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HomeMy WebLinkAboutTrustee Application L11AA L. K. McLean Associates, P.C. 437 South Country Road • Brookhaven • New York 11719 CONSULTING ENGINEERS (631)286-8668 • FAX(631)286-6314 Associates EUGENE F.DALY,P E,P T 0 E TM,PRESIDENT and C E O CHRISTOPHER F.DWYER RAYMOND G.DIBIASE,P E,P T O E'Im,PTPTM,EXECUTIVE VICE PRESIDENT ROBERTA STEELE,P E DANIEL P.JEDLICKA,P L S,VICE PRESIDENT JAMES L DeKONING,P E STEVEN W EISENBERG,P E. E I E MATTHEWANDREW B SPEISER C JEDLICKA,LEED AP D DEC 2 2 2016 December 1,2016 Mr.John Bredemeyer _ 54375 Main Rd. Southold Tordn P.O.Box 1179 T Southold,NY 11971 RE: TOWN OF SOUTHOLD -MATTITUCK BREAKWATER SHADE SHELTER MATTITUCK,NEW YORK LKMA No. 16078.000 Mr.Bredemeyer: Thank you for consideration of the pending Wetlands Permit for our client, the Mattituck Park District. In response to your recent request, we are submitting, on their behalf, copies of a new proposed site plan, in support of the application for a Wetlands Permit to construct a shade shelter and a timber deck fastened to an existing concrete slab. The revised plan shows the 25'x40' shade shelter in a new, previously disturbed location. Enclosed herewith for your review,please find(2)copies of the following: 1. Drawing Set,including site plan and shade structure elevation details. If you have any questions or require additional information,please feel free to contact me. Very truly yours, CFD:kg Christopher F.Dwyer,Associate L. K. McLean Associates, P.C. Enc. (1) Cc: Commissioner Michael Ryan,Mattituck Park District w/enc. LKMA File Copy w/enc. •Founded in 1950 • OFFICE LOCATION: ®� S® MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 j. � Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 cr �r Telephone: 631765-1938 �. � �® ® Fax: 631 765-3136 COU (i LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: October 12, 2016 Re: LWRP Coastal Consistency Review for MATTITUCK PARK DISTRICT SCTM# 1000-99-2-19.1 L.K. Mclean Associates on behalf of MATTITUCK PARK DISTRICT requests a Wetland Permit and a Coastal Erosion Permit to install a 25' wide by 40' long steel shade shelter supported by six (6) foundation columns over a proposed 4" (25'x40') concrete slab; and to install an approximately 12'x24' timber deck fastened onto the existing concrete slab that is attached to the existing lifeguard building. Located: 5155 Breakwater Road, Breakwater Beach, Mattituck. SCTM# 1000-99-2-19.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is INCONSISTENT with the below listed Policy Standards and therefore is INCONSISTENT with LWRP. Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. Policy 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The proposed action does not comply with Chapter section 111-12 Beach Area. D. All development is prohibited on beaches unless specifically provided for by this chapter The proposed action is not permitted on a beach pursuant to Chapter 111 Coastal Erosion hazard Areas of the Southold Town Code; neither actions are designed as open timber piles or other similar openwork supports with a top surface area of less than 200 square feet or which are removed in the fall of each year. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Ire Peter Young,Chairman y Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 12, 2016 the following recommendation was made: Moved by Greg Williams, seconded by John Stein, it was RESOLVED to SUPPORT the application of MATTITUCK PARK DISTRICT to install 25'X 40' long steel shade shelter at the northwest of the existing lifeguard building as a safety measure to protect park patrons. No other disturbance of land is necessary other than for the six (6) foundation columns for the proposed shade shelter. Located: North terminus of Breakwater Road, where the road meets the LI Sound directly west of the Mattituck Inlet. SCTM#99-2-19.1 Inspected by: Keith McCamy, Jack McGreevy The CAC Supports the application, however, the project was not staked. Vote of Council: Ayes: All Motion Carried r L John M.Bredemeyer III,President ��q S®UTy® Town Hall Annex Michael J.Domino,Vice-President �® l® 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G �® Telephone(631) 765-1892 Charles J.Sanders,Trustee ®l�COU Fax(631) 765-6641 clonaos 10 KM01 BOARD OF TOWN TRUSTEES J aarmil TOWN OF SOUTHOLD To: Southold Town Building Department 6 ? 839 Re: Verification of Building Department Permit Requirements SCTM#: Property Owner Name: Mah r dc- e- 13/ea- waje - 622,-,-A- Date Sent to Bldg. Dept.: The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO / ill the proposed project require a Building Permit? 7'vWill the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: aak4 ure of eviewer Date _J s Cantrell, Elizabeth From: Chris Dwyer <cdwyer@lkma.com> Sent: Wednesday, October 05, 201610:31 AM To: Cantrell, Elizabeth Subject: Breakwater Beach Shade Shelter Good morning Elizabeth, Pursuant to our conversation relative to the proposed 4" concrete slab(25' by 40')that is to be installed underneath the 25X40 Shade Shelter at Breakwater Beach, please let this email serve as letter of clarification that although the concrete slab was not part of the project description it is in fact shown on the permit drawings and should be included in the scope of work in order to satisfy ADA requirements. Thanks in advance for your assistance relative to this permit application. Regards, Christopher F. Dwyer,Associate L.K.McLean Associates PC 437 South Country Road Brookhaven,New York 11719 Phone:(631)286-8668 Fax: (631)286-6314 Cell;(516) 779-4776 i � 4 John M.Bredemeyer III, President sou'- Town Hall Annex 4 l � Michael J.Domino Vice-President 54375 Main Road y P.O.Box 1179 James F.King,Trustee y� Southold,New York 11971-0959 Dave Bergen,Trustee O � ���_� Telephone(631) 765-1392 Charles J.Sanders,Trustee fr�'C®U �r �� Fax(631) 765-6641 rrz�" BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD / Office Use Only V Coastal Erosion Permit Application Wetland Permit Application _Administrative Permit / Amendment/TranlierOE�e nsion 1/ Received Application: ���((� ' Received Fee:$ SDd,00 'Completed Application:— 2 C E _Incomplete: SEQRA Classification: Type I Type II Unlisted Coordination:(date sent): SEP _ 9 2016 ZLWRP Consistency Ass ssme Form: /A�1�� v/ CAC Referral Sent: IfILT' � Date of Inspection: M 1161(p outhold Town _Receipt of CAC Report: B�Id of Truste _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant: MATTITUCK PARK DISTRICT Mailing Address: 11280 PECONIC BAY BOULEVARD P O BOX 1313,MATTITUCK,NY 11952 Phone Number: 631-298-9103 Suffolk County Tax Map Number: 1000- 99-02-19-1 Property Location: NORTH TERMINUS OF BREAKWATER ROAD,WHERE THE ROAD MEETS THE LONG ISLAND SOUND DIRECTLY WEST OF THE MATTITUCK INLET (provide LILCO Pole#, distance to cross streets, and location) AGENT: CHRISTOPHER F DWYER,L K MCLEAN ASSOCIATES (If applicable) Address: 437 SOUTH COUNTRY ROAD,BROOKHAVEN,NY 11719 \/ Phone: 631-286-8668 Board of Trustees Application GENERAL DATA Land Area(in square feet): 952,748 SF Area Zoning: RESIDENTIAL R-80 Previous use of property: PARK Intended use of property: PARK Covenants and Restrictions on property? Yes X No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? X Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure(s) on property have a valid Certificate of Occupancy? x Yes No Prior permits/approvals for site improvements: Agency Date NYSDEC-1-4738-01061100003 EFFECTIVE 8-24-2016 THROUGH 8-23-2021 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a"governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): THE MATTITUCK PARK DISTRICT IS PROPOSING TO INSTALL A 25'WIDE X 40'LONG STEEL (POWDER COATED I E WEATHER RESISTANT)SHADE SHELTER AT THE NORTH-WEST OF THE EXISTING LIFEGUARD BUILDING 'AND-T-6-FURNIISH-T NeRETE-PAT O 1 11 0 TO EXISTING LIFEGUARD BUILDING AS AS SAFETY MEASURE TO PROTECT PARK PATRONS NO OTHER DISTURBANCE OF LAND IS NECESSARY OTHER THAN FOR THE SIX(6)FOUNDATION COLUMNS FOR THE PROPOSED SHADE SHELTER.THE WORK IS PROPOSED SEAWARD OF THE COASTAL HAZARD EROSION LINE(CEHL)BUT DOES NOT INTERFERE WITH ANY PROTECTIVE DUNE OR COASTAL FEATURE THAT WOULD DAMAGE THE EXISTING FEATURESIN-FRONT•6F-AND BEHiN ff-F OEHL.THE-STRU fACTURED,ENGINEERED AND INSTALLED BOTH TO EFFECTIVELY WITHSTAND CEHA AREA FORCES AND TO MAXIMIZE LIFESPAN. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: THE MATTITUCK PARK DISTRICT SEEKS TO ENHANCE THE SAFFTY OF PARK PATRONS,ESPECIALLY YOUNG CHILDREN,SENIORS,AND THOSE WITH MEDICAL CONDITIONS BY PROVIDING A SHADE STRUCTURE,USAGE AND ENJOYMENT OF EXISTING PUBLIC PARK WILL BE INCREASED THE TIMBER TSE 1NG"CON , AND THE POTENTIAL FOR SEVERE CONSEQUENCES SUCH AS HEAD INJURIES A HANDRAIL,DESIGNED TO BE IN HARMONY WITH THE NATURAL SURROUNDINGS WILL ALSO BE PROVIDED Area of wetlands on lot: ZERO square feet Percent coverage of lot: ZERO % Closest distance between nearest existing structure and upland edge of wetlands: ±3831 feet Closest distance between nearest proposed structure and upland edge of wetlands: ±313' feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? 6 cubic yards How much material will be filled? ° cubic yards Depth of which material will be removed or deposited: 3+/- feet Proposed slope throughout the area of operations: 1% Manner in which material will be removed or deposited: MATERIAL WILL BE EXCAVATED BY THE USE OF AN EXCAVATOR ALL EXCESS MATERIAL FROM FOUNDATION INSTALLATION SHALL BE REMOVED FROM SITE AND DISPOSED OF OR RE-USED IN ACCORDANCE WITH ALL APPLICABLE REGULATIONS Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): THE SHADE STRUCTURE TO BE INSTALLED HAS BEEN USED SUCCESSFULLY AND WITH NO ENVIRONMENTAL HARM NATIONWIDE IN COASTAL AREAS THE TYPE OF EXCAVATOR TO PERFORM ASSOCIATED EXCAVATION WILL BE SUITABLE FOR USE ON SAND WITH MINIMAL DISTURBANCE OF ADJACENT AREA CONSTRUCTION MEANS AND METHODS WILL_BE-IN-ACCORDANCE-WI.TkI-ALLR,ELEVAAND-ERG UIDE-NN€S AND REGULATIONS. THE TIMBER RE-FACING OF EXISTING CONCRETE PATIO WILL SERVE TO ENHANCE THE NATURAL AESTHETIC OF THE PARK AND DISTURB NO GROUND IT IS NOT ANTICIPATED THAT THERE WILL BE ANY IMPACT TO THE TID S CATED OVER all FROM PROJECT AREA,EITHER DURING OR AFTER CONSTRUCTION Board of Trustees Application COASTAL,EROSION APPLICATION DATA Purposes of proposed activity: TO ENHANCE THE SAFETY OF PARK PATRONS Are wetlands present within 100 feet of the proposed activity? X No Yes Does the project involve excavation or filling? No X Yes If Yes,how much material will be excavated? 6 (cubic yards) How much material will be filled? ° (cubic yards) Manner in which material will be removed or deposited: MATERIAL WILL BE DEPOSITED IN A TRUCK AND REMOVED FROM SITE AT TIME OF EXCAVATION Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) THERE WILL BE NO ANTICIPATED EROSION INCREASE OR ADVERSE EFFECTS ON NATURAL PROTECTIVE FEATURES John M.Bredemeyer III,President ®� SO(fTjSr�' Town Hall Annex Michael J.Domino,Vice-President '`® �Q 54375 Main Road P.O.Box 1179 James F.King,Trustee Southold;New York 11971-0959 Dave Bergen,Trustee - '. ' �O Telephone(631) 765-1892 Charles J.'Sanders,Trustee Fax(631) 765-6641 r - BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE I (We) COMMISSIONER MICHAEL RYAN,ON BEHALF OF MATTITUCK PARK; DISTRICT The owners of record of property at: BREAKWATER BEACH PARK - SCTM#1000- 099.02-19.001 in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: PROPOSED SHADE SHELTER AND TIMBER DECK as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to_maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding,by the Board of Trustees that said lack of maintenance would risk life, property or imports natural r our at s �;7 - ariz si at of rec -..- Notary Public a.PROKOP Notary Pu ic,State of Now York Qualified In Suffolk County No.4977533 My commission Expires Feb.04.20 This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. f r i ��,rte"•,t x,��'.t:.e.,": { " * John M.Bredemeyer III,President �'Y , Town Hall Annex Michael J.Domino,Vice-President '� 54375 Main Road ar„ ' P.O.Box 1179 James F.King,Trustee ,' Southold,New York 11971-0969 Dave Bergen,Trustee , ' ;1 ? ' Telephone(631)765-1892 Charles J.Sanders,Trustee , { Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE I (We) MATTITUCK PARK DISTRICT The owners of record of property at: BREAKWATER BEACH PARK - - SCTM#1000- 119.02-19001 in applying for a Coastal Erosion Permit for an erosion protection structure do hereby } agree to a 30-Year Maintenance program for a structure as described: PROPOSED SHADE SHELTER AND TIMBER DECK , as shown on the attached licensed survey and/or site'plan'forthe approved structure.. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or important natural resource features. SW M� �� S..L�nL J.t '��•`h Notarized signature of oZ'dF of record Notary ubra DAVID B.PROKOP Notary public,State ofNew,%4t Qualified In Suffolk County MY COMMissiono.4 77533 Aires Feb.04,204 This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. Town Hall Annex John M.Bredemeyer III,President y . , . ,, ' 54375 Main Road Michael J.Domino,Vice-President {'� '"� � , P.O.Box 1179 " ` "° "`' ' ° Southold New York 11971-0959 James F.King,Trustee ,.�� �" �r<ti ri�,�. , Dave Bergen,Trustee • '.;` µ ..,' `r Telephone(631)765-1892 Charles J.Sanders,Trustee Fax(631) 765-6641 �".�=[x7'1• BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE (We) MATTITUCK PARK DISTRICT The owners of record of property at: BREAKWATER BEACH PARK SCTM#1000- 099.02-19.001 in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: PROPOSED SHADE SHELTER AND TIMBER DECK , as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of ees th sa' ck of maintenance would risk life, property or important nat resource t�lres. derma zoo 6 arized signature of owner o/re rd' Notary Public .PF OKOP Notary tate of NewYofig Qualified ulrolk County No.4 533 My Commission Expires Feb.ft 2k h This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. 617.20 Appendix B Short Environmental Assessment Form, Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: MATTITUCK BREAKWATER BEACH SHADE SHELTER Project Location(describe,and attach a location map): 'NORTH TERMINUS OF BREAKWATER ROAD WHERE THE ROAD MEETS THE LONG ISLAND SOUND DIRECTLY WEST OF THE MATTITUCK INLET. Brief Description of Proposed Action: THE MATTITUCK PARK DISTRICT IS PROPOSING TO INSTALL A 25'WIDE X 40'LONG STEEL(POWDER COATED I E WEATHER RESISTANT)SHADE SHELTER AT THE NORTH-WEST OF THE EXISTING LIFEGUARD BUILDING AND TO FURNISH TIMBER DECKING ON TOP OF AN EXISTING CONCRETE PATIO ATTACEHD TO EXISTING LIFEGUARD BUILDING AS AS SAFETY MEASURE TO PROTECT PARK PATRONS NO OTHER DISTURBANCE OF LAND IS NECESSARY OTHER THAN FOR THE SIX(6)FOUNDATION COLUMNS FOR THE PROPOSED SHADE SHELTER Name of Applicant or Sponsor: Telephone: 631-298-9103 MATTITUCK PARK DISTRICT E-Mail: MATTPARKDIST@OPTONLINE NET Address- 11280 PECONIC BAR BLVD P O BOX 1413 City/PO: State: Zip Code: MATTITUCK NY 11952 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑X may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: ❑ ❑ NYSDEC TIDAL WETLANDS APPROVAL RECEIVED 3.a.Total acreage of the site of the proposed action? __21 87 _acres b.Total acreage to be physically disturbed? <010 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 21 87 acres 4. Check all land uses that occur on,adjoining and near the proposed action. E]Urban ❑Rural(non-agriculture) [—]Industrial ❑Commercial El Residential(suburban) ❑Forest' ❑Agriculture ❑Aquatic ❑Other(specify): ®Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a, A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO .YES landscape? ❑ ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: = ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ❑ ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ❑ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: NOT APPLICABLE 0 ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: NOT APPLICABLE ❑ ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: NOT APPLICABLE ❑ ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ ❑ b. is the proposed action located in an archeological sensitive area? 1-71 El 13.a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ Q b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are I ikely to be found on the project site Check all that apply: ®Shoreline El Forest ❑Agricultural/grasslands ❑Earlymid-successional ❑ Wetland ❑Urban ❑Suburban 15 Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ a 16.is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, X a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES ❑ ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: MNO ❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑. 19 Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe:—, ❑ ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: _ ❑ ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE 77 � Applicant/sponsor name: CHRISTOPHER F DWYERL K MCLEAN ASSOCIATES Date: Jd ��°" . Signature: _ )C,LT Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate j small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land9 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El affect existing infrastructure for mass transit,biking or walkway 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: El ❑ a public/private water supplies? b.public/private wastewater treatment utilities9 ❑ ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e g,wetlands, ❑ Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. EICheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 j ryrzr.,2r ," John M. Bredemeyer III, President �r � '0,9 -,', f Town Hall Annex Michael J. Domino, Vice-President �'�� ti� 54375 Route 25 Glenn Goldsmith y P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Charles J. Sanders ��'41 �a� r Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------7---------------------------------------------------- In the Matter of the Application of MATTITUCK PARK DISTRICT COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE FDw 4u , residing at/dba a�-Zzo Cu7cAN. , "193-� Wool ", G•,1�. McLe�p•v /�S�Sac�A!'o,f 4°�. being dul sworn, depose and say: That on the rortday of &c roJ,49,-, , 2014, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, October 19,2016. Dated: oc-fa&,�;R_ /8� Lot y (signature) S ,orn 292 me this 0/ = /ov otary Public CHRISTINE WIEGAND NOTARY PUBLIC,State of New York No.01W16210359,Suffolk County Commission Expires August 17,2017 •.�+;`^ .� . �� . .. fpr 1. � 'b�,r .. ' '�[ti' �• A'Ih f: e># •PIE h Christine Wiegand From: trackingupdates@fedex.com Sent: Tuesday, October 18, 2016 10:19 AM To: Christine Wiegand Subject: FedEx Shipment 777480860750 Delivered Your package has been delivered Tracking # 777480860750' . Ship date: Delivery date: Mon, 10/17/2016 Tue, 10/18/2016 10:13 Christine tree gaud am L.K McLean Associates, P.0 Christine& RichardRiveraM' Brookhaven, NY 11719 Delivered 250 Sound Beach Drive US MATTITUCK, NY 11952 us YY ; Shipment Facts s Our records indicate that the following package has been delivered a i Tracking number- 777480860750 , 3 Status: Delivered- 10/18/2016 10:13 AM Signed for By: Signature not required , Signed for by: Signature not required Delivery location: MATTITUCK, NY Delivered to: Residence ; Service type: FedEx Priority Overnight Packaging type: FedEx Envelope Dumber of pieces: 1 Weight: 0.50 lb. Special handling/Services: Deliver Weekday Residential Delivery Standard transit: 10/18/2016 by 12.00 pm Please coo not~espond.0 this message, 1213 email was S.I-fF om an U p:tcnded ma4box ,his i£po-t m9s(;ones atYed at appoxrnawy 9.19:4 CCT on 10Mt.,2016 1 t + 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Christine & Richard Rivera 250 Sound Beach Drive Mattituck, NY 11952 Betty Clausen 235 Sound Beach Drive Mattituck, NY 11952 Barbara & William Demarino 50-33 186th Street Fresh Meadows, NY 11365 Donald & Nancy 'Cocks P.O. Box 884 Mattituck, NY 11952 William Beyer 88 South Country Road Bellport, NY 11713 Emily & Michael Kavourias 45 Van Arsdale Place Manhasset, NY 11030 Viola Deluca 53 Green Avenue Madison, New Jersey 07940 Town of Southold P.O. Box 1179 Southold, NY 11971 State of New York Albany, New York 12233 Town of Southold P.O. Box 1179 Southold, NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK Christopher F. Dwyer ,residing at 437 South Country Road Brookhaven, NY 11719 , being duly sworn,deposes and says that on the //-*7 day of ®�>d , ,20-64, deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names;that the addresses set Opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold;that said Notices were mailed at the United States Post Office at Brookhaven, NY that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Swom r me this Da CHRISTINE NOTARY PUBLIC,alta AND Notary ubt' No.01WI6210359,SuffolkCoof unty Commission Expires August 17,2017 ■ d oRECEIPT ■ Ln CO CO ;)yp �1. 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A. Signature ■ Print your name and address on the reverse so that we can return the card to you. X ❑Agent ® Attach this card to the back of the mailpiece, B. Received by(Printed Name Addressee or on the front if space permits. ) C• Date of Delivery 1. Article Addressed to: A - - --- - D dl ere t fro em ? Yes Town of Southold I YES,enter deliverya ress a No PO Box 1179 OCT 1 53095 State Route 25 2016 Southold,NY 11971 __ _ _ outh Ad It 111 11111 illi IIID Villi 111 lilli111 Illlll II III O Adult Signature Restricted DeliveCertified Mail@ry ❑0 Registered Registered Mai Re s8 9590 9403 0165 5120 2198 23 ❑Certified Mail Restricted Delivery ❑RetDelurn Receipt for Restricted ❑Collect on Delivery Merchandise 2. Article Number(Tiansfer from service label) ❑Collect on Delivery Restricted Delivery ElSignature Confirmation- 7015 01340 2 1 312 5 8 5 9 5 I Mad ❑Signature Confirmation Mail Restricted Delivery Restricted Delivery PS Form 3811,April 2015 PSN 7530-02-000-9053 oo) Domestic Return Receipt ---------- --- - SECTION-- SENDER- COMPLETE THIS SECTIONON IN Complete items 1,2,and 3. ■ Print your name and address on the reverse A. Signature so that we can return the card to you. X ❑Agent ■ Attach this card to the back of the mailpiece, 13 Addressee or on the front if space permits. B Received by(Printed Name C. Date of Delivery 1. Article Addressed to: Isa dr di er� ro Yes If e. ttr deq ad I ess�low Town of Southold No PO Box 1179 53095 State Route 25 OCT 7 3 Southold,NY 11971 1016 lllllllli illi IIIA 111111 III llllllll Ilii illi III ❑dui St gna a 0�° ❑Register d l E pr"sse 9590 9403 0165 5120 2198 09 ❑Cart ned Mall® d Mail Restricted 11 Certified Mall Restricted DeliveryDelivery Return Rt for nr+lrlq N��mhPr?ransfer from service label) ❑_Collect on Delivery Restricted Delivery 11SignatureeceiConfirmatiol 0 Collect on Delivery Merchandise 7 015 ued Mail I-]SignatureConfirmation 6 4 0 0 0 01, 3125 8564 h ured Mall Restricted Delivery Restricted Delivery PS Form 3811,April 2015 PSN 7530-02-000-9053 'er$500) Domestic Return Receipt ,NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: MATTITUCK PARK DISTRICT SUBJECT OF PUBLIC HEARING : For a