HomeMy WebLinkAboutTR-8169 CER ,IANCE
Date: October 5, 2016
THIS CERTIFIES that the removal and replacemeq'bf 80 linear feet of deteriorated timber
bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"• construct a 16
linear foot bulkhead return on west side of property reconstruct timber stairs-, and remove two cedar
trees;with the condition to establish and subsequently maintain a 10' wide non-turf buffer landward of
bulkhead;
At 52332 CR 48, Southold
Suffolk County Tax Map#1000-135-3-17.1
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated April 9,2013 pursuant to which Trustees Wetland Permit#8169
Dated May 15, 2013,was issued and conforms to all of the
requirements and conditions of the applicable provisions of law. The project
for which this certificate is being issued is for the removal and replacement of 80 linear feet of
deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation
6"; construct a 16 linear foot bulkhead return on west side of property;reconstruct timber stairs; and
remove two cedar trees;with the condition to establish and subsequently maintain a 10' wide non-turf
buffer landward of bulkhead.
The certificate is issued to ANN AMIAGA owner of the
aforesaid property.
.X
Authorized Signature
J.
I
John M- Bredemeyer III, President 1; °�� ` �o�y;;` Town Hall Annex
Michael J. Domino, Vice-President 54375 Route 25
P.O. Box 1179
Glenn Goldsmith o z `
",F.'
A. Nicholas Krupski ® Southold, NY 11971
• c? '�° T elephone (63 1) 765-1892
Charles J. Sanders 1 , „
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: a i-z--d ZO
V Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1St day of construction
Y constructed
►✓ Project complete, compliance inspection.
6
INSPECTED BY:
COMMENTS:
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CERTIFICATE OF COMPLIANCE:
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/• ,�y i ROPOSED 80 lF VINYL.BULKHEAD �'\
y, (IN SAME ALIGNMENT AS DM) W� \
fi APPROVED BY �US EC ' RISrUNTRAED DECKING
DW.CEDAR TREE AIiD(gyp 2PO THAT ARE CURREMLY IN POOR �
ARD Of TRUSTEES CONDIfiON DUE TO STORMS E HAIIARD TO ADJ. PROPERTY
E N OF'SOUTHOLD*HOLD (IROPOSED I VINYL BULKHEAD RETURN
TO
;;`'•r '' N SANE ALIGNMENT AS IXISL) �� ^014D
ETATED YlETlANDS Y 1, M
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{= APR - 9 2013
Southold Town
Board of Trustees
PROPERTY OWNER: DATE I REVISION
ANN AMIAGA BULKHEAD PERMIT PLANS SCALE:
NOTES: 52332 C.R. 48
SOUTHOLD, NY 11971 •=40'
1. PORTIONS OF SITE PLAN FROM SURVEY PREPARED BY: PROPOSED PLAN DATE:
NATHAN TAFT CORWIN III LAND SURVEYOR PREPARED BY: 4-4-13
1586 MAIN ROAD, JAMESPORT, NY JEFFREY PATANJO
DATE SURVEYED: JULY, 30 2003 106 HEWITT BOULEVARD 52332 C.R. 48
CENTER MORICHES, NY 11934 SOUTHOLD, TOWN OF SOUTHOLD
2. LOT AREA = 20,854.32 (0.48 ACRES) 631-484-9332 SUFFOLK COUNTY, NY SHEET:
TAX MAP NO. 1000-135-03-17.1 1 OF 2 /
PROJECT
LOCATION
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1.
PROJECT LOCATION MAP
N.T.S.
PROPOSED TIMBER TOP CAP
PROPOSED 12' LONG 8"0 CCA
TREATED TIMBER PILE, 6' O.C.
PROPOSED 3"X6"
REAR WALE NOTE: REMOVE EXISTING BULKHEAD
STRUCTURE IN ITS ENTIRETY
AND INSTALL NEW BULKHEAD
IN THE EXACT SAME POSITION
AS EXISTING. RAISE ELEVATION
6" ABOVE EXISTING TOP CAP
ELEVATION.
0
.F
PROPOSED 6"x6" CCA
TOP & BOTTOM WALE
PROPOSED 8" TIP CCA EXISTING BULKHEAD
LAY-LOG PILE TO BE REMOVED IN IT5 ENTIRETY.
PROPOSED 8" TIP CCA PILE, 6' \ APPROXIMATE M.H.W. El. 2.5f
O.C. 8' LENGTH. BOLTED TO
\\\\ \\ \\ \\ \
LAY-LOG WITH 3/4"
GALVANIZED THRU-BOLTS. 4L
// APPROXIMATE M.LW a. o.ot
PROPOSED 14' LONG 1" DIA.
GALV. TIE ROD, 6' O.C.
