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HomeMy WebLinkAboutTR-4258 O��QF SUUjyOI Town Hall Annex Michael J.Domino,President John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams ��yCOUNTI Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1514C Date: September 30, 2018 THIS CERTIFIES that the replacement of bulkhead damaged b, sue; At 196 Willow Terrace Lane, Orient Suffolk County Tax Map#1000-26-2-8 Conforms to the application for a Trustees Permit heretofore filed in this office Dated December 22, 1993 pursuant to which Trustees Wetland Permit#26-2-8 Dated January 28, 1993,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 replacement of bulkhead damaged by storm. The certificate is issued to DAVID FRENCH owner of the aforesaid property. Authorized Signature w Michael J.Domino,President ��rjf SUUlyO Town Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O..Box 1179 Glenn Goldsmith Southold,New York 11971 CA A. Nicholas Krupski • Telephone(631) 765-1892 Greg Williams O Fax(631) 765-6641 CoUPII'#;� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: �� f Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain: 1st day of construction 1/2 constructed Project complete, com lianc POCK. INSPECTED BY: 41neeisG-- COMMENTS' Lo oq_S - o Y � SRLI CERTIFICATE OF COMPLIANCE: r � AY jy , -. �- - didftIv r LIM VV damp ��„ ��- -,• .:n+`' *�.-- •�C*�-fit f, �- �`-- � �� - �Y - "- - i:�...-•+i'�=`ma's _ �'^. __ 1..rt'��� _" - r Tp� ' 1 '1 1 •w. t r� •� 4 qLA ow. 14 -.a _ e �;��.+'•~ .' �A �" , � &���i_ _ to w ..� - 1�- �' •' 1 ` ` ie 1', 1 ;.+ �';•• i' - ti' •.' is _ iti*,' , �ti- w - . . ijr,ZIP N ir �. , �4 c•i 1, , - ,�- i_1.� - -_"r.a _, ;r'' Jf i!`�y r�.- f � � � � ' Lip lit � �, - • ,, �,i'- i 4.'�� y` 1� 1►•': y� ,� '' M zy% '' ' - i/�%': k f }ram•. '�'L�.�.^ _ 1-- •.' ■iar ' a • B + * 1%,+Ift ML , r •Yi`w '_-}y .yam _ �`i,� 5 - �� rt•4. `.# � ��'�ti �,� b��, '' ,�. :a alp �. * It " -tip Nw . 1 •y� F ' To Southhold Town Board of Trustees Re: 196 Willow Terrace Road, Orient New York, 11957 As the owner of the above referenced property, I give you permission to visit said property (tax map #1000-26-2-8). It is my understanding-Me purpose of the visit is for a final inspection and issuance of a CERTIFICATE OF COMPLIANCE for the dock and bulkhead, permit 26-2-8, 1/28/93 and permit 4258 12/6/93 Thank you so much for your help in this matter Should you require my assistance any further, I can be reached at 914-588-6397 Best Susan S French 23 Studio Lane i Bronxville, New York 10708 �I � ����` SEP 13 2018 Oft 1%0- / A —j �, �® ��/y� Southold Town Board a S P&P r_y ^ yy \• H ,� r � ti��Uf s/.a Y! �,:.,v:✓ // t �✓/f � , y �,;� .//,GJ ,^� �\!^f \` f� IIlF�: 1� Board . Of Southold Town Trustees ; SOUTHOLD, NEW YORK `'- " •«.. ( PERMIT NO. .. .................o........ DATE. ............. ................... ISSUEDTO ........DAVID...FRENCH.............................................................. Y i D Pursuant to the provisions of Chapter '615 of the Laws of 1 is the State of New York 1893; and Chapter 404 of the. Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS ! IN AND ON TOWN WATERS AND PUBLIC LANDS and the !w� } REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the it a Resolution of The 'Board adopted at a meeting held on ....12./..6./93..... 19....93.., and in consideration of the sum of .....Z00..00...... paid by ......Costello....Marine.......for...DAVID...FRENCH................................................... l of ...........Orient......................... N. Y. and subject to the ' Terms and Conditions listed on the reverse side hereof, \ of Southold Town Trustees authorizes and permits the following: r » t P 9� c To construct 4' X 100' of fixed timber dock and (4) 2-pile <+ dolphins. Orient Harbor . rtl all in accordance with the detailed specifications as presented in the originating application. R c IN WITNESS WHEREOF, The said Board of Trustees here- 1, b causes its Cor orate Seal to be affixed, and these" resents to y P P t` be subscribed by a majority of the said Board as of this date. k .. ..... .......... . . ........ LAM r 'V .................... :.. .: .. ............. �.. � rustees �i n.L*=_c �►.a-yp .'J ' s�"ar' ws � 1P '►i 1t'_tl4�:rr� i �e7":. -- 1� Board Of Southold .Town Trustees -� -. SOUTHOLD, NEW YORK !'•_: .-- �,.:; . PERMIT NO. .... .6.-.278............. DATE: ....Jan,. .28.,.....1993 : . I ISSUED TO ...............D.avid. French .....:..,......-................................... 41 I. 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 ' P State of New York 1952; and the Southold Town Ordinance en- titled REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the .�j REMOVAL OF SAND, GRAVEL OR. OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;' and in accordance with the j '` -991. Resolution of The Board adopted at a..meeting held on ....1-28.-........... ' al 19...93....; and in consideration of the sum of $......exempt.. paid by �1 �. ................................................................... .......:................................................. �. ... :.: of .............................. ................:................... .............. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Grandfather permit to replace bulkhead damaged.''