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HomeMy WebLinkAboutTR-10-5-13.3 '}, � � -i- 'c�'rn� •`a4vifs.) ter"•'j'� �\"fir r �.\�?r 1 �"yA �_ _ i3t? I��• {1; Board Of Southold Town Trustees ►b ;� SOUTHOLD, NEW YORK I PERMIT NO. ....10.-5-.13...3 .. DATE: ......3./..1.1./.9.3 ........................................................................................................................................ 1. 5 a ISSUED TO OLAF NELSON Pursuant to the provisions of Chapter 615 of the Laws of » ;. the State of New York, 1893; and Chapter 40.4 of the Laws of the 'I State of New York 1952•1 e en- and the Southold Town Ordinance ! ." f. b4 k titled REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the ,) REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM �a LANDS UNDER TOWN WATERS;" and in accordance with the ^ 71 Resolution of The Board adopted at a meeting held on ......4/2.5............ 19..........93... and in consideration of the sum of $............................. paid by ................................................................................................... ......................................................... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof of Southold Town Trustees authorizes and permits the following: E . Fill 90' X 12' with clean sand, Located Private Road, yi. Fishers Island. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- �I=: 1, by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of said Board as of this date.til J / .... FO oz- ....��— r ru es .,.$..F Err "..r�... °- K,r,w ..,gr::#=s�...t`ti .z.c�' ui r ���i �r.' ,'•��.s.°�'�` ,°'..ar`�.s..,�5.' r� ;. ffl OF TRUSTEES �,� _.,,M_ SUPERVISOR John M. Bredemeyer, III, President SCOTT L.HARRIS Albert J. Krupski, Jr., Vice President HenryP. Smiths M Town Hall John B. Tuthill '_ 53095 Main Road William G. Albertson � "�� z-k� =�;� P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION Office Use Only:. )(Coastal Erosion Permit Application �, rquIr•-.STby- 11 � MWetland Permit Application Waiver from Chapter 97 I� fnI �17 1ATrustee Lands Permit Application MGrandf ather �CompletedApps. Date: IIACAC comments-Date: Sent Rec. FLi3 4vNeighbors ariance Required,notified Date: g®WN OF SO -�`� SEQRA Type � 9 Coord. Review-opt. ,mand. Date Rec. by Office Insp. comp./date: SEQRA Determin./date: Public Hearing/date: Findings: Permit Vote: (YIN) : Special Conditions: ( also see file) Application Fee: C).J© Application Number; SCTM #1000-_Jo - Project Name (If any) Date Prepared: APp 1 i c ant: Address: �� Q�segLu_, L/� Phone ( /(o ) �S3-r✓� Interest: (owner, consultant,lessee,etc. ) Owner of Propert Address 4q Ac CV1 ki2 1 Phone — Subject Property Location: 1r`Jae�r00 1 ::F40LO,,1 14Ca4tpq "20 014 (Provide LILCO Pole #, Distance to cross Streets if not on location map) Page 1 • ITl7-'.^ Tr+ 1+^.m a TTTT�ATT - Yds. to be excavated: Yds. to be filled: Manner in which material will be removed or deposited: Width of canal, creek or bay fronting property: 17 0- Depth at low tide: h Aver. rise in tide: 6.1 Distance to nearest c annel: � � c� Distanc project extends beyond similar projects in area: nl 0. Area zoning: Land area in acres: / Is project for private or business use: •� _ Intended use of property: }h C`r, ca► �� Describe known prior operations CadndiAsted bn prfemises. ( See- 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: Nh4- 47) , ,� k,,,u)(�� 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) . 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 Page 2 -2- [ ] DEC has no objection to your agency.—oranother agency assuming lead agency status for this action, but we have tHe�jfollowing�cpncerns regarding this project (see "comments" below) . ( ] DEC wishes to assume lead agency ;st28Vs farAh1i s 4dt on. [ ] The proposed action has been 'tifi.e�o-,,by DEC as� occurring wholly or partially within or substanti1011T, `co`A):-guous, ,1to a critical environmental area (CEA) that was designated-by"-— It is the position of this Department that your agency, if it has _a juris- diction over the action, should assume the lead agency role based on the existence of the CEA and the fact that the anticipated impacts are primarily of local significance. Other. (See comments below) Comments (Optional ) : Un1i5��d ac-ribn In kbRt (— �Y � Response: Please respond to this request within 30 days of the date of this letter. If no response is received within 30 days, we will assume that you have no objection to DEC- or another agency assuming the role of lead agency, and have no comments to offer regarding the proposed action at this time. If nei your ag nor any other involved agency, including DEC, has in a will- ingness serve as lead agency within 30 days of t ' ter: [ ] We will p . ion the Commi er of DEC to designate a lead agency for this action. ( ] We wi etition the Commissioner o esignate your agency as d, presuming you have jurisdiction. Please feel free to contact this office for further information or discussion. Sincerely, Zaot✓,C, .5co vzzz v Enclosures 51r. CnV'If-nmckl. 00f- cc: (see rr distribution list) New York State Department of Environmental Conservation h �r��� 93 �h yv Thomas C. Jorling SOL&Wd I buiv\ HOM n 1 M R 0 W I Commissioner 5_36g5 M�Cty, Y MAR — 9, I N 5o�,k+W d I W ! (�i� Dear f', T01NN OF SOUTHOLD RE: LEAD AGENCY COORDINATION REQUEST The purpose of this request is to determine under Article 8 (State Environ- mental Quality Review - SEQR) of the Environmental Conservation Law and 6 NYCRR Part 617 the following: 1. Your agency's interest in acting as lead agency; 2. Your agency's jurisdiction in the action described below; and 3. Issues of concern which your agency believes should be evaluated. Enclosed is a copy of the permit application and a completed Part 1 of the Environmental Assessment Form to assist you in responding. Project Name: 016 F 5 . N(>-156y) Poriy Project Location: envc4e DEC Project Number: I 3� v?