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TOWN OF' SOUTHOLD SUFFOLK COUNTY, NY L:: MATTITUCK BREAKWATER BEACH SHADE SHELTER JUNE 2016 1°ckey Creek 25 Peconie °OSe Creek jp �oyc df3 Laughi ng Waters Rkhrnond Creek Cutchogue SITE LOCATION Station Illt>'E 0"A fast Nassau Farms Creek 2S �. Waiberville Cutch ogueq o- M,atbtuck New Suffolk V ,vow Creek West o Creek o 11 } Suffolk Ave Greof Pecarvk B!QY �1/��ttltUCk Ne NewSuNoIkAw, 4k i 00ep 4 Qw�fo p�¢ Mole Creek .4 Ave LJ Lx jivq 9w ° 1 0 Y m SHEET LIST TABLE LOCATION MAP 8/31/20161 LrC ADD auoKSONS cru N.T.S. DATE BY DESCRIPMN APPRM. BY SHEET NUMBER SHEET TITLE REVISIONS TOWN OF SOUTHOLD s T1 LOCATION SHEET SUFFOLK COUNTY NY Ea MATTITUCK BREAKWATER BEACH Y 1 PHOTO SHEET SHADE SHELTER to U o w 2 PROPOSED SITE PLAN LOCATION SHEET 3 CAMPION MODEL SHADE SHELTER DETAIL o� 4 TIMBER DECK DETAIL L. K. DOME= W ASSOCIATES, P.C. twau,.w n�a,aun m swrx canrr m.,womrroK�Yo�c,n,9 of r, o-w-W. YCR/CF spa« AS NOTED sn..t No. OSUFFOLK COUNTY REAL PROPERTY TAX MAP o j DISTRICT: 1000 SECTION: 99 BLOCK: 02 LOT: 19.1 a—ar YCR oolc JUNE 2016 T1 a 4w--d W. RGD rn.No. 16078.000 II i _ w .. ►: / - LIZ - PHOTO NO. 1 PHOTO NO. 2 PHOTO NO. 3 PHOTO NO. 4 PHOTO NO. 5 PHOTO NO. 6 • _ PROPOSED r SHADE 400 SHELTER > r` �\ 5 ` PROPOSED TIMBER DECK 3 (TO OVERLAY EXISTING CRETE PATIO) o_ FD I m -y 8/31/20161 LFC ADD DIMENSON I CFD / � A DATE 8Y DESCRIPTON APPROV. 8Y ' ✓ /, ,S ,e REVISIONS o TOWN OF SOUTHOLD SUFFOLK COUNTY NY E 0 '' > 1. � + MATTITUCK BREAKWATER BEACH sSHADE SHELTER 0- I EGENDO SITE PLAN y I � 1 0S - ALE:1'-80' ,✓ PHOTO SHEET o g DIRECTION OF PHOTO TAKEN 0 80 160Feet F 20 1 I6 L. K. McLEAN ASSOCIATES, P.C. N CONSULiND DgI1EDLS L+1 9pi1N COIMIRI'R.NOQONMLN NM lUM 1171 D-W d By. YCR/CF sow.: AS NOTED Snwt N°' to $OJillOid Town YCR J 2016 0 i 1 °v"° Dw : UNE, a fTru°`ec _1a Approved W. RGD Fn.No. 16078.000 APS 0\/ED BY BOARD OF TRUSTEES ti ;TOWN OF SOUTHOL® 6zt, 'els 04. �, sF .r DATE , y � ►�, aa,, 0 0 `�°� 1, of SEA %pa 9Ar � ► 9 LpiN r PROPOSED APPROX, 24' X 12' �° ©�,�'• "� TIMBER DECK TO BE FASTENED TO R 0�0 �'' �`• � EXISTING CONCRETE SLAB. \ F SIZED IN ACCORDANCE WITH �iy\ EXISTING INSTALLATION ' \ (SEE DETAILS) \\Ar �^� COTE: 0�9 6 lON ' 1 PROPOSED 25'X40' �� - HANDICAP RAMP SHALL BE INSTALLED Z AFTER THE CONSTRUCTION OF TIMBER SHADE SHELTER +�y 6' ,°'u; DECK. FIFE 0.5 ABOVE FZk•Z ADJACENT GRADE FFE ESTIMATED AT 9.5 WITH ' .� �c►'S" �p a WALKWAY WOOD 441WA �rLEGEND sN (SEE DETAILS) g i '' 0 +wN • =PIPE o =UTILITY POLE c '� �, 3,00.�'9� ■=MONUMENT p� o� o�' ® =PROPOSED PAVILLION POSTS y 1� —■—■—_— = CHAIN LINK FENCE ° .65S �.£i 8 / ° `�' `S►� + J + = SPLIT RAIL / PICKET FENCE 3Og,91W6` ,>�" c� ��'' .-�--�— = WOOD & VIYNL FENCE M.00,Ltti Os N (OVOS >lv3ae e>rv) tTY09 SM -07 M N 11/17/2016 LMY RELOCATED SHADE SHELTER - CFD :n 8/31/20161 LFC ADD DIMENSIONS CFD a - 8/25/20181 MGI I ADDED RNISHED FLOOR ELEVATION CFD j ^ DATE I BY DESCRIPRON APPROV.BY E - REVISIONS TOWN OF SOUTHOLD o D MATTISUFFOLK COUNTY NY E 2 d TUCK BREAKWATER BEACH 0 0 SHADE SHELTER O nC DEC 2 2 2016, PROPOSED SITE PLAN N SITE PLAN i ° SCALE 1-=150• I— K. MCLEAN ASSOCIATES, P.C. �Y 0150 300 CONSUOMD� m sous MW RD.MMMVDL=V=11719 Southold Town Shmt No. O1< Feet ��Sr. YCR/C