•by Storm. ! ... t all in accordance with the detailed. specifications as presented in }a the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to <w be subscribed by a majority of the said Board as of this date. j t ....................... ... .............. t A� c` p .f?a<W1,,........ .. a L... . , MW UI Trustees `•�. ` ' �ar.'t-�. 4ay✓. /�uK .d T <.�/ '1 .1 f / .i/ -+4 Y 't li?-d�� wY 1 ! Y ♦ � 'C 1/:"I.'.* N/ /� 4. , Nit 4 ROM ..�..X .�•u�. ...d�•' �.aM1 '�av �-.4aa�.CYr +�..-.� 1fa�:i�a.e�i TRUSTEES at SUPERVISOR John M. Bredemeyer, III, President ��0 COG SCOTT L.HARRIS Albert J. Krupski, Jr., Vice President Henry P. Smith y Town Hall John B. Tuthill 0 53095 Main Road William G. Albertson y ��� P.O. Box 1179 '�O,( �a Southold, New York 11971 Telephone (516) 765-1892 Fax,(516) 765-1923 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT Permit Number: 26-2-8 Name of Applicant/Agent: Costello Marine 'Contracting Name of Permittee: .I DAVID FRENCH Address of Permittee: 196 Willow Terrace Lane, Orient Property Located: Same DESCRIPTION OF ACTIVITY: To construct a 4' X 100 ' of fixed timber dock and (4) 2-pile dolphins. Date -of permit issuance: December 6, 1993 This permit is valid for a period of two years from the date of issuance. SPECIAL CONDITIONS: NA Bluff restoration through a re-vegetation agreement is attached hereto and is a necessary special condition of this permit. NA A relocation agreement is at hereto and is a necessary special condition of this permit. xxx A. maintenance agreement is attached hereto and is a necessary special condition of this permit. John M. Bredemeyer, III President, Board of Trustees. JMB:jmd cc: Building Dept. Attachments TRUSTEES �SVfFO[�(►C SUPERVISOR John M. Bredemeyer, III, President ��► pG SCOTT L.HARRIS Albert J. Krupski, Jr., Vice President Henry P. Smith coa Town Hall � � 53095 Main Road John B. Tuthill William G. Albertson P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 8, 1993 Costello Marine Contracting P.O. Box 2124 Greenport NY 11944 Re: DAVID FRENCH SCTM #26-2-8 Dear Sue, The following action was taken by the Board of Town Trustees during its regular meeting held on December 6, 1993 regarding the above matter: WHEREAS, Costello Marine Contracting on behalf of DAVID FRENCH applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated October 15, 1993, and, WHEREAS, said application was referred to the Southold 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 Monday, December 6, 1993 at which time all interested persons were given an "opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the Board has determined that the project as proposed. will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED that the Board of Trustees approves the application of DAVID FRENCH to construct 4 ' X 100 ' of fixed timber dock and ( 4) 27pile dolphins. Permit will expire two years from the date it is sighed. 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. Permit will be issued upon payment of the following fees for work to be done below Mean High Water Mark: Fees: -Docm * y' y- 70` -, X truly yours, Jr Aery ohn M. Bredemeyer III A 10 wow President, Board of Trustees JMB/djh CC. CAC •:ti:3 I-�,4'� �1 - �I L /DO i - -I • 1 1 � ice-/D ANLM 0.0 i lei* druid 7-I 2.6 �7Gldr/ c'b - I f 1 4� �s •r O*AW r. t s�cno,�s 1b S.0 G� �/l�L�ILD �1.2P/.� �iDM7�ACT/.v6 Qt ieP. VATrL. 5lo(-491 11W •�a/ xn- j-dam. ��� ,�� �D.1OX 77 AAAAWW e-64•/?; I�t G2V,�A'��- O� .3 /kl//LLE;/V.,!/49v8 Iiaw If A,7• 1 I', r ail+ 0%eAyr rsrYs, Avy. //yPr .y?�WiLG�J�Iv © AhieAr, Nj! //9r/ S7 B N' r 14 L O N 4 't 9IA #J- SOJNP r v MCA-n0 o . o a � LO(:;(T1-4,ViyqvO '' R ,L uno) g ' e Coco .Iocd d. RL, � Z � 4 O -PI-AN MAMOV�70 rA �I-rie.o r cy goo/ -7x,W r�.yd�mar °T �c : 2 P/lam l�LP.�G.C�f SCALE fu -= 16 TibE 2�S/ \ _ 6 .va ,d5x 177 �•; / ��ld/�GOLt/T�'��CE oemmmsm /Ap73 J.NE�T/ 4� Z SlaFFO(,r�, �G Town Hall,53095 Main Road ELIZABETH A.NEVII..LE ,``t` y TOWN CLERK cm1 P.O. Box 1179 y Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS • Fax(516)765-1823 MARRIAGE OFFICER Dy �� Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of Information Officer) . One copy will be returned to you In response to your request, or as an interim response. ----- __._SECTION__,.SECT ION 1. TO: TO tJ AI 7. (Department or Officer, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.) CJZ 611 G/V, 26 — Z — W 7-"VV,6 Pj5&CMI j— PE1111 7- 04,9W/N6'C — Z s#EErs Signature of Applicant: Printed Name: 4��601,b C64 41lAl Address: G3 GY/1''—-Alp c),Q,7` Mailing Address (if different from above) : Telephone Number: '?7 7 Cal Date: 3 — —qR [ ] APPROVED [ ] APPROVED WITH DELAY* [ ] DENIED* MAR 2 1909 Eli eth A. Nevi le i own IerA 1jnola Freedom of Information Officer '� If delayed or denied see reverse side for explanation. consultant Project Name d��/!b �t'C'hcX scm #1000- -<6- Date �• + (f-- Z3 _ The Southold Town Trustee office has determined that your application for oas a. erosio ==A is - incalplete "' please consider the following information in this regard for any required return submission: 2Ae J Trustee Represen tive CC: Buie, This notice makes no claim with respect to other jurisdictions within or outside the Town of Southold with respect to permits, permission required. 4/92 Al I've" OVA ---------- rti d PC k, c, 16 Ul QJU LL VRULL 0% r/tit ` rv,68005too"E.