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Board Of Southold Town - Trustees
�I SOUTHOLD, NEW YORK
,:. PERMIT NO. ...3.73.4.................... DATE: ..Jun.e....2.3.,.....1.989
I -
;., , ISSUED TO ...... .. Walter Fink
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
yI State of New York 1952; and the Southold Town Ordinance en-
titled REGULATING AND THE PLACING OF OBSTRUCTIONS • ..: F
IN AND ON TOWN WATERS AND PUBLIC LANDS and the Iwo {j� REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM t `'
v"
LANDS UNDER TOWN WATERS; and in accordance with the
Resolution of The Board adopted at a meeting held or% ...June....2.2.,..
19...W.., and in consideration of the sum of $........................ ... paid by � r
/ .......................................................................................
of .......... Orient................................................... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
To construct 135' bulkhead above MHW backfill with
300 cu. yds. clean fill to be trucked in from upland
source.
41 all in accordance with the detailed specifications as presented in
71, {. the originating application.
"s 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.
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TERMS and CONDITIONS
The Permittee _WaltPr Fink
residing at - 15 Woodcut Lane, Manhasset, NY 11030 N. y,
part of the consideration for the issuance of ,the Permit does understand and prescribe to the fol-
lowing: 1. The Southold Town Trustees Permit must be prominently
displayed on premises effected during period of work.
1. 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 oper-
ation performed pursuant to this permit, and the said Permittee 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 of 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.
ffq
ti<X IL'rr®
;.-`RANK A. KUJAWSKI, JR., President � ��•�re F,��., ���, , ..,_� TELEPHONE
LBERT J. KRUPSKI, JR., Vice-President .ti (516) 765-1892
J•,HN M.BREDEMEYER, III �A� "Y'`>' ,�
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH 1
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
June 28, 1989
J.M.O. Consulting
PO Box 361
Wading River, N.Y. 11792
Re: Application No. 4-11-89-26-2-25
Dear Mr. Just:
The following action was taken by the Board of Town Trustees
during their regular meeting held on June 22, 1989 regarding the
above matter:
WHEREAS, J.M.O. Consulting on behalf of Walter L. Fink applied to the
Southold Town Trustees for a permit under the provisions of the
Wetland Ordinance of the Town of Southold, application dated April
13, 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 June 22, 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 J.M.O. Consulting ON BEHALF OF Walter L. Fink BE AND
HEREBY IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO:
construct 135 ' bulkhead above MHWM, backfill with 300 cu. yds. clean
fill to be trucked in from an upland source.
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.
Very truly yours,
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:jas
cc: Bldg. Dept.
Conservation Advisory Council
file
J.M.O. CONSULTING ; 6_ 1 ,3 ",_..`" _
�..._,
box 361 • NORTH COUNTRY ROAd ��
WAdINC� RIVER, N.Y. 11792 JUN _ 5 1989 `
i
(516) 929.5775
TELEFAx (516) 929.53C19 TOWN OF SOU T HOLD
June 5, 1989
Board of Town Trustees
Town of Southold
Town Hall , 53095 Main Toad
P.O. Box 723
Southold , N.Y„ :1.:1971
Attnn Mr„ Frank Kujawsk:i
Rea Application for Walter Fink, Orient
Dear Mr. Kujawsk:i
Enclosed please find one copy of the permit recently issued
by the N.Y.S.D„E.C. for the abode noted proposed project
which the Board of Trustees now has under review„
Sing- _l y
J U s
AR
1--lew York Stale OteparimpnI of Enviror1rn9ntn1 ConserIvalion
Ee�',UlaLory Afla".-s Utilt
Bldg. 4()*, SUNY, Rm. 219 NNW
Stony Brook, NY 11794
Thomas C Jorling
�, ;gay Commissioner
r
( 516) 751-7900
J
May 26, 1989
Walter Fink
15 Woodcut Lane
Manhasset, NY 11030
Re: Permit No. 10-89-0709
Dear Mr. Fink:
In conformance with the requirements of the State Uniform Procedures
Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621)
we are enclosing your permit. Please read all conditions carefully. If
you are unable to comply with any conditions, please contact us at the
above address.
Also enclosed is a permit sign which is to be conspicuously posted
at the project site and protected from the weather.
Very truly yours,
Marilyn E. Peterson
Program Aide
MEP:rw
enclosure
M1 �'n • Nf\'1 IOP.f. SIAII 111PARIn1t',1 L_ll ff•!\IRUNMF N1Al CONSt RVAIION •
LFrfCIIVL OMI
10--89--0709 p _5/26/89 —
-
.I,—il lu 1,:�aul.h ,r.,. �Lh,�;lut,—'-'------ - -) trsil -r D t.l fr'l
Under the Em:ironmental Conservation Law
N/A
Article 15, Title 3; 6NYCRR 327, 6NYCRR 608: Article Wetlands
328, 329: Aquatic Pesticides N Water Oualit Certification 1J Tirt:il
Article 15, Title 5: (--] A[licle 17, lilies 7, .8: f —1 Article 27, Title 7; 6NYCRR 360:
CN Protection of Water "PDE S L_-_J Solid Waste Management"
(� --ll Article 15, Title 15: —1 4rlirle 19: Article 27, Title q; 6NYORR 373:
1__-1 Wale[ Supply I Ali Pollutioii Control' Ilaza.rdut.ls Waste Marl,190lnent
F-1Article 15, Title 15: Article 23, 1 itle 27: f Article 34:
_ Water Transport I_1 Mined Land Reclamation Coastal Erosion Management
Article 15, Title 15: Article 24: Article 36:
Long Island Wells !—1 Freshwater Wetlands Floodplain Management
—�I Article 15, Title 27: N—New, R—Renewal, M—Modification, Articles 1, 3, 17, 19, 27, 37;
L—J Wild, Scenic and Recreational C—Construct ("only), 0---Operate ("only) F-71 6NYCRR 380: Radiation Control
Rivers
PERMIT ISSULD TO
Walter Fink
AIIDRLSS UI PERMIT11L
15 Woodcut Lane, Manhasset, NY 11030
__F
AGENT FOR PERMITTLE.lCONTACT PERSON TELEPHONE NUMBER
. Glenn Just 5 —
NAME AND ADDRESS OF PROJECT/FACILITY(It different from Permittee)
Orient Harbor, Willow Terrace Lane
LOCATION OF PROIECT!FACILITY COUNTY __TTOWNIt54i1 UTM COORDINATES
Orient Suffolk Southold
DESCRIPTION OF AUTHORIZED ACTIVITY 1,
Construct 135' of new timber bulkhead above spring high tide and backfill
with 300 cubic yards of clean sand from an upland source. ,All work shall be in
accordance with the attached NYSDEC approved plan 5/23/89.
