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HomeMy WebLinkAboutTR-5201 Docko, Inc. P.O. Box 421, Mystic, CT 06355 (860)572-8939 Fax: (860)572-7569, e-mail: docko@snet.net 9 I � January 18, 2005 Mr. Albert Krupski, President Southold Board of Trustees P.O. Box 1179 Southold, NY 11971 Re: Rolla Campbell Property Boat Lift Variance Dear Mr. Krupski: Last summer the Board of Trustees approved the removal of a floating dock and ramp and extension of the fixed pier including an "L" shaped end pier for Rolla and Kim Campbell's property in East Harbor on Fishers Island. Part of their original application was the installation of a boat lift as well. We would like to know if the Board of Trustees would be agreeable to reconsidering the boat lift since it was not approved as part of the dock modification application. We understand that the dock ordinance prohibits the installation of boat lifts. I feel however that there are mitigating circumstances in East' Harbor` that are beyond the considerations emphasized when the ordinance was adopted. ,The water in East Harbor is usually wavy and can be rough when there is a west or especially northwesterly, wind. The waves build with significant fetch in Fishers Island Sound and as the water depths 'become shallow in East Harbor, especially at low tide, the waves build toward the breaking point'in the vicinity of the Campbell's dock. This is a tough environment to put a boat in the 20' to 35' range and during such conditions the vessel will stress and wear the tie-off lines significantly and even damage the cleats or guides on the vessel. This was the justification behind the boat lift installed at the Balcom's property next door in the 90's. We feel that this is an urgent consideration for the Campbell's for boating to be realistic and for the safety of the Campbell's and the equipment to be maximized. Conditions in the Sound can change quickly; smooth water at'departure does not guarantee smooth water upon returning. It would be greatly appreciated if you would reconsider this; we would be agreeable to making a presentation or visiting with you at the site at your convenience to observe these particular conditions. Again, we feel that the prohibition against boat lifts is a "viable consideration in small creeks and protected areas, but this is not one of those areas. If you could let me know the consensus of the Board, we will pursue this further as appropriate. D Q U tfully.submitted; O; INC. JA N. 1. 9 2005 = eft B. Neilson"P.E. Board of Trustees KBN:j m CC: Dr. &Mrs. Rolla Campbell n File: 03-03-1409 CAMPBELL 1 Dock®, Inc. P.O. Box 421, Mystic, CT 06355 (860)572-8939 Fax: (860)572-7569, e-mail: docko@snet.net February 18, 2004 Mr. Chuck Hamilton NYS DEC Building 40, SUNY Stony Brook,NY 1 1 790-23 5 6 Re: Dock Modifications, Fishers Island Rolla Campbell Dear Mr. Hamilton: We are pleased to submit herewith the revised permit application and drawings for Rolla and Kim Campbell at East Harbor on Fishers Island. These drawings reflect terms of our most recent discussion which was to remove the boat lift and add a tie-off pile in the northwest quadrant of the berthing area for boat security during high wind and higher than normal waves. In addition, we had received correspondence from Mrs. Balcom which indicated a strong preference to reduce the height of the tie-off piles from17 feet and reduce the,size of the "U' shaped pier by 10 feet. Both of those modifications have been done as well in the interest of neighborly relations. All of these changes have been coordinated with the New York State, Department of State in Albany and I believe that we have satisfied all concerns.- We are awaiting modifications to the Town's permit application process. Evidently, the proposed modifications were considered an expansion of and therefore subject to the moratorium. Nonetheless, we would request issuance of the DEC permit. at the; earliest opportunity so that these issues can be resolved. Your assistance.has been greatly appreciated, as always. Please let me know if the need for further discussion arises. Yours truly, DOCKO, INC. Keith B.Neilson, P.E. KBN Jm Enclosures CC: Dr. &Mrs. Rolla Campbell NYS DOS: Pollay Town: Krupski ACOE: Russell Smith File: 03-03-1409 CAMPBELL " 36` / 36 •'� �RF 16 3B L e 37 •fl /y L2 p EST _ 47i I 1-7 26 / �A7CL.JOf� 33`2 19 R IS I� 16 r O ee 1` 9 SUN 7[' R 13 E 1I •Fwl••� 16 • 13 4 .LJ II 12. _ 7 EO � 1,� O s / I 3 ! fp°1 10 O N/F PROPERTY C1. •o �;� I _ j o ; �• OF BALCOM TRUST 10 d � I 21 2322 PROPERTY Y' b� •3. 3 \.!� 3B OF ` CAMPBELL 4 33 53 21 2 36 43 •�• 28 G2 46 50 4B 6 vx j PROJECT _: DOCK MODIFICATIONS LOCATION 1"I�.P REFERENGE GHART:12372 GRAPHIC SCALE s. .L:: :::�:.:�' :........... V ?<VA' s O t000 IN YARDS l000 ::�. �.� N/F PROPERTY NOTES: OF ­­ FISHER-5 FI H S ISLAND 1, ELEVATIN O DATUM IS MEAN LOW WATER. -t a GLUE COUNTRY T FROM 2003 NOAA TIDE TID �::.... i E 2. DATA ISAKEN. : TABLES REFER ENGE.N OA N MYSTIC NER. and 5TONINGTON HARBOR 6 3 PROJECT DESCRIPTION: MB ::,:;.:.:..,..,........,..._. ........................................ ER ....:......:.:. . .. ...... .. ....:_;..:.:, .:.,.:.;,.. ....,.,>.•: � �``:`:<:'-�'.::> : ADD 24rLF OF 4-FT WIDE FIXED WOOD PILE AND TI PIER EXTENSION AND A 20±LF X 4 WIDE FIXED'L°, APPROXIMATE ::::•4: <; :• INCLUDING ASSOCIATED BRACED SUPPORT PILING,A NEW :: .''PROPERTY LINE -: ,r: BRACED TIE-OFF PILING AND RELOCATE THREE EXISTING .............: E ............ APPARENT HIGH WATE R LINE 4.PROJECT PURPOSE: ., THI5 I5 A PRIVATE DOCK FOR RECREATIONAL _ BOATING. i• .�•..:Fl��HEFZS ISL.�IVC� 5 THESE APPLICATION DRAWINGS REPRESENT A COMPILATION OF SURVEYS FOR PERMIT PURPOSES.THEY ARE NOT CONSTRUCTION CONTRACT DOCUMENTS. 6.ADJOINING PROPERTY OWNERS: SOUTH: NORTH: •� FISHERS ISLAND COUNTRY CLUB ROBERT GOLDIE,JR.�LUGIELE BALCOM FISHERS ISLAND 230 PARK AVENUE SUITE 1130 SOUTHOLD,NY 11971 NEW YORK.NY 10169 GRAPHIG SCALE 1'=300' PROJECT: DOCK MODIFICATIONS 300 200 100 O 300 REVISED 2-13-04 DEG LOCATION: FISHERS ISLAND,TOWN OF SOUTHOLD NOTES SUFFOLK COUNTY,NEW YORK Q� 1 `° WATERWAY: EAST HARBOR DATE: JULY11,2003 p C KO . %���rJN 'ytx.,°•r r APPLICANT: ROLLA CAMPBELL r \ � rc �: AGENT: SHEET 1 OF 4 ��°� / D0Cl- , INC. cc, �w *:''''=` Keith B.Neilson,PE R a < O pp 008���.� � / Mystic,CT 06355 �'�R�,��•. \�� 860 572 8939 FAX 800 572 7569 DWG 03-03-1409 17'Or 1.1,s/ EMAIL:docko@snet.net Kekh Neilson,Docko•Inc 2/13/2004 410 PM Gampbell_113.dwq o EAST 5 �\\ EXISTING ro'X 20' 1 TING K -7.6- 'FLOAT WITH FEASTING BATTERED RESTRAINT PILINGS TIE-OFF PILE(TYP)- TO BE REMOVED TO BE RELOCATED FOOTPRINT OF PROPOSED PIER-,�h' EXTENSION ww LIMIT OF ROCKS EXISTING RAMP -3. Q 2 TO BE REMOVED EXISTING _3_0 IPRAP REVETMENT END OF PIER EL.7.5± -2 1 '-2.9 &24 N/F PROPERTY 2� .-2.9 4-FT.7 EXISTING CLEAR WIDTH ­ FixEc)w000 PILE s TIMBER BOULDER PIER TO REMAIN 0 0 Typ) Om 0 0 0 BEGINING PR ..TE PIER EL 11,± HOUSE LAWN PROPERTY SAND✓ STONE CAMPBELL- BRUSH x DRIVEWAY E?G�TINO CONDITION. GRAPHIC 5GA..F_ V=SO' FEEEEEREr— I PROJECT: DOCK MODIFICATIONS roo 30 0 rao REVISED 2-13-04 DEG LOCATION: F15HIER515LANE),TOWN OF 5OUTHOLD PROPOSED FOOTPRINT SUFFOLK COUNTY,NEW YORK WATERWAY EAST HARBOR 141 c1c o , ­`Nl DATE. JULY 11,2003 APPUGANT. CAMPBELL- fill AGENT: SHEET 2 OF 4 Keith B.Neilson,PE eit 0686c),�- Mystic,CT 06355 860.5728939 FAX 8605727569 DWG 03-0.3-14.09 -)snet.net EMAIL:dockoL Keith Neflson,Dockalnc 2/13/2004:258 PM Campbell-2B.dw9 -5.0 X -5.3 X -5.0 X RELOCATED BRACED E T1E--OFF PILINGS NEW BRACED NEW 4-FT X-4.6 5 TIE-OFF PILING -5'5 X CLEAR WIDTH X-4.6 FIXED ,L" -4.3 X-4.2 FOOTPRINT `BOO X-4.0 �3$ OF EXISTING FLOAT \ `� -4.6 X NEW BATTERS � �Fo -3`.7/� > X-3.5 X-3.4 EA�'T SUPPORT /� NEW FIXED PIER H,�.FzB02 PILE(TYP) NEW LADDER O / Ix-3.4 EXTENSION 0_1 �\ (7) -3.3 END EL 7.5± -3.9 X p�c p-2.1 X� I- �< r -3.5 X �-2.6 X-3.9 -2.8 < OAR® O TOWN OF a � � �' :., AA X- 8 D X-2.9 TV 'A / -0.5 X-3.0 • -2.8 X 2.5 X-2.9 13 X O - X X-3.0 40 CX -1.4 1.6, -2 1 EXISTING 4-FT CLEAR WIDTH -0.7 0FIXED WOOD PILE TIMBER PIER X 2 0 X -1.7 RETAIN and MAINTAIN X-2.8 -0.5 �li X EXISTING PIER cc SUPPORT PILE(TYP) X-1.6 -2.8 X O BOULDER(TYP) . X APPROXIMATE LIMIT OF ROGK5 O \ EXISTING a0 SrT RIPRAP REVETMENT PROPERTY \y \ COIVDITlON o Ur OF �Tylla GRAPHIC SGALE 1'=20' BEGINNING �GAMPBELL��� \ 20 10 O 20 PER EL 11't PROJECT: DOCK MODIFICATIONS REVISED 2-13-04 DEG LOCATION: FISHERS ISLAND,TOWN OF SOUTHOLD NEW TIE-OFF,BOAT LIFT SUFFOLK COUNTY,NEW YORK of ¢-- . f _ , REMOVED FIXED'L'DIM. WATERWAY: EAST HARBOR DATE: JULY 11,2003 . 0 C K O �;(/7��, ":,' ,• ''� APPLICANT. ROLLA CAMPBELL AGENT: SHEET 3 OF 4 VOA - 4 C)OGK0, I NC w Keith B.Neilson,PE O p Q $ 06 gc1^ �'�`>; Mystic,Cr 06355 C' R p► ��' -�'� G,�i� , ✓� 800 572 8939 FAX 860 572 7509 DWG 03-03-14-09 Er-AL:docko@snet.net Ke"Neilson,Docko.lnc 2/l3/2004 4-.09 PM Gampbell_3G.dwq r NEW GROSS I I NEW BRACED I 1 BRACE TIE-OFF PILE TOP and NEW FIXED V NEW EL 17m(7YP) SPLIT DECK EL 7.5= LADDER' YP) CLAMP CLEAR NEW BRACED ('TYP) I V 2a* PIER SUPPORT PILE FIXED"L' _ TOP EL 3-FT A30VE DECK(TYP) EXISTING _ - ROCK TOP EL -2.3± —MHWL 25'— TO BE -a-wL o.o'-- I r 7 irk cr,, Yam:i •)Y - - �DI yS�t •BOTTOM F.. =.dry• . SGATERED Roos - SAND' 2+ '•i�'y�ri�a��! GRAPHIC SCALE 1'=10' W Z EXISTING RIPRAP - REVETMENT TO REMAIN- LAWN - --- - = -- --- --- --- — --- �HWL3.6'sM EXISTING FXED PIER H�WAI_25' -- ••,,• j -- -- --- AVVL 0.0' -_ M BOTTO EDIMENTS BOTTOM B DI • ;1 -.•Y�- ;SAND GATTERED ;. M BOULDERS and COBBLE j" ••Fr ;`,•v:i:.`it :;is NEW 24tLF NEW PIER EXTENSION SUPPORT DECK EL 7.5f PILE(TYP) NEW BRACED DGSTING FIXED PIER 2 I T1E-OFF PILE II I EL 17:t(TYP) -- --- --- — --- AHWL3.6's MHWL25' — V - ----- --------- -- --- -- — — -- --- ALWLO.O' --� - --NEW— - --------- �_ ::.>:.: •c•:;-.'�::>..,:-<;•' .:.,,.. =%.- SOTTO EDIMENTS: DER BOTTOM SEDIMENTS: - cn,• K'i kI%'=;•::: �''. 'i 5,•'.:. 1•••,4o'rl+aa^ -Fn.0 J:. _ — �.,.i e ti <�SAND ATTERE D (TY BOULDERS and GOBBLE •�:<,, .;-•,,-:::.r,:.., ;.:`� -....r..ay. „r,..y,::: BOULDE ��Q III .._ _..... ;'W`;:'o'.,r7.�•r:cfy::'1"•'^`' GRAPHIC SCALE 1"=20' FEEEEEEEI 20 10 o io PROJECT: DOCK MODIFICATIONS REVISED 2-13-04 DEC LOCATION: FISHERS ISLAND,TOWN OF SOUTHOLD ()� IVY/ PIER LENGTH BOAT LIFT SUFFOLK COUNTY,NEW YORK < ,"El a j 0. • WATERWAY: EAST HARBOR DATE: JULY 11,2003 0 C K 0 . A APPLICANT: ROLLA CAMPBELL ; , ' , ,! ;"f AGENT: SHEET 4 OF 4 _ ,q Keith B.Neilson,PE 0 R P O,R p` ` Mystic,CT 06355 '•FI=S c.i?'`4 860 572 8939 FAX 800 572 7569 • � ..s.•• DWG 03-03-1409 EMAIL:docko@snet.net Keith Neilson.Docko,lnc 2,13/20044:07 PM Compbell_4B.dwg suFFoc� Albert J.Krupski,President ���►� CMG Town Hall James King,Vice-President = 1 53095 Route 25 Artie Foster P.O.Box 1179 y Southold,New York 11971-0959 Ken Poliwoda Peggy A. Dickerson y�� a��� Telephone(631)765-1892 j Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 21, 2004 Mr. Keith Neilson, PE Docko, Inc. P.O. Box 421 Mystic, CT 06355 RE: ROLLA CAMPBELL PRIVATE RD., FISHERS ISLAND SCTM#4-4-16 Dear Mr. Neilson: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 21, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#5201 to add 24 If. of 4' wide fixed wood pile and timber pier extension and a 20 If. X 4' wide "L" including associated braced support piling. A new braced tie-off piling and relocate three existing braced tie-off pilings, and all as depicted on the plan prepared by Keith B. Neilson, PE dated July 11, 2003. