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HomeMy WebLinkAboutTR-10901A Glenn Goldsmith,President O�QSUFfO�xCO Town Hall Annex A.Nicholas Krupski,Vice President �� Gym . 54375 Route 25 Eric Sepenoski y z P.O.Box 1179 Liz Gillooly • ti Southold,NY 11971 Joseph Finora �',�O ap�;�J' Telephone(631)765-1892 1 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/ constructed Project complete, compliance inspection Glenn Goldsmith, President we�® Town Hall Annexf S®U��® Vv 54375 Route 25 Nicholas Krupski,Vice President �® �® P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone (631)'765-1892 Joseph Finora Fax(631) 765-6641 C4UNT`(,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10901A Date of Receipt of Application: December 19, 2025 Applicant: DHC Land LLC c/o Will Peckham SCTM#: 1000-115-10-1 Project Location: 4180 New Suffolk Avenue, Mattituck Date of Resolution/Issuance: January 14, 2026 Date of Expiration: January 14, 2029 Reviewed by: Board of Trustees Project Description: Demolish existing dwelling and abandon septic system and oil tank; install buried electrical wires and water supply lines; construct circular pervious driveway. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by AMP Architecture, received on December 19, 2025, and stamped approved on January 14, 2026. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. r Glenn Goldsmith, President Board of Trustees L A N � 9 � o LIJ w cz FE : 1 LLI y r" a a .il 4 .�:.,. N 1 IG .--------------- ,�"�, � ', , „�•� M I: �`� �+ � — STI NO RESIDENTIAL DWELL I NO AND LO AREA #I: ..... o DEMOLITION OF EXI _ — RESERVE/ _ °• l." O DEVELOPMENT Vic:' � '""�t 'r L C9 AE3ANDONMENT OF EX I ST I NO SAN I TAR)" SYSTEM _ 0 c N O EXISTING OIL TONIC cu �'/^� } INSTALLATION 01= E3URIED ELEGTI�IGL WIRES WTE=i� --1-- - "- — — ------- _ I _ — -- "-" - �6 gq'12 ' 3q' 4 _ .t 0O O O +�-+ (9 SUPPLY LINES 1 — - - GONSTRUGTI ON OF ORI CULTURAL BU I LD I NO S (Al L 1 — _ _-- --- cu .� ,1 1 0 I __--- __--- - -- w � c» I , • ;/"ram- >, '""• . + � � i ,— LOGTED OUTSIDE O TRUSTEES 100 JUR I SD I GT I ON LINE) 1 pu��l _ _ — _ - w/ L U s 1 DWELLING r 1 • 1 1 BN OUS�GPTION y�El. — _ -_--- 1, P, `/ N v_�w rn w/ p�L10 O K --- O 1 + I HATER 1` fi, n , 1 - - -"- 1✓ v - ttt ' p ti6 APPROX. LOCATION OF " .v 4u V y + r C. t""^ `"a= W I NEARBY PRINCIPAL . ... ' ,3 ------ 1 DWELLING STRUCTURE ! t F 1's _ _ N ➢ �, L.._ 6'II 1 I " j ,. A/ _ / 3 $.,. ., SUBJECT PROPERTY A�^,._•y "' t' l 'r ':' .0 i rn a� - '.! +1.® 4a1s • , ..I� J . .. �:"- - - ° 'C,./• Q .. , a q�''"'► "" ``•.- ,u ' �i tee,«�i ` = � lr (10) I'XII, lz� 0 DW�LI'IWp`'fGR y - _- PARKING SPACES ! - � .. �'�° I� '' M ------ 4_j m LOCATION MAC' _ - - PROP.FARMg�3°4,030 W /• I I ,' EXIST. HEDGE ROW EXIST. DRAINAGE � ¢g0'30 - STAND 135 q0% - I o 56q°36'50"E SCALE: NTS GRATE - , a R=20.00' \ \ - PROP. I , ,r V L=33.83' \` - 1, 110, PERVIOUS % ,'�% ',y„ 153,3 DRIVE LOT COVERAGE SGTM #1000-115-10-01.001 Z• / LANDWARD LIMIT OF O k TIDAL WETLANDS 15 EQUAL AREA #2 0\ o ; AGRICULTURE ��D/� ; J TO BOTTOM OF BANK 5OUTHOLD TOWN CODE SECTION 280-04 \` ' \ ROADWAY ASPHALT Q�U; ,� 1 'r�/;; ' \; 1 AREA #I RESERVE/ --____ 3o LOT (113 S.F.) p / % ,' % j '� DESCRIPTION (FOOTPRINT) AREA nn 11 _ 1 DEVELOPMENT (8q,281 S.F.) 4 % rJ , p b COVERAGE W 0 / /\cp TOTAL LOT AREA 620,542 S.F. \ ► PROP. ',� �' 0 "''" irk a� (SGTM #1000-115-10-01.001) N \ 11 PROP. NORTH ,4�� BURIED / LOT AREA p 1 ELEG. '' , ��;,!;';;,'; 8q,251 S.F. 1 GREENHOUSE ,' -, HATCHING INDICATES (AREA #I: RESERVE/DEVELOPMENT) LINES % v 'y/ % NON-DISTURBANCE BUFFER BUILDABLE LAND lU 7q 055 S.F. (AREA #I: RESERVE/DEVELOPMENT) PROF. 5 H ,' - /W �� EXISTING GARAGE 251 5.F. 0.330 1OUT _ L.P. D P 1 01ZEENHOU5E �` ,',� �' R' I y \ K ' � HOLE DEC- $ TRUSTEES-APPROVED DOCK 131 S.F. 0.29b , z � APPROVED PIER w/ 4'-WIDE ACCESS PATH THROUGH PROPOSED FARMHOUSE w/ DECK 1316 S.F. NON-DISTURBANCE BUFFER PER DEC PERMIT NO. I-4738-04281/00003 a PROPOSED POLE BARN 2,g4q S.F. 3.'7go 1 PROPURIED . ---, _/ = ' I TRUSTEES PERMIT NO. 1057cl P ( ln PROPOSED GREENHOUSE (SOUTH) WATER SUPPLY li T � )'LIN> To- ' �-Q \ PROF 1 POLE .' 