soelm AS NOTED Board of Trustau YCR Ddm JUNE 2016 /'/� App--d By: RGD Fs.Na 16078.000 0 24 GA HR-36 STEEL ROOF 25.0' 24 GA HR-36 RAFTER BEAM 0' STEEL ROOF 24 GA HR-36 +00, I STEEL ROOF 10"x10" COLUMNiz 1 RAFTER FRAME J-- RIDGE BEAM ,6' +/- ORNAMENTATION PERIMETER BEAM GUTTER & GUTTER & 4 DOWNSPOUTS MID BEAM 4 DOWNSPOUTS 7.5'+/- 7 10"x10" COLUMN GUTTER ` RAFTER FRAME, I Tr 11 11 11 10"x10" COLUMN EXTENSION BEAM PLAN VIEW DETAIL ELEVATION DETAIL END - ELEVATION DETAIL N.T.S. N.T.S. N.T.S. 10'x10' COLUMN 10'x10' COLUMN EXPANSION MAT'L HAND HOLE W/ COVER EXPANSION MAT'L HAND HOLE W/ COVER CONCRETE SLAB HEX NUT, HEX NUT, FINISHED FLOOR WASHER k BASE WASHER k BASE ELEVATION SET 6' a PLATE FINISH PLATE ABOVE ADJACENT GRADE SLAB GRADE (ESTIMATED 0 ELEVATION 9.5') • K 2 jcr 'x12' A-36 ALL THjcrREAjcrD rr OPTIONAL RCA T I 2500 PSI CONCRETE BY CONTRACTOR A—BOLT W/ (2) HIX — �AIJ THREAD • NUTS & B MIN EMBED j••,,'. y STUB ELEC A—BOLT W/ (2) (B) 5 VERTICAL REBAR 3 BY CONTRACTOR — — CONDUR PER HEX NUTS k B . •', 3 HORIZ REBAR TIES Y LOCAL CODE 5 0' SEE COL DTL MIN EMBED BY 10' OC (3) O 5' OC O 8/31/2018 EFC ADD DIMENSIONS CFD p CONTRACTOR A TOP OF FOOTING 8/25/2018 MCJ ADDED FlNSI1m FiAOR ELEVATION CFD NON—EXPANSIVE, 2500 PSI DATE 0Y DES=FnON APPROV.er UNDISTURBED' OR CONCRETE BY (5) //5 REBAR E ••' REVISIONS EACH WAY TOP 95% COMPACTED CONTRACTOR I .• . ' ' o SUBGRADE BOTTOM a I'•� j I I TOWN OF SOUTHOLD Y CAISSON FOOTING DETAIL 3� CONDUREPER SUFFOLK COUNTY NY ® E- fEC2 MATTITUCK BREAKWATER BEACH E°°- N.T.S. NON—EXPANSNE, - 3' I I- LOCAL CODE SEE COL DTL � UNDISTURBED OR ' D PSN SHADE SHELTER o� 95% COMPACTED SPREAD FOOTING DETAIL CAMPION MODEL SHADE SUBGRADE SHELTER DETAIL N.T.S. D2016 L- K. McLEAN ASSOCIATES, P.C. -- N g COIEIILIMO F]IAO® 07 SOYIX CCIAEEI®.mOOMYW IEE 10EI 111111 °I oortolre er• YCR/CF sooie AS NOTED 910eI NO' ° Southold ToWTI DR=g,, YCR Ddw JUNE 2016 3 Appmud%r RGD Fw Na 16078.000 , 24' +/ 2"x6" PRESSURE TREATED I AILS B 2"X6" PRESSURE TREATED 2"x6" ACQ SLEEPERS RAILING CAP W/ CHAMFERED EDGE 2"X6" FLOOR JOISTS ® 16" O.C. W/ H8 I I TIMBER GUARDRAIL HURRICANE STRAPS 2"X6" PRESSURE TREATED RAILS 3'-6" I I 2"X6"- PRESSURE A TREATED DECKING 4"x4" PRESSURE - 12' TREATED RAILING I 2"X6" FLOOR JOISTS ® 16" POST 1 I I O.C. W/ H8 HURRICANE STRAPS 2"X6" PRESSURE ° TREATED DECKING 2„ ° 2"X6" ACQ SLEEPERS EXISTING CONCRETE SLAB ON GRADE SECTION B-B DETAIL N.T.S. TIMBER DECK PLAN DETAIL N.T.S. 2"X6" PRESSURE TREATED RAILING CAP W/ CHAMFERED EDGE TIMBER GUARDRAIL I I 3 2"X6" PRESSURE 1'-9" TREATED RAILS 0 iu 2"X6" PRESSURE I I 3'-6" TREATED DECKING 2"X6" FLOOR JOISTS „ ® 16" O.C. W/ H4 1 -9 3 HURRICANE STRAPS I I s ° N " B J1/2016 LFC ADD DDAENSIONS CPD TIMBER BOLTS DATE BY DESMMON APPW m STAGGERED ;� 0 GALV. ° V. BY W/ PLATE WASHERS2.. REVISIONS N AND HEAVY HEX NUTS TOWN OF SOUTHOLD 2"x6" ACQ SLEEPERStl.a LL SUFFOLK COUNTY NY as 4"X4" PRESSURE TREATED POST MATTITUSHADEESHELTER BEACH 00 1 1 loll EXISTING MECHANICAL THRU BOLTED W/ J"O GALV. o CONCRETE SLAB FASTENERS AS CARRIAGE BOLTS WITH PLATE ' DEC 2 2 2016 i` TIMBER DECK DETAIL 1 0 ON GRADE REQUIRED WASHERS AND HEX NUTS �, I g SECTION A-A DETAIL �- L Ic. Mc UY ASSOCIATES, P.C. mm OKWW M6 SOUiht;Id TOy,_ —���J a„a�,,.a By YCR/CF sm� AS NOTED �'N"• m oa of Trus ees o N.T.S. o D�W. YCR Dda JUNE 2016 4 a ,.WFC. LP kcll ypf. , -Y• kc, t 4i APPw'b Bl^• RGD Foe Na 16078.000 _ 1K Al A Lo K McLean Associates, P. C 437 South C:ountrn Road a Brookhaven Ne,.ti York 11719 CONSULTING ENGINEERS (63 1)286-8668 FAX(631)286-6314 Associates EUGENE F DALY P E P T O E"' PRESIDENT and C E O CHRISTOPHER F DWYER RAYMOND G DiBIASE. P E P T O E.