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HomeMy WebLinkAboutTR-1593 June 28,2019 Board of Trustees for the Town of Southold Dear Sirs: We hereby grant permission for a trustee of the Board of Trustees for the Town of Southold to access our property at 1000 Beachwood Lane Southold for the purpose of inspecting our dock as we seek to replace the previously permitted (but no longer present) floating dock. Please feel free to contact us at 917-880-0460 if you have-any questions. Thank you, Consuelo Prol Richard Liebowitz 61��F FQ( , Michael J. Domino, Presidr �Q CDC Town Hall Annex John M. Bredemeyer 111, Vice-Pr6sluunt ��� C1.k 54375 Route 25 Glenn Goldsmith ova A, P.O. Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams ��0 ' pl,r� Telephone(631)765-1892 Fax(631)765-6641 r�- BOARD OF TOWN TRUSTEES / TOWN OF SOUTHOLD Date/Time: �C 3� / Completed in field by: 7'P tk%L Site Inspection regarding RICHARD LIEBOWITZ requesting to re-install the permitted 8'x12' floating dock. Located: 1000 Beachwood Lane, Southold. SCTM# 1000-70-10-59 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: 40 I ha d & ackno ged the foreg ' g ruiees Agent/Owner: Present were: V/J. Bredemeyer Domino �G. Goldsmith �N. Krupski e,11G. Williams Other r -1 Michael J. Domino, President ��q soUTjyO Town Hall Annex John M. Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 11 Glenn Goldsmith J�[ Southold,New York 11971 A.Nicholas Krupski G Q � O Telephone (631) 765-1892 Greg Williams 'r4UNT'( O i Fax(631) 765-6641 �y ,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/2 constructed Project complete, compliance inspection. f INSPECTED BY. V � ✓' COMME ANTS' I n -0.ra d s CERTIFICATE OF COMPLIANCE: • 'err. •—�� -- .,. s l � 7 •Law��_ J Fyn. M ,r..�i..•+►ter, aw.�, - _._.� %.�_- '�i.'�- �• -...r .. ,. �. -;-- Y► 4 1 ` t A ■y. 11 5i J1 41 Y _ - 1 r k r� r,. { ALL VICOi GS AND STAKES i•1UST DIS?L VIS1BLE IiOGRI::G i:U.IBE ?S ALL DCC:;S i+i'iD c3U=icADS MUST DISPL.iY VISIBL:7' PERMIT NU!•1EERS `�;':(+:i:- .s�#A-" .r��.h. J• r*'?L„�;tis w.�. •r _•.��_=--•`��e�'+�`^-��..r.:f'•:.',..Y.,`�:�_�er .off;T%Y✓���--•�!•'.��p�,"'�+� \.`` ` ` . •YET.• '• • T'•.'J_ f .'t'.•—•�... .( ..�'• -.9 .t.-..-� .' � � �+•'•)•.4'� ~. ,,�•7// '�� ��t%, :i"-C' e.�:iu-a:�=. _' a�.. ,.--�. 'E y-`..•.r.� .ff o' o••%_.v.e.r,o- Ft� �:l�r' f� r.. C rri i„ ..,.!- • Z. f. .n.w..�. .. ,y� -..•�y �T.i. rrl. _ .( .. ,;51�;sw7u)�;1 T'._c,"'�"✓/..;i!e d •j' •;�.�i,i E •-;,;(llt(.., �� :M\:'; � `�L'::lt::. ":�.'7••'. ^'t;.CiY,�` •,.�i(l/tl':�` -li::i•_i, :fir -.9� `ram: t `rL::• � Ef �`• ur..,..r /'..- .:t� � . y., ,�,�� _ .... ,,; ,� _ '!r ��� 1..r1s..• _ �:.ice:— jti•�7u.:r_:_..L7`r 'r••:y��• `'i�: u1�:.l,-;' ••' 0 31t-d Of soot,old a o�r�r� �1 r ustPes r SOUTHOLD, NEW YORK (4 .: MOORING NO.N/A ; rf) PERMIT NO. .. ._.i .�3.............. DATE: I`?ay.....2.9:....1983 ��'''~•= = -=i�' ISSUED TO ...................JOHN....J•.....FARRELL /gyp Tp1}ys �.��j�''•Y_+�_.., Pursuant to fhe provisions of Chapter 615 of the Laws of r'~ t to of York 1893; a ,, the State New and Chapter 404 of the Laws of the Y:�r"if(�•:>4 / State or New York 1952; and fhe Souihold Tow en-' ••.;:,�- " �,;� n Ordinance titled "REGULATING AND THE PLACING OF OESTRUCTIONS IN A ON TOWWATERS AND N AND PUELIC LAND °•• •/�'��'�`�' REMOVAL OF S and the j: ��•- 10 SAND, G RAVEL OR OTHER MATERIALS- FROM LANDS UNDER TOWN 1;. WATERS;' and in accord ' the ante with Resolution of The Board adopted at a meefir,g held on _ �:•:.rr I •_ "!-tea. 19........._.., and in consideration of the sum of $.....8.5....�.0.. .. paid b i' y , `1 �oF .r ; _ / :M .......Mr......JOh.n...J....... .arxe.11................................................. r _ f r old - of ......44 South................................................................. N. Y. and s b 9 u ject to the Terms and Ccnditio-is fisted on the ev }-� ><A- `y'r r erse side hereof, - of Soufhold Town Trustees authorizes and ermi;s the following• To construct a 81X1 ,2• float, 4 x6 ramp, and a ;'+ = 26 ' x 4 ' catwalk in Goose Creek, with the provision• �^ that 2 additional spites are used to secure the zx�, f�oat fo safety .by ? ••�y�` a , in acccr�ance Wlt , deiailed speclilGdtlOns d5 preSent�d In ?.i�^t'` d9=� .�,j� • the originating application. •• ' ic��:;, IN WITNESS WHEREOF, d of The said Board Trustees he I I N C.,S f: by causes its Corporate Seal to be affixed, and" these presents to be subscribe ' r n � .._,..