HomeMy WebLinkAboutTR-3815 ' I
John M. Bredemeyer M, President 0,13fF04C Town Hall,53095 Main Rd.
Michael J. Domino,Vice-President ,`�� �Gy P.O.Box 1179
o
James F. King 00 Southold,NY 11971
x
Dave Bergen `"o Telephone(631)765-1892
Charles J.Sanders � �O Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION:
_ Ch. 275 Ch. Ill
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1st day of construction
/ Yz constructed LL
V Project complete, compliance inspection. — Fo(- Eetner
INSPECTED BY:
COMM T : �
P
l
CERTIFICATE OF COMPLIANCE:
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OFTOWNTRUSTEES
TOWN OFSOUTHOLD
January 23, 2013
Mr. David Page & Ms. Barbara Shinn
2000 Oregon Road
Mattituck, NY 11952
RE:
DAVID PAGE & BARBARA SHINN
1854 NORTH BAYVlEW ROAD, SOUTHOLD
SCTM# 70-12-39.3
Dear Mr. Page & Ms. Shinn:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, January 23, 2013:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Wetland Permit #3815 from Edward Fergus to David Page & Barbara Shinn,
as issued on September 28, 1989.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
James F. King
President, Board of Trustees
JFK:amn
.lames I: King, President
Bob (ihosio, .Ir, Vice-Presidenl
Dave Bergen
.John Bredemeyer
Michael J. Domino
PO Box 1179
Southold. NY 11971
Telephone (631 765-1892
Fax (631)765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time:/tb,..-,._ / ~', ¢9-~1 ~
DAVID PAGE & BARBARA SHINN request a Transfer of Wetland Permit #
3815 from Edward Fergus to David Page & Barbara Shinn, as issued on
September 28, 1989. Located: 1854 North Bayview Road, Southold. SCTM#
70-12-39.3
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland
__Sound Bay
Distance of proposed work to edge of wetland
Part of Town Code proposed work falls under:
__Chapt.275 Chapt. 111 __other
Type of Application: Wetland
__Administrative__Emergency
Coastal Erosion Amendment
Pre-Submission __Violation
Info needed:
Modifications:
Conditions:
Present Were: ¢~J. King ,'~. Ghosio ¢'/D. Bergen,
v/J. Bredemeyer. ,-~ Michael Domino D. Dzenkowski__
Form filled out in the field by
Mailed/Faxed to:
Date:
other
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. 3815.
ISSUED TO ..,....,Ed.~,'a~d F~rg:u...~ ................... ! ~.~.,
Aut'h.r zati fl-
Pursuant to the provisions of Cha
the State of New York. '1~
Sfa~ of New Yo~ 19~ ~own eh-
'titled "RE~U~TIN~ AND THE ~INGr OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS a~
REMOVAL: OF S~ND. G~VEL~' ~ O~HER UATERIALS FROM
LANDS U~DER TOWN WA~RS~' and in accordance with the
Resolution of ~he B~rd adOpted at a meeting held on
19 89 , and in consideration of the sum of $ paid by
~8
DEC - 5 2012
of .................................................. N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof.
of Soufhold Town Trustees authorizes and permits the 'following:
To construct 4' X Z0' fixed dock. 4' X 16~ ramp, two 6'
X 16' floats, instal/ 9 pilings on property located on
R.O.W. off Nc~th Bayvzew Road, Southoldo
all ;n accordance wlth the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be at,xed, and these presents to
be subscribed by a majority of the send Board as of this date.
-/
_/
N
IZ' ORAV~L
FRENCH DRAIN
(!60'
(380
A~EA CF WETLANDS=3,,362 SQ. FT.
~,302 SQ. FT. - ~,362 SQ. FT, =59,g~0 SQ. FT.
LOT CO~RAGE 3,228 SQ. FT.
PE~CENT LOT COVERAGE 3,228 / 59,9~0=5.~
DRIV~
T~ST HOLE DA TA
1989
'LOOD ZONE LINES FROM FIRM J6/oJCO166 0 MA Y 4, ~998
LEVA PONS REFERENCED TO N.G. Y.D.
Ol~ fotT?///<Tr w/th the STANDARDS FOR APPROVAL
ND CONSTRUCT/ON OF SUBSURFACE SEWAGE
/SPOSAL SYSTEMs FOR SINGLE FAMILy RESIDENCES
~d ~#/ obMe b/ ~he oosd/Uons se~ forth ~here/n and on
~rm/t ~o cosstrucL
7e /coot/oD of we//~ odd cesspoo/s shown hereon ore
om f;e/d observoUoas odd or from data obtained from others,
~Y AL~AU~ OR ADD/DON TO ~IS SURly IS A WOLADON
~ SECDON 7209 OF ~E NE~ ~K STA~ EDUGAU~
'~PT AS PER SECUON Y2Og-SUBDIW~ON Z AiL OEBDFICADONS
'FE~ A~ VAUD FOR THIS MAP AND COP/ES ~f~f~ ONLY IF
,ID MAP ~ C~/ES BEAR ~E IMPRESSED SEAL ~ ~E SU~YON
IO~ S/GNA ~RE APPEARS HEREON.
'EA' 3, J02 SQ. FE =LA SEt
TO DE LINES A=WETLAND FLAG
CERTIFIED TO:
DAVID C, PAGE
BARBARA SHINN
STEWART TITLE INSURANCE COMPANY
~) =DRY WELL
[] ...... =PROPOSED CONTOUR_.
SEPT. 5, 2006 (REVISIONS)
OCT. 15, 2006 (REPLOT HSE.)
DEC. 19, 2006 (FRENCH DRAIN, CONTOUR, FILL CALC,)
OCT. 17, 2007 (REPLOT HSE.)
OCT, 50, 2007 (DRYWELLS)
SEPT, 11, 2008 (SPOT ELS)
OCT. 6, 2008 (REViSiONS)
APRIL 20, 2010 (CERTIF$CATIONS)
OCT, 7, 2011 (,REPLOT HSE.)
JUNE 1. 2012 (NEW SANITARY SYSTEM DESIGN)
JUNE 15, 2012 (SANITARY REVISION)
JULY 14. 2012 (NEW SANITARY SYSTEM DESIGN)
AUGUST 17, 2012 (REVISED BUFFER DESCRIPTION)
SURVEY OF PROPERTY
A T BA YVIE~r
TO ~rN OF SOUTHOLD
SUFFOLK COUNTY, N.
1000- ?0-1Z'-$9.?,
$CAL~: 1'--50'
FEBRUARY 20, 2004
JANUARY 6, 2005
SEPTEMBER 9, 2005 (Loc. wetlond$ flags, revi$$ prop. hou$$,
NOV. g, 2005 (REVISIONS)
FEB, 2, 2006 (ADDITIONAL LATH)
MARCH 22, 2006 (ADDITIONS)
MAY 18, 2008 (REVISIONS)
\
\
PROPOS'EO ~'~FIAC¢. DISPOSAL SYSTEM.(2 BEDROOMS)
f¢/ ~'D£EP LEACHING POOLS WITH 3' SAND COLLAR
BOTTOM OF LEACHING POOLS TO BE 2' ABOVE GROUND WATER
APPROXIMATELY 152 cu. ff. OF FILL REQUIRED.
SUBSURFACE SEWAGE DISPOSAL SYSTEM DESIGN BY:
EDWARD ARMUS ENGINEERING
56 DEER RUN
WATERMILL, NY 11976
/t~EOON/C ~SL)'t~'EYORS, P.C.
(631) 765-5020 FAX (631) 765-
P.O. BOX ..°,09
1230 TRAVELER STREET
SOUmOLO, N,~ ~97~ U~--~
+ rr :.'��.. �.r>: ''\\''i�i _�•�!u �r , �J!lr �� \ !':i^v�q�sft�SA� �'
i
Board Of Southold Town Trustees !`
�i SOUTHOLD, NEW YORK
_
PERMIT NO. ...3.8.1.5..................... DATE: ...S.ept.w...2.8. 1989 - 4,.... It,
SU T ...........d......................... ...................................................... . ...........................
� IS ED O E ward Fergus
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 ;k .
y 'I State of New York 1952; and the Southold Town Ordinance en- !: c`•:: `,
,•..:. tl titled REGULATING AND THE PLACING OF OBSTRUCTIONS ! ,.
