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500 Broadwaters, LLC (2)
Glenn Goldsmith,President � Q ,( O vsffo1CG�� Town Hall Annex A.Nicholas Krupski,Vice President .� 54375 Route 25 0 Eric Sepenoski P.O.Box 1179 Liz Gillooly y • �!� Southold,NY 11971 Joseph Finora �O! �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: : z Completed in field by: Costello Marine Contracting Corp. on behalf of 500 BROADWATERS, LLC requests a Wetland Permit to place up to 50 cubic yards of clean loam/topsoil fill to level yard with the installation of two upland stone retaining walls consisting of a 2' high by 50' long seaward retaining wall with steps to ground, a 2' high by 60' long landward retaining wall with steps down, and a 10' east return connecting the two walls; remove one cedar tree located in between proposed retaining walls; and reseed all fill and seed disturbed areas with native lawn grass. Located: 500 Broadwaters Road, Cutchogue. SCTM# 1000-104-10-5 Type of area to be impacted: s altwater Wetland Freshwater Wetland 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.: " for Pj(►.rad"'4''l ) Alt G�-- q gvJtj' Present Were: _U_/G. Goldsmith ✓N. K�pski E. Sepenoski �/ L. Gillooly ,/ J. Finora i DROADT,I,ATER POOL EL. 12.0' CO Vj 20.0' 10.01 S 8 • nE LINE GRADE EL. 12.0' NICOLOCK ALTA GRAVITY WALL 07�48 E (TYPICAL) 71.9Z' I b SHORELINE 1 GRADE EL. 10.0' Bout wyAS c POOL EN�COE'g1EDASy M I AUD. S N2p?,, _ MNw INrERnD� MARSy IV GRADE EL. e.o' KENNETH M WOYCHUK LAND SURVEYING, PLLG 07}+ERwis Professional Land Surveying and Design NOV. e s�DAR DYED MHy..-..- •- - P.O. Box 155 AgNebogue, New York I Ig31 ' �`� R 5T. WALL CROSS PHONE (631) 298-158 FAX (651) 298-1555 �- ------ FENCE SECTION A OF NEW - __-- ZONE AE(EL PIPE S.sE P �N M o )0 _ s_ W® N.T.S. 1� - _ W VE ACTION Y 5 DE LIMIT OF UNDISTURBED BUFFER U — EL 7) Z FLOOD ZONE BOUNDARY NE C��S� D50882 � LIMIT OF DISTURBANCE / Zp LOT O J t" 3" CAP UNIT SILT CONTROL FENCE doop% 0 FLO' m c'° KENNETH M. WOYC14UK N.Y.S. LISC.#0W882 DUG IN GROUND 12"-b" HIGH — C Ij"1t� ALTA WALL UNIT INCHES OF FREE _ LARGE OAK TO REMAIIN 12 INC -�II/•-�I�- 1 �1/- PROPOSED RETAINING WALL5 .-f'` DRAINING AGGREGATE SEE DETAILS THIS PG. 1 �' �'' AREAS TO BE FILLED WITH CLEAN LOAMY FILL DRESSEM WITH TOPSOIL MULTI TRUNK CEDAR TREE O M1.'- i,� \ AND SEDDE� FOR NEW LAWN FILL TO BE LOCALLY SOURCED \/ TO BE REMOVED If .:.''' r \ E. N,. \ \\/ I" PER COURSE SETBACK io UP TO 50 C.Y. LOT ids ' o- on wTm - -�'I"�N0 = `� AREAS DISTURBED B1f CONSTRUCTION `,N TO BE RE-GRADED, ORE55ED WITH TOPSOIL, BO�fNO �d I 1 A i,, AND SEEDED FOR NEP«4 LAWN. 4"(P SLOTTED DRAIN PIPE-OUTLET TOPSOIL FILL TO BE LOCALLY SOURCED RETAINED SOIL EL 1183 �OlONE 1 iNC2. PpOL _______-- TO DAYLIGHT 40' O.C. I"IAX. SPACING F`• 1_-_�- EL 2.0 1° LOT I WOOD DECK m, 4 OZ. NON—WOVE N I I rh MACHINE/SUPPLIES 1 1/ 2.6e FILTER FABRIC AGGES ROUTE I �L/ DECK 15.6 N I j 2s.5 a'� /\\/j \/\ 1"I I N. BURIED I ,,.•1 cn ^' G47E G"x24" COt1PACTED , - .. , . 1 1 1 aa' GRANULAR BASE ��: \�\ Iw7NOO 2 S>r ,rr LEVELING PAID 1 7n�i DK'ELLtNC 1 >s W E 1 7.2' FF 5�Oi o 50 2411 CON77R(X p EL I � W a1LC.OVER SANITARY LOCATION 13 y, o coNc.STOOP POINT'A" POINT"B" j A9s.2• S FUJI 17 45.5 w 1 C.D 15jB NICOLOCK AL-TA WALL DETAIL D.P. 24.5 49' LP 1 24 58 1 1 0° Co LC°VER 1 O 1 I NC. STOOP I i i.T.S. LP2 40 67 ON Lpi 0 Rui CEN70 I O D,P, I Z l 0 ®°RVN 21.3 I it 3" CAP UNIT LP2 \ I v 'DE 1 \ EP 1 GRAVEL ° m P I R7VLZ y O Gr 1211 I STONE TO I"IATCH L. GAS \�\\/ WALL UNITS MOH• � I 9\0,_ //\/ NOTES= Foc i € / E,RED ARCh/T \�\\\ W SURVEY INFORMATION FROM KENNETH M WOYCI-IUK C?\ LAND SURVEYING, PLG LA ST DATED JUL. 20,2024. p°�F '7� j mm Q �p /\\ ` co LOT1 1 IY 1 M MAF` ENNTITLEDSERS AMENDED MAP A OSHOI-4N ARE F NA SAU POINT u.Po �4 . w FILED ON AUG. 16, 1a122 AS MAP NO. 156 `��� w�M MDnL Q, - s� 0418 0 �,------- Q�- �0 46 � ELEVATIONS S4-IOWN BASED ON N.A.V.D 55 DATUM �� 90?� G� ®� � STAIR D ETA I L }EL. 7.6' EXISTING SPOT ELEVATION Q,' N.T.S. -----e.o'----- EXISTING CONTOUR —`+•o'— PROPOSED CONTOUR SITE PLAN FOR TAX MAP SOO BROAD WA TERS ROAD D I STIR I CT 1000 SECTION 104 B SITUATE LOCK 10 LOT 5 C UTCHOG UE AREA) 32,105 5Q.FT. _ TOWN OF SOUTHOLD — SUFFOLf< COUNTY, N .Y. (0.7370 AC.) — SCALE: I " INCH = 40' FEET RICHARD M. MATO, A. I. A. Nov PREPARED: 2/G/25 A R C H I T E C T GR -I APEIC SCALREVISED:= 111-40' _ REVISED: G/6/25 G/7/25 P.O. Box 2284, Aquebogue N.Y. 11931 (631) 523-5879 email: rmatoarchitect@gmail.com 40 0 40 50 120 I S.C.T.M.