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Home My WebLink AboutFishers Island Elizabeth Field - Rehabilitate Runway e. SCOTT A.RUSSELL ° ; Town Hall, 53095 Route 25 SUPERVISOR s,A; d.: 5 P.O.Box 1179 C Southold,New York 11971-0959 q Fax(631) 765-1823 Telephone(631) 765-1889 OFFICE OF THE SUPERVISOR TOWN OF SOUTHOLD June 15, 2023 Ms. Evelyn Martinez Federal Aviation Administration, NYADO One Aviation Plaza, Suite 111 Jamaica, NY 11434 Re: Fisher's Island— Elizabeth Field Final application FY-2023 File: OB8 Please find attached the Final Application for the following project: Rehabilitate Runway 12-30 Ph I (Construction) If you have any questions or need additional information, please do not hesitate to contact us. Town of South Scott A: Russell Town Supervisor • 1 ELIZABETH FIELD AIRPORT (0138) FISHF-RS ISLAND FY 2423 FINAL APPLICATION N... j�'� 7 .. .� fir. ~�� - _•_ z___� { ,, ,/`^.;� :fit � ,..•..�._A�9'�.•."_�_,.�__ _� �aPo•.p� ,_ R40 vay '12-30-Rehabilitatio Program Rehabilitate Runway 12-30 Phase I (Construction) ` a �qf$0U fJ r ..4: Town of Southold Fishers Island Ferry District 4 PREPARED BY ARP SOP No.6.00 Effective Date: 10/1/2015 AIP Grant Application Checklist AIRPORT NAME: Elizabeth Field Airport Fishers Island DATE: .06/13/2023. SYSTEM FOR AWARD MANAGEMENT(SAM)CAGE CODE#: 39TN9 SYSTEM FOR AWARD MANAGEMENT(SAM)EXPIRATION DATE: 02/10/2024 This checklist(and attached instructions)is a tool to assist a grantee(airport sponsor)in identifying the requirements and considerations associated with preparing an Airport Improvement Program(AIP)grant application package for submittal to the FAA.Airport sponsors should read and consider each of the items carefully.Some of the items can be answered by simply checking the "Yes" and "No" boxes while others require providing additional information as part of the airport's request for AIP funds. Ref. ( Yes No N/Aomme is Attach `c 'acF'he^ ">' '•° t'<s rF ai.� � t .s .;.a,3est!d. 'z ,f "d�sx �„ r, :7t°�ti..',3�.'� '6.;. 's 'c'.t': --' Js' � t 1. Standard Form 424 (signed) ✓ 2. Project Cost Breakdown (attached) ✓ 3. Project Sketch (at the request of the ADO) ✓ 4. Project Narrative (attached or within Form 5100-11/101 Part IV) ✓ 5 Form 5100-100 (parts II - IV) (airport development grants) ✓ Form 5100-101 (parts II - IV) (planning grants) i 6. Bid Tabulations/Negotiated Amounts (attached or previously submitted to the ADO) ✓ } 1, i _ ✓ ___ _ 7, EXhlbltA(attached orOraGiouslysubmitted tothe ADO) t I 8. Title Certificate or Long Term Lease Agreement (at the request of the ADO) ✓ « OMB Number:4040-0004 Expiration Date:11/3012025 Application for Federal Assistance SF-424 '1.Type of Submission: '2.Type of Application; 'If Revision,select appropriate letter(s): ❑Preapplication ®New ®Application ❑Continuation 'Other(Specify): Changed/Corrected Application Revision '3.Date Received: 4.Applicant Identifier: ©t8 5a.Federal Entity Identifier: 5b;Federal Award Identifier: 3-36-0029- -2023 State Use Only: 6.Date Received by State: .. 7.State Application Identifier: 10913. 8.APPLICANT INFORMATION: 'a.Legal Name: Toown or. Southold 'b.Employer/Taxpayer Identification Number(EIN/TIN): 'c.UEI:.. 11-6003307 QFNADND8HTG5. d.Address: •Streetl: Town of Southold Street2: Town Hall PO Box 1179 'City: Southold County/Parish: State: NY: New York Province: 'Country: USA: UNITED STATES 'Zip/Postal Code: 11971-0000 e.Organizational Unit: Department Name: Division Name: f.Name and contact information of person to be contacted on matters involving this application: Prefix: Mr 'First Name: pay«id Middle Name: 'Last Name: gCall Suffix: Title: Fa Organizational Affiliation: Fishers Island Ferry District *Telephone Number: 1631-788-7463 Fax Number: 'Email: dmccall@fiferry.com Application for Federal Assistance SF-424 '9.Type of Applicant 1:Select Applicant Type: D: Special District Government Type of Applicant 2:Select Applicant Type: Type of Applicant 3:Select Applicant Type: *Other(specify): *10.Name of Federal Agency: Federal Aviation Administration 11.Catalog of Federal Domestic Assistance Number: 20.106 CFDA Title: Airport Improvement. Program *12.Funding Opportunity Number: FAA-ARP-AIP-G-23-002 'Title: FY 2023 Competitive Funding Opportunity: Airport improvement Discretionary Grants Rehabilitate Runway 12-30 Phase I (Construction) 13.Competition Identification Number: Title: 14.Areas Affected by Project(Cities,Counties,States,etc.): _--Add Attachment : Delete Attachment I View Attachment '15.Descriptive Title of Applicant's Project: Rehabilitate Runway 12-30 Phase 1 (Construction.) Attach supporting documents as specified in agency instructions. Add Attachments Delete Attachments View.Attachments Application for Federal Assistance SF-424 16.Congressional Districts Of: 'a.Applicant NY22 •b.Prbgram/Project NY22 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete;Attachmen( View Attachment, . 17.Proposed Project: "a.Start Date: 10/01/2023 'b.End Date: 12/31/2025 18.Estimated Funding($): "a.Federal 1,349,127.00 `b.Applicant 74,951.00 'c.State 74r952.00. "d.Local 0.00 "e.Other 0.00 'f. Program Income 0.00 "g.TOTAL 1,499,030.00 '19.Is Application Subject to Review By State Under Executive Order 12372 Process? D a.This application was made available to the State under the Executive Order 12372 Process for review on ! ❑ b.Program is subject to E.O.12372 but has not been selected by the State for review. ® c.Program is not covered by E.O.12372. 20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) Yes ®No If"Yes",provide explanation and attach Add~Attachment'_ Delete Attachment; View Attachment 21.`By signing this application,l certify(1)to the statements contained in the fist of certifications"and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to comply with any resulting terms if i accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 18,Section 1001) ®"IAGREE ""The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: �Sr. �� 'First Name: Scott„ Middle Name: A. "Last Name: RUssell Suffix: 'Title losm Supervisor. 'Telephone Number: 631-765-1889 Fax Number. 631-765-1823 "Email: scot:r.russell'�town,southold.ny.us 'Signature of Authorized Representative: �f. 'Date Signed: . .�: Project Cost Breakdown Airport: Elizabeth Field Airport-Fishers_.Island Project Description: Rehabilitate Runway 12-30-Phase I (Construction) Construction or Engineering/ Brief Item Description Land Cost Land Incidental IFE Admin.Cost Total Cost Federal Share Non-Federal ;r 90% 10% Runway 12-30 Rehab- Phase 1 $1,305,670 $190,600. $2,760 $1,499,030 $1,349,127 $149,903 Totals $1,305,6701 $190,6001 $2,760 $0 $1,499,030 $1,349,127 $149,903 . ENGINEERS hJ 1ECH':ICIa RE.SUIRCU: P ELIZABETH FIELD AIRPORT-FISHERS ISLAND ENGINEER'S OPINION OF B&W PAVING&LANDSCAPING, EMPIRE PAVING,INC. TOWN OF SOUTHOLD CONSTRUCTION COST LLC 30 BERNHARD ROAD RUNWAY 12-30 REHABILITATION,PHASE 1 C&S ENGINEERS,INC. 70 FOSTER ROAD NORTH HAVEN,CT 06473 AIP NO.3-36-0029-24-19 499 COL.EILEEN COLLINS WATERFORD,CT 06385 BOULEVARD SYRACUSE,NY 13212 ITEM FAA UNIT -UNIT UNIT NO. SPEC NO, DESCRIPTION QUANTITY UNITS PRICE TOTAL PRICE TOTAL PRICE TOTAL 1 C-100 CONTRACTOR QUALITY CONTROL PROGRAM CQCP 1 LS $30.00D.00 $30,000.00 $40,000:00 $40,000100 $75,000.00 _ $75,000.00 2 C-105 MOBILIZATION(8%MAX) 1 LS $120;950.00 $120,950,00 $80;000.00 '$80,000.00 $120,000.00 $120,000.00 3 C-106 SAFETY.SECURITY AND MAINTENANCE OF TRAFFIC 1 .. .. LS $25.000.00 $25,000;00 $100,000.00 $100;000.00 $501,645.00 $501,645.00 4 P-101 JOINT AND CRACK FILLING REPAIR 1,000 LF $50.00 $50,000.00 .$10.00 $10,000.00 . $15.00 $15,000,00 5 P-101 FULL DEPTH JOINT AND CRACK REPAIR 1,000 SF $200.00 $200,000.00 $33.00 '$33,000.00 $50.00 $50,000.00 6 P-101 PROFILE MILLING 12,000 SY $18.00 $216,000.00 $9.00 $108,000.00 $39:60 . $403,200:00 7 P-401 -ASPHALT SURFACE COURSE GRADATION 2 2,050 TON $300.00 $615;000.00 $300:00 $615,000.00 $2,60,00 $533,000.00 e 1 P-603 1EMULSIFIED ASPHALT TACK COAT " 600 GAL $25.00 $95;000.00 $12.00 $7,200:00 $33,00 $19,800:00 9 P-605 IJOINT SEALING FILLER 2,210 LF $55.00 $121.550.00 '$7,00 $15,470.00 $20.00 544,200.00 10 P-620 SURFACE PREPARATION 1 LS $4,000.00 $4,000.00 $140,000.00 .. $140,000.00 $1,500:00 $11500.00 11 P-620 MARKING 8,600 SF $20.00 5172,000.00 $10.00 $86,000.00 $2.05 $17,630:00 12 _ P-620 REFLECTIVE MEDIA 1 LS $2,500.00 $2,500,00_ $15,000.00- $15,000.00 $2,325.00 . $2,325.00 13 P-620 TEMPORARY RUNWAY AND TAXIWAY MARKING 5,600 SF $10.00 $56,000:00 $10:00 $56,000,00 $2:05 $11,480,00 TOTAL BID $1,628,000.00 $1,305;670.00 $1,794,780.00 BID SECURITY *DENOTES ERROR,THE CORRECTED VALUE IS SHOWN. C&S ENGINEERS,INC, I CERTIFY THAT THIS IS A TRUE AND CORRECT TABULATION OF BIDS RECEIVED MAY 9,2023. JOB NUMBER: 211.020.001 SIGNED: Thomas J.Horth,P.E. DATE: 10-May-23 Page 1 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 4/ Federal Aviation Administration EXPIRATION DATE:6/30/2023 Application for Federal Assistance (Development and Equipment Projects) PART II — PROJECT APPROVAL INFORMATION Part II-SECTION A The term"Sponsor'refers to the applicant name provided in box 8 of the associated SF-424 form. Item 1. Does Sponsor maintain an active registration in the System for Award Management Yes ❑No (www.SAM.gov)? Item 2. Can Sponsor commence the work identified in the application in the fiscal year the XYes ❑No ❑N/A grant is made or within six months after the grant is made,whichever is later? ❑ Item 3. Are there any foreseeable events that would delay completion of the project? If yes, E]Yes ©No ❑N/A provide attachment to this form that lists the events. Item 4. Will the project(s)covered by this request have impacts or effects on the environment that require mitigating measures? If yes, attach a summary listing of ❑Yes ❑X No ❑N/A mitigating measures to this application and identify the name and date of the environmental document(s). Item 5. Is the project covered by this request included in an approved Passenger Facility Charge(PFC)application or other Federal assistance program? If yes, please ❑Yes ❑X No ❑N/A identify other funding sources by checking all applicable boxes. ❑ The project is included in an approved PFC application. If included in an approved PFC application, does the application only address AIP matching share? ❑Yes ❑No ❑The project is included in another Federal Assistance program. Its CFDA number is below. Item 6. Will the requested Federal assistance include Sponsor indirect costs as described in ❑Yes ❑X No ❑N/A 2 CFR Appendix VII to Part 200,States and Local Government and Indian Tribe Indirect Cost Proposals? If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate the Sponsor proposes to apply: De Minimis rate of 10%as permitted by 2 CFR§200.414. []Negotiated Rate equal to %as approved by (the Cognizant Agency) on (Date)(2 CFR part 200,appendix VII). Note:Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs. r FAA Form 5100-100(8/20)SUPERSEDES PREVIOUS EDITION Page 1 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:6/30/2023 PART II-SECTION B Certification Regarding Lobbying The declarations made on this page are under the signature of the authorized representative as identified in box 21 of form SF-424,to which this form is attached.The term"Sponsor'refers to the applicant name provided in box 8 of the associated SF-424 form. The Authorized Representative certifies,to the best of his or her knowledge and belief,that: (1)No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress, an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment,or modification of any Federal contract,grant, loan,or cooperative agreement. (2)If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,the Authorized Representative shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3)The Authorized Representative shall require that the language of this certification be included in the award documents for all sub-awards at all tiers(including subcontracts, subgrants,and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352,title 31, U.S. Code.Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. FAA Form 5100-100(8/20)SUPERSEDES PREVIOUS EDITION Page 2 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:6/30/2023 PART II—SECTION C The Sponsor hereby represents and certifies as follows: 1. Compatible Land Use—The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity of the airport: Present and future land use is compatible with the airport. No significant impact on land use in vicinity of the airport. 