IN AND ON TOWN WATERS AND PUBLIC LANDS and they
W
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
r ; LANDS UNDER TOWN WATERS;" and in accordance with the F
;:..; Resolution of The Board adopted at a meeting held on .S.ept......2.8....
19....8.9..., and in consideration of the sum of $............................. paid by
of .......................................................................................... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
gal of Southold Town 'Trustees authorizes and permits the following:
To construct 4' X 20' fixed dock, 4' X 16' ramp, two 6'
X 16' floats, install 9 pilings on property located on y -
>• R.O.W. off North Bayview Road, Southold.
,,,`,�': #,1 all in accordance with the detailed specifications as presented in '.
the originating application.
I" -
�, i
IN WITNESS WHEREOF The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this date. /y
t
Ln
f
........-... ...............
p
I
\ t ....e `,..ea�,��"�-:i.rt steer ,:a r Jr...:,t >`r� i r :a'i.%�'' 'w • -•• 11&, il1Am._ :_fir A i?Ki7N�,, A` y'�WRr"\ \:. -/ * �}r �' , y ., _
TERMS and CONDITIONS'
The Permittee —_ Edward Fergus
residing at 5 Haig Drive, Dix Hills, NY 11746 N. Y, as
pan of the consideration for the issuance of the Permit does understand and prescribe to the fol-
lowing:
i. That the said Board of Trustees and the Town of Southold are released from any and
all damages, or claims for damages, of suits arising directly or indirectly as a result of any open
ation performed pursuant to this permit, and the said Permit-tee will, at his or her own expense,
defend any and all such suits initiated by third parties, and the said Permittee assumes full liability
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
2. That this Permit is valid for .a period of 24 mos. which is considered to be the
estimated 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.
3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that auth-
orization was originally obtained.
4. 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
revocation of this Permit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along
the beach between high and low water marks.
7. 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
work shall cause unreasonable obstruction to free navigation, the said Permittee will be required,
upon due notice, to remove or alter this work or.project herein stated without expenses to the Town
of Southold.
8. That the said Board will be notified by the Permittee or the completion of the work auth-
orized.
9. That the Permittee will obtain all other permits and consents .that may be required sup-
plemental to this permit which may be subject to revoke upon failure to obtain same.
L
TRUSTEES OSUFFO�,�c SUPERVISOR ,
John M. Bredemeyer, III, President 0�. pG SCOTT L.HARRIS
Albert J. Krupski, Jr.; Vice President
Henry P. Smith y Town Hall
John B. Tuthill 0 53095 Main Road
William G. Albertson. y �� P.O. Box 1179
Telephone (516) 765-1892
Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
December 22, 1993
Edward Fergus
3 Haig Drive
Dix Hills, NY 11746
RE: SCTM #1000-70-12-39. 3
Permit #3815
Dear Mr. Fergus:
The following action was taken by the. Southold Town Board of
Trustees on Tuesday, December 21, 1993 :
WHEREAS, the Board of Trustees have received concerns of
.possible navigation problems from neighbors, and
WHEREAS, the current dock does not meet the requirement of not
more than 1/3 the distance of the channel`,
It is RESOLVED that the Southold Town Board of Trustees require
the catwalk to be moved landward eight feet (81-) .
If there are any further questions, please do not hesitate to
contact this office.
ay truly yours,
ftp- -7
ohn M. Bredemeyer, II
President, Board of Trustees
JMB:jmd
cc: En-Consultants
TRUSTEES ®�. �� SUPERVISOR
John M. Bredemeyer, III, President �� ��� SCOTT L.HARRIS
Albert J. Krupski, Jr., Vice President .
Henry R Smith ZZ�� ® Town Hall
John B. Tuthill 53095 Main Road
William G. Albertson �0,{ ��® EO. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 23, 1992
Roy L. Haje
En-Consultants, Inc.
1329 North - Sea Road
Southampton, NY 11968
Re.: Edward Fergus
Permit *3915
Dear Mr. . Haje
.The following action was taken by the Board of. Trustees at their
regular meeting of October 22, 1992:
Resolved that the Southold Town Board of Trustees grant a one
year extension for the construction of a dock to expire Sept.
28, 1993 . This is the last extension on permit #3815.
If you have any questions please contact our office.
. Very truly yours,
e' tea=
John M. Bredemeyer, III
President, Board of Trustees
av
JMB:djh
FRANK A. KUJAWSKI TR. President
ALBERT J. KRUPSKI, JR., Vice-President lt TELEPHONE
.-'.O
�•- s�R+ '-k'` (516) 765-1892
QY iti�i v',ir ?
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
June 23 , 1989
To Whom It May Concern:
Attached hereto is a Short Environmental Assessment Form
submitted by En Consultants on behalf of Edward Fergus for a wetland
permit to construct a timber dock consisting of a 41x20 ' fixed,
Elevated (4 ' above grade of marsh) walk; 4 ' x 161 ramp; (2) 6 ' X 16 '
floats; house, deck, pool, and sanitary system on property located
North Road, Southold.
Frank A. Kujawski, Jr.
President
Board of Town Trustees
Posted: June 23 , 1989
Nk
FRANK A. KUJAWSKI TR. President =� y
ALBERT J. KRUPSKI, JR., Vice-President w �= TELEPHONE
JOHN M. BREDEMEYER, III �' .y�o` (516) 765-1892
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
June 23 , 1989
Mr. John Holzapfel, Chairman
Southold Town Conservation Advisory Council
Southold Town Hall
Main Road
Southold, New York 11971
Dear Mr. Holzapfel:
Transmitted herewith is application No. 6-6-89-70-12-39. 3 for a
Wetland Permit submitted by En Consultants on behalf of Edward
Fergus.
Please prepare a written report of findings and recommendations
with respect to this application.
Very truly yours,
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:jas
cc: Bldg. Dept.
�o�oSUFFo�,��oG
TRUSTEES
John M.Bredemeyer,III,President c y� SUPERVISOR
Henry P. Smith,Vice President c SCOTT L.HARRIS
Albert J.Krupski,Jr.
John L.Bednoski,Jr. yWN �► � 53095T _Main Road
Hall
John B.Tuthill
P.O.Box 1179
Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971
Fax(516)765-1823 TOWN OF SOUTHOLD
June 11, 1991
En-Consultants, Inc.
1329 North Sea Raod
Southampton, NY 11968
RE: Edward Fergus
Permit #3815
Dear Mr. Haje:
The following actions were taken by the Southold Town Board of
Trustees on June 6, 1991:
RESOLVED that the Southold Town Board of Trustees approve the
request for an extension to permit #3815 to expire on September
28, 1992.
If you have any questions, please do not hesitate to contact
this office.
Very truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB:jmt
O
FRANK A. KUJAWSKI, JR., President TELEPHONE
ALBERT J. KRUPSKI, JR., Vice-President Lr (516)765-1892
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR. o! y`a
HENRY P. SMITH
BOAR
D OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
October 16, 1989 '.
En Consultants
1329 North Sea Road
Southampton, N.Y. 11968
RE: SCTM 1000-70-12-39.3
Dear Mr. Haje:
The Trustees reviewed your application submitted on behalf
of Edward Fergus to construct a single family dwelling with
associated sanitary system, deck and pool outside of 75' from
wetlands on property located on Goose Creek, Southold, NY.
After an on site inspection by the Board of Trustees it .was
determined that this project is out of Trustees jurisdiction.
All other approvals that may be applicable should be secured
prior. ,to the commencement of the project.
Very truly yours,
4�y
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:j as
cc: Bldg. Dept.
file
cqe-
o � .
