capacity exist to allow connection? ❑Yes ❑No b) If Yes, will improvements be necessary to allow connection? []Yes ❑No 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? []Yes E�SNo 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? ®Yes ONO 20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes [Tlo B. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) t a. Total contiguous acreage owned or con rolled by project sponsor ,' acres. b. Project acreage to be developed:�G 11 C acres initially; acres ultimately. C. Project acreage to remain undeveloped N, ti"S C acres. d. Length of project, in miles: K 1/1 (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed /y � %; f. Number of off-street parking spaces existing,49> C-40t`' e : proposed g. Maximum vehicular trips generated per hour Ao (upon completion of project)? h. If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially K/A Ultimately i. Dimensions (in feet) of largest proposed structure height; r' width; 16'� length. j. Linear feet of frontage along a public thoroughfare project will occupy is? N 01 ft. 3 i 2. How much natural material ( rock, earth, etc.) will be removed iron_,.__.'? site? tons/cubic yards 3. Will disturbed areas be reclaimed? Dyes ❑No IN/A a. If yes, for what intended purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? ❑Yes ❑No c. Will upper subsoil be stockpiled for reclamation? ❑Yes ❑No 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? Dyes tbNo 6. If single phase project: Anticipated period of construction months, (including demolition). 7. If multi-phased: N M a. Total number of phases anticipated (number). b. Anticipated date of commencement phase 1 month year, (including demolition). c. Approximate completion date of final phase month year. d. Is phase 1 functionally dependent on subsequent phases? ❑Yes ❑No 8. Will blasting occur during construction? ❑Yes MNo 9. Number of jobs generated: during construction ; after project is completed 10."Number of jobs eliminated by this project 11. Will project require relocation of any projects or facilities? ❑Yes )JNo If yes, explain 12. Is surface liquid waste disposal involved? ❑Yes E�No a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? ❑Yes EpNo Type 14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes TONo Explain 15. Is project or any portion of project located in a 100 year flood plain? InYes ❑No 16. Will the project generate solid waste? Dyes 7No a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? ❑Yes ❑No c. If yes, give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No e. If Yes, explain 17. Will the project involve the disposal of solid waste? Dyes 17�40 i a. If yes, what is the anticipated rate of disposal? tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? Dyes rNo 19. Will project routinely produce odors (more than one hour per day)? ❑Yes I$No 20. Will project produce operating noise exceeding the local ambient noise levels? Dyes XNo 21. Will project result in an increase in energy use? ❑Yes JNo If yes , indicate type(s) 22. If water supply is from wells, indicate pumping capacity gallons/minute. 23. Total anticipated water usage per day �Ifllq gallons/day. 24. Does project involve Local, State or Federal funding? ❑Yes rNo If Yes, explain 4 25. Approvals Required: Submittal Type Date City, Town, Village Board []Yes ❑No City, Town, Village Planning Board []Yes ❑No City, Town Zoning Board Dyes []No City, County Health Department ❑Yes. El No _ Other Local Agencies ]Yes []No �YI ��'`ts �S «/y� z//5 3 Other Regional Agencies []Yes ❑No State Agencies OYes O No 'C-C Art oZ(^ Y 3 -Federal Agencies ❑Yes ❑No C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? ®Yes ❑No If Yes, indicate decision required: ❑zoning amendment ❑zoning variance ❑special use permit ❑subdivision ❑site plan ❑new/revision of master plan ❑resource management plan ❑other 2. What is the zoning classification(s)of the site? R-qd 3. What is the maximum potential evelopment of the site if develgped as permitted by the present zoning? b o A"C 1C:�cth,r' d C--//.7 4. What is the proposed zoning of the site? IV/A 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? A t/} 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? BTLes ❑No 7. What are the predominantnd use(s) and zoning classifications within a 1/. mile radius of proposed action? 0- 'Vv 0C—a1'S. 8 Is the proposed action compatible with adjoining/surrounding land uses within a 1/s mile? ®Yes ❑No 9. If the proposed action is the subdivision of land, how many lots are proposed? a. What is the minimum lot size proposed? 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes C1l0 11 . Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? 13 Yes JNo a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes ❑No { 4 12. Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes P�Io a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes ❑No D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. E. Verification I certify that th informa 'o provided above is true to the best of my knowledge. Applicant/Sponso me V 4 Date y/Y Signature Title If the action is in the Coastal Area, nd you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 TRUSTEESoo SUPERVISOR John M. Bredemeyer, III, President ,�� Gy SCOTT L. HARRIS Albert J. Krupski, Jr., Vice President c Henry R Smith * ,? Town Hall John B. Tuthill 53095 Main Road William G. Albertson y'�1p1 �.��� P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-99-3-1 Chapt. 97 - Wetlands NAME: Virginia Meyran 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 II DESCRIPTION OF ACTION: Applicant proposes to construct 106 l.f. of timber retaining wall plus 20 ' return on w/s. On e/s wall will connect to adjacent bulkhead. Approx. 375 c.y. of clean sand will be trucked in via Bailie Beach Road to west. A 3 ' wide stairway from west of bluff to beach will be repaired/replaced as appropriate. Project is necessitated by damaged caused by 12/11/92 storm. Located 175 Soundview Avenue, Mattituck. LOCATION: SCTM ##1000-99-3-1 REASONS SUPPORTING THIS DETERMINATION: 1. 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 following mitigation measures be implemented. cc: CAC TRUSTEES �guFFO(�-c SUPERVISOR John M. Bredemeyer, III, President ��. QG SCOTT L.HARRIS Albert J. Krupski, Jr., Vice President Henry P. Smith y - Town Hall John B. Tuthill 0 53095 Main Road William G. Albertson A � P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 12, 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 following applications for a wetland permits: Robert Celic 123-8-29 George Buckley 71-1-8 Schuyler Bergen 119-1-2 Marian Ales 119-1-20 Aristedes Speres 119-1-76 Joseph Mandelbaum 119-1-75 Thomas Losee 118-4-2 John Tobin 118-4-3 Virginia Meyran 99-3-1 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 JMB:jmd RECULATORY AFFAIRS REGION BUILIy3I7G -10 STAVE UT11,57EI►CITY OF. 117-11717 7.'O7I k BTfONly ;"I'LLC5OK, I'IEW Iti'+:.iC 11790.2356 New York State Department of Environmental Conservation -1-OW/1 6 -o c)Q-ao /cL Boo rd 1),)0_T(,C)sur eS Thomas C. Jorilnq 7a,u,-i qu t/ ) qb R 0) f f 79 Commissioner Dear S C-ak ('dp(-d��r- RE: LEAD AGENCY COORDINATION REQUEST The purpose of this request is to determine under Article 8 (State Environ- mental Quality Review - SEQR) of the Environmental Conservation Law and 6 NYCRR Part 617 the following: 1. Your agency's interest 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 the permit application and a completed Part 1 of the Environmental Assessment Form to assist you in responding. Project Name: )/ �c m� yr�� ����f Project Location: ��J�%s�GLiq� -fG�,•>� 70u"-, Suyllw 4 //O/v62 � i ns .Sv�.,ct� v rw �� . , /�'►�Y�,�rr�� sc��'l /GGG� ��3�� DEC Project Number: �, �� 99Y1o0e0/__C' DEC Permits: �Ivv SEQR Classification: [ ] Type I Lj Unlisted APR 2 9 1993 DEC Contact Person: Ifal 0�7 4 `/y1�2 � - TO N OF SOUTH L DEC Position: [ ] DEC has no objection to your agency or another agency assuming lead agency status for this action, but reserves the right to comment on this action if a positive determination of significance is made. -2- [ ] DEC has no objection to your agency or another 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 proposed action has been identified by DEC as occurring wholly or partially 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 anticipated impacts are primarily of local significance. - [ ] Other. (See comments below) Comments (Optional ) : Response: Please respond to this request within 30 days 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, and have no comments to offer regarding the proposed 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 the Commissioner of DEC to designate your agency- as lead, presuming you have jurisdiction. Please feel free to contact this office for further information or discussion. w Sincerely, Enclosures cc: (see distribution list) Tow�v o� s�wi Ka�� EN-CONSULTANTS INC 1329 NORTH SEA RD, SOUTHAMPTON N, Y. 11968 516-283-6360 1 f I Y. .� �� �Iw�� C�:�df tisk;..'