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TR-3966 GF Amend
. i TRUSTEES :,,! �� ��� SUPERVISOR John M. Bredemeyer, III,.President . �� SCOTT L. HARRIS Albert J. Krupski' Jr., Vice President W Henry P. Smith �� ® Town Hall John B. Tuthill 53095 Main Road William G. Albertson ®.� �`j°�®� P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 P Fax (516) 765-1923 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 1, 1992 Docko, Inc. P.O. Box 421 Mystic, CT 0635S i Re: Katharine Dupont Weymouth SCTM#1000-7-4-5 i Dear Mr. Neilson: The following action was taken by the Board of .Trustees at their regular meeting of April 30, 1992: Resolved that the Southold Town Board of Trustees amend permit 43966 to move 2-pile fender now installed as .well as moving. the floating dock 2 feet to the east, relocating the dock shed, and replacing the one crib with 2 piles for dock. support. All other terms and conditions of the permit are still in effect. If you have any questions, , please give us a call. Very truly yours, 77' John M. Bredemeyer, II President, Board of Trustees JMB/jmt r` MIMIANEW fir) � � /1 vA`�• �/i � �VAv S_s i�'•"� � aA f// A,.� 1pl tW"\1 �.�ro, Y . ` <.�f ;.Y f � may„ �/,Y � �yyh Y �.;, +EQ�°'�~ ,; Y.::� �»r?�Y '�v\mQ�P7" +••,'�Y ` p� i d <V) ;tip 1Vv .\"t`'�is `` �•• � \\'\.S,�,i, :: �y� �Vl.. ` `V� � , � Board Of Southold Town Trustees 2 ! r �i SOUTHOLD, NEW YORK r PERMIT NO. .........3.9.Gb................ DATE: ..Aec.'.....13...,....1991 !E , ,.; ISSUED TO . .............. '' •�i Ili }yp ,�11if � ttftQ1T ; 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 i4 State of New York 1952• and the Southold Town Ordinance en- titled REGULATING AND THE PLACING OF OBSTRUCTIONS v r ! 11 IN AND ON TOWN WATERS AND PUBLIC* LANDS and the a� REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER ` OWN WATERS;" and in !accordance with the >' Resolution of The Board adopted at a meeting held on ...D.e.c.......1.2..... 19......9.1, and in consideration of the sum of ....50...00.......... paid byL� gal s of .............................. .................... N. Y. and subject to the ,. Terms and Conditions listed on the reverse side hereof, r: of Southold Town Trustees authorizes and permits the following: I" ` Grandfather Permit for dock as on application and survey dated October 31., 1991 A Docko, Inc. West Harbor, F.I. i1+4 r,t M '4. all in accordance with the detailed specifications as presented in � . i .. the originating application. c ze IN WITNESS WHEREOF The said Board of Trustees here- 1; 6y causes its Coroorate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. ' �Wh ti 5 0 ... fj ti [flSZ' .. d .............`.. .. ......... •.,\ ,:� 1. •� � f'� ,: b .................................. .......•........................................ ,4 ! >� Trusteesi ,A1 � .r�;.•:a��i.•� � r�. •��.t"•�.'rs�;x rJL!..!�� + '���i,r:G,i�:.:w:"iaT�a;,a;•'rr �x�, 5r r�r� v� n, v �y. f �$`^ JT\ �� rr� /!� va //\ '•, � /a y/,�\,' / rr�; ., //.� fir•�\4 /��`t .Qw, j��t> o,q ► ^ \t G A 3 styes,`\Y nL1 r i �ah\� A =" b �n��� �� ,.. � .:fi�bu;�\•.�. /JJ�.,\�`''V� r�'rih,' �tiC• x`'•' .yam,•.7�j3�-• r \.• C'2i�:q� �e .;,-1 � '�-ate" ••`'�'• Docko, Inc. P.O. Box 421, Mystic, CT 06355 (203) 572-8939 Fax: (203) 572-7569 May 13,' 1992 , ` 92 Mr. John Bredemeyer III, President Southold Board of Trustees PO Box 1179 � ��� Southold, NY 11971 Re: Weymouth Permit #3966 Final Dock Shed Location Dear Mr. Bredemeyer: Transmitted herewith is a copy of the final location plan of the dock shed at the Weymouth's dock on Fishers Island. I trust that you will find this in conformance with SCTM#1000-7-4-5; please let me know if there is need for any further discussion. Yours truly, DOCKO, INC. J-4�� Keith B. Neilson, PE Enclosures cc duPont, Weymouth Chuck Hamilton, DEC File 90-08-218 TRUSTEES John M.Bredemeyer,III,President c µ SUPERVISOR Henry P. Smith,Vice President A :a SCOTT L.HARRIS Albert J.Krupski,Jr. John L.Bednoski,Jr. '�1®1 �.�� 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 December 16, 1991 keith Neilson Docko, Inc. RD2 Box 420A Stafford St. Mystic, CT 06355 RE: Applications on Fishers Island Dear Mr. Neilson: The following action was taken by the Southold Town Board of Trustees on Thursday, December 12, 1991: RESOLVED that the Southold Town Board of Trustees grants Grandfather approvals for the following applications: Hay Harbor Club Katharine Dupont Patterson Property Parsons Property Enclosed please find individual permits for the above mentioned properties. If you have any questions, please do not hesitate to contact this office. .5�4ncerely, John M. Bredemeyer, III President, Board of Trustees JMB:jmt DoCKrfoUSE F��TT/�VG /x+x jOPOF PrLEs -,f'A&oV6_DFcK. Su PP�P/CFS •, / MP �, FF A 25'/rOP of )U_ - 2/-1 -MAJU C-wsTrNG NEW P-AIL, fir/ E�o MNw+8L 2p • OM SLA/M6AI"5 - — n�' — — �wy>>> —c t!�C�/�•i`EP49CE c7ooAARs6 SAA/D,6#2s+✓Ec - ' ►NiTH �55() Coi_a\bC_65 A-rV0 bOUL062s IV6d46A/7E�2 f/CAS we5r hq'4p8op_ U PILE T. �, AFRN/MArE Ti UA L 2on16 !y 3-PILE -•-i 9 - �-MEvI pe-OFF 'pm NR a NEW C►✓4 L T/OIQ t. a go E1C/ST%Nfo �(' -- P WX 22' F-OAT' O/> �;� Top of SLGPC- gm SH&D _ CA/vD/�va mdF RELOCATED Feivp-=P- `-- F�NDER.S(7y'P) �I M1 AjEW db 5-PILE PCLP14INS �,,. Ie o--Ky S NOP-E FRONT' T rO iee-A4A I" MNwFL TS - M W Et-0.0 f )SAWS SC) Pt.E f; 54 20 1 /-fA]'CH &XlZ /ram FILE /Nj6211At5/(!doJF/GL/RATIoN ANO /-fb/GHr Sur' fJ.5L� A)Aj] D PA-ES /fit uEU OF SP-AC/A.1d. PROJECT: aOCK196VErM ENr /2C-C'ON Sp_UCT/W f�xvsEp 4 23.92 5 ��7' LOCATION: �/SNEIe5 /SL.AN0j/oW1V �SoU7/•�O( 0 FeN� �Ce��2Euo�,�rcr.oAT�n/� SuFFoLk/CouNrYl NEW Yo�2JC NE �i %�'YEIT'y T, LoCAPOA))VC)Ck :bHETa WATERWAY: WIEST /-7A�/30jZ• DATE: OG 8sp- gl1� /"79/ APPLICANT: MY-IA,Q/NG Neym 1 OC �f. k0 4 z _ f 9 � • LU Lu AGENT- SHEET 'Z OF ' G DOCKO, INC. r� t` 68692.'\ KEITF{ B. NEIL.SON, P.E. oFESS10�P P.O. BOX 421, MYSTIC, CT 06355 203 572 8939 FAX 572 7569 r.. Docko, Inc. P.O. Box 421, Mystic, CT 06355 (203) 572-8939 Fax: (203) 572-7569 -4i I --------- April 24, 1992 m PY 1 5 1992 Ms. Christine Costopoulos NYS DEC, Regulatory Affairs Building 40, SUNY � d'� �� � � Stony Brook, NY 11790-2356 Re: duPont Property, Fishers Is. Revetment Reconstruction Permit Application No. 1-4738-00426/00002 Dear Ms. Costopoulos: On behalf of our client, we request a Tidal Wetlands Permit including Water Quality Certifications, as necessary, for reconstruction of a shore protection revetment destroyed by Hurricane "BOB" and subsequent storms at the .duPont property on Fishers Island, New York. We enclose the following in support of this permit application: - Four prints of application drawings titled: Project: "Revetment Reconstruction" Waterway: West Harbor Location: Fishers Island, Town of Southold Suffolk County, New York Applicant: Katharine duPont .Weymouth Date: October 31, 1991, Revised April 1992 - Four copies of the DEC Joint Application, including the Short Environmental Assessment Form, SAAF, site photographs, Tax Assessor's Map and location plan. Pursuant to instructions of Mr. Thurber of your office, we have separated the revetment reconstruction from the dock word to expedite processing that application.I trust that you will find this application package complete and acceptable; please let me know if the need for further information arises. Very truly yours, Keith B. Neilson, PE Enclosures cc:duPont/Weymouth J' aggerty, CE ohn Bredemeyer, Town of Southold rile. i oor— wrD- ovil John Clavin, Fishers Island Harbor Master Tom Law/Sandy McGugan File 91-08-238 \•19-3(8/89)-7e _ DEC APPLICATION NUMBER NEW YORK STATE DEPARTMENT OF El )NMENTAL CONSERVATION 1-473E 1426 00002 JOINT APPLICATION FOR PERMIT u.S.ARMY c .,. OF ENGINEERS APPLICATION NO. 