2. Defaults—The Sponsor is not in default on any obligation to the United States or any agency of the United States Government relative to the development, operation, or maintenance of any airport, except as stated herewith: None 3. Possible Disabilities-There are no facts or circumstances(including the existence of effective or proposed leases, . use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings)which in reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of the Grant Assurances, either by limiting its legal or financial ability or otherwise, except as follows: None 4.Consistency with Local Plans—The project is reasonably consistent with plans existing at the time of submission of this application)of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding the airport. The project is consistent with existing plans. 5.Consideration of Local Interest—It has given fair consideration to the interest of communities in or near where the project may be located. Yes 6.Consultation with Users—In making a decision to undertake an airport development project under Title 49, United States Code, it has consulted with airport users that will potentially be affected by the project(§47105(a)(2)). Primary users of the airport are aware of the project. 7.Public Hearings—.In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the opportunity for public hearings for the purpose of considering the economic, social,and environmental effects of the airport or runway location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall,when requested by the Secretary,submit a copy of the transcript of such hearings to the Secretary. Further,for such projects, it has on its management board either voting representation from the communities where the project is located or has advised the communities that they have the right to petition the Secretary concerning a proposed project. N/A 8.Air and Water Quality Standards—In projects involving airport location, a major runway extension,or runway location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located,designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days after the project application has been received by the Secretary. N/A FAA Form 5100-100(8/20)SUPERSEDES PREVIOUS EDITION Page 3 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:6/30/2023 PART 11—SECTION C(Continued) 9. Exclusive Rights—There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or controlled by the Sponsor except as follows: None 10. Land—(a)The sponsor holds the following property interest in the following areas of land, which are to be developed or used as part of or in connection with the Airport subject to the following exceptions,encumbrances, and adverse interests, all of which areas are identified on the aforementioned property map designated as Exhibit"A".[1] None The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such attorney or title company has determined that the Sponsor holds the above property interests. (b)The Sponsor will acquire within a reasonable time, but in any event prior to the start of any.construction work under the Project, the following property interest in the following areas of land on which such construction work is to be performed,all of which areas are identified on the aforementioned property map designated as Exhibit"A".[1] (c)The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the Project,the following property interest in the following areas of land which are to be developed or used as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1] State the character of property interest in each area and list and identify for each all exceptions, encumbrances,and adverse interests of every kind and nature,including liens,easements,leases,etc.The separate areas of land need only be identified here by the area numbers shown on the property map. FAA Form 5100-100(8/20)SUPERSEDES PREVIOUS EDITION Page 4 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:6/30/2023 PART III- BUDGET INFORMATION - CONSTRUCTION SECTION A—GENERAL 1.Assistance Listing Number: 20.106 2. Functional or Other Breakout: Airport Improvement Program SECTION B—CALCULATION OF FEDERAL GRANT LatestApproved Adjustment. Total Cost Classification Amount +or()Amount Amount (Use only for (Use only for Required revisions) revisions 1. Administration expense 2. Preliminary expense (IFE) 2,760 3. Land,structures,right-of-way 4. Architectural engineering basic fees 5. Other Architectural engineering fees 6. Project inspection fees 190,600 7. Land development 8. Relocation Expenses 9. Relocation payments to Individuals and Businesses 10. Demolition and removal 11. Construction and project improvement 1,305,670 12. Equipment 13. Miscellaneous 14. Subtotal(Lines 1 through 13) $ 1,499,030 15. Estimated Income(if applicable) 16. Net Project Amount(Line 14 minus 15) 17. Less:Ineligible Exclusions(Section C,line 23 g.) 18.Subtotal(Lines 16 through 17) $ 1,499,030 19. Federal Share requested of Line 18 1,349,127 20. Grantee share 74,951 21. Other shares 74,952 22. TOTAL PROJECT(Lines 19,20&21) $ 1,499,030 FAA Form 5100-100(8/20)SUPERSEDES PREVIOUS EDITION Page 5 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:6/30/2023 SECTION C—EXCLUSIONS Amount Ineligible for 23.Classification(Description of non-participating work) Participation a. b. C. d. e. f. g Total SECTION D—PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE 24.Grantee Share—Fund Categories Amount a.Securities b. Mortgages c.Appropriations(by Applicant) 74,951 d. Bonds e.Tax Levies f.Non-Cash g.Other(Explain): h.TOTAL-Grantee share $74,951 25.Other Shares Amount a.State 74,952 b.Other c.TOTAL-Other Shares $74,952 26.TOTAL NON-FEDERAL FINANCING $ 149,903 SECTION E—REMARKS (Attach sheets if additional space is required) FAA Form 5100-100(8120)SUPERSEDES PREVIOUS EDITION Page 6 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:6/30/2023 PART IV—PROGRAM NARRATIVE (Suggested Format) PROJECT: Rehabilitate Runway 12-30-Phase 1 [1,000 LF x 100 LF](Construction) AIRPORT: Elizabeth Field Airport-Fishers Island 1.Objective: See attached Objective 2.Benefits Anticipated: See attached Benefit 3.Approach: (See approved Scope of Work in Final Application) 4.Geographic Location: Elizabeth Field Airport is located on the western side of Fisher's Island. Fishers Island is located at the eastern end of Long Island Sound, 2 miles off the southeastern coast of Connecticut. 5.If Applicable, Provide Additional Information: 6.Sponsor's Representative: (include address&telephone number) Mr. David McCall, Manager; Phone: 631-788-7463, email: dmccall@fiferry.com;address: Fishers Island Ferry Districk, PO Box 607, Fishers Island, NY 06390 FAA Form 5100-100(8/20)SUPERSEDES PREVIOUS EDITION Page 7 of 7 Elizabeth Field Airport Rehabilitate Runway 12-30—Phase I [1,000 LF x 100 LF] (Construction) Objective J This project includes rehabilitating the existing runway pavement, including milling the top two inches of pavement, performing full depth pavement repairs to address cracking, filling remaining cracks, and new asphalt paving—minimum two-inch asphalt overlay.It is anticipated this projectwill be completed in three(3)construction phases;FY23 is the anticipated first year of the three phases.Each phase would rehabilitate 100 LF of runway width(full runway width,with varying runway lengths. Additional work would include new pavement markings. No airfield lighting replacements will be performed as part of this project. Benefits Anticipated: Last sealed in 2011,the existing Runway 12-30 pavement is exhibiting full-depth cracking,localized raveling, and failed pavement joints.The previous project addressed partial depth cracking and an asphalt rejuvenator was applied to the entire length of runway.In accordance with Table 3-8 of the AIP Handbook,the minimum useful life of asphalt seal coating and joint sealant is three years.Based upon the age of the existing joint sealant and current level of pavement deficiencies, extensive pavement rehabilitation is necessary to maintain safe operations at the airport.This project is shown on the approved Airport Layout Plan and will enhance safety at the airport. Based on the preliminary results of an ongoing Airport Pavement Management System(APMS)study in 2017,the 2017 PCI is 64,however the value decreases to 60 in year 2023,when construction of the project is anticipated.The optimum PCI level to maintain for Runway pavement from a safety and condition basis is 65. U.S.Department of Transportation Federal Aviation Administration FAA Form 5100-129, Construction Project Final Acceptance — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor,and a person is not required to respond'to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number.The OMB Control Number for this information collection is 2120-0569.Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions,searching existing data sources, gathering and maintaining the data needed,completing and reviewing the collection of information.All responses to this collection of information are required under 49 U.S.C.Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information,including suggestions for reducing this burden to: Information Collection Clearance-Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth,TX 76177-1524. FAA Form 5100-129 f1 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 `/ Federal Aviation Administration EXPIRATION DATE:6/30/2023 Construction Project Final Acceptance Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Elizabeth Field Airport-Fishers Island Project Number: 3-36-0029- -2023 Description of Work: Rehabilitate Runway 12-30 Phase 1 (Construction) Application 49 USC§47105(d),authorizes the Secretary to require me certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program. General standards for final acceptance and close out of federally funded construction projects are in 2 CFR§200.343—Closeout and supplemented by FAA Order 5100.38.The sponsor must determine that project costs are accurate and proper in accordance with specific requirements of the grant agreement and contract documents. Certification Statements Except for certification statements below marked not applicable(N/A),this list includes major requirements of the construction project.Selecting"Yes"represents sponsor acknowledgment and confirmation of the certification statement.The term`will"means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance.This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards.The source of the requirement is referenced within parenthesis. 1. The personnel engaged in project administration,engineering supervision, project inspection,and acceptance testing w&e or will be determined to be qualified and competent to perform the work (Grant Assurance). rVI Yes ❑No ❑N/A 2. Construction records, including-daily logs,were or will be kept'by the resident engineer/construction inspector that fully document contractor's performance in complying with: a. Technical standards(Advisory Circular(AC) 150/5370-12); b. Contract requirements(2 CFR part 200 and FAA Order 5100.38); and c. Construction safety and phasing plan measures(AC 150/5370-2). Yes ❑No ❑N/A 3. All acceptance tests specified in the project specifications were or will be performed and documented. (AC 150/5370-12). Yes ❑No N/A FAA Form 5100-129(8/20)SUPERSEDES PREVIOUS EDITION page 1 of 3 4. Sponsor has taken or will take appropriate corrective action for any test result outside of allowable tolerances(AC 150/5370-12). Z Yes ❑ No ❑ N/A 5. Pay reduction factors required by the specifications were applied or will be applied in computing final payments with a summary made available to the FAA(AC 150/5370-10). Yes [:] No ❑ N/A 6. Sponsor has notified,or will promptly notify the Federal Aviation Administration (FAA)of the following occurrences: a. Violations of any federal requirements set forth or included by reference in the contract documents(2 CFR part 200); b. Disputes or complaints concerning federal labor standards(29 CFR part 5);and c. Violations of or complaints addressing conformance with Equal Employment Opportunity or Disadvantaged Business Enterprise requirements(41 CFR Chapter 60 and 49 CFR part 26). ❑Yes ❑ No ❑ N/A 7. Weekly payroll records and statements of compliance were or will be submitted by the prime contractor and reviewed by the sponsor for conformance with federal labor and civil rights requirements as required by FAA and U.S. Department of Labor(29 CFR Part 5). ZYes ❑ No ❑ N/A 8. Payments to the contractor were or will be made in conformance with federal requirements and contract provisions using sponsor internal controls that include; a. Retaining source documentation of payments and verifying contractor billing statements against actual performance(2 CFR§200.302 and FAA Order 5100.38); b. Prompt payment of subcontractors for satisfactory performance of work(49 CFR§26.29); c. Release of applicable retainage upon satisfactory performance of work(49 CFR§26.291; and d. Verification that payments to DBEs represent work the DBE performed by carrying out a commercially useful function(49 CFR§26.55). Z Yes ❑ No ❑ N/A 9. A final project inspection was or will be conducted with representatives of the sponsor and the contractor present that ensure: a. Physical completion of project work in conformance with approved plans and specifications (Order 5100.38); b. Necessary actions to correct punch list items identified during final inspection are complete (Order 5100.38);and c. Preparation of a record of final inspection and distribution to parties to the contract (Order 5100.38); VNI Yes ❑ No ❑ N/A 10. The project was or will be accomplished without material deviations,changes,or modifications from approved plans and specifications, except as approved by the FAA(Order 5100.38). Z Yes ❑ No ❑ N/A FAA Form 5100-129(8/20)SUPERSEDES PREVIOUS EDITION page 2 of 3 1 11. The construction of all buildings have complied or will comply with the seismic construction requirements of 49 CFR§41.120. ❑Yes ❑ No ❑ N/A 12. For development projects, sponsor has taken or will take the following close-out actions: a. Submit to the FAA a final test and quality assurance report summarizing acceptance test results,as applicable (Grant Condition); b. Complete all environmental requirements as established within the project environmental determination(Oder 5100.38); and c. Prepare and retain as-built plans(Order 5100.38). 