HomeMy WebLinkAboutTR-44-1-10 1 s.
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Board Of Southold Town Trusteesti
SOUTHOLD, NEW YORK
-, tiN- ►-�o j-l��-`3
PERMIT NO. .. ........ DATE: ..................... :.:
�s a ISSUED TO .......... .Gce.:1.. . Z ..................................................... '
;. Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Or&nance en-
} 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
LANDS UNDER TOWN WATERS;" and in accordance with the I '
Resolution of The Board adopted at a meeting held on ....
19............ and in consideration of the sum of $� ..�Z/ paid by �.
/ ...'. .. `r ...................................................... . ................................................................................. ,
of
�a� N. Y and subject to the `
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following: !="
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AS ��C. ALL 4` Covoq eM
t all in. accordance.with the detailed specifications as presented in
+� the originating application. . �. S
;. IN WITNESS WHEREOF, The said Board of Trustees here- LL.
b causes its Corporate Seal to be affixed, and these resents to f.
Y P P
t
a' be subscribed by a majority of the said Board.as of this date.
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......... ..................... ....................................
Trustees
7..,, •.�.-�r�„''..�:r:�u,.�, ��r ,.'�d.�''. ::.u:Lr.;'r,.��...,a�;..�d`"`er: �!wf �������.�.s,"...:F`.._�.uF.�:'�.���,�T.,+':*a feu•:>Y�t:�°�' ��
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'� SUPERVISOR
TRUSTEES :ir. L '�2.
John M. Bredemeyer, IJI, President ✓'s SCOTT L.HARRIS
Albert J. Kru ski• Jr. Vice President
P
Henry P. Smith "' Town Hall
53095.Main Road
B. Tuthill John
P.O. Box 1179
William G. Albertson
a Southold, New York 11971
Telephone (516) 765-1892
Fax.(516)765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
COASTAL EROSION MANAGEMENT PERMIT
. Permit Number: 14N - 1 - 18
Name of Applicant/Agent:
Name of Permittee:
Address of Permittee: 55355
i
Property Located: 56-wlx�
DESCRIPTION OF ACTIVITY: .
c i k\r, ,� e 5�one, �o b� SQ C)
e,,,,�
Date of permit issuance: 3c�v�cc} s�( �u 1`lg3
This permit is valid for a period of two years from the date of,
issuance.
SPECIAL CONDITIONS:
✓Bluff restoration through a re-vegetation agreement is
attached hereto and is a necessary special condition of this
permit.
A relocation agreement is attached hereto and is a
necessary special condition of this permit.
A maintenance agreement is attached hereto and is a
necessary special condition of this permit. .
1\ �. • • \ For I� ,�..J'�% qh� `••�►/4 � �..,r�'°'"rrr'��` " y.
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Board Of Southold, Town Trustees `4
W
SOUTHOLD, NEW YORK
ie
PERMIT NO. .Emer.g.e.n.c. ...Storm Damage DATE: ...11.9.05..............
�a ISSUED TO .....1?.QNALD....CAV.AL.U.Zz1.... ....... .... ........................................
'! Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York I893; and -ha ter 404 of the Laws of the
» ; p
,. State of New York 1952; and the Southold Town Ordinance en-
fit led "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the Otis
j REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM IFR I
LANDS UNDER TOWN WATERS; ' and in accordance with the �y
Resolution of The Board adopted at a meeting held on .1.1.9.1..95........... 1:'• �' - ,
19....9.5..., and in consideration of the sum of $................... ...... paid by
..................... ............................. .. ............
.;:. of N....Y....and..subject..+o...the -
............................................. k
Terms and Conditions listed on the reverse side hereof,
\\ =a of Southold Town Trustees authorizes and permits the following: «`
�,, Emergency Storm Damage Permit to build bulkhead as per
DEC specifications and conditions.
all in accordance with the detailed specifications as presented in
jj
"a! the originating application.
r `a� IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to :- k
�a be subscribed by a majority of the said Board as of this date.
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.................................. ......................................................
TrusteesJ.