# DISTRICT 1000 SECTION 104 BLOCK 10 LOT 5 BROADWATER COVE SOUNDINGS REFERENCE MLW 0.0 o FLOAT T p x,30" x-30" y O � L x-29" x-24" n x-27" v o x-24" x-24" a $ x-18" x x-18" x-12" x-12" a x-6" x-6" TIE LINE _ S 81°0T46"E 71!92' _� LW 0.0•-- - 0 x. TIDAL WETLAND x10 SHORELINE BOUNDARY AS O DELINEATED BY p x17 EN-CONSULTANTS x1.6 INTERTIDAL MARSH AUG. 5, 2021 ---------____sr+a�----E FENCE L3.0 l OTHERWISE PROTECTED ------ --S� 5.6,E AREA BOUNDARY NOV. 16, 1991 , EL PIPE 6.0'WO,- ---- ZONE AE(EL 7) T' P��pN vM� of M00 o / ZONE AE(EL 7) / z r Z 03 71 y mO /00�a O z o m .r LOT 184 0 / ZONE X / 0.2% CHANCE ANN AL FLOOD LOT 185 0 ZONE X 13.0' X POOL EQP- LOT 183 18.9' 6.5' ROUND.:FOOL:••..::: D WOOD DECK 2.6'E m n m m z m WOOD DECK v:::::::;::::: rn i X 1.4'E 25.5.::::::: ::': : ::N GATE 16.4' 4.3';.::•::.,:�:':2:::S1Y•FRAME•...,•..•:::.. WWELL •DWELLING:;:;;' #500 .:'::'m C, OVER BAL CONC. STOOP WINDOW ::.......... .:::.:...::.::.::: AIR PUMP .. •: .:::::13.9'::.:.;.::.::':.::;;::o" CONTROL PANEL :;,':::':::,::: '0 15.1 rB f 20.1 ' IC.O. wr SANITARY LOCATION BALC OVER I POINT"A" POINT"B' w o CONC. srooP I �' FUJI 17' 45.5' o O FUJI CEN10 �' I D.P. 24.5' 49' LP10 I I N LP 1 24' 58 N D.P. J LP2 40 67' o00 ® ::::::21.3..'::?.. I i o O DRAIN Z O : :''':::::: " rn LP2 rn I 2 1 o'4x 1 'IDEEP GRAVEL '::`�:.o m::•:;':::::.. I I DRIVEWAY rl 14.71 0 m I I � m L.P. i�i I _p GAS It rn Iao= D I mZ MON. i m m? o m m I � Aq�FMFNT V// N RECORD DEPTH SOUNDINGS/SHORELINE ELEVATIONS 03-26-25 0.1'E UPDATE 11-20-24 JOB / O REVISED SANITARY LOCATION 07-20-24 ��� �I'/ W.M. a REVISED 05-31-24 W.V. FINAL SURVEY 05-07- 8 U.P MON. 46y 02, FOUNDATION LOC. 01-08-24 REVISED 05-30-23 FIELD INSPECT/UPDATED 03-22-23 0 FEMA MAP#36103CO164H MLW 0.0 AREA: 32,105 S.F. or 0.74 ACRES ELEVA77ON DA7UM. UNAUTHORIZED ALTFRA770N OR ADDITION TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW PORK STATE EDUCA77ON LAW. COPIES OF 771IS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY. GUARANTEES INDICATED HEREON SHALL RUN 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. - - THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD177ONAL S77?UCTURES OR AND 0774ER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARAN7FED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: LOT 184 CERTIFIED To: TERRY-ANN BURRELL MARILA,ND LLC; '1I:i'•' MAP OR AMENDED MAP A OF NASSAU POINT FILED: AUG 16, 1922 No. 156 SITUATED AT: CUTCHOUGE TOWN OF: SOUTHOLD SUFFOLK COUNTY, NEW YORK KENNETH M WOYCHUK LAND SURVEYING, PLLC Professional Land Surveying and Design THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL P.O. Box 153 Aquebogue, New York iJ1931 LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS FILE #221-198 SCALE: 1"=30' DATE: OCT. 15, 2021 N.Y.S. LISC. N0. 050882 PHONE (631)298-1588 FAX (631) 298-15818 AND OR DATA OBTAINED FROM OTHERS. I 500 Broadwaters LLC at 500 Broadwaters Road Cutchogue, New York 11936 (SCTM 1000-104-10-05) to Place up to 50 CY of clean fill to level yard with installation of two stone 2' high retaining walls with return greater than 75' landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel. Remove one cedar tree. Stone wall dimensions are 2' high with one 45' long stone lower wall, with one 60' long stone upper wall and one 10' eastern stone return. Near Map Photo April 9. 2025 f �. /t r WAk W'T.. r. r, a I` 500 Broadwaters LL,a, 500 Broadwaters Road Cutchogue, New York 11936 (SCTM 1000-104- 10-05)to Place up to 50 CY of clean fill to level yard with installation of two stone 2' high retaining walls with return greater than 75' landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel. Remove one cedar tree. Stone wall dimensions are 2' high with one 45' long stone lower wall, with one 60' long stone upper wall and one 10' eastern stone return. Photo June 2, 2025 1730 } 1 a M Y•{h , `s �..• Pl{.'w�t �gin,?' �� I ' ^ .1.. 1� Y 1 ,, .. .. 500 Broadwaters LL.,a,. 