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HomeMy WebLinkAboutTR-10964A Glenn Goldsmith,President o�OOffalx-roa Town Hall Annex A.Nicholas Krupski,Vice President �� y�T 54375 Route 25 Eric Sepenoski y z P.O. Box 1179 Liz Gillooly 0 • Southold,NY 11971 Joseph Finora Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed XProject complete, compliance inspection Glenn Goldsmith,President QF S®(/�� Town Hall Annex ��� �1 54375 Route 25 Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoski J 1 Southold,New York 11971 Liz Gillooly G Telephone (631) 765-1892 Joseph Finora Fax(631) 765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10964A Date of Receipt of Application: April 17, 2026 Applicant: Hess Retail Stores LLC SCTM#: 1000-122-3-10 Project Location: 11100 Main Road, Mattituck Date of Resolution/Issuance: May 13, 2026 Date of Expiration: May 13, 2029 Reviewed by: Board of Trustees Project Description: Remove underground storage tanks and associated equipment. 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 Island Pump &Tank, received on April 17, 2026, and stamped approved on May 13, 2026. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees X Schedule Your Je S`f Care-Expert I en , (ROUTE 25) � +.,� 2 EESG Custom Appar( F 1 y d6•"` `7 V ! , MAIN ROAD `�9'o SITE /25 — G—G— G—G—G G G G— G— G G G G—G G— G— G G�—G G— G— G G G G G— G— G— G APPROVED ), G G G G G G G G— G— G G G G G _G— G G G G—G—G `� Starbu,cks, BOARD OF 1 hUSTE E$ Holiday IM ' TOWN OF SOUTHOLD 4' Starbucks T/E � � /E / / T/E T/E .� Holiday Menu c� / CONC.WALK i N 51 °50'00" E The Taco 105 E Legion �''� DATE Taos e Legion Ave E L r/�G 1`� 0 , — — — — — — — — — — — — W E N 150.00C� � / / FUEL ISLANDS AND Cl C9 DISPENSERS / \ ,�TO BE REMOVED LOCATION MAP C9 ASPHALT S. SCALE: N.T.S. / APPROX. LOCATION OF TO REMAIN >c SAW CUT LINE, G.C. TO CONFIRM OUTLINE \ / / / k GENERAL NOTES ® >f �_73 PARCEL INFORMATION: TOWN OF SOUTHOLD 00 / I \ I >� SECTION:122 / / BLOCK: 3 LOT: 10 k 1. TANK/OWNER: CJ I — — — I / ® k XXXX 0 / ? , / 2. THE CONTRACTOR IS RESPONSIBLE FOR VERIFYING THE EXACT LOCATION AND —1 I I CONCRETE _ —1 I ® CB I #1/2 #3/4 TO BE #5/6 DEPTH OF ALL UNDERGROUND APPURTENANCES(WHETHER DEPICTED ON THESE Co k PLANS OR NOT)PRIOR TO THE START OF WORK. THE CONTRACTOR MUST 0 I ( I I I REMOVED i i I ®/ / CONTACT THE"ONE CALL"SYSTEM T ENSURE THAT ALL UTILITIES ARE PROPERLY AND COMPLETELY MARKED OUT PRIOR TO PERFORMING ANY WORK. 0 (.� / k ANY DISCREPANCIES BETWEEN THE FIELD LOCATIONS AND THE PLANS MUST / J / / I I I I I I I I ^ ,° / BE VERIFIED BY THE CONTRACTOR. ANY DAMAGE OR DISTURBANCE TO I I I 'V FENCE TO STRUCTURES DURING CONSTRUCTION MUST BE REPAIRED OR REPLACED AT 0 (0 k THE CONTRACTOR'S EXPENSE. / REMAIN (TYP) 3. AREA OF PARCEL IS.528 ACRES. C7 CONC. TANK o J k / O FIELD TO BE I /�� / 4. DEPTH TO GROUNDWATER<11 �I.—.—.—.—.—.—.—.—.—.—.—.—.—.—�.J .—.—..—.—.—. I 17 Q / REMOVED I .—.—.—.—.—.—.—.—.—...—.—.—.—.—.—.—.—.—.—.—.—.—.--- — . �.—.—.—.—.—.—.—.—.-- /0 OO �J I �—1 ®CB ®/ k 5. CONTRACTOR TO ENSURE NO IMPACT OR DAMAGE OCCURS TO ANY ON OR O ✓V` O� BOLLARDS OFF SITE STRUCTURES WHICH ARE TO REMAIN UNDISTURBED. THIS Z RESPONSIBILITY APPLIES TO STRUCTURES WHICH MAY OR MAY NOT BE 0 / OvC PRODUCT PIPING TO k�--- TO REMAIN DEPICTED ON THESE PLANS. F_ 0 �` I '� I BE REMOVED (TYP) % (TYP) 0 co 6. ANY EXISTING ADJACENT PROPERTIES AND/OR STRUCTURES SHOWN HEREIN J / k ARE DEPICTED FOR GENERAL LOCATION INFORMATION ONLY AND ARE NOT TO Q BE CONSTRUED AS BEING REPRESENTED IN ANY OTHER MANOR. W / ®CB / I z C) I I I I I I I