Wetland Permit and a Coastal Erosion Permit to install a 25' wide by 40' long steel shade _ shelter supported b_y_six_(6)_found,ation -columns-over a_proposed_4" (25'x4.0_)_concr_ete slab; and to install an approximately 12'x24' timber deck fastened onto the existing concrete slab that is attached to the existing lifeguard building. Located: 5155 Breakwater Road, Breakwater Beach, Mattituck. SCTM# 1000-99-2-19.1 TIME & DATE OF PUBLIC HEARING : Wednesday, October 19, 2016 — at or about 5:30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 i Board of Trustees Applicv` 'Eon AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signa e f Pro a Owner ell SWORN TO BEFORE ME TRIS _ DAY OF ,p d'^ 20 (� Notary Public DAVID B.PROKOP Notary Public,state of NowYodt Qualified in Suffolk county No.4977533 ` My commission Expires Feb.04.20 Board of Trustees Application ,AFFIDAVIT MATTTITUCK PARK DISTRICT COMMISSIONER N4GK DEEGAN BEING DULY SWORN DEPOSES ANRAFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of PropertyjOwner SWORN TO BEFORE ME THIS DAY OF 20 16 Notary P 9 11C NOWY ubliic ID State of N w Yo* y Qualified in Suffolk County No.4977533 toy Commission Expires Feb.04,20 r Board of Trustees application AFFIDAVIT MATTTITUCK PARK DISTRICT COMMISSIONER GERARD GOEHRINGER BEING DULY SWORN DEPOSES'AND AFIFIRMSTHAT HE/SHE'IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES D ING THE TERM OF THE PERMIT. Signature of Property Owner 6- SWORN SWORN TO BEFORE ME THIS "Z � DAY OF-- S��-��� , 20. 16 Notary P lic NotaryliicD ubID See olf New York Qualified in Suffolk County No.4977533 MY Commission Expires Feb.04.20, Board of Trustees Applic�- ',on AUTHORIZATION (where the applicant is not the owner) 1� COMMISSIONER MICHAEL RYAN 11280 PECONIC BAY BLVD. residing at (print name of owner of property) (mailing address) P.O.BOX 1413,MATTITUCK,NY 11952 do hereby authorize (Agent) CHRISTOPHER F.DWYER,L.K.MCLEAN ASSOCIATES -to apply for permit(s)from the Southold Board of Town Trustees on my behalf. F (Ow e ' at e Bowed of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, COMMISSIONER NICK DEEGAN residing at 11280 PECONIC BAY BLVD (print name of owner of property) (mailing address) P.O.BOX 1413,MATTITUCK,NY 11952 do hereby authorize - (Agent) CHRISTOPHER F.DWYER,L.K.MCLEAN ASSOCIATES _ to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) Bard of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1, COMMISSIONER GERARD GOEHRINGER residing at 11280 PECONIC BAY BLVD. (print name of owner of property) (mailing address) P 0.BOX 1413,MATTITLICK,NY 11952 _ do hereby authorize (Agent) CHRISTOPHER F.DWYER,L.K MCLEAN ASSOCIATES to apply for permit(s)from the Southold Board of Town Trustees on my behalf. wner's signature) p APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is'to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: L.K.McLEAN ASSOCIATES,P.C. (Last name,first name,piddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion X Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you personally.(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has,even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C),an officer,-director,partner,or employee of the-applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 6-0r day of#DWYER�ASSOCIATE" 20f Signature , �-� Print Name CHRISTOPHER F Form TS 1 L.K.McLEAN ASSOCIATES,P C. i APPLICANT/AGENUREPRESEN'I'A'I'IV TRANSACTIONAL DISCLOSURE,FORM The Town"2f S�nuth©Id's Code of Ftltics prol�ibits"coriflicts of intcrest on the Hart of to m afficerc and employees The nurtiose of I that form as to nrovide information which can alert the"touni of bassi ie Conflicts of jnLgrett and allow it to`taSl a wijatc ver action at I necessary to avoid same. YOUR NAME: MATTITUCK PARK DISTRICT (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the,other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion X Approval of plat Mooring Exemption from plat or official map Planning I Other (If"Other",name the activity.) Do you Oersonally,(or through yaur.campany,spousc;sibling,parent,or child)have a relationship with any officer or employee of the'6,wn of Southold? "Relationship"includes byblood,ulareiage,orbusiness interest."Business interest"means a business, including,a partnership,fn.which=the toiwnOfeCcr or emrtoyee hasxvela a partial ownership of(or employment by)a corporation in whioh•thc.t%4n ttfficcror,employee.owns more tlran;5%.oftlae shares. " *** YES NO =X I If you answered"YES",complete the balance of this form and date and sign where indicated. i Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. I The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): , A)'tlie'owner of greater than 5%-of the shares of the corporate stock of the applicant (when the appikani is-a corporation);, B)the legal drbh nefieiOowncr of any interest,in a non-corporate entity(when the applicant is not a corporation); C)'aaa officer,dirccto4 partner.orempluycb of the'applicant;or D)the actual applicant. DESCRIPTION Of RELATIONSHIP *** Signatory is a member of the Town of Zoning Board or Apgea s Submitted this qday D{ Signatuts�� .�- Print Name ERALD 69 (,a Form TS i COMMISSIONER OF MATTITUCK PARK DISTRICT I f APPLICANVAGENUREPRESENTATIVE9 TRANSACTI®NAL DISCLOSURE FORMj Tlt f S hold' ode'af.Ft 'as r s conflict a `ntcrest on the of ovr afHeers aril ern I ees.The ose' f this"farm is to'orovide information wltioii can alert the town�of nussible eontllcts cif interest and allow'it to take�*thateycr tctian i s neoessary to avoid same. YOUR NAME: MATTITUCK PARK DISTRICT (Last name,first name,Middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion X Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other'',name the activity.) Do you personally(or 0111-01411yourcompany,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer oretnployce has even a partial ownership of(or employment by)a corporation in which tbaJoNvn offic*r or.emlifoy=,owns'more than's%offlke shares. NO X YES - i If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): e A)-{ite owner of greater than 5%of the'shaies'ofthe corporate stock of the applicant (when the applicant is a corporation), B)'the 1Cg3i;©r1Tenefcial owner of any interest in a-non-corporate entity(when the applicant is not a corporation); as officer,direct®r,partner,or employee of the'applicant or D)the actual applicant. DESCRIPTION OF RELATIONSHIP SubmittedLl �' d of 2 Z t6 Signatwe. r Print NameI D EG N Form TS I r COMMISSIONER OF MATTITUCK PARK$DISTRICT APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emWoyecs.The pumose of this form is to provide inforination which can alert the town of Possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: MATTITUCK PARK DISTRICT (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion X Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer-or employee has even a partial ownership of(or employment by)a corporation in which the town-officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%-of the shares of the corporate stock of the applicant (when the applicant is a corporation); I3)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the'applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP ay Submitted i G f 29�'zot� Signature Print Nae Form TS l CO I I R OF MATTI UCK PARKS DISTRICT l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject,to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before,answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its si nig ficant beneficial and adverse.effects upon the-coastal area(which includes-all-of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus,tach answer must be eutilainW in detail, listing both supporting and,non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000 _ 09902 .. 