FRANK A. KUJAWSKI, JR., President TELEPHONE
ALBERT J. KRUPSKI, JR., Vice-President .` (516) 765-1892
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
October 10, 1989
En Consultant:
1329 North Sea Road
Southampton, N.Y. 11968
Re: Application No. 6-6-89-70-12-39.3 - Edward Fergus
Dear Mr. Haje:
The following action was taken by the Board of Town Trustees
during their regular meeting held on September 28, 1989 regarding the
above matter:
WHEREAS, .En Consultants on behalf of Edward Fergus applied to the
Southold Town Trustees for a permit under the provisions of the
Wetland Ordinance of the Town of Southold, application dated June 23 ,
1989 and,
WHEREAS said application was referred to the Southold Town
Conservation Advisory Council for their findings and recommendations,
and,
WHEREAS, a public hearing was held by the Town Trustees with respect
to said application on September 28, 1989 at which time all
interested persons were given an opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are familiar
with the premises in question and the surrounding area, and,
WHEREAS, the Board has considered all the testimony and documentation
submitted concerning this application, and,
WHEREAS, the Board has determined that the project as proposed will
not affect the health, safety and general welfare of the people of
the town,
NOW, THEREFORE BE IT
RESOLVED that En Consultants ON BEHALF OF Edward Fergus BE AND
HEREBY IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO:
Construct 4' x 20' fixed dock, 4' x 16' ramp, two 6 ' x 16' floats,
install 9 pilings on property located on R.O.W. off North Bayview
Rd. , Southold, N.Y.
C
This permit will expire two years from the date it is signed if
work has not commenced by said date. Fees must be paid and permit
issued within six months of the date of this notification. Two
inspections are required and the Trustees are to be notified upon
completion of said project.
Please return to the Building Department for a determination on
the need for any other permits which may be required for this project.
Permit will be issued upon payment of the following fees for
work to be done below Mean High Water Mark:
4 ' x 14 catwalk $ 84.00
4 ' x 16' ramp 96. 00
6 ' x 16' float 144. 00
6 ' x 16 ' float 144. 00
9 pilings 225.00
total fees $693 .00
Very truly yours,
/ J
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK: jas
cc: Bldg. Dept.
Conservation Advisory Council
file
s(:5-16A 765.1892
BOARD OF •r()a'N •I'l?t STEL
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road1� ��
P.O. Box 728
Soutliold, New York 11971
APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES, TOWN OF SOUTHOLD, SUFFOLK
COUNTY, HEW YORK, FOR THE ISSUANCE OF A PERMIT PURSUANT TO THE LAWS,
ORDINANCES AND REGULATIONS GOVERNING THE COASTAL AND INTERIOR WETLANDS,
FLOOD PLAINS AND DRAINAGE AREAS OF SOUTHOLD TOWN, AND THE ISSUANCE OF
PERMITS PURSUANT TO CHAPTER 32 OF THE CODE OF THE TOWN OF SOUTHOLD.
APPLICATION NO. - - �o-�o� -� •3 DATE June 19 , 19 8'9.:_.
APPLICANT' S NAME: Edward Fergus TEL. NO. 586-6095
MAILING ADDRESS: North Road, Southold, New York 11746
AGENT: En-Consultants., Inc. TEL NO. 283-6360
AGENT ADDRESS: 1329 North Sea Road, Southampton, New York 11968
PERMIT REQUESTED TO: SEE ATTACHED
LOCATION OF PROPERTY FOR REQUESTED PERMIT: North Road, Southold
HAMLET: - Bayview
TAX MAP NO: 1000- 70-12-39 . 3
CREEK, BAY OR HARBOR FRONTING PROPERTY: Goose Creek
SIZE OF PROPOSED WORK: _- ---
LENGTH: See project description.
WIDTH:
YDS. .TO BF' EXCAVATED: 0 YDS. TO BE FILLED: 300
MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED:
Trucked in, dumped and graded
WIDTH OF CANAL, CREEK OR BAY FRONTING PROPERTY: 300+
DEPTH AT LOW TIDE: 2 .5 ' AVER. RISE IN TIDE: 2.5 '
= DISTANCE TO NEAREST .CHANNEL: 100+'
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN AREA:
AREA ZONING: Residence A IS PROJECT FOR PRIVATE OR BUS. USE: Private
INTENDED USE OF PROPERTY: Residence
DESCRIBE KNOWN PRIOR OPERATIONS CONDUCTED ON PREMISES:
Site appears to have been used for spoil in the past.
HAS ANY PRIOR LICENSE OR PERMIT BEEN ISSUED TO ERECT STRUCTURES, DREDGE,
DEPOSIT FILL ON SAID PREMISES: None known -'- -'
HAS ANY LICENSE OR PERMIT EVER BEEN REVOKED .OR SUSPENDED BY A GOVERNMENTAL
AGENCY: No
DESCRIBE FULLY THE REHABILITATION OF PROPERTY:
None proposed.
DESCRIBE PROPOSED CONDITION OF PROPERTY AFTER WORK IS COMPLETED. INCLUDE
AN ADDITIONAL SURVEY OF PROPERTY SITE .IF NECESSARY: N/A
ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED WHICH WOULD PROHIBIT
THIS PROJECT: None known.
WRITTEN CONSENT OF OWNER IF NOT THE SAME AS APPLICANT:
See attached.
12
. PROJECT I.D.NUMBER 617.21 S EQ
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 I 2. PROJECT NAME
Edward Fergus by En-Consultants, Itpc.
J. PROJECT LOCATION: —
Municlpalily North Road, Southold county Suffolk
4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map)
North Road, Southold
SCTM 1000-70-12-39 . 3
5. IS PROPOSED ACTION:
ONew ❑Expanslon ❑Modlllcatlonialteratlon
{ 6..DESCRIBE PROJECT BRIEFLY-
It
See Attached
I
7. AMOUNT OF LAND AFFECTED: --
Initially 53, 000 sq, c r4 Ultimately 53 , 000 sq_ft�r////
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OH OTHER EXISTING LAND USE RESTRICTIONS'
LJ Yes ❑No 1.1 No,describe briefly _
1
9. WHAT IS PRESENT LAt.0 USE IN VICINITY OF PROJECT7
DI Flesrdential ❑lndustrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other
Describe:
P
TION INVOLVE A PERMIT APPROVAL. OR FUNU:t4G, NOV4 OH ULiiMA;LLY FROM ANY OTHi H GO`.'! R.'O.ENTAL AGE,1JCY 1F[DER:,L
a LOCAL)?Yes No If yes, list agency(s) and oermitlapprovals
OE, DOS
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes M0 If yes,list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITlAPPROVAL REQUIRE MODIFICATION?
❑Yes (25 No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE'
Applicant/sponsor name:;,ard F rgus by En-Consultants, Inc. 6/16/89
\ Date:
Signature:
I
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 -
r i
PROJECT DESCRIPTION
Construct a timber dock consisting of a 4 ' x 20 ' fixed,
elevated ( 4 ' above grade of marsh) walk; 4' x- 16 ' ramp;
(2 ) 6-' x 16' floats.
Owner also intends to construct a house, deck, pool,
sanitary system, etc. , all as shown on attached site
`. plan. However, it is our belief that .these are all in
excess of 75 ' from water/wetland and:, therefore, Trustees
jurisdiction. Please confirm by letter or' process with
request for dock should you disagree.
COUNTY OF SUFFOLK )
STATE OF NEW YORK )
4�.
BEING DULY SWORN DEPOSES
AND SAYyS THAT HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS, AND
N THAT ALIT STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE
- AND BELIEF, AND THAT 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
TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT, IF GRANTED.
IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE _THE TRUSTEES, THEIR',
AGENT OR REPRESENTATIVE, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES
IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
SignaturO of App icant
SWORN TO BEFORE ME THIS DAY OE 19
NOTARY PUBLIC
EXAMINED BY
APPROVED
DISAPPROVED
CONDITIONS ( If any)
SIGNATURE OF CHAIRMAN
COMPUTATION OF FEES
Approved 2/27/85
/ t # , \ ¥ w a \ TRUSTEES.Aw"k
\ 'k�\ \ \ / / ` / � � � � � \ �. ` �, 2
�� � . e: z & yZ »� . -
/ «
o
Issued To-- Qwwa vate
� � .
A. . � 2e - ». 2aw-o za . k% Y!dAj :z«AM& . .
THIS NOTICE MU _ BE DISPLAYED DURING CONSTRUCTION
TOWN T ► ` OFFICE TOWNOF SOUTHOLD
SOUTHOLD, N.Y.
EDWARD T. FERGUS
5 Haig Drive
Dix Hills, NY 11746 �
lip gg i'YY
L[iH,�� APR 61990
April 3, 1990
Mr. Frank A. Kujawski, Jr.