500 Broadwaters Road Cutchogue, New York 11936 (SCTM 1000-104- 10-05) to Place up to 50 CY of clean fill to level yard with installation of two stone 2' high retaining walls with return greater than 75' landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel. Remove one cedar tree. Stone wall dimensions are 2' high with one 45' long stone lower wall,with one 60' long stone upper wall and one 10' eastern stone return. Photo June 2, 2025 1730 AW r i r L � l 'G - 3 500 Broadwaters LL.,a, 500 Broadwaters Road Cutchogue, New York 11936 (SCTM 1000-104- 10-05) to Place up to 50 CY of clean fill to level yard with installation of two stone 2' high retaining walls with return greater than 75' landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel. Remove one cedar tree. Stone wall dimensions are 2' high with one 45' long stone lower wall,with one 60' long stone upper wall and one 10' eastern stone return. Photo June 2, 2025 1730 1 irk ' 1. :t f� ,w + ; 4 a z)U• �� �� QS' M1�. � 'm � ow t - ;o-z>a, N XOp 1 � f ' P „j. W \5 \' t N y\p\ 3M\ roe � O ! y � e \1K e• `. tZ 1LBp ♦•' ♦�1�� \p \y d OS1I 11 �wta 9 5p1 nastT *'\ea ,�•. r` � \5 = :w m \ 9\]. � � 1 x O otaorp � T • N • � + tos' p O ]?1 et• \ U 1 ♦8 CDt BROADWATERS COVE t.• as ♦° -p g]♦♦ $^ \o ♦p ♦a e`n �'� „di TOWN�OF�SOUTHOLD 01 �./ •ark' „qv 1 ' zt � ,.wet +? � �•� �` y a � 5 p N tN 1 ,� ! •� 'ei-..�'" ! • t u „� ♦ e`Fi lam` HAYWATER COVE ♦5 a = 13 F , P r\ e� � W` izr t N — — �� __'^__ �� __•__ NOTICE ,n COUNTY OF SUFFOLK © E soungUu SECTION NO rt' eReal Properly Tax Service Agency Y E �� '•�� rypnrr wrMmwp.nrttwt M 04 loon PROPERTY IIM OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971 COU 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: February 5 2026 Re: LWRP Coastal Consistency Review 500 BROADWATERS, LLC, SCTM# 1000-104.-10-5 This application is to place up to 50 cubic yards of clean loam/topsoil fill to level yard with the installation of two upland stone retaining walls consisting of a 2' high by 50' long seaward retaining wall with steps to ground, a 2' high by 60' long landward retaining wall with steps down, and a 10' east return connecting the two wails; remove one cedar tree located in between proposed retaining walls; and reseed all fill and seed disturbed areas with native lawn grass. 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: Policy 6. Protect and restore the quality and function of the Town of Southold's ecosystem. Protect and restore ecological quality by adhering to the following measures. 6.1 Protect and restore ecological quality throughout the Town of Southold. 2. Retain and add indigenous plants to maintain and restore values of natural ecological communities. a. Protect existing indigenous plants from loss or disturbance to the extent practical. The removal of the native cedar tree should not be allowed, but if permitted it should be mitigated through native plantains of at least 6 - 3gallon high tide bushes (Baccharis halimifolia) within a permanent non-disturbance buffer created below the proposed retaining wall. 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. D. Provide adequate buffers between wetlands and adjacent or nearby uses and activities in order to ensure protection of the wetland's character, quality, values, and functions. The proposed work does not meet the setback requirements from a bank defined as: Land incline adjoining a body of water, wetland and/or beach under Chapter §275-2 Definition; word usage. Under this definition, the entire backyard is a bank so none of the proposed work meets the setback requirements as defined by §275-3 Findings; purpose;jurisdiction; setbacks. D. Setbacks. (1) The following minimum setbacks apply to any and all operations proposed on residential property within the jurisdiction of the Board of Trustees.- (a) Wetland boundary or bank. [5] Swimming pool and related structures: 60 feet. Pools requiring retaining walls greater than two feet above grade— 100 feet. [6]Landscaping or gardening. 50 feet. 2 If any of the proposed work is to be considered for approval a permanent non- disturbance buffer should be established beginning immediately seaward of the second (lower) retaining wall and this area should be planted with the high tide bush shrubs noted above. 