-" 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. ANDREW B SPEISEP September 1,2016 n.4ATTHEW C JEDLICKA LEED AP Mr. John Bredemeyer 54375 Main Rd. P.O. Box 1179 py Southold,NY 11971 RE: TOWN OF SOUTHOLD - MATTITUCK BREAKWATER SHADE SHELTER MATTIITUCIK, NEW YORK LKMA No. 16078.000 Mr. Bredemeyer: Thank you for consideration of the bending 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(ivill be finalized and sent oars when hearing dale is assigned) 5. Application Affidavit 6. Agent Authorization 7. LWRP Consistency Assessment Form 8. Drawing Set, includingsite 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:Ifc Clu-istopher F. Dryer. Associate L. K. n7cLean Associates, PC. Enc. (8) Cc: Commissioner Michael Ryan,Mattituck Parks District w/enc. LKMA-Fi]`e;Copy w/enc. Founded in 1950 ,�tit�fl} SUU��I� John M.Bredemeyer III,President Town Hall Annex 74375 Main Road Michael J.Domino,Vice-President " P.O.Box 1179 James F.King, Trustee Southold, New York 11971-0959 Dave Bergen,Trustee Telephone (631) 765-1892 Charles J. Sanders,Trustee l l(?� ���', Fax(631)765-6641 BOARD OF TOWN TRUSTEES ES TOWN OF SOUTHOLD WETLAND or WETLAND-COASTAL EROSION APPLICATION CHECKLIST Completed Application — Original plus three (3) copies containing all of the following: n Detailed project description (pgs 2, 6, & 16) including dimensions or square footage of all proposed or existing structures. See § 275-6. DR] Short Environmental Assessment Form through pg. 3 (Pail 2 - for office use only). O Authorization Form to be completed and notarized by current property owner. ❑ Agent Authorization (where applicant is not the owner) to be completed by current property owner. F Applicant/Agent/Representative Transactional Disclosure Form to be completed by homeowner and any,agent/re presentative. ❑x LWRP Consistency Assessment Form. ® Survey of property in its current state. See § 275-6. Fxj Project Plan must be to scale. with dimensions and a side elevation view. See § 275-6. x❑ Photographs current photos of subject area" See § 275-6. ❑x Application Fee for a Wetland Permit is $250.00. Application fee for a Wetiand Permit & a Coastal Erosion Permit is $500.00. Check made payable to: Town of Southold. d The applicant is responsible for staking/marking out the proposed project prior to the date of the Board of Trustee Field Inspection. Upon receipt of a completed application to this office; the project will be reviewed by the Building Department. If the project requires a Zoning Board of Appeals variance, the application will be held until a determination is made by the ZBA. John M.Bredemeyer III,President �`���Q� Q Town Hall Annex F.d ll> 54375 Main Road Michael J.Domino,Vice-President P.p.Box 1179 James F.King,Trustee Southold, New York 11971-0959 , Dave Bergen,Trustee ^ Telephone(631) 765-1592 Charles J