PROPOSED 10' LONG C-LOC
9000 VINYL SHEETING
TYPICAL SECTION A-A D EC IVE
N.T.S.
APR — 9 2013
Southold Town
Boar of Trustees
PROPERTY OWNER: DATE I REVISION
ANN AMIAGA BULKHEAD PERMIT PLANS SCALE:
52332 C.R. 48
NOTES: SOUTHOLD, NY 11971 AS NOTED
1. PORTIONS OF SITE PLAN FROM SURVEY PREPARED BY: PROPOSED SECTION DATE:
NATHAN TAFT CORWIN III LAND SURVEYOR PREPARED BY: & LOCATION MAP 4-4-13
1586 MAIN ROAD, JAMESPORT, NY JEFFREY PATANJO
DATE SURVEYED: JULY, 30 2003 106 HEWITT BOULEVARD 52332 C.R. 48
CENTER MORICHES, NY 11934 SOUTHOLD, TOWN OF SOUTHOLD
2. LOT AREA = 20,854.32 (0.48 ACRES) 631-484-9332 SUFFOLK COUNTY, NY SHEET:
TAX YAP NO. 1000-135-03-17.1 2 OF 2
John M. Bredemeyer[[[, President �PfFD(,- Town Hall,53095 Main Rd_
Michael J- Domino,Vice-President ,�� Gy P-O.Box 1179
James F. King V3 Southold,NY 11971
x
Dave Bergen Telephone(63 1)765-1.892
Charles J.Sanders Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE F INSPECTION: z����7 e),
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt c 4
1"day of construction
Z12 constructed
Project complete, compliance inspection.
INSPECTED BY:
COMMENTS: _
l(o �
CERTIFICATE OF COMPLIANCE:
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i
James F.King,President ���5l1FEQ(,l-c
4G Town Hall,53095 Main Rd.
. _ Bo_b.Ghasio;Ir,Vice-President � ��� � � -
DaveBergm P.O:Box 11.79-
w. Southold,NY 11971 .
JohaBredemeyer p ;:
A ,�, Telephone(631)765-1892
Michael J.Domino ¢ O
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN-'OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN:
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO'DO. SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT_
INSPECTION SCHEDULE
Pre-construction, hay bale line
1't day of construction
%2 constructed
Project complete, compliance Inspection
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I BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD,NEW YORK '
PERMIT NO. 8169 DATE: MAY 15,2013 pld
ISSUED'TO: ANN AMIAGA
-
`" PROPERTY ADDRESS: 52332 CR 48, SOUTHOLD
„ SCTM# 135-3-17.1 •,,,
AUTHORIZATION
g : ^ Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in
accordance with the Resolution of the Board of Trustees adopted at the meeting held on May 15,2013,and in le
consideration of application fee in the sum of$250.00 paid by Ann J. Amiaea or authorized waiver of Town
Board and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of r
Trustees authorizes and permits the following:
Wetland Permit to remove and replace 80 linear feet of deteriorated timber
bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6";
construct a 16 linear foot bulkhead return on west side of reconstruct timber •'' ' `
property; _'•
., stairs; and remove two cedar trees; with the condition to establish and subsequently
maintain a 10' wide non-turf buffer landward of bulkhead; and as depicted on the site
r
on
plan prepared by Jeffrey Patanjo, last dated April 4,2013, and stamped approved
May 15,2013. `
IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,
and these presents to be subscribed by a majority of the said Board as of this date.
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TERMS AND CONDITIONS
The Permittee Ann Amiaga residing-at 52332 CR 48 Southold New York as part of the
consideration for the issuance.of the Permit does understand and prescribe to the following:
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
operation 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 exclusion of the Board of
Trustees of the Town of Southold.
2. That this Permit is valid for a period of 24 months, 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
authorization was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or its,
agents, and non-compliance with the.provisions of the originating application may be cause
for 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.
6. 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 require 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
required, upon due notice,to remove or alter this work project herein stated without
expenses to the Town of Southold.
8. The Permittee is required to provide evidence that a copy of this Trustee permit has been
recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction
to the deed of the subject parcel. Such evidence shall be provided within ninety(90)
calendar days of issuance of this permit.
9. That the said Board will be notified by the Permittee of the completion of the work
authorized.
10. That the Permittee will obtain all other permits and consents that may be required
supplemental to this permit,which may be subject to revoke upon failure to obtain same.