I k .7. ALL EXCAVATIONS SHALL BE PROPERLY BACKFILLED WITH COMPETENT MATERIALS 0 / COMPACTED PURSUANT TO THE GEOTECHNICAL ENGINEERS RECOMMENDATIONS. I DEBRIS SHALL NOT BE BURIED ANYWHERE ON SUBJECT SITE. 0 II II I I k z SCOPE OF WORK: 0 O�V / I II II I U CB I I / / NOTES/ASSUMPTIONS: m I II II i � k 1. DISCONNECT, REMOVE, AND DISPOSE ELECTRONIC DEVICES O O O O I o `L / CONNECTED TO THIS TANK, IF ANY, (TANK GAUGE l­_. Q k PROBE AND LEAK SENSOR) 0 / / 2. USING VAC TRUCK SERVICES, REMOVE AND PROPERLY DISPOSE ANY 1 STORY I RESIDUAL LIQUID TANK CONTENTS. (DEAD-LINE THE TANK, THROUGH BLDG. TO / k/ LIGHT POLE EXISTING 4"OPENINGS) W REMAIN ,/ TO REMAIN 3. PROVIDE SERVICES TO WASH & RINSE THE INTERIOR OF THE TANK. �' (TYP) REMOVE AND PROPERLY DISPOSE LIQUID RINSATE GENERATED. p JCON ` —X X Q k / X X X —X LOX —X —=X X —X �—X — 4. SAW-CUT EXISTING CONCRETE SLABS ABOVE THE UST, ONLY TO THE / ASPHALT 0 0 0 � O X X— X— X— X— X X X X EXTENT NEEDED FOR THE ABANDONMENT. p TO REMAIN \ VL 5. EXCAVATE, REMOVE AND DISPOSE A PORTION OF THE EXISTING z AIR PUMP 10,000-GALLON PREMIUM CONCRETE SLAB. W UNDERGROUND TANK TO / 6. EXCAVATE EXISTING BACKFILL MATERIALS (SOIL OR GRAVEL)ABOVE TO REMAIN BE REMOVED THE UST, AS NECESSARY TO FACILITATE THE REMOVAL PROCESS. / \ 7. DISCONNECT. REMOVE, AND DISPOSE EXISTING PIPING RISERS ABOVE / UST VENTS AND (3) 10,000 GALLON UNDERGROUND TANKS TO BE REMOVED THE TANK. PIPING TO BE BACKFILL SOILS WILL BE PLACED IN UNIFORM LIFTS NOT 8. DISCONNECT, CUT AND CAP EXISTING VENT PIPING -WHERE \ REMOVED EXCEEDING 6 INCHES IN COMPACTED THICKNESS AND ACCESSIBLE WITHIN THE EXCAVATED FOOTPRINT OF THE TANK. MECHANICALLY COMPACTED TO A MINIMUM OF / 9. DISCONNECT, CUT AND CAP EXISTING ELECTRICAL CONDUITS WITHIN — WOODED THE EXCAVATED FOOTPRINT OF THE TANK. 12 RELATIVE COMPACTION EXCEPT THAT THE TOP AREA / 10. BACKFILL THE EXCAVATED AREAS USING EXISTING STOCKPILES SOIL, — -- INCHES OF BASE UNDER TRAFFIC AREAS, WHERE A MINIMUM 95% RELATIVE COMPACTION IS REQUIRED THEN COMPACT. 11. RESTORE DISTURBED SURFACES. (ASTM D 1557). A COMPACTION REPORT IS TO BE PROVIDED AT THE COMPLETION OF THE PROJECT. GEOTEXTILE FABRIC O WILL BE USED TO SEPARATE THE AGGREGATE FROM THE G V °23,1 0,, W MATERIAL MATERIAL. SITE BE USED FROM 5 FEET TO THE PAVING BASE / / SITE ADDRESS: 191.61� - / 1 STORY — — SPEEDWAY MATTITUCK BLDG. _ _ 11100 MAIN ROAD 1 STORY _ —�_ �f MATTITUCK, NY 11952 BLDG. — — APR 1 7 2026 SCALE: DRAWN BY: SOUtho1G Toy°rn 1:10 DC DATE: JOB No.: 11/08/2024 LEGEND TITLE: ------- PROPERTY LINE —X —X — FENCE LINE REMOVALS PLAN CALL 811 THREE DAYS TO TEN DAYS E) STORM DRAIN BEFORE YOU START ANY DIGGING DISPENSER ISLAND PROJECT. WHETHER YOU ARE Q UTILITY MANHOLE ' PLANNING TO DO IT YOURSELF OR *NOTE.- ALL SITE FEATURES ARE APPROXIMATE — SOURCES; SITE SURVEY PREPARED BY HIRE A PROFESSIONAL SOMEONE STORCH ASSOCIATES — UNDERGROUND STORAGE TANK SHEET No.: Know what's be19w. , Call before you d NEEDS TO CALL 811. REGULAR/PLUS/PREMIUM PRODUCT LINES S T LD TRUSTEES OU HO No. ioq 6�-E A Issued To VIP-ss - ►oyes wCDate VIVA(& . lll00 Mv�;� �nd, mocml-vAck ' Address. _ THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION .TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 CB - CONCRETE BASE CLF - CHAIN LINK FENCE CONC- CONCRETE UB - UTILITY BOX USB - U-SHAPED BUMPER VF - VINYL FENCE O' WF - WOOD FENCE OO - LIGHT POLE O GJ P � w G S o o' 000 ` 0 000 P _ o cL� �000 �o 0 80.0' `Sb v�o c) �w 6 c� �� w 43.4 0 0 Ld Gp�G� O eO c v > GAF o v- O O 37.1' Zs Ouj o p0 1 tip. p0' 0 1 0 SS 0 . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S�OR .. p 1. 