tteceived

JUL (},B 2OI8

NYSD$SNEw yoRK srArE DErARTMENT oF YTE Flanninp & $evelCIpment

COASTAL MANAGEMENT PROGRAM

Federal Consistency Assessment Form

An applicant, seeking a pormit, license, waiver, certifieetion or similar tlpe of approval from a federal agency u*rich

is subject to the New York State Coastal Management Program (CMP), shall corylete this assessment form for any

proposed activity that will occur wirhin and/or directly affect the State's Coastal Area. This form is intended to

assist an applicant in certifing that the proposed activity is consistent with New York Statc's CMP as required by

U.S. Departnent of Commerce regulations (15 CFR 930.57). lt should be completed at the time when the federal

application is prepared. The Department of State will use the completed form and accompanying infonrmtion in its

review of the applicanfs certification of consistency.

A. AEElIg$llI @leaeeprint)

1. Name: 6Ad- J \t I ^/tL2. Address:

3. Telephone: Area Code t=$f =YZ - ZA O O

B. PROPOSEDACTIVTIY:

l. Brief description of activity:

tJ(/4 -stb

lr L+Kc O p T/r<, a2. Purpose ofactivity:

/*,,t J

Oc t- e-7 n S.r+rulV Ccee KCounty City, Townl or Village

Tlpeoffederalpermit/licenserequired: DFL P-o *-, | .ltgd flen:/

Federal application number, ifknown: E'ilqt nt ee p''s

6. If a state p€rmit/licens was issued or is required br thc proposed activity, id€ntiry the state agency and

provide the application or permit number, if known:

tSttli

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CarY-5.

47 sau4,Street or Site Descri

C. COASTAL ASSESSMENT Check either "YES" or *NO" for each ofthese questions. The numbers following

each question rofer to the policies described in the CMP documcnt (see footnote on page 2) nfiich may be affectod

by the proposed rctivity.

l. Will the proposed activity result in any of the following:

a. LargB physical chaagB to a site within tic coastal area which will rrquire the prcparatioo of aa

environmental impact statenrenCI (ll, 22, 25, 32, 37, 38, 41, 43)

b. Ph)rsical alteration of rnore than ts,o ar:res of land along the shoreline, land rmder water or

coas&al unt€rs? (2, I I' 12, 20, 2& 35,4)c. ReviBlizationhedwelopment of a deteriorated or rmderutilized watsrfront site? (1)

d. Reduction of existing or potential public access to or along coastal waters? (19,20)

e. Adverse effect upon the commercial or recreational use of coastal fish resowces? (9,10)

f. Siting of a facility essential to the exploratiorS dwelopment and production of energy

resources in coastal waters or on the Outer Contineoal Shelfi (29)

g. Siting of a facility essmial to*he g€D€retim or ranmissioD of ener$a (27)

h. Mining excavation, or drodging activities, or fte placemeot of dredgod or fill material in

coastal waters? (15, 35)

i. Discharge oftoxics, trazardous substances or other pollutants into coastal waters? (8, 15, 35)

j. Draining of stormwater nrnoffor sewer overflows into coasial waters? (33)

k Transporg st{xage, treatm€nt or disposal of solid wastes or hazardous marcrials? (36' 39)

l. Adverse effect upon land or water uses within the Stafie's small harbors? (4)

2. Will the proposed activity affect or be located in, on, or adjacent io any of the following:

d. State deoignatd frmhwateror tidal wetland? (ztzl) ?b. Federally designated flood alrd/or state desi$ated crosion hnzad area?,"(] l, 12- 17) --f ?c. Statedcsigpatedsignificantfishand/orwildlifthabitat? (7) l+W rd. Stotc deigroted sigpificant scenic resornce or ara? (24) #e. State designated important agricultural lands? (26)

f. Beach, dune or Barrier Island? (12)

S. Mqior ports of Albany, Buffalo, Ogdensburg, Oswego or New Yorl0 (3)

h. State, county,or localpark? (19, 20)

i. Historic resource listed on the National or State Register of Historic Places? (23)

3. Witt the proposed activity requile any of the following:

a. waterfront site? (2,21,22',)

b. Provision of new public services or infrastnrctune in undeveloped or spamely populated

sectiotrs oftbe coastal area? (5)

c. Construction or reconstruction ofa flood or erosion contnol structrre? (13, 14, 16)

d. State water quality pumit or certification? (30, 38' 'm)e. State air quality permit or certification? (41,43)

4. Will the proposed activity occur within and/or Affect an arca cove,red by a State-4proved local

waterfront revitalization program, or State.ry,proved regional coastal managFm€nt progam?