�(� v 6J a 1 —0 DEC Permits: SEQR Classification: )(Type I [ ] Unlisted DEC Contact Person: t_6U+ rC, SC o UC,22_0 DEC Position: [ DEC has no objection to your agency or another agency assuming lead agency status for this action, but reserves the right to comment on this action if a positive determination of significance is made. - 4 n NCi p.o. bfix 447 - R�IJ(2R�a1 � N.Y. I M 9 Project Description Applicant proposes to £ill an area (approx. -90 ' x 12 ' ) with approx. 25 c .y. of clean sand. Area is located landward of existing 'bulders and. has been eroded during various periods of extremely high lunar tides . All work shall- be in accordance with plans prepared ny Chandler, Palmer & King last dated 7/17/92 . ,r4-16-2t'2/87)—7c 617.21 SEAR Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or action. Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project . data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: if any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: ❑ Part 1 ❑ Part 2 ❑Part 3 Upon review of the information recorded on this EAF (Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead "agency that: ❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a Significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* [I- C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) Date 1 PART 1—PROJECT INFORMATION � •. Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the application for approval and maybe subject to further verification and public review. Provide any additional information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION LOCATION OF ACTION (Include Street Address, Municipality and County) Private Road, . F'ishers Island, Suffolk NAME OF APPLICANTISPONSOR BUSINESS TELEPHONE J.M.O. Consulting for Olaf S . Nelson (516 ) 653-0607 ADDRESS P. O. Box 447 _ CITY/PO STATE ZIP CODE Quogue NY 11959-044 NAME OF OWNER(If different) BUSINESS TELEPHONE Olaf S .Nelson (516 ) 788-7782 ADDRESS 44 Patterson Avenue _ CITY/PO STATE ZIP CODE Greenwich Ct . 06830 DESCRIPTION OF ACTION "Please see attached" Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas. 1. Present land use: ❑Urban ❑►ndustrial ❑Commercial oResidential (suburban) ❑Rural (non-farm) ❑Forest ❑Agriculture ❑Other 2. Total acreage of project area: —M I A— acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) acres acres Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) _ acres acres Roads, buildings and other paved surfaces acres acres Other (Indicate type)__ acres acres 3. What is predominant soil tyl �(s) on project site? _ a. Soil drainage: 57Wei :]rained 100 % of site ❑Moderately well drained % of site ❑Poorly drained __ % of site b. If any agricultural land is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classificationn System? /a acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? ❑Yes VNo a. What is depth to bedrock? 600 (in feet) 2 5. Approximate percentage of proposed project site with slopes: [�O-10% 100 % Ell 0-15% % 015% or greater % 6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the National Registers of Historic Places? ❑Yes 6]No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes X]No 8. What is the depth of the water table? n/a (in feet) 9. Is site located over a primary, principal, or sole source aquifer? EdYes ❑No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? k-7Yes ❑No 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? Dyes R]No . According to _ self Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) []Yes R]No Describe 13. Is the project site presently used by the community or neighborhood as an open space or recreation area? Dyes X]No If yes, explain 14. Does the present site include scenic views known to be important to the community? []Yes f�-]No unknown 15. Streams within or contiguous to project area: —_ri/a a. Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland areas within or contiguous to project area: a. Name West Harbor b. Size (In acres) n/a 17. Is the site served by existing public utilities? X❑Yes ❑No a) If Yes, does sufficient capacity exist to allow connection? ❑XYes ❑No b) If Yes, will improvements be necessary to allow connection? ❑Yes ®No 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? ❑Yes )C]No 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? E&es ❑No 20. Has the site ever been used for the disposal of solid or hazardous wastes? Dyes ONo B. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor acres. b. Project acreage to be developed: n/a acres initially; n/a acres ultimately. c. Project acreage to remain undeveloped n/a acres. d. Length of project, in miles: n/a (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed 0 %; f. Number of off-street parking spaces existing 0 proposed 0 g. Maximum vehicular trips generated per hour m (upon completion of project)? h. If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially One Ultimately One i. Dimensions (in feet) of largest proposed structure height; width; length. j. Linear feet of frontage along a public thoroughfare project.wi,ll occupy is? —'d ft. 3' i 2. How much natural material (i.e., rock, earth, etc.) will be removed from the site. tons/cubpc.yards 3. Will disturbed areas be reclaimed? ❑Yes ❑No LIN/A a. If yes, for what intended purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? ❑Yes ❑No c. Will upper subsoil be stockpiled for reclamation? ❑Yes ❑No 4. How many acres-of vegetation (trees, shrubs, ground covers) will be removed from site? acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? ❑Yes ERN 6. If single phase project: Anticipated period of construction 1/2 months, (including demolition). 