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TRUSTEES
John M.Bredemeyer,III,President SUPERVISOR
Henry P. Smith,Vice President r�� '"-`''� SCOTT L.HARRIS
Albert J.Krupski,Jr. •^
`"'
John L. Bednoski,Jr. =';�� '� � .y .�4� Town Hall
John B.Tuthill �1 . 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:
Coastal Erosion Permit Application 010HInos J® O,
Wetland Permit Application
Trustee Lands Permit Application
Grandfather V661 I
Completed Apps . Date: IZ-ott-Fly
Variance Required, n
Neighbors notified Date: W
SEQRA Type
Coord. Review-opt. ,mand. Date Rec. by Office _
Insp. comp. /date: Q
SEQRA Determin. /date:,,3-�X 7r-)� {
Public Hearing/date: y/9 /qr
Findings:
Permit Vote: UY N)
Special Conditions:
( also see file) Application Fee: AOA
Application Number; SCTM 41000- y 7
Project Name (If any)
Date Prepared-: dw 7/ r 71 2 - 511-0 0
Applicant: =b,.rrn u"� V'A4,L)"Y-z-1 J 3 `l S� 6-6
Address: SS3 ( i �� �� / 16
Phone
Interest: (owner, consultant,lessee,etc. )
Owner of Property:
Address
Phone ( )
Subject Property Location: 3 �1—�•c�
(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: /00
Manner in which material will be removed or deposited:
c►c
Width of canal, creek or bay fronting property: �' G,/. ���✓v
Depth at low tide: Aver. ise in tide:
Distance to nearest channel: Distance project
extends beyond aimilar projects irf area:
Area zoning: Land area in acres:
Is project for private or business use:
Intended use of property:
Describe known prior operations conducted on premises:
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) .
'�GJOM "✓Y!n - l)Na-gg- 1411Yao
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
r
Albert J. Krupski,President y. �Gy Town Hall
John Holzapfel, Vice President c .�� 53095 Main Road
C4 z P.O. Box 1179
William G. Albertson V%- ^�
Martin H. Garrell �,f, O�� Southold,New York 11971
Peter Wenczel �4j �a Telephone (516)765-1892
Fax (516)765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
S.E.Q.R.A.
NEGATIVE DECLARATION
NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT
APPLICATION NO. 1000-44-1-10 Chapt. 97 - Wetlands
NAME: Donald Cavaluzzi Chapt. 37 - Coastal Erosion
DATE: March 31, 1495
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: I
DESCRIPTION OF ACTION: Applicant requests a Wetland Permit to
construct 60 l.f. of timber bulkhead with 2 12' returns and place
approx. 100 c.y. of clean fill, all in accordance with NYSDEC Plans
dated 1/5/95.
LOCATION: SCTM #1000-44-1-10
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
M +
New York State Department of Environmental Conservation fffta
Building 40—SUNY; Stony Brook, New York 11790-2356
Telephone (516) 444-0365
Facsimile (516) 444-0373
Langdon Marsh
Commissioner
January 5, 1995
Mr. Donald Cavaluzzi
92 Murray Drive
Westbury, NY 11590
'RE: 1-4738-00453/00004-0
Dear Permittee:
In conformance with the requirements of the State Uniform
Procedures Act (Article 70, ECL) and its implementing. regulations
(6NYCRR, Part 621) we are enclosing your permit. Please read all
conditions carefully. If you are unable to comply with any
conditions, please contact us at the above address.
Also enclosed is a permit sign which is to be conspicuously
posted at the project site and protected from the weather.
Very truly yours,
J
Margaret M. Rorke
EnCon Program Aide
MMR:cg
enclosure
printed on recycled paper
NEW C STATE DEPARTMENT OF ENVIRONMENTAL CONSEV ON
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-00453/00004-0 January 3, 1995
FACILITY/PROGRAM NUMBER(S) P E I T EXPIRATION DATE(S)
Under the Ernrirnn�ntal January 31', 1996
Conservation Law
TYPE OF .PERMIT ■ New 0 Renewal 0 Modification 0 Permit to Construct ❑ Permit to Operate
■ Article 15, Title 5: Protection ■ 6NYCRR 608: Water Quality 0 Article 27, Title 7; 6NYCRR 360:
of Waters Certification Solid Waste Management
❑ Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPDES 0 Article 27, Title 9; -6NYCRR 373:
Supply Hazardous Waste Management
0 Article 19: Air Pollution
0 Article 15, Title IS: Water Control 0 Article 34: Coastal Erosion
Transport Management
0 Article 23, Title 27: Mined Land
0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain
Island Wells Management
0 Article 24: Freshwater Wetlands
0 Article 15, Title 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37;
Scenic and Recreational Rivers I Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control
0 Other:
PERMIT ISSUED TO TELEPHONE NUMBER
Donald Cavaluzzi (516) 334-5950
ADDRESS OF PERMITTEE
92 Murray Drive
Westbury, NY 11590
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Same
NAME AND ADDRESS OF PROJECT/FACILITY
Cavaluzzi Property
55355 Route 48
LOCATION OF PROJECT/FACILITY
Southold, NY 11971
COUNTY TOWN WATERCOURSE MYTH COORDINATES
Suffolk Southold Long Island Sound
CESMIPTICN (T AJTFMIZE) X71VON
Construct 60 linear feet timber bulkhead. Construct (2) 12' returns. Place approximately 100 cubic yards clean fill.