1"1'°IrER U ,,,, 1440 S.F. 1.8gb BARN LINES EXIST. WIRE 1 � / ;� ,• , , \ r FENCE TO BE 1 i / /' / ,' " LIMIT OF EXIST. TREE LINE PROP05ED 6REENHOU5E (NORTH) 1,440 S.F. I.BY (EXISTING CLEARING) PROPOSED FARM STAND 288 S.F. 0.4% ' EXIST. 1-5TORY WD. FR. DWELLING w/ WELL I N BASEMENT TO BE d X SGTM #1000-115-10-01.001 11 r -___ , TOTAL AREA OF ALL STRUCTURES 7821 S.F. CIA% ACRIGULTURE � TOWN DEVELOPMENT RIGHTS DEMOLISHED; WELL TO BE (2) q'xlq' PARKING I i / r�_� "�, ' �' �� ABANDONED PER SGDHS STANDARDS. L.P. \ �� 0� '\ ' SPACES UPON IIA OWTS � � i u- � _.�� �, ,' ', '�1 ;p,�P MAXIMUM LOT COVERAGE ALLOWED: 2095 (PROP. SEPTIC SYSTEMS r' `;;t" ,' EXIST. GONG. COVER; V.I.F. STRUCTURE \ PROP' 1 BELOW 4 ABANDON IF CONNECTED TO - "BUILDABLE LAND"EXCLUDES ALL LAND SEAWARD OF THE TOP OF BLUFF LINE,AND LOT COVERAGE DESIGNED BY OTHERS) 1 FARM- �� - J L rn PERCENTA&E5 ARE RELATIVE TO THE TOTAL BUILDABLE LAND AREA. .� EXIST. SANITARY SYSTEM HOUSE \ 9 TEST IQ ,' EXIST. OIL FILL GAP; EXIST. TANK y \ r \ AREA #2 N DECK HOLE ; • ` ' TO BE EMPTIED $ ABANDONED NOTE: N` \ TOWN OF SOUTHOLD �' I I. FLOOD MAP DATA: ' 't EXIST. CESSPOOL TO BE ABANDONED MAP #: 36103G0482H PER SGDHS STANDARDS � \\ •'` \\� DEVELOPMENT RIGHTS , MAP DATE: Oq/25/200q O ',`\ EASEMENT AREA 11 ' 1 \ , ' EXIST. GRA55 DRIVEWAY \ (426 663 S.F.) �. FLOOD ZONE: X AE (EL.=6') ' EXIST. 1-5TORY WD. FR. ►U- \ EXIST. UTILITY \ POLE (T'(P.) ' ' ' ' 2. SITE PROTECTION/SILT FENCING TO BE ,� �',',� �' I' 12.2'x20.3' GARAGE INSTALLED AS REQUIRED BY THE TOWN OF w Q 2 \ 586°4021 W � , ,� , ,q0%50 ( ' ,' '',o '� I� SOUTHOLD. 0 O 54.64 ° 20"E ',N��gf•20' : 55 8 �, EXIST. IRREGULAR WIRE FENCE 3. SURFACE WATERS OR WETLANDS ARE \ 2\\ \ \ EXIST. GRAVEL DRIVEWAY LOCATED WITHIN 300' OF THE PROPERTY. \'\ AREA #2 \ 1 I' r 4. ELEVATIONS REFERENCE NAVD Ig85 ° EXIJT. I-STOR+ I z `\ AGRICULTURAL WD.:FR. GAR GE w ul rn I D 5. ANY VISIBLE WELL5 LOCATED WITHIN 150 W ` STRUCTURE AREA f \ 1 \ `, (104,456 S.F.) OF SUBJECT PROPERTY LINES ARE Q DEPICTED ON SITE PLAN. o LIMIT OF EXIST. AREA OF MOWED GRA55 _ ------------------------ \ �I I rn D E E P \ EXIST. SEPTIC TANK 8 LEACHIN10 POOL ^� / J I 3> H O L E o'er`, , I I C R E E K PROJECT: � \ 35 � � > EXIST. 1-1/2 STORY � I, �,' I DHC LAND, LLC HD. FR. DWELLING TIDAL WETLAND t APPROVED 1 BOUNDARY AS \ I rn x DELINEATED BY BOARD OF I PZUSTEES rnx / \ MAYON2O2ANTs ON TOWN OF SOUTHOLD 4180 NEW SUFFOLK AVE \ ! I 0 o I \ j MATTITUCK, NY 11952 / 1 j • DATE CA k kCk I lob.( 51TE LAYOUT NOTES: \ 1 I. THIS 15 AN ARCHITECT'S SITE PLAN 8 15 '\ , DRAWING TITLE: I i SUBJECT TO VERIFICATION BY A LICENSED \ 1 — --- - --- SURVEYOR. THE INFORMATION REPRESENTED O �N PROJECT LOCATION &SCOPE ON THIS SITE PLAN IS TO THE AR CHITECT'S '\ ExlsT.`-!7 m; i I�N ! --- I SITE PLAN & ZONING DATA BEST OF KNOWLEDGE. \ ►� 35 I - EDGE of p 2. SURVEY INFORMATION WAS OBTAINED FROM �\ \ ` '� WOODS i\--MEAN HIGH WATER MARK A SURVEY DATED JUNE 50, 2014, M05T \, RECENTLY REVISED FEBRUARY 0-7, 2024, AND PREPARED BY: N�`j EXIST. FIRE \ j o` NI,I +02 001 PAGE: KENNETH M. WOYGHUK LAND SURVEYING, PLLG N9 HYDRANT \ _ 16.55, '12"E ry��°� I #1000'115���ENTI PAL �� I6.35' I _ P.O. BOX 153 WTL-00loOOOEXIST.AQUEBOGUE, NY 11151 �� \ IRRIGATION •� v I LOW �� 12832� - PHONE: (631) 2q8-1555 WELL HEAD \ EXIST. 