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. 3 i Office: (631)477-1199 Fax: (631)477-0005 PO Box 2124 423 5th Street, Greenport, NY 11944 COSTELLO MARINE CONTRACTING CORP. Office@CostelloMarine.com C February 6, 2026 j Southold Town Trustees P.O. Box 1179 Southold,NY 11971 Re: 500 Broadwaters LLC—Retaining Walls 500 Broadwaters Road, Cutchogue,NY11935 SCTM: #1000-104-10-5 Dear Trustees: { With regard to the above-referenced project,please find enclosed the following: - Affidavit of Posting - Photographs of the posted notice at the subject property - Proof of Mailing Notice - Certified Mail Receipts If you have any questions or concerns, do not hesitate to contact me. Sincerely, Robert Lehmann Permitting Assistant Enclosures JOHN A. COSTELLO, President JACK F. COSTELLO, Vice President JANE P. COSTELLO, Secretary Board of Trustees Application PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS, APPLICATION NAME & SCTM#: 500 Broadwaters LLC, SCTM# 1000-104-10-5' NAME: ADDRESS: Mazi Holdings LLC 149 Dosoris Lane, Glen Cove, NY 11542 Jeffrey R. &Anca Lemler 1289 Lexington Avenue, 8A, New York, NY 10028-1463 Craig &Annie Cantelmo 255 Broadwaters Road, Cutchogue, NY 11935 Rahul Sharma &Veena Issac 345 E. 69th Street,#14EF, New York, NY 10021 STATE OF NEW YORK COUNTY OF SUFFOLK d/b/a Robert Lehmann --0Q-„,*; Costello Marine Contracting Corp. P.O. Box 2124, Greenport, NY 11944 , being duly sworn, deposes and says that on the 29th day of January , 20 26 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office located at Greenport(11944) , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. f Signature Sworn to before me this (0 Day of t-ebracv _; 20q �_� LYNN E STEVENS Notary Public-State of New York NO.OIST6269424 Notao Public Qualified in Suffolk Count Commission Expires ` Do1 Client: 500 Broadwaters LLC Address: 500 Broadwaters Road,Cutchogue,NY 11935 Date: 1/29/26 CERTIFIED MAIL RECEIPTS Er 4�U O r-3 O f3 rq rq m m O Certified Mail Pee O Certified Mail Fee Extra Services&Fees(check box,add fee as appropriate) Extra Services&Fees(check box,add fee as appropriate) 1 El Return Receipt(hardcopy) $ rq ElReturn Receipt(hardcopy) $ ❑Return Receipt(electronic) $ Postmark ❑Return Receipt(electronic) $ Posfmarkk ❑Certified Mail Restricted Delivery $ Here El Certified Mall Restricted Delivery $ f Here ❑Adult Signature Required $ / ❑Adult Signature Required $ F f Adult Signature Restricted Delivery rJ rU Ln ❑Adult Signature Restricted Delivery$ 7,,r, 6r) ❑ g ry$ Postage `V Postage ? � 1 C3 $ o ; Mazi Holdings LLC d Jeffrey R. &Anca Lemler �- 149 Dosoris Lane R"�_____ a- 1289 Lexington Avenue, 8A 13uRA6it, -----CO Glen Cove, NY 11542 Ln New York, NY 10028-1463 o- ; --- Ir O K�O�Mi o a- - c a a -e o • " 4 rq s e a e • c e rq m m O Certified Mall Fee O Certified Mail Fee Extra Services&Fees(checkbox,add fee as appropriate) Extra Services&Fees(check box,add fee as appropriate) ❑Return Recelpt(hardcopy) $ ❑Return Receipt(hardcopy) $ g�e, ❑Return Receipt(electronic) $ Postmark El Return Receipt(electronic) $ Postmark a ❑Certified Mall Restricted Delivery $ Here' � ❑Certified Mall Restricted Delivery $ HererU ` ❑Adult Signature Required $ rU ❑Adult Signature Required $ Ljj ❑Adult Signature Restricted Delivery$ A r u7 ❑Adult Signature Restricted Delivery$ 'Postage �>,hr Postage TrJ rq $ O $ Craig&Annie Cantelmo O : Rahul Sharma &Veena Issac s 255 Broadwaters Road buRl, 345 E. 691"Street, #14EF I�uRL CO Ln Cutchogue, NY 11935 L I New York, NY 10021 c .1BA6@.A. •+_a�a . ,mamiwwa.�vswraw.uv -e..n:.r.�a��.a. _.�PlAAU.rb:E'a.