James F.King,President ��0v so yo Town Hall Annex
Bob Ghosio,Jr.,Vice-President ,`O l0 54375 Main Road P.O.Box 1179
Dave Bergen Southold,New York 11971-0959
John Bredemeyer G Q
a� Telephone(631)765-1892
Michael J.Domino OI�,C�U Fax(631)765-6641
e
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 15, 2013
Mr. Jeffrey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934
RE: ANN AMIAGA
62332 CR 48, SOUTHOLD
SCTM# 135-3-17.1
Dear Mr. Patanjo:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, May 15, 2013 regarding the above matter:
WHEREAS, Jeffrey Patanjo on behalf of ANN AMIAGA applied to the Southold Town
Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code,
the Wetland Ordinance of the Town of Southold, application dated April 9, 2013, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory
Council and to the Local Waterfront Revitalization Program Coordinator for their findings
and recommendations, and,
WHEREAS, the LWRP Coordinator recommended that the proposed application be
found Inconsistent with the LWRP, and,
WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront
Revitalization Program to the greatest extent possible through the imposition of the
following Best Management Practice requirements: issuance of permit on structures;
proposal is for a replacement of an existing bulkhead, not for a newly proposed
bulkhead in a new area; and
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said
application on May 15, 2013, at which time all interested persons were given an
opportunity to be heard, and,
2
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 standards set forth in Chapter 275 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 for the mitigating factors and based upon the Best Management
Practice,requirement imposed above, the Board of Trustees deems the action to be
Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5
of the Southold Town Code, and,
RESOLVED, that the Board of Trustees approve the application of ANN AMIAGA to
remove and replace 80_.linear feet of deteriorated timber bulkhead with new vinyl
bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot
bulkhead return on west side of property; reconstruct timber stairs; and remove two
cedar trees; with the condition to establish and subsequently maintain a 10' wide non-
turf buffer landward of bulkhead; and as depicted on the site plan prepared by Jeffrey
Patanjo, last dated April 4, 2013, and stamped approved on May 15, 2013.
Permit to construct and complete project will expire two years from the date the permit
is signed. Fees must be paid, if applicable, and permit issued within six months of the
date of this notification.
Inspections are required at a fee of$50.00 per inspection. (See attached schedule.)
Fees: $ 50.00
Very truly yours,
James F. King
President, Board of Trustees
JFK/amn
FF
James F.King,President Town Hall Annex
Bob_Ghosio,Jr.,Vice-President 54375 Route 25,P.O.Box 1179
Dave Bergen Q.` Southold,MY 11971
John Bredemeyer d( �,`3a Telephone(631)765-1892
Michael J.Domino Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO: 1 l
Please be advised that your application dated. has been
reviewed by this Board at the regular meeting of 5 and
your application has been approved pending the completion of the following items
checked off below.
Revised Plans for proposed project
Pre-Construction Hay Bale Line Inspection Fee ($50.00) ,
1st Day of Construction ($50.00)
% Constructed ($50.00)
Final Inspection Fee ($50.00).
Dock Fees($3.00 per sq. ft.)
Permit fees are now due. Please make check or money order payable.to Town of
Southold. The fee is computed.below according to the schedule of rates as set forth in
Chapter 275 of the Southold Town Code.
The following fee must be paid within 90 days or re-application fees will be necessary.
You will receive your permit upon completion of the above.
COMPUTATION OF PERMIT FEES:
TOTAL FEES DUE: $ D In
BY: James F. King, President
Board of Trustees
Peter Young,Chairman H Town Hall,53095 Main Rd.
Lauren Standish,Secretary P.O. Box 1179
Southold,NY 11971
Telephone(631)765-1892
Fax(631)765-6641
Conservation Advisory Council
Town of Southold
At the meeting of the Southold Town Conservation Advisory Council held Wed., May 8,
2013 the following recommendation was made:
ANN AMIAGA to remove and replace 80 If. of deteriorated timber bulkhead with new vinyl
bulkhead in same location as existing; raise elevation 6"from existing; construct 16 If.
bulkhead return on west side of property; reconstruct timber stairs and remove two cedar
trees.
Located: 52332 County Rd. 48, Southold. SCTM#135-3-17.1
SUPPORT — conditioned upon receipt of bulkhead construction plan. Do not recommend
raising height of bulkhead.