7. If multi-.phased: n/a a. Total number of phases anticipated (number). b. Anticipated date of commencement phase 1 month year, (including demolition). c. Approximate completion date of final phase month year. d. Is phase 1 functionally dependent on subsequent.phases? ❑Yes ❑No 8. Will blasting occur during construction? ❑Yes ONo 9. Number of jobs generated: during construction 3 ; after project is complete 0 10. Number of jobs eliminated by this project 0 11. Will project require relocation of any projects or facilities? ❑Yes k1No If yes, explain 12. Is surface liquid waste disposal involved? ❑Yes x❑No a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? ❑Yes JONo Type 14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes ❑No Explain 15. Is project or any portion of project located in a 100 year flood plain? ilYes ❑No 16. Will the project generate solid waste? ❑Yes ClNo a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? ❑Yes ❑No c. If yes, give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No e. If Yes, explain 17. Will the project involve the disposal of solid waste? ❑Yes CRNo a. If yes, what is the anticipated rate of disposal? tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? ❑Yes ®No 19. Will project routinely produce odors (more than one hour per day)? ❑Yes FENo 20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes RNo 21. Will project result in an increase in energy use? ❑Yes ❑tJ0 If yes , indicate type(s) 22. If water supply is from wells, indicate pumping capacity n/a gallons/minute. 23. Total anticipated water usage per day n/a gallons/day. 24. Does project involve Local, State or Federal funding? ❑Yes X7No If Yes, explain 4 � �SA | Required: � _ _ Approvals Submittal ' Type Date [ity, Town, Yi|i/:' R'yJ k.]Yes []No Trustee Wetlands 6 C%M 2 /93 City. Town, Village P|a/minp Board []Yes JjNo _-_-_----_ [ih/. Town Onan| []Yes k-]No O(y. [uun\v i Department []Yes RNo Other Local AAenca`` []Yes Ix-1No Other Regional Age"cies BYos FXNo D[ .� S D � C -��rticle 25 2/93 ��o/e Agencies �]Ye� []No ^ ^ ` ^ ^ ^ Federal Agencies []Yes ,ONo C. Zoning and Planning Information 1 Does proposed action involve planning o, zoning decision? OYes No If Yes, indicate decision required: L]znningamexJment ' []zoningvahancc Ospedu| use permit []Subdivision []site plan Onew/mvisiono( master plan Onsounce management plan Oother 2 YVhut is the zoning Jasdficadon(s)oFth-e'site? 3. What is the maximum potential development of the site if developed as permitted by the present zoning? l family reeidezzce -------Oz�e� 4 What is the proposed zoning of the site? 5 What isthe maximum potential development of the site if developed as permitted by the proposed zoning? 6 |s the proposed action consistent with the recommended uses in adopted local land use plans? Q9Yes []No 7- What are the predominant land use(s) and zoning classifications within a 1/4 mile radius of proposed action? 8 /s the proposed action compatible with adjoining/surrounding land use* within a % Mile? zd:]Yes []No 9. /f the pvnpuscJ action is the subdivision o/ land, how many lots are proposed? a. What is the minimum lot size proposed? 10 Will proposed action require any authuhzahon(dfur the formation of sewer or water districts? OYes bdNn 11 Will the proposed action create a demand for any community provided services (recreation, education, police, f ire pvotechon)? OYes F�Nn a. If yes, is existing capacity -sufficient to handle projected demand? OYr, MNo 12 Will the proposed action result in the generation o/ traffic significantly above present levels? OYes ONo a. If yes, is the existing road network adequate to handle the additional traffic? OYes ONo D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may 6e any adverse impact5 associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or ovoid them. E Verification 1993I certify that e formati i ed above is true to the best of my knowledge. VIA— V President, J.M. O . Consulting Signature !I— / Title If the action is ie/ie Coastal Ar((a�, Vnd Applicant/Spons r Jtle G111 0 — Date — with this assessment. are a state agent"Y'�'�complete the Coastal Assessment Form before proceeding Part 2—PROJECT IMPACTS AND THEIR MAGNITUDE Responsibility of Lead Agency General Information (Read Carefully) • In cornplcting the form the reviewer should be guide;/ by the question: Have my response< aid determinations been reasonable? The reviewer is not expected to he an export environmental analyst. • identifying that rn impact will be potentially large (( olumn 2) does not mean that it is also ne,-:essorily sigrvfieant. Any large impact must be evaluated in i".P%f 3 to determine significance. Identifying an impact in 0;.:;nn 2 simp)y asks that it be looked at further. • The Examples provided are to assist. the by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance They do not constitute an exhaustive list of impacts and thresholds to answer each question. o The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects. Instruclions (Read ca(efully) a. Answer each of the 19 questions in PART 2. Answer Yes if there will be any impact. b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact. If impact threshold equals or exceeds any example provided, check column 2. If impact will occur but threshold is lower than example, check column 1. d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This must be explained in Part 3. 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By IMPACT ON LAND Impact Impact Project Change 1 . Will the proposed action result in a physical change to the project site? ONO DYES Examples that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ ❑ ❑Yes [I No foot of length), or where the general slopes in the project area exceed 10%. • Construction on land where the depth to the water table is less than ❑ ❑ ❑Yes ❑No 3 feet. • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ El Yes El No • Construction on land where bedrock is exposed or generally within ❑ ❑ El Yes ❑No 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ ❑Yes []No than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ❑No Construction in a designated floodway. ❑ ❑ ❑Yes ❑No • Other impacts ❑ ❑ El Yes ❑No 2. Will there be an effect to any unique or unusual land forms found on the site? (i.e., cliffs, dunes, geological formations, etc.)