(see policies in plogram docume'ntt)

YESN.IO

rr{-r'rr<lrutrIEItrIET

GEEEE}rorwYES/NO

lvII

ffiai^-r,]"fif;qI $zt_

ffi'CWEtrTYES/NO

_rytrErtrErtrErEB

D. ADDITIONAL STEPS

l. If all of the qtrestions in Section C are an$w€red "NO", th€o ths applicant u agwy shall corylete S€ction E and

submit the documentation required by Section F.

2. If any of the questions in Section C are answercd'YES', ttlen the applicant or egeot is dvised to corr.srlt th€

CMP, or where appropriate, the local waterfront revitalization program docnment*. The proposed activity must be

amlfred in more d€tail with respect to the ap,plicable state or local coastal policies. On a sepmarc pag(s), the

applicant or agent shall: (a) id€nriry, by their policy numbers, which coastal policies are affcctcd by the activity, O)briefly assess the efu of the activity upon the policy; and, (c) state how the activity is consistent with each policy.

Following the completion of this uritten assessment, the applicant or agency shall corrylete Section E and submit

the documentation required by Section F.

E- CERTIFICATION

The applicant or sgpnt Eust c€rtify thor the proposd activity is crosist€nt with the State's CMP or the approved

local waterfront revitalization progxarL as appropriate. If this certification cennot be made, the proposed activity

shall not be undertsken. If this certification can be made, complete this Section.

"The pmposed activity corylies with New York State's approved Coastal Management Frogram, or with the

applicablc approved local watertont rcvitalization program, and will be conducted in a marmer consistent with such

program-n

Applicant/Agent's Name: ?, c-k*,.J \ t)r y' /./ e-

Address:

Applicant/Agent's Signanne:

F. SUBMISSION REOUIREMENTS

l. Thc applicant or ageot shall sr$mit the following documaats to the Ncw York Statc Dcplrtncnt of Statp'

Oflicc of Phnning rnd Developmen! Attn: Consistency Revicw Unit, One Commcrcc PhzrSuite 101O

99lVashinglon Avenug Albrnn Ncw YorklZ23l.

a. Copy of original sigped form.

b. Copy ofthe completed federal agency applicatioac. Other available information which would support the certification of consistency.

2. Tb applicant or ag€mt shall also submit a copy of this coryleted form along with his/ber application to thfederal agc rcy.

3. If there are any questions rcgarding the submission of this forrn, contact the Deparfincnt of State at

(stg)474-ffi.

*Thcse statc md local rloqments uc availablc for inspcction d the ofrccs of rrmy fc&ral agencics' Dcprmt ofenvironmtat Conservatior andDeprtuent of State regional offices, andthe 4propriate rcgionalmd cormtyptrnning ageocies

Local program documents re also available for inqoction at 6e offices ofthe appropriate local govemment

Darc:""*ryot{

coastal permi t

matt Maragl i oJUne 28 2018

per the permi t requi est

Adding gne foot of fill (crushed stone and top soil)to an exi sti ng I awn area (goi ng back 30

yeSfs or more) would_1ot affect the surrounding wetlandhabi tat si nce the fi I 1 wi I I be contai ned from

enterinq the laqoon on tindsay Creek, rhe fill will not beable to-enter the creek due t6 a two foothigh block wall. Therefore, there would no adverse effectsto water temperature, tUrbidity, water depth

or reduce the water inflow to the North pond. Consequently,there would be no effect on fish or wildlife.

As far as any di scharge of sewage or storm waterrunoff, r have never seen any water outFlow from

the lawn since the water settJed into the lawn inself.rn the six years that r have lived on this property,

r have never used ahy fertilizers,herbicides, insecticides or chemical pollutants which couldi npact on the wi I dl i fe. The onl y acti vi tythat has been done i n thi s area has been to mow the I awn.The I awn can not be mowed now because of the

wetl and encroachment.

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STATE OF NEW YORKDEPARTMENT OF STATEONE COMMERCE PLAZA99 WASHiNGToN AvENUEALBANY, NY 12231-0001\AAA^/V.DOS, NY.GOV

Received

AUG (} 6 ZrIiNYSDOS

Planning & Development

ANDREW M. CUOMOGovERNoR

ROSSANA ROSADOSECRETARY OF STATE

Dlrr: Jut-Y 25" 201 8

Notice of Incomplete Coastal Consistency Submissionfor a Federal Authorization

The Division ofCoastal Resources received correspondence regarding your application for a federal permit or other authorization and

the proposal's consistency with the New york coastal Management Program. Unfortunately, your colrespondence did not include all

the necessary information and data required for us to begin our review of your proposal. Please provide us with the following

necessary iniormation and data. please refer to the file nrrnb"r identified below when submitting the required information. Once the

required information has been received and our review has begun additional information needs may be identified'

