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HomeMy WebLinkAboutTR-10892A Town Hall Annex SD+JT�® 54375 Route 25 Glenn Goldsmith. President ®�� �® p p. Box 1179 ki. Vice President L Southold. New York 11971 p, Nicholas Firup- , Eric Sepenoski Telephone (631) 765.1892 Fax (631) 765-6641 Liz Gillooly • �O Elizabeth Peeples l BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES CONTACT THE OFFICE OF THE BOARD OF TRUST OFFEES YOU ARE REQUIRED TO CO 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES BELOW INSPECTION SCHEDULE _ Pre-construction, hay bale line/silt boom/silt curtain V day of construction _ '/Z constructed When project complete. call for compliance inspection, i Glenn Goldsmith, President _.`�QF S® � Town Hall Annex A. Nicholas Krupski,Vice President ,`®V� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski ! Southold, New York 11971 Liz Gillooly Q Telephone(631) 765-1892 Elizabeth Peeples • �® Fax(631) 765-6641 ®l�c4UNT i BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10892A Date of Receipt of Application: December 1, 2025 Applicant: Mazi Holdings LLC SCTM#: 1000-104-10-4 Project Location: 530 Broadwaters Road, Cutchogue Date of Resolution/Issuance: December 17, 2025 Date of Expiration: December 17, 2028 Reviewed by: Board of Trustees Project Description: Conduct construction activity within 100' from the landward edge of the wetlands for the construction of a swimming pool, pool patio, and pool fencing. 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 Adragna Designs, LLC, received on December 18, 2025, and stamped approved on December 19, 2025. Special Conditions: Establish and perpetually maintain a 20' wide vegetated non-turf buffer landward of the wetland line. 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. Glenn Goldsmith, President Board of Trustees I TO _ I / I PROPOSED UTILITIES TO 1' I � IMPROVED LOT I Nnn ,�t{Q /7� � E3E CONNECTED IN '1�*4a,50'' E i ACCORDANCE TO TOWN \ � RESIDENCE 1 /7� /7� I \ � - L - / - - SC/ AND UTILITY STANDARDS '� PU5LIC WATER \ 340.01 � 4\11 ir- / ' Po FENCE SILT FENCE /I ,; `\ \ \ \ \\ \ \\ LIMIT of DISTURBANCE m / \` ---- \ \ Im \ \ m -\ \ --fv- ��o. lfdsa TIDAL , Cd a L Al�� Fr(G/ / / WETL E g tir4r F ti o ` -- --- 4-1 \ I T u r \ �\ \ \\ I I \ 4166 SQFT. I o o o b • r f \ OmmN \ - I -_-, \ \ \ LAND" 1. --- i\ \ \ �� `� IN-CxROUND r _ GRA L CONStRUGTION EXIST I I \\ rLANDS DUION TT( 1 r DW-2 I I- O _ :.... 13 E P OL I '- \ j 4' I � �b ,a,BL C � E.... ` I' - __ _� \� mO 's 9.00' I I I \ \ \ I _ IVEI�AY I O S O 70 .. f, I \ \�m0 \ \\ P o o R I-. la �YIW6 "TI , � ! I \ 1 �� � \ � c � v) v� � va. 0 1 4.00' r I \ \ \ OT AREA = L 4 o - �----- 1 I I ` I m .,�_• i I \ 1 \ \ 1 I � (�� � \ a rx rx a cz z •`C L R . �.• � 28-IOl SQFT. o I I I C 0 S \ I I � � R055 L minus 4,1(cOT AREA 6 SQFT. of WETLANDS 24,535 5QFT. N L l \\ ?11 \\ I I �S. w BREEZE N I I I 1 ,4CCE WAY \` \ ` I Z '' ! 1 I 1 , ° .--� cat c'7 d' Ire co 1 ♦ _ 1 ,' \ /_ 2-�iAR \\ f'i ACHE -4 \POOL I I I \ I I \ 20. 17 0 I D 1 - l0E I I -- ------------ ------------SAS -----1 � \ \ \ 2�T 1fJID I Iz 'ti \ � � \ I I 1 � TATE \ ♦ \ \\ I \�--- `-t-- 4------- ---i----------- I l9 %' NON-7UR I = r ---- ------- �rF 7 \ \ \ 1 1 I 1 �__ -------------', I - ----- WATER-- A r r r r r rrrr++r r r T � I \ b-------.----- y ----_ � � 51L1r� �CE ` 1 O It9 �__ ---,ra.,-,"._�..-..,.....�.:...{. - V`-- y I I `\ I I ..F•'�Sca .,i\ -r...+ r r _\ .. .. rrr�l�+r \ I I _ -_ _WA7EP�_-� II'I \ - r QA 1 \ dE5"POOL FENCE I. ` y �✓� r-t r 'T \ "Z \ r \ \ Rrr A/Z I Q N 7-«_-__""-1--- -�__ nW"-_<-.�� __ j Ii 1 1 \ r r rrrr: r r r.r..+ r r rr.r+r \ I SL/.SL✓I \ \\ \ % Zo \ \ �j� QQQ Cy�� 1 r 1 / I 1 I 1 r - " r r r....�r �• \ ROVED LOT � ° �� .L J.•••� r r r r ..•r.r• �. r r.rrrr 1I I \ IMPROVED \ \ \`\ `\ \\ \ 2 \ \\ per' ``� [tom �4C`���J► I ' �0 r r r.r•r r r rrr•r r r rr• r%,1'-r- W \ \ \ \ \ �C�\ �i, \ s\ `� I I f! \PU5LIC WATER \\� \ <' \ � . /J \ I It Zip'' N04 SIN ^� 1 I I OF A \ \ I I p �I do ([S \ U� O N �0 SITE f= LAN U � SCALE : 1" = 15'-011 O N V) 7� ZONING INFOF"I4TION ZONE: R-40 o � O o V) � DESCRIPTION MAX/MIN PERMITTED PROPOSED m '-' O Cd 28,701 s ft. GROSS w LOT AREA 40,000 5GISt. 24,535 sG ft. NET (z) C) U LOT WIDTH 150.017t. MIN. ± 8r' Y) �r O U N LOT DEPTH 175.Oft. MIN. ± 340' Pre-existing Grade Calculations FRONT YARD 5QI.0' 80.1' TO MAIN DWELLING; 13.50 + 13.50 -2 = 13.50 x 43.79 = 591.17 55.3' TO GARAGE REAR YARD 50.0' 132.8' 13.50 + 13.50 _2 = 13.50 x 10.46 = 141.21 • - - - Sign 4 Seal: 13.50 + 11.50 2 - 12.50 x 26.74 = 334.25 _ SIDE YARD 15.01 15.0' 11.50 + 10.50 =2 = 11.00 x 13.46 = 148.06 ��RED ARC SIDE YARD 15.01 20.0' 10.50 + 10.50 -2 = 10.50 x 16.92 = 177.66 DEC 1 7 ?C?5 ��5 �QQER�R'°���� SIDE YARD AGG. 35.0' 35.0' 10.50 + 10.50 -'2 - 10.50 x 27.37 = 287.39 FLOOR AREA MAX. 3,803.5 SQFT, 3,801.01 SQFT. 10.50 + 13.50 +2 - 12.00 x 41.71 = 500.52 I - - It i5 a olati f I y ,.r5on,unles acting BUILDING HT. 21;1 STORIES -- 35ft 34.52' 180.45 2180.25 ------ _._ B;";'C:L'r under t e din o archi ect, alter _ --- an item V FfR t I .t an LOT COVERAGE 20% 4, f0'1 sciSt. 