'Wr/ 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,ARTICLE 43 6NYCRR 646(LAKE GEORGE RECREATION ZONE) ❑ARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) ❑6NYCRR 327(AQUATIC VEGETATION) ❑6NYCRR 328(FISH) ❑6NYCRR 329(INSECTS) 3 ❑ARTICLE 15,TITLE 5 6NYCRR 608(PROTECTION OF WATERS) T ❑For the construction,reconstruction,or repair of a DAM or other impoundment structure. A T ❑For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS. 401 WATER QUALITY CERTIFICATION E ❑ARTICLE 15,TITLE 15 ❑6NYCRR 601 (WATER SUPPLY) ❑6NYCRR 602(LONG ISLAND WELL) ❑ARTICLE 15,TITLE 27 6NYCRR 666(WILD,SCENIC AND RECREATIONAL RIVERS) ❑ARTICLE 24 6NYCRR 662,663(FRESHWATER WETLANDS) ®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 AIAN Owner ❑Operator El Lessee ❑Municipality/Governmental Agency (Check as many as apply) 3. NAME OF APPLICANT(Use Full Name) Mrs. Katharine Weymouth MAILING ADDRESS TELEPHONE(Where can be reached during day) Grey Gull Partnership, A-102 Greenville Center (516) 788-7528 POST OFFICE STATE ZIP CODE Wilmington �t�-1I DE 19899 4. NAME OF ❑Owner �J Agent/Contact Person (Check one) Docko Inc. Keith B. Neilson PE MAILING ADDRESS TELEPHONE(Where can be reached during day) P.O. Box 421 (203) 572-8939 POST OFFICE STATE ZIP CODE M stic I CT 106355 5. PROJECT/FACILITY LOCATION(Mark location on map,see Number 1a on reverse side) County Suffolk I Town or city Southold I Village Fishers Island STREET ADDRESS(If different from applicant) Private Road POST OFFICE STATE ZIP CODE Fishers Island INY 06390 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, include dates. B. WILL PROJECT UTILIZE STATE LAND? El Yes nNo Show work on map and/or drawings. El Yes ®No 9. PROPOSED USE: ® Private 10. PROPOSED STARTING DATE: 11. APPROXIMATE COMPLETION DATE: 1 12. FEE OF(NYS Permit Only) ❑ Public ❑ Commercial May 1992 June 1992 $ 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.)Reconstruct a shore protection revetment severely damaged by Hurricane "BOB" consisting of 550 ± CY of stone and fill replacement and regrading of an area of 3,000 ± SF landward of the High Tide Line but adjacent to the tidal zone. 14. WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL,STATE AND/OR LOCAL PERMITS? ® Yes ❑ No If yes,please list: US Army Corps of Engineers Nationwide General Permit Southold Board of Trustees Coastal Erosion and Tidal Wetlands Permits 15. CERTIFICATION: 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 for asa more than$10,000 or imprisonment for not more than five years,or both, where an applicant knowingly and willfully falsifies,conceals,or cover1 fact;or knowingly makes or uses a false,fictitous or fraudulent statement. ®1 hereby authorize the agent named in Number 4 e t s bati on my behalf. ^� ��Z DATE TITLE PLEASE AAD ALL INSTRUCTIONS ON REVERSE SIDE PERMIT ADMINISTRATOR FI Jw BEE ;'42 28 p s - N"2" 8 R-Y'. 39 C. (. 19. /49 hid I'Vt - 5 f /8 12 'Rksg 33,.(1835ourh� 's fa H mmock `c'1" �6_`�,"':'y,`H�k,'i��i l l S__e*duY"we�;..„►,5���t�j�N sY�D-ruB.c�m.�3�iopn 13 t•:-3 �10 +K ii'tC`Ry�-✓/�lo k:8 5 �� PuJ 3 {k*u 1 4 R12 Ird 21N.4 Iti •may `�fJ_ ._`A-�.1—_— �0p 30 2 N'hh` 24 / 39 39 R C' 41 N 19 14 /g 13 hrd sN 16 13 S /17 16w HawkMest P • LRl/•. vAYo il/aO/ys .l y25llA._J f)C/4F A w, a Ye 5 90 srY � 0Rk r 'mf�NY 1 ter; 5�0 m Mol U. g< -i Fles: 41 LOCATION! MAP .eaf.'C•4"T 12 57 Z SIC. ISM �l-�c�ec ieao o YARDSp�C -7*pN NIP, Fpeo>aeTy of CREY GLILL5 FAqAeEs"AP �,, EtEv�4 jion! DAB uM /s /�C.�+/ �► ,Azwe PuFot4r 2, OUrH /DAC_ 1-).4TA /5 A A�6" FROAA A-10°r` �� 1t�Ey GeS52 7HE 1771 NOAA ;DE TA86=9 S. �a'.l� WILM IGTO )DS C 1 3. DaSGR/PrlOnl: kr'e+-C,O�NS'�e1Cj7CY�i Wre.MlnlGJ'o�1�JaG 19899 Racav5Tpuc_r ISat/-GF or N / 9Fj'ln//DE F/X&aWooD PiLGAt4D • 7'IMBEi2 r-c=I/NCLU0tNG EECON- SrR1JCT/ON OF ONE Gil/6 I// 5 ALL 1=0u�2 NEW D FC1�/4T/NG Dcar— 5 PAD SNEE" H E�2 S IeT �/LA 5 /4N *1 NE IN J TIE-OFF P/LES. l2,EC,_>N5 RUCTT A 5H09E F)ZoTEcTionl �eEv 70A"i ISLAND c0g3ISTING OF SSo t/-Cy /.1C A"D ILL R6PLAGEM ENT •��• • hECjI�ApINC� OVER, AN fLRA OF ItNIF Fko�Ty OF WO t/- �c AWACE/V O 774CADAL ZoNE .MUND CAZf-N PoP5ox R/RPOSE: 7RE5E WA,7r_-1eAQv Rov"Gy SQUAEE r}q /44PRoVISMIENT3 •42E 90A AelVA7E WotmiNG,ON ne Qi ,2ECR4470NAL. USE- 19899 suJevey..FoR. Peemir Ftm-poSe-S • �' 0"Ly; / IS NOT A CONsTP-eJGT/oN Sc�cE 1" 2oc' COnrT�T ZOCtJNGHr. 2m /oa o on PROJECT: 0QCr_/IeE✓ETME/vr IeECoN3rIeCaC 11 ,ecwI 4.25.'2 ;DEC LOCATION: s/��K C�`NDJ TD ENl OF sO1J {OLD U OU y A� W YOPM WATERWAY: W/l f'I.QPJ3©R.. O:v DATE: 6C� rM C APPLICANT: K/4Tk Ai2/NE �Y OUTH .�O kO• AGENT- SHEET r OF �p v� DOCKO, INC. r F� o �8692� KEITH B. NEILSON.P.E. �a�O�GSSICN��� P.O. BOX 421,MYSTIC, CT06355 RpO 203 572 8939 FAX 572 7569 # DoCKI JOUgE F���/rV 6 /fix roPOF PmES -4'A/3oV6 D6ce_ SuP c��eey�-'Pi[F5 77�-oFFs. TOPoF D6CId -MAR-1 6wSjinJG j2AM P FENDSP-S f Na-W 2aIL N1LW EGO MNW B6 2•� N c--�3s,, �prll S ED/M611{� •< '', ' �� - �C�/B•i`EP[.ACE p CA+36L+&5 A-VV /3ou1.0EQs Ale/3aTfr=R_f/C,&S M55r H AP_soQ_ a mop 4 ApPRoyc/Mn1E pD,4L ZoA)E y 3•PI L6 -►� / �- o r Alr=W 1'/E-OFF CwsrGR.�,►. 'pieE 'NEW L CC4 /o" E1d/SrING Q $ J4 x 22 r=LOAT' a Top of SLOPE NEW FILESRAMP d� r SKIMI I II CotA"D?Af0iS�A6 R�EM1 ie�vc.4�o �rvnEae.. lJv� I pitz 9 lyla 3.6+mac -3 PEE a/ r&15 Z_�� goc-<y sNoP_EFR0Nr MMW E6 .8 - M &D SA��1seso �ILE FL4/ V R 30 20 /O o Sal VArcI4 E)Cla7,/N5 PLE /Nj6ej(44.5,CAnIFi5UJ A loN AA/0 i4aezHr iSur WE PbA176"D PX.GS /At UEU OF sP-AGMC3. �X,CD SIC. PROJECT: Doc.Kg12EvET/NC-Nr pE-c�IS�uCTlA+�1 ) l/rSED Q•23.92 r7i5'am-1, LOCATION: =ml4EJzg /SLA/VD/TbWA1 OF SoU7}40LO SuFFol k Couoyry) NEW Yopax P 1!V ��-� 1, r", r)ocr- LoCA WATERWAY: O'fE ST /4Ai OOM DATE: OG Of3� 5l, /I99/ 'F `'` �= =t; APPLICANT: g; /-1A,2/NG YyEy/1r� O �1'-t,, 3 L I r; AGENT- SHEET 2 OF DOCKO, INC. � �A\06869 2-� � d KEITH B.NEIISON,P.E.v . P.O. BOX 421,MYSTIC, CT 06355 RPO 203 572 8939 FAX 572 7569 ��w77 VETM C-A/ PROPOSEa W02e-- o26C®n/sTP,UC f/C)Al 5140P-E FP-07w,770N Z-- �sc�rE�aT�c -n/o scs�) REVE/'a+EAjT�.� 56E 7JE le-&0 PeAAf 4AID /QieE-ST02M SECT/oIVS olV SHEETS s �Co. CO�VI�ITioN ''l"Cb2 S/.E g c�1E 1 \ CGA/di7/On1S H/GN /OE C:/NE AIEW TOE of rHE F/C.C. WILL bE :5ALVAGAD ,eeve7rrMar,/T \ , /,�//�� /�I sEmatj yt,1 MAjam P-/a C.5 bF TN G BEACH f-32OTECTE D �3Y 6c}kGC2. SAG(/AGED "Am14 LAVE VcP4E. A� C IMPOR_r ED o T�eEEs �'A1125 •CXIsp&JG (2120urex \ IBCIBC \�. $7t"E V4A LL ill � • �� /tee-Fi4/�2.. h EscAre,,a►�/EnIT o .y�4/yAG6� avr=7MENr d��• f3Y t^/AVES ESQ v ,4A L 1. NIAS.NOuTs Aral D • ' e�ss/orals �qw/v 1 7-0 R6 RE F1L-ED see sHesr 4: /l PAN y/E!N I ° r- ssiays s«1H NAe-l= �I SG.M.E /":.SO, � e � :r,�+••F"+. MNCN GIniE e AAP2ow/n.