-'ft�'+ u - 34 _ fouwlalion �leva}in+t t` 0 ' Lv �;� .•.� � � 11.0�nE•u�v� n i�'q►t SP..ty level � � - } 0 z� 80 ± 44000 tivr 114-* �16,1 1 04 1 I, DouGLq ` SCALE'_ CO- IPON PIPE w MAP OF PP,0PEQTY e SURVEYED FOR t2evtt�� April w.t9e r ti LEI STEEDL.E AT Gi.lex�Icrir►�� d +Q Tk 'i'i+Icy Gue�ir�Irt�'seiz '' ORIEN.i -- . �1• : zl�rv�yc tau 1'y'28, 1 ��3. 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Q• r' 'r'� f' , + „'`{ •���r�+ .,}.yl/l�y� t ,� ,y!�,s � � 'J- '[ }�'^ •'•' `�p�'V rt ��� A,P4 j,}, � r. 3!;J Sr[S� (:f '��i:ulv7plrii 'tEli �`k•� _ tiu. 1• _y�,y�+►k 'try 7 'flF�i�°� � 47 LONG 1 rr Terry Pt �- F .rXa. o /■. r •t ff yOy� T m N T { — Sr•IAIf ORIENT ti P�+ ° 4� P.S. - Psk,o s EEM. a 11957 9� CENfFAL Orie f Y.C. J)r I. - [EM. r!^—r VQ� 0R w�uo :N �tieR 3 E ok NAVY 0 4P QO a��► P ^� M......►: n 6 7 G = _b zCL m ORIENTS 3 1 ti V) ��J SQP� KING o HARBOR o a , N Browns F —L Pefers Neck Pt O I �. F Q CN G 6 A Bea ch 8%R ---- L.H. Pf. �. ...r__ GARDINERS �. ...�. 47 ,. • - r 92 EDWIN C. GERRITY R/O/W off Willow Terrace Orient, NY Y Ls { "#'?a•- „ I .�.»:cMr- � .,,,meµ -�:.r _.pe!c'k"'. t.,ea�4yv��.�Ja.•{.. � ,..m'•ryi�+ .i rt 4a n a + • a'• 'N t, max;. �:� i � r�r,�•.z�� ���,r, y _ ;p -«Y+••"y ` i' �,y J'•ab `'a�, lea ` . ,�1 W S �'s �lH' Y `te r' ..yd""r`aa„��'x�•°x}�,!'.-��7r ��•1 � �.j"" -�'- • s !, ,�� •� I1P��\�'�f+���a b� ,�j`f��+may^,`t,'.�,y s w t,9i•'�i� l ''_"w- 'r.tir.. • `y _ -+. I_ }��:tit.��'-"�'i 1^f, �3 k 5i PCs.•;++Ib;� -.'. + 4�=�Y � i�i►��.'y...�b�.'�o.'p�,-~��►}�..vs�-' ._- - kx-' ^i ."`'i`.ct - •t i_ -:a. o-Nb-•' ems`' s Jz fi ,4i - * TRUSTEES SCOTT L. HARRIS John M. Bredemeyer, III, President w'� x1 H= _', Supervisor Henry P. Smith, Vice President Albert J. Krupski, Jr. � L�=� i Town Hall, 53095 Main Road P.O. Box 1179 John L. B B. Tuthill Jr. Southold,New York 11971 John B. Tuthill BOARD OF TOWN TRUSTEES Fax (516) 765-1823 Telephone (516) 765-1892 TOWN OF SOUTHOLD Telephone (516) 765-1800 GRANDFATHER APPLICATION 1. Name of Applicant: L a G', Z. -ehc 2. Mailing address: 0 77 �i-dh � y� �� IV /0 /70 Q Tel. No: 33 -7 717� 3 . Address of Property: % Q 4. Tax Map Number: 1000- OZ 6 - 00 Z" 0(9yy Approx.yr.of construct: 5. Prior owner if known: . Z f-C SVee Cl 6. Diagram of existing structures, including all dimensions, must be included with this application: 7. Indicate on attached map: Location, ie; reference point, telephone Pole number, adjacent property owners, etc. Signature of applicant• 2 -�• / Date: j Z ZL J'l * Please note, there is a one time fee of $50 . 00 for filing this application. Consultant zlyr Project Name J scni #loon- -211 6--a Date The Southold Town Trustee office has determined that your application for a Coast-a erosio is -j L11 t6dtU t±tJTTMincomplete please consider the following information in this regard for any required return submission: 1-40 �Cf ,4ZILid Trustee Represen time cc: -wept. 1 . This notice makes no claim with respect to other jurisdictions within or outside the Town of Southold with respect to permits, permission required. 4/92 TRUSTEES SVfFO(� SUPERVISOR John M. Bredemeyer, III, President ��0 COG SCOTT L.HARRIS Albert J. Krupski, Jr., Vice President Henry P. Smith y Town Hall John B. Tuthill �y • 53095 Main Road William G. Albertson P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD,OF TOWN TRUSTEES TOWN OF SOUTHOLD ".E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000- 26-2-8 Chapt. 97 - Wetlands NAME: David French Chapt. 37 - Coastal Erosion DATE: October 29, 1993 RESOLVED that pursuant to Article 8 of the Environmental Conservation, Law, State Environmental Quality Review and 6NYCRR Part 617, Section 617.10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which ,may also have an application pending for the same or similar project. TYPE OF ACTION: Type II DESCRIPTION OF ACTION: Costello Marine on behalf of David Frence request permit to construct 4' X 100 ' fixed timber dock and (4) 2-pile dolphins. Located Willow Terrace Lane, Orient. LOCATION:SCTM ##1000-26-2-8 REASONS SUPPORTING THIS DETERMINATION: 1. An on site inspection has been conducted by the Board of Trustees. 2.. An environmental assessment, submitted by the applicant and reviewed and completed by the Board of Trustees,, has indicated that no significant adverse effects to the environment are likely to occur should the project be implemented as planned. cc: CAC 3 Motion carried. Moved by Bruce Loucka, seconded by Robert Keith, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Application of DAVID L. FRENCH 26-2-8 to. install a 4' x 100' fixed timber dock and four 2-pile dolphins. 196 Willow Terrace Lane, Orient Vote of Council: Ayes: Bruce Loucka, Robert Keith, John Holzapfel, Patricia Isaksen, John Hagerty, Betty Wells Nays: Stephen Angell Motion carried. Moved by Robert Keith, seconded by Patricia Isaksen, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Application of BRUCE AND BARBARA BEANY 103-3-5.1 to replace 4' x 30' fixed timber dock, 30" x 14' ramp, 6' x 20' float dock with pipe support pilings. 