19 001 PROJECT NAME MATTITUCK BREAKWATER BEACH SHADE SHELTER The Application has been submitted to(check appropriate response): Town Board 0 Planning Board❑ Building Dept. ❑x Board of Trustees F 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity,agency regulation,land transaction) El (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: X❑ Nature and extent of action: THE MATTITUCK PARK DISTRICT IS PROPOSING TO INSTALL A 25'WIDE X 40'LONG STEEL (POW ILDING AND TO FURNISH TIMBER DECKING ON TOP OF AN EXISTING CONCRETE PATIO ATTACEHD TO EXISTING LIFEGUARD BUILDING AS AS SAFETY MEASURE TO PROTECT PARK PATRONS. NO OTHER DISTURBANCE OF LAND IS NECESSARY OTHEE T AN FOR THE SIX(6)FOUNDATION COLUMNS FOR THE PROPOSED SHADE SHELTER.THE WORK IS PROPOSED SEAWARD OF THE COASTAL HAZARD EROSION LINE(CEHL)BUT DOES NOT INTERFERE WITH ANYPROTEefl FEATURES IN FRONT OF AND BEHIND THE CEHL. THE STRUCTURE WILL BE PROPERLY MANUFACTURED,ENGINEERED AND INSTALLED,BOTH TO EFFECTIVELY WITHSTAND CEHA AREA FORCES AND TO MAXIMIZE LIFESPAN. Location of action: MATTITUCK BREAKWATER BEACH,MATTITUCK Site acreage: 21 87 ACRES Present land use: - PARK Present zoning classification: RESIDENTIAL R-80 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: MATTITUCK PARK DISTRICT (b) Mailing address: MATTITUCK PARK DISTRICT 11280 PECONIC BAY BOULEVARD,P.O.BOX 1413,MATTITUCK NY 11952 (c) Telephone number: Area Code( ) 631-298-9103 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No❑ If yes, which state or federal agency? NYSDEC TIDAL WETLANDS PERMIT APPROVED C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes'efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LVVP.P Section III—Policies; Page 2 for evaluation criteria. ❑x Yes ❑ No ❑ Not Applicable THE PROPOSEDSHADESHEI T R AND TIMBER DECKING WILL INCREASE THE BENEFICIAL USE OF AN EXISTING COASTAL PUBLIC PARK BOTH WILL BE DESIGNED AND CONSTRUCTED INA MANNER THAT WILL HAVE NO ADVERSE IMPACT ON THE ADJACENT WETLANDS NOR INCREASE COASTAL EROSION THE AESTHETIC OF BOTH STRUCTURES WILL BE CONSISTENT WITH THE NATURAL ENVIRONMENT AND ENHANCE-THE . Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold, See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria 0 Yes ❑ No ❑'Not Applicable THE SHADE STRUCTURE WILL BE AESTHETICALLY CONSISTENT WITH THE NATURAL ENVIRONMENT IT FEATURES A SIMPLE CANOPY SUPPORTED BY SIX SLIM COLUMNS IT IS NOT ANTICIPATED THAT THE SIZE,LOCATION OR DESIGN WILL IMPACT ANY SCENIC VISTA IN THE AREA OR ADJACENT NEIGHBORHOOD THE TIMBER DECKING WILL REPLACE THE"MANUFACTURED"LOOK OF THEEXISTIUG— CONCRETE PATIO AND ENHANCE THE VISUAL QUALITY OF THE PARK Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria E Yes 1:1 No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and 'improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ ❑ Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the 'Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes No' Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in 'Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes No xNot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. E Yef—I No❑ Not Applicable THE MATTITUCK PARK DISTRICT SEEKS TO ENHANCE THE SAFETY OF PARK PATRONS,ESPECIALLY YOUNG CHILDREN,SENIORS,AND THOSE WITH MEDICAL CONDITIONS BY PROVIDING A SHADE STRUCTURE,USAGE AND ENJOYMENT OF EXISTING PUBLIC PARK WILL BE INCREASED THE_TIMBEB DECKING WILL SERVE TO COVER THE EXISTING CONCRETE PATIO,THEREBY REDUCING TRIP AND FALL HAZARDS,AND THE POTF T_N IAL EQR SEVERE CONSEQUENCES SUCH AS HEAD INJURIES A HANDRAIL AND ADA-COMPLIANT RAMP,DESIGNED TO BE IN HARMONY WITH THE NATURAL SURROUNDINGS,WILL ALSO BE PROVIDED BOTH OF THESE IMPROVEMENTS IMPROVE THE ACCESSIBLITY OF THE PARK AND IMPROVE PUBLIC ACCESS TO THIS RECREATIONAL RESOURCE Attach additional sheets if necessary `I WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑,Yes ❑ No E Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of Hiving marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 0 No 0 Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands-in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No El Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ❑x Not Applicable- PREPARED BY CHRISTOPHER F DWYER,L K McLEAN ASSOC TITLE ASSOCIATE DATE 8-31-2016 r L011AA L. K. McLean Associates P.C. 437 South Country Road a Brookhaven ® New York • 11719 CONSULTING ENGINEERS (631)286-8668 v FAX(631)286-6314 Associates EUGENE F DALY,P.E,P T.O.E TM',PRESIDENT and C E O CHRISTOPHER F DWYER RAYMOND G DiBIASE,P.E,P T O E TMPTPTM EXECUTIVE VICE PRESIDENT ROBERT A.STEELE,P.E. DANIEL P JEDLICKA,P L S.,VICE PRESIDENT JAMES L DeKONING,P E -STEVEN W.EISENBERG,P.E ANDREW B.SPEISER August 29, 2016 Mr.John Bredemeyer AUG 3 0 2016 54375 Main Rd. P.O. Box 1179 outhold Town Southold,NY 11971 RE: TOWN OF SOUTHOLD - MATTITUCK BREAKWATER SHADE SHELTER MATTITUCK,NEW YORK LKMA No. 16078.000 Mr.Bredemeyer: Thank you for consideration of the pending Wetlands Permit for our client, the Mattituck Parks District. In response to your request, we are submitting, on their behalf, copies of proposed site plans and existing site survey, in support of the application for a Wetlands Permit to construct a shade shelter and a timber deck fastened to an existing concrete slab. Enclosed herewith for your review,please find(4)copies of the following: 1. Drawing Set,including site plan and shade structure elevation details 2. Property Survey performed by Peconic Surveyors,P.C. Now that we are aware that this project will further require a Wetland-Coastal Erosion Permit, additional supporting application materials will follow in the near future. If you have any questions or require additional information,please feel free to contact me. Very truly yours, •J I�� CFD:Ifc Christopher F. Dwyer,Associate L. K McLean Associates, P.C. Enc. (8) Cc: Commissioner Michael Ryan,Mattituck Parks District w/enc. LKMA File Copy w/enc. ® Founded in 1950 • r� t i "(,&A h L. J. McLean Associates, P.C. 437 South Country Road • Brookhaven • New York • 11719 CONSULTING ENGINEERS (631)286-8668 • FAX(631)286-6314 Associates EUGENE F DALY,P.E,P T O E TM,PRESIDENT and C E.0 CHRISTOPHER F DWYER RAYMOND G DiBIASE,P.E,P.T.O.E. M,PTPTm,EXECUTIVE VICE PRESIDENT ROBERT A STEELE,P E DANIEL P JEDLICKA,P L S,VICE PRESIDENT JAMES L.DeKONING,P E. STEVEN W EISENBERG,P E. ANDREW B.SPEISER September 1,2016 MATTHEW C JEDLICKA,LEED AP Mr.John Bredemeyer 54375 Main Rd. P.O.Box 1179 ORIGINAL Southold,NY 11971 RE: TOWN OF SOUTHOLD -MATTITUCK BREAKWATER SHADE SHELTER MATTITUCK,NEW YORK LKMA No. 16078.000 Mr.Bredemeyer: Thank you for consideration of the pending permit for our client, the Mattituck Parks District. In response to your recent determination, we are re-submitting, on their behalf, a complete application package, in support of an application for a Wetlands/Coastal Erosion Permit to construct a shade shelter and a timber deck fastened to an existing concrete slab. Enclosed herewith for your review,please find the following: 1. Completed Wetlands/Coastal Erosion Permit Form 2. Signed 30-Year Maintenance Agreement 3. Short EAF 4. Draft Mailing Notice&Notice to Adjacent Property Owner(will be finalized and sent out when hearing date is assigned) 5. Application Affidavit 6. Agent Authorization 7. LWRP Consistency Assessment Form 8. Drawing Set, including site plan and details/dimensions of proposed structures(4 copies) 9. Property Survey performed by Peconic Surveyors,P.C. (4 copies) If you have any questions or require additional information,please feel free to contact me. Very truly yours, CFD:lfc Christopher F.Dwyer,Associate L. K. McLean Associates, P.C. Enc. (8) -- Cc: Commissioner Michael Ryan,Mattituck Parks District w/enc. D C E I V E LKMA File Copy w/enc. SEP ® 9 2016 Southold Town 6 •Founded in 1950 • Egard of Trustees DAVID B. PROKOP ATTORNEY AT LAW 131 ROUTE 25A, SUITE 2 ROCKY POINT, NY 11778 TELEPHONE(631)821-1314 FACSIMILE (63 1)821-1190 ALSO ADMITTED IN DISTRICT OF COLUMBIA AND PENNSYLVANIA April 21, 2016 John Bredemeyer, President D0 E ft Southold Board of Trustees U Box 1179 1 Southold, NY 11971 APR 2 6 2016 Re : Mattituck Park District Breakwater Beach Southold lovyn 1000/99/2/19 . 