3,892 SQFT. 150& 50 2180.25 180.45 - 12.08 Pre-existin Grade architect a�9e the altering arch e affix to o e IT MAX MORTAR WINE h,s Item t thQ¢a�j$b ' i ,"followed by his signat a�IQ'tt,tt�� h at,on,and a LOT COVE AGE/ BUILDING AREA: MNSHED&RIDE APPROXIMATE WATERLINE AUTOMATIC descr, MAX. GLOSS FLOOR AREA: L R E � AUTor1AT7G SKIMMER AUTOMATIC SKIMMER. 3,350 SQFT. PLUS 10% OF LOT AREA IN EXCESS OF 20,000 RESIDENCE 2049 24,535 SF, - 20,000 = 4,353 SF• BREEZEWAY 248 MASONRY PAVER UNITS r�' •'ry:'•:.�.;5�.,-:'.` I I/�•"5C1TIN6 CFD �c' 4,535 SF. x 10% = 453.5 S.F. GARAGE 512 :'"':'";r' '''� '`` 3,350 + 453.5 3,803.5 SQFT. FRONT PORCH ro4 WORE MESH wlm 2"MlNR11Jd GOV[!t Architect: REAR DECK 383 ccMPITW 6LOGRAM m STEEPEST ALLOWABLE SLOPE POOL 516 BEFORE BR64K-W7 3,892 5Q.Ft. � 5 SAFTER5T LOWAg E SLOPE MASONRY PAVING DETAIL Nor To 6y u 4 b'-O"MINIMUM DISTANCE ExEPORE E3REAK 4� � \ MAIN DRAIN WITH HYDROSTATIC VALVE AND COLLECTOR TUBE IN&RAVEL BASE DRAIN GONERS AND SPAGIN6 SHALL BE V68 GOMPLIRNT � DIVERSION RIDGE REQUIRED EXTRA STRENGTH FILTER FABRIC WHERE GRADE EXCEEDS 2% 2 GREATER NEEDED WITHOUT WIRE MESH SUPPORT SEE TYPICAL I' POOL WALL SECTION I STEEL OR aOADWAY � \ 5iWOOD POST } i'ROVED1 i SECTION THROUGH LENGTH OE SWIMMING POOL ATTACH FILTER FABRIC FILTER FABRIC SDEUOF POST TYPICAL UPSTREAM A. FENCE SHAD NOT EXCEED 4'-0" BARD OF I�USTE ES $ 1 SECTION A-A . . B. FENCE SHALL BE BLACK IN COLOR TOWN rNN OF SOUTHOLD �: .. ..,.>;�';.;.•; �DW G. FENCE SHALL BE OF IRON CONSTRUCTION \ NOTE: ' -tr- I1-�--�- D. ALL GATES TO HAVE SELF CLOSING SELF I ' O �J SPILLWAY USE SANDBAGS, STRAW BALES :+ t �� LATCHING CAPABILITIES �t AD RAG 1 �lA n STRAW BALES, SANDBAGS, OR OTHER APPROVED METHODS ' '' } OR CONTINUOUS BERM OF TO CHANNELIZE RUNOFF TO y j• y } `- �e�m�er 4" SPHERE SHALL EQUIVELENT HEIGHT - 13A51N AS REQUIRED. 4" SPACING BEWTEEN NOT PASS THROUGH MAXIMUM SPACING WITH CENTERLINES OF RAILS(TYP) VERTICAL MEMBERS DESIGNS L LG SUPPLY WATER TO WASH \ / // \ \ \\//`\\ MARE SUPPORT � WHEELS IF NECESSARY / �\ �\�\ \ /� 6 MAXIMUM SPACING WITHOUT _ A2ARCH 1 F@GMAIL.COM ti WIRE SUPPORT FENCE TOP RAIL 'D'15 THE DISTANCE FROM THE TOP OF THE WALL DOWNWARD. E3E5IN 5PL DEPTH NO RA15ED BOND BEAM�STEEL AND"NITE THICKNESS T INDICATED'D' BULLN05E POOL GOPIN5--� E,_ - '\ STEEL OR WOOD POST H Z BOND BEAM 5. APPROXIMATE WATERLIIE (51 6) 289-2461 POOL / I D T VERTICAL STEEL d. p 36 NIGH MAX. Uu STOP OF POOL WALL -- ry FLOW --� f- v. 4 AST T�ATILE 2"REPAR&ROUND P Protect Title: FLOW l'1 UJI3 (� O'to 2'-b" 12" *4 0 12' SPACIN MAX yq„ FLOW Z }- 5'-O" 12" »4!b" »4 BAR. 6RAAT 60 REPAR AROUND PERIMETER OF POOL 530 B r o a d w a t e r s R d H A° o o, o,� O- N. n°°Q �BP � c q°° PONDING HEIGHT- PONDING"HEIGHT !C1 lll 5'-6" 12' «4•b" I 1"MIN.WAI L THICKNESS 2"-3" 3/4 MIN. DRAIN ROCK H 4b" 12" *4•b" n I Cutcho ue NY COURSE AGGREGATE e 12' MIN. FLOW 9" MAX. _ ' 4'b' 12" •41p b^ MIN. 6' THICK l7 STORAGE HT. B" } Ill 4 Q s'-o" 12 •4 a S. - � 12" 04 w 9" v ®b'-O" 12" 9"•4• f 111 04 ASTM&BADE 60 VERTICAL REBAR 2ii MAX CLEAR n � I 04 ASTM 6R.,4DE 60 HORIZONTAL RE-BAR 12" MIN.!�\ '\' �� 12" MIN. \�� b'-6' 12" +14 s 5° B/T RAIL AND 1 O• 12' Add(5)04 d PAPPLITDGALLY Drawing Title,: DIVERSION RDCE / FINISH GRADE v coNCReTE 0,4 MIX RATIO) \ I.-b.v 12" odd(5)04• -� 50' MIN. A* TRENCH BOTTOM RAIL SITE PLAN WITH COMPACTED f�� FINISHED GRADE b'-O" 12" Add(5)04 PLAN BACKFILL 8'- ZONING INFO6" 12" add(5)«4 d �ry'� NOTES: TRENCH DETAIL INSTALLATION WITHOUT_TRENCHING 1. THE ENTRANCE SHALT. BE MAINTAINED IN A CONDITION THAT WILL PREVENT NOTES; BASIC GRID->t4 BARS AT TRACKING OR DRESSING, OF SEDIMENT ONTO PUBLIC RIGHT-OF-WAYS.WAYS. THIS MAY r ` 12"ON CENTER EACH WAY REQUIRE TOP DRESSING, REPAIR AND/OR CLEANOUT OF ANY MEASURES USED 1. SILT FENCE SHALL BE PLACED ON SLOPE CONTOURS TO MAXIMIZE I CA L I ' TO TRAP SEDIMENT. PONDING EFFICIENCY. VERTICAL REINFORCEMENT A5 SPECIFIED IN TABLE STARTS AT A DISTANCE'D'DOWN FROM THE TOP Or- 2. / a '1"MIN.WALL THIGKNtE WHEN NECESSARY, WHEELS SHALL BE CLEANED PRIOR TO ENTRANCE ONTO 2. INSPECT AND REPAIR FENCE AFTER EACH STORM EVENT AND REMOVE POOL WALL. REINt-ORGEMENT OTHER THAN BASIC V!R&IN 501LJ ; \� ° �- *f, -- d Project#: Scale: PUBLIC RIGHT-OF-WAY. SEDIMENT WHEN NECESSARY. 9" MAXIMUM RECOMMENDED STORAGE 1 !! ?ORAL NEED NOT EXTEND TO THE TOP OF THE POOL 3. WHEN WASHING I5 REQUIRED, IT SHALL BE DONE ON AN AREA STABILIZED HEIGHT. SCALE i2 e 1 -0 WALL. ADDITIONAL BARS TO BE EQUALLY SPACED (FILL MAX.VE V ) MAX�__ _ _ - - � 1000-104-10-4 As Noted BETWEEN BASIC GRID. g5SG MAX.DENSITY) ( _ I WITH CRUSHED STONE THAT DRAINS INTO AN APPROVED SEDIMENT TRAP OR 3. REMOVED SEDIMENT SHALL BE DEPOSITED TO AN AREA THAT WILL ( 12"M . 12"MAX, 12"MAX. 