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HomeMy WebLinkAboutTR-10984A S FFQ(,� Glenn Goldsmith,President O�0 COG Town Hall Annex A.Nicholas Krupski,Vice President �'�� yam'? 54375 Route 25 Eric Sepenoski CODx P.O. Box 1179 Liz Gillooly �r Southold,NY 11971 Joseph Finora y p?; Telephone(631)765-1892 A, Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection Glenn Goldsmith, President `yi®F so Town Hall Annex Nicholas Krupski,Vice President ,`o ®�® 54375 Route 25 P.O. Box 1179 Eric Se enoski p Southold, New York 11971 Liz Gillooly Joseph Finora Telephone(631) 765-1892 Fax(631) 765-6641 c®uu>r�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10984A Date of Receipt of Application: July 13, 2026 Applicant: Bodenstein Family 2012 Irrevocable Trust SCTM#: 1000-86-6-19 Project Location: 6145 Indian Neck Lane, Peconic Date of Resolution/Issuance: July 15, 2026 Date of Expiration: July 15, 2029 Reviewed by: Board of Trustees Project Description: Install 35-50 pieces of rip rap and a slight berm. 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 Ruth Jordan, received on July 13, 2026, and stamped approved on July 15, 2026. Special Conditions: Berm should not exceed 18" in height. 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 E ( f a RICHMO14D. g'E.E.K fl 8roa.00„ �IDIEED)AL) JUL 3 2026 51.011, ACTUAL) Southold Towr,—`-- 51.17 Board of Trus fees . aj es of � ,s�. SURVEY OF t.D,F ' � � I°"` PROPERTY �>E OA x SIT UA TE SOUTHOLD N Rr nr d ' °AC�' TOWN OF SOUTHOLD *0"4a ; SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-86-06- 19 i SCALE 1 "=50' APRIL 26, 2022 AUGUST 30, 2022 CHANGE DATUM/CONTOURS i i N n i AREA = 38,136.3 sq. ft. WAM ar N WALIINIR i aat 0.875 cc. i pAt i i i i s � At aeT i j w to . l to VIPso.22�Jib Lr ;'' a 20' R O.WROCICS STOOPS } 8 ADD POND N �7 n &rj ulultv APPROVED BY ". BOARD OF •I RUSTEES mm , JOVKK .WN,'OF SOUTHOLD - ,ri0� p 1 + DATE 7 1 f 'Q`O mm Rarorlsrs LMM TAUSr { �� + 3 1 +{ { Ft oat► � �'�j CO AQ ta o is Go t + M 0 z n► ;�56.10" W S , 74•,1��OM W �a.20 NOTES: 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM s�•a6� 1�E EXISTING CONTOURS ARE SHOWN THUS:XMWAM 4 1` symanm ►n W."T Mom[,NE 1wr COMM 1` lt5 SLYLY 5 7lla[CI IC II,\U![VC.I METES AND BOUNDS SURVEYING ::aarccoc.see,°,:til pt w"c'l est 53 PROBST DRIVE %&A IRKuCR2CC µlC.Al Cr.rR ACCTCA 1C A SHIRLEY. NY 11967 SEA l A YC4 CA Cr-ICLt a3-..S[c.c'.•Ce5 ,M.SLl CYSCr.7.Cr l.[w[ll R.R liAiC PHONE 516) 972-5812 CCLCAIt.IA. E��IIICILC'Offi •CCPit% Irem We origlrct of RI,[Lney mcp rot meryee wilt- arlgircl of tte I... LOTS: 19 BLOCK: 06 SECTION: 86 DISTRICT- 1000 etdl yro,�be k....icer.e c nut ant cac nd .• ,Z;.Iltl,cIIcr Ireleel.c t.r.cr,Igr:ty R.I �lY{P OF: Ip* .i oy.•..•o•r•. TEST WELL +t.ailt:rg Coee CI PreeUu is fare S.rnr[ ccepl.e by Ito New Yeek Stole blecilller of Prolna;4,el left l'—ye". SCte CONC. MON. FOUND STIUATED AT: SOUTHOLD e.mreeror.,felt -1,1. It,p.reor TOWN OF SOUTHOLD SUFFOLK .Y. For.tom It.urnr it prat e"c.ere or nl t CO.,. eetclf to Ire 1111.c.mpery,ge errmcrtd ._6 UTILITY IDLE e5erey crc lerdr'irltiMiur, Cerliileeliera Cr. .l 1_11 rcbl.to ® WELL CERTIFlEO CC.+liorel irflll�lior[ or ublKlert e.f.rli %* WATER VALVE TO JOB NO: 20-2328 ' 16 WATER METER DATE: AUGUST 30, 2022 S THOLD OU . . TRUSTEES No. lockgLi A Issued To% P--)loAen' s;k",,m 1'rusT Date ,10+ 115/2� Address. G145 Tnkc%* me-cx. I-afte, VeConoxC .THIS. NOTICE MUST' BE DISPLAYED DURING CONSTRUCTION .TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 � 4 Glenn Goldsmith,President v���0 eaGy Town Hall Annex A.Nicholas Krupski,Vice President 40 54375 Route 25 Eric Sepenoski ,x x P.O. Box 1179 Liz Gillooly �y old Southold,NY 11971 Joseph Finora ��l �� Telephone(631)765-1892 $L Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 7Z)3 Completed in field by: �. �o)���►,*�� BODENSTEIN FAMILY 2012 IRREVOCABLE TRUST requests an Administrative Permit to install 35-50 pieces of rip rap and a slight berm. Located: 6145 Indian Neck Lane, Peconic. SCTM# 1000-86-6-19 Type.6f area to be impacted: ✓Saltwater Wetland Freshwater Wetland Sound ✓ Bay Part of Town Code proposed work falls under: ✓Chapt. 275 Chapt. 