� I ' this cl a dy a ma ori,y or the said hoard.as or at.e. , OLZ =x ki Trustees .t• q� '�i� � 1,�•a. '-� .iE\SiC --�•�^ - •_�� -_...� __-_ .�:. 2___ _ _ _ -_ .,�' ,�• :`:' was/� ~'jam- `Cs�' ! iti '�r^•' i�cc-. y .�fi/T r' f S?7J�j."r' .: Tf cl�ii!,r �`-:-may: �. �!•� ,lZl:�,. ... ..: •••jt.•a �.� e;r�7aZ:'.t.�,,,.�.s� :':��,_-<- '>..��r � e�. •'�iy/ < �-..:I! % `._ .L: fv::fi�;�`<<-t�,•f�vtcr. �n_,� �.._., - ���- �:�1�:•,�,-Ni+T�°—'-: �c�-.t:':o~�..�1 r~-9R1�17� - Cyr.�.� •.a;,:, 9 ? S y• _ /ate?r . = Y.i. .,�5.. I -: ;�;�! ' - k t; :�.14 �. �fl. :- :'-•Vou�` :t�6•• �: a-� 1�}', w_� �sk "� v;,fir r•�p� 9.7 xl� alto ` .�.. rt�• �:?i c� ��ti_ .sr�'_AYl{ ��ftdl` 4+. �i�•�j�s `��cr��a>CY� y'1�ASa �'y'^�l —— •�t .,u.w:''% �.r„",i, %�^` ` "Yr• �+ u.c�9--�,-_ ,,,, ���-_--•'-`=Y�"•:'a"�.y'��.y`ti 'r= _`C:^�.; r i. ••1"T,f`i.;�� f' ---- --------------\-- J=---T . ..�-J'F�-\c3�^ !-seL1Q_i - , _'rusr�� ------ ------- -- Bard Of Southold Town i rusteps SOUTHOLD, NEW YORK MOORING NO•N/A PERMIT NO. ....,.....1593 • DATE: .,. May 20, 1983 ISSUED TO ,,,,,John J. Farrell I� certify that the work as authorized in -this permit has been completed and is now ready for your insoec— tion. Also, the nu:aNer required on this project is clearly visible. I further understand this permit is not valid until this tear sheet — is returned to the Trustees. �I TERMS and CONDITIONS a f The Permirtee John J. Farrell ra residing at 1000 Beachwood Lane SoutholdN. Y•, as Ka part of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: ..1. That the. Southold Trustees Permit must be prominently displayed on the premises effected thereby during the period of • 2. That the said Board of Trustees and the Town of Southofd are released from any and P=I all damages, or claims for damages, of suits arising directly or indirectly as a result of any o work r� ation performed pursuant to this permit, and the said Permittee will, at his or her own .7. e� under r l defend any and all such suits initiated by third parties, and the said Permitter assumes full liabilitythe o ith respect thereto, to the complete exclusion of the Board of Trustees of the Town of SoutholdPermi.t . That this Permit is valid for a period-of QEF, "z AR which is considered to be sufficient time required to complete the work involved, but should circumstances warrant; request for an extension may be made to the Board at a later date, L 4. .That this Permit should be retained indefinite)y, l C'. �I , or as � as the said. I'ermitree wishes �- to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. E; 5. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for p� revocation of this Permit by resolution of the said Board. 6. That there will be no unreasonable interference with navigation as a result of the work PA herein authorized. 7. That there shall be no interference with the right of the public to pass and repass along Y=� the beach between high and low water marks, J Ea 8.. That if future operations of the Town of Southold require the removal and/or alterations $ � in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the j �aI work shall cause unreasonable obstrumon to free navigation, the said Permictee will be required, K upon.due notice, to remove or alter this work or project herein stated without expenses to the Town '? of Southold. ? 9. That the said Board will be notified by the Permirtee of the completion of the work auto- + ; I orized. (See tear off sheet. ) .�I 10• That the Permirtee will obtain all other permits and consents that may be required sup- -4 '� plemental to this per.nit which may be subject to revoke upon failure to obtain same. _..,,. �R rftIV PAY IVc/c4N J&DkS R �y{.F��yG•'. cr'•s a §' .' .�i..' ...::..:':.c:::-:::-:�. �y.r,..vy-•;.ram...._`-nY:�. 4 1. h/ 9EK L o He Q a p '4 WALK 141 CL uTic,�ry CA /a TELEPHONE (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 1 1971 May 4, 1983 Mrs. Judith T. Terry Southold Town Clerk Southold Town Hall Southold, New York 11971 Dear Mrs. Terry: Transmitted herewith is the action taken by the Board of Southold Town Trustees at a regular meeting held on May 3", 1983 : RESOLVED to recommend to the Southold Town Board approval of the application #130 submitted by John J. Farrell to construct a dock with a floater, in Goose Creek, Southold, with the provision that two pilings are installed to secure. the floater. Very truly yours, Board of Town Trustees Paul Stoutenburgh President PS/ip C) fir. Y4 ,{ x 1 ' TELEPHONE (516)765-1801 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 April 6, 1983 Mrs. Judith T. Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Transmitted herewith is the action taken by. the Board of Town Trustees at a regular meeting .held on April. 6, 1983 : RESOLVED to recommend to the Southold Town Board to table the Wetland Application #130 of John J. Farrell until the next meeting, so that the Trustees can talk to Mr. Farrell in regard to some unanswered questions on the application. Very truly yours, Board of Town Trustees Paul Stoutenburgh President PS/ip Town Hall, 53095 Main Road P.O. Box 728 ® Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD March 18, 1983 Mr . Paul Stoutenburgh, President Board of Southold Town Trustees Southold Town Hall Southold, New York 11971 Dear Mr. Stoutenburgh: Transmitted herewith is application no.130 for a wetland permit submitted by John J. Farrell. Please prepare a written report of findings and recommendations with respect to this application. Very truly yours, �5;" Judith T. Terry Southold Town Clerk Attachment Town Hall 53095 Main Road •: 4i;a,x ..._�`�Ssv' r° :'r ,=./ P.O. DUX 720 a`rv :a Southold, New York 11971 JUDITH T.TERRY "'�':'"�-'-%��`"�! TELEPHONE TowN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT Dated: May 11, 1983 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 Board, as lead agency for the action described below, has determined that the project , which is unlisted will not have a significant effect on the environment . DESCRIPTION OF ACTION Application of John J. Farrell for a Wetland Permit to construct dock and float at 1000 Beachwood Lane, on Goose Creek, Southold, New York. The project has been determined not to have a significant effect on the environment for the following reasons: An environmental assessment has been submitted which indicated that no significant adverse effect to the environment are likely to occur should the project be implemented as planned. Because there has been a response from the Board of Southold Town Trustees and Southold Town Conservation Advisory Council indicating that this project would not have a significant effect to the environment. Because there has been no response in the allotted time from the New York State Department of Environmental Conservation and the Southold Town Building Department , it is assumed that there are no objections nor comments from those agencies. Further information can be obtained by contacting Mrs. Judith T. Terry, Southold Town Clerk, Southold Town Hall, Main Road, Southold, New York 11971. Copies to: David DeRidder, DEC, Stony Brook Commissioner Williams, DEC, Albany Southold Town Building Department Southold Town Trustees ''-- Southold Town Conservation Advisory Council Town Clerk' s Bulletin Board John J. Farrell DO UD OF TOWN TRUSTEES Torun of South. Alain Road Southold, New York 11971 NOTICE OF ACTION - NOT A PERMIT To: ..Mx....,7.okuL.,7....k:az. .o�1,:...�.Q.Q.Q.Beachwood„Lane, Southold, NY 11971 1. Your application, dated .....March..l8,...J.J83....................................... ha: aer:n r,..vicwed by this Board, at a meeting of the Trustees held on ...,,Apri,1..5.,..1983............................................ and resulting in the action, as indicated below: (........= Application approved. (............) Application denied. (............) Application tabled. 2. Comments and remarks: With the provision that two additional piles are installed for safety.• .to secure the floating dock. A PERMIT FEE 3. If vcur cao!icotion is Slb'gCnd abr�ve. It -r�nit- r� is now duty and should be mode payable to the order of the Board of Southold Town Trustees. This fee is cornpuled bejcw occcrduia to ;he,ScheGul pf R es s set forth in the Instruction "Dicet IIForm I/lj. 'his �—ge must -be paid within �� days or re—applying and ad di Iona fie w1.Yl be necessa,:; If the Permit Fee is 'paid in person to the Secretory of the Board, 'i he Permit will be obtaincble of the same time. If the fee is paid by mail, the permit will be rnciled in reply. Computation of Permit Fee: 1—. 