1 \ 3. ELEVATIONS REFERENCE NAVD IcI55 I., 403.0 '� WIRE 1 ° �G RO.V�• — I DEC 1 0 ^ter \ EXIST. ROW OF �n FENCE ' \ SPRUCE TREES 2001 '�� LNG w/ ��____� DATE: 12/18/25 1 OF 1 PROJECT / ZONING DATA /57., \ #1000-I15'1GIWp,T�R t # I DOO-I I S-1 o-OI.001 N7j°39�0" \ SGTM P�GRIG�L� — —__ o p _- -- - - U �X15,t ROVy ' _ ,� I P,...•,.,�, . TAX MAP N24e38 30 W W \ EXIST. EDGE _ �- p1nlELLING "'R R-80 GDNFORMING \ 13.6'i' \ U \ /° OF PAVEMENT 014-1 ZONING DISTRICT N7 3 4 g�8 10 W LOT AREA 14.2 ACRES G N .� W _ 20.0 p -\ EXIST. AREA OF _ _ pU8LI1G I � C `� \\ l - O.W. -_ 'sr I I C�:? O�`\� Sig-rr 0�t>,��0 FEMA FLOOD ZONES X 8 A\E (EL.=6) / ��a°��'1O„W SOUTHOLD TRUSTEES #105'7q: DOCK (APPROVED) UBL�C NG Wj �.� PENDING: DEMOLITION + UTILITIES �4 ry R - NJL: #1-4755-044281/00002; 10/13/1? NYS DEC PENDING: #1-4755-04251/00003; EXIST. ARBORVITAE � �'��. 0�7�s�� y4 OF Ib�� LC SUFFOLK COUNTY HD APPROVAL _-__-____ PENDING 20.0' S 1 TE PLAN SCALE: 1" = 50'-0" SOUTHOL.D TRUSTEES No. 1 Ol O 1 A Issued To. Dafe � /�y /�6 Add ress y � �o IJew S uGGoIK AvQ � NI:Gtt;-rucK THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 Glenn Goldsmith,, identSOFFO(kCOG Town Hall Annex A.Nicholas Krupski,Vice President 0��� y�k. 54375 Route 25 Eric Sepenoski A P.O. Box 1179 Liz Gillooly �y Southold,NY 11971 Joseph Finora l Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed infield by: . AMP Architecture on behalf of DHC LAND LLC c/o WILL PECKHAM requests an Administrative Permit to demolish existing dwelling and abandon septic system and oil tank; install buried electrical wires and water supply lines; construct circular pervious driveway. Located: 4180 New Suffolk Avenue, Mattituck. SCTM# 1000-115-10-1 Typ of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Zchapt. 275 Chapt. 111 other Ty�of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.. i N Present Were: ✓ G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples i pWPUBuN WATER) (USES pwELLINWATER) � (USES PUBUO w gg7.23"OUS I 5 wEV-) GREEtA & IRREGATION — (USES pUBUc -o m _ 796.71' I }I1� rae irlE D\gL uNWATER) u�,/ 5TK• E, („SE ELK AVENU _ 11r I D �oz � SU r IF __ Ew o°• N (PUBLIC wA�R IN ST p`NELLIc WATER) I �110'ti� I USES mGo E 21 / £0 N 7g 40'30 0" I o S 7 350g0, _ \ 2257 \ �I sM II_ �"9. ASPHAL 86 7.8'E 3r5 1- GRATE 155'� AREA #2 E I i H ROADWAY ASPHALT 113 SQ.FT. R,20 1 / 57, �'33 .00, \ 83 II I RESERVE/DEVELOPMENT� y:Ilk/4. // AREA #1A �= h ? 3 � . 89,281 Sq. Feet 02 * N p 2.05 Acres o : lop h N I 9� \ I \ 100 s o i N � / W LL I"` I W # w J O \ 426,778 AREA #2 s or9.80 acres oI BSJI = 3 W \ TAX No. 1000- 1 15- 10-01 q IS o M 03 W I � N W TOWN OF SOUTHOLD m I I EXISTING WELL " +a F Q T ap N BASEMENT k S ., W DEVELOPMENT RIGHTS EASEMENT AREA z N 1 N TO R°'""20 24. $ � / C7 0 :�-::..N.. ... O \. \ 426,775 S.F. r^ II WIRE FENCE o of STNGcFr 9.7'... 55.6 TO E LINE i A I W u10.6:.DWEUJN�.. r\ / • r 1cZi cAP �`'.� p � 110 12 I On 25 � 961.GIRIGE \ � / I ( ND I�IATQt/NO SAMINrf '[ �"No I I 94.8'TO TIE UNE 31AZG L �P"" \ upP� � ' M::4:< , 3292' 7K50 7y \ I .S 8T1731 S S ARE cE 31.76 IN 8 540 0„ N. I FE PLANJO NCE 1RREc�v� EOzs i o°F° N 78 40 30" \ \ I 9.52'MON 35.12' N 86'40, r 20" E 97 20, 5.88 .c^ LP.GAS \ \ \ HEDGE TAX#1000-115-10-02 \� 200' RESERVE/DEVELOPMENT AREA #1B LAND N/F OF DOUGLAS & LESLIE XIRSCH PROPOSED 35' WIDE ACCESS 25,967 S.F. \�= AREA #2 \ vP#� AG. STRUCTURE AREA 104486 Sq. Feet \ I \ 2.40 Acres Z 35' a\a>r. I. o >t \ STK- CA (_n 0 °p N \ p O ISO, 0s \ mUN1 P°ks- \ a o a >. .twos 100, Ld ` W 0 o m STK. y� \ O. o \ N 7'47"0� E ° 4 PW/*nRE O \ W �f20 *Q HEN RESERVE/DEVELOPMENT AREA #1 B .07 O X X 0 10' WIDE\ACCESS RESERVE/DEVELOPMENT AREA #1B SDK- MO E \ 151 3 z y 2,022 S.F. 35' WIDE ACCESS °'S' 9 GRAVEL DRNEWAY FEE WIRE 440.77 � 1.1'S• � � ' _ _ _ . \ /y ) -39'2pb W z0g8g• AREA cRnssEST1� O _280.2�r 5.75E g01 4/ /FNONs O \ ��/J�0 :^.