GENERAL CONDITIONS
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli-
ance with the ECL,all applicable regulations and the conditions specified herein or attached hereto.
1 The permitter shall File in the office of the appropriate regional permit administrator,or other office designated in the special conditions,a notice of intention to commence
work at least 48 hours in adsance of the time of commencement and shall also notify him/her promptly in writing of the completion of the work.
2 The prrmtted wurk shall be subject to inspection by an authorized representative of the Department of Environmental Conservation which may order the work suspended if
the public interest so requires pursuant to ECL §71.0301 and SAPA§401(3)
.i I he permittee has accepted expressly,by the execution of the application,the full legal responsibility for all damages,director indirect,of whatever nature,and by whomever
suffered,arising out of the project described herein and has agreed to indemnify and save harmless the State from suits,actions,damages and costs of every name and descrip-
tion resulting from the said project.
4. The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when:
ai the scope of the project is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found;or
b) the permit was obtained by misrepresentation or failure to disclose relevent facts:or
c) newly discovered information or significant physical changes are discovered since the permit was issued.
5. The permittee is responsible for keeping the permit active by submitting a renewal application,including any forms,fees or supplemental information which maybe required
by the Department, no later than 30 days(180 days for SPDES or Solid or Hazarduous Waste Management permits)prior to the expiration date.
b This permit shall not be construed as conveying to the applicant any right to trespass upon the(ands or interfere with the riparian rights of others in order to perform the
permitted work or as authorizing the impairment of any rights,title or interest in real or personal property held or vested in a person not a parts,to the permit.
7. The permittee is responsible for obtaining any other permits, approvals, (ands,easements and rights-of-way which may be required for this project.
8 Issuance of this permit by the Department does not,unless expressly provided for,modify,supersede or rescind an order on consent or determination by the Commissioner
issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination.
9 Any modification of this permit granted by the Department must be in writing and attached hereto.
_7
I PERMIT ISSUANCE DATE PERM T A MINIS ATOR ADDRESS B1dg.40,SUNY',RLTI,. 219
5/26/89 Christine J.Costopoulos Sto
j AUTHORIZED SIGNATURE I Q 3
C.1� Page I of
cc: BMHP
95.2U-6a(1/86)-25c
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( )
10. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the
teration in the position of the structure or work herein authorized, or project.
if, in the opinion of the Department-of Environmental Conservation 14. Any material dredged in the prosecution of the work herein permitted
it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across
waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a
the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of
resources of the State,the owner may be ordered by the Department to a waterway. •
remove or alter the structural work, obstructions, or hazards caused 15. There shall be no unreasonable interference with navigation by the work
thereby without expense to the State, and if, upon the expiration or herein authorized.
revocation of this permit, the structure, fill, excavation, or other 16. If upon the expiration or revocation of this permit,the project hereby
modification of the watercourse hereby authorized shall not be com- authorized has not been completed,the applicant shall,without expense
pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the
extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may require,remove all or
Conservation may require,remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site
structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of
and flood capacity of the watercourse.No claim shall be made against New York on account of any such removal or alteration.
the State of New York on account of any such removal or alteration. 17. If granted under Article 36, this permit does not signify in any way
11: That the State of New York shall in no case be liable for any damage that the project will be free from flooding.
or injury to the structure or work herein authorized which may be caused 18. If granted under 6 NYCRR Part 608, the NYS Department of Environ-
by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject project will not
conservation or improvement of navigation,or for other purposes,and contravene effluent limitations or other limitations or standards under
no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977
12. Granting of this permit does not relieve the applicant of the responsi- (PL 95-217)provided that all of the conditions listed herein are met.
bility of obtaining any other permission, consent or approval from 19. All activities authorized by this permit must be in strict conformance
the U.S. Army Corps of Engineers, U.S.Coast Guard,New York State with the approved plans submitted by the applicant or his agent as part
Office of General Services or local government which may be required. of the permit application.
13. All necessary precautions shall be taken to preclude contamination
of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans were prepared by
solvents, lubricants,epoxy coatings,paints,concrete, leachate or any Glenn Just
on . .
SPECIAL CONDITIONS
Supplementary Special Conditions (A) Through (J) attached.
DE PERMIT NUMBER
�0-89-0709
PROIvGftAAMfFACILITY NUMBER 2 3
/ Page of
�
j .m.o. consulting
p.o. box 361
wading river, n.y. 11792
516-929-5775
April 25, 1989
Board of Town Trustees
Town of Southold
Town Hall , 53095 Main Road
P.O. Box 728
Southold, N.Y. 11971
`~- --
Attn: Mr. Frank Kujawski Jr.
Re:Wetlands Application for Walter Fink , Orient
Dear Mr. Kujawski :
Enclosed please find a copy of the "Notice of Complete Application" which
was issued on April 21, 1989 by the N.Y.S.D.E.C. and I subsequently recieved
in this morning ' s mail .