Proposed by Doug Hardy, seconded by William McDermott. All in favor
James F.King,President p� G'Q P.O.Box 1179
Bob Ghosio,Jr.,Vice-President �� GS Southold,NY 11971
Dave Bergen y Telephone(631 765-1892
John Bredemeyer ,y, Fax(631)765-6641
Michael J.Domino
Southold Town Board of Trustees
Field Inspection/Work Session Report
Date/Time: - ,� 3
Jeffrey Patanjo on behalf of ANN AMIAGA requests a Wetland Permit to remove
and replace 80 linear feet of deteriorated timber bulkhead with new vinyl
bulkhead in same location as existing and raising elevation 6"; construct a 16
linear foot bulkhead return on west side of property; reconstruct timber stairs; and
remove two cedar trees. Located: 52332 County Road 48, Southold. SCTM#
135-3-17.1
Type of area to be impacted:
_Saltwater Wetland Freshwater Wetland Sound Bay
Distance of proposed work to edge of wetland
Part of Town Code proposed work falls under:
_Chapt.275 Chapt. 111 other
Type of Application: Wetland _Coastal Erosion_Amendment
—Administrative—Emergency Pre-Submission Violation
Info needed:
Modifications:
-,rPiJd yr�s5�o i
Conditions:
Presept'Were: J. King.- B. Ghosio D. Bergen,
✓J..Bredemeyer -" Michael Domino D. Dzenkowski other
Form filled out in the field by
Mailed/Faxed to:
Date: .
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9 2013
Southold Town
Boar of Trust e
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APR - 9 2013
Southold Town
Boar of Tr st e
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APR - 9 2013
Southold Town
ar of Tr, to
April 4, 2013
NYS Dept. of Environmental Conservation
SUNY @ Stony Brook
50 Circle Road
Stony Brook, New York 11790-2356 D ECEIVE
Attention: Duty Analyst
APR - 9 2013
RE: 52332 CR 48 SOUTHOLD, NY
SCTM No. 1000-135-03-17.1
APPLICATION FOR PERMIT Southold Town
BoardTrustees
Dear Sir/Madame:
We hereby submit four(4) copies of the proposed plans, applications, check,
photographs and required data for permit approval for the above referenced project.
If you should have any questions or require anything further, please do not hesitate to
call me at 631-484-9332 or e-mail at jpatanjo@optonline.net.
Very truly yours,
0
Jeffrey Patanjo
106 Hewitt Blvd.
Center Moriches, NY 11934
cc: NYSDOS
,wTawn=ofa_Southold=.-
Ann Amiaga
JOINT APPLICATION FORM
For Permits/Determinations to undertake activities affecting streams,waterways, I '
waterbodies,wetlands,coastal areas and sources of water supply.
of
New York You must separately apply for and obtain separate Permits/Determinations from Army Corps
State each involved agency prior to proceeding with work. Please read all instructions. Enn Army
(USAGEE
)
APPLICATIONS TO
1. NYS Department of Environmental Conservation 2. US Army Corps of Engineers 3. NYS Office of 4. NYS Depart-
General Services ment of State
Check all permits that apply: Check all permits that apply:
❑ Stream Disturbance ❑Coastal Erosion ❑ Section 404 Clean Water Act Check all permits that Check if this
Management apply: aapp�lies:
❑ Excavation and Fill in ❑ Section SO Rivers and Harbors ❑ State Owned Lands L�CoastaI
Navigable Waters ❑ Wild,Scenic and �,
Under Water Consistency
❑ Docks, Moorings or Recreational Rivers Nationwide Permit(s)-Identify Concurrence
Platforms ❑ Water Supply Number(s): ❑Utility
Easement
❑'Dams and Impoundment ❑ Long Island Well (pipelines,
Structures ❑Aquatic Vegetation Control 3 conduits,
❑ 401 Water Quality cables, etc.)
❑Aquatic Insect Control ❑Docks Certification Preconstruction Notification - ,
❑ FF eshwater Wetlands ❑ Fish Control „ Y / ❑ N Moorings or
LrJ Tidal Wetlands ❑Incidental Take of Endan- Platforms
gered/Threatened Species E,/
� I am sending this application ❑ I am sending this I am sending
2--am sending this application to this agency. application to this this application
to this agency. agency. to this a enc .