�.._.._.._•--.._..�... ..�..�..\-• -_•._.._.._.•—ROW OF`SPRUCE TREES gFLBR pwEUBUNWATER) I1/ PD A' Mp�1. `.._.._ Rg�Y JY"SFI3R (USES P Q \ l'YT RD, 0 ZONE 4 CE1fiER uN b, RrcTIT OF IrA= o/F AREA c OF MOWED NpWE�B`N WATER) THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL 6.4 N » o e°F sr1c. 1 N/g DIFFay (USES P LOCATIONS SHOWN ARE FROM FIELD OBSERVAAONS n/ pq lrp�T 5 7g 47'10 " / G RA N y pIFFLB AND OR DATA OBTAINED FROM OTHERS. RESERVE/DEVELOPMENTEY EXII EXISTING 0' WIDE PORTION (US PU<<�NG223 9I sP1c zo c CEr. U (U—S�EwpUBUG wA R) MAP NOT BEARINGUNAUTHORIZED AL�THERA nLAND SURVEYOR'S TO THIS SURVEY EMBOSSED SEAL SHALL NOTOBE CONSDERED7209 TO BE A7VALID TRUEEE NEW RCOPY.4 GUARANTEES INDICATED COPIES HEREON THIS HALL RUN OF EXISTING 20' RIGHT OF WAY BCIC WATER �" ►qp ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 7771E COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON 2,374 S.F. N SHOW LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHO HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 77-IEREFORE THEY ARE C°�I µ. GE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS 7.4N AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF:DESCRIBED PROPERTY �P���O M NWo y CERTIFIED TO: DHC LAND LLC• 1 00 200 �� C'." C' SITUATED AT: MATTITUCK TOM OF:SOUTHOLD = SUFFOLK COUNTY, NEW YORK Fy J`" ' KENNETH M WOYCHUK LAND SURVEYING, PLLC Is, O80g82 J Professional Land Surveying and Design FIDE #14-62 scALE:1 =50' DAB SEPT. 1, 2025 P.O. Bog 153 Aquebogue, New York 11931 N.Y.S. LISC. NO. 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Main Rd. &Youngs Ave.) y ,e Telephone: 631 765-1938 Southold, NY 11971 GSA • Q C4UNT`I,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees Cc: Honorable Lori Hulse, Attorney From: Heather Lanza, AICP, Planning Director LWRP Coordinator Date: January 9, 2026 Re: LWRP Coastal Consistency Review DHC LAND LLC c/o WILL PECKHAM, SCTM# 1000-115.-10-1.1 This application is to demolish existing dwelling and abandon septic system and oil tank; install buried electrical wires and water supply lines; construct circular pervious driveway. The proposed action has been reviewed to Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the policies of the LWRP as follows: Policy 6. Protect and restore the quality and function of the Town of Southold's ecosystem. 6.3. Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The proposed plan includes actions which are consistent with the "Administrative Permit" requirements of Chapter §275-2 A of the Wetlands Law of the Town of Southold which qualify under§275-5 (B)(2)(b) Removal of any material or structure, provided that a project limiting fence and a silt fence with hay bales is installed to contain disturbance if deemed necessary and provided that such operations will not have an undue adverse impact on the wetlands and tidal waters of the Town. and, (0 Construction or improvement of pervious residential driveways or walkways, provided that such activity will not have an undue adverse impact on the wetlands and tidal waters of the Town. The proposed action has been reviewed to Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront-Revitalization Program (LWRP) Policy Standards. J Glenn Goldsmith,President V SU!/j, Town Hall Annex }' �91 54375 Route 25 A. Nicholas Hrupski,Vice President to P.O.Box 1179 Eric 3epenoski J { fL Southold,New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Elizabeth Peeples ` ",O ® YO�ti Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Once Use Only Coastal Permit Application fon I.