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HomeMy WebLinkAboutTR-10896A Glenn Goldsmith,President O�S FFU(�CD Town Hall Annex A.Nicholas Krupski,Vice President Gyl? 54375 Route 25 Eric Sepenoski x P.O. Box 1179 Liz Gillooly Southold,NY 11971 Joseph Finora 'f' pl,�Y Telephone(631)765-1892 Cl far 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 1 st day of construction % constructed Project complete, compliance inspection Glenn Goldsmith, President ®F s®�/�� Town Hall Annex ®� ®�® 54375 Route 25 Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoski l Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Joseph Finora Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10896A Date of Receipt of Application: December 22, 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: Install a 12' x 9.4' FLUPSY (Floating Upweller System) at end of dock in Deep Hole Creek to hold shellfish seed. 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 Will Peckham, received on December 22, 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. f — p4ra-ly Glenn Goldsmith, President Board of Trustees Nc�v\' S'�t P�C�VN- Sc-'I-e' 1 Floating Upweller System Cross Section View, MHW 24.00 p' .00 0 20.00 20.0 -- ----------- --------- ---- I N N 010.0 o i I I � Fbe�lc-,,bs (56.00) cowlp os'l I d-`"0§ E P i�.✓ Fes...4:. BY I l I V c7 i BOARD OF �i rUSTEES Coyv�Qos;h� I I I ®ATE nv�G� � I I � I s At MHW, depth is 4.9 Approximately 36' clearance to bottom < is e u ��- I DEC 2 2 2025 JUtditltild Town Board of Trasfea s Floating Upweller System Cross Section View, MLW 24.00 .00 20.00 20.00 Cd -------------------------------- -------- !CD t I j N O N 010.00 I I C6 o I I I � M I I I i I — ! (56.00) — I ' I � I I I I I I n � At MLW, depth is 2.5' or 30" Unit does not contact bottom 1` DEC 2 2 2025 Southold Town Board of Trustees 2 A_ Floating Upweller System 144" Plan View N _ 2O" Sq J- JAI N O " o p DDC 2 2 2025 1 I � 3 g��tholtiTo�+:� Board.ofTru�e?s Floating UpweRer System Cross Section to Scale 27' bAA�4LMV4'( 419, 1P 32' 59, A 1 7F - - O\ \ Rat' -; ��i-A 77771 9. 4W ——————————- -————————— r - 7 M.XNT AIN i"11N. C CLEAR4NCP 8' O.C. 6110 PILES S' O.C. Uses recent survey data from TOS Trustees Wetland Permit #10579 FLUPSY unit shown in blue at MHW and MLW See pages 1 -2 for detail F DEC 2 2 2025 soumid Town Board of Trustees Floating Upweller System Plan View to Scale 29 TILA - +- 0, 32, -j-7 1; X -_7 -49. =i Fo 47a,i J- 9.3' -L!.V4 IC4 It E DEC 2 2 2025 1 E D-'7 3 Srulhoic--T� 7E "I J APPLICANT C L-41. _LZ HD JUNE Z"-', ENLARGED SITE PLAN ADDRESS v7RCE-., P'T:=P4RE1* BY KS PDVIEED By- KS JOB SITE. C01 COSTELLO MRII1� NTRIC TII-,ic CUR?. P.O. BOX GREENPOPT.1-.,.Y. iioLi, 29 SCTM# 15 10 V631',,477-1194 (SHEET I OF Z) DATE: L =5. 05,;-;= FLUPSY unit shown in blue. See pg 3. for detail plan view. 5 SOUTHOLD TRUSTEES No. 1ogg� R Issued To. t>"C I'mma Ll-c Date Address. y I ggewS;t&�ol,K0 Ave, ki%mv'-rtACK THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 Glenn Goldsmith,Prey;.. t ����g�FFU(��0� Town Hall Annex A.Nicholas Krupski,Vice President y<'� 54375 Route 25 Eric Sepenoski w ,? P.O.Box 1179 Liz Gillooly Southold,NY 11971 Joseph Finora Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 12 Z Completed in field by: r_ Ocy[A #2 DHC LAND, LLC c/o WILL PECKHAM requests an Administrative Permit to install a 12' x 9.4' FLUPSY (Floating Upweller System) at end of dock in Deep Hole Creek to hold shellfish seed. Located: 4180 New Suffolk Avenue, Mattituck. SCTM# 1000-115- 10-1 Typef area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: `/Chapt. 