5. Name of Applicant(use full name) Applica must be: 6. Name of Facility or Property Owner(if different than
Owner Applicant)
N M 1& G•- ❑ Operator
Mailing Address ❑ Lessee Mailing Address
(check all that apply)
5 a331 C q
Post Office City Taxpayer ID (If applicant Post Office City
/� is NOT an individual):DJ^l'KD �(�
State ffel
Zip Code q-7State Zip Code
daytime) Email Telephone(daytime)' Email
5 • �343
7. Contact/Agent Name 8. Project/ Facility Name Property Tax Map Section/Block/Lot Number
t {G f) A-An o IA, w (Le S/d", Cle !voo - j35 - b3 •l7
Company Name Project L cation-Provide directions and distances to roads, bridges and bodies of waters:
5-ee e- +44G A k-P
Mailing Address Street Address, if applicable Post Office City State Zip Code
l o L at w 5 a 3 b a- C R • Lit 5,9 "+k o f cl
NYi«l I
Post Office City Town/Village/City County
Gen+c,r 1l/lv(,t"es Some +kotd Sv LA-
State Zip Code Name of USGS Quadrangle Map Stream/Water Body Name
t—N l 113y Soti+k o I it A- rsh N.n o1-n e. t,e— P.,,a
Telephone (daytime) 6 3).-
). L $ '` 3 3 Location Coordinates: Enter NYTMs in kilometers,OR Latitude/Longitude
Email 'T NYTM-E NYTM-N Latitude Longitude
J 0a'�ccn aGJ DP�'br►Liae.Nc�- 91 °os' •01.lo" �a rpq, 51.5-b"
'� � $ •ra � f � r,. 'F USAGE tuber 4 i
Fpr.Aaencv Use Only <��D��Application Number -� Y 7,{, � n L„NU ,
JOINT APPLICATION FORM 09/10 This is a 2 Page Application Application Form Page 1 of 2
Both Pages Must be Completed
ENT APPLICATION FORM— PAGE 2 OF 2
_. it this completed page as part of your Applicatio.::-
9. Project Description and Purpose: Provide a complete narrative description ofthe proposed work and its purpose. Attach additional page(s) if
necessary. Include: description of current site conditions and how the site will be modified by the proposed project; structures and fill materials to
be installed; type and quantity of materials to be used (i.e., square ft of coverage and cubic yds of fill material and/or structures below
ordinary/mean high water) area of excavation or dredging, volumes of material to be removed'and location of dredged material disposal or use;
work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource
Impacts; and where applicable,the phasing of activities. ATTACH PLANS ON SEPARATE PAGES.
It,KovG &AX rcplkt c $o -F tP.t�CCt��� �.�� +, �n Iven-
Ni-w vlN� L baLV` ee e,( , Psi Sc -e-i-e -��s�► li 120Uc yxl S4,—�y
Gv -SIC( v e-( l b c.,�- 'bYw c y b-u 11,k e 4-& S ei m-0
Proposed Use: Private ❑ Public [ Commercial Proposed 'I Estimated e!
Start Date: Com letion Date: ! ' '13
Has Work Begun on Project? ❑Yes Elo If Yes,explain.
Will Project Occupy Federal,State or Municipal Land? ❑Yes 9'oNo'o If Yes, please specify.
10. List Previous Permit/Application Numbers (if any) and Dates:
11. Will this project require addiitional Federal, State,or Local Permits including zoning changes? 11 Yes ElNo If yes, please list:
A I" f I Y -1 f,A b S l L(i 'r r ,S'f•t c S
12. Signatures. 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 State from suits, actions, damages and
costs of every name and description resulting from said project.In addition, Federal Law, 18 U.S.C.,Section 1001 provides for a fine
of not more than $10,000 or Imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies,
conceals, or covers up a material fact; or knowingly makes or uses a false,fictitious or fraudulent statement.
Signature of Applicant U Printed Name Title Date
Signature of Owner n Printed Name Title Date
14- -Jore
n e of AgeKt Printed Name a Title Date
For Aaencv ie Only Y, a DETER YNATION OF NO PERMIT REQUIRED
!
r 11 n riz rs
r r __tb ;r �r"t T4.. ry F_. , �µ'r,Agency,I?rb1ectryNurntie
.d , a ,.: a t s, ` 'has determined ha N�oyP KII is�M.We .*bm this Agency for the project descnb�d en
_x , �z5
(Agency Name) p
I ! -
Agenc�Representatlfiie t��:Name)(pnnted)� �� � * � t � t s x � Title
... ...., ._ .. .. .. _...... _s.... . .. ts... ..ter,. � :.
JOINT APPLICATION FORM 09/10 Application Form Page 2 of 2
' c
617.20
Appendix C
State Environmental4Quality 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(.
A/vN AM a,te A.Mwe-iLSr6 er►t.t- 13✓LIGtira.d
3. PROJECT LOCATION: C
Municipality 5 u✓ 1/►o GQ County
4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map)
5 233a- cA ,
5. PROPOSED ACTION IS:
New Expansion Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
+2,t/vLovc
N L w V t L, b S a j
7. AMOUNT OF LAND AFFECTED:
Initially ,n i acres Ultimately •o I acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
2Yes El No If No,describe briefly
9. WHAT IS RESENT LAND USE IN VICINITY OF PROJECT?
esidential Industrial Commercial Agriculture Park/Forest/Open Space Other
a R
Describe:
14m In c
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY
(FEDERAL,STATE OR LOCAL)?
Yes EJ No If Yes,list agency(s)name and permit/approvals:
l�vw a bj, 5 JaJ x II,'. let N`1
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Yes H<o If Yes,list agency(s)name and permit/approvals:
12. AS A RESULT OF PROP ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
Yes ErNo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: Pc>y I\j �Rm I a C A- 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
PART II- 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 EAR
❑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.