`
Sincerely
Glenn E. Just
1*2-4.(1]w(,)-27a
NIAVPORKSIAII DEPARIMIN1OI 1NVIRONMIN'IAI.CONSI'RVAIION
V NOTICE OF COMPLETE APPLICATION
Applicant: Walter Fink, by Glenn E. Just/J.M.O.Consulting Date: 4/21/89
Address: P. 0. Box 361
Wading River, NY 11792
Permits applied for and application numbers Tidal Wetlands, Protection of Waters,Water Quality
10-89-0709
Project description and location. Town/Off of Southold County of Suffolk
Applicant proposes to construct 1351 of timber bulkhead above mean high water,
backfilling with 300 cubic yards of clean sand from an upland source. Bulkhead
will tie into adjacent bulkheads located to west.
SCTM 1000-26-2-25
STATE ENVIRONMENTAL QUALIIY REVIEW(SEQR)DETERMINATION:(Check appropriate box)
❑SEQR-1 Project is not subject to SEQR because it is an exempt, excluded or a Type II action.
❑SEQR-2 Project is a Type I action and will not have a significant effect on the environment.A Negative Declaration is on file and a coordinated review with
other agencies performed.
6�¢EQR-3 Project is an unlisted action and will not have a significant effect on the environment, a Negative Declaration is on file:
❑A—coordinated review performed 913—no coordinated review performed.
❑SEQR-4 A draft environmental impact statement has been prepared on this project and is on file.
❑SEQR-5 A final environmental impact statement has been prepared on this project and is on file.
SEQR LEAD AGENCY None designated
STATE HISTORIC PRESERVATION ACT(SHPA)DE TERMINATION:(Check appropriate box)
❑SHPA-1 Project is not subject to SHPA: ❑A—exempt permit type ❑B—federal review performed.
❑SHPA-2 Project will not have an adverse impact and an assessment is on file.
❑SHPA-3 A Cultural resources survey has been prepared on this project and is on file.
AVAILABILITY FOR PUBLIC:CONIMI:NT: CONTACT PERSON:
Applications may be reviewed at the address
to the right.Comments on the project must he Marilyn E. Peterson
submitted to the Contact Person by no later than: Bldg. 40, SUNY, Rm. 219
May 19, 1989 Stony Brook, NY 11794
(516) 751-7900
TO THE APPLICANT:
1 . THIS IS NOT A PERMIT
2. This is to advise you that your application is complete and a review has commenced.Additional information may be requested from you at a
future date, if deemed necessary, in order to reach a decision on your application.
3. Your project is classified MAJOR. Accordingly, a decision will be made within 90 days of the date of this Notice. If a public hearing is
necessary, you will be notified within 60 days and the hearing will commence within 90 days of the date of this notice. If a hearing is held,
the final decision will be made within 60 clays after the hearing is completed.
4. Publication of this Notice in a newspaper is: ❑ required X6J not required
If required, please consult the accompanying transmittal letter for further instructions.
CC: Chief Executive Officer Tn.of Southold
Environmental Notice Bulletin, Room 509, 50 Wolf Road, Albany, N.Y. 1 2 2 3 3-0001
File USWS
APPLICANT
FRANK A. KUJAWSKI, JR., President
TELEPHONE
ALBERT J. KRUPSKI, R., Vice-President �'� t ` '"` r
Ve:jkj} ri. (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
April 18, 1989
Mr. John Holzapfel, Chairman
Southold Town Conservation Advisory Council
Southold Town Hall
Main Road
Southold, New York 1.1971
Dear Mr. Holzapfel:
Transmitted herewith is application No. 4-11-89-26-2-25 for a
Wetland Permit submitted by J.M.O. Consulting on behalf of Walter L.
Fink.
Please prepare a written report of findings and recommendations
with respect to this application.
Very truly yours,
/7
J
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:j as
cc: Bldg. Dep' t.
_ TELEPHONE
BOARD OF TOWN TRUSTEES (516) 765-1892
TOWN OF SOUTHOLD, '
Town Hall, 53095 Main Road ,' APR 7.1989
P.O. Box 728 `
Southold, New York 11971l,
APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF
SOUTHOLD, SUFFOLK COUNTY, NEW 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 THE TOWN OF SOUTHOLD, AND THE ISSUANCE OF PERMITS PURSUANT
TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD.
APPLICATION NO � ��---DATE OF APPLICATION �cl q
IDENTITY OF APPLICANT,- � -� �(] /�------------------- NE NO
ADDRESS OF APPL I CANT LS_ -c��----Lga(-z t ' zS- oxL4.
---------------------------------------------------------------------=--
TAX MAP NO.__JjC0Q_a v-a- ---------------------------p-----------
AGE NT- 'Lj '�-�= 1� T- � .Q_ C�� C d 1�� PHONE NO .--
PERMIT REQUESTED TO -cm A-c act.as C;A loft
Ckeckn Sc�►r1 �,.aY1�C:�'1 Sh��l\ 10e i�Gl�� i rl era-� C��1 Opt :
LOCATION OF PROPERTY FOR WHICH PERMIT WANTED
-----------------------------
------------------------------
HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION
-----------------------------------------------------------------------
CREEK, BAY OR HARBOR FRONTING PROPERTY-- � �_- - In
----------
SIZE OF PROPOSED WORK---_ `a,5------------------------------------------
LENGTH
-
WIDTH
- --------- -----------------------------------------------------
HEIGHT ABOVE HIGH WATER L\ I
DEPTH BELOW LOW WATER
i YARDS TO BE EXCAVATED
------ --------------------------------------------
YARDS TO BE FILLED
,-------------
WIDTH OF CANAL , CREEK OR BAY FRONTING PROPERTY---_���---_----_
D E,P T H.. AT LOW- TIDE
-_-js! ------------------------------------------------
AVERAGE RISE IN TIDE--- _LL-
DISTANCE TO THE NEAREST CHANNEL_J o�----FT.