°A� TD/.�L 20 E PROJECT: ;1QEVeTME,NT'/eECLVV$rk-uGT/dV LOCATION: FISHERS /S LAND)rONN OF SO up4az 5UFicO[K GDUN]y, NEW �/0ZX WATERWAY: W65 l-lAR45OR. O 2 3 I 199/ >c APPLICANT: K,A l4� AI`6 4e_YA4Cxjr l Ck AGENT- SHEET OF • DOCKO INC. KETTH B. NEILSON.P.E. A P.O. BOX 421, MYSTIC, CT 06355 203 572 8939 FAX 572 7569 ------------------- G � � 'Pie m -- .�to MLwL -� �� � T3RIce5 L>--- BW5 C.eawnF QGVET ��T AIR- vErA�W 7-D -8E 57 ,2=5T'OR"D ( o P2E-gTo2M C-"E (e>c7 6".5ICAJ bF �OCk WALL •7-0 FOP of 5TAiP-WAy) R(=-Z oee To CA DE saAce / 20, ��- ,OE372eE CA-wN 4A1,D REV MENj Va�" \Va VH a "✓N yn Ui. 7b PRr E-Vo" C 0l0j V/r0 A/5 o O ,�E. 'o�E Wi7H Lim sT'pwlG-S C ,c �EM►4M/�/�!G Ex�ST/n�ca P64GE Fl(-P R r-AepJC. / ` �EVETMCNT �fZ SCACs2 1�201'C��1 � � ����• Ouj' AS NGCC-tSA9Y ]'O EN!!eA 70E. Z©s oAi 2C1-(4a/6. 1TY�7/� ` 2 1 O Z PROJECT: REY //IiJEA�r 1eeHar5lL1TA17dV LOCATION: fl&HEe3 f-SCAA D Tow" of goup4o[.> $f1pFbCk COUR./7y) /JE►1/ YWr— ;. �.,. WATERWAY: WEST HAP.BGI�L DATE: AFIe/C. E 8� 199 Z APPLICANT: wEYMOc'7W OC I AGENT- SHEET Q OF (, DOCKO, INC. r� N, <d ` KEITI-I B. NEIISON,P.E. 'O F.: S1; 1:w P.O. BOX 421.MYSTIC, CT 06355 vRp 203 572 8939 FAX 572 7569 Dw5 1.,y, -08- 2 sa.o t `i. v /E 5F HAP- 0P-- � s Ald roNE�'` Da .....: *::... Q �..::... ...................... .................................. ::::::::::::::::::: :: ............................... N .,.. :.. ON.WOW `' a ''►. :. : D :: .. ::..... .G. � ` ` . CAWS! .::::: ::::::::::::.::..:.... :::::::::::::::::: :::::::: :::::: ::: : c N v ...:::.:. ........... .... PROJECT: )P--✓&7'Ml5Alr )2EHA;5ILlrA,7ONJ LOCATION: ,CisrfE�25 /sCAIJO��'bWn! OP �pvTNoLD 2uFFoLe coutirry) Nel you y WATERWAY: Y 65r]' HARR0R- '�• DATE: APtZ#L 23� 1992 - 9 APPLICANT: k5Ar44P-"G Nl6yA40 ,7H �OCc`O AGENT- SHEET OF , U of DOCKO, INC. y ,.� %J KEITH B. NEIISON,P.E. `•'�C: r•o r C1` P.O. BOX 421, MYSTIC, CT 06355 RPO 203 572 8939 FAX 572 7569 7 og-038.05 ----------------- C/,,-/o�j Lac L-. 1B P-1 cr-s :S&C7�OAJ f T iz SCFC/770�J,3 SCE / Z- Aojr.> :S L OA) upjb N 14fA#--'Z AJM Ala-- c-7,4 le- %A"(-0 W kt^jMM- -/,c ICA e.) -Cell�'- PROJECT: Revg 15a' REP45/07 IoN se '�T LOCATION: ptsm=" 7tP%oV"6ir OUNMD ZUM=Oc.0 COUA4YINCVVyoeg.L WATERWAY:W&ST HAZ80Z DATE: AAe 7 7 9 APPLICANT: 9AMARAJ& We?eMotfN oc 0. JI AGENT- SHEET OF DOCKO, INC. 0-, KEITH B.NEILSON,P.E. P.O.BOX 421,MYSTIC, CT 06355 %-Ov 203 572 8939 FAX 572 7569 14-16.4(2/87)—Text 12 PROJECT I.D. NUMBER 617.21 SEQR 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 Mrs. Katharine duPont Weymouth Revetment Reconstruction 3. PROJECT LOCATION: Municipality Fishers Island Town of Southold County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks,etc.,or provide map) The project site is in West Harbor on Fishers Island. The property is accessed by a private road (no name) as shown on the attached Tax Assessor's map. 5. IS PROPOSED ACTION: �yy ❑New El Expansion IN Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Reconstruct a shore protection revetment severely damaged by Hurricane "BOB" consisting of 550 ± CY of stone and fill replacement and regrading of. an area of 3,000 ± SF land- ward of the High Tide Line but adjacent to the tidal zone. 7. AMOUNT OF LAND AFFECTED: Initially 1 i10 ± acres Ultimately N/A acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? L Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 129 Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other Describe: The property at the dock site and surrouding properties are characteristically single family residential. 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL. STATE OR LOCAL)? F1 Yes ❑No If yes, list agency(s)and permit/approvals US Army Corps of Engineers, Nationwide General Permit, Southold Board. of Trustees, Coastal Erosion and Tidal Wetlands permits. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E3Yes ❑No If yes, list agency name and permit/approval The existing structures pre-exist current State and Town permit programs and were "Grandfathered" by the US Army Corps of Engineers in 1968. 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes IN No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Mrs Katharine duPont We O h �']A,� Qz Date: '� ` _ k L") Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II—ENVIRONMENTAL ASSESSMENT (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. ❑Yes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic 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: C4. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land or other natural resources?Explain briefly. C5. Growth,subsequent development,or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative,or other effects not identified in C1-05? Explain briefly. C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes, explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency 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 2 95-20-7('10/90) New York State Department of Environmental Conservation Supplement to Application for Permit STRUCTURAL-ARCHEOLOGICAL ASSESSMENT FORM (SAAF) PART I - APPLICANT COMPLETES Applicant Information 1 . Applicant Name Mrs. Katharine duPont Weymouth 2. Applicant Address c/o Reynolds duPont, Jr. P.O. Box 365, Fishers Island, NY 06390 Project Information 3. Project/Facility Name Dock/Revetment Reconstruction 4. Project/Facility Location West Harbor, Fishers Island, NY 5. Is the proposed project adjacent to, or does it contain a building or structure listed in the State or National Register of Historic Places? Yes No x 6. Are there any buildings or structures built prior to 1940 adjacent to or within the proposed project area? Yes No x If the answer to question 5 and/or 6 is yes, provide the following information for each building and structure (use attachments if necessary) : a. name of structure b. location c. type of structure (ex: house, outbuilding, barn, bridge, dam, ruins) d. approximate age or date of construction 7. Might the proposed project have any impact (physical/visual ) upon any buildings or structures listed in the State or National Register of Historic Places or built prior to 1940? Yes No x If yes, describe briefly (use attachments if necessary) : r 8. Provide photographs of every building and structure that may be impacted by the project as described in number 7, above. The following standards are recommended: o minimum of two photographs o minimum size 4" x 4" prints from negatives preferred; polaroid photos are acceptable o photos must be clear and focused o clearly label photos so it is obvious what is being illustrated; key photos to map or plan, if possible o photo 1: show both the entire front and side of the structure in a single shot from as close to the building as possible. Be sure the structure is not partially or fully blocked by trees or other obstructions o photo 2: show relationship of building or structure to roadway or surroundings 9. Has the land within the proposed project area been previously disturbed or altered (excavated, landscaped, filled, utilities installed)? Yes x No If yes, describe briefly, including depth of disturbance (use attachments if necessary) : See attached application drawings; this project is the reconstruction of an existing dock and revetment in the same dimensions and basic configuration. 