0 s J' . . . . . 119.9, `�;qt . . . . . . . . . . . 0 .�1 0. . . . . . . . . . . 102.2 . BULKHEAD o ° 102.7' 98.8' W00D DOCK N BULKHEAD 0 u a oEs ; p :� CONCRETE RAMP v A I R 1 7 2026 DOWN- 0 1 2 3 ORIGINAL SIZE IN INCHES ADDRESS: 11100 MAIN ROAD, MATTITUCK, NEW YORK NOTES: CERTIFIED TO: " THIS SURVEY WAS DONE FOR ENVIROTRAC ENVIRONMENTAL SERVICES AND IS INTENDED TO SHOW 7HE LOCA71ON OF THE pF NE CONCRETE TANK FIELD WITH RESPECT TO THE BULKHEAD BY "ES CREEK ONLY. ENVIROTRAC ENVIRONMENTAL SERVICES DATE SURVEYED: MARCH 17, 2025 ,�,5,_ P 2. NO GUARANTEE IS IMPLIED BY THIS MAP AS TO THE EXISTENCE OR NONEXISTENCE OF ANY EASEMENTS OF RECORD THAT WOULD AFFECT SUBJECT PROPERTY, UNLESS SURVEYOR HAS BEEN FURNISHED WITH A COMPLETE COPY OF TITLE REPORT. ALL COUNTY LAND SURVEYOR PC co 3. THIS MAP WAS MADE AT A SCALE OF 1" = 15' WHEN ORIGINALLY DRAWN TAX MAP 167-1 4 AVENUE BU CKLEY PLS BU O ONAL A. ' r { 4. PROPERTY CORNER MONUMENTS WERE NOT PLACED AS PART OF THIS SURVEY. D 5. IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR TO ALTER AN ITEM IN ANY WAY. FLUSHING, NY 11358 6. THIS IS TO CERTIFY THAT THERE ARE NO VISIBLE STREAMS NOR NATURAL WATER COURSES IN THE PROPERTY EXCEPT AS DISTRICT 1000 TEL. 718-358-8114 7. O ONN ON THIS SURVEY. SECTION 122.00 TOWN OF SOUTHOLD FAX. 718-353-0938 LY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITHIN AN ORIGINAL OF THE LAND SURVEYOR'S EMBOSSED SEAL BLOCK 03.00 COUNTY OF SUFFOLK EMAIL: DOBUCKLEYQACLSNY.COM F �4�6a� f`�✓ SHALL BE CONSIDERED TO BE VALID TRUE COPIES. 8. THIS SURVEY IS NOT INTENDED TO BE USED FOR NEW CONSTRUCTION. LOT 010.000 STATE OF NEW YORK DONNEW YO CENS 50641 ,�._ - g�EFQIK jZ Glenn Goldsmith,President ��0 Cps Town Hall Annex A.Nicholas Krupski,Vice President a� y1 54375 Route 25 Eric Sepenoski w ,? P.O.Box 1179 Liz Gillooly �.y 0�� Southold,NY 11971 Joseph Finora �I Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed in field by: Envirotrac on behalf of HESS RETAIL STORES LLC requests an Administrative Permit to remove underground storage tanks and associated equipment. Located: 11100 Main Road, Mattituck. SCTM# 1000-122-3-10 T5p of area to be impacted: Saltwater Wetland Freshwater Wetland Sound fBay Part of Town Code proposed work falls under: --/Chapt. 275 Chapt. 111 other Typ7of Application: Wetland Coastal Erosion Amendment �A Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly J. Finora t View Looking East L yq+. t3 yr� I Former Speedway #7795 ,. -11100 Main Road Mattituck, NY April 7, 2026 - 3View Looking Southeas ' f. /.a �� ��s? P ► 'Pit f��� ra `?c nTnlp I a, Former Speedway #7795 11100 Main Road Mattituck, NY April 7, 2026 _ 1 - View Looking Sout ieti•P '3 ..7r"-9.' ��i d`!'t:-- � ... .+m"^+IFIr.. i►". AVER aN Will �� ��tr'•',� ,yJ I 1f �'> ,��� 4� �' +•5 �� , . ,+_ .,mac- *,r i ! , �j` ,, � , _ seGFAhI �� _ ��� -� ..-�.:.....�....y� N'l�L� •tee;._ �"�" • _— � ��"' I � I2E .. -- - 40 - a �. Former Speedway #7795 11100 Main Road - '- Mattituck, NY r April 7, 2026 View Looking South-So _,__tr est MOM �� �A{ „ � «1y�'4`: r _._'� -' 'may _ �cr. = i�• ,R., � b - Ri M Y7 u►'ae r c y i ���b °'3c _+ --'` - ,yI_ •� r � r , al 01 Pry_='--, r ...'l��►1I� �'r-. ..+�. ` ~ . ��1►Fj��y _ a. 1- Former Speedway #779 11100 Main Road - _ Mattituck, NY A ri l 7 2026 U. i e' { hA Aoft. A ` �RMN Vr- ni w �t ti `Yt _✓ r ` _ e as t Fo_rrxtib' S eedwa -r. a ai.n Ro" d aF My NP, c NY 7. 't _ 'ri■ � .k-C �•.-�: a ,.�'..� k``.L''�_ 4r G4� ;.3��'+.:j6�y�.'sc�3�' `. ^;' ' ..�� - - - - t� . . '�si-:•e�''s i ����{",-'•'ra'�'t�'' •.at��`.Gr`�.' _�gs. �'►�°"''es`.