1 bard of T hska Dear Mr. Bredemeyer: I am counsel to the Mattituck Park Disrtict . The park district commissioners have expressed an interest in constructing a pavilion at Breakwater Beach. In furtherance of this proposal enclosed is a current survey with the proposed pavilion location. At this time we respectfully request ,a pre-submission inspection at the property. To perform this inspection the Mattituck Park District hereby grants access to the Board of Trustees . At the present time I have all three commissioners available the week of May 8, 2016 except for Monday, May 9th, if any day that week is convenient for the Trustees . Plesae call my office to suggest availability by the Trustees and then I will confirm the date and time with the three park commissioners . Thank you for your courtesy. Sin e ly, David okop James F.King,President ®f so j® Town Hall Annex Bob Ghosio,Jr_,Vice-President 54375 Main Road P.O.Box 1279 Dave Bergen Southold,New York 11971-0959 John Bredemeyer Michael J.Domino � �� Telephone (631) 765-1892 Fax(631)765-6641 ]BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit Dro _Amendment/Transfer/Extension _Received Application: ; _Received Fee:$ JUL 7086 _Completed Application _Incomplete _SEQRA Classification: Southold own Type I Type II Unlisted ;t _Coordination:(date sent) _LWRP Consistency Assessment Form _CAC Referral Sent: /? ccfv- � _Date of Inspection: tj l�,�/A�n _Receipt of CAC Report: f - r _Lead Agency Determination: � Par��3 i _Technical Review: _Public Bearing Held: _Resolution: �; Y Name of Applicant Commissioner Michael Ryan Mailing Address 11280 Peconic Bay Blvd. , Mattituck, NY 11952 Phone Number:( ) 631-298-9103 Suffolk County Tax Map Number: 1000- 099-02-19 . 1 Property Location: The �Pro-i es „. is in Matt titu.ck at the north termi,mds o� Br eakwa tear Po7pnue (L. 7 . Sound) (provide LILCO Pole#, distance to cross streets, and location) AGENT: Christopher F. Dwyer (If applicable) Address: 437 South Country Rd. , Brookhaven NY 11719 —Phone:-631-286-8668 Lrd of Trustees Appliaatio GENERAL DATA Land Area(in square feet): 952, 748 S F Area Zoning: Residential R-80 Previous use of property: Park Intended use of property: Park Covenants and Restrictions on property? Yes X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? X Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure(s) on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency Date NYSDEC - 1-4738-01061/00001 _expired 2/28/98 X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explantation: Project Description(use attachments if necessary): The Mattituck Park District would like to install a 25'wide by 40' long steel (powder coated)shade shelter north and west of the existing Lifeguard Building The project also includes the completion of a timber deck that would extend directly north off of the existing Lifeguard Building. No other disturbance of land is necessary other than for the six(6)foundation columns. The work is proposed seaward of the Coastal Hazard Erosion Line (CEHL) but does not interfere with any protective dune or coastal feature that would protect the existing features in front of and behind the CEHL. El; d of Trustees Application, WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: to provide shelter to the patrons using the Mattituck Park District ' s beach facility. The deck that is to be installed over the existing concrete is for safety purposes . Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No X Yes only a maximum of three feet below surface for footings (6). If yes,how much material will be excavated? 6 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited:_ 3+/- feet Proposed slope throughout the area of operations: 1 Manner in which material will be removed or deposited: Material will be excavated by the use of an excavator. All excess material from foundation installation shall be removed from site. Statement of the effect,if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): Town of Southold Erosion, Sedimentation $ Stolrri'-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A tri 1000 99 02 19 .1 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN mfrs T SecTT -9oT a cl— tot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YOM SCOPE OF WORK - PROPOSED CONSTRUCTION yjCEM# / WORK ASSESSMENT fes No a. What Is the Total Area of the Project parcels? 1 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) 21 - 8 7 A� (This Item will include all ruts-off created b site b. What is the Total Area of Land Clearingis F IAores) Y X clearing and/or construction activities as well as all El and/or Ground Disturbance for the proposed 10 0 0 S F Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S F./Acres) PROVIDE B� PROTECT DESCREMON (ProvideAddrHaralPaganasNeeded) 2 Does theSitePlan and/or Survey Show ca Proposed ED- Work Qrainage Structures Indicating Size 8 Location?This Item shall Include all Proposed Grade Changes and —is for excavation and installation Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion of six (6) concrete columns to support and sediment control practices that will be used to control site erosion and storm water discharges. This — tLa 12rC)DQS .d shade shelter. item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards F71 X of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ® X (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or El Submission of a SWPPP is required for ail Construction activities invahring soil Beach? disturbances of one(1)or more acres; Including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Construction activities involving sol disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? X the DEC has determined that a SPOES permA is required for storm water discharges. "— El (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 3 Will Driveways,Parking Areas or other Imperviousi for Storm Water Discharges from construction activity-Permit No.GP440.001.) Surfaces be Sloped to Direct Storm-Water Run-Off F-1 X 1.The SWPPP shall be prepared prior to the submittal of the Na.The NOI shall be submitted to the Department prior to the commencement of construction active into and/or in the direction of a Town fight-of Way? i Z The SWPPP shall describe the erosion and sediment control practices and where 9 W71 this Project Require the Placement of Material, required,post-oonstnsction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ; constructed to reduce the pollutants in storm water discharges and to assure item Within the Town Right-of-Way or Road Shoulder X compliance with the terns and conditions of this perm In addition,the SWPPP shall Area?(tuts Item wIn NOT Include the tnstAW9M of Drivewaay Aprons) i ID i identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Cheek Mark 3.All SWPPPs that require the post-c-structlon storm water management practice in a Box and tho construoQon site dlsturbence is between 5,000 S.F.81 Acre in area, I component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage A Erosion Control Plan is Required by the Town of that is knowledgeable-,En the principles and practices of Storm Water Management Southold and(dust be submitted for Review Prior to issuance of Any Building Permit. (NOTE: ACheckMark(j)andlorAnswerforeachQuestlonIs"uiredforacompleteAppGwrion) I STATE OF NEW YORK, COUNTY OF.;ac�IS.