10. Approximate percentage of proposed project area with slopes: 0-10% % 10-15% % 15% or greater % 11. Approximate percentage of proposed project site-with the following drainage characteristics: Not applicable; the dock site is underwater. well drained % moderately we rained % poorly drained % Prepared by I K,',nUC., Keith B. Neilson, P.E. Date October 30, 1991 SAAFI.LK/G 10/90 Katharine Weymouth 91-08-238 October 30, 1991 STRUCTURAL-ARCHEOLOGICAL ASSESSMENT FORM (SAAF) PART 2 - DEPARTMENT OF ENVIRONMENTAL CONSERVATION (DEC) COMPLETES Applicant/Project Information 1 . Applicant Name Mrs. Katharine duPont Weymouth 2. Project/Facility Name Dock/Revetment Reconstruction 3. DEC Number Buildings and Structures 4. Might the proposed project have any impact (physical/visual) upon any buildings or structures listed in the State or National Register of Historic Places or built prior to 1940? Yes No If .yes, DEC must consult with the Office of Parks, Recreation and Historic Preservation (OPRHP) . The DEC must request a determination of eligibility for the State Register of Historic Places and/or comments regarding project impact. Include information supplied by the applicant in response to questions 5, 6, 7 and 8 of Part 1 of this form. Archeological Sites 5. Does the proposed project area coincide with a circle, square or stippled area on OPRHP's Statewide Archeological Inventory Map? Yes No 6. Is the proposed project area outside of a circle or square, but one for which information has been provided (ex: documented reports of known sites) that suggests the area is archeologically sensitive? Yes No If yes, what is the nature and source of information? 7. Is the proposed project area apparently undisturbed? Yes No 8. Will the proposed action include a physical disturbance of the project area? Yes No 9. Is the slope in the area characteristically less than 15% (unless on limestone/flint escarpments)? Yes No 10. Is the proposed project area characteristically moderately well or well drained? Yes No If the answers to 5, 7-10 are yes, an archeological survey should be performed by the applicant. Provide the applicant with a copy of Report Format for Cultural Resource Investigations and list of archeological consultants. If the answers to 6-10 are yes, DEC must consult with OPRHP before requiring that the applicant perform an archeological survey. Results of Evaluation No buildings, structures or archeological sites identified -at the project location (SHPA-1) Buildings, structures or archeological sites identified, but no impacts will occur, no survey required. No further cultural resources review required (SHPA-2) Consultation by DEC with OPRHP required structures archeology Archeological survey required Prepared by Date SAAF2.LK/G 10/90 3- TAX ASSESSOR'S MAP Project: DOCK/REVETMENT RECONSTRUCTION T' Project tjc Location: FISHERS ISLAND, NEW YORK ='• ;/ ,' \>z -a- Waterway Waterway: WEST HARBOR 7 - AApplicant:Jc_ pl a OCTOBER 31, 1991 Applicant: KATHERINE duPONT WEYMOUTH Date: Agent: t. TAX DOCKO, INC. (D ct�l 1-2 1':. 6 A 6 to scr sEc No, No FOR P—EL 10- legend SOUTHOLD c— COUNTY OF SUFFOLK Service Agency MU 1000 Reol Property Tax Ser 007 . C...ty A Center q;—b—d.I I,N.-Y.,k PROPERTY MAP xatnerine weymoutn 91-08-238 0 pa4es991 Rev. April 23, 1992 APPLICATION CHECKLIST NOTE: APPLICATION MUST INCLUDE: X 1. STANDARD FORMS - Appropriate Application for Permit. Short Environmental Assessment Form, Structural Assessment Form. NOTE: For all projects requiring Wild, Scenic & Recreational Rivers Permits and for commercial, industrial or multi-residential pro- jects, submit a long Environmental Assessment Form. $200 2. APPLICATION FEE: Refer to enclosed fee schedule $10.00 minimum, Check or Money Order payable to NYS DEC. You will be notified of additional fees, if any. X 3. Authorization letter from the owner where the applicant is not the owner. See Joint Application Form X 4. Staking and labeling of the seaward/wetland side of the proposed structure or fill area. X 5. Photographs of the staked project area mounted on a separate and labeled page. X 6. County Tax Map Numbers: Photo of Tax Bill will suffice. Suffolk: Dist. Sect. Blk. Lot Nassau: Sect. Blk. Subblock Lot X 7. Project Plans (four copies) - Plans must clearly show the pro- posed project and include all appropriate dimensions, elevations and must be at a scale of 1" to 100 ' or larger. X 8. Address of project location ( if vacant land; telephone pole # or other identifying landmark) . MINIMUM PLAN REQUIREMENTS (FOUR COPIES REQUIRED) PROJECT: Alterations and/or Extensions 1, 3, 5, 6, 7, & 8 New House Construction 1, 3, 5, 6, 7, & 8 Accessory Structures 1, 3, 5, & 6 Repairs to Existing Structures 2, 3, & 4 Dredging 2, 3, 4, 5, & 6 * Catwalks and Docks 2, 3, 4, & 5 Subdivisions 1, 2, 3, 5, & 6 Bulkheads 1, 2, 3, 4, 5, 6, 9, & 10 Groins and Jetties 2, 3, 4, 5, 9, & 10 Filling 1, 4, 5, & 6 KEY: 1. Stamped Sealed Survey * 2. Plot Plan * 3. Location Map * 4. Sectional View * 5. Wetland Line or Mean High Water, as appropriate 6. Fill and Clearcut Area 7. Sanitary System Location 8. Test Hole and Data 9. Profile View 10. Distances from fixed structures NOTE: IF YOU WISH CONFIRMATION OF RECEIPT OF YOUR APPLICATION, PLEASE SUBMIT A SELF-ADDRESSED, STAMPED POSTCARD. NOTE: THE PERMIT PROCESS TAKES AT LEAST EIGHT (8) WEEKS. i / j J4. "dr •i„•YT3�-�L'37J.� �fly �' �_ �� r r /� + • t• � J + 7»/ �I�` � tiT I � }.i ,Z.Cy j..r..ra•t-i,R�yTf� � _ �, ,>�\ 4 �,,p�/�/jl:{r r r 1�, i•►.i i fry-�S o-�, �'� ! � � - .�,. h f' 'C4•�.4 ` - ,F*�r^��-fir f?.,ty >� It jr { M,j_1? r�, F r b •N.h 5. ' i J,�,.• i + it J,^ .1 , + Y 7jiaNR jeTj 14- rT '°fic ��3 '.,�+11,ice..- ' �r�s•� —e'-�-•-- .,. .��,�_� i�r•' «. i . Mh ---�"y'' Y_-yam y,.{-,.yr_, _ •,� / '�,I�--�-t�qy^^� `'� � ..� ..-._-� ��. _�.... - --'�`� "..:`` �;,,r�.,,r��' .�3.� s•�� �:. �r. -. �... � ..,.,w --may. .-._ "'ter-r-.• '�li'"'�'1�,� �. �-�.. l� `d�'��+e�� .,� '-"�' 4 � �, ' � �� - �-i ��_ _-` •.?fir�' r Ir,'` I I Qi cr I � I i Docko, Inc. RD2 Box 420A,Stafford . -.iY ir•M1:.. ABOVE: Southerly revetment looking north toward the grouted stone wall and dock beyond, showing revetment backfill failure and loss of materials. a� :EI • • - up view of the same stretch of the revetment and the size and extent of the void left by the erosive forces of two storms; October '91 �,. *fir. / � ..�2� Py g �• 'a.• - - ' i ;•t i\.;; '` '�'-�". 1 �lei.. �a•tb��\'�' '^Yv�. v;. • t n � � t t "" �s.}pT -. } �✓ �}�� „tit' 4('1.3' ;'� -'4:-/•"' ` ', 1% - . [ 1 •� it r`y'� S �'$� `rgf --"'ti ,r�1. t--rr. 'S\;, - _�__.... ._ • .`� sue. ...f•:.;r-.•Lidut-,.;:- 7 • _ ` t�-x�^u` _ ,� r� :�%":,ram,, ti. , � J Rem• - �t 'v..