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims ti. -- - __ Dock®, Inc. (� 0 flE 1Fn P.O. Box 421, Mystic, CT 06355 (860 939 Fax: (860) 572•-756 , e ail: docko@snet.net JAN 2 0 2004 Southold Town Ja t Mr. Robert H. Goldie, Esq. Satterlee Stephens Burke&Burke LLP 230 Park Avenue New York, NY 10169-0079 Re: Application.No. 2003--01296 L2 Rolla Campbell Dear Mr. Goldie: We are in receipt of your letters dated December 5v' and 151h to the U. S. Army Corps of Engineers regarding the modification of the dock system at the home of Rolla B. and Kim Campbell on Fishers Island. I have discussed with Dr. Campbell your proposed modifications to the dock which would relieve your current objections. I explained that the purpose of the tie-off piles being at 17 "feet is'to afford protection of a berthed boat even if storm surge tides are encountered and the Campbell's are unable to move the boat in advance of such,tides. These tie-off piles could be lowered five feet to an elevation of 12 and still provide a reasonable level of protection for up to 10-year stornis. On that basis, Dr. Campbell is agreeable to lowering the tie-off piles. I have also explained to Dr. Campbell that with his current 27-foot Osprey motorboat, a berthing pier of 25 feet would accommodate almost all of their needs without blocking the lift slip. It does not provide such desirable access for the southwesterly slip. Dr. Campbell has agreed that in the interest of maintaining neighborly relations, he will direct us to shorten the"L" by 10 feet. We will submit revised drawings to the Corps of Engineers in response to your letters so that this permit process may be completed and drawings to the other agencies who have already issued permits. We trust that you will find this all to your satisfaction. Yours truly, DOCKO 1NC. 7 � _ Keith B. Neilson,:P.E. . ; . CC:'Dr.'Rol Ia•Campbell NYS DEC: Westerlind US ALOE: Roth " TOS: Krupski File: 03-03-1409 CAMPBELL .ti, oSuflFot,�� .� Town Hall Telephone y 53095 Route 25 (631)765-1992 0� ® P.O.Box 1179 �01 � Sao Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN.OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, January 13, 2004, the following recommendation was made: ROLLA CAMPBELL to Amend Permit#5201 to add 24 (+/-) If. of 4' wide fixed wood pile and timber pier extension and a 30 (+/-) If. X 4' wide wood fixed "L", a boat-lift kncluding associated braced support piling and relocate three braced tie-off pilings all waterward of the apparent high water line. Located: Private Rd., Fishers Island. SCTM#4-4-16 The CAC did not make an inspection, therefore no recommendation was made. ROLLA CAMPBELL PHOTOGRAPHS Fr- ALv - s XL ABOVE: THIS PHOTOGRAPH SHOWS THE EXISTING PIER LOOKING FROM THE BALCOM PROPERTY TO THE EAST. THE REASON FOR THE PIER'S LENGTH IS CLEARLY EVIDENT IN THIS AND THE NEXT PHOTO SHOWING SHALLOW SUB-TIDAL WATERS AND AN EXTENSIVE INTER-TIDAL SHELF NEAR SHORE,STREWN WITH BOULDERS. k D EDECf- - � � DEC2003 OO Southold Town Board of Trustees ROLLA CAMPBELL PHOTOGRAPHS ABOVE: THIS PHOTOGRAPH SHOWS THE CAMPBELL HOME AND SHALLOW INTERTIDAL AREA AT MEAN LOW WATER EXTENDING OUT HALF OF THE PIER'S LENGTH. WATER DEPTHS ARE NOT APPRECIABLE UNTIL THE BERTHING SLIP IS REACHED WHICH IS THE REASON FOR THE EXTENSION. THE "L" SHAPED AS PREVIOUS DESCRIBED IS TO HAVE THE BERTHING SLIPS ALIGNED INTO PREVAILING WIND AND WAVES FROM THE WEST AND MOST SIGNIFICANT WAVES FROM THE NORTHWEST. ROLLA CAMPBELL PHOTOGRAPHS ABOVE: THIS PHOTOGRAPH SHOWS THE EXISTING PIER AND TIE-OFF PILE CONFIGURATION FROM THE SHORELINE BY THE HOUSE LOOKING TO THE NORTHEAST. THE PROPOSED PIER WILL EXTEND INTO THE CURRENT TIE- OFF PILE CONFIGURATION AND TURN LEFT ACROSS, TRANSVERSE TO THE CURRENT SLIPS. THE REASON FOR THE "L" IS TO ALLOW THE BERTHING SLIPS TO FACE INTO THE ONLY AREA OF SIGNIFICANT FETCH WHICH IS TO THE NORTHWEST. THE SITE IS PROTECTED BY THE POINT IN THE BACKGROUND FROM NORHEASTERLY WAVES AND SHIELDED AGAINST ALL OTHER WAVES BY FISHERS ISLAND. [DATE: LOCATION MAP NEW(oVO : "DOCK MODIFICATIONS" -BLOCKISLq�VpfERRVAY: EAST HARBOR _----- ---____ N: FISHERS ISLAND,TOWN OF SOUTHOLD 75 SUFFOLK COUNTY,NEW YORK NT: ROLLA CAMPBELL JULY 11,2003 70 �jl 30 Eest \)\�� Clump 1S0\ _1 67 �0 / � 1E I?ldl 53 C u p —I}— 60 f y 2 O I� 35 -� v---- _ 9°� F Was �� ---- _ Clu p ��. )E 42 'I6 ul it O ock Pi e �12'�0�� Br old —� �iE I lands 27 i n* Fou �. cl ` 6`-- '�' 9""s _ o, '�r ,ll? ` '` •_ :K3'd. "/-- �:' �. ..0�`' %•'pi:.j 11 A\ ,t � �•. rJ''Ii: nt^ m � .V \'.A�k\ � .• Mr"' IIp °J • •�- ("� .\1\ �.,"J,1 is i :.`•;r /, e •F AI dteVI- rytw j�% � `i� �I`%'�—•`,.. dj e. ec :, .�, ° 0-IE il--• 22 IL (T Taure. . Al >E r�av P t 48 / �u a Ida ow 30 Isl¢nd a/ as 5 �.\ P nd � •` (-., i' 1 orb/ P1 'Zo 79 g0 O 25 57 96 2 TAX ASSESSOR'S MAP 004,SECTION 4,LOT 16 t """' PROJECT: "DOCK MODIFICATIONS" 2 WATERWAY: EAST HARBOR _��1L Fis,yF�,s LOCATION: FISHERS ISLAND,TOWN OF SOUTHOLD tN°N[LIN4) i SUFFOLK COUNTY,NEW YORK kt.4.. APPLICANT: ROLLA CAMPBELL r DATE: JULY 11,2003 �•� C` .1 SEE SEC. N " o.eo R.D.a I r• FO�'1 �- � 13 ' •�••• �4,S,T I to R.3 A 1 14 ��09 4.0A _.,._. ... ... , .._.. P E , a: o 1 3. ' 12 1.74 i 4 ��Q• 4.3A 13 \ 3AA 5 ISA S IbA 17A N.1w F� J \ 10 t „ 12 I/ 1.4A 29.7 A(c) Y ,i • }, 'R EASTJU �. 14 3A E.2A .� A• M. •: No • IJ 0 �,. t,•rE FIB ' 4.1. 4.2 T+'. 1.7A It .. �' 2.7AW 5.SAW Z, cl •iP - t I.OA EM1 h.. 510 5.2 AAk) y lPPlcxil•L w[.) ` f R< z.: �•`R� .� q. Jio CU E.64(c) Oa.6 ti 9 .� RD. 12.3 A(a) 5.8 3.3A(c) ;'I I•c'• YY.Y. (UNDERWATER LAND) txoN •" a S 3.EA � 7.4 N � 7 ,..r40 •4• 0 �•• ) P� f 14 rl �j . cove �G\' w 7.3 A f' - :! EY�IE�D �V I • A 8 PR L SEE SEC. NO. ISO i 3 764 \� -\ ••. , IT'TEMANC 11i\°TION[Of ANY N 17pNTION 0ME!T,C SWFLK COU ONTY TA MAY 13 FROM ITCO t •1 .a �\..•` /\ WITNO N."t I[NT-W-IN W THE OPE•^��/ NEAL INRTT TAR tCRVIC[ AOCNCY I ��'••Y N.1Y.._% ��_••.JMNLCSS ORIMM CtKCR11SC, ALL PRP fCRTICS �R1[[ F' ••�_ ARE 1110IM TM[ r°LLOWIM■ 0 ICT[I 11 `\` [ONO°L tCM[N SOUND ww° I'EiflT ENOKLIIA[J `— , 1._.... A EERNr •o Llt Ni YAi[R PARR REFUSE SI ©KEY MAP j COUNTY OF SUFFOLK TDRNDF SOUTHOLD SECTION NO. Real Property Tax Service Agency YILLAGEOF 004 oat a0i oR SCALE IN FEET County Center DISTRICTNO. IOOO AI Ito Riverhead,L.I., New YES I. Pk PROPERTY MA .1 D.h.l C.1.I.11.R k { Docko, Inc. P.O. Box 421, Mystic, CT 06355 (860)572-8939 Fax: (860)572-7569, e-mail: docko@snet.net October 30,2003 NYS DEC Environmental Permits Building 40, SUNY Stony Brook,NY 11790-2356 Re: Rolla Campbell Dock Modifications . To Whom It May Concern: On behalf of Dr. Rolla Campbelll we request a Tidal Wetlands Permit including Water Quality Certifications, as necessary, for dock modifications on Fishers Island, New York. e enclose the following in support of this permit application: — ❖ Four prints each of plans titled: 4 1 9 2003 : . Project: "Dock Modifications" Waterway: East Harbor Location: Fishers Island, Town of S u so tees Suffolk County,New Yo Applicant: Rolla Campbell Date: July 11,2003 ❖ Four copies of the NYS DEC Joint Application, including the Short Environmental Assessment Form, Tax Assessor's Map, Photographs and Location Map. 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. C Keith B.Neilson, P.E. KBN Jm Enclosures CC: Rolla Campbell US ACO-E - CTon of Southold: Krupski File: 03-03-1409 CAMPBELL f ~ 95-19-3 (e/00)plp JOINT APPLICATION New York State POR PERMIT i1, United States Army Corps of Engineers Applicable to agencies and permit categories listed in Item 1. Please read all instructions on back. Attach additional information as needed. Please print legibly or type. 1.Check permits applied for: 2.Name of Applicant (Use full name) Telephone Number (daytime) NYS Dept.of Environmental Conservation ROLLA CAMPBELL (631)788-7803 ❑ Mailing Address Stream Disturbance(Bed and Banks) PRIVATE ROAD El Navigable Waters(Excavation and Fill) ❑ Docks,Moorings or Platforms Post Office State Zip Code (Construct orPlace) FISHERS ISLAND NY 106390 ❑ Dams and Impoundment Structures 3.Taxpayer ID (if applicant is not an individual) (Construct,Reconstruct or Repair) ❑ Freshwater Wetlands ❑ Tidal Wetlands 4.Applicant Is a/an: (check as many as apply) ❑ Coastal Erosion Control ❑ Owner ❑ Operator ❑Lessee ❑Municipality/Govemmental Agency ❑ Wild,Scenic and Recreational Rivers 5.If applicant is not the owner,identify owner here- otherwise, you may provide Agent/Contact Person information. ❑✓ 401 Water Quality Certification Owner or Agent/Contact Person ❑ Owner ❑Agent/Contact Person Telephone Number (daytime) ❑ Potable Water Supply KEITH B. NEILSON. P.E., DOCKO, INC. (860)572-8939 ❑ Long Island Wells Mailing Address ElAquatic Vegetation ControlP. O. BOX 421ol post Office ❑ Aquatic Insect Control MYSTIC state Zio code El Fish Control CT 016355 6.Project/Facility Location (mark location on map, see instruction la.) NYS Office of General Services Countv: Town/CitvNillaae: Tax Mao Section/Block/Lot Number. (State Owned Lands Under Water) SUFFOLK F.I.,TOWN OF SOUTHOLD 1000-004-4-16 ❑ Lease,License,Easement or Location (includinn Street or Road) Telephone Number (davtme) other Real Property Interest PRIVATE ROAD (631) 788-7803 Utility Easement(pipelines,conduits, cables, etc.) Post Office State Zip Code 1 7.Name of Stream or Waterbody (on or near project site) El Docks,Moorings or Platforms FISHERS ISLAND CT 06390 EAST HARBOR (Construct or Place) 6.Name of USGS Quad Map: Location Coordinates: Adirondack Park Agency NEW LONDON, CT-RI-NY ❑ Freshwater Wetlands Permit NYTM-E NYTM-N 4 ❑ Wild,Scenic and Recreational Rivers 9.Project Description and Purpose:(Category of Activity e.g.new construction/installation,maintenance or replacement; Type of Structure or Activity e.g.bulkhead,dredging,filling,dam,dock,taking of water, Type of Materials and Quantities; Structure and Work Area Dimensions;Need or Purpose Served) Lake George Park Commission ADD 24(+/-) LF OF 4-FT.WIDE FIXED WOOD PILE AND TIMBER PIER ❑ Docks(Construct or Place) EXTENSION AND A 30(+/-) LF X 4'WIDE FIXED"L",A BOAT LIFT INCLUDING ❑ Moorings(Establish) ASSOCIATED BRACED SUPPORT PILING,AND RELOCATE THREE BRACED TIE-OFF PILINGS ALL WATERWARD OF THE APPARENT HIGH WATER LINE. US Army Corps of Engineers ❑ Section 404(Waters of the United States) ❑✓ Section 10(Rivers and Harbors Act) ❑ Nationwide Permit(a) Identify Number(s) For Agency Use Only: DEC APPLICATION NUMBER US ARMY CORPS OF ENGINEERS ropose Use: 11.Will Project Occupy 12.Proposed Start 13. Estimated Completion ❑ ❑ ❑ State Land?❑ ❑ Date: Date: .Private Public Commercial Yes No T.B.D. T.B.D. 14.Has Work Begun on Project? (If yes, attach ❑ ❑ 15.List Previous Permit/Application Numbers and Dates: (If Any) explanation of why work was started without permit.) Yes No 1-473Ig_09'7 p-7 000 I AUG 11 910W 16. Federalthis, Staect te, ocaAennitnal ❑ ❑ If Yes, U.S.ACOE,TOWN OF SOUTHOLD Federal, State,or Local Permits? Yes No Please List: 17. If applicant Is not the owner,both must sign the application I hereby affirm 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 suffered,arising out of the project described herein and agrees to indemnify and save harmless the Stale 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 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years,or oth where an applicant knowingly and willingly falsifies,conceals,or covers up a material fact;or knowingly makes or uses a false,ficticious or fraudulent statement. I Cs `\d, 'Yvr� 7 1 Date Signature lic t ` Title Date A� 21 Signature of wner ° � �^^— �`� Title RESET PROJECT ID NUMBER SEAR APPPENDIENDI X C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME ROLLA CAMPBELL DOCK MODIFICATIONS 3.PROJECT LOCATION: FISHERS ISLAND,TOWN OF SOUTHOLD SUFFOLK Municipality County 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map PRIVATE ROAD 5.IS PROPOSED ACTION: 0 New ❑Expansion Ft/1 Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: ADD 24(+/-) LF OF 4-FOOT WIDE FIXED WOOD PILE AND TIMBER PIER EXTENSION AND A 30(+/-) LF X 4-FOOT WIDE FUXED"L",A BOAT LIFT INCLUDING ASSOCIATED BRACED SUPPORT PILING AND RELOCATE THREE BRACED TIE-OFF PILINGS ALL WATERWARD OF THE APPARENT HIGH WATER LINE. 7.AMOUNT OF LAND AFFECTED: Initially 100+/•acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑✓ Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) WIResidential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other. (describe) 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 name and permit / approval: US ARMY CORPS OF ENGINEERS,TOWN OF SOUTHOLD 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes 5/1 No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes ✓❑No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name ROLLA CAMPBELL\ Date: Cs 2 Signature V1A ) 11 tol 5 V�c1Z If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART If- IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ❑Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. 