111 other Typf 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.: C.ay%A,k ©n 6 c ,. V0_;p_\nk nek to dassc� 18- Present Were: ✓G. Goldsmith ✓ N. Kr J. ✓E. Sepenoski L. Gillooly J. Finora OND CR,.E.OK -- - -- gICHM oEEo) L ;�--� � C ��. N 87C5,25" EACTIfA ) N pEE )p� 51•a1 . �pC.Tu ) 51. JUL 3 2026 toe As or AMARM goi told Town .� e " SURVEY so ofTrustees �000 Lot � PROPERTY SITUATE wr N S OUTHOLD >•� •nr ias' °A TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-86-06- 19 i SCALE 1 "=50' APRIL 26, 2022 AUGUST 30, 2022 CHANGE DATUM/CONTOURS i N o i aaE AREA = 38,136.3 sq. ft. I►AM& .I x W LXB'R j 0.875 cc. SOW i FE lot i r � 0 SO�z 30" E i� a o/t• 20' � I�_� O � Y ROOT R.O.W. •°� ' n 8 ppp*201" SICOPS� LO 1= N 17 eraoc N PA110 r FMW mislollopm �# RMCABLR LMMC TRUST ~ �V 11 1� 1 I, 1 IN i 1 1 3 1 ,Q- ?1 1 FE oft 0 sar k 1 1 c 549.39 o to !/1 M 1 1 11 00 a 1 1 O z t �er56•Ao0 W � S , `> 74.11,ZQ" W 3a•2o NOTES: 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM 6�•46� t EXISTING CONTOURS ARE SHOWN THUS: NOR LOCAMM NO 00S1 =0r ANY 1{V- WMWACE OI =AIOC i11NJ 10 W?WAMY Yl�L AK 110T courm Ta s.1c, s nuccf IC c.,wr.u., METES AND BOUNDS SURVEYING :: :°:;;�•zu�C'Y�F,'C7CSSC%SCrIc,1 53 PROBST DRIVE %h.T.C9xlC AIISetIC.CA RCTG TC SHIRLEY, NY 11967 Sm 3 A.C4 Ck CI"IC cW C*-..3ttICk e 5 1"9.Ste CIS C.7.Cr,.0.ew CR.511TC PHONE 516) 972-5812 cCl.t.CIw sur")xlu el ftma1Imm Caplet I— We.6S1rct 01 IN.t -,mcp rat mC,Yee .ilr cr anSil,I el It.1— LOTS: 19 BLOCK: 06 SECTION: 86 DISTRICT: 1000 i�cii�clt Qe kc-l"m C'Klic 1".icCt! ..•� 0F: 'C nrlifia... ir.....c rrncr tl r:y pet TA lri.. .ir. c..p•r.c c cart• io TEST WELL pe e.i1Gr5 COcc CI PrccUce to lcrc 5urt17 cceple, by tre New Yerk$tell ASIOCICliar el Pref.,V0r41 lcrc S—ycrt. Scic CONC. MON. FOUND SITUATED AT: SOUTHOLD n.rtnmarnrt Itch nr arlr 10 we per.ar MW OF SOUTHOLD SUFFOLK CO.. N.Y. ter.r0m pe 1N.•r 11 pr0pc,0c.Cr. Ht f Qe,.,,to fre IIIIe campery,SO.errmerlG c4b UTILITY POLE cierCy rt crc I.rcir'irffl.ti0r, 1. Ceilleellart ue al trcrflnrc Qle l0 eelliarCl irtlil.liprt C<IlQS9Cc.er1 a•Nrf; ® WELL CERTIFIED %* WATER VALVE TO JOB NO.: 20-2329 ti' WATER METER DATE: AUGUST 30, 2022 Glenn Goldsmith,President �0 COGy Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski o ? P.O.Box 1179 Liz Gillooly A � Southold,NY 11971 Joseph Finora l �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed in field by: RUTH JORDAN requests a Pre-Application Site Inspection to discuss installing rip rap. Located: 6145 Indian Neck Lane, Peconic. SCTM# 1000-86-6-19 Type ofyea to be impacted: _ ltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: _ZChapt. 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 V Not Applicable Info needed/Modifications/Conditions/Etc.: Qks > am� fir Present Were: Goldsmith ✓N. Krupski 'V E. Sepenoski �L. Gillooly L/J. Finora • ddL. • � e • / � �•r '.� �air_ •ram'= •� •/ � ;w�i^ •.. .� • ••fir f �� ''�r.�- `4�,�•,�',�, .�!� t• 1R- 1 1t pi w t` a ~ a =err'� .• :r��t r. ,. i. 1- t Y t•w � :. �� it A ��. � x r.1t�l'a��y,•,�'r��,, .'•� ij p 1 yK � ,7 r 1 . : .x ` ` G". '-!y.•. .fir -d , -�. tip-• ♦ •` µ' M. �' s 46 _fir.. .�" ,�� � �' • ,R+ "`� .. Y Sit, W. 4 FI :f.•' y 7 IINE oszoo� o4 L+_ �M *s ,mot« 4 E 4 i aooe,� • ais o,o " l z 'R oa.a.03 � ti • ,m�tt��`^eiai0 22AIe1 $.� wwv ¢F a � tiaP �Q-: o oc.4coa,enr»any "•. os an-, 8�- t.yr e ti sA i ,} 01 O 92.Ba_'S a at—19 W-tare �" 1992U rory,1 .f •4 01-m.24J, tam 2a P ✓>'b u6' 'r. `�� n" � tt` '�: Batt 25 A.1 ayo w- •` :s�` A tl ^g , u � 1 e h n za .1 a _ti •4i9 45 _. 02 `�y 1 .• i3 - x�1 % %r �t"�Bx t ��a�•, ��"% �'., 4 �' t 2 �'^t y at ` ,. .,M.o 4 N � ,u t `� „ .1 e t B 1 ```-s,, •. ,', +ate, r tAr�� ."�,z s --�. .,.,i E t Q �...�..., � __._ bBy, Bt `Y,, ." �y,,cl -.,» ��• �CHM0.Yp CREEK •a w 13 n¢si3Uft.J !:•. 4 9 1Pt 14 A..Y3..vi 1.y,W1 a LL �Y x o:. .• .[µal � >., . ?7 m 21 r �t m y¢� f 3 � B t W 02� _ ', - � t u t1�t •.� f1't • .(�. r 6 0 A 9 .+ 4 t m, • 4'� -�ate" ¢.fA� \ A z 5 3 t t iA 4 6 1bA v _ �•A� -.:�\ ° � . :- 4 ram', � �g � f a^ tirt�. y z.¢ AM'1 71 4` g' "c. a 4z , yo '. 2 y v� aw•: 2 3 ,. �� 18^ yc v G 1Nra + u4� COUNTY OF SUFFOLK o NOTCE K .