8' X 12" Float = 96 sq. ft. @.25 per sq. ft. _ $24.00 1— 4' X 6' Ramp = 24 sq. ft. @.25 per sq. ft. = 6.00 1— 4' X.15' Dock = 60 sq. ft. @.25 per sq. ft. = 15.00 8 .pilings at $5.00 per piling 40.00 Total amount $85.00 Paid 65.50 1ti0 �� '• '� Amount due $19.50 Total Fee for this application .............................:.............................. 19.50 due additional 1 SignetSc . .., ..... Pres. 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'U 6 - ba ' SCF+,'.?--- - 5. -- SEIAER _- ---- -- I — — - -- SH ORE LINE _ rir.E �� - !- RANT._.- MAINTENANCE A_-ERS'CN, _-;.E OR L IS`7 T_ 43WA -0,STR,BUT,O'. ,'. aNY R;R7,0h O� _ Ca RK---- --- - ----- 4E FUSE.- 6 COIN_ -At n,5c ;S FR3N_R'TED 6 T^C�' wa." , °E NS Sc= ,'F T-E SEaL KEY MAP © COUNTY OF SUFFOLK TOWN OF SO�THOLD I QG 3 --- — --- ---y Real Property Tax Service Agency lVILLAGEOF I -0 j , - \L. i 11 ---- - -- ------ - County Cente! I �OCC DISTRICr NO. . - — -- Rlvtrhead L 1 New York --- — — -- IQOfe of I - SUFFOLK CO. HEALTH DEPT. APPROVAL 4 � ` STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL 3 1 �� ®� _ SYSTEMS FOR THIS RESIDENCE WILL l` LtF\t�f$ � t y iFf�a� -`�/�� l T CONFORM TO THE STANDARDS OF THE - SUFFOLK CO. DEPT. OF HEALTH SERVICES. a, (S) APPLICANT SUFFOLK COUNTY DEPT OF HEALTH SERVICES — FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.: !+` � Q • 0 APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: S:cite 5� -- !" DIST. SECT. BLOCK PCL.. �kou r 2-4,750t 1000 070 010 5g OWNERS ADDRESS: - - _ ✓" .� �'�.�C.1 s;i C.7 1'f"mcr t'`�r f�f: i`., f!:,�t�; N r' fi �l�vcrl�ivr-s r-e)rer 4-0 rrr�cxr-a _-,ec level. IV ff }'Y !lr�:�e: yr rra Fl�3t�GT- �K� r°F��r { '1 �,`. � DEED: L. G .28 P. 1OR it) TEST HOLE STAMP ro''s,,,i-'.aUTC§OS12ED ALTERATION 08 ADDITIO11_ �}! �` 1�lCJ't•"'.' ; l_o+ 171Jf`!"aVVuY'.. shown r' r^ •7 U l ��� M_rl SUAYEY 15 A YIOLATIC44 Of 72D9 Of THE MEW YOFX STAH i s Ji Mcxa ��1� >-x.,r-Frtwond, filed rt7 Su9) ld, hurnos Try L>w. 9' :;":SS.C.'T 7A9I5 SUi,N:M M-99 NOT$&ARl�fi Q Jyl ,c:99 a� r'1 a Pig. 21-41 ---__.__ ._- -- '� f'••�.. J• 1 s ; L RT�1RYf`iOR'S IMED SEAL OR —r• "•. •!- L� ��s uo1'm C> nv D ^ O �• ",�.- AA�' ` �t�1\? V•gam^ - '1, j --- Ent+<'2s":. `iC. ;NFR:,ON SHALL WH /� ��• Ni. l,•T:r".°',i. (7r 3?N'1 t z 4 FOR %MjON:SHE pjRVE /•'Wy TJ x 4t A I115 R:i.ALF TO 7ME �' - EhPt k»iAL A(yftSCY AND H'CniY.K AND .4' THE ASsR�7^`.'("a 31 'ieif;I.ECfGIfdG l TI- Q'f ,j-.1, / - __�__-_"...�� 3` "'`PO&GLIA1 A:IV''S X',,..:MOT TRA'N:"i`ERAYI p- .{''A�d'SDITICHAl 11N5Tt:t)75i i+S n4 lu_sm- J . 3 y ;r,. SEAL �L3ou.7 /Yr WALKWAY.4 PAST oodA4 `f e.. i .��°a�Yr'r. r"r ��' �,� RSau7 lo�X�o� Fi.ol#�d�1t 1��1'^; .75arrc/ C k1 CNk �� WA�kNAy � I•ty� X yS �3a So � �f�icccl�o �7'r-f-!` lrtsurcxr-tC�a C�rrt���xracf a Y.4%ft a $o.od ,�/r RODERICK VAN TUYL, P.C. �J�2 ovGkAbV� 6rua�aJ -------- LICENSED LAND SURVEYORS GREENPORT NEW YORK ` FJ 01780 1 _NA,%IE OF CREEK C )SC-7 BOARD OF TOWN TRUSTEES :; f Town Of Southold Main Road Southold, New York 1/p1�971 �d APPLICATION FOR FIXED and/or FLOATING DOCKS 1. Applicant's name and address: ... df. ....:T .......................................................... JQ®Q.....�d. l°YCHWOot„�.....L11 105 ..stau:.TiH.��. �. .N...:.:.......................Te1.:.....G.:r.....:r.:...? 2. Contractor's me and a dress .. .........r .QGLF .......................................................... �...N:Y...............................Tel.: 3..1..`..`.'..1:� 3. Briefly explain the purpose of this application: SFr. ,.. !yJ.,s (9y/......................... .....�.....tsQev.Anmi i.... ... .°G ...................._................................................................................ ............................................................................................................................................:..................... .................................................................................................................................................................. 