0 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 quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood 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 land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If es,explain briefly: ❑ Yes No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: Yes ❑No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(a) 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. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of CEA. 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. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting W determination. Name of Lead Agency Date 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) r Docko, Inc. P.O. Box 421, Mystic, CT 06355 (860)572-8939 Fax: (860)572-7569, e-mail: docko@snet.net October 30, 2003 NYS DOS Department of Coastal Resources 41 State Street, 8 h Floor Albany,NY 12231 Re: Rolla Campbell, Fishers Island Dock Modifications To Whom It May Concern: On behalf of our client,we submit the attached Federal Consistency Assessment Form for dock modifications on Fishers Island, New York. We enclose herewith the following in support of this permit application: pn ••• Two prints each of plans titled: E C E u E p p D Project: "Dock Modifications" %OV 19 2003 Waterway: East Harbor Location: Fishers Island,Town of uth Suffolk County,New Yo Southold Town Board of Trustees Applicant: Rolla Campbell !. Date: July 11, 2003 ❖ Two copies of Corps of Engineers, NYS DEC and Town of Southold Application forms, Location Map, Tax Assessor's Map and NYS DOS Coastal Management Federal Consistency Assessment Forms. 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. Keith B.Neilson, P.E. KBN:jm Enclosures CC: Rolla Campbell NYS_DE_C_-Regulator_y_A-ffairs C Cown of Southold: Krupski_ File: 03-03-1409 CAMPBELL UUAS I AL'IYIAIVAUC1V1CIV 1 f KUIiKHIVI Federal Consistency Assessment Form An applicant,seeking a permit,license,waiver,certification or similar type of approval from a federal agency which is subject to the New York State Coastal Management Program(CMP,shall complete this assessment form for any proposed activity that will occur within and/or directly affect the State's Coastal Area. This form is intended to assist an applicant in certifying that the proposed activity is consistent with New York State's CMP as required by U.S. Department of Commerce regulations (15 CFR 930.57(. It should be compOleted at the time when the federal application is prepared. The Department of State will use the completed form and accompanying information in its review of the applicant's certification of consistency. A. APPLICANT 1. Name: ROLLA CAMPBELL 2. Address: PRIVATE ROAD, FISHERS ISLAND, NY 06390 3. Telephone: Area Code(631) 788-7803 B. PROPOSED ACTIVITY 1. Brief description of activity: ADD 24(+/-)LF OF 4-FT.WIDE FIXED WOOD PILE AND TIMBER PIER EXTENSION AND A 30(+/-)LF X 4-FOoT WIDE FIXED°L°,A BOAT LIFT INCLUDING ASSOCIATED BRACED SUPPORT PILING AND RELOCATE THREE BRACED TIE-OFF PILINGS ALL WATERWARD OF THE APPARENT HIGH WATER LINE. 2. Purpose of activity: THIS IS A PRIVATE DOCK FOR RECREATIONAL BOATING. 3. Location of activity: SUFFOLK FISHERS ISLAND,TOWN OF SOUTHOLD PRIVATE ROAD County City,Town or Village Street or Site Description 4. Type of federal permit/license required: US ARMY CORPS OF ENGINEERS 5. Federal application number,if known: NOT YET KNOWN 6. If a state permit/license was issued or is required for the proposed activity, identify the state agency and provide the application or permit number,if known: C. COASTAL ASSESSMENT Check either"YES" or"NO" for each of the following questions. The numbers following each question refer to the policies described in the CMP document (see footnote on page 2) which may be affected by the proposed activity. YES NO .1. Will the proposed activity result in any of the following: a. Large physical change to a site within the coastal area which will require the preparation of an environmental impact statement?(11,22,25,32,37,38,41,43)............ ........ X b. Physical alteration of more than two acres of land along the shoreline, land under water or coastal waters?(2, 11, 12,20,28,35,44). ........ ... ... .. ..... .................. X c. Revitalization/redevelopment of a deteriorated or underutilized waterfront site?(1)....... X d. Reduction of existing or potential public access to or along coastal waters? (19,20). ..... X e. Adverse effect upon the commercial or recreational use of coastal fish resources?(9,10)... X f. Siting of a facility essential to the exploration,development and production of energy resources in coastal waters or on the Outer Continental Shelf? (29).. .. ... ..... .. .... X g. Siting of a facility essential to the generation or transmission of energy? (27)......... .. X h. Mining,excavation,or dredging activities,or the placement of dredged or fill material in coastal waters?(15,35).. ........... ... ... ................. ... ............ X I. Discharge of toxics,hazardous substances or other pollutants into coastal waters?(8,15,35) X j. Draining of stormwater runoff or sewer overflows into coastal waters?(33).. ... ... ...... X k. Transport,storage,treatment,or disposal of solid wastes or hazardous materials?(36,39). X I. Adverse effect upon land or water uses within the State's small harbors? (4).. ......... X 2. Will the proposed activity affect or be located in,on,or adjacent to any of the following: a. State designated freshwater or tidal wetland?(44).......... ....................... X _ b. Federally designated flood and/or state designated erosion hazard area? (11, 12, 17).... X _ c. State designated significant fish and/or wildlife habitat? (7)... ... ................... X d. State designated significant scenic resource or area?(26). ... .................. ..... X e. State designated important agricultural lands? (26)........... ......... ... ......... X f. Beach,dune or barrier island? (12).............. ... ............................ X g. Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3)................ X h. State,country,or local park? (19,20)... .......... ............. ....... .. ........ X I. Historic resource listed on the National or State Register of Historic Places?(23).. .. ... ... X.t. 3. Will the proposed activity re any of the following: a. Waterfront site? (2,21,22)... ... ....................... ............ .... ... . X _ b, Provision of new public services or infrastructure in undeveloped or sparsely populated sections of the coastal area? (5).......... :... ......:: ..:..... ... ... .... . .. .. X c. Construction or reconstruction of a flood or erosion control structure?03, 14, 16)....... X d. State water quality permit or certification?(30„38,40).. ... ......... ....... ....... X e. State air quality permit or certification? (41,43).......... ..... ... ....... ........ X 4. Will the proposed activity occur within and/or affect an area covered by a State approved Local waterfront revitalization program? (see policies in local program document)......... X D. ADDITIONAL STEPS 1. If all of the questions in Section C are answered"NO",then the applicant or agency shall complete Section E and Sub the documentation required by Section F. 2. If any of the questions in Section are answered "YES", then the applicant or agent is advised to consult the CMP, or where appropriate,the local waterfront revitalization program document. The proposed activity must be analyzed in more detail with respect to the applicable state or local coastal policies. In the space provided below or on a separate page (s),the applicant or agent shall: (a)identify, by their policy numbers,which coastal policies are affected by the activity, (b)briefly assess the effects of the activity upon the policy;and(c)state how the activity is consistent with each policy. Following the completion of this written assessment, the applicant or agency shall complete Section E and submit the documentation required by Section F. E. CERTIFICATION The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved local waterfront revitalization program, as appropriate. If this certification cannot be made, the proposed activity shall not be undertaken. If this certification can be made,complete this Section. "The proposed activity complies with New York State's approved Coastal Management Program, or with the applicable approved local waterfront revitalization program,and will be conducted in a manner consistent with such program." Applicant!Agent's Name: ROLLA CAMPBELL Address: PRIVATE ROAD,FISHERS ISLAND NY O6 90 _ Telephone:Area Code 631 788-7803 Applicant/Agent's Signature: ��� �� Ct�rr- ������ n� Date: cx `Z , F. SUBMISSION REQUIREMENTS 1. The applicant or agent shall submit the following documents to the New York State Department of State, Division of Coastal Resources and Waterfront Revitalization, 162 Washington Avenue,Albany, NY 12231. a. Original signed form. b. Copy of the completed federal agency application. c. Other available information which would support the certification of consistency. 2. The applicant or agent shall also submit a copy of this completed form along with his/her application to the federal agency. 3. If there are any questions regarding the submission of this form,contact the Department of State at(518)474-6000. 'These state and local documents are available for inspection at the offices of many federal agencies, Department of Environmental Conservation and Department of State regional offices, and the appropriate regional and county planning agencies. Local program documents are also available for inspection at the offices of the appropriate local government. -2- Docko, Inc. P.O. Box 421, Mystic, CT 06355 (860)572-8939 Fax: (860)572-7569, e-mail: docko@snet.net October 30,2003 y, 1. Mr. Michael Vissichelli U.S. Army Corps of Engineers Jacob Javits Federal Center,Room 1937 New York,New York 10278-0090 l Re: Rolla Campbell Dock Modifications Dear Mr. Vissichelli: On behalf of Dr. Rolla Campbell we request a Department of the Army Permit for dock modifications on Fishers Island, New York. We enclose herewith the following in support of this permit application: np ❖ Two prints each of plans titled: nD 10� Project: "Dock Modifications" :N01V19 2003Waterway: East Harbor Location: Fishers Island,Town of outh ►d Town Suffolk County,New Yo k f Trustees Applicant: Rolla Campbell Date: July 11, 2003 ❖ Two copies of Corps of Engineers and NYS DEC Application Forms, Location Map, Tax Assessor's Map, photographs and NYS DOS Federal Consistency Assessment Form. 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. 