'L Date: 5heet#: SEDIMENT BASIN. NOT CONTRIBUTE SEDIMENT OFF-SITE AND CAN BE PERMANENTLY I STABILIZED. I December 18, 2025 2 of 21 TEMPORARY GRAVEL CONSTRUCTION Sheet: ENTRANCE/EXIT DETAIL SILT FENCE DETAIL SCALE: NTS SCALE: NTS S P - 1 0 0 . 0 0 # - I U EES So'UTHOL.D TR., ST No. Issued To M4z; Uo Id:��s ��-c Date.La I iI LA5 Address ' 530 V>C00A w" cAer(. Rool , =chog%Ae THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 Glenn Goldsmith,Presic____� ..... ., �O��SUfFO(�-COG Town Hall Annex A.Nicholas Krupski,Vice President �a yw4'�k 54375 Route 25 Eric Sepenoski ? P.O.Box 1179 Liz Gillooly y ol�ti, Southold,NY 11971 Elizabeth Peeples �Cl � yJ Telephone(631)765-1892 ' Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: /? 811gr Completed infield by: l�•!/� . 1 MAZI HOLDINGS LLC requests an Administrative Permit to conduct construction activity within 100' from the landward edge of the wetlands for the construction of a swimming pool, pool patio, and pool fencing. Located: 530 Broadwaters Road, Cutchogue. SCTM# 1000-104-10-4 Typ of area to be impacted: Saltwater Wetland Freshwater Wetlan Sound Bay Part of Town Code proposed work falls under: Chapt. 275 Chapt. 111 other Type 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.: ov- r}t� n,�ro� t►�/ I's �id� V+,i ` Present Were: G. Goldsmith " N. KruP ski E. Sepenoski L. Gillooly E. Peeples t i I 1 PROPOSED UTILITIE5 TO IMPRCOvED LOT 1 - I BE CONNECTED IN l 1 c 48,50II " _ ACCORDANCE TO TOWN RESIDENCE AND UTILITY STANpARDS \ '(� PUBLIC WATER 1 40.0' T �— r r �r� w r r� r — / 48" F NC SILT NCE -- \ . r .....� - w wry r - 1 LIMIT OF DI tURSANCE 1 / / r i-� � \ \` \ \\ trtA� � \ j,`(iT \ \� �G►1-1 r) �_`_ �X- / \ •I // � l ------ \ �R11 \ \ t-1i \ \`_L� u- _ Mtn. 00' TIDAL /. / i _.... _ - _ \ .\ \ i E LAhlD SETBACK------------------ ® I i 1 1 \\ �\ �\ � \\ 1053' \ I \ 1 I U U rn SQFT. o III \ _ _ _ \ C=RA L GONSTRUGTION EXIST - >I I ,-- 1 5'S' \ \ \ I DUGTION > .a ,r' \ \ gr ` IN-GROUND _ _._.J \ �\ \ 1 I \ 1�TLAN05 11 fCt N _ �� � D yA -�-- - - _ 8LE L N , I W 2 , I t~ r~ w-1 \ I I GRAV$L i \ _ 1 \m70mp r u, 1 ' ' \ \ I \ N 0? S D r � J m \\ m��\ \\ � I I _ 1 STO LAIN I E-.----;.., } \ i \ � _ r102 � \ 1 \ \ 1 I \ 1 LXARX 0 s 1 \ 1 \ 1 -- I \ 1\ 1 � 1 I I � RO55 LOT AREA = 28,'1m1 SC�F o f minus 4,16b 5 1. 04 OET�AI AS ' nt o 0 0 \ \ \\ zb�' ems' �♦ .,I .. --1 �� �__ 1 1 I \ 1 1 24 ra35 N1=Y 1- o � coorl �j f I AGC S. e�l=zE I 1 \ 1 I 1 1 \ ; \ WAY \� s 11 11 \ I Il 11 ' 1 11 o 2-GAR 11 1 ' � � z > 1 __..� �\.., .•(r_I I \ � I I 1 ;��. _4EPooL 1 I I \ I I \\ // 1 ' z \ , ------------ GAS---- , ti \ l i i 1 I , \ I I ,�-' \ \ 1 1 1 I1 I 1 WATER--4-------------- `♦ `�` I \ \ 11 \ �. y ��. - w w r rr� r r rr=rr C) / \ ' � — � \ LT NGE \\ - --- - -- __-----------\— I� � I \ � \ - O ATE ----------- 1_------------ -- �.0 \ \ \ \ /� S \ \ I I I `•' OvED LOT CIO 0 \ \ \ O\ -►. \ , r I 1 I \ IMPR S 23 00 U� RESIDE \ � yam\ F18LIG WATER \\ \ c��`\ CIC \\ \ \ \ \ I I 0 ;.-1U Q) rI \ \ 1 \ \ \ \ \\ r-- \ \ \\ \ \ \ \\ \\ \ \ I > H--) Clp (CS S{TE i=LAN I o v SCALE ; 1" 15'-0" r? O IS U U) Z � U O ZONING INFORt-14TION ZONE: iz-40 q O DESCRIPTION MAX/MIN PERMITTED PROPOSED 28,701 SCIFt, GRO55 R' LZ U LOT AREA 40,000 sq.ft. 24 35 s ft- NET TYPICAL FENCE INFORMATION: � U LOT WIDTH 150.OFt. MiN. ± 86' A, FENCE SHALL NOT EXCEED 4'-0" B- FENCE SHALL BE BLACK IN COLOR LOT DEPTH I-15.0ft. MIN. ± 340' C. FENCE SHALL BE OF IRON CONSTRUCTION Q Z 41 80.1' TO MAIN DUELLING LATCHING ALL GATES TO-HAVE SELF CLOSING SELF --- _ _ FRONT YARD 50.0' 55,3' To GARAGE 4" CAPABILITIES 4" SPHERE SHALL REAR YARD 500' 132.8' 4" SPACING BEWTEEN NOT PASS THROUGH sg"d sea CENTERLINES of RAILS(TYP)� VERTICAL MEMBERS SIDE YARD 15.0' 15.0' TOP RAIL 11111110' ED Ali SIDE YARD 150, 20.0' - R' y�l Z I Jr MAx.MORTAR,12M' SIDE YARD AGG. 35.0' 350' '�o� I, DEC �2 FLOOR AREA MAX. 3,803.5 SQ.FT. 3,801-01 SQFT. LU ID ,__ __ MASONRY PAVER UNITS ` �IJ`4 ' e BUILDING HT. 21/2 STORIES -- 35ft 34-52' 4• 5 :F^ I I/7"�TTlrrb DIM • _ It d r of f I y arson, roles acting -" under t ,dlr o rchl ect, alter 1- �1 r14�t '!I fan {..., i an Item MERE MF`41 1 M Q L07 COVERAGE 20% 4,90� sq.ft. 3 892 SOFT. wrrtt roman architecta�01 the altering arc e affix to .:-o' :•- r ^ .fir r,�T. } Q=I G�A6T�OAORAtE - -_.___.