-k`;s�i ��"��� ?'L_ • FF `"Oki, Wgst P 4 1 3 1 OR � `�# `�. � � �`it , l J � i ..._,a '7�• s r � '1'7 a ana •"r�`k' ., � �� t - '! '� ' i �' � i arty , r•�' .ter ,.f: �.: :N For r Speedway #7795 - G� 0 Main load t Attu c•�c N�( April ? 2026 s - , '-z; 2v M.2'.- �'�''� ti:G ��' :e i �yy.: �. .�:• v rx�x k 6-�'= u �`E� *•y t � -r?.� _ ��M, .1 1 _ { Y ".`v y - 38 � ...mow �,_•...� _ �i-`r�°,.. 'Cw-=�C"� , } e.✓ r _>` •,� a ..•t� - L--+• - •�' is-S,--. 4F�{y\e.��,.,,� �fir. x � s.. .p "•S" #,}. } ^s- ON JL- NEWS LO 6, 1FCN. ,.. .._Gh�..z`.u�F�i��:.Y :._ _ tv►i`�' View Looking Southeast "I" 1 ,�-41OW-0*01"114 Former Speedway #7795 11100 Main Road Mattituck, NY April 7, 2026 View Looking South h Ana _ -Ij .�. i A 1 l ��P Former Speedway 11 Main R• . • AprilMattituck, NY 1 °b as a. .•,a" sEc_"°. �,�\ t`' `'. , NO z! e 2% 1 ��� Y, a1 -�4 :1 S � v 'r � •2 '3 ,, �� \. .�� �� yn� iM r iIA s �n-'Si`r�•• NA R ,., '� 4<, s.. •. � • �'� *,' II ?a h^..� .! i _.._ ..OILJII l�i;w! "° •y°. lt• W .. :,, s., .y v r st �? :i'- e, q�F� "+• o,aso.. p... •,•� ! ��. .< ♦ ,dr°w � °lsa'�a�! � ,' �,•��p9s��y4Oa��.,�n�\�� � - .> - \ � " an1...M __ •" - � °A a � t 5' c u a,' mawo] a: Z Pt'b � ¢ •.w` 3 � r ,< . �' ! _ - tT - �. Im At i4 z asaau s aaY a•= e• `x tw.. x�+a Y �s n a a !! mi m ,�,F ,y, a a �. _. _ \4J •`T 3° :°r _new. q. a aEe..NO V a 0 1 W ♦.I w o ]a$?- ffiµ. Y 2.. 121 •;. <� `a�.� � 'P]q� .aa r i� ..� � �e ],e lei' eusrouccauxrr �` .y v r "8At JM]E,1YlMORRY $;•'.. ... rC,'�, Y - ... .. ''! 'I n w.a ' r SEE lEG.NO.;R' ,. M1 pn„ N . .• \. \ t yyci SA S°loas t � ,• - , '�� lo It S aNz� a outer. -E w.+ RIO y SEE SEC NO '. NOiE<H w4NREHI OVEN_r.v CONJiIgI. ~`�\\\*YT ''a ' - ^•r'�- ?C IX4T91MNM1■.OGtOfi SETYlEEY aawcE.a!ltusa e :,.:.•la. >.,T• ,..��.......,..M...._, o_, — �� '� COUNTY OF SUFFOLK(� NOTICE N E It 1 Yr pert 1 n,.r.lken„ sur ae v Sn;. an ur N wy J!—__ __ __ __ ____ u• (21) � u n., .,„rrw�r 69WrB,lN p LL OFFICE LOCATION: �QF so(/�y MAILING ADDRESS: Town Hall Annex ��� Ol0 P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY y Telephone: 631 765-1938 G p www.southoldtownny.gov UNTI, PLANNING BOARD OFFICE 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: May 13th 2026 Re: LWRP Coastal Consistency Review HESS RETAIL STORES LLC, SCTM# 1000-122.-3-10 This application is to remove underground storage tanks and associated equipment. The proposed action has been reviewed to Chapter§268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the policies of the LWRP as follows: Policy 6. Protect and restore the quality and function of the Town of Southold's ecosystem. 6.3. Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The proposed plan includes actions which are consistent with the "Administrative Permit" requirements of Chapter§275-2 A of the Wetlands Law of the Town of Southold which qualify under Chapter§275-5 (13)(2)(b) Removal of any material or structure, provided that a project limiting fence and a silt fence with hay bales is installed to contain disturbance if deemed necessary and provided that such operations will not have an undue adverse impact on the wetlands and tidal waters of the Town. The proposed action includes the removal of residual liquids from the tanks which reduces the potential for environmental impacts through spillage. 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. 