1750 Beebe Drive, Cutchogue Vote of Council: Ayes: All Motion carried. Moved by Robert Keith, seconded by Patricia Isaksen, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Application of JOHN J. CONFORTI 107-7-5 to obtain a permit for an existing floating dock (5' x 709 with 3' x , 16' ramp. 1935 Westview Drive, Mattituck Vote of Council: Ayes: All Motion carried. TRUSTEES ,�►�4�il�F�3(��® John M.Bredemeyer,III,President ' SUPERVISOR Henry P. Smith,Vice President w . ; s SCOTT L.HARRIS Albert J.Krupski,Jr. John L.Bednoski Jr. Town Hall � John B.Tuthill �' ' 53095 Main Road �� P.O.Box 1179 Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971 Fax(516)765-1823 TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION Office Use Only: R J Coastal Erosion Permit Application Q L5 W �5 Wetland Permit Application M Trustee Lands Per?git Application Grandfather 0C Completed Apps. Date: Variance Required, . TOWN ® S® Neighbors notified Date: OLD SEQRA Type Coord. Review-opt. ,mand. e Insp. comp./date: o SEQRA Determin. /date: Public Hearing/date: OCT Findings: ` � Permit Vote: (Y/N) : Special Conditions: I' ( also see file) . a Application Number; SCTM .tt1000'- .0 , 6 ' 002, b 0 Project Name (If any) kepC,�, Date Prepared: Applicant: r,,;c/ �h v Address:: 0 v1 17 /Sr°ri'h.dvi IV y /a 706 Phone ( i1,f) S3 '7 ?171 Interest: (owner, cons��ul1ltant,lessee,etc. ) r the Owner of Property: [J17V / Z C, Address Phone ( ) Z ra_ Subject Property Location: _ti l o � A, rI-T Z 2 0 a ` �/7' /%1, -6ht 07, &-e (Provide LILCO Pole #, Distance to cross Streets if not on location map) THIS IS NOT A PERMIT Yds. to be excavated: Yds. to be filled: �� C Manner in which material will be removed or deposited: 1 Uc (L Width of canal, creek or bay fronting property: 2 ,ILS Depth at low tide: IAver. rise in tide: - . 5- Distance to nearest channel: Distance project extends beyond similar projects in area: Area zoning: Land area in acres: [� Is project for private or business use: ler, L- Intended use of property: 'E4 jfs �,x f MCA. 2q I"a, Describe known rior operations co/nd�f ted(�on[ypremises: / / Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: Has any license or permit ever been revoked or suspended by a Governmental Agency: Project Description The project description must also include plans for reclamation of land disturbed during construction of the principle and accessory structures and underground structures. (i.e. , pipeline and septic system; make additional attachments if necessary) . 4rJ.Z Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) do hereby authorize to apply for Coas 1 Er ion per ,) /from the Southold Town Trustees Signature THIS IS NOT A PERMIT i W-16-4(2/87)—Text 12 j e P{30JECT I.D.NUMBER 617.Z7 SEQE ' 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 j 3. PROJECT LOCATION:Municlpallty Qr/eq �Q /7 it 0 �J County u o.//L 4. PRECISE LOCATION(Street address and road intersections,%prominent landmarks,etc.,or provide mr) c' ^ 0J—iPh /000 0 OU — - 0UL 5. IS PROPOSED ACTION: y� n ❑New ElExpansion ❑Modification/alteration ✓ /C F)1' 6. DESCRIBE PROJECT BRIEFLY: � �(�-e� IGrj y /6�'��laC4� /h t ` G• r t'1 f j-��/Ge rh P /osI" �/� 1 . 7. AMOUNT OF LgND AFFECTED: n Initially o 0 z?"' acres Ultimately 0• acres 8. W ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑No If No,describe briefly 9. IS PRESENT LAND USE IN VICINITY OF PROJECT? WHAresidential ❑!ndustrial ❑Commercial El Agriculture ❑Park/Forest/Open space ❑Other Cabe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STAY�� R LOCAL)? ' es ❑No If yes, list agency(s)and permit/approvals / 0CJJ� J L" S7�P 1 it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ❑No If yes,list agency name and permit/approval 12. AS A RESULT .ROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes jNo CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: i Signature: 1 --------------- 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 "• Liar+I (I Uu cornplall.d by A(lency) A. DOES ACTX_jEED ANY TYF .RESHOLD IN 6 NYCRR, PART 617.12? II yes, c late the review process and use tra FULL L`q❑ F. Yes8. WILL ACTIE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.67 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, existingtraffic patterns, solid waste potential for erosion,drainage or flooding p Production or disposal, 9 g 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: Cd. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land of 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. IS THERE,OR I 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, explanations contain sufficient detail to show that all relevant adverse dimpacts have been identified attachments or reference PPortin materials. Ensure that ed and adequately addresse d. Fum,, his box if YOU have identified one or more potentially large or significant adverse impacts hen proceed directly to the FULL EAF and/or prepare a positive declaration. pacts which MAY Clhis box if you have determined, based on the information and analysis above and documentation, that the proposed action WILL NOT result in an any supporting vide on attachments as necessary, the reasons Supporting significant adverse environmental impacts pporting this determination: Pacts N•,mc ul LedJ ngcncy N.uur of xvspunsiol UUn,certitle ul Hespons,ble Ull,cer e of Krspon+mle Unccern lead/+'cn cy..';-_�4 of 1'reparer tlf d,flerenf from rr+ uns,ofe ulh • p cPr) • DJIC County of Suffolk ) State of New York ) BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE. OF SAID PERMIT(S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(s) OR REPRESENTATIVE(s) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. v� SIGNATURE SWORN TO BEFORE ME THIS DAY OF _,19 / 3 N TAFY PUBLIC JOYCE M.WILKINS Notary Public,State of New York No.V952246,Suffolk County Term Expires June 12,19 Suggested space for location Map THIS IS NOT A PERMIT SUPERVISOR TRUSTEES Q j1�,�;v ,;4:.