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. Long term,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)?
Yes ❑ No If Yes,explain briefly:
E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
Yes ❑ No If Yes,explain briefly:
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;(e)
geographic scope; and(f)magnitude. If necessary, add attachments or reference supporting materials: Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. 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 the 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 action WILL
NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination
Name of Lead Agency 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)
New York State _
Department of Environmental Conservation
PERNUSSION TO INSPECT PROPERTY
By signing this permission form for submission with an application for a permit(s)to the
Department of Environmental Conservation("DEC"),the signer consents to inspection by DEC
staff of the project site or facility for which a permit is sought and,to the extent necessary, areas
adjacent to the project site or facility. This consent allows DEC staff to enter upon and pass
through such property in order to inspect the project site or facility,without prior notice,between
the hours of 7:00 a.m.and 7:00 p.m.,Monday through Friday. If DEC staff should wish to conduct
an inspection at any other times,DEC staff will so notify the applicant and will obtain a separate
consent for such an inspection.
Inspections may take place as part of the application review prior to a decision to grant or
deny the permit(s)sought. By signing this consent form,the signer agrees that this consent
remains in effect as long as the application is pending, and is effective regardless of whether the
signer,applicant or an agent is present at the time of the inspection. In the event that the project site
or facility is posted with any form of"posted"or"keep out"notices,or fenced in with an unlocked
gate,this permission authorizes DEC staff to disregard such notices or unlocked gates at the time
of inspection.
The signer further agrees that during an inspection,DEC staff may,among other things,
take measurements, may analyze physical characteristics of the site including,but not limited to;
soils and vegetation(taking samples for analysis),and may make drawings and take photographs.
Failure to grant consent for an inspection is grounds for, and may result in, denial of the
permit(s) sought by the application.
Permission is granted for inspection of property located at the following address(es):
5a33 � c.g. Lleb � o_ +kola , V�j -71
By signing this form, I affirm under penalty ofperjury that I am authorized to give consent
to entry by DEC staff as described above. I understand that false statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.*
ANti -Am t w q a.i own►e ti
Print Name and Title Signature Date
*The signer of this form must be an individual or authorized representative of a legal entity that:
• owns fee title and is in possession of the property identified above;
• maintains possessory interest in the property through a lease,rental agreement or other legally binding agreement;or
• is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in
the property for the purpose of consenting to inspection of such property.
Permission to Inspect Property Application Supplement 12/08
ENVIRONMENTAL OUESTIONNAIRE
This is intended to supplement ENG Form 4345, Application for Department of the
Army Permit, or the Joint Application for Permit used in the State of New York
Please provide complete answers to all questions below which are relevant to your
project Any answers may be continued on separate sheet(s)of paper to be attached
to this form.
PRIVACYACT STATEMENT
The purpose of this form is to provide the Corps of Engineers with basic information
regarding your project This information will be used to facilitate evaluation of your
permit application and for public dissemination as required by regulation. Failure
to provide complete information may result in your application being declared
incomplete for processing, thereby delaying processing of your application.
GENERAL—APPLICABLE TO ALL PROJECTS
1. Explain the need for, and purpose of, the proposed work
THE EXISTING BULKHEAD IS DETERIORATED AND IN NEED OF REPLACEMENT TO PROTECT AGAINST
LOSS OF LAND.
2. Provide the names and addresses of property owners adjacent to your work site
(If not shown on the application form or project drawings).
SEE PLAT.
(Please note that depending upon the nature and extent of your project,you may be
requested to provide the names and addresses of additional property owners
proximate to your project site to ensure proper coordination.)
3. Photographs of the project site should be submitted. For projects in tidal areas,
photographs of the waterway vicinity should be taken at low tide. Using a separate
copy of your plan view, Indicate the location and direction of each photograph as
well as the date and time at which the photograph was taken. Provide a sufficient .
number of photographs so as to provide a clear understanding of conditions on and
proximate-to your project site.
4. Provide a copy of any environmental impact statement, or any other
environmental report which was prepared for your project.
5. Provide a thorough discussion of alternatives to your proposal. This discussion
should include, but not necessarily be limited to, the "no action"alternative and
altemadve(s)resulting in less disturbance to waters of the United States: For filling
projects in waters of the United States, including wetlands, your alternatives
discussion should demonstrate that there are no practicable altematives to your
proposed filling and that your project meets with current mitigation policy (i.e.
avoidance, minimization and compensation).
THE NO-BUILD ALTERNATIVE WOULD RESULT IN LOSS OF LAND AND PROPERTY.
WED-G G PROJECTS
Answer the following if your project involves dredging.