2 Town Hall Annex Glenn Goldsmith,President 54375 Route 25 A.Nicholas Krupski,Vice President ,`O l4 ' P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Elizabeth Peeples YD - Fax(631) 765-6641 tM BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application A PR 1 7 2026 Administrative Permit —Amendment/Transfer/Extension Southold Town Received Application: Board of Trustees Received Fee: $ Completed Application: Incomplete: SEQRA Classification: Type I Type II 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): Speedway LLC (Hess Retail Stores LLC) Mailing Address: 3200 Hackenberry Road, Irving, TX 75063 Phone Number: (937) 863-7071 Suffolk County Tax Map Number: 1000 - 122-3-10 Property Location: 11100 Main Road, Mattituck, NY 11952 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Envirotrac- Dan Ruffini Mailing Address: 5 Old Dock Road, Yaphank, NY 11980 Phone Number: (631) 924-3001 Email:dan.ruffini@envirotrac.com __ F_ -:d of Trustees Application GENERAL DATA Land Area(in square feet): 0.528 Area Zoning: M I Previous use of property: Commercial - Gas Station Intended use of property. Unknown at this time 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 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): Permanently remove all underground storage tanks (UST's) and associated equipment. E° -;7d of Trustees Application' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To remove all underground fuel tanks so that the property can be sold. Area of wetlands on lot: 0 square feet Percent coverage of lot: 8 % Closest distance between nearest existing structure and upland edge of wetlands: +/-98•5 feet Closest distance between nearest proposed structure and upland edge of wetlands: +/-98.5 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? cubic yards Depth of which material will be removed or deposited: Unknown feet Proposed slope throughout the area of operations: N/A Manner in which material will"be removed or deposited: A large excavator will be used to break up asphalt and remove material. 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 to remove the underground storage tanks and associated equipment will not have any adverse effects on the wetlands nearly 100' away. Any environmental impacts during construction will be temporary and the area is expected to recover immediately after construction is complete. 61 Z20 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: Speedway Station#7795 Project Location(describe,and attach a location map): 11100 Main Road,Mattituck,NY 11952 SCTM#1000-122-3-10 Brief Description of Proposed Action: Permanently remove all underground storage tanks(UST's)and associated equipment. Name of Applicant or Sponsor: Telephone: (937)863-7071 Speedway LLC E-Mail: brandie.lehman@7-11.com Address: 3200 Hackenberry Road City/PO: State: Zip Code: Irving TX 75063 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: The Town of Southold 3.a.Total acreage of the site of the proposed action? 0.528 acres b.Total acreage to be physically disturbed? aw acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.528acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ©Commercial ❑Residential(suburban) ❑Forest ❑Agriculture 0Aquatic ❑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. ❑ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 0 ❑ 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? 0 ❑ 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: Rl ❑ 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? 0 ❑ 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: The underground storage tanks are located nearly 100 feet from the wetland boundary. 