��� 1�t Docko, Inc. P.O. Box 421, Mystic, CT 06355 (203) 572-8939 Fax: (203) 572-7569 c .April 23, 1992 ( i ApR 2 g 19�92 Mr. John Bredemeyer, President SOUIVI LID Southold Board of Trustees PO Box 728 Southold, NY 11971 Re: duPont Property, Fishers Island Dock Permit Modification Dear Mr. Bredemeyer: The reconstruction of the fixed wood dock at the property of Ms. Katharine duPont Weymouth in West Harbor on Fishers Island is just about complete. This past week we were asked to move a 2-pile fender now installed at the location shown on the attached plans as well as moving the floating dock 2 feet east, relocating the dock shed, and replacing the one crib with 2 piles for dock support. Ms. Thorpe of your office advised me that a permit modification would be required, accordingly, I hereby request this modification on behalf of Ms. Weymouth. Attached is a check in the amount of $35. I trust that you will find this request acceptable; please let me know if the need for more information arises. Yours truly, DOCK C. Keith B. Neilson, PE Enclosures ® cc duPont/Weymouth Jim Haggerty Christine Costopoulos, DEC F 1e 91 John Clain vin, Fishers Island Harbor Master f. wf 'rl 1 :'.�. �' ll I + IA. I t 1` ` { 17.: -I' 1• SI I.t. I 7 1 f� 111 j !,`` t h.I {1{f� I } {�Iq i Ei. ....., � .,_" .. i, _:; i.•: !l...,.L t.i ....�: ! ,'.:i ,..i � .I '.f._. "' :i•Ih ' ' l ,;ai Ii � .� ]I �.Y'r a Docko, Inc. P.O. Box 421, Mystic, CT 06355 (203) 572-8939 Fax: (203) 572-7569 December 21, 1991 Ms. Jill Thorpe Southold Board of Trustees P.O. Box 728 Southold, NY 11971 Re: Permit No. 3966 duPont Docl, Reconstruction Dear Ms. Thorpe: Transmitted herewith, for your record, is a copy of the duPont's permit for dock reconstruction which I modified pursuant to our conversation last week. Your assistance, as always, is apprciated. Yours truly, DOCKO, INC. Keith B. Neilson, PE l t Docko, Inc. RD2 Box 420A, Stafford St., Mystic, CT 06355 (203)572-8939 0WR � IV 2 6 f 991 Mr. John Bredemeyer, President October 31, PO Box 728ard of Trustees TOWN OF SOUTHOL© Southold, NY 11971 Re: duPont Property, Fishers Island Dock Reconstruction Permit Dear Mr. Bredemeyer: On behalf of our client, we request a "Grandfather" Permit for the reconstruction of an existing fixed wood dock and stone revetment, damaged by Hurricane "BOB", on the duPont property on Fishers Island. We enclose the following documents in support of this permit application: - Two prints of application drawings titled: Dock/Revetment Reconstruction" In: West Harbor At: Fishers Island, Town of Southold Suffolk County, New York Applicant: Katharine duPont Weymouth Date: October 31, 1991 - Two copies of the Southold Board of Trustees "Grandfather" application, Corps and DEC applications, Tax Assessor's Map and location map. I trust that you will find this application package complete and acceptable; please let me know if the need for more information arises. Yours truly, Docko, Inc. A Keith B. Neilson, PE Enclosures cc duPont/Weymouth Jim Haggerty, CE Christine Costopoulos, DEC John Clavin, Fishers Island Harbor Master File 91-08-238 TRUSTEES r�r, SCOTT L. HARRIS a :fn � �.�`:''`xr ::5 < 1 Supervisor John M. Bredemeyer, III, President �,� Henry P. Smith, Vice President r�.•ia: a Albert J. Krupski, Jr. r i% Town Hall, 53095 Main Road John L. Bednoski, Jr. P.O. Box 1179 John B. Tuthill Southold, New York 11971 BOARD OF TOWN TRUSTEES Fax (5.1:6)= 65-1823 Telephone (516) 765-1892 TOWN OF SOUTHOLD n aT jjph�ne ( ) 765-1800 D l�r 2. 61991 GRANDFATHER APPLICATION -rA N OF SOIV OT OLD 1 . Name of Applicant• Katharine duPont Weymouth 2 . Mailing address• Grey Gull Partnership, c/o Reynolds duPont P.O. Box 365, Fishers Island, NY 06390 Tel. No• 516-788-7528 3 . Address of Property: The property is located on a private road which runs to Clay Point on West Harbor, Fishers Island 4 . Tax Map Number: 10 0 0- 007-4-5 Approx.yr.of construct 1950's orig. 5. Prior owner if known: 6. Diagram of existing structures, including all dimensions, must be included with this application: See attached application drawings and descriptive information of the dock to be built, adjoining property owners and shoreline characteristics. 7. Indicate on attached map: Location, ie; reference point, telephone pole number, adjacent property owners, etc. Signature of applicant: (-Q1,/' ?eae r ��1/e�?�J�z�t¢n Date: b �J * Please note, there is a one time fee of $50.00 for filing this application. APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB APPROVAL NO. 0702-0036 (33 CFR 325) Expires 30 Jutie 1989 The Department of the Army permit program is authorized by Section 10 of the River and*Harbor Act of 1899,Section 404 of the Clean Water Act and Section 103 of the Marine,Protection,Research and Sanctuaries Act. These laws require permits authorizing activities in or affecting navigable waters of the United States,the discharge of dredged or fill material into waters of the United States, and the transportation of dredged material for the purpose of dumping it into ocean waters. Information provided on this form will be used in evaluating the application for a permit. Information in this application is made a matter of public record through issuance of a public notice. Disclosure of the information requested is voluntary;however,the data requested are necessary in order to communicate with the applicant and to evaluate the permit application. If necessary information is not provided,the permit application cannot be processed nor can a permit be issued. One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application(see sample dmwings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned. 1.APPLICATION NUMBER (To be assigned by Corps) 3.NAME,ADDRESS,AND TITLE OF AUTHORIZED AGENT Docko, Inc., Keith B. Neilson, P.E. PO Box 421 Mystic, Ct 06355 2.NAME AND ADDRESS OF APPLICANT Telephone no,during business hours Ms. Katharine duPont Weymouth Grey Gull Partnership A/C( 1 (Residence) A-102 Greenville Center A/C Q03 ) S72 RA'AA (office) Wilmington, DE 19889 Statement of Authorisation: I hereby designate and authorize Docko. Inc. to act in my behalf as my Telephone no.during business hours agent In the processing of this permit application and to furnish,upon request. c/o Reynolds duPont, Jr. supplemental Information in support of the application. A/C( ) (Residence) SIGNATURE OF APPLICANT DATE A/C(516) 788-7528 (oma) �'FYtttnv 0 A.DETAILED DESCRIPTION OF PROPOSED ACTIVITY 4a.ACTIVITY Reconstruct 158± IMF of fixed pile supported wood dock, including recontruction of one crib, all of which was severely .damaged by Hurricane "Bob". Drive four new piles to anchor the existing 14'x 22 FT' floating dock and two new tie-off piles. Reconstruct a shore protection revetment consisting of 550 +/- CY of stone and fill replace- regrading over an area of 3,000 +/- SF adjacent to the tidal zone. 4b.PURPOSE The existing dock and proposed replacement is for private recreational boating. 4c.DISCHARGE OF DREDGED OR FILL MATERIAL Not Applicable. ENG FORM 4M, Apr 86 EDITION OF APR 82 IS 08SOLETE (Proponent: DAEN-CWO-A 3.NAMES ANO AOORESSES OF ADJOINING PROPERTY OWNERS,LESSEES,ETC.,WHOSE PROPERTY ALSO ADJOINS THE WATERWAY South: Edmund N. Carpenter II North: David S. Johnson P.O. Box 551 35 West 90th Street One Rodney Square New York, NY 10024 Wilmington, DE 19899 IL WATERSOOY AND LOCATION ON WATERSOOY WHERE ACTIVITY EXISTS OR IS PROPOSED The dock site is located along the east shore of West Harbor. 