�� ��, John M. Bredemeyer, III, President �'ey f ,` " : `�` SCOTT L. HARRIS Albert J. Krupski, Jr., Vice President Henry P. Smith ;x jy Town Hall John B. Tuthill 53095 Main Road William G. Albertson ' P.O. Box 1179 Telephone (516) 765-1892 w� Southold, New York 11971 Fax (516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 year Maintenance Agreement Erosion Protection Structures Chapter 37 Southold Town Code Southold Trustees as Administrator I (we) type or print name(s) the owners of record of property at: (type or print street address) SCTM *1000- e o Zt - © V I.- o O(Y in applying for a Coastal Erosion permit for an Erosion Protection Structure do hereby agree to a 30 year ,maint nance program for a structure commonly known as a a„l,t';"hCGj of 6-0 as shown on the attached feet of length licensed survey of the as-built structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and or equivalent to the original approved structure and that for any maintenance which involves more than 5% in length of this structure we are to give prior written notice to the administrator,. waiting for their approval in all but true emergency situation's which would seriously endanger life, property and important coastal natural resource features such as bluffs or wetlands. We further understand that failure to maintain the structure could result in a requirement to post a bond and or have the repairs ordered as a lien against the property upon a finding by the Trustees that said lack of maintenance would risk life, property or important natural resources features including protected, rare or threatened animals and plants. Notarized Signature of owner. of record SWORN TO BEFORE ME THIS ls� DAY OF J 19I� JOYCE M.WILKINS Notary Public.State of Now York O PUBLIC No.4952246,Suffolk Courrt� Term EvIresJun912,18�.` Please submit three copies of a licensed land survey made within one year of the original construction. This maintenance agreement shall only be valid upon the final approval of the . administrator. Subsequent owners may apply to the Southold Town Trustees to re-authorize this maintenance agreement. o% UF014r TRUSTEES �O G John M.Bredemeyer,III,President Q y� SUPERVISOR Henry P. Smith,Vice President e�i2 �y. � SCOTT L. HARRIS Albert J.Krupski,Jr. John L.Bednoski,Jr. O'�� Q� Town Hall John B.Tuthill �'� �a 53095 Main Road P.O.Box 1179 Telephone(5I6)765-1892 , BOARD OF TOWN TRUSTEES Southold,New York 11971 Fax(516)765-1823 TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION Office Use Only: , oastal Erosion Permit Application I� . Wetland Permit Application Q rustee Lands Permit Application randfathek UGT ( 5 19M Completed Apps. Date: (g ,(.5 ariance Required, eighbors noti ' ed Date: C�I1�" ` /�� I,�� ;° SEQRA Type "em s,w'�-�I orb SOUTH OLD Coord. Revie -opt. ,mand. Da a c. b Office _ Insp. comp./date: [,=� SEQRA Determin. /date: �e_q- Qom- InAg�3 Public Hearing/date:- la�c1�sP3 Findings: OCT 5 (9m Permit Vote: (YIN) : Special Conditions: (also see file) Ap � ic�a ion Fee: Application Number; SCTM 41000- Oaf Oa _ op t Project Name (If any) 'DAVI D L. ERFNCH Date Prepared: 10 /11/43 Applicant: CO.STF LLO MA;,) Nt C6 ►.STRAC-TIQQ CoP-P. Address:' ,p , rJ Po Phone (sI(p) V7 Llg`r� Interest: (owner, consultant,lessee,etc. ) _A GE 1J l Owner of Property: J)A U I -D k E 2,E 0 C}) Address 19(o WIL.LOL,) -1ER( , fiNE- • ORIENT Pho e (51(0 ) 3a - aLF q r ubject Property Location: ?.r7 .�O I�7 V I L.(.E N I [ 670 R� J (Provide LILCO Pole #, Distance to cross Streets if not on location map) THIS IS NOT A PERMIT Yds. to be excavated: ytA Yds: to be filled: NIA Manner in which material ill be removed or deposited: Width of canal, creek or bay fronting property: 1C)nof4_ Depth at low tide: Aver. rise in tide: Distance to nearest channel: N[A Distance project extends beyond similar projects in rea: Area zoning: REsi DC JTIA Land area in acres: 1 + Is project for private or business use.- Intended use of property: EXI ST ►tJ 6 'R ES I_b.f: U71 A t_ Describe known prior operations conducted on premises: ST(Jrz�A - DflMAC-E b 3U L K+I FA h Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: v F_s BoLiCiif-An -Tz�, R-FRF_ AS PFRM1TT-E_b S3V -r0LA')ij aF --, o-VloLn D ti S. Eel Has any °lice se or permit ever been revoked or suspended by a Governmental Agency: MC) Project Description The project description must also include plans for reclamation of land_ di.sturbe.d-during construction of the principle and accessory structures and underground strudtures. (i.e. , pipeline and septic system; make additional attachments if necessary) . -xNSTALL_ ' X /0n IF1xCn TIMi3V_� dock A hi N a- PILE• rNS -AuT 1i61i�! 