275 Chapt. 111 other Typ of Application: Wetland Coastal Erosion. Amendment 5'Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: k c Present-Were: "/G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples I DWVL U" WATER) (USES DWELL%"WATER) PM (USES ++� _ �•• ' 997'23' 4g.39'. I N _ 45' w ENHOVSES t;pT10N WEu-) =. c� 4� GRE w � IRRE �•- \ (USE PULUC WATER — m I w 0 s S m — COM of P 7g6: I PdE DMELL\"W ATER) u I+ !-E!a (USES OL1! C)m< w jcR IN STREET) m rn pWELUN WATER) ti/ I PULUC lb p�0/ t;l MON. (USES _ ' I ' QD „ E 200' / a, N „ A j8.40'30 W I o _ T S 7835 g01 69.36. �• _ ASPHALT \7.8'E sTK•CRATE tar `4` ' •F MON 4382,Ob f AREA #2 � . ��, !-" ROADWAY ASPHALT 113 SO.FT. 22.57, 330 00, \ I or ytiti// / �•Ar vM '83' I I RESERVE/DEVELOPMENT N \ I AREA #11A r 89,281 q. Feet e V Q o ; 2.05 Acres y Q7 r \ s \ Nee q�PS' pow I / S oAll G vP►A \ At I / O \ \ I 100' o h so �3 E I 3 / o i AREA #2 o I ar31n� NN _ �► \ 426,778 s.f. or 9.80 acres i 0+I /--s W 3 I 0 TAX No. 1000- 1 15- 10-01 CO. Poly \ O t27I / i V ! o M /� `z to to ` TOWN OF SOUTHOLD m I I EXISTING WELL / cz COMM NOISE N BASEMENT P•+o �u W DEVELOPMENT RIGHTS EASEMENT AREA z N I 1°`�'"'" $��4 0 \ 426,775 S.F. WIRE FENCE o�:6•S1NOtE N :9.7... C6 i0 E LINE j W • toVAN / I I _ .o.•. I s '..OIL FILL ar i Z CAP j y i . Os al z 710 R1xG4N� � !I to Cs I I\ '�y ND NAIER/M]S�MWif N i 1 J \ I 94.8'TO TIE LINE j: I p•N ,oryk uP .3 ,.,S 8T1731 I/.... S ,I 2 •\ I I 224 WIRE F� 31.76 N\ , N 8 ' 64�„ EN. I FENCE o IRRE Eo.2's 11 7 N Z 40'30„ \ 9,52'MON 35.12' N 86'40,0 E g7.20' 55.88 :c^ LP.GAS \ I HEDGE TAX//1000-115-10-02 ^--�200' DOUGLAS & LESLIE RESERVE/DEVELOPMENT AREA #1B LAND HIR SC OF H PROPOSED 35' WIDE ACCESS \C'Lr I 25,967 S.F. �� LP AREA #2 I AG. STRUCTURE AREA \ \ 104486 Sq. Feet 2.40 Acres I Z \ zv(op 35(2128 -o n STK• W \ \ \ Oi ISO Ci \ N l � 1 \ q1 P \ :\ �� \ o .11L 100, OSTK- W '3 \ o F \ j,=37•g3 Mo O \ 47 E \ WM#20Lf HEN RESERVE/DEVELOPMENT AREA #1 B N 7405 07 O 4'�` °-� m S y e 10' WIDE\ACCESS RESERVE/DEVELOPMENT AREA #113 s`I` M E X 0i \ 1�391 2,022 S.F. 35' WIDE ACCESS pas'j4� six GRAVEL DRIVEWAY E vnRe 440.77' \ SPK. A AREA OF MOWED ..ROW N 'T 3g 20. W 206 e9. cRAss STK' oO _ _ _ _ _ —'2g0.20r —'IAON. 5.7 SNE ED1►WD�H"N"S �. _ _•._.._ - - _ - ,Rs LING ROW OF SP N/O gFL6R pWEL 0 WATER) po/ N. PaLu T� gENRy y boFFGER (USES IO \ NT a xnrr RO, o ° ZONE 4 � R uN —*�� x DTFFT EY AREA RO�F�MOWED 77-1E WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL BX sTx• 16 gTGFTT OF DWEULLN WATER) ^ N OR- 10„ GSR O E' DIFFLEY (USES LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS 5 7g b7' K,oN t. AND OR DATA OBTAINED FROM OTHERS RESERVE/DEVELOPMENTEXISTING 0' WIDE PORTION AREA #16 (us "CLLING223 gT. �" 2° �0�°� c N (U5pE5IPUL1 0 WA R) MAP NOT BEARING THEUNAUTHORIZED AL TERA nLAND SURVEYOR'S T EMBOSS SURVEY SED SSED SEALS A SHALL NOT BE CONSIDERED7209 TO BE A VALIDF THE ETRUERCOPYA GUARANTEES INDICATED COPIES HEREON SHALL RVEY UN OF EXISTING 20' RIGHT OF WAY C Wg7tR� I►qp ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS777U770N, GUARANTEES ARE NOT TRANSFERABLE. 2,374 S.F. _ N THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE ra HEDGE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE 1T/E ERECTION OF FENCES ADD/770NAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS 7 AND/OR SUBSURFACE SMUC71JRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY ORDESCRIBED PROPERTY P�� N N!