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: 0 Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional 0 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? � El 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, ❑ 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: Lid NO AYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: Rl ❑ 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: F ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spolor name: Brandie Le an,Manager,Environmental Services Date:_ ,_3/9 q Jd u Signature: 1 Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. 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 ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ 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 ❑ Elproblems? 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 __'rd of Trustees Applicatioi; _ AFFIDAVIT Brandie Lehman, Manager, Environmental Services BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN 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 R)6L G�1 , 20 a ST KELLEY L RYAN 7 AL - m Notary Public State of Ohio �o' � ��� `�, y Comm.Expires Notary P II ti o December 22,2026 - jrd of Trustees Application - AUTHORIZATION (Where the applicant is not the owner) I/We, Brandie Lehman for Speedway LLC owners of the property identified as SCTM# 1000-122-3-10 in the town of Mattituck ,New York, hereby authorizes Dan Ruffini of Envirotrac to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. ,P)4110A Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF JhArch , 20 r)(0_ s' KELLEY L RYAN 9 a� f1 Notary Public State of Ohio 6 '•? � o My Comm.Expires �°ti+• ��� ova Otary P December 22,2026 li 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-purvose 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. YOURNAME: Lehman, Brandie (Last name,first name,griddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ✓ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES 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 th d fA 20 Signatureai a Print Name Brandie Lehman Fonn TS l 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 emnlovees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whateveraction is necessary to avoid same. YOURNAME: Ruffini, Dan (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent;or,child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than.5%of the shares. YES 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 20 910 Signature 1•�AJM /? Y I Fonn TS 1 r Print Name Dan Ru- ffini T� 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, listinp-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# 122 -3 -10 PROJECT NAME Speedway Station #7795 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: 0 Nature and extent of action: Permanently remove all underground storage tanks (UST's) and associated equipment. Location of action: 11100 Main Road, Mattituck, NY 11952 Site acreage: 0.528 Present land use: Commercial - Gas Station Present zoning classification: M I 2. If an application for the proposed action has been filed with the Town of Southold agency, the folowing information shall be provided: (a) Name of applicant: Speedway LLC (b) Mailing address: 3200 Hackenberry Road, Irving, TX 75063 (c) Telephone number: (937) 863-7071 Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No❑✓ If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LVW Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ✓❑ Not Applicable Our proposal is to remove underground tanks. There will be no outward expansion. The proposal 