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE AREA_-----FT.
IS THIS FOR PRIVATE OR BUSINESS USE?_-'
AREA ZONING_ `iC ( �C%�(-
-------------------- ---------
-------------
MANNER 1N WHICH MATERIAL WILL BE REMOVED OR DEPOSITED_ Ck::�-C3�1
- INTENDED USE OF PROPERTY
i -_ .4--n- -------------
DESCRIBE ANY KNOWN PRIOR OPERATIONS. CONDUCTED ON THE PREMISE
---- Q� --= --m` -- ------------------------------
AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT
STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID PREMISES AND WHETHER
ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENTAL
AGENCY
-------------------------------------------------------------------
------- ��--�-- -=i�LZn � �-----------------------------
DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE
PREMISES AFTER THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF
THE PROJECT SITE IF NECESSARY
-------------------------------------
-------------------------------------------------------------------------
WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF NOT THE SAME AS THE
APPLICANT. f-0r-
-------------------------------------------------------------------------
ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT WOULD
PROHIBIT THIS PROJECT? w
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1 2 3
IMPACT ON WATER Small to Potential Can Impact Be
3. Will proposed action affect any water body designated as protected? Moderate Large Mitigated By
(Under Articles 1.5,24, 25 of the Environmental Conservation Law, ECL) Impact Impact Project Change
ONO DYES
Examples that would apply to column 2
• Developable area of site contains a protected water body. ❑ ❑ ❑Yes ❑No
• Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes ❑No
protected stream. _
• Extension of utility distribution facilities through a protected water body. ❑ ❑ ❑Yes ❑No
• Construction in a designated freshwater or tidal wetland. ❑ ❑ El Yes []No
• Other impacts: ❑ ❑ ❑Yes El No
4. Will proposed action affect any non-protected existing or new body
of water? ❑NO DYES
Examples that would apply to column 2
• A 10% increase or decrease in the surface area of any body of water ❑ ❑ El Yes ❑No
or more than a 10 acre increase or decrease.
• Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ El Yes ❑No
5. Will Proposed Action affect surface or groundwater
quality or quantity? ONO DYES
Examples that would apply to column 2
• Proposed Action will require a discharge permit. ❑ ❑ ❑Yes ❑No
• Proposed Action requires use of a source of water that does not ❑ ❑ ❑Yes ❑No
have approval to serve proposed (project) action.
• Proposed Action requires water supply from wells with greater than 45 ❑ ❑ El Yes ❑No
gallons per minute pumping capacity.
• Construction or operation causing any contamination of a water ❑ ❑ ❑Yes El No
supply system.
• Proposed Action will adversely affect groundwater. El El ❑Yes ❑No
• Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ El Yes ❑No
do not exist or have inadequate capacity.
• Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ ❑Yes ❑No
day.
• Proposed Action will likek, cause siltation or other discharge into an ❑ ❑ ❑Yes ❑No
existing body of water to the extent that there will be an obvious visual
contrast to natural conditions.
• Proposed Action will require the storage of petroleum or chemical ❑ ❑ ❑Yes- ❑No
products greater than 1,100 gallons.
• Proposed Action will allow residential uses in areas without water ❑ ❑ ❑Yes ❑No
and/or sewer services.
• Proposed Action locates commercial and/or industrial uses which may ❑ ❑ ❑Yes El No
require new or expansion of existing waste treatment and/or storage
facilities.
• Other impacts: ❑ ❑ ❑Yes ❑No
6. Will proposed action alter drainage flow or patterns, or surface
water runoff? ❑NO ❑YES
Examples that would apply to column 2
• Proposed Action would change flood water flows. ❑ ❑ ❑Yes ❑No
7
1 2 3.•
Small to Potential Can Impact'Be
Moderate Large Mitigated By
Impact Impact Project Change
• Proposed Action may cause substantial erosion. ❑ ❑ El Yes ❑No
• Proposed Action is incompatible with existing drainage patterns. ❑ ❑ ❑Yes ❑No
• Proposed Action will allow development in a designated floodway. ❑ ❑ El Yes ❑No
• Other impacts: ❑ ❑ - El Yes ❑No
IMPACT ON AIR
7. Will proposed action affect air quality? ❑NO DYES
Examples that would apply to column 2
• Proposed Action will induce 1,000 or more,vehicle trips in any given ❑ El ❑Yes El-Nohour.
• Proposed Action will result in the incineration of more than 1 ton of ❑ ❑ ❑Yes ❑No
refuse per hour.
• Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes ❑No
heat source producing more than 10 million BTU's per hour.
• Proposed action will allow an increase in the amount of land committed ❑ ❑ El Yes El No
to industrial use.
• Proposed action will allow an increase in the density of industrial ❑ ❑ ❑Yes ❑No
development within existing industrial areas.
• Other impacts: ❑ ❑ ❑Yes ❑No
IMPACT ON PLANTS AND ANIMALS
8. Will Proposed Action affect any threatened or endangered
species? ONO DYES
Examples that would apply to column 2
• Reduction of one or more species listed on the New York or Federal ❑ ❑ ❑Yes ❑No
list, using the site, over or near site or found on the site.
• Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ❑No
• Application of pesticide or herbicide more than twice a year, other ❑ ❑ ❑Yes .[--]No
than for agricultural purposes.
• Other impacts: ❑ ❑ ❑Yes ❑No
9. Will Proposed Action substantially affect non-threatened or
non-endangered species? ONO DYES
Examples that would apply to column 2
• Proposed Action would substantially interfere with any resident or ❑ ❑ ❑Yes ❑No
migratory fish, shellfish or wildlife species.
• Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes ❑No
of mature forest (over 100 years of age) or other locally important
vegetation.
IMPACT ON AGRICULTURAL LAND RESOURCES
10. Will the Proposed Action affect agricultural land resources?
ONO DYES
Examples that would apply to column 2
• The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes ❑No
land (includes cropland, hayfields, pasture, vineyard, orchard, etc.)