„.,.. ,n 7 Property T t g cy N ou sonar¢., v z c .N _— .. .... ... : FO�x CgNfY TAK iuf• V . vu•w p » __, c ___,_._ "'. — sa.tww. Izt) +.,, vrt•xwr vntrt,eu rtwnB. A -r.. 4, x ". sv Wr*rone,e g w,t OFFICE LOCATION: *OF so�Tyo MAILING ADDRESS: Town Hall Annex ,`O l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) H Telephone: 631 765-1938 Southold,NY 11971 G.A • olyC4U�`1,� 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: July 13, 2026 Re: LWRP Coastal Consistency Review Jordan Conservation of Soil and Vegetation, SCTM #1000-86.-6-19 This application is to shore up beach to conserve the soil and plants already there in attempt to save existing stairs using a small amount of stone material provided by neighbor. 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 4. Minimize loss of life, structures, and natural resources from flooding and erosion. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. D. Use hard structural erosion protection measures for control of erosion only where: 2. Vegetative approaches to controlling erosion are not effective The proposed stone material used for erosion control could be defined as a riprap revetment pursuant to Town Code Chapter §275-2 Definitions: RIPRAP A layer, facing or protective mound of rubble or stones randomly placed to prevent erosion, scour, or sloughing of a structure or embankment, also the stone used for this purpose REVETMENT A shoreline hardening structure landward of the wetland boundary typically constructed of rock or stone. See "gabion." The proposed construction of a riprap revetments is consistent with Policy 4.1 D(2) which states that a revetment can be found consistent if vegetative approaches to control erosion are not effective. The proposed parcel has existing vegetation; however, this vegetation is not effective against the increased erosion caused by the bulkheads on the surrounding properties. The addition of a riprap revetment at the toe of the existing stair is consistent will decrease erosion on the wetland boundary. 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 Glenn Goldsmith,President Town Hall Annex g a:. A.Nicholas Krupski,Vice President ,k 54375 Route 25 } P.O.Box 1179 Eric Sepenoski �1 Southold,New York 11971 Liz Gillooly iA a,q Telephone(631) 765-1892 Elizabeth Peeples W � Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office nt- Coastal Erosion Permit Application t 6 E i . Wetland Permit Application lip Administrative Permit _—Amendment/Transfer/Extension JUL 3 202E Received Application: Received Fee: $ SouthoidTown Completed Application: Board of Trustees 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): 3e d eti sic i h Fh.i/y/ Z a 12— -Trrc✓vacIle- _ 7#-a s i - Mailing Address: a �°i Jorc(ah Trt-flee, 1wd;.CA lVe4 - 44 Acw Phone Number: 370 Suffolk County Tax Map Number: 1000- I 1-k J Property Location: (0 3 _Ir d i a h fV e G k L ah e_ �e e01, 96- , )y (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email:. _ . Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Ae do M A...- / W i e- ^-A 4. Intended use of property::;.. R-eS _ Covenants and Restrictions on property? Yes ^No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? E-Yes _nNo 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. his project re"'�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 F-1_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?—L No ❑ Yes If yes,provide explanation: Project Description(use attachments if necessary): _ 9 � S a� an. Akllf a IrO-dy 7V«L fifi h R.</aA" v. Sa Ye. hI ex is f�', S,71a rr r (R sr.- c r4%4-/l 01"i k• 0� .r Ai t h&oL4c V#,a.-/ t r a v r e.t' Jy in See., 1 Ie, SSkbmi4ed -4 -6-0fleCS doe,ad Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: C�6.rSu✓�T�� Q f So i I GFhd� V- e1A ice; Area of wetlands on lot: square feet Percent coverage of lot: % A//A Closest distance between nearest existing structure and upland edge of wetlands: _feet Closest distance between nearest proposed structure and upland edge of wetlands: — feet/VIIA 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: feet ED Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate)': 617.20 Appendix B Short Environmental Assessment Form Instructions f6r Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: Project Location(describe,and attach�a location map): ,� /�S ,Lhdi`tah %C/ PCe—ohiG A/,�/ Brief Description of Proposed Action: S It Q ri h q cs P C,t r yt '�a coASG r I-e, s' 4b 14 4/-r 9T 4L�e,�v4t- 44,cl,[c�rt�o M etv 1sLfai•-s t.ct�.