'Keith B.Neilson, P.E. KBNjm Enclosures CC: Rolla Campbell NYS-DEC: Environmental Permits Town of Southold: Krupski File: 03-03-1409 CAMPBELL To Wn APPLICATION FOR D RTMENT OF THE ARMY PERMIT OMB APPROVAL NO.0710-003 �.,3 CFR 325) Public reporting burden for this collection of information is estimated to average 5 hours per response,including the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.. Send comments regarding this burden estimate of any other aspect of this collection of information,including suggestions for reducing this burden,to Department of Defense,Washington Headquarters Service Directorate of of Information Operations and Reports,1215 Jefferson Davis Highway,Suite.1104,Arlington,VA 22202-4302;and to the Office of Management and Budget, Paperwork Reduction Project(0710-0003),Washington,DC 20503. Please DO NOT RETURN your form to either of those addresses.Completed applications must be submitted to the District Engineer having jurisdiction over the location of the proposed activity. PRIVACY ACT STATEMENT Authority:33 USC 401,Section 10; 1413,Section 404. Principal Purpose:These laws require permits authorizing activities in,navigable waters of the United States the discharge of dredged or fill material into waters of the United States,and the transportation of dredged material for the purpose of dumping it into ocean waters. Routine Uses: Information provided on this form will be used in evaluating this application for a permit. Disclosure: Disclosure of requested information is is voluntary. If information is not provided,however,the permit application cannot be processed nor can a permit be issued. One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and instructions)and be submitted to the District Engineer having jurisdiction of the proposed activity. An application that is not completed in full will be returned. (ITEMS 1 THR U 4 TO BE FILLED BY THE CORPS) 1.APPLICATION NO. 2.FIELD OFFICE CODE 3.DATE RECEIVED 4.DATE APP.COMPLETED ITEMS BELOW TO BE FILLED BYAPPLICANT 5.APPLICANT'S NAME 8.AUTHORIZED AGENT'S NAME&TITLE ROLLA CAMPBELL DOCKO,INC. THOMAS C.LAW 6.APPLICANT'S ADDRESS 9.AGENT'S ADDRESS PRIVATE ROAD P.O.BOX 421 FISHERS ISLAND,NY 06390 MYSTIC,CT 06355 7.APPLICANT'S PHONE NO'S W/AREA CODE 10.AGENT'S PHONE NUS W/AREA CODE a.Residence (631)788-7803 a.Residence b.Business b.Business (860)572-8939 11.STATEMENT OF AUTHORIZATION I hereby authorize,DOCKO,INC.to act in my behalf as my agent in the processing of this application and to furnish,upon request, supplemental information i upport of t 's permit application. �' cA Ju Q6e l l APPLICANT'S SIGNArURE DATE ROLLA CAMPBELL NAME,LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY 12.PROJECT NAME OR TITLE(See instructions) DOCK MODIFICATIONS 13.NAME OF WATERBODY,IF KNOW(if applicable) 14.PROJECT STREET ADDRESS(if applicable) EAST HARBOR PRIVATE ROAD 15.LOCATION OF PROJECT SUFFOLK NY COUNTY STATE 16.OTHER LOCATION DESCRIPTIONS,IF KNOWN, (See instructions) LAT.41°17'00"N, LONG.71°56'38"W OLD COAST GUARD STATION AT EAST HARBOR,FISHERS ISLAND,NY 17.DIRECTIONS TO THE SITE TAKE FERRY TO FISHERS ISLAND,TAKE EAST END ROAD TO THE LAST LEFT, (DRIVEWAY)PRIOR TO FISHERS ISLAND COUNTRY CLUB GOLF COURSE. TURN RIGHT WHERE DRIVEWAY SPLITS. ENG FORM 4345,Feb. EDITION OF SEP 91 IS OBSOLETE. (Proppnent:CECW-OR 18.Nature of Activity(Description of project,include all features) ADD 24(+/-)LF OF 4-FT.WIDE FIXED WOOD PILE AND TIMBER PIER EXTENSION AND A 30(+/-)LF X 4-FT.WIDE FIXED"L",A BOAT LIFT INCLUDING ASSOCIATED BRACED tUPPORT PILING AND RELOCATE THREE BRACED TIE-OFF PILINGS ALL WATERWARD OF THE APPARENT HIGH WATER LINE. 19.Project Purpose(Describe the reason or purpose of the project,see instructions) THIS IS A PRIVATE DOCK FOR RECREATIONAL BOATING. USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED 20.Reason(s)for Discharge N/A 21.Type(s)of Material Being Discharged and the Amount of Each Type in Cubic Yards N/A 22.Surface Area in Acres of Wetlands or Other Waters Filled(see instructions) N/A 23. Is Any Portion of the Work Already Complete? Yes No X IF YES,DESCRIBE THE COMPLETED WORK 24. Addresses of Adjoining Property Owners,Lessees,Etc.,Whose Property Adjoins the Waterbody(if more than can be entered here, please attach a supplemental list). NORTH: ROBERT GOLDIE,TRUSTEE,LUCILLE BALCOM TRUST,236 PARK AVE.,SUITE 1130,NEW YORK,NY 10169 SOUTH: FISHERS ISLAND COUNTRY CLUB,FISHERS ISLAND,NY 06390 25.List of Other Certifications or Approvals/Denials Received from other Federal,State or Local Agencies for Work Described in This Application AGENCY TYPE APPROVAL* IDENT.NUMBER DATE APPLIED DATE APPROVED DATE DENIED NYS DEC PENDING PENDING TOWN OF SOUTHOLD PENDING PENDING *Would include but is not restricted to zoning,building and flood plain permits. 26. Application is hereby made for a permit or permits to authorize the work described in this application. I certify *th)e %dul at the i formation in this application is complete an accurate. I further certify that I possess the authority to undertake the work described herei a ' onzed agent f th applicant. a 1003 SIGNATURE OF AP LICANT XA.TE SIGNATURE OF AGENT DATE ROLLA CAMPBELL e �l KEITH B.NEILSON,P.E.,DOCKO,INC. The application must be signed by the person who desires to undertake the proposed activity(applicant)or it may be signed by a duly authorized agent if the statement in block 11 has been filled out and signed. 18 U.S.C.Section 1001 provides that:Whoever,in any manner within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies,conceals,or covers up any trick,scheme,or discuises a material fact or makes any false,fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious or fraudulent statements or entry,shall be fined not more than$10,000 or imprisoned not more than five years or both. 'U.S.GPO:1994-520-478/82018 Albert J. Krupski,President SVFF�(� Town Hall James King,Vice-President ���� CQG 53095 Route 25 P.O.Box 1179 Henry Smith y1 Southold,New York 11971-0959 Artie Foster ti 2 Ken Poliwoda �y • Telephone(631) 765-1892 �rol � Sao Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2001 Mr. Glenn Just JMO Consulting Services PO Box 447 Quogue,NY 11959-0447 ReL Kim K. Campbell Private Road,Fisher's Island,New YorK SCTM#4-4-16 Dear Mr.Just: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday. September 19, 2001. RESOLVED,that the Southold Town Board of Trustees grant an Amendment to Permit# 5201 to construct a 3-1/2'x22' ramp in lieu of the proposed 4'x12' ramp for the approved docking facility.. However,this permit does not constitute any other permits from other agencies. If you have any questions,please call our office at 765-1892. Sincerely, / Albert J. Krupski, Jr. President,Board of Trustees AJK/cj c CC: DEC Army Corp. Dept. of State o�SU urco� z Tower Hall. 53095,Main Road cat' P.O..Box 1179 . Telephone 4 • Southold. I York 11971 (631) 765-1892. Se", � SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At-the meeting of the Southold Town Conservation Advisory'Council held Tuesday, September 11, 2001, the following recommendation was made: KIM K. CAMPBELL to. Amend Permit #5201 to construct a 3 WX 22' ramp in lieu of-the approved 4'X 12' ramp for the approved docking facility. Private Road, Fishers Island..SCTM#4-4-16 The CAC did not make an inspection, therefore no recommendation was made. FROM JmO CONSULTING PHONE NO. : 653 0607 Aug. 14 2000 08:3BAM P02 AirM.00 Environmental Consulting Services August 14, 2000 Southold Town Trustees P,Q, Box 1179 u Southold, N.Y. 11971-1179 LL AUG 14 2000 RE: Application for Kim Campbell-dock S.C.T.M,No. 1000-004.4-16 Dear Sirs: Enclosed for your preview and files please find a copy of the N,Y.S.D.&C, Permit recently issued for this project. jl4ennust ly, arh Phone (631) 653-0607 • Fax (631) 653-3348 121 Jessup Ave - 2nd Floor + RO, Box 447 Quogue, New York 11959-0447 FROM JmO CONSULTING PHONE NO. 653 0607 Aug. 14 2000 0e:3ew P03 v New York State Department of Environmental Conservation Division of Environmental Permits, Region One O Building 40- SUNY, Stony Brook, New York 11790-2356 Phone: (631)444-0365 + FAX: (631)444-0360 Website: www,dec,state,ny.uS John P.Cahill Commissloner August 1, 200p �5 u a 42000 Kim K. Campbell AUG 1 z 8965 Southeast Bridge Road, 1r'` Suite 2002 Hobe sound, FLU 33455 RE:1-4738-02707/0owl, Dear Permittee: in conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions care- fully. If you are unable to comply with any conditions, please contact us at the above address . Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. very truly yours, a E�itaeltAenalyst lynEnvixonme I MEP:cg enclosure FROM JmO CONSULTING PHONE NO. : 653 0607 Aug. 14 2000 08:39AM PO4 NEw TuRK STATE DEPARTMENT OF ENViRONMENTAL CONSER q ION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738.02707/00001 August 1 2000 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under rho Environmental August 31, 2003 conservation Lau �j TYPE OF PERMIT A New 0 Renewal ❑ Modification`r❑ Permit to Construct 0 Permit to Operate 0 Article 15, Title 5: Protection 0 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management E7 Article 15, Title 15: Water ❑ Article 17, Titles 7, 0: SPDES 0 Article 27, Title 91 6NYCRR supply 0 Article 19: air Pollution 373; Hazardous Waste Management ❑ Article 15, Title IS: Water Control El Article 34: Coastal Erosion Transport Management 0 Article 23, Title 27; Mined ❑ Article 15, Title 15: long Land Reclamation ❑ Article 36: FLoodplein Island Wells Management C.) Article 24: Freshwater Wetlends ❑ Article 15, Tirlo 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rlvers 0 Article 251 Tidal Wetlands 6NYCRR 3801 Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Kim K.Ca betl 631) 788-5550 ADDRESS OF PERMITTEE 8965 Southeaot Bridge Road (Suite 2002) Hobe sound FL 33455 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Glenn E. Just - JMO Consulting PO Box 447 Quo ue NY 11959-0447 (631 653-0607 NAME AND'ADDRESS OF PROJECT/FACILITY Campbell Property Private Road - off East End Road LOCATION OF PROJECT/FACILITY Fishers Island NY 06390 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold East Harbor DESCRIMON OF AUTHORIZED ACTIVITY Construct a 41 x IR0' flged dock, 41 x 121 ramp and 61 x 201 float, 4 2000 By acceptance of this permit, the permlttee agrees that the permit is contingent upon strict compliance With the ECL, all applicable regulations, the Genoral Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Roger Evans MEP Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE Page 1 of 4 Au uat 1 2D00 FROM JmO CONSULTING PHONE NO. : 653 0607 Aug. 14 2000 08:39AM P05 NL_.