Ftln #: F-2018-0752 APPLICAN-r: RICHERO J. DgVINP

! A copy of a completed and a signed Federal Consistency Assessment Form (FCAF) including the required written analysis

(cf. D.i) of the pioposed activity=s consistency with the relevant enforceable policies of the State's Coastal Management

Program. (Enclosed - Please Sign)

X A copy of your application for federal agency authorization (e.g. a Joint U.S. Army Corps of Engineers & NYS Department

of Environmental Conservation permit application)' (Enclosed)

X A copy of all supporting documentation submitted with the federal application and the following information if it is not

included in the above:

tr a detailed description ofthe proposed activity including its associated facilities and coastal effects

! location map showing where the activity will be conducted

f} site map drawn to scale and showing all components of the activity

n recent color photographs ofthe project site

tr statement of the purpose of, and need for, the activityX identification of the'owner(s) of all properties on which the activify will be conducted and of abutting properry

owners, both uPland and underwater

X written analysis ofalternatives to the proposed activity considered by the applicant

D A copy of the Final Environmental Impact Statement, if one is required by an involved federal or state agency

X Copiei of any applications for permits or other authorizations, and related correspondence, submitted to involved

State agencies (e.g. DEC, OGS, SHPO, PSC).

Please submit the above checked information to: NYS Department of State

Office of Planning, Development. and

Community lnfrastructureAttn: Consistency Review UnilOne CommercePlaza - Suite l0l099 Washington AvenueAlbany, New York 12231

or email : QR@dgs.nY. gov

If you have any questions regarding this matter, you may contact us by telephone at (5 I 8) 474-6000. (Additional information is

available on our website, www.dos.ny'gov)

Departmentof State

fi.*to**-

srATEoF/ oPPoRTUNtw.-fi-

C*ul*,,ny hrnn"il * "9.i-!;#fa6)6?e [""f"u)r\ Re.E'tlonv;l$ /V. f. / Aoz2,

Gr-ory .D ;4" - oo a, /E-o;-o*tzz( fu-s{ Cr"--L e4.f3urf /v.V /#oer

ilo ,fr /f-o az*,frr'e7- Z4L /rop)c)s-J ,"z*urQ a r'/--.' rt^ ,/o iu.rcr rg ,{a (7 / oru fueto'

Received

firwr'- YORK{ . STATE\*-OepartmentofEnvlronrnentalConservatisn

Office ofGonerd Scllces

oepnrtment AUG o 6 zols ffi$orstate ,,.nr,"nYi??jopr"ngffiEHl

Jorr Appucmor FonmFor Permib for ac{ivities activities affecting sforams, watermys, waterbodis, vYetlands, mstal areas, sotlroBs of water,

and endangered and threatened species.

you must separately apply for and obtaln Permlts from each lnvolved agency beforo ctartlng worlc Please read

d! lnstructlons.

//, sr+,-dy P"-/ /ru/etrc)Jt/,Je-P@ TtuC , Co!

Applicant Must be (ctteck altthatapply): f Orner E operator f] Lessee

Address tr[rEmail

1. Appllcatlone To:>l*YS Department of Envircnmental Concervation E Cnecf herc to corfinn pu sent this fuim to NYSDEC.

Ched( all permits that apply: l-lOams and lmpoun&

fl Sfeam Disfurbarrce ment Shrctlres

I excavaion and Fillin E1o1 watorQualty" Navigabte Waters - Certification

[-l Docks, Moorlngs or f] Freshwater WetandsPla$orms

l-l rioatwetlands

l--l wild, Scenlc and

- RecrBational Rivers

I-_] CoastalErosion" Management

f] waurwitmrawal

[ -LonS lslend Woll

[--l hcidental Take of" Endangered /Thrwtened Species

Yes

>US Army Corps of Engineers ffi Ctrecx here to confirm 1ou sent this form to USACE.

Gh€ck all permits that apply: f] Sectiur 4O4 Glean WaterAct [] Secfon 10 Riverc and Harbors Act

lstheprojectFederallytunded? i" Yes l( tlolf yes, name of Federal

General PermitType(s), if known:

Preconsbuction Notiff cation:

E Cfrecf here to confirm you sent this form to NYSOGS.>NYS Office of General Services

Check all permits that applyl-l state Owned Lands UrderWater

E Urif,tyEasement (pipelines, conduits, cabbs, etc.) fl Oocks, Mmrings orPlafiorms

>NYS Department of State ffi Cn"* here to confirm lou sent this form to NYSDOS.

Check if this applies, E Coastal Consistency Gonctrnence

Jotrr AppucAnor FoRr - Continued. Submit this completed page as part of pur Applicalion.