0 Yes ❑ No ❑N/A 13. Sponsor has revised or will revise their airport layout plan(ALP)that reflects improvements made and has submitted or will submit an updated ALP to the FAA no later than 90 days from the period of performance end date.(49 USC§47107 and Order 5100.38). ❑X Yes ❑ No ❑ NIA Attach documentation clarifying any above item marked with"No"response. Sponsor's Certification certify,for the project identified herein,responses to the forgoing items are accurate as marked and additional documentation for any item marked"no"is correct and complete. Executed on this 1.5 dayof OU Ae 2023 Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott A.Russell Title of Sponsor's Authorized Official: Town Supervisor Official: Signature of Sponsor's Authorized ffcial: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines,imprisonment,or both. i FAA Form 5100-129(8120)SUPERSEDES PREVIOUS EDITION page 3 of 3 Attach documentation clarifying any above item marked with a"No"response. Sponsor's Certification I certify,for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked"no" is correct and complete. Executed on this f day of �� 2023 Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott A.Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official: ` I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment,or both. FAA Form 5100-130(8/20)SUPERSEDES PREVIOUS EDITION Page 3 of 3 13. All contracts and subcontracts exceeding$25,000: Measures are in place or will be in place(e.g. checking the System for Award Management)that ensure contracts and subcontracts are not awarded to individuals or firms suspended, debarred,or excluded from participating in federally assisted projects(2 CFR parts 180 and 1200). ❑x Yes ❑ No ❑ NIA 14. Contracts exceeding the simplified acquisition threshold(currently$250,000)include or will include provisions, as applicable, that address the following: a. Construction and equipment installation contracts-a bid guarantee of 5%, a performance bond of 100%, and a payment bond of 100%(2 CFR§200.325); b. Construction and equipment installation contracts-requirements of the Contract Work Hours and Safety Standards Act(40 USC 3701-3708,Sections 103 and 107); c. Restrictions on Lobbying and Influencing(2 CFR part 200,Appendix II); d. Conditions specifying administrative,contractual and legal remedies for instances where contractor of vendor violate or breach the terms and conditions of the contract(2 CFR §200,Appendix II);and e. All Contracts-Applicable standards and requirements issued under Section 306 of the Clean Air Act(42 USC 7401-7671q), Section 508 of the Clean Water Act(33 USC 1251-1387, and Executive Order 11738. x❑Yes ❑ No ❑ NIA Attach documentation clarifying any above item marked with"No"response. Sponsor's Certification I certify,for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked"no"is correct and complete. Executed on this S day of 2023 Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott A.Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official:; I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§1001 (False Statements)and could subject me to fines, imprisonment,or both. FAA Form 5100-131 (8/20)SUPERSEDES PREVIOUS EDITION Page 4 of 4 AM U.S.Department of Transportation Federal Aviation Administration FAA Form 5100-132, Project Plans and Specifications -- Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor,and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number.The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,completing and reviewing the collection of information.All responses to this collection of information are required under 49 U.S.C.Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200.Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth,TX 76177-1524. FAA Form 5100-132 %1 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 Q/ Federal Aviation Administration EXPIRATION DATE:6/30/2023 Project Plans and Specifications Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Elizabeth Field Airport-Fishers Island Project Number: 3-36-0029- -2023 Description of Work: Rehabilitate Runway 12-30 Phase 1 (Construction) Application 49 USC§47105(d)authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program(AIP). Labor and civil rights standards applicable to AIP are established by the Department of Labor(www.dol.gov/). AIP Grant Assurance C.1—General Federal Requirements identifies applicable federal laws, regulations,executive orders,policies,guidelines and requirements for assistance under AIP. A list of current advisory circulars with specific standards for procurement,design or construction of airports,and installation of equipment and facilities is referenced in standard airport sponsor Grant Assurance 34 contained in the grant agreement. Certification Statements Except for certification statements below marked as not applicable(N/A),this list includes major requirements of the construction project.Selecting"Yes"represents sponsor acknowledgement and confirmation of the certification statement. The term"will"means Sponsor action taken at appropriate time based on the certification statement focus area,but no'later than the end of the project period of performance.This list is not comprehensive and does not relieve the sponsor from fully complying with all - applicable statutory and administrative standards.The source of the requirement is referenced within parenthesis. 1. The plans and specifications were or will be prepared in accordance with applicable federal standards and requirements,so that no deviation or modification to standards set forth in the advisory circulars,or FAA-accepted state standard, is necessary,other than those explicitly approved by the Federal Aviation Administration(FAA)(14 USC§47105). 0 Yes ❑ No ❑N/A 2. Specifications incorporate or will incorporate a clear and accurate description of the technical requirement for the material or product that does not contain limiting or proprietary features that unduly restrict competition(2 CFR§200.319). ®Yes ❑ No ❑N/A FAA Form 5100-132(8/20)SUPERSEDES PREVIOUS EDITION Page 1 of 3 i r 3. The development that is included or will be included in the plans is depicted on the current airport layout plan as approved by the FAA(14 USC§47107). 0 Yes ❑ No ❑N/A 4. Development and features that are ineligible or unallowable for AIP funding have been or will be omitted from the plans and specifications(FAA Order 5100.38, par. 3-43). © Yes ❑ No ❑N/A 5. The specification does not use or will not use"brand name"or equal to convey requirements unless sponsor requests and receives approval from the FAA to use brand name(FAA Order 5100.38,Table U-5). 0 Yes ❑ No ❑N/A 6. The specification does not impose or will not impose geographical preference in their procurement requirements(2 CFR§200.319(b)and FAA Order 5100.38,Table U-5). 0 Yes ❑ No ❑N/A 7. The use of prequalified lists of individuals,firms or products include or will include sufficient qualified sources that ensure open and free competition and that does not preclude potential entities from qualifying during the solicitation period(2 CFR§319(d)). 0 Yes ❑ No ❑N/A 8. Solicitations with bid alternates include or will include explicit information that establish a basis for award of contract that is free of arbitrary decisions by the sponsor(2 CFR§200.319(a)(7)). 0 Yes ❑ No ❑N/A 9. Concurrence was or will be obtained from the FAA if Sponsor incorporates a value engineering clause into the contract(FAA Order 5100.38,par.3-57). 0 Yes ❑ No ❑N/A 10. The plans and specifications incorporate or will incorporate applicable requirements and recommendations set forth in the federally approved environmental finding(49 USC§47106(c)). 0 Yes ❑ No ❑N/A 11. The design of all buildings comply or will comply with the seismic design requirements of 49 CFR §41.120. (FAA Order 5100.38d, par.3-92) [] Yes ❑ No 0 N/A 12. The project specification include or will include process control and acceptance tests required for the project by as per the applicable standard: a. Construction and installation as contained in Advisory Circular(AC)150/5370-10. 0 Yes ❑ No ❑ NIA FAA Form 5100-132(8120)SUPERSEDES PREVIOUS EDITION Page 2 of 3 b. Snow Removal Equipment as contained in AC 15015220-20. ❑Yes ❑ No p N/A c. Aircraft Rescue and Fire Fighting(ARFF)vehicles as contained in AC 150/5220-10. ❑Yes ❑ No p N/A 13. For construction activities within or near aircraft operational areas(AOA): a. The Sponsor has or will prepare a construction safety and phasing plan (CSPP)conforming to Advisory Circular 150/5370-2. b. Compliance with CSPP safety provisions has been or will be incorporated into the plans and specifications as a contractor requirement. c. Sponsor will not initiate work until receiving FAA's concurrence with the CSPP(FAA Order 5100.38,Par.5-29). p Yes ❑ No ❑ N/A 14. The project was or will be physically completed without federal participation in costs due to errors and omissions in the plans and specifications that were foreseeable at the time of project design (49 USC§47110(b)(1)and FAA Order 5100.38d, par.3-100). El Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with"No"response. Sponsor's Certification I certify,for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked"no"is correct and complete. .-Yh Executed on this �j day of Jn-R— 2023 Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott A.Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-132(8/20)SUPERSEDES PREVIOUS EDITION Page 3 of 3 U.S.Department Z of Transportation Federal Aviation Administration FAA Form 5100-134, Selection of Consultants — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor,and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number.The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,completing and reviewing the collection of information.All responses to this collection of information are required under 49 U.S.C.Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200.Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth,TX 76177-1524. FAA Form 5100-134 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 I Federal Aviation Administration EXPIRATION DATE:6/30/2023 Selection of Consultants Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Elizabeth Field Airport-Fishers Island Project Number: 3-36-0029- -2023 Description of Work: Rehabilitate Runway 12-30 Phase 1 (Construction) Application 49 USC§47105(d)authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program(AIP)..General requirements for selection of consultant services within federal grant programs • are described in 2 CFR§§200.317-200.326. Sponsors may use other qualifications-based procedures provided they are equivalent to standards of Title 40 chapter 11 and FAA Advisory Circular 150/5100-14, Architectural, Engineering,and Planning Consultant Services for Airport Grant Projects. Certification Statements Except for certification statements below marked as not applicable(N/A),this list includes major requirements of the construction project.Selecting"Yes"represents sponsor acknowledgement and confirmation of the certification statement.The term"will'means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance.This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards.The source of the requirement is referenced within parenthesis. 