•NEw��O CERTIFIED TO: DHC LAND LLC' 50 0 25 50 100 200 co SITUATED AT: MATTITUCK �" Y•., TOWN ORSOUTHOLD = 1 , SUFFOLK COUNTY, NEW YORK 2 A ' KENNETH M WOYCHUK LAND SURVEYING, PLLC SF OSOg82 J� Professional Land Surveying and Design ALE 14-62 scALE:1"=50' DABSEPT. 1, 2025 P.O. Box 153 Aquebogue, New York 11931 N.Y-S. LISC NO. 050882 PHONE (631)298-1588 I , I' LC r_ a , I Site Photos • 1100hrs 1� A• • A• •ve: T-Section facing NW Below: End of dock facing NW Below: End of pier facing SE 4�'r Mae � T J y. s r s f 'r A A W s iw4e%Earth Imagery Date:4/4/2021 40159'31.19"N 72131'13.27"W elev 16 ft eye alt 2337 ft 0 � x sEEsec No,ae o as S +"•;J;; sir '°. o` .= w, -w' \`mac.� � � � _ y.�.._"--'.'a' ,a'. n c aDwus�oo gN�:.,,. ., m-.. !21 ,4 t s '� •t a s %° #e • 1 w m ,az l� �,`8 ma A Hct ad 13 OE 3 f ?, ✓.y, R� v T 8 a _ y t�D • 1' 18♦ ..\` � :,A- .�'.. 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'Z „_,,,,_ —iz— .. ,a„u�.na• CO, OF SUFFO N _ _ _.__ z,,.kr Pal Prey , l' S•r} Az—" Teu*nNTa NE OP Y or_ q+„E souTrwEo 115 OFFICE LOCATION: ��OF so yo MAILING ADDRESS: Town Hall Annex ,`O l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) y Telephone: 631 765-1938 Southold, NY 11971 G.i� • Q 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 This application is to install a 12' x 9.4' FLUPSY (Floating Upweller System) at the end of dock in Deep Hole Creek to hold shellfish seed. 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, including installation of a FLUPSY under §275-5 (8) (2) (o) An application for proposed aquaculture activity that includes surface-mounting gear in an area greater than five square yards. 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. Town Hall Annex Glenn Goldsmith,President `� �I+I j�t 54375 Route 25 A.Nicholas Krupski,Vice President �� �G� P.O.Box 1179 Eric Sepenoski - Southold,New York 11971 Liz Gillooly cn ac Elizabeth Peeples Telephone(631) 765-1892 F �(6 -1) 765-604 cvum DEC 2 ?Q25 BOARD OF TOWN TRUSTEES DEC 2 2 2025 TOWN OF SOUTHOLD This Section For Office Use Only ""F _,•> E`tihcicl To�ut�es Board of Trustees Coastal Erosion Permit Application Wetland Permit Application K_. Administrative Permit —Amendment/Transfer/Extension Received Application: 134111.15 Received Fee: $ 4-St- to Completed Application: Incomplete: SEQRA Classification: Type I__ Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): X LWRP Consistency Assessment Form Sent: I dal , CAC Referral Sent: Date of Inspection: 1/ Receipt of CAC Report: _Technical Review: _Public Hearing Held: 1 f\`1 f I` Resolution: Owner(s) Legal Name of Property (as shown on Deed): D H-C Lan oL , L LC_ d, 6,),i Mailing Address: &-j/ Z-2"1 v s S0ujl� fn i AN 11 j69 Phone Number: 31 cu d Z(0 _ Suffolk County Tax Map Number: 1000 - I 1 S ` © � j Property Location: 'q n 5 f Fo k ve. AN (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email-: __ard of Trustees Application GENERAL DATA Land Area(in square feet): 5 11 q _ — ---- --- Area Zoning: #' - �D C6ATC)(M l ()q Previous use of property: Intended use of property: t ou��e act Covenants and Restrictions on property? Yes =No If"Yes", please provide a copy. Will this project require a.Building Permit as per Town Code? Yes J> No 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 No If"Yes", please provide copy of decision. is project Tany demolition as per Town Code or as determined by the Building Dept.?re Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes gNo Prior permits/approvals for site improvements: Agency o( . 