---•---• .....SS � f That I.Muct......4r........ iment)...................being duly sworn,deposes and says thatlie/she is the applicant for Permit,inrlhfidual signing 1 Andthat be/she is the ........... .L.S .LU .!! ................................................................................................. (Owner,Contractor,AgeM Corporate Olricer,elc) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge*and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; g� / i ..........(.1...... a f... 20�i Notary Pub . ....... Eve L . .... ... ............... .UA'Y 'SCHWAIC�I3n' d pplinnr) FORM - 06/10 Registration No.01GA6274028 � Qualified in Suffolk County Commission Expires Dec.24,2016 E -d of Trustees Applicatioi County of Suffolk State of New York Commissioner Michael Ryan BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WIT RE OF IS APPLICATION. �t Property Owner SWORN TO BEFORE ME THIS , ll DAY OF l Nota P li E'f -SCHWAMBORN STATE OF NEW YORKo.OIGA6274028n Suffolk Countyxhires Dec.24,2016 r f i y _ I - i - i APPLICANT/AGEr URE-PRESENTATYV]E _ TRANSACTIONAL DISCLOSURE FORM � The Town of Southold's Code of Ethics prohibits conf(jcts of interest a}i the part of town officers and employees.The_uurnose of this form is to provide i forination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. = - I YOURNAME: Michael Ryan (Last name,fist name,Middle initial,unless you are applying m—the name of _ someone else or other enft such as a company.If s%indicate the other t person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval ofplat Mooring Exemption from plat or official map Planning i Other (if"Other,name the activity.) Wetlands Permit I Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee , of the Town of Southold? "Relationship"includes by blood,rgarriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than %of the shares. I Yes NO - . Ifyou answered"YES",complete the balance of this form and date and sign where indicated. - 1 Name of person employed by the Town of Southold Title br position of that person i Describe the relationship between yourself(the applicantlagent/representative)and the town officer or employee.Either check Ilf the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 50A of the shares of the corporate stock of the applicant j (when the applicant is a corporation); B)the legal or beneficial owner ofany interest in a non-corporate entity(when die applicant is not a corporation); j C)an officer,director,partner or employee of the applicant or D)the actual applicant. i DESCRIPTION OF RELATIONSHIP SubmittedM , day of J0 4 L 200 Signature PrintN Form TS I Town of Southold LNVRP CONSISTENCY ASSESSMENT FORINT A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. `Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form.should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A p oposed action will be evaluated. as to its sigificant beneficial and adverse effects upon the coastal area(which includes all of Southold Town,. 3: If any question in Section C on this form is answered "yes"or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supportink facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold I s website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000 - 099-02 - 19.1 PROJECT NAME Breahwater Beach - Propsed Shade Shelter&Deck The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. Q Board of Trustees 0 1. Category of Town of Southold agency action(check appropriate'response): (a) Action undertaken directly by Town agency(e.g.capital construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Q Nature and extent of action. Need approval to build shade shelter in area seaward of the coastal erosion hazard line. Met with Trustees at site on May 11, 2016 and they understand that project does not impact any coastal erosion barrier or would it create any erosipr.to the beach area. Location of ae4lion: Matt ituck Site acreage: 21.87 Acres Present land use: Park Present zoning classification: Residential R-80 2. If an application for the proposed action has been filed with the Town.of Southold agency, the following information shall be provided: (a) Name of applicant: Commissioner Michael Ryan (b) Mailing address: Mattituck Parks District 11280 Peconic Bay Blvd. P.O. Box 1413,Mattituck NY 11952 (c) Telephone number:Area Code( ) 631-298-9103 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes © No❑ If yes,which state or federal agency? NYSDEC- Letter of No-Jurisdication C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LVVRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No EJ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LVVW Section III=Policies Pages 3 through 6 for evaluation criteria ❑ Yes 0 No 0 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No X❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No -X❑-- Not Applicable Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section In —Policies Pages 16 through 21 for evaluation criteria EJYes El No F0 Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands, See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ 0 r Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III -- Policies Pages 32 through 34 for evaluation criteria. Yes F] No Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LVW Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes L__san_I No 0 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III=PoIicies; Pages 38 through 46 for evaluation criteria. El Yeso No FJl Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III.—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No X❑ Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands-in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No n Not Applicable ,Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies;Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No ® Not Applicable PREPARED BY Christopher F. Dwyer TITLE Associate DATE 6-08-16 617.20 Appendix C State Environmental (duality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I -PROJECT INFORMATION To be completed b A licant or Pro"ect Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Commissioner Michael Ryan 11*T►ruGK 759�EAKwA-MR SHADE S�f_LTfg, 3. PROJECT LOCATION Municipality Mattituck County Suffolk 4 PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 5155 Breakwater Avenue Mattituck NY 11952-the precise location is at the north terminus of Breakwater Avenue where the road ends at meets the Long Island Sound and is just west of the Mattituck Inlet. 5 PROPOSED ACTION IS ❑✓ New ❑ Expansion Modification/alteration 6 DESCRIBE PROJECT BRIEFLY- The Mattituck Park District would like to install a 25'wide by 40'long steel(powder coated)shade shelter north and west of the existing Lifeguard Building. The project also includes the completion of a timber deck that would extend directly north off of the existing Lifeguard Building. 7 AMOUNT OF LAND AFFECTED' Initially 1000 SF or 023 acres Ultimately 023 acres S WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? FYes ❑ No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0 Residential ❑ Industrial Commercial Agriculture ❑ Park/Forest/Open Space ❑ Other Describe 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? 