President
Board of Town Trustees
Town of Southold
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
Dear Mr. Kujawski, Jr. :
Attached . is my check of $693 . 00 in payment of the fee due
your office in connection with the dock permit covered in the
attached October 10, 1989 correspondence from your office.
Thank you.
Sincerely,
ETF:pd
cc: En Consultants - c/o Mr. Roy Haje
r
ENVIRONMENTAL
SERVICES
SEP 1 8 1992 U,
UTHCRAIJ
EN-CONSULTANTS, INC. - �r
1329 NORTH SEA ROAD, SOUTHAMPTON, NEW YORK 11968 516-283-6360
FAX NO. 516-283-6136
September 16, 1992
Board of Trustees
Town of Southold
53095 Main Road
Southold, New York 11971
RE: EDWARD FERGUS - Permit No. 3815
Dear Board Members:
The above-referenced permit will expire on September 28,
1992 .
Due to various delay, work has not commenced on this
project. .
We, therefore, request an extension of at least one year.
Thank you for your anticipated cooperation.
Ve truly yours,
Roy Haje
Pre dent
RLH:KD
6 ENVIRONMENTAL
SERVICES
---�- ' G 1991
TOWN OF SOUTHOLD
EN-CONSULTANTS, INC.
1329 NORTH SEA ROAD, SOUTHAMPTON, NEW YORK 11968 516-283-6360
FAX NO. 516-283-6136
April 24, 1991
Mr. John Bredemeyer
Southold Town Trustees
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
RE: Edward Fergus Permit # 3815
Dear Mr. Bredemeyer:
Due to financial constraints, Mr. Fergus will be unable to
construct his dock before the above referenced permit expires on
September 28, 1991. We respectfully ask for an amendment to the
permit extending in for one year from its expiration (September 28,
1992) .
Thank you for your consideration.
Yours truly,
Roy Haje
President
cc: Edward Fergus
il_IL_ 1 !J '-R..1-111 DR.' i-Ui l'= riL SAI1`i' 11`i' PA6E . lil=t
N'ew York State Department of Environmemal Cr�n��ry � 1� =
r,
A5 `ialf Road. Albany Now York 12233 �..�- �.'.�� 'w;V::l; ` �.'.���.D
Thomas C. Jorfing
Commissioner
Cyr ev
D e a r Ae—Q/f
RE: LEAD AGENCY COORDINATIQf1 REQUEST
The purpose of this request is to determine under Article 8- (state Env- ren-
men tal Qua i ty review - SEQR) of the EnV4
ironmental Conservation Law and 6 NYCRR
Part 617 the following:
.. I . `:'our agency' s interest in acting as lead ag6-ncv:
2 Your agency' s jurisdiction in .tre action described 'below' and
3. issues of concern which your -a-gency believes should be evaluated.
Encl G'sed "= a CGP-j of ^the Permit application and a cor,,pl eted Part 1 of the
Er:, i rar men gal Assessment Form to assist yo--, in responding.
Project Name:
Project Location: ;�I`-�� ��rx.c�, u(�('A0 �� r�'��a`�'_ C�f:'�r� ��D su '�'Yc�'.:�, (J�
DEC Project Number
C=-C Permits:
SE: P. C1a�S1i'�::ar1Jn : N\I wee 7 J,nliS P� ! �.�it•ll�.��'r� (!1 1_. {l /S �;
C o n t a c t P e r o n: EC%!(��i f) 1 ��',.t.j�:i G-
�C•: POSitior.
v L.E C. ;s n'- 'JP;'r Q o your r e 'y C' Other agencv ass g lead ag E'r.c-f
J VGA.u5 -F th1 4vUien� b;��. resery-s the r'�^L to z,;D tment on this action � I
C~.cte,-,-, nation l?f sigi i i iC_anc? 1 made-
JL !L _3 11 FR.01.1 EF-W C -.HS AL t=if..l HY F'!!GE 01_1
' r
-2-
DEC has no objection to your agency or another agency assuming lead agency
status for ;his action, but we _Have•,the following concerns regarding this
project (see "comments" below) .
[ ] DEC wishes to assume lead agency status for this action .
[ ) The proposed action has been identified by DEC as occurring wholly or
partially within 'or substantially contiguous to a critical environmental
area (CEA) that was designated by S�c•PCo _
It is the position of this Depar6ment that ,your agency, if it has a juris-
diction over the action, should assume the lead agency role based on the
existence of th,e CEA and the tact that the anticipated impacts are
primarily of )veal significance.
[ ] Other. (See comments below)
Comments (Optional ) : ,
4o �r �C'4 /' /c_(�'OG✓
C.
Response:
Please respond to this request within 30 days of the date of this letter.
it ;i0 response is received within 30 days, we will assume that you have no
objection to DEC or another agency assuming the role of lead agency, and have no
comments to offer regarding the proposed action at this time. t-! t?ej char
-�gy—r,o-r�--and--o-th.e�it:,ua�red--�-ae-ncy;i-n�-tad•;�g---Q.E.C...-.�a_s_ir�.d�_ca�ed---a-i�i�1-
t e r•-v e-a s -+-ee-a d a gsgc-y--V4th+rr 30 days--O-f 1--s-d et e r:
[ ] t•!e ,•ii\11ppet!ti on the Commi ss i over of DEC�o designate_a •iead agency
for tti ora -t ] We wlti t i on the rommi Ssi onAr of �i`-��0 'Gies i anate, your agency as
lead(,' resurnLng you have ur isdict•ion.� ,t
Pl ease !eel free to contact this ,o ff_c4 for further information of
discussion .
S i n c rely,
J
Enc'osures
1.c. !see lyt'j� �•; ;uti Gil
i3
,
95.19.2(1185)
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION NUMBER
0 . APPLICATION FOR PERMIT
Read Instructions on back before completing this application. Please type or print clearly in ink. Use separate addenda and exhibits to provide all data and
explanations for which space on this form is inadequate.
❑ ARTICLE 1S,TITLE 3(CONTROL OF AQUATIC INSECTS,WEEDS„OR UNDESIRABLE FISH)
® ARTICLE 15,TITLE S(PROTECTION OF WATERS)
❑ For the construction,reconstruction,or repair of a DAM or other impoundment structure.
❑ For the disturbance of a STREAM BED or excavation in or fill of navigable waters.
❑ ARTICLE 15,TITLE 15 ❑ WATER SUPPLY ❑ LONG ISLAND WELL _
❑ ARTICLE 24(FRESHWATER WETLANDS) ❑ Permit ❑ Letter of Permission O 8 9 I
® ARTICLE 25(TIDAL WETLANDS)
1. NAME OF APPLICANT:
Edward Fergus by En-Consultants, Inc.
2. APPLICANT IS AIAN ❑ Individual ❑ Partnership ❑ Association M Corporation ❑ Municipality ❑ Governmental Agency
3. NAME AND TITLE OF OFFICIAL SIGNING APPLICATION PHONE
Roy L. Haje, President 516-283-6360
STREET ADDRESSIPOST OFFICE
1329 North Sea Road
STATE ZIP CODE
POST OFFICE
Southampton N.Y. 11968
4. NAME AND ADDRESS OF OWNER(if not applicant) PHONE
Edward Fergus 516-586-6095
STREET ADDRESSIPOST OFFICE
5 Haig Drive
POST OFFICE STATE ZIP CODE
Dix Hills N.Y. 11746
5. PROJECT LOCATION: NAME OF STREAM OR OTHER WATER BODY: 6. WILL PROJECT
a) City or Village + If appropriate; if un-named,show on map—See UTILIZE STATE-OWNED
Item 56) LAND?
North Road, Southold
Town ❑ Yes �No
Southold Goose Creek
County
Suffolk
b) Specific project site or area is marked on U.S.G.S.or equivalent map, attached as Exhibit Number
7. PROPOSED USE: 8. PROPOSED STARTING DATE: 9. APPROXIMATE COMPLETION DATE: 10. FEE OF
1'1'Private
❑ Public ❑ Commercial ASAP 1 year S 16 . 00 Enclosed
11. PROJECT DESCRIPTION:
Feet of rip-rap new channel;cubic yards of material to be removed;draining,dredging,filling,and location of disposal sites;type of structure to be installed;height
of dam; size of impoundent;capacities of propsed water sources;extent of distribution system;etc.