1ZHT p ►v -A7-TJrC E� Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) do hereby authorize to apply for Coastal Erosion permit( s) from the Southold Town Trustees Signature THIS IS NOT A PERMIT County of Suffolk ) State of New York ) 0 H N }F C.OSTE L _L_r) BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN- OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT( S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(s) OR REPRESENTATIVE(s) , TO ENTER ONTO MY PROPERTY TO- INSPECT THE PREMISES IN CONJUNCTION -WITH REVIEW OF THIS APPLICATION. )e SIGNATURE SWORN TO BEFORE ME THIS THIS46 DAY OF (`)C-C 6 , 19 C SUSAN E.LONG Notary Public,State of NewYark No.01LO4958343 J1 j i0fil AA Qualified in Suffolk County Commission Expires November 6,1930 OTARY PUBLIC Suggested space for location Map THIS IS NOT A PERMIT 14•do(0ttif—Tek112 PROJECT I.D. NUMBER 617.21 SEAR Appendix C Stale Etivlronmental Quallly A6016 N SNORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only DART I—PROJECT INFORMATION (To be completed by Applicant or project sponbor) i. APPLICANTdSPONSOR 2. PROJECT NAME F L"o E ct I G 3. PROJECT LOCATION: Municipality E bF County S U F F o L 4, PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) AKFA KA 1P L,4-T-TAQ" Fb 5. IS PROPOSED ACTION: _,New ❑Expansion ❑Modlficalionlalleratlon 9. DESCRIBE PROJECT BRIEFLY: INSTALL Aq C)D1 t= rXED � 1MBE fZ 1�oc� A Cy) a- •PILE wLPI+ fNS \ 7. AMOUNT OF LAND AFFECTED: Initially © acres Ultimately C�) acres 6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? VIYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? P951esidentlal d Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other Describe: W 1}-T f=lz f Ro N T W. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? fc ui wYes No If yes, list agency(s) and permftlapprovals -Coww of SOUTt}0L_ 6 ��S DEc >4'�Mv Co�PS o � ENGfN �Ei2S � I 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 39Yes ❑No II yes,list agency name and permitlapproval TOWN D1 SOO-TgOU D m4s �JEC R But,K41�AD t1=P�Ac>cM�NT 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ,� Applicantlsnonsor name: C STF_LL 2A r_—t'1 W G Date- 161 11 1 q,-3 Il Signature: If the actlori Is In the Coastal Area, and yoU are a staid agericy, complete the Coastal Assessment Forth before proceeding with thl$ assessment OVER i PAIN 11-1-EiJlilFiONMENTAL A§sEssMl:, (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes. coordinate the review process and use the FULL EAF. LJ 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, II legible) Cf. Existing air quality, surface or groundwater quality or quantity, nolsd levels, existing traffic patterns, 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: CA. 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. I l C5. Growth, subsequent development,or related adilvilies likely to be Induced by the proposed action? Explaln'briefly. C6. Long term, short term,cumulative,or other effects not Identified in C1•C5? Explain briefly. C7a Other Impacts(Including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE,OR IS THERE LIKELY TO BE.CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No It Yes,explain briefly I RAgT III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) , INSTRUCTIONS: For each adverse effect Identified above,determine whether It is substantial,large,Important or othervtrise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probabillty of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (1) magnitude. It necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Idenlified and adequately addressed. ❑ Check this box if you have Identified one or more potentially large or significant adverse impacts winch 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 LeadAgency Print or fype Name of Responsible Officer in Lead Agency Title of Responsible Officer I Signature of Responsible Officer in Lead Agency Signature of Preparer(it different from responsible officer) Date 2 SOUTHOLD TRUSTEES . xo. y.2 r� S d �Ad�i� F,2FifJGf� Date- "O'/6 ISY� TOE �� Address.UL THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE.TOWN OF SOUTHOLD SOUTFIOLD, N.Y. 11971 TEL: 765-1892 NEW YOA 4TE DEPARTMENT OF ENVIRONMENTAL CONSERVAT DEC PERMIT NUMBER / /,J? O /{� /,�V ® EFFECTIVE DA FACILITY/PROGRAM NUMBERS) PERMIT (TWSP1) EXPIRATION DATES) ' Under the Environmental Conservation Law O r TYPE OF PERMIT a New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to 0 t! a Article 15, Title 5: Protection a Aerate of Waters' 6NYCRR 608: Water Quality Certification ❑ Article 27, Title 7; 6NYCRR 3609 k �❑ Article 15, Title 15: Water _ Solid Waste Management , � �-. ❑ Article 17, Titles 7 8: SPDES Supply ❑ Ar"ticle 27, Title 9; 6NYCRR 373: ❑ Article 15, Title 15: Water ❑ Article 19: Air Pollution - Hazardous Waste Management Transport Control ❑ Article 34: Coastal Erosion f i_ ❑ Article 23,'Title 27: Mined Land Management ❑ Article 15, Title 15e Long Reclamation Island Wells ❑ 'Article 36: Floodplain ❑ Article 24: Freshwater Wetlands Management ❑ Article 15, Title 27: Wild, Scenic and Recreational Rivers ® ❑ Articles 1, 3, 17, 19 i Article 25: Tidal Wetlands 6NYCRR 380: Radiation�Control' t ❑ Other: � gFDREF O ITTEE 9 6U R 7 - � � 16 IFOR PERMITTED WORK TE OF PROJECT/FACILITY TOWN OF S UTHOLD E i e l LOCATION OF PROJECT/FACILITY COUNTY CITY Owe 4 WATERCOURSE NYTM COORDINATES { Ee N: l DESCRIPTION OF AUTHORIZED ACTIVITY l i Construct, reconstruct, replace or repair open ile catwalks or docks having { install or replace floating docks and ramps. 