__' his Item t.. �c9 nQ4pT�? t. I followed Q b hl9 sl nat a h atlon,and a Y 9 XIMATE WATERLINE speaflc de5crlL �111 MAX. GROSS FLOOR r4R1=A: ,w ic1 rOMAnc,5ICIMMVR AUTOMAM sIUMMER 3,350 SOFT. PLUS 10<, OF LOT AREA IN EXCESS OF 20,000 � <r 2 MAX CLEAR ccNcagrE P� 24,535 SF, - 20,000 = 4,353 SF. B/T RAIL AND 4535 SF. x 10% 453.5 S.F. BOTTOM RAIL FINISH GRADE MASONRY PAVING DETAIL A 3,350 + 4535 m 3,803.5 SQFT. FINISHED GRADE "°`i°5G"` 4 Architect: LOT COVERAGE/ BUII_pING AREA: ST�sTALLAwAeLESLOPE RESIDENCE 2(949 ����-I', — BREEZEWAY 240 7 F I CA L F E NC�E D E T AL 1 STEEPEST ALLOWABLE SLOPE --- - II GARAGE 5'12 5 AFTER BREAK-1.5 FRONT PORCH 6,4 1/2 REAR DECK 3f33 SC��--E POOL 53 6'-O'MINtM1M DISTANCE BEFORE BREAK 4 m MAIN DRAIN WITH HYDROSTATIC, 3,E 9W SQ,FT. VALVE AND COLLECTOR TUBE IN&RAVEL BASE DIVERSION RIDGE REQUIRED EXTRA STRENGTH FILTER FABRIC DRAIN LOVERS AND SPAGIN6 WHERE GRADE EXCEEDS 2% 2� GREATER NEEDED WITHOUT WIRE MESH SUPPORT SHALL V6B GOMPI.fAMr OI IWALL SECTION \ STEEL OR ` REFER TO PLAN FOR ROADWAY ,,, "', �\\\ /i/\/ WOOD POST / OPEN OR SOLID COVER�\ /// / /,,/�//i / /� SECTION THROUGH LENGTH OF SWIMMING POOL FRAME AND GRATE BRICKED TO \ \/♦\\�\��\ \/ 7 ATTACH FILTER FABRIC RADE BY CONTRACTOR IN REINFORCED CONCRETE FILTER FABRIC SECURELY TO UPSTREAM 1 FIELD ALLOW 4" MIN. 12- M COVER SLAB - T FFIC SIDE OF POST FOR ACiJUSTMEtNT C.I. FRAME & GRATE TQP (H-20 RATED SECTION A-A •"' RIM -�LEV. 8 THICK/�5 AT e E.W. '' . `�"- I TOP OF RING ELEV. Z M SEE PLAN FOR FRAME AND COVER TYPE , OW• :. NOTE: HDPE INLET PIPE \ (FOR SIZE AND INVERT _ TOP ELEV. SEE PLAN) STRAW BALES, SANDBAGS, SPILLWAY USE SANDBAGS, STRAW BALES 4- I PRECAST CONC. OR CONTINUOUS BERM OF TO OR OTHER APPROVED METHODS E 0m����®- - - ___ STORM DRAIN EWIVELENT HEIGHT BASIN AS REQUIRED.ELIZE TO D RAC 1�1 YA ®® - -_ SUPPLY WATER TO WASH 1 / /`/`///\/ \\/\ \��� 10' MAXIMUM SPACING WITH DESIGNS, L...L,G GEOTEXTILE A r WHEELS IF NECESSARY /\C�\\,\/\\��\\� ♦ ♦/Y/�\ / fi RMAXIMUM�SPAC N6 MA1HaJT WIRE SUPPORT FENCE A2ARCH i 6@GMAIL.COM o I I O IS THE IPIEV G T FROM THE TOP OF THE WALL I WNWARv. (516) 289'246 l BE61N BPEGIPIED BT@EL AND&UNITE THK:KINE98 AT INDICATED D' 017125®1714 r1t - -- ` I STEEL OR WOOD POST POOL DEPTH NO RAISED,BOND BEAM EULLNOSE PP COPS BOND .. APPROXIMATE WATER(.INE _/ FLOW 36' HIGH MAX. -TOP or POOL WALL D T VERTICAL BT6� p. U o- FLOW FLOW FROST PROOF TILE Prgect Tit e:_O. Cn®25®®® - - -- ' w w O'to 2'-6" 12` �4 12' N4 ASTM&RADE 60 REPAR AROUND PERIMETER OF POOL u! 0 0 0 0 o E 12' •4•b' I D ` o. REPAR TIE5 AT IZ 5PACINS MAXIMUM iYP ®C^J ®® I w Ao°o I c .-O PONDING HEIGHT PONDING HEIGHT 5'-6' 12" 040 6' i" I 1'MIN.WALL TFNGKNE55 530 B r o a dw a t e r R d ®CJIn Mn® - --- � A A 2'-3- � 3/4" MIN. DRAIN ROCK 4'-0' 12' •4 a 6' n ` + y, -_ COURSE AGGREGATE o 12' MIN. FLOW 9' MAX. I ClltCllO�lle, NY ®C�®V" - -- BOTTOM OF MIN. 6' THICK 4- 4'-6' 12 •4 6' AS NOTED ON PLAN I N L o o 0 0 0 0 o O Cr' ou STORAGE HT. $- S'-0' 12 «4•S. 0I MINIMUM TO ��o^ ••"•• `•••` 1 GROUND WATER \ �\ \ •/\ ♦ \ \ 6'-6' 12' •4•5' 1 / \�\\ \ \ \ 6'-0' 12' .4•s' i.. 04 ASTM 6RADE 60 VL'RTIGAL REPAR 6' MIN. PENETRATION �" \/\ \/\ \/\•� INTO ACCEPTABLE - LEACHING MATERIAL ,y`�:�� BACKFILL UNDER AND AROUND DRYWELL ` / •//�/ \// //\//�//// - WITH GRANULAR MATERIAL CONTAINING DIVERSION RIDGE 12' MIN. <\ '\���\\\j� 12" MIN. % \\��\ 6'-6' 12' M4 s 9' l .--� I M4 ASTM&RADE 60 HORIZONTAL REPAR �/ I PNEUMATICALLY Drawmq Title: LESS THAN 15%CLAY. (SILT & CLAYEF ON SILT NOTrTO ��\ \% 1'-0' 12' add(S)M4 t �a APPLIED (L4 MIX RATIO) GEED 5R 50' MIN. ♦ / "x6. 1RENCH L__ C/\\ 1'-6' 12' add M)M4 EX ) • - WITH COMPACTED ��/�/� 6'-O' 12" add(5)«4 PLAN VIRGIN STRATA -�" P1,Ad BACKFILL NOTES: TRENCH DETAI INSTALLATION WITHOUT TRENCHING 6-61 12" add M)04 1%kd°� ♦,�� ZONING INFO DRY ELL 1. THE ENTRANCE MALL BE MAINTAINED IN A CONDITION THAT WILL PREVENT �\ TRACKING OR FLOWING OF SEDIMENT ONTO PUBLIC RIGHT-OF-WAYS. THIS MAY NOTES: BASIC,&RID-04 BARS AT SCALE: NTS REQUIRE TOP DRESSING, REPAIR AND/OR CLEANOUT OF ANY MEASURES USED 1. SILT FENCE SHALL BE PLACED ON SLOPE CONTOURS TO MAXIMIZE 12.ON CENTER EACH WAY TO TRAP SEDIMENT. PONDING EFFICIENCY. VQRTIGAL REINFORGEML"3NT AS SPECIFIED IN TABLE ♦ 2 WHEN NECESSARY, WHEELS SHALL BE CLEANED PRIOR TO ENTRANCE ONTO STARTS AT A DISTANCE D'DOWN FROM THE TOP OF \ 7'MIN WALL THIGICNC-58 PUBLIC RIGHT-OF-WAY. 2. INSPECT AND REPAIR FENCE AFTER EACH STORM EVENT AND REMOVE POOL WALL REINFORGEMIETJT OTHER THAN BASIC, _� - \�� a -�- -g- =. �- Protect M: Scak SEDIMENT WHEN NECESSARY. 9' MAXIMUM RECOMMENDED STORAGE GRID NEM NOT EXTEND TO THE TOP OF THE POOL VIR&IN 501E 3. WHEN WASHING IS REQUIRED, IT SHALL BE DONE ON AN AREA STABILIZED HEIGHT. WALL. ADDITIONAL BAR5 TO BE EQUALLY 5PACED (FILL LOMPAGTED TO 1 �� ' - 'b 1000-104-10-4 As Noted WITH CRUSHED STONE THAT DRAINS INTO AN APPROVED SEDIMENT TRAP OR BETNE�N BASIC.GRID. 11 %MAX.Dt1'15ITY) -- ------- ---`1-TFF` 3. REMOVED SEDIMENT SHALL BE DEPOSITED TO AN AREA THAT WILL Iate: Sheet N: SEDIMENT BASIN. NOT CONTRIBUTE SEDIMENT OFF-SITE AND CAN BE PERMANENTLY 1 --` 12 T t2 MAX.Mom I STABILIZED. � I October 26, 2025 2 of 21 TEMPORARY GRAVEL CONSTRUCTION TYPICAL REBAR REINFORCING DIAGRAM TYPICAL POOL WALL SECTION Sheet: ENTRANCE/EXIT DETAIL SILT FENCE DETAIL a SCALE: N,� SP - 10 0 . 0 0 Revisions CREEK ,- :r—" ]e b @ .' � °, "a s�a V' e a x M��tr RvramrBrllc� F.O.A _ ^♦Imo.