7. LOCATION ON LAND WHERE ACTIVITY EXISTS OR IS PROPOSED ADDRESS: The site. is located on a private road on Fishers Island as shown on the attached location map and assessors map. STREET,ROAD,ROUTE OR OTHER OESCRIPTIVE LOCATION 11ffc1 k NPw York COUNTY STATE ZIP CODE Tnwn of Sniit-hnl d, Bc)ar(i of TniGi-ipa LOCAL GOVERNING SOOY WITH JURISDICTION OVER SITE S.Is any portion of the activity for which authorization Is sought now complete? ❑YES NO If answer is"Yea"give reasons,month and year the activity was completed. Indicate the existing work on the drawings, The damaged dock remains in place. . 9.List all approvals or certifications and denials received from other federal.Interstate,state or Iocai agenciea for any structures,construction, discharger or other activities described In this application. ISSUING AGENCY TYPE APPROVAL IOENTIFICATION NO. DATE OF APPLICATION DATE OF APPROVAL DATE OF DENIAL NYS DEC Tidal Wetlands Pending . October 30, 1991 Pending Coastal Erosion Southold Grandfather Pending October 30, 1991 Pending 10.Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the information contained in this application,and that to the best of my knowledge and belief such information Is true,complete,and accurate. 1 further cartlfy that I pamm the authority to undertake the proposed a=ivltiea or I am eating as the duly authorized agent of the applicant. it SIGNATURE OF AOLICANt OA E SIGNATURE F AGENT OATH Docko, Inc., Keith B. Neilson,PE The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly authorized agent if the statement in Block J has been filled out and signed. 18 U.S.C.section 1001 provides that: Whoever,in any manner within the jurisdiction of any department or agency of The United States knowingly and willfully falsifies,conceals,or covers up by any trick,scheme,or device a material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false fictitious or fraudulent statement or entry,shall be fused not more than$10,000 or imprisoned not more than five years,or both. Do not send a permit processing fee with this application. The-appropriate fee will be assessed when a permit is issued, [ ! Ft , 702 ;r' m 1._n u, - 4 P> ' e RoCk 40, - ell r I:, LOCATION! MAP' Ir, - is-�.:. �•,�� y-- , , - �•�� �r , Project: DOCK/REVEPM NT RECONSTRUCTION Location: FISHERS ISLAND NEW YORK �? * ? Qh /) e7 `-P "�� Waterway: WEST HARBOR " * `` " , ,}• ���� Applicant: KATHARINE duPONT WEYMOUTH 77 fG / Date: OCTOBER 31, 1991' Agent: DOCKO, INC. - \�4 0 0 ---- t-!T''1E � 'U ..\\ No .�� C-`I (\, `sue, � •,� 1 t,� � ( _ - �� 10 RhV \� '• ` .., �' rs� D -�J '%% � J'�ice' �� �* �') �' �1�� ` a °1 • - /9 b SZ'G718T'FiQIvO " f. �9. o •` \\ `�_> _ R * -_ TER'= o Elizabe h Field -- 7 7der'dss /\'/'// . LAIN'U' 18 Po 2 Jni / $p p 1 ( (r� '2S - Y /!Yl 22 t�j3 - )A� 2/30r/ J,, 0 INTERIOR—GEOLOGICAL SURVEY.RESTON•VIRGINIA-1984 a 24(j 810 YY L J ].F' 72 b0' -.- 2 540 000 FEET (N.Y.) '50 '51OOWE )00 ROAD CLASSIFICATION Mapped, edited, and published byth, 1 MILE in cooperation with Connecticut Depa EEEEZEZZI Primary highway, Light-duty road, hard or a000 sgQo a000 7000 FEET hard surface ._ improved surface J ...SIT T ... ... ltr It TAX ASSESSOR'S MAP 6-1 ProjeProject: DOCK/REVETMENT RECONSTRUCTION T' c t: ca Z FISHERS ISLAND, NEW YORK Location: -a— Waterway: WEST HARBOR (D p Jc_ Applicant: KATHERINE duPONT WEYMOUTH Date Agent:mt Agent: DOCKO, INC. '' ' \ _ Date: OCTOBER 31, 1991 3AM M !it It Ile ...... EA Duo %,0 1'E.t.) 12. 31, lo IT Po,27 113. SEE SIC %0 Z % --s' COUNTY OF SUFFOLK N�CT SOUTHOLD mc'"IIII) WE.ME..mL. Agency IF Reol Property Tax Service07 C...Iy CIT.,., 11113 1000 qi—h..J.t I.N.-Y.,% FI—II JC—,— r Docko, Inc. _ ✓ RD2 Box 420A,Stafford St., Mystic,CT 06355 (203)572-8939 .r r i ABOVE: Aerial photograph of the site from 500 feet looking south, May 1990. BELOW: Dock system after Hurricane "BOB" showing heaved decking and broken stringers (looking westerly); September 1991. I I I Docko, Inc. RD2 Box 420A, Stafford St., Mystic,CT 06355 (203)572-8939 i ABOVE: Close up photgraph of the dock showing damage to the stringer system and decking (looking northwesterly) ; September 1991. - 2 - Docko, Inc. RD2 Box 420A,Stafford St.,Mystic,CT 06355 (203)572-8939 f' ABOVE: Revetment running northeasterly from the dock; stones substantially in tact, however, voids appearing behind indicating backfill subsidence. BELOW: Northerly section of revetment from the north looking southwesterly. Small stones will have to be reset and protected with larger stones. - " Docko, Inc. RD2 Box 420A, Stafford St., Mystic,CT 06355 (203)572-8939 it r8 a f - i, fi f ABOVE: Damaged escarpment at the northerly end of the site showing accumulated lumber as well as sluffed embankment materials and turf. BELOW: Same site looking southeasterly showing the sluffed embankment materials and accumulated lumber; photos taken after unnamed storm of 10/23/91 i Docko, Inc. RD2 Box 420A, Stafford St., Mystic,CT 06355 (203)572-8939 -. 4W ABOVE: Southerly revetment looking north toward the grouted stone wall and dock beyond, showing revetment backfill failure and loss of materials. BELOW: Close up view of the same stretch of the revetment and the size and extent of the void left by the erosive forces of two storms; October '91 s z � d,'t w''r '"'1 ,71� :,' +vim iy+��"�e;'r:�.r� �! .:c•�r. r� Docko, Inc. RD2 Box 420A,Stafford •. i • i•VE: Photograph • the revetment looking south toward the south - • of the property, showing the extent of eroded backfill repairs needed. :EI •W: South - • of - site showing eroded embankment • damage to •- repaired; both photographs ar- after unnamed storm of october 23 1991. y j. Docko, Inc. RD2 Box 420A,Stafford St.,Mystic,CT 06355 (203)572-8939 /I October 31, 1991 Ms. Christine Costopoulos NYS DEC, Regulatory Affairs Building 40, SUNY Stony Brook, NY 11790-2356 Re: duPont Property, Fishers Is. Dock Reconstruction Permit Dear Ms. Costopoulos: On behalf of our client, we request a Tidal Wetlands Permit and Coastal Erosion Permit, including Water Quality Certifications, as necessary, for reconstruction of a fixed dock and shore protection revetment damaged by Hurricane "BOB", at the duPont property on Fishers Island, New York. We enclose the following in- support of .this permit application: - Four prints of application drawings titled: "Dock/Revetment Reconstruction" In: West Harbor At: Fishers Island, Town Of Southold Suffolk County, New York Applicant : Katharine duPont Weymouth Date: October 31, 1991 -Four copies of the DEC Joint Application, including the Short Environmental Assessment Form, SAAF, site photographs, Tax Assessor's Map and location plan. I trust that you will find this application . package complete and acceptable; please let me know if the need for further information arises. Very truly yours, Dock , In �j Keith B. Neilson, P.E. Enclosures cc: duPont/Weymouth . Jim Haggerty, CE John Bredemeyer, Town of