SEE ATTACHED
12. THIS PROJECT WILL REQUIRE ADDITIONAL,PERMITS, APPLICATIONS FOR WHICH ARE THE RESPONSIBILITY OF OTHERS:
❑ Dam ❑ Excavation/Fill ❑ Stream Disturbance ❑ SPDESINPDES ❑ Water Supply ❑ L.I.Wells ❑ Freshwater Wetland
❑ Tidal Wetlands
13..NAME AND ADDRESS OF OFFICIAL NEWSPAPER OF LOCALITY WHERE PROPOSED WORKS ARE LOCATED:
LONG ISLAND TRAVELER-WATCHMAN, Traveler Street, Southold, New York 11971
14. IS ANY PORTION OF THE ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BEGUN OR COMPLETED?
❑ Yes UNo If YES,explain in addenda, giving reasons and dates, and show existing work on drawings or map.
15. CERTIFICATION:
I hereby affirm that under penality of perjury that information pr v�d 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 Clas A misdemea or pursuant to Section 210.45 of the Penal Law.As a condition to the issuance of a
permit,the applicant accepts full responsibility for all damage,d'ect u�indite�of whatever nature,and by whomever suffered,arising out of the project described
herein and agrees to indemnify and save harmless the State fr m suits, and costs of every name and description resulting from said project.
June •16 , 1989
DATE Roy L. Haje, es idenTGNATURE
—SEE REVERSE SIDE—
INSTRUCTIONS
1. Prepare and submit four(4) copies of this application. Use typewriter or print clearly in ink.
2. Submit with the application three copies of a drawing showing location and extent of work to be done.
3. Applications by counties,cities, towns and villages shall be signed by the chief executive officer thereof or the head
of the department or agency undertaking the project.
4. The applicant may be required to publish a"Notice of Application"as provided by the Regional Permit Administrator.
5. If other,than owner'makes application, written consent of the owner must accompany application.
6. Acceptance of a permit subjects permittee to restrictions,regulations or obligations stated in application and/or permit.
7. If a public hearing is necessary, the applicant may be required to furnish the names and addresses of all adjacent
landowners and all known claimants to water rights.
8. Applications for the construction, reconstruction or repair of a dam or other impoundment structure must be
accompanied by Supplement D-1.
9. Applications for a water supply permit must be accompanied by Supplement W-1, special instructions on which
SUPERCEDE certain. of the above instructions. See "Water Supply" handbook.
10. Applications for a permit to apply a chemical to control or eliminate aquatic vegetation must be accompanied by
Supplement A-1, A-2, or A-3.
11. Question No. 12 pertains to projects involving two or more applicants. One typical example is a new subdivision,
requiring a Wetlands Permit for the developer, the project to be within a water district extension, requiring a Water
Supply Permit for the town.
12. Be sure to enclose proper application fee, noted accordingly in item 10; see Part 621, Uniform Procedures Rules,
Rule 621.4. (If in doubt, discuss with Regional Office before submitting application).
13. INCOMPLETE OR INACCURATE INFORMATION MAY DELAY PROCESSING!
INFORMATION
Application for permit to the New York State Department of Environmental Conservation is authorized by Environmen-
tal Conservation Law,Article 15(Title 3-Control-of Aquatic Insects,Weeds,or Undesirable Fish; Title 5-Stream Protection;
Title 15-Water Supply), and Article 24 (Freshwater Wetlands).
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION REGIONS
Region 1 Region 2 Region 3
Bldg. 40-Room 219 2 World Trade Center 21 South Putt Corners Road
SUNY at Stony Brook 61st Floor New Paltz, N.Y.12561
Stony Brook,N.Y.11790 New York, N.Y.10047 Attn: Regional Permit Administrator
Attn: Regional Permit Administrator Attn:Regional Permit Administrator (914)255-5453
(516)751.7900 (212)488-2758
Region 4 Region 5 Region 6
2176 Guilderland Ave. Rt.86 State Office Building
Schenectady, N.Y.12306 Ray Brook,N.Y.12977 317 Washington Street
Attn: Regional Permit Administrator Attn: Regional Permit Administrator Watertown, N.Y. 13601
(518)382-0680 (518)891-1370 Attn: Regional Permit Administrator
(315)785-2245
Region 4(Sub-Office) — Region 5(Sub-Office) Region 6(Sub-Office)
Route 10,Stamford N.Y.12167 Hudson Street,Warrensburg, N.Y.12885 State Office Building
Attn:Alternate Regional Permit Administrator Attn:Alternate Regional Permit Administrator 207 Genessee Street,Utica,N.Y.13501
(607)652-7364 (518)623-3671 Attn:Alternate Regional Permit Administrator
(315)793-2555
Region 7 Region 8 Region 9
P.O. Box 5170, Fisher Avenue 6274 E.Avon-Lima Road 600 Delaware Avenue
Cortland,N.Y.13045 Avon,N.Y.14414 Buffalo.N.Y. 14202
Attn: Regional Permit Administrator Attn: Regional Permit Administrator Attn: Regional Permit Administrator
(607)753-3095 (716)226.2466 (716)8474551
or
Region 7
7481 Henry Clay Blvd. Liverpool, N.Y.13088
Attn:Alternate Regional Permit Administrator
(315)42B-4497
' � �^p,��/mx/, p,,r~n `/ p,oi*'pnoro|er| site vvithslopes
����l�»6 �
! !15YX0 ., xn`^o', - Y6
^ Is pr-r. t 1u6S1,111haU` . "nhAuou/ to, o, contain a bvi|6io | site, or district, listed on the State or the National /
'./ Hi`|o,ir Yi'. ,s/ FlY1,5 DDNo
' Is i`r. ':hs|xn|iaU, '=h;om/s to a site listed on the Ru�=/pr o/ National Mo/oro| Landmarks? '--!Yes INo
�
Ux' J,|`(h at /).' `,a|r, u6|r/ (in fo,o
v' /vcoted over o onmary, prindpa\, or so|e source aquifer? r3Yes .2.mo '.
|(/ |)o '.n^n�. ii~hin4 ,' `|`,U fi`hing opp^rtunities pre+ent|N exist in the project »npo? X-71Yes 7No ' .
11 Do( or"ier, sit' 'n:um onv species of plant or xnim.J life that is identified as threatened cir 'endangered? ��
']\'/ According to '
,
12 Are U`~ne onv vmvo, ", vnuwa| |^nJ forms on the pn`i"u site? (i.e., cliffs, doney, other geological formations) '.
X'111' Describe
\ � |` ''w v",r, / `*' vs ,| k, the rommvnit' ", neighborhood as an open space o, recreation area?
J{.-,.'' If ''`. '`p|'"» ----- - --
14 |^^'` Ux` po``,n| ^/.' ,v|od, `/rni/ views know !' to ix` on|vnrtont to the community?
� \,.
|s / /
whichtributary
11) | ak'`, ponds. areas within o, contiguous to project area:
^. *xm, h. Size (in acres)
( |
17 |` /!^' site spp,J h` -`Ming public utilities? [lYos ,GRMn �. ..
�
,it 1/ \,` '}',, `o//v ,'o/ ' .x`.xi\v ,o`/ to oUmw ronn,/|"`n/ Yr� ilNo '
h) it Yes. vviU /mp"o`.`n`pn* hp necessary to allow connection? LJYes UNn `
18 Is 'he site |n' ntpd '` an agricultural district certified nunoant to Agriculture and Markets La°, Article 25+AA.
S,' x"n V)\ .`^,| N.: X!No
ly IS :I',(- site located Ill !)I su6standaUv contiguous to Critical Environmental Area designated puoijxnt to Article 8�
, '
n, .� ECi� on� x �\� KR �l7! IN []Mo , \ '
30 ||,' |h, `itt' over b,'', x.,J for |h, disposal of solid o, |1.van10u5 =o`(,s! []Yp* -`�o
� | '
.�
. .
B. Project Description
1 Mv ^. ^| Ji/n.`u`"v^ .v"| v.`|, of |`,"i,,t (fill in dimrnsiox` as appropriate) '
l 5 �
./ |"u| .vnoxovv. .^ m`x, ^xnrd "r 'on�roUrd hv ow/n�� `pnn,o, -_���_---�_ o,n'`
I, |`,oiert n,wage ,' h, dr`Joprd: -- . 45�----- ^/,v^ mihvUv; -��4 -9__---- or,,` u|hm.o,|y
. r,oi,n arrpxx, ''' 'rnmic Undeveloped --�1.-05 acres.