1 / /� a ma surface width of 4 feet; and I NOTE: Additional activities described on page (3) are also approved under this permit if the adjoining box is checked and the proposed Work is shown on the approved plan. i tj I By acceptance of this permit, the permittee agrees that the permit is contingent Upon strict compliance with the vironmental Conservation Law (ECL), all applicable regulations, the General Conditions specified (see plicable Special Conditions included as part of this permit. page 2) and ell PERMIT ADMINISTRATOR: ADDRESS i Bldg. 40, SUNY, Stony Brook, New York 11790-2356 ,UTHORIZED SIGNATURE DATE �� 1` Page 1 of 6 GENERAL CONDITIONS Instructions 1 . The permitted site or facility, including relevant records; is subject to in- spection 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 and the ECL. Such represen- tative may order the work suspended pursuant -to ECL 71-0301 and SAPA 401(3) . A copy of this permit, including all referenced maps; drawings and special conditions; must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit. upon request by a Department representative is a violation of this permit. Permit Changes and Renewals 2. The Department reserves the right to modify; suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or. provisions of the ECL and pertinent regula- tions is found; b) the permit was obtained by 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. i 3. The permittee must submit a separate written application to the Department for renewal , modification or transfer of this permit. Such application must include any forms, fees or supplemental information the Department requires. Any renewal , modification or transfer granted by the Department must be in writing. j: 4. 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 (SWOF) ; and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination perviously issued by the Department. or any of the terms; conditions or requirements contained in such order or determination. ' Other Legal Obligations of Permittee 6. The permittee has accepted expressly; by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and by. whomever suffered, .arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions; damages and costs of every name and description resulting from this f project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required for this project. Page 2 of CO • 1. p •sUba(7'92)—Sc I .AbbItIONAL GLNERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 and 6 NYCRR Part 608 ( ) 9 that if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of the structure or work herein authorized.or project. if, in the opinion of the Department of Environmental Conservation ! 13 Any material dredged in the prosecution of the work herein permitted i it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across eaters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a j the people of the State, or cause loss or destruction of the natural tendency to.cause damage to navigable channels or to the banks of ` resources of the State,the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused thereby wit6ut expense to the State, and if, upon the expiration or 14 There shall be no unreasonable interference with navigation by the work d ize . ! revocation of this permit, the structure, till, excavation, or other herein author - _ modification of the watercourse hereby authorized shall not be com- 15. If upon the expiration or revocation of this permit,the project hereby pleted, the owners, shall, without expense to the State, and to such authorized has not been completed,the applicant shall,without expense extent and in such time and manner as the Department of Environmental to the State, and to such extent and in such time and manner as the Conservation may require,remove all or any portion of the uncompleted Department of Environmental Conservation may require,remove all or structure or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site and flood capacity of the watercourse.No claim shall be made against to its former condition. No claim shall be made against the State of the State of New York on account of any such removal or alteration. New York on'account of any such removal or alteration. 10 That the State of New York shall in no case be liable for any damage 16. If granted under 6 NYCRR Part 608. the NYS Department of Environ or injury to the structure or work herein authorized which may be caused mental Consevtaticn hereby certifies that the subject project will not by or result from future operations undertaken by the State for the contravene effluent limitations or other limitations or standards under conservation or improvement of navigation,or for other purposes,and Sections 301. 302, 303, 306 and 307 of the Clean Water Act of 1977 no claim or right to compensation shall accrue from any such damage. (PL 95-217)provided that all of the conditions listed herein are met. 11. Granting of this permit does not relieve the applicant of the responsi- 17. All activities authorized by this permit must be in strict conformance bility of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant or his agent as part the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State of the permit application. Office of General Services or local government which may be required. 