--. Wetland Erosion ��----�___ -- -:.�a.- :'� c.� t _Administrative Permit d� + DEC 1 9 2025 _Amendment/Transfer/Extension I 'c Received Application: 1l c�)IS j `� X Received Fee: $ as o - 0 S '.cJUlii E�TKfi-ii Completed Application: ____. _ __BLaroafT -e.s Incomplete: SEQRA Classification: Type I__ Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): __T LWRP Consistency Assessment Form Sent: VIM CAC Referral Sent: KDate of Inspection: Receipt of CAC Report: _Technical Review: _ X Public Hearing Held: . 1'1 J Resolution: Owner(s) Legal Name of Property (as shown on Deed): DHC Land LLC (Will Peckham) Mailing Address: 1990 N Sea Road, Southampton, NY 11968 Phone Number: 631-433-3123 Suffolk County Tax Map Number: 1000 - 115-10-01 . Property Location: 4180 New Suffolk Avenue, Mattituck, NY 11952 (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable):AMP Architecture Mailing Address: PO Box 152, Mattituck, NY 11952 Phone Number: 631- 603-9092 ____ Email:bep person @ajp2 chitect.com board of Trustees Application GENERAL DATA Land Area(in square feet): 89,281 sf Area Zoning:Agriculture; R80 Conforming Previous use of property: Single Family Dwelling C Intended use of property: Agriculture Covenants and Restrictions on property? �I Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? FV1 Yes F-1No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? =Yes _2]_No If"Yes", please provide copy of decision. Wrighis project requirq any demolition as per Town Code or as determined by the Building Dept.? ✓ Yes No Does Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: Agency Date ❑ No prior permits/approvals for site improvements. - Has any permit/approval ever been revoked or suspended by a governmental agency?1L No ❑ Yes If yes, provide explanation: Project Description (use attachments if necessary): - Demolition,of existing dwelling and abandonment of existing sanitary system and oil tank - Installation of buried electrical wires and water supply lines - Proposed Circular pervious lDriveway Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Remove existing dwelling, abandon existing septic and oil tank. Property to be proposed for argiculture buildings, all to be placed landward of 100' Jurisdiction Setback Area of wetlands on lot: 10,226 square feet Percent coverage of lot: 0.3 % Closest distance between nearest existing structure and upland edge of wetlands: 56_2 feet Closest distance between nearest proposed structure and upland edge of wetlands: 100+ feet Does the project involve excavation or filling? ❑ No _�✓ _ Yes If yes, how much material will be excavated? 53.3 cubic yards How much material will be filled? 53.3 cubic yards Depth of which material will be removed or deposited: 4'-0" feet Proposed slope throughout the area of operations. <1 Manner in which material will be removed or deposited: Excavation for buried utilities to be kept at site for backfill once utilities are installed Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): The proposed work does not have an adverse affect on the Wetlands. An existing dwelling is being removed which sits 56.2' from the top of bluff. All proposed work at the site for new buildings will be landward of the 100' setback line. 