8
2 3
Small to Potential Can Impact Be
Moderate Large .Mitigated By
Impact Impact Project Change
• Construction activity would excavate or compact the soil profile of ❑ ❑ ❑Yes ❑No
agricultural land.
• The proposed action would irreversibly convert more than 10 acres ❑ ❑ ❑Yes ❑No
of agricultural land or, if located in an Agricultutal District, more -
than 2.5 acres of agricultural land.
• The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑No
land management systems (e.g., subsurface drain lines, outlet ditches,
strip cropping); or create a need for such measures (e.g. cause a farm
field to drain poorly due to increased runoff)
• Other impacts: ❑ El El Yes ❑No
IMPACT ON AESTHETIC RESOURCES
11 . Will proposed action affect aesthetic resources? ONO DYES
(If necessary, use the Visual EAF Addendum in Section 617.21,
Appendix B.)
Examples that would apply to column 2
• Proposed land uses, or project components obviously different from ❑ ❑ ❑Yes ONO
or in sharp contrast to current surrounding land use patterns, whether
man-made or natural.
• Proposed land uses, or project components visible to users of ❑ ❑ ❑Yes ❑No
aesthetic resources which will eliminate or significantly reduce their
enjoyment of the aesthetic qualities of that resource.
• Project components that will result in the elimination or significant ❑ ❑ ❑Yes El No
screening of scenic views known to be important to the area.
• Other impacts: ❑ ❑ ❑Yes ONO
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
12. Will Proposed Action impact any site or structure of historic, pre-
historic or paleontological importance? ONO DYES
Examples that would apply to column 2
• Proposed Action occurring wholly or partially within or substantially ❑ ❑ El Yes ❑No
contiguous to any facility or site listed on the State or National Register
of historic places.
• Any impact to an archaeological site or fossil bed located within the ❑ ❑ ❑Yes. ❑No
project site.
• Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes ❑No
archaeological sites on the NYS Site Inventory.
• Other impacts: ❑ ❑ El Yes ❑No
IMPACT ON OPEN SPACE AND RECREATION
13. Will Proposed Action affect the quantity or quality of existing or
future open spaces or recreational opportunities?
Examples that would apply to column 2 ONO DYES
• The permanent foreclosure of a future recreational opportunity. ❑ ❑ ❑Yes ❑No
• A major reduction of an open space important to the community. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ El Yes ONO
9
IMPACT ON TRANSPORTATION 1 2 3
Small to Potential Can Impact BE
14. Will there be an effect to existing transportation systems? Moderate Large Mitigated By
❑
Examples that would apply to column 2 NO DYES Impact Impact Project Chang(
• Alteration of present patterns of movement of people and/or goods. ❑ ❑ El Yes ❑No
• Proposed Action will result in major traffic problems. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ El Yes ONO
IMPACT ON ENERGY
15. Will proposed action affect the community's sources of fuel or
energy supply? ONO DYES
Examples that would apply to column 2
• Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ El Yes ❑No
any form of energy in the municipality.
• Proposed Action will require the creation or extension of an energy ❑ ❑ El Yes ❑No
transmission or supply system to serve more than 50 single or two family
residences or to serve a major commercial or industrial use.
• Other impacts: ❑ ❑ ❑Yes ONO
NOISE AND ODOR IMPACTS
16. Will there be objectionable odors, noise, or vibration as a result
of the Proposed Action? ONO DYES
Examples that would apply to column 2
• Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ El Yes ❑No
facility.
• Odors will occur routinely (more than one hour per day). ❑ ❑ El Yes 'El No
• Proposed Action will produce operating noise exceeding the local ❑ ❑ ❑Yes ❑No
ambient noise levels for noise outside of structures.
• Proposed Action will remove natural barriers that would act as a ❑ ❑ El Yes ❑No
noise screen.
• Other impacts: ❑ ❑ []Yes ❑No
IMPACT ON PUBLIC HEALTH
17. Will Proposed Action affect public health and safety?
ONO DYES
Examples that would apply to column 2
• Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ ❑Yes. _ ❑No
substances(i.e. oil, pesticides, chemicals, radiation, etc.) in the event of
accident or upset conditions, or there may be a chronic low level
discharge or emission.
• Proposed Action may result in the burial of "hazardous wastes" in any ❑ ❑ ❑Yes ❑No
form (i.e. toxic, poisonous, highly reactive, •radioactive, irritating,
infectious, etc.)
• Storage facilities for one million or more gallons of liquified natural ❑ ❑ ❑Yes ❑No
gas or other flammable liquids.
• Proposed action may result in the excavation or other disturbance ❑ ❑ El Yes NO
within 2,000 feet of a site used for the disposal of solid or hazardous
waste.
• Other impacts: ❑ 0 ❑Yes ❑No
10
f
" 1 IMPACT ON GROWTH AND CHARACTER 2 3
Small to Potential Can Impact Be
OF COMMUNITY OR NEIGHBORHOOD Moderate Large Mitigated By
18. Will proposed action affect the character of the existing community? Impact Impact Project Change
❑NO DYES
Examples that would apply to column 2
• The permanent population of the city, town or village in which the ❑ ❑ ❑Yes ❑No
project is located is likely to grow by more than 5%.
• The municipal budget for capital expenditures or operating services ❑ ❑ ❑Yes El No
will increase by more than 5% per.year as a result of this project.
• Proposed action will conflict with officially adopted plans or goals. ❑ ❑ El Yes ❑No
• Proposed action will cause a change in the density of land use. ❑ ❑ ❑Yes ❑No
• Proposed Action will replace or eliminate existing facilities, structures ❑ ❑ El Yes ❑No
or areas of historic importance to the community.
• Development will create a demand for additional community services ❑ ❑ ❑Yes ❑No
(e.g. schools, police and fire, etc.)