►/y 4 s�..�y QBit �rwT OT L,/ R�� �`i�e� Py ✓lCi��,'bdr . Name of Applicant or Sponsor: 11 Telephone:2 6-.Z. 376 Tte_ E-Mail:J-t A4 z.f'o /iset,i crtL Address: (� tf S ih di n /ve G4 L, City/PO: State: Zip Code- e_ c 0-h ic- 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO VES administrative rule,or regulation? Nn ❑ If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? 8 7 S' acres b.Total acreage to be physically disturbed? 0.z-A acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? C.7X� acres 4. Che I land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) �lndustrial Commercial residential (suburban) Forest [:]Agriculture []Aquatic ❑Other(specify):_ Parkland Page I of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? Fla 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• © ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO : YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: �a j ❑ 12. a.Does the site contain a structure that is listed`on either the State or National Register of Historic NO YES Places? b. Is the proposed action located in an archeological sensitive area? X 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. T ntify the typic bitat types that oc n,or are likely to be found on tIMroject site. Check all that apply: 1 reline Forest Agricultural/grasslands LJ Early mid-successional LJ 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 If Yes, a. Will storm water discharges flow to adjacent properties? &JNO DYES b. Will storm water discharges be directed to established conveyance syste f IFNO f an m drains)? If Yes, briefly describe: �'ES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond, waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES, completed)for hazardous waste? If Yes,describe: FY ❑ I AFFIRM THAT THE.INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE l k JO,-o(2q lres S�Gs� �l 2-0 Applicant/sponsor name:, _ lI Date: . Signature: _ "" cn �_ 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 Elregulations? 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)? s 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? FYq El 6. W ill the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? © t 7. Will the proposed action impact existing: ® ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? e F1, 8. Will the proposed action impair the character or quality of important historic,archaeological, trZil z � a� architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, €' waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 1 10. Will the proposed action result in an increase in the potential for erosion,flooding.or drainage problems? 11. Will the proposed.action create a hazard to environmental resources or human health? 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. Town of Southold-Board of Trustees Name of Lead"Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Agency Signature of Preparer(if different from om ice Responsible Officer) PRINT Page 4 of 4 Board of Trustees Applica�:�un AFFIDAVIT ``74 t)erGC2on BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Pr rty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF.\l U l .202 417&r-M X - 1i),iWWA otary Public TRACEY L.DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DWS306M OU4A�LIFIED IN SUFFOLK COUNTY COMRAISSION EXPIRESdUNE 30,20aP Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified as SCTM# 1000-.. _._. _._.._....... in the town of New York,hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS. DAY OF , 20, Notary Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibiis conflicts of intereston the parf'of town"offieers and emoloyees.The purpose of this.form•is to provide information which can alert"the town of passible conflicts of interest and allow it to take whatever action is necessary to avoid same YOUR NAME: _ (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 throughyour company,spouse;sibling,parent;br.child)haue`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 n 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): _nA)the owner of greater than 5%of the shares of the corporate"stock of the appticruit _n (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 131*j� day of .