1. Indicate the estimated volume of material to be dredged and the depth (below
mean low water) to which dredging would occur. Would there be overdepth
dredging?
Z You can apply for a ten-year permit for maintenance dredging. If you wish to
apply for a ten year permit please provide the number of additional dredging events
during the ten-year life of the permit and the amount of material to be removed
during future events.
3.Indicate of your drawings the dewatering area(if applicable)and disposal site for
the dredged material (except landfill sites). Submit a sufficient number of
photographs of the dewatedog and disposal sites as applicable so as to provide a
clear indication of existing conditions For ten-year maintenance dredging permits,
indicate the dewatedng/disposal sites for future dredging events,if known.
4. Describe the method of dredging(i.e. clamshell, dragline, etc.)and the expected
duration of dredging.
5.Indicate the physical nature of the material to be dredged(i.e.sand,silt,clay,etc.)
and provide estimated percentages of the various constituents if available. For
beach nourishment projects,grain size analysis data is required.
6. Describe the method of dredged material containment (Le. hay bales,
embankmen4 bulkhead, etc.)and whether return flow from the dewatering/disposal
site would reenter any waterway. Also indicate if there would be any barge overflow.
MOORIA G FACILITIES
Answer the following if your project includes the construction or rehabilitation of
recreational mooring facilities.
1.It is generally recommended that any fixed piers and walk ramps be limited to four
feet in width,and-that floats be limited to eight feet in width and rest at least two feet
above the waterway bottom at mean low water. Terminal floats at private, non-
commercial facilities should be limited to 20 feet in length. If you do not believe your
proposal can meet with these recommendations,please provide the reason(s).
2. Using your plan view, show to scale the location(s), position(s) and sizes)
(including length,beam and draft)of vessels)to be moored at the proposed facility,
including those of transient vessels)if known.
3.For commercial mooring sites such as marinas,indicate the capacity of the facility
and indicate on the plan view the location(s)of any proposed fueling and/or sewage
pumpout facilities. If pumpout facilities are not planned,please discuss the rationale
below and indicate the distance to the nearest available pumpout station.
4.Indicate on your plan view the distance to adjacent marine structures, if any are
proximate and show the locations and dimensions of such structures.
5.Discuss the need for wave protection at the proposed facility. Please be advised
that Na permit is issued,you would be required to recognize that the mooring facility
may be subject to wave action from wakes of passing vessels, whose operations
would not be required to be modirted. Issuance of permit would not relieve you of
ensuring the integrity of the authorized siructurle(s)and the United States would not
be held responsible for damages to the structure(s)and vessel(s)moored thereto
from wakes from passing vessels.
BULKHEADINGBANK STABIUZATIONIOUING ACTIVITIES
Answer the following if your project includes construction of bulkheading (also
retaining walls and seawalls) with backfill, filling of waterwWodands, or any other
bank stabilization fills such as dprap, revetments, gabions, etc.
9. Indicate the total volume of fill(including backfill behind a structure such as a
bulkhead)as well as the volume of fill to be placed into waters of the United States.
The amount of fill in waters of the United States can be determined by calculadng the
amount of flit to be placed below the plane of spring high tide in tidal areas and
below ordinary high water in non-ddal areas.
NO FILL WILL BE IMPORTED FOR CONSTRUCTION.
2. Indicate the sources)and type(s)of fill material.
WA
3. Indicate the method of fill placement(i.e. by hand,bulldozer, crane, etc.). Would
any temporary fills be required in waterways or wetlands to provide access for
construction equipment? If so, please indicate the area of such waters and/or
wetlands to be filled, and show on the plan and sectional views.
ALL WORK TO BE ACCOMPLISHED BY LAND WITH RUBBER TRACKED EXCAVATOR_
The foregoing requests basic information on the most common types of projects
requiring Department of the Army permits. It Is intended to obviate or reduce the
need for requesting additional information;however, additional information may be
requested above and beyond what is requested in this form.
Please feel free to add any additional informadon regarding your project which you
believe may facilitate our review.
NEW YORK STATE DEPARTMENT OF STATE
COASTAL MANAGEMENT PROGRAM
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 anyproposed
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 completed 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 (please print)
1.Name: A nn t
2.Address: 'S 3 V - C a- 4 cb, $u a 4 lel , �' `'� 1 I q - �
3.Telephone: Area Code( ) b 3 I - -7 b S • -2 3 q 3
B.PROPOSED ACTIVITY
1.Brief description of activity: /�"
Re1-k% oL dot, rw/oAGG
vCn.H L yvc.(LGi��,&L L keewO l•e-E-c,t.�-�
2.Purpose of activity:
3.Location of activity:
Ly- $...* 1 ek 5-2 33 a- c ,(L, Li
County City,Town,or Village Street or Site Description
4.Type of federal permit/license required: 14 it,nt�J S
5.Federal application number,if 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:
tu�l 54 � L
C.COASTAL ASSESSMENT Check either"YES"or"NO"for each of these 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.