•.b°d4i'I_NA'.L11.4'�4•�c+ rew•I:W�PI•li:•a -ns Prepared by: Costello Marine Contracting Corp. 423 5th Street, PO Box 2124, Greenport, NY 11944 (631)477-1199 Phone (631)477-0005 Fax Glenn Goldsmith,President �St1�F�(��; Town Hall Annex A.Nicholas Krupski, Vice President � �A, 54375 Route 25 Eric Sepenoski P.O. Box 1179 Liz Gillooly p Southold,NY 11971 Joseph Finora ���� �aO�,, ' Telephone(631)765-1892 Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of F 19 500 BROADWATERS, LLC COUNTY OF SUFFOLK _ STATE OF NEW YORK AFFIDAVIT OF POSTING DO NOT COMPLETE THIS FORM UNTIL THE POSTING HAS REMAINED IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC ....... ....... HEARING DATE- COMPLETE THIS FORM ON EIGHTH DA Y OR LATER I, Robert Lehmann ,residing at/dba Costello Marine Contracting Corp. P.O. Box 2124, Greenpo_rt, NY 11944 being duly sworn, depose and say: That on the30th day of January , 20 26 , I personally posted the property known as 500 Broadwaters Road Cutcho ue NY 11935 by placing the Board of Trustees official noticing poster where it can easily be seen from the street, and that I have checked to be sure the noticing poster has remained in place for a full seven days immediately preceding the date of the public hearing. Date of hearing noted thereon to be held Wednesday, February 11,2026. Dated: (signature) Sworn to before me this (,per day of156w,200(o LYNN E STEVENS Notary Public-State of New York _ NO.OIST6269424 Notary blic Qualified in Suffolk County Commission Expires r1w � Client: 500 Broadwaters LLC Address: 500 Broadwaters Road,Cutchogue,NY 11935 Date: 1/30/26 NOTICE OF HEARING POSTING PHOTOGRAPHS ;<G;4 OR mm a v.� % ` r „ s w �w c r YpI 111 p > e, qw g ?z:--'.. �.� z-tx' r •r �fr � �ss�,ya¢c� +� sxe S r 4 4 Prepared by: Costello Marine Contracting Corp. 423 5th Street, PO Box 2124, Greenport,NY 11944 (631)477-1199 Phone (631) 477-0005 Fax L �, Glenn Goldsmith,President. }�ra� O Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President ► P.O.Box 1179 Eric Sepenoski ! Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ' ++ r Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLDThis Section For Office Use Only I —11 I Coastal Erosion Permit Application NOV 1 3 2025 Wetland Permit Application Administrative Permit Amendment/Transfer/EXtension Southold Town _Received Application: l( 3 Board oPTrustees Received Fee: $ DSb _Completed Application: I � Incomplete: SEQRA Classification: Type 1_, Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent):_ X LWRP Consistency Ass ssment Form Sent: 11301,24, CAC Referral Sent: Date of Inspection: _ Receipt of CAC Report: -ec _ Technical Review: --q--Public Hearing Held: aT 2T Resolution: Owner(s)Legal Name of Property (as shown on Deed): 500 Broadwaters LLC Mailing Address: 138-32 227th Street, Laurelton, NY 11413 Phone Number: (347) 623-7986 Suffolk County Tax Map Number: 1000 - 104-10-5 Property Location: 500 Broadwaters Road, Cutchogue, NY 11935 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable):Costello Marine Contracting Corp. Mailing Address: P.O. Box 2124, Greenport, NY 11944 Phone Number: (631) 477-1199 Email:permits@costellomarine.com C'J Se' ird of Trustees Applicati GENERAL DATA Land Area(in square feet): 32,105 sq.ft. _ Area Zoning:-R-40 Previous use of property: Residential Intended use of property: No use change 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 ✓ 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. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date NYSDEC 8/5/2025 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: Project Description(use attachments if necessary): Place up to 50 CY of clean loam/topsoil fill to level yard with installation of two upland stone 2' high retaining walls and east return with stone stairs greater than 75' landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel. Reseed all fill and seed disturbed areas with native lawn grass. Stone wall dimensions are one 45' long 2' high stone lower wall, one 60' long 2' high stone upper wall and one 10' eastern stone return. Y zd of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations. Provide level grass area in area of the pool for enjoyment outside the enclosed pool fence. Area of wetlands on lot: 0 square feet Percent coverage of lot: 1.0 % Closest distance between nearest existing structure and upland edge of wetlands: 109 feet Closest distance between nearest proposed structure and upland edge of wetlands:76 feet Does the project involve excavation or filling? No ✓ Yes If yes,how much material will be excavated? N/A cubic yards How much material will be filled? 50 cubic yards Depth of which material will be removed or deposited: NSA feet Proposed slope throughout the area of operations: 51% Manner in which material will be removed or deposited: Fill will be placed using a skid steerer. 