4- After issuance of a Permit, work must, be completed within one year, LARGE Secure the correct Area Map from the Clerk of this Board, and by using a/X WITHIN C�_)A CIRCLE indicate as closely as possible the location of this dock. On..th.e reverse side of this map, provide a SCALE DRAWING which will show Ordinary High Water Mork; the shape and size of the dock and any supplemental pilings which ore needed to hold a floating dock _ or tie-uA n boat. Give all dimensions necessary to determine the area of the dock surface WHICH EXTENDS OFFSHORE from the O. H. W. M. if adjacent property owne_fs _have docks, specify location and length to scale. — , Will any portion of this construction extend offshore into Town Waters beyond an imaginary line or boundary formed by other similar structures along the area's shoreline? YES of NO. If it does extend beyond this so-called dock line indicate by how for, approximately...........ft. Provide the following documents: (a) A Licensed._Enginee 's.Survey of the property invol,-ed. a (b) A cop Contractors y_of the Flans'and Specifications. d ((c Short Env ironmen-ffl-Assessment--Form. Wetlands Applicatl',on /8. Wi I this construction require the Filling of any land offshore of the Ordinary High Water Mark or the Dredging of any material from Town Lands under water? YES or NO. If it does, A Form A/4 (Application for Dredging/Filling) must be completed and attached as part of this `P,r� application. NV 1 9. In requesting approval of this application, I subrrfit that: the information presented herein is true and correct to the best of my knowledge and belief; I am the person accountable for the performance of the work in accordance with the plans and specifications attached; I have read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work involved; and further, I intend to adhere to and abide by the Terms and Conditions of the Permit, when and if issued to me. 10. To expedite finding specific location for inspection, indicate by using a temporary marker. .- 'A/2' .?tee•: -2/82 .. . . . ._,.. L. S. d `. :.%va............................ TOWN OF SOUTHOLD SHORT ENVIRONMENTAL ASSESSMENT FORM INSTRUCTIONS : a In order to answer the questions in this short EAF it is assumed that the preparer will use currently available information concerning the project and the likely impacts . of the action . It is not expected that additional studies, research or other investigations will be undertaken . (b) If any question has been answered Yes the project may be significant and a completed Environmental Assessment Form is necessary . (c) If all questions have been answered No it is likely that this project is not significant . (d) Environmental Assessment 1 . Will project resu t in a large physical change to the project site or physically. alter more than 10 acres of land? . . . . . . . . . . . . . . Yes ✓ No 2 . Will there be a major change to any unique or . unusual land form found on the site? . . . . . . . . . . Yes ✓ No 3 . Will project alter or have a large effect on existing body of water? . . . . . . . . . . . . . . . . . . . . . . . Yes ✓ No 4. Will project have a potentially large impact on groundwater quality? . . . . . . . . . . . . . . . . . . . . . . . I Yes ✓No 5 . Will project significantly effect drainage flow on adjacent sites? . .. . . . . . . .. . . . . . . . . . . . . . . . Yes ✓ No 6 . Will project affect any threatened or endangered plant or animal species?.. . . . . . . . . . . Yes ✓ No 7 . Will project result in a major adverse effect on . air quality? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes VINO . 8 . Will project have a major effect on visual character of the community or scenic views or vistas known to be important to the community? Yes No 9 . Will project adversely impact any site or structure of historic, prehistoric or paleontological importance or any site designated as a critical environmental area / by a local agency? . . . . . . . . . . . Yes / No 10 . Will project have a *Major effect on existing or future recreational opportunities? . . . . . . . . . Yes ✓ No 11 . Will project result in major traffic problems or cause a major effect to existing transportation systems? . . . . . . . . . Yes ✓ No 12 . Will project regularly cause objectionable odors, noise, glare, vibration, or electrical disturbance as a result of the project ' s. operation? . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ✓ No 13 . Will project have any impact on public health or .safety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . Yes ✓ No 14 . Will project affect -the existing community by directly causing a growth in permanent population of more than 5 percent over a one year period or have a major negative effect on the character of the community or / neighborhood? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . . Yes No 15. Is there public controversy concerning the / project? . . . . . . Yes " No PREPARER ' S SIGNATURE.Skg/iti`+. REPRESENTING DATE 3 SOUTHOLD amp . ' >�� �^ 1 •'41Z ''Y 4� '�np �-: b.r s� r.- � o�T F � c. i C Date o� , is NOTICEAddress-Joco &QchLdmlft_92A Lanle - .01 THIS T BE DISPLAYED DURING CONSTRUCTION t �: TOWNOF SOUTHOLD SOUTHOLD, N. Y. 9. 71 h' 8! - Town Of Southold Town Clerk's Office Southold, N. Y. APPLICATION FOR WETLANDS PERMIT Application No. ......... /... :�......... Date of Application ...... /�.......................... Identity of Applicant .J�7H^�....... .�AR!PELL........................ .......... ................................... Address of Applicant f�.��....�-�.ER.CHa1oo�....�!AMEN..d.4!till�oLlJ.f.N:y:............................ INSTRUCTIONS FOR PERMIT A. This application is to be completely filled in by typewriter'or ink and submitted to the Town Clerk in quadruplicate, accompanied by written .permission from the owner of the property if not the some as the applicant. B. Pilot Plan must be drawn to scale on the reverse side of this application showing the location of property, the names and locations of owners of adjoining properties, and a detailed description of proposed project. (Note: Copies of the Pilot Plan may be made by a copy machine and attached to the Permit Application:) C. No operation shall be initiated by the applicant until all.permits that are required are issued. D. A detailed statement of the rehabilitation and proposed condition of the premises after the work is completed must be given, including a survey if required. . E. If permit is being sought for a more sizeable excavation than the construction of a private single dock or jetty, then this application must be accompanied by a survey and topographical map certified by a registered land survey or Professional Engineer. The. horizontal control of survey shall be based upon an approval local coordinate system. The vertical control for elevation and sound- ings shdll-be based upon United States Coast and Geodetic Survey and/or United States Geological Survey datum. F. A statement must accompany the application describing any known prior operations conducted on the premises in question and whether any prior licenses or permits have been issued to erect structures or to dredge or deposit fill on said premises and whether any such permits or licenses were ever revolted or suspended by a governmental agency. G. A filing fee of $25.00 shall accompany the application. This filing fee includes one inspection, there is a $5.00 fee for each additional inspection. H. The Town Board upon reque t he applicant f r a per it, may waive in whole or in part, the provisions of Article ll, Secti§ , subdivisions (�) and (;where it finds that nature of the proposed operations are such that 'the requirements of such provisions are not necessary for a proper consideration of a permit application. I. Upon approval of this application the Town Clerk will issue a permit to the applicant. Such permit shall be available for inspection at any time, upon request. Examined ........r . . ..3.1.............. 19..g.�3 Approved ........... . .. ...r y..../.../......3....... . Disapproved .......`.�: ................ .... .�.. Conditions, if any .. .. .........A.... ........ ...... .. ........' ...... ....... ... ................. .. ...... ... �.. . .... ... . r .1.r.................................................................. .................................................................................................................................................................. ExaminingBody ..........................................................................................................I.......................... Signatureof Chairman ........ .................................................... ................................................ APPLICATION IS HEREBY MADE to the Town Board of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the Laws, Ordinances and Regulations govern- ing the Coastal and Interior Wetlands, Flood Plains and Drainage Areas of the Town of Southold: Permit requested to ...L:'.ArS.!!euC7...A..