❑NO DYES • Specific: land forms: _ ❑ ❑ ❑Yes 0No. 1 2 3 IMPACT ON WATER Small to Potential Can Impact Be Moderate Large Mitigated By � 3. Will proposed action affect any water body designated as protected? Impact Impact Project Change (Under Articles 15, 24, 25 of the Environmental Conservation Law, ECL) ONO OYES Examples that would apply to column 2 • Developable area of site contains a protected water body. ❑ ❑ El Yes ❑No • Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes ❑No protected stream. • Extension of utility distribution facilities through a protected water body. ❑ ❑ ❑Yes ❑No • Construction in a designated freshwater or tidal wetland. ❑ ❑ ❑Yes ❑No • Other impacts: _. ❑ ❑ ❑Yes ❑No 4. Will proposed action affect any non-protected existing or new body of water? ONO OYES Examples that would apply to column 2 I • A 10% increase or decrease i'n the surface area of any body of water ❑ ❑ ❑Yes ❑No or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 5. Will Proposed Action affect surface or groundwater r quality or quantity? ONO OYES Examples that would apply to column 2 • Proposed Action will require a discharge permit. ❑ ❑ El Yes ❑No • Proposed Action requires use of a source of water that does not ❑ ❑ El Yes El No 4 have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 ❑ ❑ ❑Yes ❑No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ El Yes ❑No supply system. + • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes El No • Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ ❑Yes ❑No do not exist or have inadequate capacity. • Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ El Yes ❑No day. • Proposed Action will likely cause siltation or other discharge into an ❑ ❑ ❑Yes ❑No existing body of water to the extent that there will be an obvious visual contrast to natural conditions. • Proposed Action will require the storage of petroleum or chemical ❑ ❑ ❑Yes ❑No products greater than 1,100 gallons. • Proposed Action will allow residential uses in areas without water ❑ ❑ El Yes El No and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may ❑ ❑ []Yes ❑No require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: ❑ ❑ El Yes 0N0 6. Will proposed action alter drainage flow or patterns, or surface water runoff? ONO OYES Examples that would apply to column 2 • Proposed Action would change flood water flows. ❑ ❑ ❑Yes ❑No� 7 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change • Proposed Action may cause substantial erosion. ❑ ❑ El Yes ❑No O Proposed Action is incompatible with existing drainage patterns. ❑ ❑ ❑Yes ❑No • Proposed Action will allow development in a designated floodway. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON AIR 7. Will proposed action affect air quality? ONO DYES Examples that would apply to column 2 • Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ -]Yes ❑No hour. • Proposed Action will result in the incineration of more than 1 ton of ❑ ❑ El Yes ❑No refuse per hour. • Emission rate of total contaminants will exceed S lbs. per hour or a ❑ ❑ ❑Yes ❑No heat source producing more than 10 million BTU's per hour. • Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes El No to industrial use. • Proposed action will allow an increase in the density of industrial ❑ ❑ ❑Yes ❑No development within existing industrial areas. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON PLANTS AND ANIMALS 8. Will Proposed Action affect any threatened or endangered species? ❑NO DYES Examples that would apply to column 2 • Reduction of one or more species listed on the New York or Federal ❑ ❑ ❑Yes ❑No list, using the site, over or near site or found on the site. • Removal of any portion of a critical or significant wildlife habitat. El El ❑Yes ❑No • Application of pesticide or herbicide more than twice a year, other ❑ ❑ ❑Yes ❑No than for agricultural purposes. o Other impacts:. ❑ ❑ ❑Yes ❑No 9. Will Proposed Action substantially affect non-threatened or non-endangered species? ONO DYES Examples that would apply to column 2 Proposed Action would substantially interfere with any resident or ❑ ❑ ❑Yes ❑No migratory fish, shellfish or wildlife species. ® Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes El No of mature forest (over 100 years of age) or other locally important vegetation'. IMPACT ON AGRICULTURAL LAND RESOURCES 10. Will the Proposed Action affect agricultural land resources? ONO DYES Examples that would apply to column 2 • The proposed action would sever, cross or limit access to agricultural ❑ ❑ [:]Yes El No land (includes cropland, hayfields, pasture, vineyard, orchard, etc.) 8 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change • Construction activity would excavate or compact the soil profile of ❑ ❑ ❑Yes ❑No agricultural land. • The proposed action would irreversibly convert more than 10 acres ❑ ❑ ❑Yes ❑No of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. • The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑No I land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) C Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON•AESTHETIC RESOURCES 11 . Will proposed action affect aesthetic resources? ONO ❑YES (If necessary, use the Visual EAF Addendum in Section 617.21, Appendix B.) Examples that would apply to column 2 • Proposed land uses, or project components obviously different frorn ❑ ❑ El Yes El No or in sharp contrast to current surrounding land use patterns, whether man-made or natural. • Proposed land uses, or project components visible to users of ❑ ❑ ❑Yes ❑No aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. • Project components that will result in the elimination or significant ❑ ❑ ❑Yes El No screening of scenic views known to be important to the area. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? ❑NO ❑YES Examples that would apply to column 2 • Proposed Action occurring wholly or partially within or substantially ❑ ❑ ❑Yes ❑No contiguous to any facility or site listed on the State or National Register of historic places. ® Any impact to an archaeological site or fossil bed located within the ❑ ❑ ❑Yes ❑No project site. - m Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes El No archaeological sites on the NYS Site Inventory. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity .or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 ONO ❑YES • The permanent foreclosure of a future recreational opportunity. ❑ ❑ ❑Yes ❑No • A major reduction of an open space important to the community. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 9 1 2 IMPACT ON TRANSPORTATION Small to Potential Can Impact Be. I 14. Will there be an effect to existing transportation systems? Moderate Large Mitigated By IIII ❑NO ❑YES Impact Impact Project Change Examples that would apply to column 2 4 Alteration of present patterns of movement of people and/or goods. ❑ ❑ El Yes ❑No Proposed Action will result in major traffic problems. ❑ ❑ El Yes ❑No Other impacts: ❑ ❑ El Yes ❑No IMPACT ON ENERGY 15. Will proposed action affect the community's sources of fuel or energy supply? ONO ❑YES Examples that would apply to column 2 ® Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ [I Yes ❑No any form of energy in the municipality. ® Proposed Action will require the creation or extension of an energy ❑ ❑ ❑Yes ❑No transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. . Other Impacts: ❑ ❑ ❑Yes ❑No NOISE AND ODOR IMPACTS 16. Will there be objectionable odors, noise, or vibration as a result of the Proposed Action? ONO OYES Examples that would apply to column 2 Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ El Yes ❑No facility. Odors will occur routinely (more than one hour per day). ❑ ❑ El Yes ❑No ® Proposed Action will produce operating noise exceeding the local ❑ ❑ El Yes ❑No ambient noise levels for noise outside of structures. Proposed Action will remove natural barriers that would act as a ❑ ❑ ❑Yes ❑No noise screen. Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON PUBLIC HEALTH -17. Will Proposed Action affect public health and safety? ❑NO OYES Examples that would apply to column 2 Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ ❑Yes ❑No substances(i.e. oil, pesticides, chemicals, radiation, etc.)in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. Proposed Action may result in the burial of "hazardous wastes" in any ❑ ❑ ❑Yes ❑No form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) Storage facilities for one million or more gallons of liquified natural ❑ ❑ ❑Yes El No. gas or other flammable liquids. © Proposed action may result in the excavation or other disturbance ❑ ❑ El Yes El NO within 2,000 feet of a site used for the disposal of solid or hazardous waste. ® Other impacts: ❑ ❑ ❑Yes El No 10 _ . 1 IMPACT ON GROWTH AND CHARACTER 2 3 Small to Potential Can Impact Be OF COMMUNITY OR NEIGHBORHOOD Moderate Large Mitigated By. 18. Will proposed action affect the character of the existing community? Impact Impact Project Change ONO ❑YES Examples that would apply to column 2 • The permanent, population of the city, town or village in which the ❑ ❑ ❑Yes ❑No project is located is likely to grow by more than 5%. • The municipal budget for capital expenditures or operating services ❑ ❑ ❑Yes El No will increase by more than 5% per year as a result of this project. Proposed action will conflict with officially adopted plans or goals. ❑ ❑ [I Yes ONO Proposed action will cause a change in the density of land use. ❑ ❑ ❑Yes ❑No' • Proposed Action will replace or eliminate existing facilities, structures ❑ ❑ El Yes ❑No or areas of historic importance to the community. Development will create a demand for additional community services ❑ ❑ El Yes El No (e.g. schools, police and fire, etc.) 4 Proposed Action will set an important precedent for future projects. ❑ ❑ ❑Yes ONO . Proposed Action will create or eliminate employment. ❑ ❑ El Yes ❑No' Other irnpacts: ❑ ❑ ❑Yes ❑No 19. Is there, or is there likely to be, public controversy related to potential adverse environmental impacts? ONO ❑YES If Any Action in Part 2 Is Identified as a Potential Large Impact or If You Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3---EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1 . Briefly describe the impact. 2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: • The probability of the impact occurring a The duration of the impact Its irreversibility, including permanently lost resources of value a Whether the impact can or will be controlled o The regional consequence of the impact • Its potential divergence from local needs and goals o Whether known objections to the project relate to this impact. (Continue on attachments) 11 49135 95-19-3(4/91)-7c - DEC AP LICATLON N M,f3E/R NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL-CONSERVATION (�J((�J JOINT APPLICATION FOR'PERMIT U.S.ARMY CORPS OF ENGINEERS APPLICATION NO. Please read ALL instructions on back before completing this application. Please type or print clearly in ink.Attach additional information as needed. ❑ARTICLE 9,TITLE 1; AK ARTICLE 43 6NYCRR 646(LE GEORGE RECREATION ZONE) ❑6NY TF�j3,27(AQUATIC VEGETATION) ❑6NYCRR 328(FISH) ❑6NYCRR 329(INSECTS) ❑ARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) S ' ' ❑ARTICLE 15,TITLE 5 6NYCRR 608(PROTECTION OF WATERS) rf' T A ❑For the.construction, reconstruction,or repair of a DAM or other impoundment structure. T El For the disturbance of a STREAM BED OR BANKS or excavationin or fill of NAVIGABLE WATERS. ❑401 WATER QUALITY CERTIFICATION E ❑ARTICLE 15,TITLE 15 06NYCRR 601 (WATER SUPPLY) r16NYCRR 602(LONG ISLAND WELL)'; ❑ARTICLE 15, TITLE 27 6NYCRR 666(WILD, SCENIC AND RECREATIONAL RIVERS) ❑ARTICLE 24 6NYCRR,662, 663(FRESHWATER WETLANDS) ❑ARTICLE 36 6NYCRR 50U(FLOODPLAIN.MANAGEMENT) )4,ARTICLE 25 6NYCRR 661 (TIDAL WETLANDS) ❑ARTICLE 34 6NYCRR 505(COASTAL EROSION) --------------------------------------------------------------------------------------------------------------------------------------------------- F ❑SECTION 10(RIVER AND HARBOR ACT OF 1899)for structures and work in navigable waters of the U:S. ❑COASTAL CONSISTENCY CERTIFICATION. E ❑SECTION 404'(CLEAN WATER ACT OF 1977)for disposal of dredged or fill material in waters of the U.S. D ❑SECTION 103(MARINE PROTECTION, RESEARCH AND SANCTUARIES ACT)for the transportation of dredged materials for dumping into ocean waters. 1. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES(If any) Unknown 2. APPLICANT IS A/AN' O "• wner ❑Operator ❑Lessee ❑Municipality/Governmental Agency (Check as many as apply) 3. NAME OF APPLICANT(Use Full Name) J.H. 0.., Consulting for Olof S .- Nelson MAILING ADDRESS TELEPHONE(Where can be reached during day) 44 Patterson Ave . c/o ( 5'16 788-7787 POST OFFICE STATE ZIP CODE Greenwich II�� Ct 06830 4. NAME OF ❑Owner b iA ent/Contact Person 91Q�j ;Glenn E . Just/J.Mg10. ' Consulting k°"Pl., MAILING ADDRESS TELEPHONE,(Where can be reached during day) P . O. , Box 447 (516 ) 653-0607 POST OFFICE STATE ZIP CODE Quogue VY 11959-0 47 5. PROJECT/FACILITY LOCATION(Mark location on map, see Number 1B on reverse side) e County Suffolk I Town or city Southold Village Fishers Island STREET ADDRESS(If different from applicant) Private Road POST OFFICE STATE ZIP CODE Fishers ' Island Ny 106360 6. NAME OF STREAM OR BODY OF WATER West Harbor 7. HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work without permit, includes dates. 8. WILL PROJECT UTILIZE STATE LAND? ❑Yes DgNo Show work on map and/or drawings. . El Yes ;9 No 9. PROPOSED USE: Private 10. PROPOSED STARTING DATE: 11. APPROXIMATE COMPLETION DATE: 12. FEE OF(NYS Permit Only) . ❑ Public ❑'Commercial ASAP ASAP $ 200 Enclosed 13. PROJECT DESCRIPTION: (e.g. quantity and type of material to be excavated, dredged or used for fill or'rip rap, location of disposal sites;type of structure to be installed; height of dam; size of impoundent; capacities of proposed water sources; extent of distribution system; etc.) 7PI-CC S F Ka 7c��\GsC I1 t�"r 14. WILL THIS PROJECT REQUIRE ADDITIONAL TEDERAL, STATE AND/OF. [:OCAL PERMITS? Yes ❑ No If yes, please list: Southold Town Trustees 15. CERTIFICATION: I hereby affirm that under penality of perjury that information provided on'this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further. the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever 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 or a fine of not re than $10,000 or imprisonment for not more than five years, or both, where an applicant knowingly and willfully falsifies,coJno am,up i materi ct;or i wingly makes or uses a false,fictitious or fraudulent statement. ❑I hereby authorize the agent named in Number it t is ap c ion o m behalf. _ _• ,,.,, ..,., _ ., ,. _ I�nTF — clr•nln Ia4 �1�"�.`�.`/.,- V f III�.V� 4 A J.M.O. CONSUlTi CI p.o. box 447 QUOCIUIE, N.Y. 11'� (516) 63,0607 Project Description Applicant proposes to fill an area (approx. 90 ' x 12 ' ) with approx. 25 c .y. of clean sand . Area is located landward of existing 'bulders. and has been eroded during various periods of extremely high lunar tides . All work shall be in accordance with plans prepared ny Chandler , Palmer & King last dated 7/17/92 . ._...__...___.._.. ._ _.�_ _.._:_i._......- �._ ..-�.-.:_i:::...�...�....t.r_....,� ��.-i .....�.....4.:.i+.�c��....w.�...��.u✓.3 ? .+�r�..K-.rwuw.Ma%Yfl .. PART 1--PRG.IEECTi IN1=GRsY�i�,1")Gi:� Prepared by Project Sponsor No 1( f 111I• dog Iinu•nl IS desi�-rwd to assisl in determining whether Ille 1( Lion proposed 11my ;t significant effect., on 111(� eitviI,,11 rnl I'le;tsct complete Ilse entire form, Palls n through 1'. Answers to these gtwI n:IIo will be consicleted as part of flit ,II)Irlir ,Minn fc,I ipproval and may Ile subje(-t to further V('I'ifi(ation and public review I'rr:vidit anv additional information \•sI!l hrli(�vc, will be nrecled In contlrlete Palls ? and 1 _ It is expected I11,11 c nntpletion of the full I Al will be dependent on information currently available and %%.ill not involve IWw studies, rose trr_b or investig;ttion. If information requiring such additional work is Unavailable, so indicate and specify each instance. NAME OF ACTI()14 LOCATION OF A(;IION Iklclude Street Address. M tin icir.alily and Counly) Private_ Road,__:Fishers Island , Suffolk NAME,OF APPLICAN17SPONSOR BUSINFSS TELEPHONE J . I. O. Consulting for Olaf S . Nelson . 15_ 16 ) 653-0607 ADDRESS P . O . Box 447 CITYIPO STATE Tzip COD Quogue NY 111959-044 NAME OF OWrIFR(lr dil(nrr•.nl) BUSINESS TELEPHONE Olaf S . Nelson ---_ ,516 ) 788-7782 ADDRESS . 44 Patterson Avenue - ----- -- CITY/PO Sr E ZIP CODE Greenwich Ct . 06830 DESCRIPTION OF nCflnN "Please see attached" ----- - ----- ----- - — Please Complete Each Question—lridicate N.A. if not applicable A. Site Description Physical setting; of overall project, both developed and undeveloped areas. 1. Present land use: I iUrhan ( Ilnclustrial [_1Cornmercial k1Residential (suburban) l.)Rural (non-farm) 1-IForest [ Irlgricultnre f lother --------------- 1 Z. Total acreal:(• of project area: _-- -(� p- A( rrs. AI1PR0XI.NiAIf A(-REnGf PRFSENTLY AF1FR COMPLFIION Meadow, or f1 ishland (Non apric ultural) c -- ----- — acres -- ----.. _ acre.. forested' - - -- — acres — -- - - acres" Af;ricullural (Includes orchards, (rnlrland, IMt (tire, etc.). __.._ . _.. .__..__..._- ..___ acres _. ..___.. _...-----. 'acres - Wetland (I reshwaler• or tidal as per Articles "LA, Z i of I (,I_) . --------.----_..__-- acres -----_.-.-- acres. Wiser Surfrtce Area _.. ..--.----._-._— acres ------------- acres (Invegela•ted (Ro( k, earth or fill) —.--_-.------ -- acres _-- acres Ro;tcJs, huilditigs anti other paved sur(ac e< ----,-----__—_-- acres acres ()flier (Indi('a(e tyltc')— -- ---- ... - - --- -..... - - --- ------ -- acres — acres 1. \Vlmt is pw(Jonlinant soil tyl ( •I on proje( t site? __.__.,. ....---------.