Southold John Clavin, Fishers Island Harbor Master Tom Law, Sandy McGugan File 91-08-238 95-19-3(8189)-7e DEC APPLICA' NUMBER _ NEW YORK STATE DEPARTMENT OF ENV,•, !MENTAL CONSERVATION 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,ARTICLE 43 6NYCRR 646(LAKE GEORGE RECREATION ZONE) ❑ARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) 06NYCRR 327(AQUATIC VEGETATION) 1:16NYCRR 328(FISH) 06NYCRR 329(INSECTS) S ❑ARTICLE 15,TITLE 5 6NYCRR 608(PROTECTION OF WATERS) T El For the construction,reconstruction,or repair of a DAM or other impoundment structure. A (� T El For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS. U401 WATER QUALITY CERTIFICATION E ❑ARTICLE 15,TITLE 15 ❑6NYCRR 601 (WATER SUPPLY) 1:16NYCRR 602(LONG ISLAND WELL) ❑ARTICLE 15,TITLE 27 6NYCRR 666(WILD,SCENIC AND RECREATIONAL RIVERS) ❑ARTICLE 24 6NYCRR 662,663(FRESHWATER WETLANDS) :RIARTICLE 2S 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 ®Owner ❑Operator ❑Lessee ❑MunicipalitylGovernmental Agency (Check as many as apply) 3. NAME OF APPLICANT(Use Full Name) Mrs. Katherine Weymouth MAILING ADDRESS TELEPHONE (Where can be reached during day) Grey Gull Partnership, A-102 Greenville Center ( ) POST OFFICE STATE ZIP CODE Wilmington DE 119899 4. NAME OF ❑Owner �Agent/Contact Person (Check one) Docko, Inc., Keith B. Neilson, eilson P.E. MAILING ADDRESS TELEPHONE(Where can be reached during day) P.O. Box 421 CO3 ) 572-8939 POST OFFICE STATE ZIP CODE Mystic CT 106355 5. PROJECT/FACILITY LOCATION(Mark location on map,see Number 1a on reverse side) County Suffolk I Town or city Southold I Village STREET ADDRESS(If different from applicant) ; Private Road POST OFFICE STATE ZIP CODE Fishers Island NY 1 06390 6. NAME OF STREAM OR BODY OF WATER West Harbor 7. HAS WORK BEGggU--��N ON PROJECT? If YES, attach explanation on starting work without,permit, include dates. 8. WILL PROJECT UTILIZE STATE LAND? ❑Yes tJNo Show work on map and/or drawings. El Yes 11IT No 9. PROPOSED USE: 10. PROPOSED STARTING DATE: 11. APPROXIMATE COMPLETION DATE: 12. FEE OF(NYS Permit Only) [91 Private ❑ Public ❑ Commercial November 1991 January 1992 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.)Reconstruct a pile supported fixed wood dock and shore protection revetment all severely damaged by urricane Bob. Drive four new piles to anchor an existing 14'x20' floating dock and two new tie-off piles, 14. WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL,STATE AND/OR LOCAL PERMITS? R] Yes ❑ No If yes,please list: U.S. Army Corps of Engineers Nationwide General Permit Southold Board of Trustees "Grandfather" Permit 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 for a fine of not more than$10,000 or imprisonment for not more than five years, or both, where an applicant knowingly and willfully falsifies,conceals,or covers up a material fact;or knowingly makes or uses a false,fictitous or fraudulent statement I hereby authorize the agent named in Number 4.above to submit this application on my behalf. 11 DATE ' " SIGNATURE TITLE PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE 14.16.4(2/87)—Text 12 PROJECT I.D.NUMBER 617.21 SEOR 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 Mrs. Katharine duPont Weymouth Dock Revetment Reconstruction 3. PROJECT LOCATION: Municipality Fishers Island, Town of Southold county Suffolk 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) The project site is in West Harbor on Fishers Island. The property is accessed by a private road (no name) as shown on the attached Tax Assessor's map. 5. IS PROPOSED ACTION: ❑New ❑Expansion ®Modification/alteration 6. DESCRIBE PROJECT BRIEFLY:Reconstruct 158 ± LF of fixed pile supported wood dock, including reconstruction of one crib, all of which was severely damaged by Hurricane Bob. Drive 4 new piles to anchor the existing 14'x22' floating dock and two new tie-off piles. Re- construct a shore protection revetment consisting of 550 ± CY of stone and fill replace- ment regrading of an area of 3,000 ± SF adjacent to the tidal zone. 7. AMOUNT OF LAND AFFECTED: Not Applicable Initially acres Ultimately acres 8..WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �t Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other Describe: , The property at the dock site and surrounding properties are characteristically single -fail ily.residential. 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATES OR LOCAL)? faYes ❑No If yes, list agency(s)and permit/approvals U.S. -Army Corps of Engineers, Nation-wide General Permit, Southold Board of Trustees, "Granfathered" by the U.S. Army Corps of Engineers in 1968. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑No If yes, list agency name and permit/approval The existing structures pre-exist current State and Town permit programs and were "Grandfathered" by the US Army Corps of Engineers in 1968. 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Mrs. Katharine duPont Weymouth Date: _ Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART II—ENVIRONMENTAL ASSESSMENT (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. ❑Yes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaratlon may be superseded by another Involved agency. ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic 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: C4. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly C5. Growth,subsequent development,or related activities likely to be Induced by the proposed action?Explain briefly. C6. Long term,short term,cumulative,or other effects not Identified in C1•C5? Explain briefly. C7. 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 If Yes,explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above,determine whether It is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e)geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency 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 2 Katherine Weymouth 99c1�-08-238 1�op�Z-pacfes 991 " APPLICATION CHECKLIST NOTE: APPLICATION MUST INCLUDE: x 1. STANDARD FORMS - Appropriate Application for Permit. Short Environmental Assessment Form, Structural Assessment Form. NOTE: For all projects requiring Wild, Scenic & Recreational Rivers Permits and for commercial, industrial or multi-residential pro- jects, submit a long Environmental Assessment Form. 2252. APPLICATION FEE: Refer to enclosed fee schedule $10.00 minimum, Check or Money Order payable to NYS DEC. You will be notified of additional fees, if any. X 3. Authorization letter from the owner where the applicant is not the owner. See Joint Application Form X 4. Staking and labeling of the seaward/wetland side of the proposed structure or fill area. x 5. Photographs of the staked project area mounted on a separate and labeled page. X 6. County Tax Map Numbers: Photo of Tax Bill will suffice. Suffolk: Dist. Sect. Blk. Lot Nassau: Sect. Blk. Subblock Lot x 7. Project Plans (four copies) - Plans must clearly show the pro- posed project and include all appropriate dimensions, elevations and must be at a scale of 1" to 100 ' or larger. X 8. Address of project location (if vacant land; telephone pole # or other identifying landmark) . MINIMUM PLAN REQUIREMENTS (FOUR COPIES REQUIRED) PROJECT: Alterations and/or Extensions 1, 3, 5, 6, 7, & 8 New House Construction 1, 3, 5, 6, 7, & 8 Accessory Structures 1, 3, 5, & 6 Repairs to Existing Structures 2, 3, & 4 Dredging 2, 3, 4, 5, & 6 * Catwalks. and Docks 2, 3, 4, & 5 Subdivisions 1, 2, 3, 5, & 6 Bulkheads 1, 2, 3, 4, 5, •6, 9, & 10 Groins and Jetties 2, 3, 4, 5, 9, & 10 Filling 1, 4, 5, & 6 KEY: 1. Stamped Sealed Survey * 2. Plot Plan * 3. Location Map * 4. Sectional View * 5. Wetland Line or Mean High Water, as appropriate 6. Fill and Clearcut Area 7. . Sanitary System Location 8. Test Hole and Data 9. Profile View 10. Distances from fixed structures NOTE: IF YOU WISH CONFIRMATION OF RECEIPT OF YOUR APPLICATION, PLEASE SUBMIT A SELF-ADDRESSED, STAMPED POSTCARD. NOTE: THE PERMIT PROCESS TAKES AT LEAST EIGHT (8) WEEKS. MYSTIC COVE MARINA TEL N0 . 