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): Our proposal for the installation of the stone retaining walls in the upland portion of the property will have no adverse effects upon the wetlands and tidal waters of the town. 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: 500 Broadwaters LLC Retaining Wall Construction Project Location(describe,and attach a location map): 500 Broadwaters Road,Cutchogue,NY 11935 Brief Description of Proposed Action: Place up to 50 CY of clean loam/topsoil fill to level yard with installation of two upland stone 2'high retaining walls and east return with stone stairs greater than 75'landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel.Reseed all fill and seed disturbed areas with native lawn grass.Stone wall dimensions are one 45'long 2'high stone lower wall,one 60'long 2'high stone upper wall and one 10'eastern stone return. Name of Applicant or Sponsor: Telephone: (347)623-7986 500 Broadwaters LLC E-Mail: terryanndavis@icioud.com Address: 138-32 227th Street City/PO: State: Zip Code: Laurelton NY 11413 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: ElPermits are required from NYSDEC,pYSDOS,Army Corps of Engineers,and Town of Southold 3.a.Total acreage of the site of the proposed action? 0.74 acres b.Total acreage to be physically disturbed? 0.01 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.74 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban El Rural(non-agriculture) [:]Industrial [:]Commercial 0Residential(suburban) ❑Forest ❑Agriculture OAquatic ❑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 YES If Yes,identify:Peconic Bay and Environs-Protect public health,water,vegetation,and scenic beauty. ❑ 7 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: ❑✓ ❑ Potable water is not necessary for our proposal. 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ Our proposal does not involve the production of wastewater. 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑✓ El 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: m Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional m 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 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, Ela.Will storm water discharges flow to adjacent properties? m NO ❑YES b.Will storm water discharges be directed,to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: m NO ❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO I 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 ABOVE iS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Terry-Ann Burrel,Owner o2 Applicant/sponsor name: Data: OZD•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 I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. . Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ Elreasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage El ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check 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. Name of Lead Agency Date 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 ;ward of Trustees Application AFFIDAVIT Terry-Ann Burrell for 500 Broadwaters LLC, 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 WORD 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 COMPLETLNGTHIS 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. Qig4na�qturfP�roperty�0«ner Signature of Property Owner L SWORN TO BEFORE ME THIS 171 DAY OF f'.eh�✓� , 20 �fr 1 5REEWATTIE GOBIN - Notary Public- Notary Public NO. State of New York 01G062125bs Qualified in Bronx County My Commission Expires Dec 14, 2025 l I COSTELLO MARINE CONTRACTING CORP DOCKS • BULKHEADS • ROCK REVETMENTS • JETTY REPAIR - DECKS • BLUFF STAIRS • PILE INSTALLATION To: Town of Southold AUTHORIZATION The undersigned, as owner of property located at 500 Broadwaters Road, Cutchogue,NY 11935, SCTM 41000-104-10-5, hereby authorizes Costello Marine Contracting Corp. to act as agent to process all permit applications needed to constrict retaining walls at my property. Dated: Id vo2 s Sign He e: Printed Name: � L- SWORN TO BEFORE ME THIS /�L DAY OF OV otary Public Signature SREEVVATTIE GOBIN Notary Public-State of New York NO.01G06212568 Qualified in Bronx County My Commission Expires Dec 14,207.5 - r JOHN A. COSTELLO, President JACK F. COSTELLO, Vice President JANE P. COSTELLO, Secretary 423 FIFTH STREET•P.O. BOX 2124• GREENPORT, NY 11944•631.477.1199(o) •631.477.0005(f) • OFFICE@COSTELLOMARINE.COM 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 nur-nse 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: Terry-Ann Burrell (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other%name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includesby blood;marriage,or business interest.".Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or.employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X 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 ay of 20-� Signatur I _ Print Na rr =Ann urrell Form TS I APPLICANT/AGENT/REPRESENY'ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics.urohibits conflicts of interest on the part oftown officers-and emolovees:The numose of this form is to provide information which can alert the town of nossible conflicts of interest and allow It to take whatever action is necessary to avoid same. YOUR NAME: Costello Marine Contracting Corp. (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 �T 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 56/9of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent/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(chcdc 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 162 day of o0emIze`'20 L5 Signature, Print Name We P.-costelto, Corporate Secretary Fottn TS l 4r' Office: (631)477-1199 Fax: (631)477-0005 ❑ I PO Box 2124 __ • 423 5th Street, Greenport, NY 11944 COSTELLO MARINE CONTRACTING CORP. Office@CostelloMarine.com November 13, 2025 Southold Town Trustees �� - a �_ _ � fF; ` PO Box 1179J' Southold,New York 11971 �� Re: Initial Application Submittal for: NOV 1 3 2025 500 Broadwaters LLC—Retaining Walls Southold 7o�m 500 Broadwaters Road, Cutchogue,AT H935 : _aoara of rrJstees SCTM: #1000-104-10-5 Dear Trustees: We are requesting authorization to construct one 45-foot long retaining wall, 2-foot high and one 60-foot retaining wall, 2-foot high and one 10-foot eastern return,no higher than 2-foot high. Construct two stone staircases integrated with the walls. Place 50 cubic yards of clean loam/topsoil fill to level yard. Remove one cedar tree. Reseed all fill and seed disturbed areas with native lawn grass. Enclosed you will find a complete application consisting of the following: - Agent Authorization(4 copies) - Southold Town Wetlands Application(4 copies) - LWRP Assessment Form(4 copies) - Short Environmental Assessment Form(4 copies) - Project Plans (4 copies) - Property Survey (4 copies) - Site Photographs (4 copies) - Check in the amount of$1,250 made payable to the Town of Southold,representing the application fee Please feel free to contact me if there are any questions or concerns. Sincerely, G� ane P. Costello Permitting Manager Enclosures JOHN A. COSTELLO, President JACK F. COSTELLO, Vice President JANE P. COSTELLO, Secretary Board of Trustees Application PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME & SCTM#: NAME: ADDRESS: ) AA a 'e4 u t-1 - la - ?a l STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office located at that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Signature Sworn to before me this Day of 720 Notary Public NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: 500 BROADWATERS, LLC F, SUBJECT OF PUBLIC HEARING: For a Wetland Permit to place up to 50 cubic . yards of clean loam/topsoil fill to level yard with the installation of two upland stone retaining walls consisting of a 2' high by 50' long seaward retaining wall . with steps to ground, a 2' high by 60' long landward retaining wall with steps down, and a 10' east return connecting the two walls; remove one cedar tree located in between proposed retaining walls; and reseed all fill and seed disturbed areas with native lawn grass. Located: 500 Broadwaters Road, Cutchogue. SCTM# 1000-104-10-5 TIME & DATE OF PUBLIC HEARING: Wednesday, February 11, 2026 — at or about 5:30P.M. If you have an interest in this project, you are invited to view the Town