'l o d -ro a)n -ry-U.S f ee5 ���Ia n(,�Date 2 Pam i f 14- 1057q ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?-1,2L No Yes If yes, provide explanation: Project Description(use attachments if necessary): Aonll cant pr-gPose oLi a 2-1 LX q►'�`+ PLyPSV'/(FloafiY)y Upwel1e(-6V6tem)af �- (, in(A. of Ae- do&l— n D�e-p ��ree�CACT--Lu[5� ha5 r2 unJ5 fhaf wd hold 6hd1Ti5h geed► maInk11 oy5f er5,Thr- 6 elR1 wi[I be- G fo n % m llmm -it gmm b6oce- lbe( n fi n5-p2rreA-to `�hel arch - 5e pte m e( _._)ard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: cr Died FLU?. 9 uWl be. ws ed D C(AJ i yak smecll (l-Z..mm) hatcheN reared she)1-Fish._! eed-f-o Q. 6r&e. where fhN can be, ou�q)ankd i 0o Th& M,41 yafi on g&rc4c4 go h;n516 a.M , Thcg w_t fl be_ M.bre, at-6f e4ecfi Ve4r*)P— op\o-ralr�1 N o1 d 1 l o VJ bttkr ebn+ry l over o R+Plan-h-n i _ Area of wetlands on lot: — R&zm 10.p6square feet Percent coverage of lot: 0. ) Closest distance between nearest existing structure and upland edge of wetlands: 16—bff feet Closest distance between nearest proposed structure and upland edge of wetlands: LA'5- feet CFlv�sy) Does the project involve excavation or filling? No Yes If yes,how much material will be excavated?—T cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: _ A1 �} Manner in which material will be removed or deposited: 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): There, will he h141f_-h Lno e4ec+ on nea..rbu weflands or�i-dad wa4-fx5 ertht_ FLURby,:5 axial l l t)w rnoio r(a,tce-rafer)ei rw.laies Sur-face cja.+er LkD throUh ucnifs holoh-m h elf 5 h . W a.4-er-O e n t o ui o u�-lh ro uA h a e, a+ -ffi-e-+o p C)� +h,p-- cw ii­anCL 7mi-0 oc- rov,5h Whe.re_� aJair 70+5 back tn�p i-he bur-4ace_ uoQ+cr5 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I -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 I -Project and Sponsor Information Name of Action or Project: MCL.a,nl LLC e5t Robm50 CJlfi h wed I�u r:5er Project Location(describe,and attach a location map): CFI Ob Neu) 6(t.46)l Ave,,, &d 4uc I P- e.n he d k ae le /) Brief Description of Proposed Action: /� )p jj e�Yarl f propo� S +O C10,1Oy 0. �ZIL��'�1i�v✓ FLOPS` ck++hie ene� t� f1��2 dock.�h&' +et�6t,5 tn+o i�wp kl�e-r?r,ee(L Jhf_ F_LVPsX. ha_6 Iz unI Fs hof wf 11 hotof �he1«rsh se_,ed)MCL`n'y o 4'r-rs ,rh,e She -Pt5h to tht- T"L j) uP5V w // be5 wf1 �ronil IrnrnzSrYIn abe e ra b�t 1�5 ^at�s �elrr'~?cA +u 'f h �o -o u-F 5y5fevn o o-fi Ro b iYt<s�s Name of Applicant or Sponsor: Telephone:Lb 1 — OZ 66 IV d I 1 Pec khaM E-Mail:to i l w e-s+rDb f i C Address: b 136Y ;z�. City/PO: State: Zip Code: 5ouJham JDn Al 0 q&0 I_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. 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: ❑ /1JV3VEC-Di V51on 4 Mart ne���c�s-Sllell�l5hl�aVlaSe�let�tU�l� 3.a.Total acreage of the site of the proposed action? O bU 5 acres b.Total acreage to be physically disturbed? n b n 1t? acres c.Total acreage(project site and any contiguous properties)owned J I p or controlled by the applicant or project sponsor? 1 ( -1 acres 4. Che I land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) Industrial Commercial QResidential(suburban) Forest Agriculture Aquatic QOther(specify): EParkland Page I 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? X 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: DL'21 1!