�oclt.....wl.tia...F�oA7rFR............................................... .................................................................................................................................................................. Location of property for which permit wanted ..LANE 64 0 � ..........................................................................,....................................................................................... Home address of permit applicant if different from aforesaid location .........S � �' ..................................... .........................................................................................................:........................................................ Creek, Bay or Harbor fronting property ....�fbOsE.... L��C.......................................................... .................................................................................................................................................................. Size of proposed work: p � 0 FL .. o'q: rta 0- Length . .... . .................... ...... .... ...M. ...................... ....................................................... Width9.<p ... °.�X.! ......................................................... ...... .... . ... .................. HeightAbove High Water !! i4.L. . ........................................................................................ DepthBelow Low Water ....NOMA.......................................................................................................... Yards to be Excavated .::�E7.....N CrKQ kjv6................................... Yards to be Filled ..............N .......................... *M:-r ............................................................................... .:.......... Width of canal, creek or bay fronting property..!4 .°.`4 ..Soo.!.. Depthat Low Tide ................................................................................................................................. AverageRise in Tide ............................................................................................................................. Is this for private or business use? ........10 Y A'f.E................ .......................................................... AreaZoning ............................................................................................................................................. Manner in which material will be removed or deposited :.................................................................. . .................................................................................................................................................................. Intended use of property ....R.Y!.... DOGk .................................................................................................................................................................. Written consent of owner of property, if not the same as the applicant ......................................... ..........�!4?.. .................................................. ............................................................................... .......................2;�e) ........................................................................................................................................... COUNTY OF STATE OF NEW YORK ) SS: \ ..............................................................................:......... being duly sworn deposes and says that he is the applicant for the above described permit, and that all statements contained herein are true to the best of his knowledge and belief; that the work will be done in the manner set forth in this application and as may be approved by the Town Board of the Town of Southold. The applicant agrees to hold the Town of Southold and the Town Board harmless and free from any and all damages and claims arising under or by virtue of said permit, if granted. ...... .,......... .. ..... ... . ... .. ............................. Sign.ature of pplicant Sworn to before me this ................................ day of .... `- `. 1— 19... 8...3.... ......................................Zlic ................................. Notary ALICE SCHNEIDER C / NOTARY PUBLIC. State of New Yor& „ (A"o 41-3513722 Quceas Cormty Cert. filed in Ne, York Comity Term Expires March 30. 1983