1. Sponsor acknowledges their responsibility for the settlement of all contractual and administrative issues arising out of their procurement actions(2 CFR§200.318(k)). p Yes []No ❑N/A 2. Sponsor procurement actions ensure or will ensure full and open competition that does not unduly limit competition(2 CFR§200.319). x❑Yes []No ❑N/A 3. Sponsor has excluded or will exclude any entity that develops or drafts specifications, requirements, or statements of work associated with the development of a request-for- qualifications (RFQ)from competing for the advertised services (2 CFR§200.319). x❑Yes ❑No ❑N/A FAA Form 5100-134(8/20)SUPERSEDES PREVIOUS EDITION Page 1 of 3 4. The advertisement describes or will describe specific project statements-of-work that provide clear detail of required services without unduly restricting competition(2 CFR§200.319). MYes []No ❑N/A 5. Sponsor has publicized or will publicize a RFQ that: a. Solicits an adequate number of qualified sources (2 CFR§200.32O(d));and b. Identifies all evaluation criteria and relative importance(2 CFR§200.320(d)). p Yes ❑No ❑N/A 6. Sponsor has based or will base selection on qualifications, experience, and disadvantaged business enterprise participation with price not being a selection factor(2 CFR§200.320(d)). x❑Yes ❑No ❑N/A 7. Sponsor has verified or will verify that agreements exceeding$25,000 are not awarded to individuals or firms suspended,debarred or otherwise excluded from participating in federally assisted projects(2 CFR§180.300). p Yes ❑No ❑N/A 8. A/E services covering multiple projects: Sponsor has agreed to or will agree to: a. Refrain from initiating work covered by this procurement beyond five years from the date of selection (AC 15015100-14);and b. Retain the right to conduct new procurement actions for projects identified or not identified in the RFQ(AC 150/5100-14). 0 Yes []No ❑N/A 9. Sponsor has negotiated or will negotiate a fair and reasonable fee with the firm they select as most qualified for the services identified in the RFQ(2 CFR§200.323). D Yes ❑No ❑N/A 10. The Sponsor's contract identifies or will identify costs associated with ineligible work separately from costs associated with eligible work(2 CFR§200.302). p Yes ❑No ❑N/A 11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the procurement action,,rationale for contract type and basis for contract fees(2 CFR§20O.318(i)). ElYes ❑No ❑N/A 12. Sponsor has incorporated or will incorporate mandatory contact provisions in the consultant contract for AIP-assisted work(49 U.S.C.Chapter 471 and 2 CFR part 200 Appendix 11) ZYes []No ❑N/A FAA Form 5100-134(8/20)SUPERSEDES PREVIOUS EDITION Page 2 of 3 13. For contracts that apply a time-and-material payment provision (also known as hourly rates, specific rates of compensation, and labor rates),the Sponsor has established or will establish: a. Justification that there is no other suitable contract method for the services (2 CFR §200.3180)); b. A ceiling price that the consultant exceeds at their risk(2 CFR§200.3180));and c. A high degree of oversight that assures consultant is performing work in an efficient manner with effective cost controls in place 2 CFR§200.3180)). px Yes ❑No p N/A 14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost(CPPC)contract method. (2 CFR§200.323(d)). px Yes ❑No ❑N/A Attach documentation clarifying any above item marked with"no" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked"no"is correct and complete. I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. Executed on this 15 day of ��n 4- 2023 Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott A.Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-134(8/20)SUPERSEDES PREVIOUS EDITION Page 3 of 3 U.S.Department of Transportation Federal Aviation Administration FAA Form 5100-135, Certification and Disclosure Regarding Potential Conflicts of Interest — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number.The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources,gathering and maintaining the data needed,completing and reviewing the collection of information.All responses to this collection of information are required under 49 U.S.C.Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth,TX 76177-1524. i FAA Form 5100-135 �1 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 Federal Aviation Administration EXPIRATION DATE:6/30/2023 Certification and Disclosure Regarding Potential Conflicts of Interest Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Elizabeth Field Airport-Fishers Island Project Number: 3-36-0029- -2023 Description of Work: Rehabilitate Runway 12-30 Phase 1 (Construction) Application Title 2 CFR§200.112 and§ 1201.112 address Federal Aviation Administration (FAA)requirements for conflict of interest.As a condition of eligibility under the Airport Improvement Program(AIP),sponsors must comply with FAA policy on conflict of interest. Such a conflict would arise when any of the following have a financial or other interest in the firm selected for award: a) The employee, officer or agent, b) Any member of his immediate family, c) His or her partner,or d) An organization which employs,or is about to employ, any of the above. Selecting"Yes"represents sponsor or sub-recipient acknowledgement and confirmation of the certification statement.Selecting"No"represents sponsor or sub-recipient disclosure that it cannot fully comply with the certification statement. If"No"is selected, provide support information explaining the negative response as an attachment to this form.This includes whether the sponsor has established standards for financial interest that are not substantial or unsolicited gifts are of nominal value(2 CFR§ 200.318(c)).The term"will"means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. Certification Statements 1. The sponsor or sub-recipient maintains a written standards of conduct governing conflict of interest and the performance of their employees engaged in the award and administration of contracts(2 CFR§200.318(c)).To the extent permitted by state or local law or regulations,such standards of conduct provide for penalties,sanctions,or other disciplinary actions for violations of such standards by the sponsor's and sub-recipient's officers,employees, or agents,or by contractors or their agents. fel Yes ❑No FAA Form 5100-135(8/20)SUPERSEDES PREVIOUS EDITION Page 1 of 2 2. The sponsor's or sub-recipient's officers,employees or agents have not and will not solicit or accept gratuities,favors or anything of monetary value from contractors,'potential contractors,or parties to sub-agreements(2 CFR§200.318(c)). N Yes ❑ No 3. The sponsor or sub-recipient certifies that is has disclosed and will disclose to the FAA any known potential conflict of interest(2 CFR§ 1200.112). 0 Yes ❑ No Attach documentation clarifying any above item marked with"no"response. Sponsor's Certification certify,for the project identified herein,responses to the forgoing items are accurate as marked and have the explanation for any item marked"no"is correct and complete. Executed on this day of f ane 2023 Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott A.Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official:. ��i�� I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment,or both. _i FAA Form 5100-135(8/20)SUPERSEDES PREVIOUS EDITION Page 2 of 2 a CERTIFICATION REGARDING LOBBYING Certification for Contracts,Grants,Loans,and Cooperative Agreements The undersigned certifies,to the best of his or her knowledge and belief,that: (1)No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement,and the extension,continuation,renewal,amendment,or modification of any Federal contract,grant,loan,or cooperative agreement. (2)If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with this Federal ; contract,grant,loan,or cooperative agreement,the undersigned shall complete and submit Standard Form-LLL,"Disclosure of Lobbying Activities,"in accordance with its instructions. (3)The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers(including subcontracts,subgrants,and contracts under grants,loans,and cooperative agreements)and that all subrecipients shall certify and disclose accordingly.This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352,title 31,U.S.Code.Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance The undersigned states,to the best of his or her knowledge and belief,that: If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan;the undersigned shall complete and submit Standard Form-LLL,"Disclosure of Lobbying Activities,"in accordance with its instructions.Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352,title 31,U.S.Code.Any person who fails to file the required statement shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. 'APPLICANT'S ORGANIZATION Town of Southold 'PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE Prefix: f4r.. "First Name:iscott Middle Name:1A. 'Last Name: Russell Suffix: *Title: `yawn Supervisor Ar i SIGNATURE: 'DATE: j Obstacle Action Plan Worksheet 1 Obstacle Reference Number is a locally generated number or FAA Digital Obstacle File(DOF)number uniquely identifying the obstacle 2 Obstacle Type describe the type of obstacle 3 Latitude enter the latitude(for example N342218.32 for N34°22'18.32") .. . . ...... 4Longitude enter the longitude(for enniple..W983211.11 for W98'32'11.11") 5 AMSL Elevation(ft.) enter the Above Mean Sea Level(AMSL)elevation of the obstacle at its highest point, 6 Height AGL(ft.) enter.the Above Ground Level.(AGL)height of the obstacle measured from the ground at the base of the obstacle 7 Surface Penetrated enter either the word,approach or departure surface 8 Penetration_Amount enter the,amount the obstacle.penetrates the,surface in in feet, _ 9 Reference Runway enter the runway designation for the.runway the surface protects Obstacle Disposition Plan 1 Obstacle Reference Number is a locally generated number or FAA Digital Obstacle File(DOF)number uniquely identifying the obstacle 2 Obstacle Type describe the type of obstacle 3 Obstacle located on or off airport Identify if the airport is"ON" of"OFF"airport property 4 Sponsored Controlled Identify if the the obstacle is under sponsor control ("YES",under sponsor control,or"NO."not under sponsor control 5 Proposed Mitigation enter the proposed disposition of the obstacle 61 Proposed Disposition Date enter the date as in the MM/DD/YY format. Proposed Maintenance Plan' 1 Runway Designator IjEnter the runway designator the maintenance plan supports 2 1 Proposed Maintenance Action Describe your plans to maintain the runway surfaces clear of obstacles Airport,Contact Information Airport Name: Elizabeth Field Airport Location Identifier: OB8 Sponsor: Town of Southold&Fishers,.lsland,Ferry District Street Address: PO Box 607 Street Address 2: City:, Fishers Island State: New York Zip Code+4: 06390 Telephone Number: (631)788-7463 Email Address: David McCall DMcCall@fife[Ey.com Proposed Maiotenanta Phan Runway Designator Proposed Maintenance Action Obstructions fisted were Identified by third party aerial survey dated March 2019.The obstacles were evaluated and documented in an Airport-Wide Obstruction Study funded underAll?Grant 21-2016.Recommended mitigation Runway i2-30 procedures areattachnd herewlth. Runway 2-25 r ELIZABETH FIELD AIRPORT(08) OBSTRUCTION SURVEY AND ANALYSIS The Town of Southold/Fishers Island Ferry District was notified of these obstructions and a recommendation was made to take action to mitigate them as soon as practical. The majority of the obstructions consisted of individual trees and vegetative brush.The Sponsor took action to mitigate the majority of the obstructions, and work was completed in December of 2019. A summary of the obstructions that were noted,along with the mitigated action, is shown in Appendix B. The data provided by EFPT dated September 2019 was evaluated against the survey data obtained by Woolpert, Inc. in March 2019 and validated. Upon completion of the TERPS mitigation work,the updated obstruction data was reconciled.As such,a supplemental set of obstruction analysis plans were generated to reflect the most current state of obstructions to reflect the RESAS/TSS and OCS surfaces;see Appendix A. Tables 6 thru 9 below identify remaining obstructions left to mitigate in order to comply with TERPS 20:1 Obstacle Identification Surface (OIS) Visual Surface. Note that the obstacle