(JI� Qr'2f—k ❑ 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: ❑ M 11.Will the proposed action connect to existing wastewater utilities? J Q NO YES If No,describe metho for providing wastewater treatment:7htre W ill be ot) vJC4S ❑ wa4- -, :5w wafer 15 c(r I d +hr)v -to 6q6jew 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? IHI 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? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. ntify the typic4LLwbitat types that ocEAgr n,or are likely to be found on 0"roject site. Check all that apply: Shoreline Forest icultural/grasslands Early mid-successional Wetland Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? NO YES K TT 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO Tn If Yes, ❑ a. Will storm water discharges flow to adjacent properties? ❑NO OYES b. Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,briefly describe: [7NO �ES 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)? 1f 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: ® ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVEIS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ," 1 r p / Applicant/sponsorrn"a T name: IJ-rIL �G,�QA-L-LL �W.1�� ICc�na►++� Date: 12- �/ Z� Signature: 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 1 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 l. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 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? tL®I 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? S. Will the proposed action result in an adverse change in the existing level of traffic or ❑ 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? S. Will the proposed action impair the character or quality of important historic,archaeological, © ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ry ❑ waterbodies,groundwater,air quality,flora and fauna)? L.1 N 1 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 problems? 11. Will the proposed action create a hazard to environmental resources or human health? EJ 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. EICheck 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 _.-ard of Trustees ApplicatiG.. AFFIDAVIT PP.CkI Q(w (bHC LAJ )__BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)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 j CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION 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. G- Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS 1 DAY OF- DeCttwti bcir , 20 2T- Notary ub is MELISSA J SUTTER Notary Public,State of New York No.01 SU6361050 _ Qualified in Suffolk County My Commission Expires 07/03/2092 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The 134112ose 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: I l l �e� (Last name,first name,.piddle 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� NO If you answered"YES",complete the balance of this form anddate and sign where indicated. Name of person employed by the Town of Southold /y/,} Title br position of that person /4 4 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): 12A)the owner of greater than 5%of the shares of the corporate stock of the applicg n.t f2 (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 NLh Submitted this $ day of v 20 2 Signature I-W Print Name W iM ?