� r 20 Signature - w I-'- a��✓ 1 Print Name /2r r�-�. JO rd-a,4l Form TS 1 " 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,.tir6ii6sed.action will be evaluated as to :its sigluficarit beneficial and adverse.effects upon the coastalarea(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 aupporting.and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and condition, 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. 5 B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTMi# PROJECT NA o �tS c/t/a'f%�i u� o f ve ��i�-741 ter, ME 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: Lf Nature and a ent of action: o.rr k. PAeA ib, C n r/v Set a C !h it 75 .��Vt- L i J� S'J(�c�`tl Alt%I� C� SM.� 1 _ Ahaan7 p f S G G1�c� 't'�t ry✓l d h e 4q `r r Location of action: i74 CrACam_ Site acreage: 7� 1 Present land use: _ �'.s-.Ie Present zoning classification: �e. �leot �' D 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant. (b) Mailing address: (c) Telephone number: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes '❑ No If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Yes No J��oot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes 0 N�1ot Applicable Attach additional sheets if necessary's 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 ❑ NoKNot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No RNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No9Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑NoM Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ NoKNot Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III--Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No of Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ N Not Applicable 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 J� PREPARED DY 4741t �/ ���� TITLE DATE 7 6/24/2026 = - Ruth Jordan _ ��- kz� (r p +� t 6135/6145 Indian Neck Lane ' Peconic NY 11958 UL 13 2026 Town Of Southold Boarc!of Trustees.. �utho►d Tovdn d o.Ttiatee ' Boar s My name is_RuthJordan i hve m a small cottage at 6145 Indian Neck Lane h Peconicw�th approximately 60'offrontageon Richmond Creek My'neighbors on each'side of me have 6ulkheads`but i_have none and myshoreline is fast eroding Mynext-doorineighbor is=Building a new-house and offered.me a.smal amount ofaeftover rip rap;about 35 pieces::but no,more .: than 50 pieces,at no charge if:remo�red by myself to help shore up my beach to;:conserve the soil and plants that are already there, prevent further erosion and.attempt to save my:=existing stairs. . This effort would be undertaken by me personally, i.:don't have he,financial resources=to hire a contractor or obtain the multitude of permits.that would be required in the unttkety event this = activity rose to that IeVel of On 'on.f am trying-tq protect my property and°its value for` my 3_growrf children I have attached,photos with this_request showing the stones-and beach as:is forthe July 8 2026 Trustees visit to provide me guidance going forward I can only remedate what I am allowed to do personally as a homeowner`not-required to be a licensed contractor under5outhold Town:Code Article General Provisions (B)Exceptions: No Ucense shall be required forthefollowmg; B{1).An Individual`=who engages in coastal :' '.' construction on his or.he'r own restdential:_prOperty. "The best outcome forme and.protection.of the soil,vegetati and:stairwell would bean ok to -proceed under Town of Southold Article [ General Provisions_ti)The-provisions_af his tee, shall,not regwre.a ermit for the followm b :The ordinaryand usual operations relative to conservatjon of sod,vegetation,fish'and wildLfeaandward ofthe udetlandboundary. Thank You for Your Consideration, Rut Jordan _ =