data obtained during the TERPS 20:1 evaluation represent single data points, and the AGIS survey data obtained for the RESAS/TSS, Part 77,and OCS surfaces reflects point groupings, it is conservatively assumed that only a portion of the obstacles have been removed.Therefore,the recommendations contained in Tables 6 thru 9 is to mitigate the entire obstacle grouping. Table 6 - Runway 7 End TERPS 20:1 Visual,A . roach Surface: Runway 7 End Obstructions(2021) Runway 7 Runway 7 DWG On/off Airport Recommended Action to ID Station Offset Description Area(AC) Property Comply with TERPS 20:1 , (at ctr.) (to ctr.) G-5 13+50 R 160' TREE CANOPY On 0,79 Clear/Grub G-6 11+50 R 190' TREE CANOPY On 0.18 Clear/Grub G-7 11+25 0' TREE CANOPY On 0.08 Clear/Grub G-8 10+50 R 70' TREE CANOPY On 0.08 Clear/Grub G-20 12+00 R 135' GROUND On 0.19 Regrade G-21 9+75 R 50' GROUND On 0.41 Regrade Table 7 - Runway 25 End TERPS 20:1 Visual Approach Surface: Runway 25 End Obstructions(2021) Runway On/off DWG Runway 25 Recommended Action to 25. AirportDescrlption. ID Offset Comply with TERPS 20:1 Station Property T-59 38+46.95 L4 21.8' Off TREE Clear/Grub Runway DWG 25 Runway.25 On/off Recommended Action to ID Station Offset Description Airport Area(AC) Comply with TERPS 20:1 at ctr.) (to ctr.) Property G-14 27+25 1 L210' TREE CANOPY On 0.30 clear/Grub AIP No.3-36-0029-021-2018 18 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS Table 8 - Runway 12 End TERPS 20:1 Visual Approach Surface: Runway 12 End Obstructions(2021) Runway . Runway; On/off DWG 12 12 Recommended Actiomto, Description Airport .Area(AC) ID Station Offset Comply with TERPS 20:1 (at ctr.) (to ctr.) Property G-3 11+00 R 250' TREE On&Off 1.32 Clear/Grub CANOPY Table 9 - Runway 30 End TERPS 20:1 Visual 40proach Surface: Runway 30 End Obstructions(2021) On/off DWG Runway30 Runway Recommended Action to Comply with ID Station 30 Offset Airport Description TERPS 20:1 Property . 30-1 17+46.38 L'143.1' On TREE Clear/Grub RunWay30 Runway, On/off DWG Recommended Action to ID Station 30 Offset, "Description Airport" Area(AC) Comply with TERPS 20:1 (at ctr.)'" (to ctr.). Property G-9 18+50 L 150' TREE On 0.49 Clear/Grub 3.3 Surface Evaluation Note and Recommended Actions For the purposes of this analysis, vegetation located within 12.5 feet of these surfaces, were also considered as part of the obstruction evaluations, as vegetation can grow over time and encroach on these surfaces.The airspace surrounding Elizabeth Field Airport has a fair number of obstructions to the surfaces of interest. Individual tree canopy obstructions are identified where possible; otherwise, groups of trees and forest areas have been outlined and identified as canopy area obstructions. Obstructions are discussed under the various surfaces through which they penetrate. Recommended actions are listed in the obstruction data tables for each surface analyzed.The Recommended Actions have been categorized into six(6)types as follows: 1) "Clearing & Grubbing" of the natural vegetation,such as individual tree canopies and canopy areas, involves cutting the tree trunk to ground level, grubbing out the stumps to below ground surface, regrading the ground surface with topsoil, and seeding and mulching the disturbed area for site restoration; 2) 'Install Obstruction Light" would consist of complying with standards as outlined in FAA Advisory Circular AC 70/7460-1 M, Obstruction Marking and Lighting, and in the case of natural vegetative growth, lighting would involve erecting Tower(s) with red lights for tree canopies, or installing red obstruction lights directly onto the fixed obstruction; 3) "Remove/Relocate Obstruction" generally refers to utility poles,flag poles and light poles and would involve burying the utility and removing or relocating the poles; 4) "N/A or No Action"suggesting that the object may be so located with respect to other objects or terrain, removed from general flow of air traffic, or may be so conspicuous by,its shape, size, or color that marking or lighting would serve no useful purpose; AIP No.3-36-0029-021-2018 19 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS 5) "Regrade" generally refers to minor rehabilitation of existing unpaved access roads or private driveways in the vicinity of the airfield pavement that is anticipated to require only regrading (est. less than 1ft) to alleviate penetrating the protected airspace;and 6) "Reconstruct to Lower Grade" generally refers to reconstruction of existing access roads or private driveways in the vicinity of the airfield pavements,whereby more effort than regrading is warranted to mitigate any penetration to protected airspaces. In order to facilitate the future removal of obstructions that may adversely affect the safe operation of aircraft using Elizabeth Field Airport, it is recommended that the Obstruction Plans and Profiles from this document be incorporated into the zoning ordinances of the municipalities surrounding the airport.Such jurisdictions include the Fishers Island Ferry District, Town of Southold Zoning Board, and Town of Southold Building Department. 3.4 Airspace Analysis Results Ali obstructions identified in the surfaces described above, and updated per the 2019 TERPS 20:1 mitigation improvement efforts, are shown in the tables below. Table 10-Runway 7 CFR Part 77 Obstruction Summary: Runway 7 End Obstructions(2021) CFR Part 77' FAR PART 77. DWG Runway 'Runway7 Above onRecommended Elevation Airport Description Action ID station Offset' - Ground Property Surface • Penetration P-13 9+25.65 R1.89' 11.92' 2.84' On OLON POLE Primary 7.64' N/A 7-2 11+84.71 R 144.81 31.27' 4.22' On POLE Approach 15.63' N/A 7-5 14+56.12 845.29' 18.53' 10.62' On TREE Approach -10.68' Clear/Grub T-30 11+34.88 R260.37' 21.13' 13.04' On TREE Transition -8.83' Clear/Grub T-31 11+41.52 R 262.9' 19.24' 12.17' On TREE Transition -11.31' Clear/Grub T-32 9+76.30 ER247.43' 12.93' 7.53' On TREE Transition -9.51' Clear/Grub P-22 3+76.98 02.86' 5.36' 0.00' On GROUND Primary 0.47' Regrade Runway7, Runway 7; Above On/off FAR Part,775urfaces DWG Penetration Recommended Station Offset ` Ground Airport _ 1Description Penetration. Action ID Range Surface Area{A[) (at ctr.) (to ctr.) Range, Property- Average G-4 15+50 R60' 12.1 18 -11.4-)-6.0 On CANOPY TREE Approach 1-9.4' 0.08 Clear/Grub TREE G-5 13+50 R 160' 3.4 4 24.3 -12.3 4 2.4 On CANOPY Apch./Trans >61' 0.79 Clear/Grub G-6 11+S0 R 190' 8.4-424.2 -6.0422.8 On TREE Transition 6.1' 0.18 Clear/Grub III CANOPY i G-7 11+25 0' S.3 4 10.3 1.3 4 8.1 On TREE Approach I 3.6' 0.08 Clear/Grub CANOPY G-8 10+50 R 70' 0 4 9.0 0,6 4 11.9 On TREE Approach 6.7' 0.08 Clear/Grub CANOPY G-20 12+00 R 135' 0 5.1 3 11.1 On GROUND Apch./Trans 8.5' 0.19 Regrade G-21 9+75 R 50' 0 0.8->5.4 On GROUND Apch./Primary 2.8' 0.41 Regrade G-22 7+25 R 100' 0 0.2 4 0.5 On GROUND Primary 1 0.3' 0.24 Regrade G-23 6+50 L.120- 0 0.2--)5727 On GROUND Trans./Primary 2.7' 0.65 Regrade AIP No.3-36-0029-021-2018 20 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS Table.11-Runway 7 RESAS/TSS Surface Obstruction Summary: Runway,7 End Obstructions(2021) Runway End Siting Surfaces-, On/off TSS,Type 2 TSS,-Type 4 DWG Runway? "Runway Eleation Above Airport Description Recommen Elevation ID Station 7 Offset Ground Penetration Penetration ded Action . Property P-13 9+25.65 R 1.89' 11.92' 2.84' On OL ON POLE -0.77'. N/A 7-2 11+84.71 R 144.81 31.27' 4.22' On OL ON POLE - 5.63' 15.63' N/A 7-5 14+56.12 R45.29' 18.53' 10.62' On TREE -20.68' -10.68' Clear/Grub Runway 7, Runway Above.' On/off TSS,Type 2 . TSS,Type 4 DWG Station 7Offset Description Ground Airport Area Recommend ID Penetration Penetration .Penetration' Penetration (AC) ed`Action (at dr.) (to dr.) Range Property Range Average Range Average G-4 15+50 R 60' TREE 12.18. -� 18. CANOPY 18.7 On - - -11.4-->-6 -91W 0.08 Clear/Grub G-5 13+50 R 160' TREE 3,4 4 On -22.2 -7.5 -16.0' 11.9 7.7 4.0' 0.79 Clear/Grub CANOPY 24.3 G-6 11+50 R 190' TREE 8.44 On - 4.8 4 25.8 13.1' 0.18 Clear/Grub CANOPY 24.2 G-7 11+25 0' CANOPY 10.3 On -8.6--) -1.8 -6.4' 1.348.1 3.6' 0.08 Clear/Grub G-8 10+50 R70. TREECANOPY 049.0 On -9.5-->1.9 -3:3'' 0.6 4 11.9 6.6' 0.08 Clear/Grub G-20 12+00 R 135' GROUND 0 On -2.8 4 1.1 •0.6' 7.2 4 11.1 9.4' 0.19 Regrade G-21 9+75 R 50' ' GROUND 0 On - - 0.8-)2.1 1.5' 0.41 Regrade G-23 6+50 L 120' GROUND 0 On 0.3 4 3.4 1.9' - 0.65 Regrade Table 12-Runway 7 PAPI OCS Surface Obstruction Summary: Runway 7 End Obstructions(2021) PAPI OCS Surface DWG Runway, "Runway Above`` On/off PAP[OCS' Recommended - 7 Station 7 Offset Description Ground Airport Area(AC) ID Penetration Penetration Action (at ctr.) (to ctr.). Range Property Range Average G-7 11+25 0' TREE CANOPY .3 On -10.2'4-3.3' 7:9' 0.08 Clear/Grub AIP No.3-36-0029-021-2018 21 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS Table 13-Runway 25 CFR Part 77 Obstruction Summary. Runway 25 End Obstructions(2021) CFR Part 77 On/off FAR PART 77 DWG Runway Runway Above Elevation Airport Description• Recommended Action ID 25 Station° 25 Offset° Ground property Surface Penetration T-33 4+03.14 L 220.7' 45.15 37.20 On ANT/OL ON POLE Transition 25.01 N/A T-34 9+72.37 L 228.5' 39.97 32.43 On ANT ON BLDG Transition 18.04 N/A T-35 9+66.70 L 259.6' 39.37 32.09 On VENT ON Transition 12.99 Relocate BLDG T-36 10+00.39 L352.3' 48.39 29.94 On POLE Transition 8.75 N/A T-37 10+46.11 L325' 47.74 29.39 On POLE Transition 11.97 N/A T-45 3+14.56 L423.2' 36.68 30.43 On TREE Transition 112.21 Clear/Grub T-38 9+46.26 L221.3' 27.23 19.42 On BLDG Transition 6.33 Install Obstruction Light T-46 5+72.25 L509' 50.08 36.13 On TREE Transition -11.56 Clear/Grub T-47 10+96.85 R 242' 12.88 6.80 On BUSH Transition -11.03 Clear/Grub T-39 9+04.07 R 152.7' 13.36 6.61 On BUSH Transition 2,29 Clear/Grub T-40 12+35.99 R 143.7' 13.83 8.17 On TREE Transition 3.94 Clear/Grub T-48 11+24.92 R 194.7' 14.53 8.49 On TREE Transition -2.63 Clear/Grub T-49 7+95.80 R 235.7' 13.25 7,74 On BUSH Transition -9.62 Clear/Grub T-41 11+46.43 L 160.2' 20.79 9.55 On TREE Transition 8.56 Clear/Grub . 25-3 14+72.76 R 92.6' 13.25 6.88 On TREE Approach -5.20 Clear/Grub T-56 13+37.54 L230' 26.72 5.40 On BUILDING Transition 1.31 Install Obstruction Light T-60 13+08.47 L 302.5' 25.79 9.56 On TREE Transition -8.94 Clear/Grub T-61 13+92.33 L241.8' 25.55 7.53 On TREE Transition -3.50 Clear/Grub T-50 7+99.72 L 694.7' 80.39 62.02 On TREE Transition -8.04 Clear/Grub T-51 2+98.71 L424.4' 39.59 30.65 On TREE Transition -9.43 Clear/Grub T-52 10+09.31 L469.1' 50.56 31.30 On TREE Transition -5.76 Clear/Grub T-53 10+78.83 L 215.5' 19.20 10.14 On TREE Transition -0.94 Clear/Grub T-42 11+25.04 L 165.2' 18.73 10.28 On TREE Transition 5.78 Clear/Grub T-43 11+39.28 L 155' 18.73 9.04 On TREE Transition 7.24 Clear/Grub T-54 11+68.62 L 281.9' 22.57 8.98 On TREE Transition -7.05 Clear/Grub T-62 13+61.84 R 148.3' 11.83 5.55 On TREE Transition -2.77 J Clear/Grub T-44 11+92.62 L 143.7' 11.58 0.00 On PRIVATE Transition 1.71 Reconstruct to Lower Grade DRIVE P-15 12+20.02 L 120' 10.87 0.00 On PRIVATE primary 3.66 Reconstruct to Lower Grade DRIVE ' P-16 12+26.63 L 116.7' 9.93 0.00 On PRIVATE Primary 2.71 Reconstruct to Lower Grade DRIVE P-17 12+38.44 L 110.8' 9.69 0.00 On PRIVATE Primary 2.48 Reconstruct to Lower Grade DRIVE 25-5 12+50.73 L 102.3' 8.98 0.00 On PRIVATE Approach 1.64 Reconstruct to Lower Grade DRIVE P-18 12+28.28 L 54.4' 7.33 0.00 On PRIVATE Primary 0.12 Reconstruct to Lower Grade DRIVE P-20 12+17.61 L 11.1' 7.40 0.00 On GROUND Primary 0.18 Regrade P-21 12+05.56 839.6. 7.35 0.00 On GROUND Primary 6.14 Regrade 25-4 35+11.40 L340.5' 112.71' 60.05' Off TREE Approach -7.66' Clear/Grub H-6 57+70.53 L303.0' 147.38' 76.22' Off TREE Horizontal -9.83' Clear/Grub H-7 59+29.16 L99.9' 148.33' 68.28' Off TREE Horizontal -8.88' Clear/Grub H-8 48+43.09 L685.2' 152.48' 73.20' Off TREE Horizontal -4.74' Clear/Grub AIP No.3-36-0029-021-2018 22 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS H-9 54+94.51 L853.3' 150.11' 81.17' Off TREE ,Horizontal I, -7.10' - Clear/Grub T-59 38+46.95 L 421.8' 140.66' 72.65' ( Off TREE Transitional -1.78' Clear/Grub H-11 61+47.64 L954.7' 145.48' 107.81' Off TREE Horizontal -11.73' Clear/Grub Runway Runway= Above On/off FAR Part 77 Surfaces DWGPenetration Recommended 25 Station 25 Offset. `Ground Airport Description Penetration ID Range Surface Area(AC) Action (at ctr.) (to ctr.) Range Prop" Average', 51.3'4 -12.5' G-30 6+00 L 640' 66.3' 3.7' On TREE CANOPY Transition -7:3' 0.17 Clear/Grub 33.8'4 -10:7' G-11 7+50 L 525' 46.1' 3.1' On TREE CANOPY . Transition 6.2' 0.39 Clear/Grub G-12 8+00 L365' 17.1' 116.2' On TREE CANOPY Transition =7.1'° 0.44 Clear/Grub 39.4'G-13 12+00 L 565' 45.5 8.4' On TREE CANOPY Transition 57.5' 17.4' 3.2' 0.64 Clear/Grub G-14 27+25 L 210' 51.3' 9 12.0' On TREE CANOPY Approach -9,1' 0.30 Clear/Grub 60.4' 6.7 - G-15 48+50 L425' 84.0, 8.0 OFF TREE CANOPY Horizontal 9:7` 0.01 Clear/Grub G-16 51+00 L 645' 76'--)85' -11.4'4 OFF TREE CANOPY Horizontal 42' 0.61 Clear/Grub 1.4' G-17 53+00 L 775' 1 71'3 -7.2'->3.3' OFF TREE CANOPY Horizontal -2.,;7'' 0.57 Clear/Grub 83.8' G-18 59+50 L 250' 55'-->82' 12.6 2'-) OFF TREE CANOPY Horizontal -5.7' 1.03 Clear/Grub �- G-19 61+00 L 200' 54.4'4 -12.2 69 5.8' OFF TREE CANOPY Horizontal 9.71 0.46 Clear/Grub Table 14-Runway 25 RESAS/TSS Surface Obstruction Summary: Runway 25 End Obstructions(2021) Runway End Siting Surfaces DWG IRunway Runway, Above On/off TSS,Type 2 TSS,Type 4_ Recommended ID 25 25' Elevation Ground Airport Description' Action Station Offset Property, '. Penetration penetration 25-5 12+50.73 L 102.3' 8.98 0.00 On PRIVATE N/A 1.64 Reconstruct to DRIVE Lower Grade 25-4 35+11.40 L340.6' 112.71' 60.05' Off TREE NIA -7166' Clear/Grub T-59 38+46.95 L421.8' 140.66' 72.65' Off TREE N/A 3.50' ClearJGrub Runway,.