Maiting Address Post ffice / Citv -Staltel Zp

4e-- rt'L {.\psY fown Mllage City

Project Location Cdordinates: Enter I+tituOg_€ldlqryihrde in degrees, rninubslsaconds:

6. Profect [lescrlfilon: Provide the following inbrmaton about your project Continue each rcsponse and provide

any additional information on othsr pages. Attach olana on aeoarate oaoeg.

b e l*,,rsuQ/ ,oAt,,\, q

*o F rej etq

of cunent site conditons:

Tlpe of sbuctures and fftt materids to be installed, and guantr'ty of materials to be usod (e.9., square ieet ofcubic vards of fill structures below

ls hee cutting or cleadng proposed? Yes tf

Timing of the propo.sed cutirg or dearing (monthlyear):

yn ,lolAV ( co h) dt fr a N>{rJ< ,-n-,{ {/ o o/,

/-o

f>gtr-/PE

,/.ar3€ /Cvyr, *' tPt.

Drf *pfroure*r 1A&!<-p 6/'71"c-K l*qd tr,-s.,-l,{, lz7'fii ,- q* )'r"'l ,*--( P/?u/ e( u-t"

volumeof materid to be

Numberof hes to be qlt: Acreage of hs to be dered:

Jorin Appuclnoil Fou - Gontnued. Submit this completed page as part of pur Appl'tcation-

U^"@ Sfure- * 4t *f .-4^-t S f .6 y g rv1*L( 7/rr<--}-o aa tP t fk a"

t. Proposed u."' ,ffi Pdvate I euutlc l--l commerclal

Estimated Gompletion Date:

DNf hr*t-KnodL, e.f,Q a-.,"-,t

4 crlsL*c/ s/?Ne o.J ft7a-'fr.r-,- 4/*.-Ln /ruf-ar/ ft,/g

h*J a Ptt blac-t{C,U,--l_-A--at 6'' 6*-f7 1) tt

b /+<AGr* f-5 qrn J,e# "'-* Ih t) t.-T<-t, / /*- ct o N

thetwillbe usod b

se<- ; trLa""<

k. Aftemawes considered to avoid regulated areas. lf no feasible altematives exlst, explain how the ptoiect will

m. Proposed Start Date:

COn'f 5fpaT ,/,aJf:, I a'- bge /2etzrYt t T-t-10 .Lp7 fnr-/y4€,7 /e.<n.', /- t.5 t3S;/

Pil l' u"/lo '' 2-jjsz-bo *'tf / ctaeo 4

q. Wltthis proiect require addibnd Federat, State, or Local authorizations, induding zonlng changes?

-- Yes lf Yes,listbe&ow.

rt

.*-:i$,1,"'rtrl

Jotffi Apprlcmon Fonr - Continued. Submit this completed page as patt of your Application.

7. Signatutrs.Applicant and Owner (lf different) must sign the application.Append additional pages of this Signature section if there are multiple Applicants, Owners or ContacU{gents.

I hereby affirm that information provided on this form and alt attachments submitted herewith is true to the best ofmy knowledge and belief.

Permission to lnspect - I hereby consent to Agency inspection of the projed site and adjacent property areas.Agency staff may enter the property without notice between 7:00 am and 7:00 pm, Monday - Friday. lnspectionmiy occur wtnout the ownsr, applicant or agent present. lf the property is pcted with teep ort- signs or funcedwith an unlocked gate, Agency staff may sfill enter the property. Agency stafi may take measurements, analpesite physicalcharacteristics, take soil and vegetation samples, sketch and photograph the site. I understand thatfaifure to give this consent may result in denial of the permi(s) sought by this application.

False statements made herein are punishable as a Ctass A misdemaalxr pursuant to Section 210.45 of the NYS

Penal Law. Furthsr, the applicant acepts full responsibility for all damage, direet or indirec( of whatever nature,and by wtromever suffered, arising out of the project described herein and agrees to indemniff and save harmlessthe State from suits, actions, damages and costs of every name and desoiption resutting fnorn sald project. lnaddition, Fedelal Law, 18 U.S.C., Section 1001 provides for a fine of not more than $10,000 or imprisonment fornot more than 5 y€ars, or bottr where an applirxnt knowingly and willingtly falsifies, oonoeals, or coverB up amaterialfact; or knowingly makes or us€s a false, fictiiious or fraudulent statemont

of Owner difrerent than

Date

allthat apply): f] Owner

TiS€

-R,.-).. A-LJ ) . DeY t ve-Date

Printed Name Ti0e

Date

For Aoencv Use Onlv DETERTINATION OF NO PERISIT REQUIRED

Agency Application N umber

(Agency Name) has determined that No Permit is

required ftom this Agency for tre pr$ect deseribed in this application.

Printedi,lame

Signature