12. All necessary precautions shall be taken to preclude contamination Such approved plans w re prepared by of anv wetland or waterway by suspended solids, sediments, fuels, on Il solvents,lubricants,epoxy coatings,paints,concrete,leachate or any SPECIAL CONDITIONS Additional Approved Activities (if box is checked) - ❑ Install up to four (4) mooring piles (see special conditions 8 and 9) . ❑ Construct a boat lift or davit. ❑ Construct a board walk or footpath up to four (4) feet in width to access the dock (see special conditions 10 and 11) . h iI I li 1 Important: Refer to Special Conditions on the following pages which apply specifically to any additional activities checked. t DLC PER.101T NUMBER PROGRA IJACILITY NUMBER Page 3 of 6 ii;.i)-35c NEW YOF 1TE DEPARTMENT OF ENVIRONMENTAL CON5ERVA1Now SPECIAL CONDITIONS For Article 1. The use of wood treated with pentachorophenol in the constructio of structures that will be in contact with tidal waters is strictly prohibited. 2 . Those portions of docks, catwalks and ramps which extend over vegetated tidal wetlands shall have a maximum surface width of 4 feet and .shall be a minimum of 3 1/2 feet above grade, as , measured from the ground surface .to the bottom of the planking. Floating docks shall not rest on vegetated tidal wetlands at any tidal stage. 3 . Docks and floats shall not: (a) extend laterally beyond propert lines, (b) be placed so that docked boats extend over adjacent property lines, (c) interfere with navigation, (d) interfere with other landowners' riparian rights. 4 : Dock reconstruction or replacement or seasonal installation shall not involve expansion or substantial modification of existing structures or facilities. 5. Installation of additional docks at marinas, boat basins, or other commercial facilities is not authorized by this permit. 6. No dredging, excavating or other alteration of shoreline or underwater areas is authorized by this permit, nor shall issuance of this permit be construed to suggest that the Department will issue a permit for such activities in the future. 7 : Any debris or excess materials from clearing or construction activities performed under this permit must be immediately and completely removed from the wetland adjacent area and disposed off at an upland site. Disposed of debris in tidal wetlands is prohibited. DEC PERMIT NUMBER FACILITY ID NUMBER PROGRAM NUMBER Page Qf 6 .rtlF171';J=lSc NI )RK STATE DEPARtMENT OF EN\'IRONXIENTAL CONbErwATION f r` - �. SPECIAL CONDITIONS. a . For Article 1 ` Moorin Piles . (if approved, see page 3 _ } P g ) _ 8: No structures are to be constructed on pilings without further authorization of the Department. 9. Pilings shall not: (a) ' extend beyond property lines, (b) be placed so that docked boats extend over property lines interfere with navigation; , (c) (d) interfere with other landowners riparian rights. Access Daths boardwalks (if approved, see page 3) 10: The ground area cleared for construction of a path or boardwalk is limited to a maximum width of six (6) feet. The path or boardwalk itself is limited to a maximum width of four (4) feet. 11. Cover material- used for footpath is -limited to natural wood/bark chips, stone, gravel or sand: DEC PERMIT NUMBER -61,1)6 - a FACILITY ID NUMBER PROGRAM NUMBER Page S of 6 �A SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply td all permits! A• A copy of this permit, including all conditions and approved plans; shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit shall be protected from the weather and posted in a conspicuous location at the work site until, all authorized work hag been completed. B. The 'permittee shall require that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands, and complies with this permit and all its general, special, and supplementary special conditions. Any failure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing; shall be treated as A violation of the Environmental Conservation Law: If any of the permit conditions are unclear, the permittee must contact the Division of Regulatory Affairs at the address on page one or telephone (516) 444-0365. C. If project design modifications become necessary after permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to Undertaking any such modifications. The permittee is advised that substantial modification may require submission of a nevi application for permit: i s D• At least two day 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 the authorized work, the bottom portion of that form shall also be signed and returned, along with I` photographs of the completed work and; if required, a survey. i; E• For projects involving activities to be undertaken. in phases over a period of more than one year; the permittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. F. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement; or other necessary approval from the Division of Land Utilization; Office of General Services, Tower Building, Empire State Plaza; Albany; NY 12242 (518) 474-2195, which may be required for any encroachment upon State-owned lands underwater. DEC Permit No: _DQ-�P ¢glzwo O u ry _ Page (p of �p 3 f e If AUTHORIZATfON FORM bate! ' Div1 (o�.J 1r-V-".Ldc L/Yt t► S/14(JI(� �' /yLit'/1lC/'� owner O� �9 � business/property name located at �.e e.,V i do herby give Costello Marihe Cohtracting Corp. the authority to act as agent in my behalf in applying for all of the necessary permits in order for work to be done/; kopettybed above, s ature