'! L,n0{6 of p,oip' : /n miles: -�N/A_----- (If appropriate)
.. !t the project i' /n ,,pxnsinn, indicate percent ofeu`xnsion proposed - N/A-_-_ 010, ; `
/ �unn6,r of nfi'`!'rt porimg spaces exisdngn proposed ----��--__--
' 4 %A^`mn.n' `rhi. '/�.n m/,-; lzencra,ed per hour __-t�-_ (upon completion of project)?
|` :/ ,,`xi,`:o.J y'^,i^`, ."`.! |q`r Of hou'inx units:
`p, | a'ni|r Two 1-ami|r -Mu|hp|e Fxnni|v [»ndnmmiom
'l'n`"n`/pp` ", '' ''' "f |^ri.!rs| proposed structure he/�,ht: 42�-- width. - 5 ) r-_' length.
.J"n� thoroughfare ,
|`|i/ �hon,ux� n' ,ni,r/ =iU or' xnv i`/ U''
3
. ! .
) ,
,2. How Much natural m erial (i.e., rock, earth, etc.) will be removed from the site? (� tons/cubic yards
3. Will disturbed areas be reclaimed? ❑Yes ❑No [—)N/A
a. If yes, for what intended purpose is the site being reclaimed?
I) Will topsail be slockpiled for reclamation? Flyes IINo
Will upp(•i •.ul:,(nl Iw ..li:: Im If-( lani.1lionl I [Yv-. i INS)
4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? . 35 acres.
5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
❑Yes X]No
6. If single phase project: Anticipated period of construction 12 months, (including demolition).
7. If multi-phased: N/A
a. Total number of phases anticipated (number).
b. Anticipated date of commencement phase 1 month year, (including demolition).
c. Approximate completion date of final phase month year.
d. Is phase 1 functionally dependent on subsequent phases? ❑Yes ❑No
8. Will blasting occur during construction? ❑Yes MNo
9. Number of jobs generated: during construction '12 ; after project is complete 0
10. Number of jobs eliminated by this project 0
11. Will project require relocation of any projects or facilities? LJYes KNo If yes, explain
12. Is surface liquid waste disposal involved? C7Yes ,CJNo
a. It yes, indicate type of waste (sewage, industrial, etc.) and amount
b. Name of water body into which effluent will be discharged
13. Is subsurface liquid waste disposal involved? $]Yes ❑No Type
14. Will Surface area of an existing water body increase or decrease by proposal? ❑Yes X7No
Explain
15. Is project or any portion of project located in a 100 year flood plain? k7Yes ❑No
16. Will the.project gener.ite solid waste? MYes ❑No
I
a. It yes, what is the Lunount per month 01 tons
i
b. If ves, will an existing solid waste facility be used? Mes ❑No
c. It yes, give name Sonthol d 'Tnwn 1 anrlf i 1 1 location CIItr-haug
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ERN
e. If Yes, explain
17. Will the project involve the disposal of solid waste? ❑Yes X❑No
a. If yes, what is the anticipated rate of disposal? tons/month.
b. If yes, what is the anticipated site life? years.
18. Will project use herbicides or pesticides? RYes ❑No
19. Will project routinely produce odors (more than one hour per day)? ❑Yes IRNo
20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes X]No
21. Will project result in an increase in energy use? {]Yes ❑No
If yes , indicate tvpe(s) Oil and electricity
22 If water cupply i,; from wells, indicate pumping capacity .__ 3 gallons/minute.
23. Total anticipated water usage per day 300 gallons/day.
24 Doe, project involve Local, State or Federal funding? '-]Yes MNo
If Yos, explain
4
125. Approvals Requires 0 Submittal
Type Date
City, Town, Village Board l_-iYes ❑No
City. Town, Village Planning Board i_]Yes ❑No
Oily, 1 mvil Zonnig Ito,ucl I IYc> 11No
City, County Health Department Mes ❑No SCDH—Rani taery System _ 6/8q
, an w
Other local Agencies &Yes ❑No _.. q ru tees 6�/g9
— we Mls
Other Regional Agencies ❑Yes ❑No
State Agencies ❑Yes ❑No
Federal Agencies ❑Yes ❑No Section 10 COE 6/89
C. Zoning and Planning Information
1 . Does proposed action involve a planning or zoning decision? ❑Yes XNo
If Ye<, indicate decision required:
L zoning amendment Uzoning variance Ospecial use permit ❑subdivision ❑site plan
1. new revision of master plan ❑resource management plan ❑other
What is the zoning cla,;sification(s)of the site?
S. What is the maximum potential development of the site if developed as permitted by the present oning?
--- — N/A
4. What is the proposed zoning of the site? N/A
5 What k thr 111axImUm potential development of the site if developed as permitted by the proposed zoning?
( 1 ) one—family dwelling
b Is the proposed action consistent with the recommended uses in adopted local land use plans? ®Yes ❑No
7 What are the predominant land use(s) and zoning classifications within a '/4 mile radius of proposed action?
one—family dwellings
8 Is the proposed action compatible with adjoining/surrounding land uses within a '/4 mile? 29Yes ❑No
9. If the proposed action is the subdivision of land, how many lots are proposed? N/A
a. What is the minimum lot size proposed?
10 Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes ilNo
11 . Will the proposed action create a demand for any community provided services (recreation, education, police,
fire protection)? f-,Yes L-X4o
a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes ❑No
12 Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes MNo
a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes ❑No
D. Informational Details
Attach any additional information as may be needed to clarify your project. If there are or may be any adverse
impacts w,soc.iated with your proposal, please discuss such impacts and the measures which you propose to mitigate or
avoid theln.
E. 'Verification
certify that the inform7t�on proviLd_f.d above is true to the best of my knowledge.
Applicant Sponsor Name Ro �? ria •e En—Consultants Inc. Date 7/19/87
Signature Title PYPsi dent
If the action is in the Coastal Area, and you aie a state.agency, complete the Coastal Assessment Form before proceedkng
with this assessment.
5
PART 1—PROJECT INFORMATION
Prepared by Project Sponsor
NOTICE: This document is designed to assist in determining whether the action proposed may have a significant
on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be consi
as part of the application for approval and may be subject.to further verification and pu`61ic review. Provide any addi
information you believe will be needed to complete Parts 2 and 3.
It is expected that completion of the full EAF will be dependent on information currently available and will not in
new studies, research or investigation. If information requiring such additional work is unavailable,so indicate and sG
each instance.
NAME OF ACTION
LOCATION OF ACTION(Include Street Address,Municipality and County)
North Roadi Southold
NAME OF APPLICANT/SPONSOR
Ro L. Ha e -. President BUSINESS TELEPHONE
ADDRESS (516) 283-6360
1329::.North::Sea Road
CITY/
Southampton STATEJ_ z:1'P11C9O
DENAME OF OWNER(It different) N•Y 6 8
Edward FergLls BUSINESS TELEPHONE
ADDRESS (516) 5e-f-�6-Qn�},
CITY/PO
STATE ZIP CODE
DESCRIPTION OF ACTION N•Y.. 1 -7 4 6
I _
SEE ATTACHED.
Please Complete Each Question—Indicate N.A. if not applicable
A. Site Description
Physical setting of overall project, both developed and undeveloped areas.
I. Present land use: DUrban E3Industrial ❑Commercial Residential (suburban) ❑Rural (non-t.
❑Forest ❑Agriculture OOther
1. Total acreage of project area: 1.5+
acres.