Sanders,Trustee f'r on, Fax(631) 765-6641 GU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Offiee Use 011:1 ' _Coastal Erosion Permit Application �tJetland Permit Application `_ Administrative Permit _Amendtnent/Transier,'E-xtension _ Received Application. _Received Fee. r _ _Completed Application: _incomplete: _SEQRA Classification. Type I Type 11 Unlisted —Coordination:(date sent)• _LAIRP Consistency Assessment Porn: _CAC Referral Sent:_ Date of Inspection. Receipt of CAC Report 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 IVLImber: 631-298-9103 Suffolk County Tax Map Number: 1000 - 99-02-191 _ — Property Location: NORTH TERMINUS OF BREAKWATER ROAD,WHERE THE ROAD MEETS THE LONG ISLAND SOUND DIRECTLY WEST OF THE MATTITUCK INLET (provide LILCO Pole 4. 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 ofro ert PARK P p y� _--_ 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 detennined 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-1-4738-01061/00003 EFFECTIVE 8-24-2016 THROUGH 8-23-2021 No prior permits/approvals for site improvements. Has any pen-nit/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 TO-FiJRNlSH--TIIrf N(3RET-E-PATIO-AiTAEE STING 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 FEATURES IN FRONT OF AND-BEHIND THE CEHL. THE ST-RUCT-URE- Vttt-BE�ERtY-MANUFACTURED,ENGINEERED AND INSTALLED BOTH TO EFFECTIVELY WITHSTAND CEHA AREA FORCES AND TO MAXIMIZE LIFESPAN. Board of Trustees Application, WET) AICD/TRUSTE ELANDS APPLICATION DATA Purpose of the proposed operations: THE MATTITUCK PARK Dls9TRLCT SEEKS TO ENHANCE TH -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 TIMBER -D tNG CONCRET FA I IU, I HEREBY REDUCING TRIP DS; 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 _ Bio Closest distance between nearest existing structure and upland edge of wetlands: +383' _ 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 flled7 0__ __ cubic yards Depth of which material will be removed or deposited: 3+/- feet Proposed slope throughout the area of operations: _ �% _ 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 WITH ALL RELEVAOASTAL NSI-AND ERQSIGNI GONTRO4GUIDELINES 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 ATTFMP CT_f'6 f—NMDA WETLANDS LOCATED OVER:PY FROM PROJECT AREA,EITHER DURING OR AFTER CONSTRUCTION. Board of Trustees Application COAS'T'AL 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 (3� S001, Town Hall Annex John M.Bredemeyer III,President Michael J. Domino,Vice-President ,;J �O 54375 Main Road P.O. Box 1179 James F. King,Trustee i ILKS Southold, New York 11971-0959 Dave Bergen,Trustee Charles J. Sanders,Trustee �O. � ,'' Telephone(631) 765-1892 /.{'COU + �a +' 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) 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 importarA naturalr our / atys C / ,� �. "arizsi at of rec __- Notary Public B.PROKOP Notary Pu lic,State of New 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, rl.. I`' John M.Bredemeyer III,President r I LI � SQ�� Town Hall Annex Michael J.Domino,Vice-President 54375�� 1� 54375 Main Road 'S P.O.Box 1179 James F, King,Trustee tl, }`.; Southold,New York 11971-0959 Dave Bergen,Trustee Charles J.Sanders,Trustee Telephone(631) 