All work to be done in accordance with approved NYSDEC plan.
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the
ECL, all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of
this permit.
DEPUTY REGIONAL PERMIT ADMINISTRA- ADDRESS
TOR:
George W. Hammarth Bldg. 40, SUNY, Roam 219, Stony Brook, NY 11790-2356
AUTHORIZED SIGNNATURE DATE
G� January.5, 1995 Page 1 of 5
C CDOITM
Inspections
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 Departrent of Envirorrrental Conservation (the . Department) to determine
whether the permittee is ccaplying with this permit and the ECL. Such represen-
tative rray order the work suspended pursuant to ECL 71-0301 and SAPA 401 (3) .
copy of this permit, including all referenced rreps, drawings and special
conditions, rrust be avaiIable for inspection by the Department at a I I tirres at
the project site. Failure to produce a copy of the permit upon request by a
Department representative is a violation of this permit.
Pe rmi t Changes and Perxm I s
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 wes obtained by misrepresentation or failure to disclose
relevant facts;
c) nervrraterial information is discovered; or
d) envirorrrental conditions, relevant technology, or applicable lary or
regulation have materially changed since the permit was issued.
3. The permi ttee must submi t a separate wr i tten appl icat ion to the Deparumnt for
reneAeI , modification or transfer of this permit. Such application crust include
any forms, fees or supplerental information the Department requires. Any
renenel , modification or transfer granted by the Department crust be. in writing.
4. The permittee must sub-nit a reneneI application at least:
a) 180 days before expiration of permits for State Pollutant Discharge
Elimination System (SFCES) , Flazardous Vleste IVhnagerEnt Facilities
(F M/F) , ma j o r Ai r Po I I ut i on Cont ro I (AFC) and So I i d Vleste Ubnagerent
Facilities Off) ; 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 Departrrent or .any of the tears, conditions or requirerents contained in such
order or determination.
Othe r.Lega I Clo I i gat i ons of ll'Ew i ttee
6. The permittee has accepted expressly; by the execution of the application, the
full legal responsibility for all damges, direct or indirect, of whatever
nature and by Wwrever suffered, arising out of the project described in this
permit and has agreed to indem ify and save harmless the State fran suits,
actions, damges and costs of every nave and description resulting fra-n this
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,
easerents and rights-of-wey that may be required for this project.
Page 2of5
95-20-6d(7192)-25c TIDAL WETLAND
ADDITIONAL GENERAL 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
it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across
waters 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
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 without expense to the State, and if, upon the expiration or 14 There shall be no unreasonable interference with navigation by the work
revocation of this permit, the structure, fill, excavation, or other herein authorized.
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 Conservation 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. Stamped
12. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by P
of any wetland or waterway by suspended solids, sediments, fuels, NYSDEC approved on 1/03/95
solvents, lubricants,epoxy coatings,paints,concrete, leachate or any
SPECIAL CONDITIONS
1. Any debris or excess material from construction of this
project shall be completely removed from the adjacent area
(upland) and removed to an approved upland area for
disposal. No -debris is permitted in tidal wetlands and or '
protected buffer areas.
2 . All areas of soil disturbance .resulting from this project
shall be stabilized immediately following project completion
or prior to permit expiration, whichever comes first. . The
approved methodologies are as follows:
a. stabilization of the entire disturbed area with appropriate
vegetation (grasses, etc. ) .
C. Temporarily stabilized with straw or hay mulch or jute
matting or other similar natural fiber matting within 1 week
of final grading. Temporary stabilization shall be
maintained until a mature vegetative cover is established.
3 . All fill shall consist of "clean" gravel and soil (not
asphalt, slag, flyash, broken concrete or demolition
debris) .
4. No excavation of the beach is authorized for the purpose of
obtaining fill or stone materials.
DLC PERN11T NUMBER
1-4738-00453/.00004-0
PROGRAM FACILITY NUMBLR
TPage 3 or 5
95-20-6f(7/87)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
For Article 25 ( Tidal Wetland
5. All peripheral berms, cofferdams, rock revetments, seawalls,
gabions, bulkheads etc. shall be completed prior to
placement of any fill .material behind such structures.