APPROXIMATE ACREAGE
Meadow or E3rushland (Nort agricultural) 1.5 PRESENTLY AFTER CO,'IPLETIO-
Forested acres 1 . 3
acre
acres : acre
Agricultural (Includes orchards, cropland, pasture, etc.)
acres
Wetland (Freshwater or tidal as per Articles 24. 25 of ECL) a acre
acres
Water Surface Area acre
Unvegetated (Rock, earth or till) acres acre
Roads, buildings and other pavedpavedsurfaces acres acre
i - 1
Other (Indicate type Landsca) P n9 acres acre
acres . l
3. What is predominant soil type(s) on prop-ct site! Sand acre
a. Soil drainage: [3Well drained 90 �o of "ite E:Moderately well drained 8
L�Poorly drained 2 of site
90
b. If any aI n —� of site
eultural land Is involved, how rnany acres or soil are cl,is,ilwd within ,oil Troup 1 throur;h .I i,l th,•
Land Classirlcathon System, No acres (fee I NYCRR 370)
4. Are there bedrock outcroppings on project site?
11Yes C,vo
a. what is depth to bedrock? Unknown
(in feel)
2
5. Approximate percentage of proposed project site with slopes: CO-10 100 070 15"0
015"0 or greater %
6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the Natio,
Registers of Historic Places? Dyes ONO
7. is project substantially contiguous to a site listed on the Register of National Natural Landmarks? Oyes C:
8. What is the depth of the water table? 5 (in feet)
9. Is site located over a primary, principal, or sole source aquifer? NYes ONO
10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? MYes ❑No
11. Does project site contain any species of plant or animal life that is identified as threatened or endangere
Oyes ffNo According to
Identify each species
12. Are there any unique or unusual.land forms on the project site? (i.e., cliffs, dunes, other geological formatior
Dyes llo Describe
' 13. Is the project site
P I presently used by the community or neighborhood as an open space or recreation are:
Dyes tNo If yes, explain
14. Does the present site include scenic views known to be important to the community?
Oyes X)No
15. Streams within or contiguous to project area:
a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland areas within or contiguous to project area:
a. Name Goose Creek
b. Size '(In. acres)
17. Is the site served by existing public utilities? Oyes ®No
a) If Yes, does sufficient capacity exist to allow connection? CjYes ❑No
b) If Yes, will improvements be necessary to allow connection? Oyes ENO
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-Aa
Section 303 and 304? OYes MNo
19 Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to ,\rticle
of the ECL, and 6 NYCRR 617? ( Yes ONO
20. Has the site ever been used for the disposal of solid or hazardous wastes? Dyes IZNo
B. Project Description
1. Physical dimensions and scale of project (fill in dimensions as appropriate)
a. Total contiguous acreage owned or controlled by project sponsor 1�5 acres.
b. Project acreage to be developed: • 2 acres initially; acres ultimately.
c. Project acreage to remain undeveloped 1. 3 acres.
d. Length of project, in miles: (If appropriate)
e. If the project is an expansion, indicate percent of expansion proposed
f. Number of off-street parkins~ spaces existing proposed �
g. Maximum vehicular trips generated per hour 6
(upon completion of project)?
h. If residential: Number and type Of housing units:
One Fancily Two f••rmrly Multi rle Family
Initially 1 j Condominium
lllhmately 1
i. Dimensions (in reet) of largest proposed structure 35
height; 30 width: 5 length.
j- Linear feet of frontage along a public thoroughfare project will occupy is? -- ft.
3
2. How much natural material (i.e., rock, earth, etc.) will be removed from the site? 0
3. Will disturbed areas be reclaimed? — tons/cubic I yard,
Oyes ONO �lN/A
a. If yes; for what intend..,:.purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? Dyes ONO
C. Will upper subsoil be stockpiled for reclamation? Dyes ONO
4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? 1
S. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
Dyes K]No
6. If single phase project: Anticipated period of construction S
months, (including demolition).
7. If multi-phased:
a. Total number of phases anticipated NSA (number).
b. Anticipated date of commencement phase 1 month
c. Approximate completion date of final phase month year, (including demolition)
d. Is phase 1 functionally dependent.on subsequent phases? Oyes ONO year.
8. Will blasting occur during construction? Oyes. MNo
9. Number of jobs generated: during construction 12 0
after project is complete
10. Number of jobs eliminated by this project 0
11. Will project require relocation of any projects or facilities? Dyes MNo If yes, .explain
12. Is surface liquid waste disposal involved? Dyes Of"o
a. If yes, indicate type of waste (sewage, industrial, etc.) and amount
b. Name of water body into,which effluent will be discharged
13. Is sub urface liquid waste disposal involved? Myes ❑No Type Sewage
14. Will-surface'area of -an existing water body increase or decrease by proposal? Dyes
X1No
Explain
15. Is project or any portion of project located in a 100 year flood plain? MYes ❑,No
16. Will the project generate solid waste? K]Yes ❑No
a. If yes, what is the amoi:;�t per month 1 tons
b. If yes, will an existing solid waste facility be used? (NYes ON
c. If yes, give name Southold Landfill ; location Mattituek
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? Dyes
e. If Yes, explain
1N0
17. Will the project involve the disposal of solid waste? Dyes ffNo
a. If yes, what is the anticipated rate of disposal? tons/month.
b. If yes, what is the anticipated site life? years.
18. Will project use herbicides or pesticides? Dyes :K]No
19. Will project routinely produce odors (more than one hour I�er day)? Dyes NO
20. Will project produce operating noise exceeding the local ambient noise levels? Dyes )]NO
21. Will project result in an increase in energy.use? ®Yes ONO
If yes , indicate type(s) Domestic oil and electricity
22 If water supply is from wells, indicate pumping capacity 3__ gallons/minute.
23. Total anticipated water usage per day 300 gallons/day.
24. Does project involve Local. State or Federal funding? Oyes PgNo
If Yes, explain
4
25. Approvals Required: Submitta`.
Type Date
City; Town, Village Board Dyes ONo
City,'Town. Village Planning Board Dyes ❑No
City, Town Zoning Board Dyes ONo
City, County Health Department IXYes ONo =H, Sanitary system 6/89
Other Local Agencies Dyes ❑No
Other Regional Agencies Dyes ONo
State Agencies ffYes ONo DEC TW _ 6/89
Federal Agencies ffYes ONo COE, Section 10 6/89
C. Zoning and Planning Information
1. Does proposed action involve a planning or zoning decision? ❑Yes MNo _
If Yes, indicate decision required:
Ozoning amendment Ozoning variance Ospecial use permit ❑subdivision Osite plan
Onew/revision of master. plan ❑resource management plan Oother
2. What is the zoning classification(s)of the site? Residence A
3. What is the maximum potential development of the site if developed as permitted by the-present zoning?
One house
4. What is the proposed zoning of the site? N/A
S. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
N/A
6. Is the proposed action consistent with the recommended uses in'adopted local land use plans? 1 'es ❑'
7. What are the predominant land use(s) and zoning classifications within a ;: mile radius of proposed action?
Residence
8. Is the proposed action compatible with adjoining/surroundin� land uses within a /. mile? MYes C'
9. If the proposed action is the subdivision of land, how many lots are proposed? N/A
a. What is the minimum lot size proposed?
10. Will proposed action require any authorization(s) for the formation of sewer or water districts? Yes ;
11 . Will the proposed action create a demand for any community provided services (recreation, education, polic
fire protection)? Dyes nNo
a. If yes, is existing capacity sufficient to handle projected demand? Dyes ONo
12, Will the proposed action result in the generation of traffic significantly above present levels? Dyes KIN
a. If yes, is the existing road network adequate to handle the additional traffic? Dyes ❑No
D. Informational Details
Attach any additional information as may he needed to clarify your project. If there are or may be any adver
impacts associated with your proposal, ple"se discuss such impacts and the measures which
avoid them. you propose to mitigate
E. Verification
I certify that the information provided above is true to the best of m kn wledge.
ApplicantlSponsor Name Edward Fergus by En—Consultants,Qlnc.
Signature R Date 6/19/89
Title President
If the action is in they
Coastal Area, and you arc a state agency, complete the Coastal Assessment Form before proceedin
with this assessment.
5
.M WHa4 IT MAY OQICERN '
I authorize -QxLsultants, Inc. to applyfor pezixdta
on uV behalf.
OA
S�TKba p ockey
1 H WW&A no
;cn,A
_ i = Ire
E[� O
r.E�T —
o js sa ��Crick se 0 " con
� so
�tioQ,e`P�N i � WY e�8 ; SCM
HOC
1 Sv,s�tK mac, HAGS-naorr
HAP
®/9TU/`I: HLCJ ^
Pu/?PpS, PRIv/aTE l3,e,q-r !✓ocK
AA.IAc,ONTRe 10
r ;� ?