-.')RK STATE DEPARTMENT OF ENVIRONMENTAL,CONSERVATION NOTIFICATION OF OTHER PERMITT15E OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permitlee expressly agrees to Indemnify and hold harmless the Department of Environmental Conservation of the Stale of Now York, Its representatives,employees, agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit In compliance or non-compliance with the terms and conditions of the permit. Item S. Permltte9'8 Contractors to Comply with Permit The permittee Is responsible for informing Its Independent contractors, employees, agents end assigns of their responsibility to complywith this permit,Including all special conditions while acting as the permlttee's agenlwith respect to the permitted activities,and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C:'Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or interfere with Riparian flights 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. GENERAL.CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, Including relevant records, is subject to Inspection at reasonable hours and Intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit end the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompAny the Department's representative during an Inspection to the permit area when requested by the Department, 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 or facility. Failure to produce a copy of the permit upon request by a Department representative Is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department,issuance of this permit does not modify, supersede or rescind any order or determination previously Issued by the Department or any of the terms, conditions or requirements contained In such order or determination. General Condition 3: Applications for Permit Renewals or Modifications 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 or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be In writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types, Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2358 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation Include: 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 regulations is found; b) the permit was obtained by misrepresentation 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. DEC PERMIT NUMBER PAGE 2 OF 1-4738-02707/00001 FROM JmO CONSULTING PHONE NO. : 653 0607 Aug. 14 2000 00:40RM P06 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PErWIT,1W.wpd,rev.6190 ADDITIONAL GENERAL,CONDITIONS FOR ARTICLES.15 (TITLE 5), 24, 25,34 AND 6NYCRR PART 608 (TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration In the position of the structure or work herein authorized, or if, In the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health,safety or welfare of the people of(lie State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work,obstructions,or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill,excavation, or other modification of the watercourse hereby authorized shall not be completed,the owners,shall,without expense to the State,and to such extent and In such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to Its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the Slate of New York on account of any such removal or alteration. 2, The State of New York shall In no case be liable for any damage or Injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or Improvement of navigation,or for other purposes,and no claim or right to,compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission,consent or apptoval from the U.S.Army Corps of Engineers, U.S,Coast Guard.New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids,sediments,fuels,solvents,lubricants,epoxy Coatings,paints,concrete,leachate orany other environmentally deleterious materials associated with the project. G. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. B. There shall be no unreasonable Interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the Slate, and,to such extent and In such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore the site to Its former condition. No claim shall be made against the Slate of New York on account of any such removal or alteration. 8, if granted under 6NYCRR Part 6111A. rha NVC nopartmont of Cnvironmo„ta,oV„oC,vutlull nereoy certltles that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302,303, 306 and 307 of the Clean Water Act of 1 Q77 (GI or._.t17)providod that cell of ti is u1 u1I(lul 1p flstea rlereln are met, g. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along will)photographs of the completed work and, If required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by-Chandler. palm r&King on 5 _JJ P100 DEC PERMIT NUMBER 1-4738-02707/00001 PAGE 3 0F_J_ FROM JmO CONSULTING PHONE NO. : 653 0607 Aug. 14 2000 08:41AM P07 NEW YORK STATE OEPARTMONT OF ENVIRONMENTAL.CONSERVATION SPECIAL CONDITIONS 1. Dock or timber catwalk shall not exceed 4 feet In width and shall be a minimum of 3'/2 feet above grade"over tidal wetland areas ('as measured from ground to bottom of dock sheathing), 2. Moats and ramps may not rest on or be stored In any vegetated tidal wetland, 3. 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. 4. No permanent structures may be Installed on dock/cetwelk/float without first obtaining written Department approval (permit, modification, or amendment). G. Pilings may not: (a)extend beyond property lines, (b)be placed so that docked boats extend over property lines, (c)Interfere with navigation, (d)interfere with other landowners riparian rights, 6. No structures are to be constructed on pilings without further authorization of the Department. DEC PERMIT NUMBER PAG E 4 of_4_ 1-4738-02707/00001 _ m _ m 0 3 FAST HARBOR SITE PROPOSED PILINGS 3 -eat o z a v o v = PROPOSED 20' LONG X 6' WIDE C N {gp►IfNG DOCK x - v FLOAT= DOCK W/ 4' WME �v 9 vv - _ �- _ RAAIR W/ RAILJNGS z v v v v -- - vovvv =- —= X 3-W 'A v v v == PROPOSED PUNGS °P __- ,�'"' •�,..�. PROPOSED FD(ED DOCK 120' LONG X 4' WIDE U L.W. M.H.W. _ KEY _MAP SCALE: 1"=2000' 8� i`_ J "N 77WOD0 W o _ 195.3 L' N 3T67'00" W 66.3V • � (A N/F EXISTING �s,Z AA � RONAL D BALCOM m SROCK N�o\�\@\t N 0 FORMER GARAGE . LOCATION ,v v 3 D £ c E ,ppRpVED AS PER TERMS `'. . ..`. lL:EXISTNG RESWENCE PER? AICit4. sad BATE / J S 42'29'00" E PLAN OF PROPOSED DOCK 230.OV �� PREPARED FOR ►� -./ KIM K. CAM PBELL NOTESi FiSHUZS ISLWD, NEW PORK -4 50 L PILINGS TO BE DRIVEN 25' MIN. 25 TO REF SAL, 25 0 w 3 2. SUFFOLK COUNTY TAX MAP REF, GRVIHIC SCALE IN FEET c"m , ctwvs��+a. ��+ Hc�e xir�a 0 DIST. 1000 SEC. 004 BLOCK 4 LOT 16 MAY V,2000 ���i• �„�,�.�,..�,y,..,:,, U,,,,.,,, m SHEET 1 OF 3 . .w m CY,m ..�►,d 0 3 WINGED RAMP W/ RAILINGS 0 PROPOSED 2Q' LONG X 6` WIDE 0 0 FLOATING DOCK cn z c r z QED FDED DOCK M.L.W. z m z 0 ` E*STiNG GR M or, f W i m 5 2.5 0 5 - VEFCAL SCALE 20 10 0 2017D? � KWI'4TAL SCALE DATE d'- .�7 � PLAN OF PROPOSED DOCK PREPARED FOR CD KIM K. CAMPBELL m CD FISHERS ISLAND. NEW YORK fV 3 • CtiANDLOR. ►At�l�C1! !. KIIVC . MAY 10, ZOQO t% m ■� -u SHEET 2 OF 3 %- r m - -- --,�..Q s--- CD �a aawo.v.pt,t�w r.�n-tvv ra r.w-rt O _ 3 3 O s' uAm DOCK dUr+a( DX j �000 O aEc 1 row::Nc�f�) co s�� C sTr�zs (Tw) � Ulm MIENNON � )s(w fit MLw FLOAT rlw FLOAT 1" Z air S;7 a67FA A(at1(R yOT TO SCALE x IV FRAIC O CRASS TIE GMEMR Z �� 12' DIA 2' x 8'."lECK m RaD U-BOLTS (Tw) PIL )2' DIA Z ST7Rp I1Atf PILm O F r SECTIE>H l PRE f V. ?,0 3' x 10' STRIHQR 2' , 6' SKD?T 2' : W SIDES L M. 'V. i Q1 AROU[BD ALL , el S 2' . V DECKING 2 SEC;IONS EACH W. 3' c 6' SPLIT (Al W 6' VIDE RAW IB' LOW FASTENED WITH 1' LLD. GALVAMMI) BOLTS 3 MC. ,c E' CRASS G "T-TO SCALE tf0?TO SCAM D l= lD V F c D e C I� T RIIs PLAN OF PROPOSE DOCK •�v ; OF PREPARED PERM" � FOR m DATE - ,� Kf M K. CAMP BELLCD / FISHERS 1SLMD, NEW PORK � 3 m m MAY i O, 2Q00 OHM � a 0-"� ' '� MEET 3 OF 3 "� Rom,. ,ro -- 0 3 96.241�8187)-9d - .. CA 3 CD New York State 0 Department of Environmental ConservationF z v NOTICE r 0 z m The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being -conducted at this site. For further information regarding the nature and extent of work approved and anED Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the 9 ,r shown when contactingthe DEC. Permit number � . Regional Permit Administrator Permit Number A JOHN W. PAVACiC , m m Expiration Date 3/ -aoo m NOTE: This notice is NOT a permit 3 m ry Mrs. Lucille Balcom The'Boat House Fisher's Island, NY 06390 August 17, 2001 Dear Sirs: I am writing to object to the fact that my neighbors, lAr. and Mrs. Rolla & Kim Campbell of Fisher's Island, New York have been given permission to build a 140 foot dock 'in front of .their property in East Harbor, •Fisher's Island. I sent two previous letters regarding my:objections' to this dock, heard nothing back. I have learned recently from my neice, �wha spoke to The Army Corps of Engineers and the Dept. of Env i r•oriiiiental Corlservat iori that neither of my letters were received. by these organizations. Although the dock is going to be built beginning in Sept.2001 , I would like to register with all of you my concerns. East Harbor is a lovely, quiet,small ,open harbor. ; Nothing .has marred this harbor for over fifty years, and small and larger boats have enjoyed this harbor all summer long because of its beauty, swimming, fishing and good water. Many boats anchor along the shore to enjoy these pleasures. I feel it would certainly limit some public usage to have 'such a hugh dock in this harbor, which has been so beautifully preserved for so long. Lobster catching is done in this harbor, too, and this dock would limit space for this. I see the dock limiting public use .in. an: area they have always enjoyed. East Harbor is one of the few protected.-open harbors left along .the NY and Connecticut shores and the 'preservation of its natural beauty,wild life and public use should be protected-and the waters should be left as open as possible. I realize that personal issues do not come into play in decisions you make regarding requests for docks, but I think it is important for'you to know that the couple who are building this dock are doing it for Mrs. Campbell 's adult- son who .-visits the island for approximately 10. days to two weeks a year and would like to,perhaps,get a boat someday. Pr1r. -and 1"'cs. Campbell are good friends, but I just do not think this harbor should 'De disturbed for such a reason. Furthermore, I am 89 years of age, the dock is only 90 feet from my deck over the water, and the noise involved with pile driving will be terrible in September,while I am in residence,until the end of October. I would appreciate hearing your thoughts in regard to this letter, which I am sending to Southold the Dept. of Engineers and the DEC. Yours sincerely, Luci l l e :Bl cc: Dept of Coastal Resources AUG 2 12001 U --- - --� .r WWI . .. y . Board Of Southold - Town Trustees .,h. SOUtHOLD, NEW YORK 11 (� DATE: Aug....29......2000 PERMIT NO. ... ...C?c: .... �....... KIM K. CAMPBELL v 1 < . 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 x State of New York 1952; and the -Southold Towne Ordinance en- titled ."REGULATING AND THE AND ING PUBLIOC LANDS and ONS the IN AND ON TOWN WATERS REMOVAL OF .SAND, GRAVEL-OR OTHER.MATERIALS FROM Y LANDS.-UNDER TOWN*WATERS;:": and in accordance with the IT Au` 23, Resolution of.The Board adopted at a meeting held on ....... .�`::..... _..... 00 150 00 ` I ?.......:.., and in consideration of the sum of �............:................ paid by ..... ... Kim K. Campbell ,v of .......Fis her Island ..................... N. Y. and. subject to the Terms,_-and Conditions listed on the reverse .side. hereof, of Sduthold Town Trustees authorizes and permits the following: ' ,y Wet -and. ermit to construct a 4'X: 120' fixed dock elevated 4' ' above grade, 4'X 12' ramp, 6'X 20' float and (4) out piles all in accordance with the detailed specifications as presented in ,cN the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- 1 Seal to be affixed, and these resents to '`• � • , by causes its Corporate Se p E " be subscribed by a majority.of the said Board as of this date. i � V IV Q •, 1 ;i ► , AS" �A` p' y 'a fiv Syr `4 �• 'f.+yJ �A tiQyZ 1 TERMS and CONDITIONS The Permittee _ Kim K. Campbell residing at 8965 South East Bridge Rd. , Hobe Sound, FL N. Y .� part• of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all:.,damages, or claims for damages, of suits arising directly or indirectly as a result of any open. anon performed pursuant to this permit, and. the said Permittee will, at his or her own-expense, defend any and all'such suits-initiated by third parties, and the said Permittee assumes'full liability with respect thereto, to the complete'emdusion .of the Board of Trustees of the Town of Southold 2. That this'Permit is valid for a-period of 24 mos. which is considered to be the estimated time'required to complete the work involved, but•should circumstances warrant, request .. for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, '.to provide evidence to anyone concerned that auth- orization was originally obtained, •4. That the work involved will be subject to the inspection .and approval of the Board .or its agents, and non-com liance with the provisions of the originating a licatio ma be cause for P � P application,.n,� y revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. G. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold requite the removal and/or alterations . in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will be requited, upon due notice, to remove or alter this work or project herein stated without expenses to the Town . of Southold. 8. That the said Board will be notified by the Permittee of the completion,of the work #nth- . othed. 9.. That the. Perruittee will obtain all*other permits and consents that may be required sup'. plemental to this-permit which may be subject to revoke upon failure to obtain same. Albert J. Krupski, President OSVFF�(�C Town Hall James King,Vice-President =�0 o(jy� 53095 Route 25 Henry Smith P.O.Box 1179 Artie Foster Cfj r2 Southold,New York 11971-0959 Ken Poliwoda Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 29, 2000 Mr. Glenn E. Just J.M.O. Environmental Consulting P.O. Box 447 Quogue, NY 11959-0447 Re: KIM K. CAMPBELL SCTM#4-4-16 Dear Mr. Just: The following action was taken by the Board of Town Trustees during its regular meeting held on August 23, 2000 regarding the above matter: WHEREAS, J.M.O. Environmental Consulting on behalf of KIM K. C'AMPBELL applied to the Southold Town Trustees for a permit, under the provisions of the Wetland Ordinance of the Town of Southold, application dated July 17, 2000, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 23, 2000 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 structure complies with the standard set forth in Chapter 97 of the Southold Town Code, 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 approve the application of KIM K. CAMPBELL to construct a 4 'X 120 ' fixed dock elevated 4 ' above grade, 4 'X 12 ' ramp, 6 'X 20 ' float and (4) out piles . BE IT FURTHER RESOLVED that this determination 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. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees : None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms cc: DEC ACE Dept. of State FAST HARBOR SITE PROPOSED PILINGS- �s.23 • vvv v v a v v = PROPOSED 20' LONG X 6' WIDE vvvvvvv - v NEIGHBORING DOCK FLOATING DOCK W/ 4' WIDE x RAMP W/ RAILINGS + vvvv vvvv - ---_-- vvvvv =- =__= x _3.5g PROPOSED PILINGS x -3 zs _ cvAi+acr PROPOSED FIXED DOCK O �o. 120' LONG X 4' WIDE M.LW�� M.H.W. _ " _ — \ —N 70'55'00' W- .KEY MAP SCALE: 1 =2000 s� ��_� 195.31'� . Z N 3767'00" W 0 66.35' W. \mot----- / � �\�\\\ \ AI OD I O \\ \\\ Zp+pO p�� O o IF s"° N/ EXISTING \ ? CD fm a RONALD BALCOM m ROCK Y ; SLOPE '0 FORMER � ( - LOATPROVED BY �EOfPdEwy EXISTING BOARD OF TRUSTEES N �29' %N �9� RESIDENCE MON. Po H.S TOWN OF F s 23a.00� E f/2-v'PLANOF PROPOSED DOCK P EPARED FOR F t� NOTES, r , nea4 - - FISHERS ISLAND, NEW PORK 'T. PILINGS TO BE DRIVEN 25' MIN. OR TO REFU AL. 50 25 0 50 2. SUFFOLK COUNTY TAX MAP REF. GRAPHIC SCALE IN FEET T _ :� CNANDLER� PALMER G. KING DICT. 1000 SEC, 004 BLOCK 4 LOT 16 MAY 10,2000 %No o= N 'Itectu e, Engineering and Surveying SHEET1 OF 3 110 ww""r,«vI".cr*6360 ac0-889-3"7 ru"0_8,-?M HINGED RAMP W/ RAILINGS PROPOSED 20' LONG X 6' WIDE FLOATING DOCK PROPOSED FIXED DOCK M.H.W. M.L.W. EXISTING GRADE 77 5 2.5 0 5 VERTICAL SCALE 20 10 0 20 H❑RIZ❑NTAL SCALE �� PLAN OF PROPOSED DOCK JUL 17 2000 PREPARED FOR KIM K. CAMPBELL FISHERS ISLAND, NEW YORK MAY 10, 2000 fim% � wojr CHANDLER, PALMER S. KING SHEET 2 OF 3 � :� Architecture. Engineering and $ur"ying 110 IRa4v_MRWICR.CT e6%0 0"-"9--2397 FAX 860-886-78M i , 6' MAIN DOCK 10'f MAIN DOCK WOOD PILE(TYP) DECKING DECKING (TYP) T. 5TM� CROSS MEMBER STRINGERS (TYP)OST !-.. ] 11 1 MLW FLOAT MLW FLOAT MHW = DECKING MLW 1-SPACE(TYP)—II— END VIEW SIDE VIEW 10 (Ty') CENTER TO CENTER TYPICAL FLOATING DOCK FILM HEN NOT TO SCALE 4' x 4' CORNER 2' x 6' 2' x 8' 10' CTYP) 2' x 10' FRAME CROSS TIE [ DECKING MEMBER 12' DIA 2' x 8' DECKIN 12' DIA ROD U—BOLTS (TYP) PILING--_— PILING STYRO FOAM I� P SECTION f PILE ELEV. 7.0 3' x 10' STRINGER I II� ELEV. 7.0 M.H.W. M.H.W. 2' x R SKIRT 2' x 10' SIDES 2 SECTIONS EACH 3' x 8' SPLIT CLAMP-' M. .W. 0.0 1.6 ALL AROLND AND ENDS 2' x 8' DECKING 10' LONG FASTENED M W 16' WIDE RAMP WITH N O.D. GALVANIZED 3' x 8' CROSS BRAC BOLTS 3' O.C. .. END VIEW TO' TYP lo'(Ty)- PLAN VIEV �rB rDira� �'maER rD axr[c� CROSS SECTION SIDE VIEW TYPICAL FLOATING DOCK TYPICAL FIXM DOCK NOT TO SCALE NOT TO SCALE L - t : t is ' . JUL 17 2000 _ .•F PLAN OF PROPOSED DOCK i PREPARED FOR - : . < KIM K. CAMPBELL FISHERS ISLAND, NEW YORK J CHANDLER, PALMER IL KING MAY 10, 2000 ■ ML 'I":.teCture, En Inee- SHEET 3 OF 3 : m g ng and Surveying Il0 BR°gOveT IQtvICN.Cr 063"860-889-3397 F-860-886-7901 c��FF01,�C' i s � Town Hall. 53095 Main Road Telephone P.O. Box 1179 (516) 765-189z o�jol ��0�. Southold. New York 11971 SOUTHOLD TOWN. CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, August 15, 2000, the following recommendation was made: KIM K. CAMPBELL 4-4-16 to construct a 4'X 120' fixed dock elevated 4' above grade, 4'X 12' ramp, 6'X 20' float and (4) out piles. Private Rd., Fishers Island The CAC did not make an inspection,therefore no recommendation was made. DEPARTMENT OF THE ARMY ,��\�� NEW YORK DISTRICT, CORPS OF ENGINEERS. JACOB K.JAVITS FEDERAL BUILDING ' NEW YORK, N.Y. 10278-0090 REPLY TO -August .2'.., .2-00.0.: ATTENTION OF: Eastern Permits Section SUBJECT: Application Number 2000-00898-L2 by Kim K. Campbell To Whom It May Concern: The---New York District; -U.S Army-Corps of-Engineers;-has - - received a request for Department of the Army authorization for the following activity: L� APPLICANT. Kim K. Campbell . Suite 2002 � 2 8965 Southeast Bridge Road 000 ", I Hobe Sound, FL 33455 nt c ACTIVITY: Construct a 4-foot by 120-foot ' LTC' �.fi ed—p±�er '1-eading to a 4-foot by 12-foot ramp connected to a 6-foot by 20-foot float secured to three pilings with four mooring piles, - one: off.. each corner of the float . The purpose of this project is to provide a safe mooring facility for the applicant' s boat . .WATERWAY: East Harbor-.;'. Long: Islarid 'Sound LOCATION: Fishers-. I-sland,- Town of ' Southold, Suffolk County, New York As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States . To accomplish -the coordination required, "prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. ----- --=---- --_--Pursuant---to--Section 307 (c) -.of _t he­Coast al-,Zone--Management--�-- -;--=-- _=---� -- Act of 1972 -as amended (16 U.S:C.- 1465 "(c)-(3)-(A)-) ---the--applicant -- has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of the date of this letter. Sincerely, 7pJames W. Haggerty C �ief, Eastern Permits Section Enclosures FOR ADJOINING AREA SEE MAP i'Wi 49 50 52 53 54 55 ) ' . Sm6 In Fwt(Appr°>anutW N" oo ON ON CO. ' o woo da a000 WOO/ SUFFOUC CO, — NrcrKur MYSTIC TOWN NEW YORK SOUNFLD TOWN ScW8I.Kkrneh+VPMZImu) - -- '•• ONORTH DUMpuN6 o' T, 7 LATIMER REEF ••\ r SOUTH DUMPDN6 FISHERS ISLAND I -SOUND 1 - FLAT HUMMOCK 1 .'i. Y ..�' ] :t 4 •" � v ' n '� ? '\ �} -• ,fY Y`�h f�- s'L t ��-- �r�s.+ � ll NiII r- •- Bra."Point� �, � �q }. . ~3 � t. -. .5 i -CNOCONOUNT l 5 I COVE ,fi �4 r1p •,.i .g„ wICOPESSET I Hawks ma! \ Pt p$ l rd r •Ke^ yryt R..$ - . Point ! 7•• �r ":c I POpQ' 9mm ld .�. herre. T N 7 c eN F ��.� ti�� _ wES A - �. Lmed � et► � o� - O W flECK IS: a a Pend Ol i , -r�.fie. •c .c BeP _ Ob Q ,Ma.., F t a SSE ;.. BL OCK LSLAN. D S0 UND t -; �I L - I WLlderntuPpint .i ° am 52 53 54 55 � y 3 r.e� Y G A R jD I N E R S � r f �• 5 y.+ r,_ ! -�, � 7. s to S 2•�'s 3•✓+i ...x r { - t 5 r1,k �.er .:.c ¢ r :.rrr SJ7x�.rid°v� �i,l:t r t...!.'.a. 'f: e.-'at_v!!F ✓.: •:> ;iti x Y { �. "'�.:� ...i. r;w f... . ..P'45 '}... s Yf.'r"�" '"" 'r r - K�a 1 ..w s. '?wt?.a :`A•Y•F}r-(L ^ti'. •�� .J S-D+a s. x'3,_+. f '' Yy" „1^ .I'.-�.�,:�'�sr Y.R i a .:.y �rk ! �..� 7 C'4'1: "1' �(t i\'1 '� !:":-� < �a( 'r ch•. �.::,} -1:: r .Ya i. i "�eYy,�(1. �7 s ......, 4 ..: �; f --rr.:l atx s-r sT tY".-fi'S..f �z :.���ti_, �.E d,�";cy n+X+u.��4fy�IYF ss,s 1 �•�r;,t��� ��;r� •. c {f� Y i s4A� s� �* �-:p�c.r•A �-� wg" ty'��'� ,tr '�,('`�;P+ ] -h.-! !} € -,rn-xI Y cAre"g;,y,,. -• �� '� t a ��. m �i'i- nr �+ : I c t y.,!� e r �, h i �.,. y ; `B i ::•v ill y p a$ 1 € r�, - c p T• ,E'?, I . 7 � LIONHEAD 0 ROCK SITE EAST HARBOR PROPOSED PILINGS �6.23 vvv ! :•� PROPOSED 20' LONG ' NEIGHBORING DOCK X 6 WIDE X was FLOATING DOCK W/ 4' WIDE v v v v _- ___ __ RAMP W/ RAILINGS vvvv -- vvvvv = ----- vvvv =-___ -- X -3.56 PROPOSED PILINGS. X -3.25 v - `�'`: •"'""°E" PROPOSED FIXED DOCK 120' LONG X 4' WIDE M.LW. M.H.W. 1 KEY MAP SCALE• 1"=2000' ! — — ! 6 \, —N `70'55 00 W II rn �N 37-67-00- W bo co N/F g .:i �� �� 00 EXISTING i � ,; � \� . ??,� RONALD BALCOM m ROCK �� ��� S �62•�' i SLOPE !. ;= FORMER a\A i J" GARAGE; ! LOCATION 6 i EXISTING ICON. tJ 1,29c,6 �tpZE OF Nf{y yGj� \ RESIDENCE S 42'29'00" E 230.00' �_ (y 1•• + PLAN OF PROPOSED DOCK PREPARED FOR KIM- K. CAMPBELL NOTES FISHERS ISLAND,-, NEW YORK 1, PILINGS TO BE DRIVEN 25' MIN. ❑R'T❑ REF SAL, 50 25 0 50 mmmmmmoll 2. SUFF❑LK COUNTY TAX MAP REF, GRAPHIC SCALE IN FEET ! ! CHANDLER, PALMER 8. KING' DIST. 1000 SEC, 004 BLOCK 4 L❑T 16 MAY 10,2000 Archltecture, Engineering and Surveyhg SHEET1 OF 3 ,��.m.n�..�«.u„.�,au. .H m>r-o"-f"_70a HINGED RAMP W/ RAILINGS i , PROPOSED 20' LONG X 6' WIDE FLOATING DOCK i PROPOSED FIXED DOCK M.H.W. i M.! EXISTING GRADE 5 2.5 0 5 VERTICAL SCALE k .' 20 10 0 20 HORIZONTAL SCALE I r i PLAN OF PROPOSED DOCK PREPARED FOR KIM K. CAMPBELL 1 FISHERS ISLAND, NEW YORK MAY 10. 2000 AW CHANDLER, PAL-HER I. KING Aw _SHEET 2 OF 3 �j MEOW JROA2 turl, Engineering and Surveying • 110 7RMIVAT 101VICM,[i Oi)60 Yf.-yY9-7J9)fu p5p-pg5-7gp i t I _ , a i 6' MAIN DOCK I I 10't MAIN DOCK h WOOD pLE(rrP) a DECKING DECKING (TYP) tn STRINGER CROSS MEMBER STRINGERS (TYP) MHW MLW FLOAT MHW MLW FLOAT MHW e k DECKING MLWz ND VI r SPACE(TYP)—I I VI W lo'(TVP) ! i CENTER TO CENTER TYPICAL OATIN DOCK NOT TO SCALE ! PLAN VIEW I r 4' x 4 CORNER 2' x 6- 2' x 8' 10' CTYP) 2' x 10' FRAME CROSS TIE DECKING MEMBER 12' DIA 2' x 8' DECKIN ROD U—BOLTS (TYP) PILING_ 12' DIA I PILING STYRO FOAM PILE Ip SECTION f ELEV. 7.0 3' x 10' STRINGER I I ELEV. 7.0' M.H.W. .2' x 6' SKIRT 2• x l0' SiDES MJ-I W ALL AROUND 8' DECKING 2 SECTIONS EACH M. .W. 3' x 8' SPLIT CLAAND ENDS10' LONG FASTENED M. .W. .0 jpx [DE RAMP j j WITH 1' O.D. GALVANIZED 3' x 8' CROSS BRAG BOLTS 3' D.C. END VIEW 10 TrP PLAN VIEW mu1 10 r(w) j CROSS SECTION SID aFW TYPICAL FLOATING DOCK TYPICAL Fl ED DO -K NOT TO SCALE NOT TO SCALE i f PLAN OF PROPOSED DOCK PREPARED FOR KIM K. CAMPBELL 1 FISHERS ISLAND, NEW YORK CHANDLER, PALMIER IL KING MAY 10, 2000 fou p Co { W ■_ Archltecturv, En Invvrl SHEET 3 OF 3 110.ROADWAY IOtvICN,CT 063U 99s339;f.=ne6o_9e6-7Ib1 J r i 1 ,`C '. SUF F®t�Cp� W _ r Town Hall 53095 Main Road Albert J.Krupski,President ��l �a0 P.O.Box 1179 James King,Vice President Southold,New York 11971 Henry Smith Artie Foster Telephone(516)765-1892 Ken Poliwoda Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ` Q.rnQY10lrY1Q r1�; ,/Received Application: 0 V / ..Received Fee: Completed Application �,i1o3 �)� Incomplete SEQRA Classification: Type I X Type II Unlisted X Coordination: (date sent) CAC Referral Sent: Date of Inspection: 01 ) s Receipt of CAC Report: �11 Lead Agency Determination: V Technical Review: --, Public Hearing Held: DEC - - 2003 Resolution: Southold Town Board of Trustees Name of Applicant ROLLA CAMPBELL Address P. 0. DRAWER, FISHERS ISLAND, NY 06390 Phone Number: (631) 788-7803 Suffolk County Tax Map Number: 1000 - 004-4-16 4� ® Property Location: PRIVATE ROAD, FISHERS ISLAND (provide LILCO Pole #, distance to cross streets, and location) AGENT: DOCKO, INC. (If applicable) Address : P. 0. BOX 421, MYSTIC, CT 06355 Phone: (860) 572-8939 Fax: (860) 572-7569 1 i t Board of Trustees Application GENERAL, DATA Land Area (in square feet) 4 . 