• Proposed Action will set an important precedent for future projects. ❑ ❑ ❑Yes ❑No
• Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ El Yes ❑No
19. Is there, or is there likely to be, public controversy related to
potential adverse environmental impacts? ONO DYES
If Any Action in Part 2 Is Identified as a Potential Large Impact or
If You Cannot Determine the Magnitude of Impact, Proceed to Part 3
Part 3—EVALUATION OF THE IMPORTANCE OF
Responsibility of Lead Agency
Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be
mitigated.
Instructions
Discuss the following for each impact identified in Column 2 of Part 2:
1 . Briefly describe the impact.
2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s).
3. Based on the information available, decide if it is'reasonable to conclude that this impact is important.
To answer the question of importance, consider:
• The probability of the impact occurring
• The duration of the impact
• Its irreversibility, including permanently lost resources of value
• Whether the impact can or will be controlled
• The regional consequence of the impact
• Its potential divergence from local needs and goals
• Whether known objections to the project relate to this impact.
(Continue on attachments)
11
14-14.11 (2187)-90 617.21 SEQR-.
Appendix R
State Environmental Quality Review
Visual EAR' Addendum
This form may be,used to provide additional information relating to Question 11 of Part 2 of
the Full EAF.
(To be completed by Lead Agency)
Distance Between
Visibility Project and Resource (in Miles)
1. Would the project be visible from: 0-1/4 1/4-1/2 1/2-3 3-5 5+
• A parcel of land which is dedicated to and available ❑ ❑ ❑ ❑ ❑
to the public for the use, enjoyment and appreciation
of natural or man-made scenic qualities?
• An overlook or parcel of land dedicated to public ❑ ❑ -- ❑ ❑ ❑
observation; enjoyment and appreciation of natural
or man-made scenic qualities?
• A site or structure listed on the National or State ❑ ❑ ❑ ❑ ❑
Registers of Historic Places?
• State Parks? ❑ ❑ ❑ ❑ ❑
• The State Forest Preserve? ❑ ❑ ❑ ❑ ❑
• National Wildlife Refuges and state game refuges? ❑ ❑ ❑ ❑ ❑
• National Natural Landmarks and other outstanding ❑ ❑ ❑ ❑ ❑
natural features?
• National Park.Service lands? ❑ ❑ ❑ ❑ ❑
• Rivers designated as National or State Wild, Scenic ❑ ❑ ❑ ❑ ❑
or Recreational?
• Any transportation corridor of high exposure, such ❑ ❑ ❑ ❑ ❑
as part of the Interstate System, or Amtrak?
• A governmentally established or designated interstate ❑ ❑ ❑ ❑ ❑
or inter-county foot trail, or one formally proposed for
establishment or designation?
• A site, area, lake, reservoir or highway designated as ❑ ❑ ❑ ❑ ❑
scenic?
• Municipal park, or designated open space? ❑ ❑ ❑ ❑ ❑
• County road? ❑ ❑ ❑ ❑ 0'
r • State? ❑ ❑ ❑ ❑ ❑
• Local road? ❑ ❑ ❑ ❑ ❑
2. Is the visibility of the project seasonal? (i.e., screened by summer foliage, but visible during other
seasons)' .
❑Yes El No
I
3. Are any of the resources checked in question 1 used by the public during the time of year
during which the project will be visible?
❑Yes ❑No
__ 1
n
DESCRIPTION OF EXISTING VISUAL ENVIRONMENT .
4. From each item checked in question 1, check those which generally describe the surrounding
environment.
Within
*1/4 mile *I mile
Essentially undeveloped - ❑ ❑
Forested ❑ ❑
Agricultural ❑ _ ❑
Suburban residential ❑ ❑
Industrial ❑ ❑
Commercial ❑ ❑
Urban ❑ ❑
River, Lake, Pond ❑ ❑
Cliffs, Overlooks ❑ ❑
Designated Open Space ❑ ❑
Flat ❑ ❑
Hilly ❑ ❑
Mountainous ❑ ❑
Other ❑ ❑
NOTE: add attachments as needed
5. Are there visually similar projects within:
*'h mile ❑Yes ❑No
*1 miles El Yes ❑No
*2 miles -❑Yes ❑No
*3 miles ❑Yes El No
* Distance from project site are provided for assistance. Substitute other distances as appropriate.
EXPOSURE
6. The annual number of viewers likely to observe the proposed project is
NOTE: When user data is unavailable or unknown, use best estimate.
CONTEXT
7. The situation or activity in which the viewers are engaged while viewing the proposed action is
FREQUENCY
Holidays/
Activity Daily Weekly Weekends Seasonally
Travel to and from work ❑ ❑ ❑ ❑
Involved in recreational activities ❑ ❑ ❑ ❑
Routine travel by residents ❑ ❑ ❑ ❑
At a residence ❑ ❑ ❑ ❑
At worksite ❑ ❑ ❑ ❑
Other ❑ ❑ ❑ ❑
2
).M.O. CONSUITINCI
box 361 • NORTH'COUNTRY ROAd
WAdINq RIVER, N.Y. 11792
(516) 929.3575
TEIEFAx (516) 929.5621
To whom it may concern:
Please be advised That I have authorized Glenn E. Just
President of J.M.D.. Consulting to act as the agent on my
behalf to apply for and to secure the necessary permits
through your agency.
Dated
COUNTY OF SUFFOLK )
STATE OF NEW YORK ) SS:
BEING DULY SWORN DEPOSES
AND SAYS THAT HE IS THE APPLICANT FOR THE. ABOVE DESCRIBED PERMITS ,
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 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
agent or representative to enter onto my property to inspect tAe
premises in conjunction with review off"ispp is tion.