0
J o U
rt�
P,QDPosc'D / 1:
,yr r ry
,3 p
� �,
� 09
LO y1�
oc / (�Ro Po Sc D Ode�C �02
Ro -rHf - Fc 2G U.3
t
- � SUFFOLK CO. HEALTH DEPT. APPROVAL
H. S. NO.
U
M A
To
,r e,�_��
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
: 3a \ '�''' �r`a�_�nf SYSTEMS FOR THIS RESIDENCE WILL
OP J l`s C.'i>>< �j:(: CONFORM TO THE STANDARDS OF THE
s- Oo
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
. , G� (S)
.yob. '� r���. {t �� APPLICANT
a c SUFFOLK COUNTY DEPT.. OF. HEALTH
SERVICES — FOR APPROVAL, OF
�0 `/' CONSTRUCTION ONLY
DATE:
CZESD� ~',vim \ H. S. REF. NO.:
f APPROVED:
SUFFOLK CO. TAX MAP DESIGNATION:
A 300_ DIST. SECT. BLOCK PCL.
�4
\ o�--E �_�,- ,�F ` _IOQQ.... -70 12 39,3
� . 5.69 rJ
';':._ OWNERS ADDRESS:
Sa / �% 5-_HA(G OfZI.V�E/
• � t /t..utfttitP.c p}c.-tom \ } '- ; a �4 rl
----
` t �.
_ Sy �r�'\�' 4\- z-- ry - e�p `e - -- - •— ' �. �- t- 'l �' ��� � � SSC-6.C395
,CR�� �h 21vE •fir - L Q. \' —� , Q
(� \ a, ptA•�1 ti — ` p ` J DEED:_L.73Z P.3/�-7 (REF)
TEST HOLE STAMP
� �`` `_ 1 \ yh -A _ �,✓ �r�� _• / / i'n^. ;'=•rfzr?^€:5: ?��r r�y�',a$i37;
�\ }4 \\\ \ _ yam` \✓.— ' i ��' ^,,r�, ;n,y l`^1q,oaif
LOAMY... ' E5 st ':'t?Tn
\\ �\ 11 ` SAND, lOa �F^TFrY
L /
NS LTh a' .. ! r t"si e tCa"S eK 2){)v4i2 Ir�}
I\_ ►1 G4 ` _MEI UM YL.� awes ^ s
� �• 1' _- .\ .�, '• � � � 1=LF-�:, PG- � � � 3� s-�� �s:�c s9�I•.¢4 r.;3:::�a�.n.,.'.fl
\� ` 'i �+S r LI c F.vJE��P.,•a , - 1! _ - _ -- To CDA25E i F 9 a ITUO y.
\ \ y �v '"cea /�/ r N_ T !p S• , a� r7�. 2 - , �6+1.DeDs!€ 9,
�20�o5Ea� ^ate r ` 2 SANDY CLAY' s
i rsn,A
4'x2C ,=iXE✓'•.4K1_G t80 5(�.F'?� - - ► •may- i % r+�� t.b{i Gt?J�D.[�r emn F rS ',4.,,r
A x t6' r?AMp5.5
\ �G;' �o '• Ifo' "t'S. _ ` / 7 S o garcrn�e m-
C% EA) � A.9 . t� WkNTE-7_ IN, y 4
,•. — .. 4`` OF \� % �'�.. i ion Z rF r s erg r�3 bPu =?3c
C S'c tt?o p t i C[AYEY SNV'J 8 tom, r,Aa..,i ,e r , s aMuzat
__ _
` t� �� v w envi
�J�L.+....'.��'f' � -_ � „tee--a-•��� '- ATE2,IN
19TLS2Gl !_Sa�Ca
IQ SEAL
1.5 AC, 21=�ic'SED MAY 23 1989
9 Q FtNtSk�4=G Gt AGE 13' r
{s �. TL
/a0-- A5'SIgI2\�Ei-4I . . Pi a2I E E�(U►M l.a 'o' , �1n
.. _CJ0Aa5 it u !RO_DERICK VAN TUYL, P.C. SAN Ya
�.-
- LICENSED LAND SURVEYORS s9
?.a . GREENPORT NEW YORK.
: ' ►Mid
_ SUFFOLK CO. HEALTH DEPT:APPROVAL
7 H. S. NO.
'T:0
f7 To [_
. ~,_J•-`�'` 3' 1'\/ ""'� e 7j'T,Zo, - - Y.. .i `4`.•I ' '"y >,. +7 �Uf 1:...! / OY,'wr� .'+ Y :' c M:: Y ice..;
STATEMENT OF INTENT
_ - THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
`r SUFFOLK CO. DEPT. OF HEALTH SERVICES.
�� )
CJ-, `\ �O �G. � p APPLICANT
SUFFOLK COUNTY DEPT. OF HEALTH
/! 'i`. �.•i / /,'/ �� SERVICES —, FOR APPROVAL OF
'7 CONSTRUCTION ONLY
q '� G' \ DATE:
r�� ti✓ �{ �` / \ H. S. REF. NO.
No. t \ 2E►� a�% pj �.� ��c'rG �'� APPROVED:
PlZu.
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL.
s o pJ• _
L• `--r- `�.• .%/I/�'a_ ' rlll`.; Y�`-�� 3i"E OWNERS ADDRESS:
5"HAIL-.0(2]VE
` 10!2-
`L' �:C Gi.X HILLSY, I174E>
DEED: L.732.�._ . .P.347 CREF
TEST HOLE STAMP
L
Ft of ry'4[3r
.\ �,` '• \\ `• ' _ -7/ r Udf
.ice \ ,_ 6 ` : ;• .. r • 5 \ LOA III Y Uwl.
D 4
5AN - 10 ??`r�Y€se !49 t'!!S •t"�€s'l'^-.;5 ftc?
r is,4LTI f — \`` MEDf[JM
1,3 ��,� � ,,^ !' M!�' C=a'3 FEI�. • •�' — L 3� 4-AF+� ����i 9t to e�� �°efi}-s��
to bw a w I Id
5fr1iQ
'. j - _ fL�• e v 3 r . �, I:i '• 4 € °H mCf 44��+rv`F2z'4�`t) L.'i k°$5t�f 9S:,0
.. `% \. 1 StSNT3Y CLfa`f 3s err asp^ r
�• PCLOP -
1 a 4'x ' FIXl=C'4,4 .(SG Sd .FT) `_ 1sc. rs , J
i hp- �. .tom. 'iv PNu� .^,l d" Pi°.
5.
CLAYS 5A!! kn 2 1w.a n m 6 h��a c avl
' ( j G x I b' FLOA-t' (c = ' ..a�rQ A j1 g 1e �31 u3 ;GAR S ST•o 8s un.,.. "s
S*ZZ
r' �r •' p� ,�`%� .^S�-�'` r_ilYEY`a'+CNCJ ryv�•�ia.;a.�O Pes.a.
Gam. 7' .. -P8, - a. _ '"" 8•. t^t. nv1 ro,
SC:ALC, (o I�, SEAL
-4 _ l A�! s� : t2E\t1SE0 MAY 23, 1989 - -\rl�ME*112
_.
r^
QCAYE._ E3
J S , {3
T
+,' l �p {} p TI:2�hi, 1--' ,a r:•,. ._—,;:r.,,ly,..-.�- :l<�r. `�5 UFC 4'yC'7. V _ r1 ..t_ E'E Urat
t PR,'2 I989
S ZO lZ5 E
! $ RODERICK VAN TUY
TAt,IG 6.5 ' 6.3 �'. .� L C.
, - - a/' '�D
'J. :�t`,T'J N;= t"'{EAiti!-.'� S._. r + . �; 'g/'...m�- �'....�.
"� LICENSED LAND SURVEYORS r: l� C R.91,cam/r
,, . , GREENPORT NEW.YORK' '""'�
+= � .=� _ I / "' ,+ ,fir '-'= � � �is:�+
_.
'`"�. ..�
eft � �.;�',•r`:�•"'►�- ^-�. ._. - . -art/
. -
�` e
�� ,..
• z.•'_�
���r:'�'
_�
a' '. fc'— � . +fir � 'S _ •:�- .,i,i~ 'yr.�++1 -.tyN"
r�
- - �
R,4
a .
J \ �
t
�,�► .
�Y
���.��"mot.'.l � -. -;Y~_.��•;`�;'t• �� �