1.Will the proposed activity result in any of the following: YES/NO
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).. ....... . ..... .
b.Physical alteration of more than two acres of land along the shoreline,land 13 12
under water or coastal waters? (2, 11, 12,20,28,35,44).. ...... .. . ..... .. ...... ..
c.Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1).... .. CL
d.Reduction of existing or potential public access to or along coastal waters? (19,20). ..... C.
e.Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10)...
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)...... .... . ..... .. . a .0
g. Siting of a facility essential to the generation or transmission of energy? (27).. ...... .. . Q is
h.Mining,excavation,or dredging activities,or the placement of dredged or fill material in
coastal waters? (15,35)....... . ..... .. ... ....... ..... . ..... . ... .. .......... a J3
i.Discharge of toxics,hazardous substances or other pollutants into coastal waters? (8, 15,35) C.
j.Draining of stormwater runoff or sewer overflows into coastal waters? (33)...... .. .... Q,
k.Transport,storage,treatment,or disposal of solid wastes or hazardous materials? (36,39). Q
1.Adverse effect upon land or water uses within the State's small harbors? (4).... ..... ... Q
2.Will the proposed activity affect or be located in,on,or adjacent to any of the following: YES/NO
a.State designated freshwater or tidal wetland? (44).... .. .... .... .. .. .. .. . ......... ® 13
b.Federally designated flood and/or state designated erosion hazard area? (11, 12, 17,). .... Er
c.State designated significant fish and/or wildlife habitat? (7).. . .... .... .. . ..... .... . ff
d. State designated significant scenic resource or area? (24)......... . . .. . . .. ..... .. .. 17
e.State designated important agricultural lands? (26).. . .. .. . . . .... . .... .. .......... 13
IS
f.Beach,dune or barrier island? (12). .. ....... ..... ..... . ....... . ... ... .... .... 13-
g.Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3). ........ .. .... ®-
h.State,county,or local park? (19,20). . ..... ...... . . ...... .... . . ...... ......... Q -®
i.Historic resource listed on the National or State Register of Historic Places? (23). ...... .
3.Will the proposed activity require any of the following: YES/NO
a.Waterfront site? (2,21,22) .. . . . .. .. . ... ... ... .. ... . . . . ... . ... .... ... ... .... ® 8
b.Provision of new public services or infrastructure in undeveloped or sparsely populated
sections of the coastal area? (5).... . . . .. ... .. .. .. .. .. . . .. . . ... . ...... .. ... . ..
13
c.Construction or reconstruction of a flood or erosion control structure? (13, 14, 16).. .. .. .
d. State water quality permit or certification? (30,38,40). . . ... ... . .. .. ...... ...... ..
e.State air quality permit or certification? (41,43). .. . . . . .. . ... .... .... .. .. ........
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). . .. ... . . ... .. C
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 submit the documentation required by Section F.
2.If any of the questions in Section C 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. 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: F icr-P- 7 P. &-�w 011 a
Address:_ 161 L H ewj-V t bLvd Ct✓i+s,( 44G.e t e- e S , )-3 1-1 7
Telephone: Area Code q '0b y 3 3;L
Applicant/Agent's Signature: Date: -3• 5• 13
F. SUBMISSION REQUIREMENTS
1.The applicant or agent shall submit the following documents to the New York State Department of State,Office
of Coastal,Local Government and Community Sustainability,Attn:Consistency Review Unit,1 Commerce
Plaza,99 Washington Avenue-Suite 1010,Albany,New York 12231.
a.Copy of 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.
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✓Jr • p 6F\ 0, `S6 � BY THE L.I.A.L.S. AND APPROVED„AND ADOPTED
a
SUCH USE B E
S FP 6p, a �� TITTLE ASSOCIATION" W ORK STATE LAND
21 .3 5'
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S 38e02'59" W
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29.45, � G� � iv':�`s. Lic. Na. 50467
�V UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF SECTION�'>> ��� S 12e 15'27" W PLO EDUCATON2LAW.09 OF THE NEW YORK STATE Nathan Taft Corwin III
•12 5• 15 \ COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR Land Surveyor
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY Successor To: Stanley J. Isaksen, Jr. L.S.
IS PREPARED, AND ON HIS BEHALF TO THE Joseph A. Ingegno L.S.
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND Title Surveys — Subdivisions — Site Plans — Construction Layout
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. PHONE (631)727-2090 FOX (631)727-1727
THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jarnesport, New York 11947 Jamesport, New York 11947
23-255