� �;+•;, }-r PROJECT INFORMATION .. PART '1 ' .,Prepared by Project Sponsor• osed may have a NOTICE This document is designed to assist in,determining whether the action Answers ro the a quest ons will be cons de ed cant eff on-the environment Please complete the entire form, Parts A through as pal\. rt of the application for approval and may be subject to further verification and public review. Provide any additions information you believe will be needed to'complete Parts 2 and 3. and will not involve It is expected that completion of the full EAF will be depend such addit on Int on ion currently availale work i unavailablebso indicate and specify new studies, research or investigation. If information requiring each instance NAME OF ACTION LOCATION OF ACTION (include Street Address, Municipality and County) BUSINESS TELEPHONE NAME OF APPLICANT/SPONSOR �j'd'Gt7f`1�,63>I T�1�T�3 INC. ( ) rF �{y Ty j,';�CI► T ltV Y. ���� STATE ZIP CODE r)tf J-283-6360 BUSINESS TELEPHONE WNER If different) Uir It,ic. ` r re / /� J 1 6u h Q Vl z / ' STATE ZIP CODE fee 6 ON OF ACTION wall plus 20' Construct 106 l.f. oP timbor rotaininq return on w/s ro Appron oximall ately cylofccleantto sandawillent be bulkhead. App stairway iEromvia west ioEeBeach Road bluff owest. rucked -to b achwillbe r repaired/ replaced as appropriate. Project is necessitated by damage caused by 12/11/92 storm. Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas. 1 Present land use- ❑Urban ❑Industrial (Commercial �JResidential (suburban) (Rural (non-farm) ❑Forest ❑Agriculture ❑Other ' �� v 2 Total acreage of project area: acres ,PRESENTLY AFTER C.QMPLETION APPROXIMATE ACREAGE '`�5 acres � q S acres Meadow or Brushland (Non-agricultural) acres acres Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc) acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres r3 acres Unvegetated (Rock, earth or fill) 0,5 acres •b 5 acres Roads, buildings and other paved su faces , '( D acres •�G acres n< 011ier (Indicate type) ---�yh S �-t---� 3. What Is predominant soil type(S) on project site? — % of site a. Soil drainage: ®Well drained 1-66_ % of site ❑Moderately well drained ❑Poorly drained % of site b If any agricultural land is involved how many acres of Soil R 370)assified within soil group 1 through 4 of the NYS Land Classification System? VA acres (See 1 NYC RR Are there bedrock outcroppings on proje���e? ❑Yes ❑No a What is depth to bedrock? (in feet) 2 -- - r� dprox"ate•percentage of proposed project site with slopes: ®0-10% % CN0-15% o?' % [615% or greater a r % 6. Is project substantially contiguous to, or contain a••,building, site, or district, listed on the State or the National Registers of Historic Places? Dyes ❑f " 7. Is project substantially contiguous to a site listed on'the Register of National {Natural Landmarks? Dyes F]No 8, What is the depth of the water table? (in feet) 9. Is site located over a primary, principal, or sole source aquifer? G6Yes ONO 10 Do hunting, fishing or shell fishing,opportunities presently exist in the project area? ®Yes ONO 11 Does project site contain any species of pl t or a imI life that is identified as threatened or endangered? Dyes INo According to " J Identify each species 12. Are there any unique or unusual land forrps on the project site? (i.e., cliffs, dunes, other geological formations) ®Yes ❑No Describe 13 Is the project site presently used by the con r�unity pr rpghborhood as an, open space or recreation area? C�Yes ❑No If yes, explain QJe<e- . -r r— /- 14 14 Does the present site include scenic views known to be important to the community? 7Yes ❑No 15 Streams within or contiguous to project area: a Name of Stream and name of River to which it is tributary 16 Lakes, ponds, wetland are .011 within or cont) u s to pr ject area. a. Name ZOij /5/��' � a4h b. Size (In acres) 17. Is the site served by existing public utilities? Dyes 710 a) If Yes, does sufficient capacity exist to allow connection? Dyes ❑No b) If Yes, will improvements be necessary to allow connection? Dyes ONO 18 Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303- and 304? Dyes E�No 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? MYes 0 N 20 Has the site ever been used for the disposal of solid or hazardous wastes? Dyes ETNO B. Project Description 1, Physical dimensions and scale of project (fill in dimensions as appropriate) 1 a. Total contiguous acreage owned or colnrolled by project sponsor , acres. b. Project acreage to be developed-��' "T C acres initially; acres ultimately. C. Project acreage to remain undeveloped N� `�A"S C acres d. Length of project, in miles: K (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed /Y 0 f Number of,off-street parking spaces existing/14> proposed g. Maximum vehicular trips generated per hour �'� (upon completion of project)? h. If residential Number and type of housing units. One Family Two Family Multiple Family Condominium Initially 'Y M Ultimately i. Dimensions (in feet) of largest proposed structure height; width, length. j Lincsir (crl (if frontage along ,ri public thoroughfare project will OCCuj)y is?