7 Yes 0 No If Yes,list agency(s)name and permit/approvals Southold Town Trustees 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? nYes ❑� No If Yes,list agency(s)name and permit/approvals: 12 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes Z✓ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ^/� Applicant/sponsoryterTLie Commissioner Mike Ryan Date Signature / If the ac`tiis in de Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1il�ese PART II - IMPACT ASSESSMENT % `: completed by Lead Agency) A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617 4? If yes,coordinate the review process and use the FULL EAF E]Yes ❑ No B WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes 11 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1 Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern;solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2 Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly C3 Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly' C4 A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly. C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6 Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly C7 Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? 11 Yes ❑ No If Yes,explain briefly E IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes No If Yes,explain briefly PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant Each effect should be assessed in connection with its,(a)setting(i.e urban or rural), (b)probability of occurring, (c)duration, (d)irreversibility, (e) geographic scope, and (f) magnitude If necessary, add attachments or reference supporting materials Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed If question D of Part II was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) � 1 LIURA L. K McLean Associates, P.C. 437 South Country Road • Brookhaven • New York 11719 CONSULTING ENGINEERS (631)286-8668 • FAX(631)286-6314 Associates EUGENE F DALY,P.E,P.T.O.E TM,PRESIDENT and C E O CHRISTOPHER F DWYER RAYMOND G DiBIASE,P E,P.T O E.TM,PTP-,EXECUTIVE VICE PRESIDENT ROBERT A.STEELE,P.E. DANIEL P.JEDLICKA,P L S,VICE PRESIDENT JAMES L.DeKONING,P E. STEVEN W EISENBERG,P.E D RE4AJ.8..SPF,.� ER July 1,201 IAT E1 D% KEEE J Mr.John Bredemeyer JUL 54375 Main Rd. — 5 1016 P.O.Box 11971 Southold,NY 11971 outhold kern RE: TOWN OF SOUTHOLD-MATTITUCK BREAKWATER SHADE SHELTER MATTITUCK,NEW YORK LKMA No. 16078.000 Mr.Bredemeyer: As Consulting Engineers for the Mattituck Parks District, we are submitting, on their behalf, an application for a Tidal Wetlands Permit to construct a shade shelter and a timber deck fastened to an existing concrete slab. Enclosed herewith for your review,please find(2)copies of the following: 1. Board of Trustees Application. 2. Erosion, Sedimentation& Storm-Water Run-Off Assessment Form. 3. Authorization Form. 4. Transactional Disclosure Form. 5. LWRP Consistence Assessment Form. 6. Short Environment Assessment Form(SEAF). 7. Check in the amount of$100.00 made payable to the Town of Southold. If you have any questions or require additional information,please contact this office. Very truly yours, CFD:yrc Christopher F.Dwyer,Associate L. K.McLean Associates, P.C. Enc. (7) Cc: Commissioner Michael Ryan,Mattituck Parks District w/enc. LKMA File Copy w/enc. �h►'�S ®wl er '' fj 771- �7)d • Founded in 1950 • �YMN OF SO UTHOLD _ /000 - i � - 19. 1 PROPERTY RECORD D CARS w OWNER STRE ET VILE-AGE DISI". SUB. LOT FORMER OWNER N ACR. � S r TYPE OF BUfLDING De Litca RES. SEAS. VL.. FARM COMM. CB. ICS. Mkt. Value 0 LAND IMP. TOTAL DATE REMARKS o , In 30o r � � 7 bb o oZ o0 - J � = Zz D- r7 O cn LD r � AGE BUILDING CONDITION - LO NEW NORMAL BELOW ABOVE LD FARM Acre VOlue Per Vofue —�L s` (_ _ 6 Acre Billable FRONTAGE ON WATER @mVoodfand �• r �7 FS"o . FRONTAGE ON ROAD 'Weadowtond m— (DEPTH 04 Mouse Plot BULKHEAD CD oto I - j ..� .d. DOCK • e� - ■ice ��le��,�i�ii�li� ,eft WON on No 1�His MUM.lay ■NE�i� •I Is Y M, 4 • • iFire Place 3 Roof , ,; 1 LO m m OW. NER _ Or STREET VILLAGE DISTRECT' SUB. LOT' _Y 7" l a, IT>D FOf�1vtiEP. OW1�lER � E ACREAGE S , Z TYPE OF BUILDING RBS. SEAS. _ VL. FARM CONA4. I IND. + GB. � misc. � - U) LAND 11v3P. TOTAL DATE REMARKS + 0 S'4492� W----- �- o 0Lo -- ' CO F- - AGE BUILDING CONDITION NEW NORMAL BELOW� ABOVE Farre Acre Value Per Acre Value --i 7- Tillable 2 "`"�' �M Tillc�ble 2 Lp iTillabfe ,.o - — WDC) 1;wampfand m3rush�artd mHouse Plot m N m ) O#aI L CD OWNER VILLAGE DISTRICT SUB. LOT w is r . IL FORMER OWNER '` -� � y ' N E REAGE S W TYPE OF BUILDING . ;. RES. SEAS. VL.' FARM I comm, I IND. I CB. I MISC, y LO LAND IMP. TOTAL DATE REMARKS co CA LOLn -� r � %7gv U f 11 d G--tmEt ?iG 0to AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Farre Acre Value Per Acre Valuer Lo Ti!table 1 r Tillable 2 Lo -- — Af— �, Tillable 3 Lo - - -- ----- Woodland 00 m Swampland m Srushland ao - -- ---- — — of House Plot m Total u� m OWNER " r STREET VJ LLAGE DISTRICT SUB. LOT ��,c i'Oti�a4t=r2 OVfNER J= ACREAGE W TYPE OF BUILDING RES. SEAS. VL. C FARM `__-- comm. I IND. I CB. I MISC. o LAND imp. TOTAL DATE REMARKS - Ln Tj lip O co Nr AGE BUILDING CONDITION[ � � s � NEW NORMAL BELOW ABOVE f=arm Acre Value Per Acre Value � TPJlable 1 - � m _ LS Ti lloble 2 Ae Tillable 3 -- ---- - -- - - .�_� LO Wcodland - -- ----� Swampland - - Brushland -- m House Plot - - -- CD --- — c� Total ! John M Bredemeyer III, Presidjo Town Hall Annex Michael J. Domino, Vice-President �� °- 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski o P" Southold, NY 11971 Charles J. Sanders '1,fj Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 3qS Completed in field by: 6. Go ldg-Tm � David B. Prokop, Esq. on behalf of MATTITUCK PARK DISTRICT requests a Pre-Submission Inspection for a proposed pavilion at Breakwater Beach. Located 5155 Breakwater Beach, Mattituck. SCTM# 1000-99-2-19.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet, 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1" II Unlisted Action Type of Application: -./ Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: �✓� f i r CoaSW u1'oS%on :2ar.e CAn0.U��o��Ze ( u �o Goc4S�A� Gr0310r 2o6)e . Present were: ,/J. Bredemeyer ✓ M. Domino ✓ G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 12 John M. Bredemeyer III, Presid(' - �gUFFO(,�C Town Hall Annex Michael J Domino, Vice-President t -J �' �Gy 54375 Route 25 Glenn Goldsmith o '`u P.O Box 1179 A. Nicholas Krupski o A Southold, NY 11971 Charles J Sanders d� Telephone (631) 765-1892 Fax(631) 765-6641 =47fYLC^' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: David B. Prokop, Esq. on behalf of MATTITUCK PARK DISTRICT_ requests a Pre-Submission Inspection for a proposed pavilion at Breakwater Beach. Located 5155 Breakwater Beach, Mattituck. SCTM# 1.000-99-2-19.1 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT' . MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion' in the'fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any-waters: H. Weaken or undermine the lateral support of other lands in the vicinity: , I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: - - Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable,and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and.natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other t Page 2 of 2 f -•� - - -- -......_.- ..,..._...._-.., ._..,. � -- — -,-NO y sm COUNTY OF SUFFOLK K o� Tari oP— -,SECTION N p<.r�s ©. soun+o�d s"eo". ReaLPro a Tax ServiceA en EeoF OafABUf10N05Nt(CORMXOFTi£, 3 09I _ �- P rtY' Agency oY E Vim* •r - - ~'m'.'�'^ �_�T ,lppvnua- �— — P4e -- -- - _ nen SL6,T0[kfpUrRY,tNtIMptS PRUp81TE0 . : : r,lY eentsiiVrarlw4a.NY 1190/. 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MJ RD CR E �..,„o-,. ,.,,., �. .'. ”—_ • ++^°'. © ov SECTION NO G �� —� x, )z1) �, O _�,w.� — x.b« _—x-- w..ow NOTICE 2�:r, COUNTYOFSUFFOLK E >o souTNOLD E "'°"'�' _--- _ _ '+�`"�, Real Property Tax Service Agency YEpF ND v..+ra n•—` awwuLi,.-- -- eeunryeenlerRrvwmea4,NY11901 M 99 xrNcl —___— -- -- aA o T • x r s� s r P TRI 0 1000 PROPERTY MAP