<9 -TI + P 0]-08-o ausoe z.eae O' oats,e \fr,"sy d}•� ss ,fie,w, <yEya•�� ,� ,. as ' p ,,;,r, ar£wz'�� _` r+r tarn ",ez olaals " o ,• ,p�x �bw 4 P„ S `f!a D w SeAlc1',`\ ",:�,®+;, +1y 9z+,. a,"•A�'� p� + __..N BROADWATERS COVE i m 1 y a +0 O 'd• ' +e °n,p +�er y 1 TOWN OFgSOUTHOLD \^ 51 1\ t14 el12 � e'a fli S� w, b HAYWATER COVE I - '+ e5' S i " \'. 0n` q ' t s� n•a,�f0.x d' +0�,iw +&eP' �\ /1 COUNTY OF S UFFOLK © E ov SOUTHOLO SECTION NO Real Property Tax Service Agency Y __r__ m�--re_— n' rAwtl umc,ar.Teaa.NY 11801 q' 104 • P ` 10� PROPERTY MAP ' I OFFICE LOCATION: *rjf soUI MAILING ADDRESS: Town Hall Annex ,`O� yOIO P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) N Telephone: 631 765-1938 Southold, NY 11971 G • ����OOUNTY,N�a 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: December 16, 2025 Re: LWRP Coastal Consistency Review MAZI HOLDINGS, LLC, SCTM# 1000-104.-10-4 This application is to conduct construction activity within 100' from the landward edge of the wetlands for the construction of a swimming pool, pool patio, and pool fencing. 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 INCONSISTENT with the policies of the LWRP as follows: The plan cannot be properly reviewed without further confirmation of the wetland boundary. The plans dated October 28, 2025, prepared by Adragna Designs,LLC indicate a wetland line, but there is no indication who flagged this line and when. Given that the proposed activities are within 100.5' of the wetland boundary, it is important that a new plan with the delineation noted be submitted, and that one or more Trustees confirm this line during a site visit. 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. Glenn Goldsmith,President ®� s®(,�� Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski E8B Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 'rou ri,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit ApplicationFFr P }' Wetland Permit Application ' . Administrative Permit Amendment/Transfer/Extension Received Application: LDE1 2025 Received Fee: $ Completed Application: Southold Town Incomplete: Board of Trustees SEQRA Classification: Type I Type Il Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): . Id1z'I.4, Z- Mailing Address: % ,r7,,, 'y'S Phone Number: Suffolk County Tax Map Number: 1000 -14—4- Property Location: G �. (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Email: and of Trustees Applicatil GENERAL DATA Land Area(in square feet): i f Area Zoning: Previous use of property: ' Intended use of property: fte4 Covenants and Restrictions on property? k Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes VINO 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. Will tt is project require any demolition as per Town Code or as determined by the Building Dept.? t, Yes No Does the structure (s) on property have a valid Certificate of Occupancy? 1// Yes No Prior permits/approvals for site improvements: /V 0 4,0v� d Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? �No Yes If yes, provide explanation: A,1, Project Description (use attachments if necessary): f .>ard of Trustees Applicat' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: fr -�� Area of wetlands on lot: square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? %49 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: _"n U04iA4 e3�QuzaZz ad,41 elki��l 0 1 - ell/ 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): �f Alf, /4i�,-� 4:�, �L um&&eez r f� s 617.20 Appendix B Short Environmental Assessment Form Instructions for CompletinjZ 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.1 -Project and Sponsor Information Name of Actio or Project: Project Location(d cribe,and attach a locatio map): 1 Brief Description of Proposed Action: Name of Applicant or Sponsor: Telephone: kh !zi! A49 ) E-Mail: r� Address. 0 / City/PO: State: Zip Code: 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. 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: ❑' 3.a.Total acreage of the site of the proposed action? r�F5 acres b.Total acreage to be physically disturbed? acres c.Total acreage*(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial WResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland 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? ❑ ❑ 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 gEE 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? El 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: El EI' 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 treatmentAa/ O 1J ❑ 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? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑ ncultural/grasslands []Early mid-successional ❑ Wetland El Urban eSuburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed YES NO by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? r O YES (TT 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, - i ❑ a.Will storm water discharges flow to adjacent properties? NO [:]YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 4 18.Does the proposed action include construction or other.activities that result m 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 ES solid waste management facility? If Yes,describe a X 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.PROVIDEDABOVE IS TRUE.