1�
SIGNATURE OF k P (CANT
CHARLES W; BOWMAN
NOTARY PUBLIC, Slate of New York
SWORN TO BEFORE ME THIS I1� No. 4668958, Suffolk Counly
Commiliion Expiro&, ktWV1V-30.•Iri.1
DAY OF �> �� .t. 19 1�1.3
l \ bl 10E 4-)IDW 'colld i U111w W133
J J .tfuno) 11olInS 18S6E99p 'elf
840A M01`1 to 0I0IS ';118f14 AtY1 F4
NOTARY PUBLIC NVVUAOE 'M S114"06
EXAMINED
APPROVED I1WETLANDS1I PERMIT (CHAPTER 97)
APPROVED 1IBOAT, DOCKS , WHARVES11 PERMIT (CHAPTER 32)
DISAPPROVED "WETLANDS PERMIT" (CHAPTER 97)
DISAPPROVED "BOATS , DOCKS, WHARVES" PERMIT (CHAPTER 32) .
CONDITIONS, IF ANY
EXAMINING BODY
SIGNATURE OF CHAIRMAN
COMPUTATION OF FEES
Approved 2/27/85
FRANK A. KUJAWSKI, JR., President = TELEPHONE
ALBERT J. KRUPSKI, JR., Vice-President
(516)765-1892
JOHN M. BREDEMEYER, III O ®
JOHN L. KI, JR
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
April 18, 1989
To Whom It May Concern: '
Attached hereto is a �b1qs ' Environmental Assessment Form
submitted by J:M.O. Consulting on behalf of Walter L. Fink for a
wetland permit to construct timber bulkhead at property located
Willow Terrace Lane, Orient, N.Y.
Frank A. Kujawski, Jr.
President
Board .of Town Trustees
Posted: April 18, 1989
1
April 18, 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. 4-11-89-26-2-25 for a
Wetland Permit submitted by J.M.O. Consulting on behalf of Walter L.
Fink.
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. Dep't.
ILI
FRANK A. KUJAWSKI, JR., President TELEPHONE
ALBERT J. KRUPSKI, JR., Vice-President (516) 765-1892
*_
JOHN M. BREDEMEYER, III �� ;'S,; ": �•' �
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
April 18, 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. 4-11-89-26-2-25 for a
Wetland Permit submitted by J.M.O. Consulting on behalf of Walter L.
Fink.
Please prepare a written report of findings and recommendations
with respect to this application.
Very truly yours,
L
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:jas
cc: Bldg. Dep't.
t §
tgw
- ,_ TELEPHONE
BOARD OF TOWN TRUSTEES i. (516)765-1892
TOWN OF SOUTHOLD . }r APR 1
Town Hall, 53095 Main Road 1989
P.O. Box 728 ;
r.
Southold, New York 11971
APPLICATION 1S HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF
SOUTHOLD, SUFFOLK COUNTY, NEW 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 THE TOWN OF SOUTHOLD , AND THE ISSUANCE OF PERMITS PURSUANT
TO CHAPTER 3Z OF THE CODES OF THE TOWN OF SOUTHOLD.
APPLICATION NO � ��DATE OF APPLICATION-_ s IC1 q ---
I'
IDENTITY OF APPLICANT NE NO---
ADDRESS OF APPLICANT _U --Lone
--------------------------------------------------------`------------------
TAX MAP NO.-�S1L,1LL— - - --------------------------------------
1G}5 �
------- --PHONE NO .--
PERMIT REQUESTED TO
Ckecar� sav-0 L'JFh cv1 Sc�h lk beg -h i",cic>C� rltnA, can op c-
LOCATION OF PROPERTY FOR WHICH PERMIT WANTED
----------------------------
--�'& c� _-C" cf'c�C -- -----------------------------
HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION
----------------------------------------------------------------------
CREEK, BAY OR HARBOR FRONTING PROPERTY _C_cici�_-V_ r �
SIZE OF PROPOSED WORK S /-
--------------------------------------
LENGTH ----------------------------------------------------
WIDTH -----
((
------ 4L -------------------------------------------------------
HEIGHT ABOVE HIGH WATER I
DEPTH BELOW LOW WATER
-----—� ---------------------------------------
YARDS TO BE EXCAVATED
YARDS TO BE FILLED - � � i-----_
------�'`� --------------------------
WIDTH OF CANAL, CREEK OR BAY FRONTING PROPERTY
DEPTH AT LOW- TIDE IV I
-----------------------------------------------------
AVERAGE RISE IN TIDE--_ _ L-----------------------------------------
DISTANCE TO THE NEAREST CHANNEL_// On----FT.
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE AREA_ VJ FT.
15 THIS, FOR PRIVATE OR BUSINESS USE?--
- ---------
AREA ZONING- � cl,ec)LLtii-
MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED- � _�11� -------
I NTENDED USE OF PROPERTY__ nC,1� Q_ [ (��1�J �Sl � -J---
DESCRIBE ANY KNOWN PRIOR --
OPERATIONS CONDUCTED- ON THE PREMISE
------------
-----tQ�rz_-- --m� -- 1 -----------------------------
AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT
STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID PREMISES AND WHETHER
ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENTAL
AGENCY
-----------------------
----------------------------------------------------------
DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE
PREMISES AFTER THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF
THE PROJECT SITE IF NECESSARY
-------------------------------------------
:
-------------------------------------------------------------------------
WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF NOT THE SAME AS THE
APPL I CANT. 35x:��cr—t _
------------------------------------------------------------
ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT WOULD
PROHIBIT THIS PROJECT? N O
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J.M.O. CONSULTING
box 361 • NORTh COUNTRY ROAd
WAdINq RIVER, N.Y. 11792
(516) 929.3575
TEIEFAx (516) 929.5621
To whom it may concern:
Please be advised That I have authorized Glenn E. Just
President of J.M.D. Consulting to act as the agent on my
behalf. to apply for and to secure the necessary permits
through your agency.