file(s) which are available online at www.southoldtownny.gov and/or in the Trustee Office until to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES *TOWN OF SOUTHOLD * (631) 765-1892 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- siu�f cant 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# 104 _10 _5 PROJECT NAME 500 Broadwaters LLC_Dock Construction 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: Place up to 50 CY of clean loam/topsoil fill to level yard.with installation of two upland stone 2'high-retaining walls and east return with stone stairs greater than 75'landward of the tidal wetland boundary to create an outdoor level lawn space on the parcel. Remove one cedar tree. Reseed all fill and seed disturbed areas with native lawn grass. Stone wall dimensions are 45'long 2'high stone lower wall, one 60'long 2'high stone upper wall and one 10'eastern stone return. Location of action: 500 Broadwaters Road, Cutchogue, NY 11935 Site acreage: 0.74 acres Present land use: Residential Present zoning classification: R-40 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: 500 Broadwaters LLC (b) Mailing address: 138-32 227th Street, Laurelton, NY 11413 (c) Telephone number: 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?NYSDEC 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 Our proposal is to construct two stone retaining-walls to provide a level -grass area outside of the upland fenced pool area. It--will not have any effect on the community character, open space, or use_ of infrastructure. 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 ❑✓ Not Applicable Our proposal will have no influence on the historic and archaeological resources of the Town of Southold. Attach additional sheets if necessary ' Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No❑✓ Not Applicable Our proposal to construct these stone retaining walls will provide a level grass area around the pool. e visual quality and scenic resources will not be negatively impacted. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP s Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable Our proposal to construct two stone retaining walls will not cause any erosion nor will it have any impact Ofl ma lne life 6r the natural resources in area.My 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 ONot Applicable Our proposal will not influence the water quality of the water supply of the Town of Southold. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No Z Not Applicable During construction, Best Management Practices will be used to protect the wetlands and waterways from construction debris. Our proposal will not have any influence on the restoration or protection of the ecosystem. Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑No Wl Not Applicable Our proposal will not have any effect on the air quality in the Town of Southold. 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 0 Not Applicable Our proposal does not involve solid waste and/or hazardous substances. 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.❑ YeO No Z Not Applicable Our proposal to construct these stone retaining walls will provide a level grass area around the pool. There will be no change.in public access to or recreational use of coastal waters, public lands, or public resources. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No ✓❑ Not Applicable Our,proposal to cos -depend Pnt uses-in-or around this location 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 Our proposal will not have any influence on the living marine resources in the Long Island Sound, Peconic Estuary, or Town waters. Once construction is complete, the area will have not changed in the sustainable use of marine-resources. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages '62 through 65 for evaluation criteria. ❑Yes ❑ No Z Not Applicable Our proposal will not influence agricultural lands in the Town of Southold. 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 Our proposal will have no influence on the use or development of energy or mineral resources. PREPARED BY Jane P. Costello TITLE Permitting Manager DATE 11/11/2025 for Costello Marine Contracting Corp.