`'Runway. TSS,Type 2 TSS,Type 4 DWG 25 25 Above On/off Area- Recommended Description Ground Airport Penetration Penetration "Penetration Penetration ID station Offset (AC) Action (at ctr; (to CM) Range Property _ Range Average Range Average TREE 51.3'4 G-14 27+25 L 210' CANOPY 60.4' On N/A -12'--)6.7' -9.1 0.30 Clear/Grub Table 15-Runway 25 PAPI OCS Surface Obstruction S.urnrrlary: Runway 25 End Obstructions(2021) PAP1 OCS Surface Runway Runway PAPI OCS Above . On/off :'DWG 25 25 Area Recommended Description .Ground ::Airport Penetration Penetration ID Station Offset •(AC) :� ,. Action (at ctr.) ,: (to ctr.) Range Property; Range Average; G-14 27+25 L 210' TREE 51.3'4 On 9X4 11.1' 10.4 0.30 Clear/Grub CANOPY 60.4' G-18 59+50 L 250' TREE 55' OFF 15'8 CANOPY 82'' 3.5' -5.8' 1.03 Clear/Grub AIP No.3-36-0029-021-2018 23 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS It has been determined through this obstruction analysis that there are no obstructions to the Runway 25 RESAS requiring displacement of the threshold. It is recommended that the Sponsor obtain a one-time right of entry easement,or avigation easement,to address the seven (7)individual trees and approximate 2.70 acres of tree canopies located off airport property. Table 16-1't0hw4v 12 CFR Part 77 Obstruction Summary: Runway 12 End Obstructions(2021) CFR Part 77 Runway , On/off: : FAR PART 77 [Istation Runway• Elevation Above. _ Airport DescrlpttonRecorrimended 12 Offset Ground•. '' Surface Penetration Action Property.- P-1 11+97.06 R 76.2' 11.51' 5.38' On SIGN Primary 4.80' Remove P-2 10+45.05 R 92.5' 9.70' 3.46' On BUSH Primary 3.00' Clear/Grub P-3 8+74.91 R 96.0' 11.11' 5.16' On BUSH Primary 4.40' Clear/Grub P-4 11+39.82 R 86.8' 12.65' 6.89' On TREE Primary 5.94' Clear/Grub 12-1 12+30.28 R 105.5' 9.34' 0.00' On PRIVATE DRIVE Approach 1.33' Regrade T-8 9+05.28 L 253.7 14.90' 8.24' On TREE Transition -10.24' Clear/Grub T-2 9+65.14 ( L142.5' 13,01' 7.74' On TREE Transition 3.80' Clear/Grub T-65 8+63.82 L 159,5' 8.53' 4.46' On BUSH Transition -3.08' Clear/Grub T-3 7+84.98 L127.5' 18,44' 12.81' On TREE Transition 11.48' Clear/Grub 12-3 12+30.31 R 101.5' 9.47' 0.00' On PRIVATE DRIVE Approach 1.46' Regrade T-4 10+34.03 R 135.6' 10.00' 3.66' On AIRFIELD LIGHT Transition 1.78' N/A-FIXED BY FUNCTION T-9 8+12.74 R 202.7' 11.89' 6.57' On TREE Transition -5.83' Clear/Grub T-63 6+96.04 R 139.2' 11.11' 5.63' On TREE Transition 2.62' Clear/Grub T-10 10+26.31 L293.9' 23.39' 16.52' On TREE Transition -7.43' Clear/Grub T-11 11+80.87 L 231.7' 13.49' 7.18' On TREE Transition -8.46' Clear/Grub T-5 10+55.85 L 152.5' 12.31' 6.30' On TREE Transition 1.69' Clear/Grub T-6 11+89.01 L223.2' 21.65' 15.00' On ROAD Transition 0.92' Regrade 12-8 12+37.08 R 26.1' 14.49' 5.14' On TREE Approach 6.14' Clear/Grub T-7 12+07.01 L372.3' 50.49' 44.38' On TREE Transition 8.35' Clear/Grub P-5 7+68.37 L 108.5' 15.17' 10.72' On TREE Primary 8.62' Clear/Grub P-68+60.68 L 117.6' 11.87' 6.67' On TREE Primary 5.18' Clear/Grub P-7 11+94.75 L94.7' 10.68' 5.07' On TREE Primary 3.98' Clear/Grub T-14 10+72.14 L242.3' 13.59' 8.40' On TREE Transition -9.88' Clear/Grub T-15 7+62.42 L204.7' 12.98' 7.53' On TREE Transition -4.94' Clear/Grub 12-10 12+38.51 R 105.1' 9.34' 0.00' On PRIVATE DRIVE Approach 0.92' Regrade 12-11 12+30.67 R 104.9' 9.58' 0.00' On PRIVATE DRIVE Approach 1.55' Regrade 12-12 12+23.68 R 104.3' 8.87' 0.00' On PRIVATE DRIVE Approach 1.19' Regrade 12-13 12+04.83 R 101.7' 6.99' 0.00' On PRIVATE DRIVE Approach 0.24' Regrade T-64 9+28.62 R 529.2' 52.78' 44.56' Off TREE Transition -11.75' Clear/Grub 12-14 12+37.02 L0.7' 8.47' 0.00' On GROUND Approach 0.12' Regrade 12-15 12+39,43 L 110.4' 10.48' 0.00' On GROUND Approach 2.01' Regrade 12-16 12+53.01 R 9.8 9,78' 0.00' On GROUND Approach 0.63' Regrade 12-17 12+47.73 R 78.2 9.07' 0.00' On GROUND Approach 0.18' Regrade AIP No.3-36-0029-021-2018 24 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS Runway Runway Above On/off" FAR Part 77 Surfaces - DWG 12Penetration Recommended, , 12 Offset, Ground Airport Description Penetration ID Station Range, Surface Area(AC), Action, (to ctr.) Range• Property Average (at ctrl. G-1 5+00 R 470' 25'8' 11.9' 47.0'' 4.42' On&Off TREE CANOPY Transition -3.5' 0.42 Clear/Grub G-2 7+25 R 475' 29.9 -12.5'--> On TREE CANOPY Transition -11' 0.10 Clear/Grub 42.1' 6.46' G-3 11+00 R 250' 5.6'-j -12.5'4 On&Off TREE CANOPY Transition -7.2' 1.32 Clear/Grub 38.8' 0.10' Table 17-Runway 12 RESAS/TSS Surface Obstruction Summary: Runway 12 End Obstructions(2021) Runway End Siting Surfaces DWG Runway _ Runway .Above On/Off TSS,Typo 2 TS5+Type 4 Recommended !D 12 12 Offset Elevation Ground ;;,Airport Description Action Station Pro rty. Penetration :Penetration 1 P-1 11+97.06 R 76.2' 11.51' 5.38' On SIGN -4.85' Remove P-2 10+45.05 R 92.5' 9.70' 3.46' On BUSH 0.95' - Clear/Grub P-4 11+39.82 R 86.8' 12.65' 6.89' On TREE -0.85' Clear/Grub 12-1 12+30.28, R 105.5' 9.34' 0.00' On PRIVATE -8.67' 1.33' Regrade DRIVE 12-3 12+30.31 R 101.5' 9.47' 0.00' On PRIVATE -8.54' 1.46' Regrade DRIVE 12-8 12+37.08 R 26.1' 14.49' 5.14' On TREE -3.86' 6.14' Clear/Grub P-7 11+94.75 L 94.7' 10.68' '5.07' On TREE -5.56' - Clear/Grub 12-10 12+38.51 R 105.1' 9.34' 0.00' On PRIVATE DRIVE -9.08' 0.92' Regrade 12-11 12+30.67 R 104.9' 9.58' 0.00' On PRIVATE DRIVE -8.45' 1.55' Regrade � 12-12 12+23.68 R 104.3' 8.87' 0.00' On PRIVATE -8.81' 1.19' Regrade DRIVE 12-13 12+04.83 R 101.7' 6.99' 0.00' On PRIVATE -9.76' 0.24' Regrade DRIVE 12714 12+37.02 L0.7' 8.47' 0.00' On GROUND -9.88' Regrade 12-15 12+39.43 L110.4' 10.48' 0.00' On GROUND -7.99' Regrade 12-16 12+53.01 R9.8 9.78' 0.00' On GROUND -9.37' - Regrade 12-17 12+47.73 R 78.2 9.07' 0.00' On GROUND -9.82' Regrade Runway ._ TSS,Type 2 TSS,Type 4 I Runway Above On/off': DWG. 12 Area Recommended 12 Offset Description" Ground Airport Penetration Penetration Penetration Penetration ID Station-. (AC)• Adian . (at ctr) (to ctrl Range Property. Range Average Range Average G-3 11+00 R 250' TREE I CANOPY .6' On&Off N/A 5.6' 8.3' T 1.32 Clear/Grub It has been determined through this obstruction analysis that there are no obstructions to the Runway 12 RESAS requiring displacement of the threshold. AIP No.3-36-0029-021-2018 25 June 2022 ELIZABETH FIELD AIRPORT(OB8) OBSTRUCTION SURVEY AND ANALYSIS Table 18-Runway 30 CFR Part 77 Obstruction.Summary: Runway 30.End Obstructions(2021) CFR Part 77 Runway k`. On/off '.` ,.; fARPART,77 DWG Runway ' ! Above :Elevation- - Airport Description Recommended Action 1D. 30 Station 300ffset ' Ground Pro Penetration Surface . i.. PertY: T-16 6+91.67 L 251.4' 26.94' 20.40' On OL ON WSK 4.18' Transition N/A P-9 13+34.44 R 82.6' 11,06' 5.04' On OL ON 7.14' Primary N/A POLE T-17 11+61.57 R 149.2' 17.97' 8.49' On TREE 10.40' Transition Clear/Grub T-18 9+15.22 R.147.6' 16.08' 3.75' On BUSH 8.40' Transition Clear/Grub P-12 14+07.00' R 78.1' 11.60' 4.61' On BUSH 7.70' Primary Clear/Grub T-19 17+62.79 L 158.8' 14.73' 7.01' On TREE -1.94' Transition Clear/Grub 30-1 17+46.38 L 143.1' 14.49' 7.01' On TREE 0.30' Approach Clear/Grub T-20 17+28.26 L 171.6' 13.31' 7.04' On TREE -3.95' Transition Clear/Grub T-25 1 16+52.43 L 255.6' 15.06' 7.82' On TREE -11.50' Transition Clear/Grub Runway Runwa Above On/off FAR Part 77Surfaces y,.: DWG' 30 Penetration Recommended 30"Offset Ground.'; Airport,. :Description Penetration`'Area Action ID Station, Range Surface (at ctr.) (to'ttr.) "Range Property' ; „° Average 3.8'� G-9 18+50 L 150' -12.2'18.3' 4.7' On TREE Apch./Trans. 4 0.49 Clear/Grub G-24 7+25 R 135' 0' 0.5'4 2.7' On GROUND Trans./Primary 1.7' 0.24 Regrade/Lower G-25 13+00 R 100' Or 2.9' 5.4' On GROUND Primary 3.8' 0.41 Regrade/Lower Table 19-Runway 30 RESAS/TSS Surface Obstruction Summary: Runway.30 End Obstructions(2021) Runway End Siting Surfaces RunwayRunwa " On/off TSS,Type 2 TSS,Type 4 DWG Y; Above , Recommended: 30• 30-- ' '-Elevation Airport Description.`' ID Ground.::. Penetration Penetration;`- Action; Station;: Offset Property. . P-12 14+07.00 R 78.1' 11.60' 4.61' On BUSH 4.38' - Clear/Grub T-19 17+62.79 L158.8' 14.73' 7.01' On TREE -10.28' - Clear/Grub 30-1 17+46.38 L 143.1' 14.49' 7.01', On TREE -9.69' 0.30' Clear/Grub T-20 17+28.26 L 171.6' 13.31' 7.04' On TREE - 0.03' clear/Grub Runway 'Runway 'TSS,Type 2.. TSS,.Type 4 Above On/off Area '.Recommended= DWG 30 30' , ;pescription. ,.Ground Airpoit -penetration, ',Penetration Penetration Penetration- ID:. Station Offset (AC) Accton' Range ',Property. -Range Average Ranger Average (at ctr.) (to dr.) 10.1' 3 G-9 18+50 L 150' TREE 3.8'18 3' On 20' -5.4' 12' 4.6' 1.5' 0.49 Clear/Grub G-25 13+00 R 100' GROUND 0'- On 10�>=1.5' AX N/A 0.41 Regrade/Lower It has been determined through this obstruction analysis that there are no obstructions to the Runway 12 RESAS requiring displacement of the threshold. AIP No.3-36-0029-021-2018 26 June 2022 Schedule A RW 12-30 Rehabilitation Phase- 1 SCHEDULE A SCOPE OF WORK Project Title: Runway 12-30 Rehabilitation-Phase 1 Airport Name: Elizabeth Field Airport Services Provided: Construction Observation&Administration Project Description: The CONSULTANT shall provide the following services,including construction contract administration and full- time construction observation, during construction of the Runway 12-30 Rehabilitation-Phase 1 project ("Project").The Project will be constructed by the SPONSOR with grant assistance from the Federal Aviation Administration (FAA) Airport Improvement Program (AIP) and the New York State Department of Transportation(NYSDOT). The Project generally includes the rehabilitation of an approximate 1,000 LF x 100 LF portion of existing Runway 12-30 pavement, initiating at the Runway 30 end. Rehabilitation will include milling the top three inches of pavement, performing full depth pavement repairs to address cracking, filling remaining cracks, and new asphalt paving.Project improvement limits will address the full 100 LF of runway width,and to the Runway 30 end threshold. Additional work includes new pavement markings. No airfield lighting replacement or electrical improvements will be performed as part of this project. I �r 4..- W��d• �ar '� � Figure 1—Project Area CONSULTANT shall provide the following services: GRANT ADMINISTRATION PHASE A-1 Schedule A RW 12-30 Rehabilitation Phase- 1 The CONSULTANT shall aid the SPONSOR by acting as its liaison and Project grant coordinator with FAA, and NYSDOT during the Project's construction. In addition, the CONSULTANT shall assist the SPONSOR in the preparation of paperwork required to secure funds for the Project. The specific services to be provided or furnished for this Phase of the Project are the following: 1. Grant project set-up for Fishers Island Ferry District/Town of Southold, Federal Aviation Administration and NYSDOT. 2. Preparation of ACIP Packages; coordination of their execution by the sponsor; and submission to the funding agencies. 3. Preparation of Pre-Applications;coordination of their execution by the sponsor;and submission to the funding agencies. 4. Preparation of grant application package; coordination of its execution by the SPONSOR, and submission to the funding agencies. 5. Prepare quarterly progress reports for submission to the FAA. 6. Prepare Annual Federal Financial Reports for submission to the FAA. 7. Preparation of reimbursement request packages; coordination of their execution by the SPONSOR, and submission to the funding agencies. i 8. Preparation of the FAA and NYSDOT grant closeout packages for this project. 