Dated ✓�G✓�G Uri ,
COUNTY OF SUFFOLK
STATE OF NEW YORK ) SS:
Glc'o J E.7. cks.F....
BEING DULY SWORN DEPOSES
AND SAYS THAT HE 15 THE APPLICANT FOR THE:. ABOVE DESCRIBED PERMITS,
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 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
agent or representative to enter onto my property to inspect tAe
premises in conjunction with review of his �pp ication.
SIGNATURE OF APPLICANT
CHARLES W. BOWMAN
NOTARY PUBLIC, Slate of 14" York
SWORN TO BEFORE ME THIS / No. 4668958, Suffolk County
{ l` Camrnillion Expiroc, lAorcl► 30, 19�j`
DAY OF WZ r� .` , 1 9
11 6l HOC �I��oy� 'tn�dXl Yu�i11Fy1lldj
xluno) 'lloll"S 18566991' rql
a,oA Merl Jo olatS ':.I1Bfl4 A!lYI6F4
NOTARY PUBLIC lgVW/AOU 'M 5.11q'0jj
EXAMINED
APPROVED "WETLANDS" PERMIT (CHAPTER 97)
APPROVED "BOAT, DOCKS, WHARVES" PERMIT (CHAPTER 32)
DISAPPROVED "WETLANDS PERMIT" (CHAPTER 97)
DISAPPROVED "BOATS , DOCKS, WHARVES" PERMIT (CHAPTER 32) .
CONDITIONS, IF ANY
EXAMINING BODY
SIGNATURE OF CHAIRMAN
COMPUTATION OF FEES
Approved 2/27/R5
CHARLES T. HAMILTON
Chief, Marine Regulatory Section
NYSDEC, bureau of Marine Habitat Protection
Bldg. 40, SUNY, Room 225
Stony Brook, N: Y. 11794
RE: Permit No.
Issued To:
Contractor's Name
Contractor's Address
Contractor's Phone No.
Dear Sir:
Pursuant to General Condition Number 1 of the above referenced permit you, are
hereby notified that the authorized activity shall commence on
This notice is 'to be sent at least two days in advance of commencement of the
project.
The permit sign will be posted at the site and copy of permit will be available
at site for inspection.
Submitted by
Failure to notify or post sign will leave owner and/or contractor subject to
applicable penalties for non-compliance with permit conditions.
------------------------------------------------------------
CHARLES T. HAMILTON
Chief, Marine Regulatory Section
NYSDEC, Bureau of Marine Habitat Protection
Bldg. 40, SUNY, Room 225
Stony Brook, N. Y. 11794
RE: Permit No.
Issued to
Contractor's Name
Contractor's Address
Contractor's Phone No.
Dear Sir:
Pursuant to General Condition Number 1 of the above referenced permit you .are
hereby notified that the authorized activity was completed on
Submitted by
This notice, with photos of completed work and or completed survey, is to be sent ,
to above address promptly upon completion of project. Failure to notify will leave
owner and/or contractor subject to applicable penalties for non-compliance with
permit conditions.
95-20.1 (8/87)-9d
New fork State
Department of Environmental Conservation
NOTICE
The Department of Environmental Conservation (DEC) has issued
permit(s) pursuant to the Environmental Conservation Law
for work being conducted at this site. For further information
regarding the nature and extent of work approved and any
Departmental conditions on it, contact the Regional Permit
Administrator listed below. Please refer to the permit number
shown when contacting the DEC.
Regional Permit Administrator
Permit Number
Expiration Date
NOTE: This notice is NOT a permit
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SUPPLEMENTARY SIDI;CIAL CONDITIONS
. The following conditions apply to all permits :
A. If any of the permit conditions are unclear , the permittee shall con-
tact the Division of Regulatory Affairs at the address and telephone
noted below.
B. A copy of this permit with supplementary conditions and approved
plans shall be available at the project site whenever authorized
work is in progress .
C. The permit sign enclosed with the permit or a copy of Letter of
approval shall be protected from the weather and posted in a con-
spicuous location at the work site until completion of authorized work .
D. At least 48 hours prior to commencement of the project , the permittee
shall complete and return the top portion of the enclosed receipt form
certifying that tie is fully aware of and understands all provisions and
conditions of this permit . Within one week of completion of the
permitted work , the bottom portion of that form shall also be com-
pleted and returned.
E. For projects involving activities to be accomplished over a period of
more than one year , the permittee shall notify the Regional Permit
Administrator in writing at least 48 hours prior to the commencement
of resumption of work each year .
F. If project design modifications take place after permit issuance, the
permittee shall submit the appropriate plan changes for approval by
the Regional Permit Administrator prior to undertaking any such modi-
fications. The permittee is advised that substantial modification
may require submission of a new application for permit .
G. All necessary precautions shall be taken to preclude contamination of
any wetlands or waterway by suspended solids, sediment , fuels,
solvents , lubricants, epoxy coatings, paints , concrete, leachate or
any other environmentally deleterious materials associated with the
project work .
H. Any failure to comply precisely with all of the terms and conditions
of this permit , unless authorized in writing, shall be treated as a
violation of the Environmental. Conservation Law.
I . The permittee is advised to obtain any permits or approvals that may
be required from the U.S. Department of Army Corps of Engineers , NY
District , 26 Federal Plaza , New York, NY 10278 , (Attention: Regulatory
Functions Branch) , prior to commencement of work authorized herein.
J. The granting of this permit does not relieve the permittee of the.
responsibility of obtaining a grant, easement , or other necessary
approval from the Division of Land Utilization, Office of General
Services , Tower Building, Empire State Plaza, Albany, NY 12242 , which
may be required for any encroachment upon State-owned lands underwater .
Regional Permit Administrator
NYS Dept . of Environmental Conservation
Bldg . 40 , SUNY-Room 219
Stony Brook , NY 11794
( 516) 751-7900
DEC # 10-89-0709
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