3 acres Area Zoning: Previous use of property: Residential-Former Coast Guard Station Intended use of property: Residential Prior permits / approvals for site improvements : Agency Date Town of Southold #5201, August 29, 2000 New York State DEC 1-4738-02707/00001, Aug, 31, 2000 X No prior permits / approvals for site improvements. Has any permit / approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary) : ADD 24 LF OF 4-FT WIDE FIXED WOOD PILE AND TIMBER PIER EXTENSION AND A 30 (+/-) LF X 4' FOOT WIDE FIXED "L" , A BOAT LIFT INCLUDING ASSOCIATED BRACED SUPPORT PILING AND RELOCATE THREE BRACED TIE- OFF PILINGS ALL WATERWARD OF THE APPARENT HIGH WATER LINE. 2 C Board of Trustees Application WETLAND / TRUSTEE, LANDS APPLICATION DATA Purpose of the proposed operations: NOT APPLICABLE Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands : feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling: X No Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate) : 3 Albert J.Krupski,President O�0 CO Town Hall G James King,Vice-President 53095 Route 25 P.O.Box 1179 Artie Foster y = Southold,New York 11971-0959 Ken Poliwoda v �,li �� Telephone(631) 765-1892 Peggy A.Dickerson Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD E E E --------------------------------------------------------------- D In the Matter of the Application 0 2004 of JAN 2 - ------�---- -----��-------------------- SouthoM Town COUNTY OF SUFF LK) Board of Trustees STATE OF NEW YORK) AFFIDAVIT OF POSTING ° I,°`tom IRT-rr�Ec a td elf'so eil -----,residing at 5 U u-L-A&C O , J aAsT LLIPtC• C' -r O G 33 being duly sworn, depose and say: personally posted the roe known as That on the 6 day of�cn�� ,200y,I p y p property rty by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in placq/fpr eight days prior to the date of the public hearing.Date of hearing noted thereon to be held � U �.�k v m Dated: (sign e) Syvorn to befor me t 's day off 200 dtary Public /�i�/ .7vnI QS/U�U -6'X.01kca— 0) �2 c,;Ok F. 1$a NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: ROLLA CAMPBELL SCTM#1000-004-4-16 YOU ARE HEREBY GIVEN NOTICE: 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ADD 24 (+/-) LF OF 4- FOOT WIDE FIXED WOOD PILE AND TIMBER PIER EXTENSION AND A 30 (+/-) LF X 41FOOT WIDE FIXED "L" , A BOAT LIFT INCLUDING ASSOCIATED BRACED SUPPORT PILING AND RELOCATE THREE BRACED TIE-OFF PILINGS ALL WATERWARD OF THE APPARENT HIGH WATER LINE. 2 . That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows : PRIVATE ROAD, FISHERS ISLAND 3 . That the property which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment. You may contact the Trustees Office at 765- 1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: ROLLA CAMPBELL MAILING ADDRESS: P. 0. DRAWER FISHERS ISLAND, NY 06390 PHONE # : (631) 788-7803 Enc. : Copy of sketch or plan showing proposal for your convenience. 5 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS U.S. Postal Service U.S.Postal S4,vice CERTIFIED MAIL RECEIPT fIEWMAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Proviele'd�i` (Domestic Mail Only; No Insurance Coverage Provided) m Postage $ m Postage $ 0 m Certified Fee rf ,/��n�S"/ Y Certified Fee / L m � nn�� m r�oatrharN', Retum Receipt Fee Ft Return Receipt Fee tv Here "� -D (Endoreement Required) � (Endorsement Required) . M 1 r O p o = r C] Restricted Delivery Fee r' ti' 3 Restricted Delivery Fee UjjW p (Endorsement Required) J(j `� r3 (Endorsement Required) 1 Total Postage S F. $ � Total Postage&Fees � / 6 C3 Er &nt To . Dom- Sent To - .� r.s---1sIand--Caor- ry-Oul ------------- r=1 Street, t.A No.; treat Apt.No.; or PO Hoc No. 23 P� /4 or PO Box No. S� -.. - - -- - - -------- - - -- - O C/ty,State,ZIP+4 p t �O r� Al /O C/ty,State,ZIP+4 ����� f O���O f� t Y /�(,/ STATE OF CONNECTICUT COUNTY OF NEW LONDON DOCKO, INC. , residing at 14 HOLMES STREET, MYSTIC, CT being duly sworn, deposes and says that on the 1' day of -)HCerr\'6et- , 20U3, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at MYSTIC, CT , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this 3 ra Day of m ek— 20 p3 Notary Public 6 Board of Trustees Application County of Suffolk State of New York ROLLA CAMPBELL 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 ALL 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 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. cc, Signature SWORN TO BEFORE ME THIS p2 oc/ DAY OF ��� , 20 6'3 I mot- G Notar Public' VERONICA HAMILTON NOTARY PUBLIC STATE OF NEW YORK NO. 01 HA6067785 QUALIFIED IN SUFFOLK COUNTY TERM EXPIRES... 0-//7/ 0- 7 i Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ROLLA CAMPBELL residing at PRIVATE ROAD (print owner of property) (mailing address) FISHERS -ISLAND do hereby authorize DOCKO, INC. (Agent) MYSTIC, CT to apply for permit (s) from the Southold Board of Town Trustees on my behalf. CX rye l l (Owner' s signature) 8 Vo/c5i V,. !LIE um:5a rnn 516 165 IjU b. utfl , x town Accounting I0001 President`• O �0� Town Hall ' Albeit J.Krupijki, ay 6$096 Mein Road Jhii es Kirg;+Vice-Pr"'Bi 4t1t'' � r:•> '.P:O.Box 1179 Henry'^a,midi CM Soutbold,New York 11971 Artie Foster Ke'n Poliwada �� ®� Telephone(516)765-1892 Fait(5.16).766-1823•. . BOARD OF TOWN TRUSTEES . „•. ,.'TOWN OF SOUTHOLD ; LETTER OF REQUEST FOR AN AMENDMENT DATE 8/2,8/01 OWNER.-K1m,''-' TK ' C ampVe'1'1 rf oNF c/o 7'8 8:=5 55 0� '-_.._.. .-ADDRESS 8965 S'outb. East Bridge 'Rd, .Hobe'' Sound Glenn i; t. .Ju. t.•� '•of. JMO AGENTCbn�s•ulti•ng gervices pHpN.E 653=0607 "':.ADDRESS ,.•P "O'. Box 44.7.;•• Quogue , NY 1195,9-0447 . 'PROPERTYLOCATICIN' P)'ivate road, Fishers Island TAX wP NO:': .10 0 0 4-.4-'16 IWe, J-M0;;.;C qn's u 1 t i n g request an Amendment to Permit#5.2 01 to can.struct •a:, 32 ' x; 22 ' ramp in lieu of tYie 'app.roved 12 ` ramp •for the approved docking facility.,.. (copy of• Permiit:- #5201 enclosed) Signed E;y: r€ 1 2001 - Gl n E . st as agentL A��• 3 IMPT Sep 25 01 11 : 13a imQ consulting 631. p53 3348 p. 2 Albert J.Krupski,President gUFF80 Town Hall .53095 Route 25 James King,Vice-President �Q Gy� P.O.Box 1179 Henry Smith 10 = Southold,New York 11971.0959 Artie Foster Ken Poliwoda O Telephone(631)765-1892 'yiJ�ol �aQ� Fax(631)766-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ------------------------------------ .in the Matter of the Application e--- f - COUNTY OF SUFFOLK- STATE OF NEW. YORK) AFFIDAVIT OF POSTING I� residing at _ P�ing dulysworn, depose and say: � . That on the Cp day of `PT� , 2001 , I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the pos er has remained in place for eight days prior to the to of he ublic hearing. Date of hearing noted thereo t e e C� Dated: �s. a n to o e me this d o 2001 r, Notary public NolAry 00blie'State of New York .Mo.4806559 Queiifi®a in'Sutfolk'County Term Expires_12131 Sep 05 01 09: 16a jMo consulting : , 531 653 3348 p. 2 Albert J.Krupski,Presi•ent �� /f'c Town Hall O t'R``' 63095 Route 25 James Mng,Vice-President O G �� 'y� P.O.Box 1179 Henry Smith p Southold,New York 11971-0959 Artie Foster h = Ken Poliwoda ,y• '� Telephone(631)765.1892 yWl �a0� Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In-the Matter-of the Application COUNTY OF SUFFOLK STATE OF NEW YORK) J AFFIDAVIT OF POSTING I resi ing at ,. being duly sworn, depose an say: That on the s* day obna,- ^'80-Pj-., 200`, personally posted the property known as All by placing the Board of Tru tees official postbrr ,where it can easily be- seen, and that I have checked to be sure the pos er has remained in place for eight days prior to the date of he public hearing. Date of hearing ed thereon to be held Dated: (s tur rn to be m this d 2 0 Notary Public, THOM F.DOHERTY Jig, � Nnt ry Public. 4808$5gNew Yerk... ;.: +j•' SAP 7 2001 Quallfloo In Wfolk County ?. L= i Term Expires 12/3149--- (` . Board Of Southold • Town Trustees . r SOUTHOLD, NEW YORK PERMIT NO. ... r � �..... DATE: Aug. 29..... 2.... ISSUED TO .............KIM K... CAMPBELL.......... ........ ........................ 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 r, ' State of New York I952; and the Southold To-kn..Ordinance en- :. titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the >E REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM LANDS UNDER TOWN.*WATERS;',.': and in accordance with the ' Resolution of The Board adopted at a meeting held on Aug.....23.?..... 50'00 1*00..:., and in consideration of the sum of $....1... ................. paid by •, Kim K..••... Campbell • .................................................... ••• Ffsher Island of ..•• ....... . .•...•...•.....•............. N. Y. and. subject to the . �t ' Terms—and Conditions listed__ on the reverse .side _hereof, of Southold Town Trustees authorizes and permits the following: y Wetland Permit to construct a 4'X: 120' fixed dock elevated 4' r` above grade, 41X 12' ramp, 6'X 20' float and (4) out piles all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here-by causes ifs Corporate Seal to be affixed, and these Pretenfs to be subscribed .bye majority of the said Board as of this date. / o • ' �.p�"� e-��A►t� 'moo�► k' � �.• a�•,y�,.a►t 4�1► "r•�•FDA-•x � '� , . TERMS and CONDITIONS' The Permittee Kim K. Campbell residing at 8965 South East Bridge Rd. , Hobe Sound, FL part• of the consideration for the Issuance of the Permit does understand and N. Yy as (of- lowing: prescribe co the fol- I. That the said Board of Trustees and the Town of Southold are released from any and all damages, or cams for damages, of suits arising directly or Indirectly as a reanhlt of any open: ration performed pirsuant to this permit; and the said Permitted will, at his or her own expense, defend any and al!'sdch suits'lnitlated by third pardes, and the said Permittee assumes full liability with respect thereto, to the complete'exclusion of the Board of Trustees of the Town of Southold. 2. That this'Permit Is'valid for it-period of 24 mos, which Is considered to be the estimated time°required to complete the work Involved, but'shonld tlydrrhstances warrant, requesi. .. for an extension may be made to the Board at a later dab- 3. That this Permit should be retalned indefinitely, or as long as the said Permittee wisht� to maintain the structure or project Involved, to provide evidence to anyone concerned that autfi- orization was originally obtained, . 4. That the work Involved will be subject to the inspection -and_approval of the Board .ot f Its agents,--and non-compllance with the provisions of the originating appllcadon,.may be can::e tot revocation of this Peimlt by resolution of the said Board. 