9. Establish DBE contract goal. 10. Monitoring of DBE participation and DBE monthly payments for life of the project. CONSTRUCTION CONTRACT ADMINISTRATION PHASE The Construction Contract Administration Phase shall consist of observation of the construction to become generally familiar with the progress and quality of the Contractor's work to determine if the work is proceeding in general conformity with the Contract Documents. In addition,the CONSULTANT shall aid the SPONSOR by acting as its liaison and Project coordinator with the NYSDOT and the FAA during the construction of the Project.Construction Contract Administration includes the following services: 1. Provide consultation and advice to the SPONSOR during construction,including the holding of a pre- construction conference,weekly construction coordination meetings, and up to two (2) additional meetings, including one pre-paving meeting, required during the course of construction. The pre- paving meeting will be held on site with additional CONSULTANT staff attending virtually. Prepare and distribute minutes of all meetings. 2. Review, approve, or take other appropriate action on all Contractor-required submittals, such as construction schedules and phasing programs,,shop drawings, product data, catalog cuts, and samples. 3. Review alternative construction methods proposed by the Contractor and advise the SPONSOR of the impact of these methods on the schedule and quality of the Project. 4. Prepare supplemental drawings and change orders necessary to execute the work properly within the intended scope.Assist the SPONSOR in resolving contractor claims and disputes. 5. Provide interpretation of the Contract Document requirements and advise the Contractor of these on behalf of the SPONSOR when necessary. A-2 Schedule A RW 92-30 Rehabilitation Phase- 9 6. Furnish the SPONSOR one reproducible set of the record drawings for the completed Project taken from the annotated record drawings prepared by the Resident Project Representative based upon Contractor-provided information. 7. Prepare reimbursement request packages; coordinate their execution by the SPONSOR; and submit to the funding agencies. 8. Conduct pre-final and final inspections of the completed Project with the SPONSOR's airport personnel,the FAA, and the Contractor. 9. Issue certificates of construction completion to the SPONSOR,the FAA,and the NYSDOT! 10. Perform an orderly closeout of the Project as required by the SPONSOR,the FAA,and the NYSDOT. 11. Provide assistance to the SPONSOR as a witness in any litigation that may arise from the development or construction of the Project. Payment for this service will be as stated in Article 2(A), Item V, of the CONSULTANT Agreement for the Project,of which this Schedule forms a part. CONSTRUCTION OBSERVATION PHASE The construction observation phase shall consist of construction observation by a full-time Resident Project Representative(RPR)and supporting staff who will also: 1. Maintain a Project record in accordance with the Manual of Uniform Record Keeping (MURK) requirements of the NYSDOT for aviation capital projects. Project records will be hosted and maintained using Appia software. 2. Review documents and submissions by Contractor(s) pertaining to scheduling and advise the SPONSOR as to their acceptability. DocExpress software will be used as the vehicle to transmit Contractor submissions and Consultant reviews. 3. Observe the Work to determine general conformity with the Contract Documents and to ascertain the need for correction or rejection of the Work. Neither the activities of the Resident Project Representative and/or supporting staff nor the presence of any of them at a construction/Project site shall relieve Contractor nor make Consultant responsible for, Contractor's obligations, duties, and responsibilities, including, but not limited to, construction means, methods, sequences, techniques, or procedures necessary for performing, superintending, or coordinating the Work in accordance with the Contract Documents and any health or safety precautions or measures required by regulatory agencies. 4. Attend and conduct pre-construction,pre-paving and pre-installation conferences;weekly progress meetings;and final inspection of the completed Project. 5. Observe testing and inspection.Arrange for, conduct, or witness field, laboratory, or shop tests of construction materials as required by the plans and specifications for the Project; monitor the suitability of materials on the Project site or brought to the Project site to be used in construction; interpret the contract plans and specifications and check the construction activities for general compliance with the design intent, measure,compute, or check quantities of Work performed and quantities of materials in-place for partial and final payments to the Contractor. 6. Prepare and submit inspection reports of construction activity and problems encountered as required by the SPONSOR,the NYSDOT,and the FAA. 7. Prepare, review, and approve monthly and final payments to Contractor(s). A-3 Schedule A RW 12-30 Rehabilitation Phase- 1 8. Prepare and implement a Quality Control and Assurance Plan as required by the FAA for monitoring material requirements and properties throughout the course of construction. The CONSULTANT agrees to perform the services in the Construction Observation Phase of this Project during the construction contract period,estimated to be as follows: Pre-Construction: Construction Supervisor, 1 day @ 16 hrs/day(pre-construction meeting,incl.travel time) RPR 3, 1 day @ 16 hrs/day(pre-construction meeting) RPR 3, 5 days @ 8 hrs/day(project setup) Project Engineer,20 hours for contractor submittal review Principal Engineer, 1 day @ 16 hrs/day(pre-construction meeting,incl.travel time) Principal Engineer,est.2 hours for shop drawing review Chief Engineer,est. 10 hrs for reviewing Contractor QA/QC Plan Construction Observation: RRR 3.Construction Observation Effort: Estimate 14 Days @ 10hrs/day,milling &paving (*Premium/OT Rate over 8hrs) Estimate 15 Days @ 8hrs/day, pavement repairs, pavement curing, pavement markings Travel Time from Main Office:5 weeks/5 trips @ 12hrs per trip 1 final inspection mtg @ 16 hrs/meeting, incl.travel time Construction Materials Testing: ASPHALT TECHNICIAN: 10 DAYS ADDITIONAL PAVEMENT CORES: 6 EACH TRIP CHARGE: 4 EACH MECHANICAL ANALYSIS: 10 EACH LA ABRASION: 2 EACH MAGNESIUM SULFATE SOUNDNESS:- 2 EACH Construction Administration: Construction Supervisor 3 on-site meetings @ 16 hrs/meeting (1 pre-paving mtg., 2 progress mtgs., incl.travel time) Construction Supervisor, est.20 hours for administration Principal Engineer,40 hours(project management) A-4 Schedule A RW 12-30 Rehabilitation Phase- 1 Post-Construction: 'Construction Supervisor, 1 day @ 16 hrs/day(final inspection) RPR 3, 1 day @ 16 hrs/day(final inspection) RPR 3,5 days @ 8 hrs/day(project closeout) Principal Engineer, 1 on-site meeting @ 16 hrs(final inspection,incl.travel time) Principal Engineer,est.4 hours for record drawing review Sr. Project Designer,est. 10 hours for record drawing preparation Administrative: Grants Program Manager/Grants Administrator,est.100 hours Senior Technical Admin.,est.20 hours for project reporting,processing Senior Technical Admin.,est.30 hours for project setup/closeout A-5 Schedule A RW 12-30 Rehabilitation Phase- 1 RESPONSIBILITIES/DUTIES OF CONSTRUCTION OBSERVATION STAFF In general,the on-site construction observation staff is responsible for monitoring construction activity on a project and documenting their observations in a formal project record.The Project record contents and its preparation shall be in accordance with the NYSDOT M.U.R.K. The M.U.R.K.System consists of the following records and duties: 1. Engineer's Daily Project Diary 2. Inspector's Daily Reports 3. Summary of Inspector's Daily Reports 4. Preparation of FAA Weekly Reports S. Prime/Subcontractor Work Summary 6. Preparation of Material Acceptance Reports 7. Preparation of Certification and Testing Log Book 8. Review Subcontractor approval forms 9. Prepare statement of days charged on a weekly basis 10. Conduct Wage Rate Interviews with prime/subcontractors employees 11. Conduct Project meetings with Sponsor and Contractors 12. Field measure quantities on a daily basis 13. Collect and monitor weekly payrolls for Davis Bacon Act Compliance 14. Preparation of Periodic Payment Request for Contractor 15. Record deviations from the contract plans for preparation of record drawings 16. Preparation and review.of Change Orders/Force Account Work The Resident Project Representative will assist the SPONSOR and Contractor regarding construction activity as it relates to aircraft operations and coordination of Notice to Airmen (NOTAMS)as required. END OF SCHEDULE A-6 t a 3 a C&S¢ndnw.im D SILVER EEL POND �f////��I,-' � .: FISHERS ISLAND Eli9 t - z; ''f. (i'ltt3k 2-F'i"1ilTSE r, '•.on v'.'c�C1 \\ � '� yd `� \\ l � � —928 y • r l f an Wh t i Ill t-£<Y li} 2328, t.000.p lad '4 ii Lr e BLOCK ISLAND SOUNDCL �> w �A :,Runway 12-30 Rehabilitation Program CD Ai 2,EM1.RAPLAN t a 2 4 cl W New York Airports District Office 1 Aviation Plaza,Suite 111 Jamaica,NY 11434 U.S.Department Telephone:718-995-5770 Fax:718-995-5790 of Transportation Federal Aviation Admintstration Mr, Gordon Murphy Elizabeth Field Airport Fishers Island Ferry District P.O. Box 607 261 Trumbull Drive Fishers Island,NY 06390 Re: Elizabeth Field Airport(0138) Five-Year Airport Capital Improvement Program Environmental Determination Dear Mr.Murphy: The Federal Aviation Administration(FAA)has recently approved the Environmental Assessment and Finding of No Significant Impact(EA/FONSI)for the proposed projects identified in the Elizabeth Field Airport(0138)Five-Year Airport Capital Improvement Program (ACIP).A copy of the FONSI signed by the Approving Official and the EA signature page signed by the Responsible FAA Official are attached. This federal environmental approval is a determination by the approving official that the requirements imposed by applicable environmental statutes and regulations have been satisfied by a FONSI. However, it is not an approval of any other federal action relative to the project proposal. In compliance with Council on Environmental Quality(CEQ)regulations 1501.4(e)(1)and 1506.6,we require that your office make the final EA with Signature Page and FONSI available to the affected public,and announce such availability through appropriate media in the area. The announcement shall indicate the availability of the document for examination and note the appropriate location of general public access where the document may be found(i.e.,your office, local libraries,public buildings,etc.). We request that a copy of such announcement be sent to us when it is issued. Finally,your attention is directed to the mitigating measures that were made a condition of approval of the FONSI. Please be reminded that these measures must betaken by the airport sponsor in order to meet the terms of the EA/FONSI. ' \ 3 2 The process of making these environmental determinations is that of a partnership between yourself,as airport sponsor,and the other contributing parties,both public and private. We thank you for your effort and cooperation. Please contact our office if you have any questions. Sincerely, ,.:vim�;.,.-�:.