-AND ACCURATE TO THE:;BEST OF Mv.. KNOWLEDGE Applicants name. r Ili Date Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe_following questions in Part 2 using theinformation contained in Part.I and other materials submitted by theproject sponsor.or otherwise availab.le.to the reviewer. W hen 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 ;.,mall.. to large impact impact .may. may . occur: occur I. Will the proposed action create a material conflictwith an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use orintensity.of use of land? El 3. Will the proposed action impair the character or quality of the existing community ❑ 4. Will the proposed action have an'impacton the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? a'. EJ. 5. 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 o ortunitres? o a 7. Will the proposed action impact existing: a.public]private water supplies? ,..� . b.public/,private wastewater treatment utilities? a a S. Will the proposed action impair the character or quality of important historic,archaeological, El. EJ architectural.or,aesthetic resources? UJ 9. . Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality;:flora.and fauna)? a` 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? ]]. 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 13, 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 boz 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 sfatement i5 required. Check this box if you have determined,based on the:information and analysis above,and:anysupporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Townof 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 Prepares(if different from Responsible Officer). PRINT Page 4.of 4 yard of Trustees Applicat,' AFFIDAVIT /� �v►�S �a.v�- I lu G BEING DULY SWORN DEPOSES AND AFFIkMS tHXT 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 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. gnatur4perty Owner Si ature of Property Owner SWORN TO FORE E THIS DAY OF ec°� LC/' 20 2 ticy a D.Noncarrow, Y No Public State of New York No.01N06224108 Qualified in Suffolk County My Commission Expires June 2i,20.._., Board of Trustees Appliaa`v --!,Im AFFIDAVIT CORINNA LAU 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 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. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS 1 DAY OF December 12025 N ,.roaWv'°oe�e, Koddi Lester Dmm` Notary Pu6Gc,State oEOklahoma u„" �♦`S Commission Expires 10-29-2028 NotB[yD) 24013556 Notarized Online with NotaryLive.com I Boord of TrUatG*e APP"Cation AFFIDAVIT K EING DULY SWORN . DEPOSES AND AM*MTHAT HEISHE'IS THE APPLICANT FOR THE ABOVE DESCRIBED PER (S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE.AND.BELIEF,AND THAT ALL WORK WILL-HE DUNE IN THE 'SET;FORTH-IN.THIS APPLICATION AND AS MAY BE APPROVED BY THE SOIITHOLD,TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TC}WN.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 CONJUNCTION WITH THIS,APPLICATIQN, 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. IAL signature operty Owner. : Sig>aature of Property Owner. I 1 SWORN TO BEFORE ME THIS,„_DAY OF �) WtmLCl- ,20 o Public WMACOI.ATA PARRINO Plr,t,il nf.of New York "11 nr1 n"County�--- ir+.;nll AW, f t�;it, f Un+,ry 19, c"VG9 �ce— j� .)ard of Trustees Applicatf'' AFFIDAVIT 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 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. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS "' DAY OF °m°° ,20 '= CHAKAIRA L RODNEY Notary Public-State of Florida NotaryPublic = N. ' � �• Q` commission#HH 896923 .. .. ...�0�p� Expires on duly 11,2029 emenzea rem°iep°none using mmmum°er°n°cnnm°ev rm rraot. A' #10AVI BEING D►ULV SWORN DEPOSES AND AFFIRMS THAT HE/SIIE IS THE APPLICANT FOR TIIE A601/L 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), 1F 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 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. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS-------- -----DAY OF 20 2-5 _ Dr_ X A Notary Public HEATHER R.LANCI Notary Public,state of New York No.O1LA6373692 Qualified In Nassau County CommIssion Expires April i6,20 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics rohibits 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. YOUR NAME: :kA4 (Last na e,first name,apiddle 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%oft 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 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); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Signature Print Nam_. i Form TS 1 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 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.. YOUR NAME: 1 o'Ile (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"OtheC',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 a 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 br 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 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); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200'15 Signature PrintNa Form TS I t 1,/Imi'la-SENTATIVE TRANSACIJONAL D1."ct.,0SUju vo1cNj. - '-rw U1,A t:�-C P!,,�" r'I"ic'010 1.5-c"M — IiVIXre il Ol the S1L ipL town officer;i !L'731 nf n nicrt tti .— r 21,L+'ojic"Ofi'j" and o\vjU! tAc%vhMrvcr ntinn iq I U- M X (i-nst n, It,UnICIS yob ar°applying in IJ e nfflnc Of Son,_ 'onc clw or other entity,such.L,a company.Ifs, indicutc the other person's of company's name.) ()I,APPLICATION: Plcc"'all that apply.) w1c'! Building TrustLe Coastal EMMOR :ljprn al of plot Mooring fr(Ill,plat or official map Planning Othcr luillic the activity.) I)()you f,.,.r'01l'1l1Y(or fillnue'll your company,spouse,sibling,parent,or child)have a relationship withinly officer or emptoyce I of, ulatrioge,or business interest."Business inlcrcsC rucansa business, ;0utijol,j', ''Relationship''includes by blood, inciliding a pal olership.in which the town officer or cmployec has even a partial ownersbip of(or employment by)a corporation in r%hick the town officcr or employee owns more filial 5%of le shares. Y ES NO I f yo it ill I-,%%clod"Y f S'*,Comple re the balance of this formand date and sign where indicated N-uric of Ix)onemployed by 1111!Town Of Southold Title,orfxlsilioa 01,01A person— Dr5cl-ij)c fill:relationship between yourself(tile applicitit/necot/rcpresentative)and the town officer or employee.Either check tjjc appropriate line A)through D)and/or describe in the space provided. The rown officer or employee Or his Or her spouse,sibling,parent,or child is(check all that apply)- the owner of'greater than 5%Of the Shares Of the corporate stock of the applicant (%%Ilen the applicant is it corporation); B)the icoal or beneficial owner of ally interest in a non-corporate entity(when the applicant is not a corporation); of tile applicant-or jin officer,director,partner,or employee fln.actual applicant. DFSCIUIT JOIN 01:RELATIONSI 11P Sabn3itt;6I 11's day Signature Print el t :; q } APPLICANT/AGr A NT/IiE P RESENTATIVE TRAN.SACTIQNAL DISCLOSURE FORM , to 0 dam" v c a s c N, ac YOUR NA,Nit I-�C CA S (Last name,first name,middle Initial,union you ate 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 Or AppLICATION: (Mcli all that apply:)' Tax griowulce Building Variance Trustee. ' orange ot'Zonc Coastal Erosion Approval. pproval of plat Mooring Fzctnption from,plat or official.map Planning Other (If"Othce"none the activity.) Do you personally(or through your company,spouse.sibling,parent,.or child)have a relationship with anyofficcr or employee of ilic 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).acorporation in which dic town o�ccr or employee owns more than 5%of a shares NO YES _. Ifyou answered"YES`',complete the balance of this form.and date and sign where indicated. Name:of person employed by the Town.of Southold Tide.or position of that person Describe the relationship bet%vicen yourself(the appiicant4ent/ropresentative)and the town officer or employee.Either checit. tite appropriate;line A)through D)and/or describe in:the space provided.. The town of iceror employee orhis or her spouse;sibling,parent,-or child is(check all that apply): Aythe'owner of greater than.56/o.of the,shares of the corporate stock of the.applicpnt (when the applicant is a corporation); ilythe legal-or beneficial owner of any interest in a non-eorpotnte entity(when'the .applicant is not a corporation), C)an officer;director;partner,or employee of the applicant;or D.)sftc actual applicant. DESCRIMON OF RELATiONSUIP Submitted tht. dayof 201 Signature Print Numo ' Form TS I N � rl'1�1 a�iV l*�rA,i}l�ftl� +� �v �� � tf�rt��i`.tl`�lY 1*f1/r�YA tf RM i� 1is,, t �?t�it I tilt tl�+ii c r d emp k .i � ;t ti��`M II is c .0 a t;�k th# �'_ j c ()je a p(1egC/nnd/a�llaw It t� C SVl1AfCVef ACtien'19 (I ASi ItanlG,.fi��t iuni��,.yidd c'irtltia,.unless You.arC APP y I ing In the nAnko of sulnconc.ctse orothcr colity. such as a company,.1 f so,indicate the other petsoilys or company's hime;) hid A3t OG A1'PLIC TION: (Chcck:all that apply,) Tax gricvancc building variance Trustee change of?.,one Coastal Erosion i jiPpravai of plat Mooring fxcmptiott from plat or official map Planning' Other (If"Outer",name the activity.). . N you.personally.