6. There shall be no discharge of runoff or other effluent over
or through any bulkhead or shoreline stabilization structure
or into any tidal wetland or adjacent area.
Supplementary Special Conditions (A) through (F) attached
DEC PERMIT NUMBER
1-4738-00453/00004-0
FACILITY ID NUMBER PROGRAM NUMBER
Page 4 of 5
SUPPLEMENTARY SPECIAL CONDITIONS
'The following con , _.ions apply to all Tidal tlands; Freshwater
Wetlands; Coastal Erosion Management; and Wild, Scenic, and
Recreational Rivers 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 has 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 shall 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
new application for permit.
D. At least 48 hours prior to commencement of the project,
the permittee and contractor shall sign and return the
top portion of the enclosed notification form
certifying that they are fully aware of and understand
all terms and conditions of this permit. Within 30
days of completion of the permitted work, the bottom
portion of that form shall . also be signed and returned,
along with photographs of the completed work and, if
required, a survey.
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,
Emm ire State Plaza, Albany, NY 12242 (316) 474-2195, which
may be required for any encroachment upon State-awned lands
underwater.
DEC Permit No. 1-4738-0045.3/00004-0 Page 5 of 5
Nysni_ c:
'• T''`/ 1 i Y A?'1'i :3�i ii.!:J �`,`; 1:'I E: '1'1:iLbiS
�1J ANID CON D:I T'R S OF
DATE 'IS
o l
0,tla -B i
i
i /)VJ(, SOU yAfZDS GIRAIV
5AND suPNC-b 131 . so
ofr- Shy
v/
SIIFATII)NG 3"X Id" `r 4.G CcA
N y s 1) f;
APPROVED AS PER TER1618
AND
VuNALER (.490 CCA -
�--- plLlN& 9" ccA
3/y'�Day Ncrr 'DIPPED
J4
j
I _
_ - )� MEAN ICI 11 �,1
to �>�i rrrs ul-lu �D a
MEAlY
I rACKFILL /apx too 1AM5 a F t, w
30� WATCR
GL.E'AN SAND V1"-S%)TW4E`D
i
�yy coNTKAc Y�aKI oFt% Sl rE' —
6'
County of Suffolk ) ,
State of New York )
r � r
E L� ,I��, `lJ".�i�'I 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.
SIGNATU
SWORN TO BEFORE ME THIS �� DAY OF —� Ny2 `� ,19 93
EILEEN A. LAPOLLO
(VOTARY PUBLIC,State of New York
/J ^cF1 C in Queons 41-4887615
y�-fe'1i`// Commission ed Expires March 23,E 19—V
"ROTARY PUBLIC
Suggested space for location Map
THIS IS NOT A PERMIT
1.:•16.4(2/87)—Text 12
�• PAOJECT I.D.NUMBER 617.21 S EQ F
Appendix C
_ State Environmental Quality Review
.,_. SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART 1—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
e qw
9. PROJECT LOCATION:
Municlpallty 1011 'l-0 County
4. PRECISE LOCATION(Street address and road intersections, prominent landmarks,etc.,or provide map)
10-2
I 5. IS PROPOSED ACTION:
• ❑New ❑Expansion Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
&'P'< 1Soyos OF ffw..
!v Q_— f`�r;t:�'?e?� QY fa e-IIfc OF S?bN6 I. CCGI,
.1
��UTZz52 ,
7. AMOUNT OF LAN AFFECTED:
Initially f acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Xy Yes ❑No If No,describe briefly
9. WHAT IS PRESENT LAP;� U�c IN VICINITY OF PROJECT?
�Resitlential ❑Industrial ❑Commercial ❑Agriculture ❑parkfForestlOpen space ❑Olher
Describe: '
l
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR'ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
Ryes ❑No If yes, list agency(s)and permit/approvals
00�{y3
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Ryes ❑NO If yes,list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes o
CERTIFY THAT THE-INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
. 53Applicant/sponsor e• Z- Date: S
\ Signature:
P t
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
EDOCSON EXCERESHOLD IN 6 NYCRR, PART 617.12? If yes, ato the rovirwprocosa antl use Ira FULL L�A�NoN RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6?erseded by another involved agency. i It No,a ne live 9 declaration
❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if Ieglble)
C1, Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid
potential for erosion,drainage or flooding problems?Explain briefly: waste Production or disposal,
i
C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Ex plain briefly:
Q. Vegetation or fauna, fish,shellfish or wildlife species•significant habitats, or threatened or endangered species?Explain brlefly:
C4. A community's existing plans or goals as officially adopted•or a change in use or intensity of use of land-or other natural resources?Explain .
i
p n briefly.;
CS. 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 CI-CS? Explain briefly.