• --, �--�r..,:.,Gr.'c.n- t - Jonathan Z. DeLaune Environmental Specialist,New York Airports District Office Enclosures:FONSI N:1Airports\Fishers Island-OB8\Environmental120181FONSI12018-02-15 0138 5-Year ACIP FONSI.pdf DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION FINDING OF NO SIGNIFICANT IMPACT WONSI) Location Elizabeth Field(0138) Fishers Island,New York Proposed Federal Action The proposed federal action is federal financial assistance for the proposed projects identified in the Elizabeth Field Airport(0138) Five-Year Airport Capital Improvement Program(ACIP).The ACIP include several airport projects tentatively proposed for implementation in the period from 2017 to 2021 at the Elizabeth Field Airport. Project DescriPtiopn Specifically,the proposed project includes the following ACIP projects: 1. Rehabilitation of Runway 12-30 pavement(2,345 feet long x 100 feet wide) 2. Rehabilitation of Runway 7-25 pavement(1,302 feet long x 75 feet wide) 3. On-airport obstruction removal through removal of 0.91 acres of vegetation and grading 0.42 acres of turf 4. Airport entrance road improvements through rehabilitation of entrance road pavement, reconstruction of a stub access drive,and installation of a controlled entry/exit system 5. Construction of a 300 square foot terminal building 6. Development of private hangar through removal of 2.80 acres of trees,3.9 acres of grading,and construction of an 11,250-sq.ft. hangar building,taxilane(900 feet long x 25 feet wide),and vehicular access drive(165 feet long x 15 feet wide). Background In 2008,the Airport began an Airport Layout Plan(ALP)Update in order to determine the extent,type and schedule of development needed to accommodate existing needs and future aviation demand at the Airport.The ALP Update Summary Report was completed in August 2011; subsequently,the FAA approved the Airport Layout Plan on October 12, 2011.The ALP Update process,along with discussions with airport management and pilots, identified obstruction removal, rehabilitation of runway pavement, improvements to the airport entrance road,and construction of a new terminal as priorities for the Airport and,its tenants and users. Purpose and Need The purpose of the proposed project is to maintain safe pavement conditions,enhance safety and efficiency of aircraft operations at the airport,and accommodate existing and future based aircraft demands.The need for the project arises from failed pavement,the existence of multiple obstructions to FAR Part 77 surfaces,and lack of dedicated general aviation shelter and amenities Alternatives In addition to the no action alternative, alternatives to rehabilitate the runway pavement,remove the obstructions, improve the airport entrance road,two options for construction of a terminal building,and two options for development of the private hangar were analyzed in the Environmental Assessment(EA). The proposed,action chosen included runway pavement rehabilitation,obstruction removal,airport entrance road improvements,construction of a terminal building adjacent to the existing electrical building,and private hangar development adjacent to the airport entrance road,and was selected because it best meets the project purpose and need. 'Discussion The attached January 2018 Final EA addresses the effects of the proposed action on the quality of the human and natural environment,and is made a part of this Finding. The following impact analysis highlights the more thorough analysis presented in the document. Air Quality The proposed project would result in an increase in emissions from stationary sources associated with combustion of fuel oil for heating new facilities(i.e.,terminal building and private hangar) as well as a temporary increase in emissions from use of various construction equipment and travel by contractors.Under the Clean Air Act General Conformity Rule,the proposed action's total annual (operational and construction)emissions for non-attainment and maintenance parameters(NOx,VOCs,PM2.5)are below the 100 tons per year de minimis threshold for nitrogen oxides and particulate matter and under the 50 tons per year threshold for volatile organic compounds. For compliance with NEPA,an emissions inventory was completed,and ' showed that the proposed action's increased emissions for all criteria pollutants(VOC,NOx, PM2.5,PM10, CO, SO2)would be below de minimis levels. Climate Change There are no federal or state standards for aviation-related greenhouse gas(GHG)emissions, but the CEQ has indicated that climate should be considered in NEPA analyses.The proposed project would temporarily increase carbon dioxide emissions due to increased vehicle movements associated with construction equipment and travel by contractors as well as permanently increase annual carbon dioxide emissions associated with heating the new terminal building. Best Management Practices, listed below,shall be incorporated into the project to minimize impacts. Bi©logical Resources Information obtained from the USFWS 1PaC system and a habitat assessment indicated that there was potential for two federally-listed threatened and endangered species to occur within the project limits(sandplain gerardia and northern long-eared bat).In addition,correspondence from the USFWS and NYSDEC indicated that the sandy and pebble beach adjacent to the proposed project area is a breeding area for piping plover. In order to avoid impacts to federally-listed threatened and endangered species,mitigation measures will be implemented,as listed below. Correspondence requesting concurrence with the "may affect, not likely to adversely affect"and "no effect"determinations for the proposed project was submitted to the USFWS in May 2017. The USFWS concurred with these determinations on June 20,2017. 2 Water Resources Wetlands The proposed project does not involve work within Federally-regulated wetlands. Although the proposed project also does not involve work within state-regulated wetlands,construction activities will occur within state-designated freshwater and tidal wetland buffer areas. Impacts to wetlands would be minimized below significant impact thresholds with the incorporation of the mitigation measures outlined below. Floodplains Several of the proposed project areas are located entirely within,or in a portion of,the 100-year floodplain or the 500-year floodplain. In order to minimize potential impacts to floodplains, the mitigation measures listed below will be incorporated. Given that the l proposed project does not meet the criteria of a"critical action', would not result in a significant encroachment to the base floodplain,and since impacts to floodplains would be minimized below significant impact thresholds with the incorporation of the mitigation measures outlined below,no significant impact to floodplains are expected. Sur lace Waters 1 No federal or state wetlands or waterways will be impacted by the proposed project with the exception of state wetland buffer areas.The proposed project will be designed to meet all relevant state water quality standards. Impacts to surface waters would be minimized below significant impact thresholds with the incorporation of the mitigation measures outlined below. Given this information and since the proposed project will be designed to meet all relevant state water quality standards,no significant impact to water quality is anticipated. ti Groundwater Impacts to groundwater were evaluated based on the proposed projects potential to adversely affect water quality or contaminate the Nassau-Suffolk Sole Source Aquifer. Impacts to groundwater and the sole source aquifer would be minimized below significant impact thresholds with the incorporation of the mitigation measures outlined below.As a result,there would be no significant impacts to groundwater resources or the Fishers Island Critical Environmental Area. Cumulative Impacts In order to determine cumulative impacts to the environment,projects occurring within the past three years and planned for the next five years are generally evaluated.The airport projects proposed for implementation over the next five years were considered and evaluated in this EA. No other projects were identified that would take place within the reasonably foreseeable future. Given that the lighting and signage replacement project scheduled to begin in December 2016 would not cause a significant impact to environmental resources and since no additional impacts other than those already addressed in the EA are anticipated to occur,there will be no further cumulative impacts. 3 Other Impact Categories The impacts of the proposed Federal action on Section 4(f)resources,Farmlands,Hazardous Materials,Pollution Prevention,and Solid Waste,Historical,Architectural, Archaeological,and Cultural Resources, Land Use,Natural Resources and Energy Supply,Noise and Noise Compatible Land Use,Visual Effects,Wild and Scenic Rivers, Socioeconomics,Environmental Justice,and Children's Environmental Health and Safety Risks were evaluated in the EA. It is the FAA's finding that the proposed action will not have any significant effect on any of the above noted categories. Public Involvement A Notice of Public Availability was published in The Suffolk Times on September 7,2017. The EA was available for review at the Ferry District Business Office,261 Trumbull Drive,Fishers Island,NY 06390 or on the Town's website(http://www.southoldtownny.gov/),the Fishers Island Ferry District's website(https://www.fiferry.como and the Island website (http://fiishersisland.net/)from September 7,2017 to October 7,2017.No public comments were received. .Mitigation Measur$s 1. Construction activities related to tree clearing and vegetation removal will be limited to the winter months(October 31 st through March 3 l st). 2. Minimize the duration of the construction period to the extent possible;no construction activities related to runway paving rehabilitation will take place between April 1 and September 1;construction will be limited to the identified project impact areas. 3. Grading,excavation,filling activities,and areas of new impervious surfaces will be limited to what is necessary for construction of the proposed project. 4. In order to protect potential bordering or nearby biotic resources,soil erosion and sediment controls will be developed during design and implemented prior-to and during project construction project,and will be consistent with the NYS Department of Transportation Standard Specification for Temporary Soil Erosion and Water Pollution Control,New York State Stormwater Management Design Manual,and the standards and Specifications for Erosion and Sediment Control. 5. Best management practices will be followed to avoid accidental spills of fuel oils, chemicals,concrete leachate,and sediments into aquatic habitats.These practices include proper storage,use,and cleanup of all construction-related chemicals. 6. Construction equipment access will be limited to project impact areas and previously disturbed areas(i.e.,mowed lawns,paved/dirt/stone roads,parking areas) in order to avoid impacting bordering or nearby biotic resources,and routes should be carefully selected to avoid wetland areas. 7. Stabilize construction entrances and exits to prevent tracking onto roadways. 8. Disturbed areas will be restored to prevent soil erosion following completion of the proposed project,and re-vegetation of temporarily disturbed work areas will occur using a native seed mix. 9. Clearing activities in the vicinity of the wetland will be conducted such that individual trees/vegetation are felled in a direction away from the wetland. 10.Marking adjacent wetlands with orange construction tape to avoid contractors extending into these adjacent areas. 4 11.Maintaining existing drainage patterns as much as possible and avoid altering hydrology of adjacent wetland resources. 12.NYSDEC Freshwater and Tidal Wetlands permit restrictions—the permits will address any necessary measures that shall be taken to avoid potential impacts to ecological communities within wetland buffer areas.Measures and/or restrictions as set forth by the NYSDEC Wetland permits in regards to ecological communities will be adhered to during obstruction removal. 13.Minimize fill placed in floodplains 14.Comply with flood-related design criteria 15.A Town of Southold Floodplain Development Permit will be obtained prior to construction for those projects that include work within the 100-year floodplain. Measures and/or restrictions as set forth by the Town will be adhered to during construction. 16.A Town of Southold Building Permit application will be prepared during design of the proposed project and will include a Stormwater Management Control Plan(SMCP) which will address stormwater runoff and erosion control issues associated with construction. Specifically,the SMCP will include(if applicable to the project) stormwater design calculations; location, size, and detail drawings for all proposed drainage structures,downspouts, leaders,and underground piping;test holes indicating soil type and depth to groundwater; limits of clearing; location and detail drawings of the silt fence and/or straw bale erosion and sediment controls; location of construction entrance; location of topsoil stockpile area. CONCLUSION A14 D APP-*k OVAL After careful and thorough consideration of the facts contained herein,the undersigned finds the federal action is consistent with existing national environmental policies and objectives as set forth in Section 101 (a)of the National Environmental Policy Act of 1969(NEPA)and it will not significantly affect the quality of the human environment or otherwise include any condition requiring consultation pursuant to Section 102(2)(c)of NEPA. Recommended: 2/15/2018 Environmental Specialist Date If New York Airports District Office 'DIgIWSUKHBIR K. SSUK BIASKGI Lby GILL Wle.2018.02.1614:12:25 Approved: -Osl.w Manager Date New York Airports District Office Disapproved: �. 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