765-1892 �_ �� t4 I� Fax(631) 765-6641 �DUNT'(,' ,I 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#1 000- 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 important natural resource features. Notarized signature of own of record Notary Pubra DAVID B.PROKOP Notary public,State of New York Qualified in Suffolk County my CommisNo.4977533 sion Expires Feb.04,211 6, This maintenance agreement shall only be valid upon the attachment of a licensed land surveyland or site plan made within one year of the original construction and validated to show the final approval of the administrator. John M.Bredemeyer III,President ;`'r,��� S `�/%' Town Hall Annex Michael J.Domino,Vice-President 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee 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- 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 Zr ees th 'sa' ck of maintenance would risk life, property or important naJur6l resource atures. rized signature of owner of reo rd ,J Notary Public • B.PROKOP Notary tale of NewYo* Qualified uffalk county No.4 533 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. 617.20 Appendix B Short Environmental Assessment Form Instructions for Cowleting Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part L Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I 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 I. 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 I -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 LE 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 I Name of Applicant of Sponsor Telephone. 631-298-9103 MATTITUCK PARK DISTRICT MATTPARKDIST@OPTONLINE NET Address:` -- ----- - ------ ---------- --- – -- �I 11280 PECONIC BAR BLVD P 0.BOX 1413 Slatel- Zip Code. MATTITUCK I NY 11952 11. Does the pioposed action only involve the legislative adoption ofa plan, local la�\,ordinance, i NO YES administrative rule or regulation? _ If Yes.attach a narrative description of the intent of the pi0llosed action ana the environmental r,!SourceS that U f may be affected in the municipality and proceed to Pail 2 If no,cnnfinue 110 question 2 ?.. Does the proposed action iequiie a permit,approval of fundin€ from any other governmental Agency^ 11N6 YES , if Yes. list agency(s)name and permit ni approval: i I� NYSDEC TIDAL WETLANDS APPROVAL RECEIVED 3 a.Total act eage of the site of the proposed action's 2187 —act es b Total acreage to be physically disturbed? <010 acres c Total acreage(project site and any contiguous properties)o�%ned of controlled by the applicant or project sponsor" 21.87—act es 4. Check all lana uses that occur on. adjoining and near the proposed action. F-1 Urban [:J Rural (non-agriculture) ❑Industrial F-1 Commercial ❑Residential (subw-bwn) ❑Forest ❑Agriculture EJ Aquatic ❑Oihei (specify) ®Parkland Page I of 4 5. Is the proposed action, NO VFS I N/A a A permitted use under the zoning regulations? ❑ ❑ b. Consistent with the adopted comprehensive plan? ❑ ❑x ❑ 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? N® YES If Yes,identify: X❑ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? N® YES ❑ ❑ b.Are public transportation sen ice(s)available at or neat the site of the proposed action? I1 