C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly.
D. IS THERE.OR IS TH
❑Yes ERE LIKELY TO BE.CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONNIENTAL MWACTS?
❑No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCc (To be competed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial•large,important or o
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); b
irreversibility;(e) geographic scope; and (f) magnitude. It necessary, ) re Probability of occurrin envise significant.
explanations contain sufficient detail to show that all relevant adverse tlmttac impacts
or reference su g% (ls duration. (d)
Pporting materials. Ensure that
P have been identified and ade adequately ately addressed.
❑ Check this box if you have identified one or more Potentially large
occur. Then proceed directly to the FULL EAF and/or prepare g or significant adverse impacts
Check this box if you have determined, based on p pare a positive declaration. Pacts which I'.1Ay
docur-entation, that the proposed action VVILL NO the information and analysis above and
AND provide on attachments as necessary, T result in any Significant adverse environ any supporting
the reasons supporting this determination: mental impacts
Name ur lcaJ A • .
autcY
Print ur IYpr Iv.ur+e ut Ke+pu----- UtliC e/m Lcad Agency•
frtle ul ke+pon+ible Ullicrr
�lgnature ut HrSpon+tole UNi(c!m
feed ARencY
-- S.gnatule ul 1'rt•para•!tlf tJillerrnl Irom rr+ unuole unr
p cell
Datr
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7 ` y
al
95 2tM(10.90)-25c NEW Y RK ST TE DEPARTMENT Of ENVIRON.�tENTAI CONSERVATION
DEC PERMIT NU`UER AM EFFECTIVE DATE
FACILITY.PROC'"%4NUMBER(s) PERMIT EXPIRATION ATE
1. der le Environmental Conservation Law ECL)
(
TYPE OF PERMIT lCheck All Applicable Boxes)
®New ❑Renewal ❑Modification ❑Permit to Construct ❑Perm it to Operate
Article
Protection�of Title
Wa Water � SPDES 17, Titles 7, 8: Article 27, Tie 9F7 Haz'a dos Waste 6NYCRR�Management 3
Article .15, Title 15: Article 19: Article 34:
Water Supply Air Pollution Control Coastal Erosion Management
Article 15, Title 15: Article 23, Title 27: Article 36:
Water Transport Mined Land Reclamation Floodplain Management
Article
15. Title 15:
1ic
Freshwater tshwa r Wetlands 6NYCRR Ra
diation
Long Island Wells Control
Article 15, Title 27: Article 25: Other:
Wild, Scenic and Recreational Tidal Wetlands
Rivers. Article 27, Title 7; 6NYCRR 360:
6NYCRR 608: Solid Waste Management
Water Quality Certification
PERMIT ISSUED TO TELEPHONE NUMBER
�'� i✓v dui �� ( I33 V -579. 0
ADDRESS OF PERMITTE
CONTACT PERSON FOR PERMITTED WORK f f TELEPHONE NUMBER
NAME AND ADDRESS O PROIECTiFACILITY
r7a e 'Pf a /Os,-e_
LOCATION OF PROTECT CILITY
ve7e p Xrho e
COUNTY, '0 T OVL'Nii-Ay0fQ 1dGE W Tr)E �OURSE��TLAN�NO. outi E YTM COORDINATES
DESCRIPTION OF AUTHORIZED ACTIVITY
/�f -^C�))
Place approximately /�a cubic yards of upland fill to restore eroded sections of Auaes
bluff', le 7dx,:" / d V'e 1/1i
.1e.:7k 1 •740
�oH� �n�t (mi t,!c.,,.r.,.� f's�c �`^ F� P f'e`!1' Ok �i'/�'P✓' ��d r-�C ��
wv y-k 519 0 1,4 �C C n r.e��4 c,P Ir�'/� �/i/'C'�<"_'
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance
with the ECL,all applicable regulations, the General Conditions specified(See Reverse Side)and any Special
Conditions included as part of this permit.
PERXIT ADMINISTRATOR ADDRESS Regulatory Affairs, Region. One — Bldg. 40 SUNY
Robert A. Greene Stony Brook, NY 11790-2356
AUTHORIZED SIGNATURE D TE
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