1-203472-7569 W .25 , 92 101b KU2 Inc. 5-72 (200) 572-7509 P.0, 9c"X40 Qsfc' C�T 06355 (��W) -89't9Fax April 23, 199? mr. Jan Bredsmeyer; President APR 2 31992 Southold board of Tr ostees L— P0 Box 728 LTQWN OF SOUTHO NN OF SO U) Southold, NY 11971 Re: duPont Hoperty, Fishers island Dock Permit Wdification War W. Exedv�t�eyer- ohn reconstruction of the fixed wood dock at the propertv of bts. i�albherine on Fishown island is h2t alcut =Plete "a ,n�)`vie g the f loating dock 2 feet east, relocaring the �Iock replacit-19 tj,)(�l c-ne cr-il., withL 2 piles for d-of s"-Ipp-o-r t 11-iarpe of yo�� of f ice advi�-,ed me that a permi t Wit ication W - di f i c -- ha 1 f of )u!6 te required, accordingly, 1 hereby request this aw�d a ti on on Le Attached is a check in the amounL of $35. 1 trust that y0j will find this request acceptable; please Wt me kn, a if the need for nore WormatiOn arises- Youm truly, ncCK0, INC. -r-C-1 Keith W Neilson, fit' QW&Wey=oth ..aggerty, Crj. :ps DEC Pishers island Farbor Master wile 91-08-23,,4, 95-20-7(10/90) New York State Department of Environmental Conservation Supplement to Application for Permit STRUCTURAL-ARCHEOLOGICAL ASSESSMENT FORM (SAAF) PART 1 - APPLICANT COMPLETES Applicant Information 1 . Applicant Name Mrs. Katharine duPont Weymouth 2. Applicant Address c/o Reynolds duPont, Jr. P.O. Box 365, Fishers Island, NY 06390 Project Information 3. Project/Facility Name Dock/Revetment Reconstruction 4. Project/Facility Location West Harbor, 'Fishers Island, NY 5. Is the proposed project adjacent to, or does it contain a building or structure listed in the State or National Register of Historic Places? Yes No x 6. Are there any buildings or structures built prior to 1940 adjacent to or within the proposed project area? Yes No x If the answer to question 5 and/or 6 is yes, provide the following information for each building and structure (use attachments if necessary) : a. name of structure b. location c. type of structure (ex: house, outbuilding, barn, bridge, dam, ruins) d. approximate age or date of construction 7. Might the proposed project have any impact (physical/visual) upon any buildings or structures listed in the State or National Register of Historic Places or built prior to 1940? Yes No x If yes, describe briefly (use attachments if necessary) : 8. Provide photographs of every building and structure that may be impacted by the project as described in number 7, above. The following standards are recommended: o minimum of two photographs o minimum size 4" x 4" prints from negatives preferred; polaroid photos are acceptable o photos must be clear and focused o clearly label photos so it is obvious what is being illustrated; key photos to map or plan, if possible o photo 1: show both the entire front and side of the structure in a single shot from as close to the building as possible. Be sure the structure is not partially or fully blocked by trees or other obstructions o photo 2: show relationship of building or structure to roadway or surroundings 9. Has the land within the proposed project area been previously disturbed or altered (excavated, landscaped, filled, utilities installed)? Yes x No If yes, describe briefly, including depth of disturbance (use attachments if necessary) : See attached application drawings; this project is the reconstruction of an existing dock and revetment in the same dimensions and basic configuration. 10. Approximate percentage of proposed project area with slopes: 0-10% % 10-15% % 15% or greater % 11. Approximate percentage of proposed project site-with the following drainage characteristics: Not applicable; the dock site is underwater. well drained % moderately well drained % poorly drained % Prepared by o, Inc., Keith B. Neilson, P.E. Date October 30, 1991 SAAFI.LK/G 10/90 Katharine Weymouth 91-08-238 October 30, 1991 STRUCTURAL—ARCHEOLOGICAL ASSESSMENT FORM (SAAF) PART 2 — DEPARTMENT OF ENVIRONMENTAL CONSERVATION (DEC) COMPLETES Applicant/Project Information 1 . Applicant Name Mrs. Katharine duPont Weymouth 2. Project/Facility Name Dock/Revetment Reconstruction 3. DEC Number Buildings and Structures 4. Might the proposed project have any impact (physical/visual) upon any buildings or structures listed in the State or National Register of Historic Places or built prior to 1940? Yes No If yes, DEC must consult with the Office of Parks, Recreation and Historic Preservation (OPRHP) . The DEC must request a determination of eligibility for the State Register of Historic Places and/or comments regarding project impact. Include information supplied by the applicant in response to questions 5, 6, 7 and 8 of Part 1 of this form. Archeological Sites 5. Does the proposed project area coincide with a circle, square or stippled area on OPRHP's Statewide Archeological Inventory Map? Yes No 6. Is the proposed project area outside of a circle or square, but one for which information has been provided (ex: documented reports of known sites) that suggests the area is archeologically sensitive? Yes No If yes, what is the nature and source of information? 7. Is the proposed project area apparently undisturbed? Yes No 8. Will the proposed action include a physical disturbance of the project area? Yes No 9. Is the slope in the area characteristically less than 15% (unless on limestone/flint escarpments)? Yes No 10. Is the proposed project area characteristically moderately well or well drained? Yes No If the answers to 5, 7-10 are yes, an archeological survey should be performed by the applicant. Provide the applicant with a copy of Report Format for Cultural Resource Investigations and list of archeological consultants. If the answers to 6-10 are yes, DEC must consult with OPRHP before requiring that the applicant perform an archeological survey. Results of Evaluation No buildings, structures or archeological sites identified at the project location (SHPA-1) Buildings, structures or archeological sites identified, but no impacts will occur, no survey required. No further cultural resources review required (SHPA-2) Consultation by DEC with OPRHP required structures archeology Archeological survey required Prepared by Date SAAF2.LK/G 10/90