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing l Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: DHC Land LLC Project Location(describe,and attach a location map): 4180 New Suffolk Ave, Mattituck, NY 11952 Brief Description of Proposed Action: - Demolition of existing dwelling and abandonment of existing sanitary. system and oil tank - Installation of buried electrical wires and water supply lines - Proposed Circular pervious Driveway Name of Applicant or Sponsor: Telephone: AMP Architecture E-Mail:bepperson@amparchitect.ch Address: PO box 152 City/PO: State: Zip Code: Mattituck NY 11952 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 21 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: ❑ Southold Town Building Department ' 3.a.Total acreage of the site of the proposed action? 2,05 acres b.Total acreage to be physically disturbed? .01 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2•05 acres 4. Che I land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) Industrial Commercial ©Residential (suburban) Forest ©Agriculture Aquatic ❑Other(specify): PParkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 0 fft( E 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ✓ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? ". NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: F/I ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ✓ b. Is the proposed action located in an archeological sensitive area? ✓ 13.a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ✓ b. Would the proposed action physically alter,or encroach into, any existing wetland or waterbody? r If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typic bitat types that occ n,or are likely to be found on t6-project site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional Wetland Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed M by the State or Federal government as threatened or endangered?16.is the project site located in the 100 year flood plain? U,17.Will the proposed action create storm water discharge,either from point or non-point sources? ro If Yes, a. Will storm water discharges flow to adjacent properties? WINO ❑YES b. Will storm water discharges be directed to established conveyance systems ff anfam drains)? If Yes, briefly describe: MNO ES A w at site will be-Gonn_-e to dedie rmwatec ment systems Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond, waste lagoon, dam)? If Yes,explain purpose and size: ❑ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: Z ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ,� �2r- Signature: Applicant/sponsor name:AMP ArchiteCtuf O Ort1110) Date: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ I Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a. public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, a architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage �i ❑ problems? 11. Will the proposed action create a hazard to environmental,resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 t H �d of Trustees Applicatio_ AFFIDAVIT BEING DULY SWORN DEPOSES AND AFF RMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJ[JNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of roperty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 20 Z� DARCEE AUFENANGER AZ C` NOTARY PUBLIC,STATE OF NEW YORK Registration No.01AU0019644 ry Public Qualified in Suffolk County Commission Expires January 9,2028 B -d of Trustees Applicatio AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified as SCTM# 1000-. 'I 57�O e 12 . 