_ ft, 3 2. How much natural material (i e , rock, earth, etc.) will be removed from the site? V toeis/cubic yari;;f„_ ' 3. Will disturbed areas be reclaimed? Dyes ❑No 5�N JA a If yes, for what intended purpose-is the site being reclaimed? b WWII topsoil be stockpiled for reclamation? Dyes ❑No r-, Will upper subsoil be Stockpiled for reclamation? Dyes ON; 4, i-low many acres of vegetation (trees, shrubs, ground covers) will be removed from site? � acres, 5. Will any mature forest (over 100 years-old) or other locally-important vegetation be removed by this project? ❑Yes O�No 6. If single phase project: Anticipated period of construction / months, (including demolition). 7. If multi-phased: K M a. Total number of phases anticipated (number). b. Anticipated date of commencement phase 1 month year, (including demolition). c. Approximate completion date of final phase month year. d. Is phase 1 functionally dependent on subsequent phases? Dyes ❑No 8. Will blasting occur during construction? ❑Yes MNo 9. Number of lobs generated. during'construction4 after project is completed 10 'Number of lobs eliminated by this project 11. Will project require relocation of any projects or facilities? ❑Yes )No If yes, explain 12 Is surface liquid waste disposal involved? Dyes E�N0 a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13 Is subsurface liquid waste disposal involved? Dyes EPNo Type 14 Will surface area of an existing water body increase or decrease by proposal? ❑Yes 'K]No Explain 15 Is project or any portion of project located in a 100 year flood plain? 1nYe5 ❑No 16. Will the project generate solid waste? Dyes [�_N0 a. If yes, what is the amount per month tons b If yes, will an existing solid waste facility be used? ❑Yes ❑No c If yes, give name , location d Well any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No e. If Yes, explain 17 Will the project involve the disposal of solid waste? Dyes 17840 a. If yes, what is the anticipated rate of disposal? tons/month If yes, what is the anticipated site life? years. 18 Will project use herbicides or pesticides? ❑Yes VNO 19 .Well project routinely produce odors (more than one hour per day)? Dyes C6No 20 Will project produce operating noise exceeding the local ambient noise levels? Dyes ' XNo 21. Will project result in an increase in energy use? Dyes JNo If yes , indicate type(s) 22 If water supply is from wells, indicate pumping capacity gallons/minute. 23 Total anticipated water usage per day �� gallons/day. 24 Does project involve Local, State or Federal funding? Dyes rNo If Yes, explain ___ _ 4 ,,Approvals-Required: Submittal Type Date City Town, Village Board F3Yes ❑No Vilkop PIRIIIIIIIH Mio, F1Mi-I - - - -- =u- City, 1 own Zomig Board LIYes I_INo _ City, County Health Department ❑Yes ❑No _ Other Local Agencies WYes ❑No �°�'►/ � 5/2-cs L �/� �/ `i 3 Other Regional Agencies ❑Yes ❑No State Agencies ®Yes ❑No �C r J�`t a r y S3 Federal Agencies []Yes ❑No C. Zoning and Planning Information 1 Does proposed action involve a planning or zoning decision? ®Yes ❑No If Yes, indicate decision required ❑zoning amendment ❑zoning variance ❑special use permit ❑subdivision ❑site plan ❑newlrevision of master plan ❑resource management plan ❑other 2--What is the zoning classification(s)of the site? R— �� 3 What is the maximum potentiOA velopment of the site if/devel ped as permitted by the present zoning? r c..r��,,� cr 4. What is the proposed zoning of the site? 5 What is the maximum potential'development of the site if developed as permitted by the proposed zoning? 6 Is the proposed action consistent with the recommended uses in adopted local land use plans? ETLess ❑No 7 What are the predominantnd use(s) and zoning classifications within a '/4 mile radius of proposed action? a— L10 O Fv,s. 8 Is the proposed action compatible with adjoining/surrounding land uses within a '/4 mile? [Res ❑No 9 If the proposed action is the subdivision of land, how many lots are proposed? (A a What is the minimum lot size proposed? 10 'Will proposed action require any authorizations) for the formation of sewer or water districts? ❑Yes filo 11 . Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? ❑Yes upNo a If yes, is existing capacity sufficient to handle projected demand? ❑Yes ❑No t 12 Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes pq-40 a If yes, is the existing road network adequate to handle the additional traffic? El Yes ❑No D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them E. Verification I certify that th informa o provided above is true to the best of my knowledge. U _/ Applicant(Spons0f-c-'k Date Signature Title mss• :A—6A/ /x ` If the action is in the Coastal Area, Ind you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 A& NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION /t/7 �� /—In Iowa JOINT APPLICATION FOR PERMIT U.5 ARMY CORPS OF ENGINEERS APPLICATION NO Please read ALL instructions on back before completing this application Please type or print clearly in ink.Attach additional information as needed ❑ARTICLE 9, TITLE 1,ARTICLE 43 6NYCRR 646(LAKE GEORGE RECREATION ZONE) ❑ARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) ❑6NYCRR 327(AQUATIC VEGETATION) ❑6NYCRR 328(FISH) ❑6NYCRR 329(INSECTS) S ❑ARTICLE 15, TITLE 5 6NYCRR 608(PROTECTION OF WATERS) T El For the construction, reconstruction,or repair of a DAM or other impoundment structure A T ❑For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS , E1401 WATER QUALITY CERTIFICATION E ARTICLE 15, TITLE 15 ❑6NYCRR 601 (WATER SUPPLY) 1:16NYCRR 602(LONG ISLAND WELL) ❑ARTICLE 15, TITLE 27 6NYCRR 666(WILD, SCENIC AND RECREATIONAL RIVERS) ❑ARTICLE 24 6NYCRR 662. 663(FRESHWATER WETLANDS) ❑ARTICLE 36 6NYCRR 500(FLOODPLAIN MANAGEMENT) EiARTICLE 25 6NYCRR 661 (TIDAL WETLANDS) ❑ARTICLE 34 6NYCRR 505(COASTAL EROSION) -------------------------------------------------------------------------- __ ---------------------------------------------------------------------- F ❑SECTION 10(RIVER AND HARBOR ACT OF 1899)for structures and work in navigable waters of the U S. ❑COASTAL CONSISTENCY CERTIFICATION E ❑SECTION 404(CLEAN WATER ACT OF 1977)for disposal of dredge;!or fill material in waters of the U S. D ❑SECTION 103(MARINE PROTECTION, RESEARCH AND SANCTUARIES ACT)for the transportation of dredged materials for dumping into ocean waters 1 LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES(If any) 2 APPLICANT IS A/AN IAlOwner ❑Operator El Lessee ❑Municipality/Governmental Agency (Check as many as apply) 3 NAME OF APPLICANT(Use Full Name) VIRGINIA MEYRAN MAILING ADDRESS TELEPHONE(Where can be reached during day) 175 Soundview Avenue F (516) 298-5139 POST OFFICE STATE ZIP CODL Mattituck NY 11952 4 NAME OF 11 Owner ®A en Contact Person g U (Check'.one) Roy L. Haie, En-Consultants Inc MAILING ADDRESS TELEPHONE(Where can be reached during day) 1329 North Sea Road (516) 283-6360 POST OFFICE Southampton STATE ZIP CODE NY 11968 5 PROJECT/FACILITY LOCATION(Mark location on map,see Number 1B on reverse side) County Suffolk I Town or city Town of SOuthOldl Village STREET ADDRESS(If different from applicant) Same POST OFFICE _ e � )QQ� i ANr� STATE ZIP CODE 4 _ I{ 6 NAME OF STREAM OR BODY OF WATER g Iron Island Sound ,°; '`4r; 7 HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work without permit,' includes dates Ly 8 WILL PROJECT UTILIZE STATE LAND? Dyes Ga No Show work on map and/or drawings Dyes GiNo 9 PROPOSED USE ® Private 10. PROPOSED STARTING DATE" 11 APPROXIMATE COMPLETION DATE 1 12 FEE OF(NYS Permit Only) ❑ Public ❑ Commercial ASAP ASAP $ Enclosed 13 PROJECT DESCRIPTION (e g quantity and type of material to be excavated, dredged or used for till or rip rap, location of disposal sites, type of r structure to be installed; height of dam, size of impoundent, capacities of proposed water sources;extent of distribution system,etc) SEE ATTACHED 14 WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL. STATE AND/OR LOCAL PERMITS? TOWN OF SOUTHOLD, DOS, COE Yes ElNoIf yes, please list 15 CERTIFICATION I hereby affirm that under penality of perjury 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 surfered, ansing out or tho projo<t 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, 18 U S C Section 1001 rovides for a tine of not more than 510.000 or imprisonment for not more than five years, or both %%here an applicant knowingly and willfully talsifies,con a s,o7cove s up a material fact,or knowingly makes or uses a false, fictitious or fraudulent statement ❑I hereby authorize the agent named in Number ovem is application on my behalt April 12, 1993 President 1)1rF R IGVAME -- -- ------ nrll PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE PROJECT DESCRIPTION Re: VIRGINIA MEYRAN Construct 106 l.f. of timber retaining wall plus 20 ' return on w/s. On e/s wall will connect to adjacent bulkhead. Approximately 375 cy of clean sand will be trucked in via Bailie Beach Road to west. A 3 ' wide stairway from west of bluff to beach will be repaired/ replaced as appropriate. Project is necessitated by damage caused by 12/11/92 storm.