-e t,k,AC1,,,1 Form IS 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 si iE beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. 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. Thus, each answer must be explained in detail,. listing both supporting and non- supportina 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 SCTIVI# lDOy - 115 PROJECT NAMED H C, d.aA[/We5� Robm5 0 yJtr5hel/A5h seed oar'5e, 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: ' Phi a-cft-MnW1 if tnvoIve- Ae de-ploy ine Lo-Fa (A L xgY'W i=[®aftn� VpfL eJe.r5y-4, eR1 Ct�l-u?5y) a4+h-P-4ermlrlal end o�,flhe exir 54m j docl whrt;6 e��ends rYl+o �eepl le Creek The F`VP<5t/ tot /l A ofo/ aunik o-�56e/1-P:5h steed, mainly OV- 64e s .The FLOI5VWill be- used -PD 5 rbw Seed- tno r►t E;m.n-L + Q ►n to 4llm yn mar-ch-Skp-f em e.r - seed 5ou,rc-e- w e cop rovecL by 4he- /VYS DC-C- Location of action: I�3 0 ecv 5uf�o1/� vex, MGt�l fuc�z jl0y/ 025Z _ Site acreage: 14, q Present land use: 4A n ca N re, Present zoning classification: ' . 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: Lanot t-LC - Wl// RecK am (b) Mailing address: 'Po T30Y 221 g , S y o-h a-m&z)yi , NV ll q b! (c) Telephone number: o�� D (0 0== 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? 11116 DE C 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. ®Yes ❑ No ❑ Not Applicable 'e o cai-f d ap ro ( to��. a.cm s e rw i b n ease im Pei►+ o it n a 1. ► cr' e 2 t •ec I v f-i ou t+to n l a a u5)e lard, t. _ o� �o I - _ a—n n e -�-( a+- n . D+ ,-err ,e - eCo . Cie .. ell 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 L,Not 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 5<1 Not Applicable 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 S through 16 for evaluation criteria ❑ Yes ❑ No L.Zsj 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 5uCn+ 1c- 5+udif5- show ino�+ �t1fir'--eedeF� liLCe rxr5le�'�,hai d Odom anx- ve- _ uW.c = ah ) / der - �s-Furt t e� :� n I A o 0p i�ea a v1 of 14 nand e s 4h i roce.c.-�- ewn .� ti w Over 16►IIIIon 6 ecl ni asea6&6.. Attach additi nal s eets 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 ❑ Not Applicable -Tn 0A66�1on ko ��?,t �11 do�,� a[ a'e bldom5 5ea ues+zri nS n +rn qtn ou +i +e o r r n r'aadislm,. Yeed— i in 1h e w a d6 ar . f pubhe / re.nja 'r-e— 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 ❑Non 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 LN 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. n LP1 Ye❑ No❑Not Applicable r o t car Dye e-e f o A 15 to 6 r ki q arwi +(o ILr . 064-e 0 - TV o d ,C a ____ ed nn o- r.___ _ a4� .V6ua/._a re e. :5 -th is_ Pros ec w._t. . n a.+__ n�er-r'fr e— wn" P tti tot I L i�.5�e (� n i i a a. . 1 f r tea Attach additional sheets if necessary IJ 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. MI-ves ❑ No ❑ Not Applicabl The-o r D' 7 3 a, ne to w a de en de n f it 5 5c o e I)-?Sld e- e-i lot a of e 'ec W1 b 2s " a + -Fr- r cc o_ in cpvn evi t -�G�P _FL U PSG -- 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 e -then roiec w ul a i5 T) a fie, o -tr h c © � 11 pe i'm . k,t4--/- abo Arr Ic)r-'. I Me Ufo h ji o m6 eC wr V r h Attach additional sh is if necessary -FLUP y i n ace-o rA&VI U- W i+h N ys'D 1=C reS�►o�i b—n 5 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 i his 6 r+e ha.s be-en preserVeod 4o Pro~I-ec f- i--E 6 a c u 1 kur-a.l a►)c! 5 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 Ve�AV,\,vy% TITLE __ DATE Q It