----_------ - --- a. Soil clrain.l{, k1Wei lr;tilled _ 100 ;f) of pile I IMoclenlely well drained _ % of site I. Woorly drained _. % of site h). If any iiioictlllnral land i, invnlvecl, hi w nl;toy a(::res of soil are c IasSified within soil group 1 through 4 of the N1'S ' I and ( la«ilic•,Ilion Systrnt� n/-a. rc res. (see I NYCRR .170) 1. All, there hr dlor I: nuts ropplllgs on• ploje( I ,tiilc I Iles INn is rlel lh to hedro(O . ...600 (in (tell l mximnirJ`,nrx|^x,v/ prnp/ '|`n`ip�A silo wi||� dnp'c [�)�10�� Y� []10'15Y6 _ Y6 ~ ' [1113Y6 nr greater `_- % ` ~ 6. Is pr 6icr! Su11«^m/.J|v 'o`n|ie000` |o. M. ' nx|xio x \x!i|Hiuu, site, or district, listed on the State or the Nal(o»a| D �i ` of }|i«o,i/ |1/�,�! L|Yr` ���n t rX p' . , 7. �s pvnipr| n/h`|x/ui�Uy ron|iAvoo� �o n /i|r |iw,d nn Uh, R;gi�|,ro[ Nohnna| Nn!i/m} Landmarks? [lyey V N o H. What is the '|'|'||` "| Ole v"ntrr _n./�. - (in frr|). - Y. Is site 16catoJ over ^ ;rimnry. p/inriyo|. or m|p.snvrc, 'ku/ifpr? kdYrS []No ` 10. Un |x/p|iug. H`|/inx '`, dh.eU|id,iog nyy»/(vni(i,� |vpa'ody exist in ||xo |xoj,d »,eoY klYcs No ' 11 [)ors p!oi/,( `it, 'oo|xin onyq,,ri,s "f |J^o| o, mixn| |i<r d`a! is iJ,o|i<irJ as thnoxienrd or endangered? ' DY' ` k|Nn Aon,di/`x to oel]�_- - _-_-_-_---- - |dooi[v ,a' |` species lZ. Are, V`orc any vni«vr orunoSoa| land fonn� oil the |`n,icct site? (i.e., cliffs, dunes' other geological formations) []Y,­, kJNo Dnsc,ihr _---_ ' 13. Is the project sitr p,c�ondy useH by the /om/nunity or n��gh[n'hon6 as on open space or recreation area? ` (]Yos �|NO |f' yes, rsp|nio _ ___--___ ` |4. Doc, (�r yn'v'o| ',it(' imiuJr nrui' vi',*` kx'vvx |o k/` io`|/ndnn( m Ux' communik/7 ( |N« uokoonro 15. 6(reams ,viH`ix "r 'ontiPvovS t(), p �r/t xr,a: ' a. Nvnx` of Stream an(] name of River to vvhic.h,it is kih,/|nry ' ' 16. Lakes, ponds, . cU^od areas within nrcontiguous \opn`irriarea: . a. Nnn`, _West Harbor 6. Size (in acres) 17. Is the site served by existing puNic Utilities? Yrs � ONo . x) |( Yes, does Sufficient capacity exist to allow connection? lk�Y,S []No b) |f Yes, will improvements be necessary |n allow conne,cAon7 (3Yes OONo 18. Is the sit located in an aAricohom| dist,i,/ certified p.ur5o6nt* 1n Acrio/|tvne and Markets Lop^ Article 25-AA, Sccdn ' ]O] and 304? [IYe s ' XlNo ' 19� |� the site |ocn(r� in or �u6sian�i^Uy ron{ixonv� �o x Critical Environmental. Area designated punoant to Article of the [[L and 6mY[RR 617? [�'cs [/No ` JO. Hns the site cvr, k,cn ooed for U`cJi�nos-ain/ solid o, 6^znn1ovs =a«c5? []Yes� ONO ` B Project Description ` ` 1 ykys�r,| dimn``i"o` ^oJ vn|r xp ppprrr'i^/,) | h U | | n / // � acres. o [o*| cm`/vo"m` .`' nnx, "wn,' or .o m, ,, .vy,o|r q/nxxx / '-_ -_ . ' | | n/u i iii U acres u|dma,|y k P'")cc( pz'�x' m ,c �cvc|ny,' � -_-'_�nr,,� n a `� ^^ ' C. Project arn'o«� m remain ""dc,,|^y,J -- 'ocns. ` u. LenA|h of ,,oi,ct. in'mi|es: (|f »pn,npr�|r) ' ' e� |( the proicc| i� -in oxpnn�ihn^ inJic�<, percrx� n�'rxpxndon propos,J �--__--� Y6; L �Num6c, of n[<-*,c,\ parking spaces r,ishxp -_-_�-._�-_- � p,opos,cl ---_0i_---- �� k4axirnum ,r|`i' v|», trips �enrm|o] pr, hour _--V�-__�- (opon ,nmp|eiio�of project)? ' b K residential: Nxm6c, »n6 typnn< 6"v�iuXnni(r ' ` ()nn Family lvvo Family NAv|hp|p Family Condominium ' |"itivUv _'Ultimately One � - ' i Dimensions (in (vr() of largest. proposed `|n/rhnr height; wwidth; m length. i f < frontage | Wi U n` xh�on` project v,iU occupy i�� 'U b i Linear fee( ^ ron nAc along x pv , `o n " --_---- ' J - ' ' r• MI be Ien;nvc'c, it he site? -._--- I nns!cuh., • I >. I Irtt�' ntu( h nnlurnl materi,(, „ a. Will clistu bed ,IIi`ns be reel,tirru`rl? a, If ye's, for what. inten(INI purpose; is the site+ hci.ng reclaimed? __._-.- ------ --- - . h. \fill tors Oil he ;toc.kpilcd for reclati,alinn! I ]yes [.1Nrt suhs0il I,(, stor l<piled for rec..lam,Linn? - I'-Vs ONo tr Ir. of �egetalinn (tr(`c`< shrubs; ground covers) will he removed from site? ----�_......._--= acres. t. Ilr,w Inn a^ gr 5. Will any n rllurc' (crest (over 1O(1 years olcl) or oth54-r locally-important vegetation he removed by this project? 5. If single phase project: Anticipaled period of construction 1/2 months, (including demolition). 7. If multi phasr'd: n/a (number) a. fol:,l I Llmlwr of phases antic ipiti'cl ------- month yc��r, (including demolition). nn b. Anti( ipatcd (late of co , )r'rt(cn,ent phase 1 —._- — c. npproxintalc completion date of final phase ______-- n,nnth — year: d. is phase 'I fIII)ctlonally dependr'nt (fin SUbsequenl phases? Dyes ONo 8. Will blaSling occur during construction? OYes k.No f 9. Number of jobs generated: during cnnst•ruction -3__..— ater.project is complete �---- 10. Number ,f jniv; eliminated by this project ..-___ _.-- i 11. Will projc�t re'riuire relocation Of any projects or faciliLies? C]}' -s ft1No If yes, explain 12. Is surface liquid waste disposal involved? t.J)'es XONo �.. If,yr s, indicate type of waste be industrial, etc.) and amount — - h. Name of wvater_body into which r'ffluent will be discharged ------ 13. Is suhsurlr:e liquid waste disposal involved? I I.1yes WINO Type — 1:�. \Aril) Surface arr'a of an existing water holy increase or decrease by proposal? ❑YesExpla L=1No 15. Is pr in o.. any portion of project loc:alcd in a 1Oo year flood plain? )E]Yes LINO 16. Will the "project generate Solid wa ]Yes I�No ste? C: a. If yr`s wlutl is the arno(Ipt p('r tons month . ----•--. h. I( ye `•, t„ill ;III exi;tinr; snlid ww*, (arilily he used? IIYr's ONo location — i v c name --- ---- o into a sewage disposal System or into a sanitary landfill? d. Will .toy w,istes not g — — 17. Will the 'PI()if'( r involve the disposal'of solid waste? ❑Yes o t UNonih. a. I( yes, .,'hat is the anticipated rate of disposal? b. If vr;S, what is the anticipated site life? _-_.�------.__---- years. 1� Dyes NNo . Will prnjr'ct Ilse herbicides or p.`sticic)es? 19, Will project routinely produce Odors (more than one hour per day)? ❑Yes �NonYeS �No 20. Will projcc t produce operatinL noise exceeding the local ambient noise levels? 21. Will prnjcc.t result in an increase in (,ncr{;y use? C.lYcs I- lo If yes , indicate type(s) ------__.- . ..-.-- - - — 22. if water supply is from wells, iodinate pumping capncil n/a gallonslminute. y ------ 23. total nniicip,,lo`d '',water LIS i er day _n a/ _._-_ gallons day. t. I)ocs projr•rl invoiw"Local, Stair' c,r ledc,r,d funding? [.IYcS 3E]No ,(Provals Required: Submittal Type Date City' 1 own, 1'i!L 1 Il'e; 1 _IN() Trustee Wetlands & CZri 2/9 3 City, r.,wn. \•'ilkq;e 11,liwing Board 1 IYc s �1No Gity,' l c «n • :,n; i4, ,ir<I I il'r ; k1No -- C.ily, l.c:,un(� 1; !ic It ,l,;utrnenl 11)'e; IgiNo — - ---- OIhcr Local Ag(—w ! I1 e; xlNo C)thei IYc; MNo 2/93. _..