0O k in the town of -An g-L ,New York, hereby authorizes J- 7t) Y'L to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS 1 DAY OF 20 DARCEE ALJI ENANGER NOTARY PUBLIC,STATE OF NEW YORK Registration No. 01AU0019644 Xq ary Public Qualified in Suffolk County Commission Expires January 9,2028 APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same.,, ' ^ - p YOUR NAME : me I �i ��''� V"�l lc�[�l�lQi�►^� (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning'' Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest" means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this (� day of 20 2� Signature 1/II r l� Print Namel APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town ofSouthold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The pumose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Anthony Portillo (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood',.marriage,;or business interest."Business interest'means a business, including a partnership,in which the town officer or employee has even,a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES F-1 NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): LIA)the owner of greater than 5%of the shares of the corporate stock of the applicant � (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); 14Q_an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OFr RELATIONSHIP r Submitted this day o 20 Signature Print Narne.AaAhcMy Portillo Fonn TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making.:a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A .proposed action- will be evaluated as to its simifcane beneficial and adverse effects upon the coasial,area(which includes all,of Southold Town). 1 If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. ,Thum each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000-115 _10 _01.001 PROJECT NAME DHC Land LLC The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑✓ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑. construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: -Proposed Circular pervious Driveway - Installation of buried electrical wires and water supply lines - Demo. of exist. dwelling and abandonment of existing sanitary system & oil tank Location of action: 4180 New Suffolk Avenue, Mattituck Site acreage: 2.05 Present land use: Single Family Dwelling Present zoning classification:Agriculture; R80 Conforming _ 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: AMP Architecture (b) Mailing address: PO Box 152, Mattituck, NY 11952 (c) Telephone number: 631_603-9092 _ Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No❑✓ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. a Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No ONO Applicable Attach additional sheets if necessary _. Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑✓ Yes ❑ No❑ Not Applicable Proposed work will remove structures from the 100' setback from top of bluff Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Z Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑✓ Yes ❑ No ❑Not Applicable The proposed work removes an existing dwelling that sits only 56.2' from the top of bluff and keeps structures out of the 1 00'jurisdiction. The existing septic sits even closer to the top of bluff, this will be removed. For future proposed work an IA OWTS will be installed Landward of the 100' Jurisdiction setback. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No Z Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑)Yes ❑No 0 Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ❑Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No 0 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES - Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No ✓❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No ✓❑ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages 62 through 65 for evaluation criteria. ✓❑Yes ❑ No❑ Not-Applicable The proposed infrastructure would be utilized for thoughtful agricultural production. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No ✓❑ Not Applicable PREPARED BY AMP Architecture TITLE Applicant DATE