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 LNW Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Z Not Applicable Our proposal will have no influence on the historic and archaeological resources of the Town of _. _ Southold. _ _._-r-- 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 is to remove the underground storage tanks. The 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 Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Z Not Applicable The underground storage tanks are located nearly 100 feet from the wetland boundary. Attach-additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section HI —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No I'' INot Applicable The underground storage tanks and associated equipment are to be removed_ . 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 HI—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No ❑� 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 ifnecessary 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❑✓ 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 ❑Not Applicable A vac truck will be used to remove and properly dispose of any residual liquid tank contents. 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 0 Not Applicable Our proposal is to remove the existing underground storage tanks. 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 The existina underground storage tanks are no longer in use. The owner wishes to remove them Permanently. 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 0 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❑✓ 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 Dan Ruffini for EnviroTrac TITLE Senior Project Manager DATE*�� Enviroirac Environmental Services April 16, 2026 Mr. Thomas Hobson E ('' E Town of Southold Board of Trustees Mattituck, NY 117971 APR 1 7 2026 Via: Email rfi;F: Southold Town Board of Trustees . Re: Tidal Wetlands Application Former Speedway #7795 11100 Main Road (Rt. 25) Mattituck, NY 11952 Dear Mr. Hobson: We spoke back in January regarding a Building Permit application that was denied. The application was to remove the existing fueling system inclusive of underground storage tanks, dispensers, product and vent lines. The denial was based upon the proximity to a Tidal Wetland. The Building Department requested either a letter of Non-Jurisdictional Determination (NJD) or a Permit from both the New York State Department of Environmental Conservation (NYSDEC) and the Town Board of Trustees. The NYSDEC has already issued an NJD letter, and we have included with this cover letter an application for a Town Permit. We request that the application be reviewed and that a Public Hearing be scheduled. Included with this application package are: • Southold Town Wetlands Application (original plus 3 copies) • LWRP Assessment Form (original plus 3 copies) • Short Environmental Assessment Form (original plus 3 copies) • Project Plans (4 copies) • Property Survey (4 original stamped copies) • Site Photographs (4 copies) • Check in the amount of$250 made payable to the Town of Southold, representing the administrative application fee s Tidal Wetland Application 7-Eleven #45004 11100 Main Street Mattituck, NY If you have any questions, please feel free to contact me at (631) 924-3001. Sincerely, EnviroTrac LLC -AaVIkaV Dan Ruffini Senior Project Manager Enclosures ec: Sam Kramer— 7-Eleven, Inc. 5 Old Dock Road,Yaphank, NY 11980 (631) 924-3001 Fax: (631)924-5001 www.envirotrac.com Offices in FL, GA, MA, MD, MI, NC, NJ, NY, PA, VA