(or through your conipaiiy,spokue sibling,parent,or child)have a:relationship with.any officeror:employee of the:'fot%n of Southold? "Relationship"includes by blood,marriage,oebusiness interest:"Business intercsr means a business, including a partnership,.in which the town officer or employcc:has cven a partial ownetship of(or employment by).a corporation in which theiown officer or employee'owns more than 5°fo of c shades. YES NO. lryou ansivered-YES"..complete the balance of this form and date and sign where indicated.. Name ofperson employedby the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agvntlrepresentativc)and the town officer or employee.Either check, the appropriate line A).through D)and/or describe in the spacc provided. The town off ceror employee or his:ocher spouse,sibling,parent,or child;is(check all that apply): A)the owner of'greater than 5%of the shares of the corporate stock of the applic ant: (when the applicant is u corporation); B)thele&al or beneficial owner of;any interest:in a non-corporate:entity.(ivhen the. "applicant is:not.a corporation); C)an officer,director,partner,or em,ploye.e of the apPlicant or D)the actual applicant. DESCRIPTION:OF RELATIONSHIP Stibtnitiedthis . ay of 20ti Signature AlAW Print Name Nan TS l ' e1 P 1'L,I Cr\N�'/�C;LN�tyith 1'R CS htY'('lt'l`I V I TRANSACTIONAX,llISCi,os[)[c[ hORhi it,�`L���CI ,c ^,rl 'Ih S2.P�1tIhlt-�4S?Ll!].i�LLSIlINstC it c r c � lo J!?b-t"� Fvi farm lion..r`'1i1�7..filiLGl&CLtl�t �• 31.Stil.11t�@ti t tt.tllYtl.t11�_(�LID.LSIIlP.1�2X.�S�..Ills R�rM��E.o>. �rtn l�ts�_Ci�.St�Ila__-..-� s-`'•rsrSi�lll.fs-t:�,tt�(1lsGS.S2ClRlst&�nR�f_nit >v ts� �,^�dh�.1s�S>��sli2��.it Iti._l "j MnLL tl.rut name,I1rst name,Middle Irtltfal,untrncs you me npplytnt;in the name of someone disc yr other cntlty,such w n company,Ir so.indicnlc the other peron's or company's munc.) Appl,lCr�'rtoN: (Check till That IIPPIM Building f 1:1�I:rievvlct "_ r� 'Trustee �_ ✓�_ _ varirnic _ Coastal Erosion C'haned•,of 7onc —' Mooring -� rl,pproval of plat — Planning I?\cmptinn tnun plat or official map — — 0111cr (Ij'i7thcr'", Mutre file activity 1, 1)�i�ou pc rsvnally(or through your company,spouse,sibling,parent,nr child)have a relationship«ith duly ofticcr t alnptnycc of air Totln of Southold,? "lictationship"includes by blood,marriage,or business interest_"Business interest"means r business incto tvhicrle 3 town .lip, i or employee owns arr ore S toyee%of to has even a partial ot%ncrship of(or employment by)a corporation NO lfyou:Ulsncred"YES",compicte the balance of this fomi and date and sign tvherc indicated. Name ofttcrson employed by(lie Town of Southold Title or position of tent person_ -- -- Describe the relationship hcltt'cen yourself(dle tkiiln dlc�{accUprov dcdtttive)nu�lthe ratan otTtccr of cmploytC C+tlurcttcck the gprupriatc line A)through D)and/or ;• a ' Ter tot+•n officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): }} 4 iv er of greater than S%of tine shares of the col- orate stock of the applicat r1)the Owner 6 (tvticn the applicant is a corporation); B)the legal or beneficial pwpCr of any interest in a non-corporate entity(when the i applicant is not a corporation); _C)an officer,director,partner.or employee of the applicant;or • f c ___-- R)the,actual applicant. S � lasscl;tCyTION OF RELATIONSHIP y w r z fI - ---- ✓ ,'^r ry Sri N'�r �w ��`$���� y�F�:�+=t �� rr i wF ` S Form TS 1 1s x ifi4 N 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 significant 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- 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# --.IP,4 - f 0 PROJECT NAME 5�j j� l'd r f,D'u ��- F=Ig:�, 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: c Z-1 Location of action:Site acreage: ,acreage: , /-.er-eA Present land use: Present zoning classification: ¢p 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: (b) Mailing address: / (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken,/require funding, or approval by a state or federal agency? Yes ❑ No D�/ 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. Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LW Sion III—Policies Pages 3 through 6 for evaluation criteria Yesect❑ No ❑ 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 2/Yes ❑ No ❑ 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 Sect io III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ 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 u Yes ❑ No ❑Not Applicable 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. M' ❑ ❑ Yes No Not Al, _. :able 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 valuation criteria. ❑ Yes ❑ No 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. . ❑ YeF-1 No u Not Applicable Attach additional sheets if necessary WORKING COAST POLIClL Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP 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 w ers. 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 eval ation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED B )/1, TITLE hq "DATE / '