-_.--- -- iiNo N.Y . S .D . E . C . -Article 25 7. State n>;enc:r.s xl :lY'es . Federal nl_erlc:iv;- 1 iYes -1No C. Zoning and Planning Information 1 : Does Irrolln:r,rl ac lion involve a I}lanning or zoning derision? I 'Yes I�No II Yes, ind.r •1tr, eler ision reduirecl: f:izoning un01101nent [.--]zoning v,irianc-c I lsirecral use p"imil I kubdivision Lasite'plan I:_1newirovi,�ioti ()f master .plan Ire,;6urce managvinent plan l other 2. What is the ;onint; classification(s)of the tide? ----__....---..-..--.-------__....--.-.----_-_—•— _ -- K What is the maxinrurll 116tential dc'velopnrc ill of the sit; if developod as permitted by the present zoning? ------0ne ...single family -residence ____...--.-.------'- 4. Whal is the proposed zoning of the site? 5. What is the m,lxirliurn po;f.ential dcrvelot>nlenl of the site if dr,velojwd as pc-milted by the proposed zoning? n/a l h. Is the proposed action c'onsistenl will, the recornmended'uses in adopted local land use plans? ixiYes • []No .7 What are the predominant land use(s) and Toning classifications within a 114 mile radius of proposed action? 8 Is the propqu•cl ,lc..tion compatible with acljoinint,/surrounding land uses within a r/. mile? ;{-]Yes UNo 9. If the proposed ac lion is the scrbdnvision of land, how many lots arc proposed? n/a a. What is 11-w minimum lot size 11roposed?. .---------------._. ._---__—__-- 10 Will proposed action require any aulhoriiation(s) for the formation of crwcr or, water districts? Oyes &No• 1,1 . Will the prop„wd action create a d0nulnd for any c:nrnnlunity provided services (recreation, eddCation, police, fire protection)? r )Yes f:�No a. .if ye;, is existing capacity ;efficient to hancllr projected demand? IJYes IXNo 12. Will the prop(),wd action resell in the g(Ni(,ration of t,<,ffic significantly above present levels? ❑Yes ❑No a. If yes, ,is the. existing.road network aclecluatc to handle the additional traffic? ["IYes ❑No D. Informational Details nttach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please disc uss such impacts and the measures which you propose to mit ;date or• avoid them. E. Verification � i certify that e )iformaticn pr iderl above is true to the best of illy knowledge. Februar 1 1993- ApplicantlSp�n•s:rr lire _:.._ G_ .e __ _ .' >1S t— __.._._-..---...__.-�___.._..._..__. Date — y Signature -__-_-. L l :. ------ .._._- rifle .-._..._P-resident , J . I.O. Consulting i If the action is ii- •, ,e Coastal Ar a, nd y arc a state agency, complete the Coastal Assessment Form before proceeding with this assessille.11t. f Consultant wv Project Name f��/-�y ,�t/e��S0 SCTA1 #1Q0Q- /'U - .3— /3, 3 Date --// ' 73 The Southold Town Trustee office has determined that your application for a coastal onion/wet an perms is non-jllrisdi ctiaral 1111.om J ete, _ ' ...I I I er the following information in this regard for any required return :submission: S✓� rt�/in� ��,�� a�� "rep-, - �� O.7e A-4 mac[ QJ rem f y � C'e:� r . ,� �►r c c �i/" ems- r1�� 1 h c�-���r'^� err, a J 7) 6 Tr ee Representat v cc: uI-I zuj r eF t r1 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 Southold Town Trustees Field Inspection Report Project. Applicant/Number / Site contains the following important natural features (Beach, Bluff, Dune, Secondary Dune, Escarpment, Kettle holes, Erratics or Significant Habitats, Rare, Threatened, Endangered or species of special concern. q ,f' Extent proposed activities are at variance from established standards of Coastal Erosion Projection; is supplemental engineering or advisory opinion ,indicated? Refer, to CAC? S'f'/1t cti�y �i�.oav CICM J/7u. ,r.o �uneJA. R- A Can impacts be moderated by sim�le Project change? Should FEMA Regs. be checked Prior to Permitting? (= L jJ"ti — pplication complete, assement form provided/complete 'IPublic services landward of Structure. Non-movable structures/additions prohibited. Permanent foundations not attached to movable structures No movable structure within 25 ' of landward limit of Bluff. No movable structure placed so excessive ground loading placed within 50' of point of inflection. Relocation agreement required/acceptable. <Surface water not directed to/over bluff face. The Activity is: Reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location. Not likely to cause a measurable increase in erosion at the proposed site and at other locations. Prevents or minimizes effects on natural protective features and their functions and protective values existing erosion protection structures and natural resources. REMARKS: Trustee signature Date inspected: �7' �� � �-x.,sr,Na. G1i� "• b Ck'o's �•�pTGI-I � L�� / � i' ,7. td PRO m 1 1 2•! i 11 t o.t_r_ t 4 , - j 11 , «�.• f7 ua r r� h7 . t.f ... Coss Sc- -IotJ A �"' to COVE , 39. pAR F Harz . 1•-Z' Q G. x L J•f 7.1 .• b f. , 4 , 27., `,. a.] " • ?]: r 174Ik1 u., \ 7.8 A(d A W E LOCATION MAF e, 400 200 0 400 GRAPHIC SCALE IN FEET i \jE--s-r -�a-�-��- S �U OV NE 8i. 76' 7.4- 3 O?. 105.g5 m .. Low rj �PA�� , `10 ray f sort( / f�'" ��ii= ! NIGI WATEiZ Li1Y.� 9.1 J /f c O'Q L ,? �k f+_STr i STQ` Y —"' __ g LDE- S O T.5 �' C>glofJ 4-4- 7.4 Aj ,V L ti S�AZE CJ'` y I0.1Z O,o 6T � ,.. 9°s TOPOC RAPH I G PLAN " PREPARED FOR NOTE-: f Ews-r.► c. ' 5ASE FOR i_E`/E:�� TAKEN FROM N.O.\/Z). !c-{21. 2. NO ALTERATION PERMITTED HEREON E-/X(,E PT A5 PROVIDED UNDER BLK. 31 LOT 14 E� i6TIUG SECTION 720d 5UBL71V1510N 2 NEW YORE. S7A"7E EDUCATION LAW. NousE 3. SITE 15 IN THE TOWN OF 50:1THOLD, GOUT`!TY OE 5UFFOL<, 10 os o io FISHERS ISLAND, NEW YORK TAX MAP 1000, SECTION OIO BLOCK 05 L07 13.3 . — - . ._.. . ._ ._ GRAPHIC SCALE IN FEET MAP REFERENCE: REVISIONS t-1 X-77 CHANDLER. PALMER tie KING 1. COASTAL EROSION ,HAZARD AREA MAP TOWN OP 50U'i MOLD, DATE DESCRIPTION C' " "' SUFFOLK COUNTY, NEW YORK PHOTO NO. 40-11-7q-55, SHEET 46-FI OF 4q,8-2U-88. .r . P, Architects, Engineers and Surveyors n 110 BROADWAY NORWICH, CT 06360 203-889-3397 FAX 203-086-7801 DATE: July 17, 1992 SCALE: 1" = 10' J 3 (0 E3 SHEE- 1 OF 1