5. That there will be no unreasonable Interference with navigation as a result of the work . herein authorized. G. That there shall be no Interference with the right of the public to pass and repass &tlong the beach between high and low water marks, 7• That if future operations of the Town of Southold requite the removal and/or alterations . ; In the location of the work herein authorized, -or If, In the opinion of the Board of Tmsteet, the, work shall cause unreasonable obstruction to free navigation, the said Petmictee will be reqult+ed,' upon due notice, to remove or alter this work or project herein stated without expenses to the Town- of Southold 8. That die said Board will be notified by the Permittee of the completion.of the work auth- othed, 9. That the Permittee will obtain all other permits and eonSents chat may be required sap: plemental to this permit which may be subject to revoke upon failutE to o" same, i 77YU jert J. I{rupski, President �QOf f 171 ^ Town Hall James King, Vice-President ��0 �ljy 53095 Route 25 Remy Smitho P.O.Box 1179 Southold,New York 11971-0959 Artie Foster era W h1 Ken Poliwoda Teiephone(631)765-1892 '�r�j►�� ��0�' Fax(631) 765-1366' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 29, 2000 Mr. Glenn E. Just J.M.O. Environmental Consulting P.O. Box 447 Quogue, NY 11959-0447 Re: KIM K. CAMPBELL SCTM#4-4-16 Dear Mr. Just: The following action was taken by the Board of Town Trustees during its regular meeting held on August ,23, 2000 regarding the above matter: WHEREAS., J.M.O. Environmental Consulting on behalf of KIM K. CAMPBELL applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated July 17, 2000, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 23, 2000 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 structure complies with the standard set forth. in Chapter 97 of the Southold Town Code, f 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 approve the application of KIM K. CAMPBELL to construct a 41X 120 ' fixed dock elevated 4 ' above grade, 41X 12 ' ramp, 61X 20 ' float and (4) out piles . BE IT FURTHER RESOLVED that this determination' 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. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees : None Very truly yours, // Albert J. Krupski, Jr. President, Board of Trustees AJK/lms cc: DEC ACE Dept. of State t Town Hall Albert J. Krupski, President 53095 Main Road James King,Vice-President o P.O. Box 1179 Henry Smith ys- T Southold, New York 11971 Artie Foster Ken Poliwoda �'�� ��� Telephone(516) 765-18.92 Fax (51.6) 765-1823 z BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use. Only Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application Waiver/Amendment/C ang�� eceived Apptic ►�1� � �--- Received Feep$ ' L�* f 11 5 l� }r } om leted A lic on u _Incomplete SEQRA Classification:! F JUL 1 7 20 Type I Type II Unlisted �� Coordination: (date sen rt .-- I /CAC Referral Sent:��1 W., ,: ' ate of Inspection: Receipt of CAC Report!-. Lead Agency Determination: Technical Review: ✓Public Hearing Held:814A100 p' Resolution: Name of Applicant Kim K. Campbell Address 8965 South East Bridge Road, Suite 2002 , Hobe Sound FL 33455 Phone Number: (c/o )631-788-5550 Suffolk County Tax Map Number: l000 - 004-4-16 Property Location:_ Private road no # (provide LILCO Pole #, distance to cross streets, and location) AGENT: Glenn E. Just/ J.M. O . Environmental Consulting (If applicable) Address: P . 0 . Box 447 , Quogue, N.Y. 11959-0447 Phone: 653-0607 FAX# : 653-33 8 1 /� Board of Trustees Application GENERAL DATA Land Area (in square feet) : } 1 acre „ Area Zoning: R-120 Previous use of property• Existing single family dwelling Intended use of property: same Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has . any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: unknown Project Description (use attachments if necessary) : Applicant proposes to construct a 4 'x120 ' fixed dock elevated 4 ' above grade , 41x 12 ' ramp, 6 ' x 20 ' float and (4) out piles as per enclosed plans prepared by Chandler, Palmer and King dated 5/10/00 . 2 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Private recreational docking Area of wetlands on lot: n/a square feet Percent coverage of lot: n/a % Closest distance between nearest existing structure and upland edge of wetlands: n/a feet Closest distance between nearest proposed structure and upland edge of wetlands: n/a feet Does the project involve excavation or filling? X No Yes If yes, how much material will. be excavated? n/a cubic yards How much material will be filled? n/a cubic yards Depth of which material will be removed or deposited: n/a feet Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: n/a Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate) : As proposed, project should have no negative impacts upon the waters or wetlands of the Town of Southold. 3 14-164(f2/97)—q SEAR PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Kim K . Campbell Proposed dock 3. PROJECT LOCATION: Municipality Fishers Island County Suffolk 4. PRECISE LOCATION:(Street address and road Intersections,prominent landmarks,etc.,or provide map) ' Private road. no # Location map and survey enclosed 5. IS OPOSED ACTION: New ❑ Expansion ❑ Modification/alteration 6. IVSWBE PROJECT BRIEFLY: Applicant proposes to construct a 41x 120 ' fixed dock elevated 4 ' above grade , 4 'x 12 ' ramp, 6 ' x 20 ' float and (4 ) out piles as per enclosed plans prepared by Chandler, Palmer and King last dated 5/10/00 . 7. AMOUNT OF LAND AFFECTED: Initially 9 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER J(ISTING LAND USE RESTRICTIONS? ❑ Yes ❑ No If no,describe briefly 9. WVAT IS PRESENT LAND USE IN VICINITY OF PROJECT? V01,Flesidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open Space. ❑ Other Bribe: Single family dwelling and country club 10. DO S ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(Federal,State or Lo I)? Yes ❑ No II yes,list agency(s)and permlVapprovals Southold Town - Trustees , 11.Y. S .D . F.C . , N.Y. S . U. O. S . S U. S . D.O.A. 11. DOES ANY Ae7fCT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes No II yes,list agency name and permit/approval 12. AS A RESUL F PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY AT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor Name '1 n E . Just as agent Date 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 FROM r JmO CONSULTING PHONE N'7, 653 0607 n. 14 :000 09:5EAM P02 I O J,M.O. Environll-rer> al C01.1sulting Sel.wices To whom it may concern: Please he advised that we have enthorized the firm of J.M.O. Euvir()nmcntal Consulting Services to act ns our agent on our hehelf it, npplying for certnin Atitxovals thwu8h your agency and otllcrs f1lVoivelt with thi9 1)rgject. J-M.(). Co i4ulting Services has been retained to coordinate all npprovnls Ifecegmry through your and othci involved agenc(es,as rvell as Our architect, engineer and contractt)ts. We request (lint all communications,correspondences, 1106oc5, Approvals 011d calla he addressed directly to the 011ces 00.14.0. Unvironnie llal Co11Stlllinl;SC viCCc. Dated_ U_ka AC)"L.-ODO ..... n Ptjonq (F,►31) (,ly;�•l�bi)1 • i CIX ((7:3�7 G�`i3-.'�.i4l 121 Avci + 2I-id 4=I►_)c)r * l•).C>. 13r)x .147 No. YOtk 1196(?..0 447 ZO 39VJ G10CHHH _._ 6 9993LT69T f_r' :Tel Gi00 1901Lc_1 FROM J and C=NSULT t NG PHONE NO. 653 0EQ7 14 2R0P1 0?;59RM Pt33 board of Trustees Application county of Suffolk State of New York BEING DULY SWORN rrr.r�s•. - j VZPOSES AND AFFIRMS AT\HE)SH IS THE APPLICANT FOR THE ABOVE DESCRIEW PERMIT(5) AND THAT ALL STATEMENTS CONTAINED HMIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WrLL BE DONE IN THE NIANNSR SET FORTH IN THXS APPLICATION AND AS MAX SE APPROVED BY THE soLrrHQLD TOWN BOARD OF 'TRUSTEES THE APPLICANT AGREES TQ MOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND AI,L DAM OCS AND CLAIMS ARISING UNDER .OR BY VIRTUE OF SAID PERMITS) , IF ORAN'x'm- IN COMPLETING THIS APPLICATION, I HERESY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S) , TO ENTU ONTO MY PROPERTY To INSPECT THE PREMISES IN CONJUNCTION WITH' R IEW OF THIS APPLICATION. At cla Le� I signature "Z&a u SWORN TO BEFORE ME THIS�-�'"-�' DAY Of Notary Puts q y -Tb10AN4�M,00"Imy JR. Neu►y Nubile lfato of Now York . N4,Rt100s9p Outllfloa In tutfolk County Term Expires 12/910 7 90 39Vd S,{I-1O�1yH 6h9980L' TE9Z LZ:TO 0Zi99rLQ — _ ---- ------------------------------- ------------------------- 1 P O��g�FFOI,�c� Town Hall Albert J.Krupski,President h`� G'� 53095 Main Road James,King,Vice-President P.O.Box 1179 Henry Smith y Southold, New York 11971 Artie Foster D Ken Poliwoda 'y �� T'c'ephone(516) 765-18q2 Fai-'516) 765-.1.823 BOARD OF TOWN TRUSTRES TOWN OF SOUTHOLD h. BCD RD OF TRUSTEES: TOWN OF SOUTHOLD SEP — T ----------------------------------- �.. . ' 2010 in rile 14atter of the Applicat.ioil „�, of u `.�� v 0 SOUTHAD C017N'1.:Y OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING; T., gAaDLD residing at being duly sworn, depose and say: That- .::i1 the e d,-1.y of Al 0L6d;2090, T Per sonall'- pUstaid trc p: �a,crtL-.V known as _ K. C'A1k q�3� 1.+.-.aing -the Board of Trustees off i ciul pest:r 4 c1ere ca. ea c-s—I';l'y' e seen, and that I have checked tolx, ,.-re t:ic ~'S.i.`_er has remained in place fcr seven days: prior t!:^ Cox 4'e public h firing. (date of hear .ng rioted _ re-on to be geld`�'4=u3�oZ� 01 AUt'�7 C 0C)0 (sign t e) to be e this Q ay 40 r FTotary Public N6t9iy OUglis State of New York No,4800659 Ouallfloo In Suffolk County Term Expires 12/31M PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address : Lucille P . Balcolm c/o Fiduciary Trust Co , 2 World Trade Center, N.Y. N.Y. 10048 U.S.Postal Service CERTIFIED MAIL RECEIPT I (Domestic Mail Only;No Insurance Co verage Provided) IrU r� LLO_ / Postage $ h3 s Ob � Certified Fee o / p Return Receipt Fee jj rq (Endorsement Required) p Restricted Delivery Fee ` 7� p (Endorsement Required) �J {� p Total Postage&Fees r �n o o iru ru N e(Please Prin rly)(T be completed by mailer) l r" (�-� �./- ` �-__ L -----�d---------- Er Str t, pt.No.;or PO BoxIr p 1 STATE OF NEWjr` ai s �Alc . �[� AQ COUNTY OF SUL 64nn CeS residing at 21 ��,� 1125g --- O '7, bein duly sworn, deposes and says that on the �_ day of L ,4�L2o0o , deponent mailed a true copy of the otice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at 67 , that said Notices were mailed to each of said ersons by (certified) (registered) mail. Sworn to before me this day of `) , $ 0 00 AROLYN C.HOGAN NotaW Public' Notary Public,State of New York No.4962579 Qualified in Suffolk County �/1/ Commission Expires February 20, CCTT PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address : Fishers Island Development Co Draw E, Fishers Island, N.Y. 06390 1U.S. Postal Service MAIL RECEIPT (Domestic CERTIFIED 1ail Only; No Insurance Coverage Provided) ru I Jrr �i5 h 1 �eUc�l .11 Postage $ �� S LLrI Certified Fee p)� QD k E-3 Return Receipt Fee �,� *- r� (Endorsement Required) we Restricted Delivery Fee JI M (Endorsement Required) (0 Total Postage&Fees ru IU Name(Please Print Clearly)(To be completed by mailer) m ---------------------------------------------------------------------- PS Er CIV STATE OF NEW -.- .... "' COUNTY OF SUFFOLK 64on GCS residing at L95cr -O�l "�, bein duly sworn, deposes and says that on the day of t: ,414t000 , deponent mailed a true copy of the otice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that saki Notices were mailed at the United States Post Office at � , that said Notices were mailed to each of said ersons by (c rtified) (registered) mail . Sworn to before me this day 'of 1-y-- ,-M Note Public CAROLYN C.HOGAN lNotary Public, No 4 State of New York Qualified in Suffolk county �0�� Commission Expires February 20, NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD r In the matter of applicant: SCTM#1000- 004-4-16 YOU ARE HEREBY GIVEN NOTICE: 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Applicant proposes to construct a fixed dock 4 'x 120 ' elevated 4 ' above grade , 4 ' x 12 ' ramp, 6 ' x 20 ' float and (4) out piles . 2 . That the property which is the subject of Environmental Review.-is located adjacent to your property and is described as follows : Private road no # , Fishers Island 3 . That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal . OWNERS NAME: Kim K Campbell MAILING ADDRESS : Env nmental Consulting P . O. Box 447 , Quogue , N.Y. 11959-0447 PHONE #: 31- 53-0 07 Enc. : Copy of sketch or plan showing proposal for your convenience.