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action" LL�❑JJ ❑ c Does the proposed action meet of exceed the state energy code requirements? NO VES if the proposed action will exceed requirements.describe design features and technologies: - NOT APPLICABLE -1 10 Will the proposed action connect to an existing public/private Waml supply" Pv'OVES ---— 1 if No desciihe method for piovidinr;potable water NOT APPLICABLE ❑ (--1 C1 i Will the proposed action connect to existing wastewaiel utilities" NO VES If No,descrlbc method foo providirq, wastewatei IIcaullcnt NOT APPLICABLE (-1 - l i 12 a Doc;the site contain a Stl uctwe that is listed on either the `:tate of National Register of I llstoi is NO I'1?S' Places", - h Is the proposed action located 11) an ttrc=hc;aLJ lciiI alea"lotscnsnit-c ---- �j E]1; ;t Dees any pr-mon orlhe site ofthc proposed action.or lauds adjoining tIIC piuposed:Ictn:,n.contain, NO VES Ll121wetlands oI other waterbodies regulated by a federal.stale of iocal ageney^ b Would (lic proposcd uwun physiCall) altC1,UI LnCrGSC11 II110 an`,'is\ISUIIg WL:11RI1d OI wal6lhod' ❑ t�l If Yes IdentliV tri! v,,ctland of \4•iitL-I'bC`dV and Lxlelll of allemiIons In gquarc tett of acre: ---J- ill Identify the typical habitat t-ypes that occur on,or are likely to lie found on the project site i:he:,k all that apply. ®Shoreline ❑Forest ❑Agi lcullmal/grasslands ❑Ear l),mio-successional ❑ Wetlan-i ❑Ui ban ❑Suburban i Does the site of the proposed action contan-'any species of animal,ur associated habitats listed l TVO �'ES by the State of Federal gave;nmenl as threatened or endangei ed9 i X 16. Is the prglect site located in the 100 year flood plain? j NO ! YES --❑-� ❑ 17 Will the proposed action create storm water dlschaige.either fioni point oI non-point sources' NO FYES- I f Yes. X a.141ill Storni water discharges flow to adjacent properties" ❑NO ❑1 ES ❑ b Will stolen watei discharges be d-rected to established conveyance systems(runoff and stor'ui drains)? if Yes,briefly describe ❑NO ❑YL-S Page 2 of 4 i S. 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,dant)? If Yes,explain purpose and size: _-- I 19, Has the site of the proposed action or an adjoining properly been the location of an active or closed ? O 'ES l solid waste management facility? l if Yes,describe: _ Fx1 ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing of NO j YES completed)for hazardous waste? If Y es,describe I AJ I A.I.aFtRitt THA T I HE INFORMATION PI2OVIDl',€1 ABOVE 113 TRUE ',NF) ACICURA T F TO 1"RE'' REST OF MY KNOW'LEDIC I CHRISTOPHER F DWYER L K.MCLEAN ASSOCIATES i P,i;i-1licantlspGnsor nam:,; I>aic I Part 2 - Impact Assessment. Thr Lead Agency is responsible, fns the comple(ion of f=at•( 2 Ans(vcl all of the following quesunns ill Part 2 usull;the information contained it, Pal i I and olhel maid lak subnlitted by the project sponsor u1 olllelwisr avall;lhle to the levlewer Villien inrN viing(lie (I(lect,ons the Ievlelvcl should he g lld,:d by the concept"Have illy Ics11011ses 1-.cell Ioasor]able oonsidel ing the senle and context ol'the piciposed actioilV" -- - - -- ----- — -----1do;or- Nliodetatr sntal! in impact I impart II VCCtIt OCC(SI � I Will the proposed action orente a matemd contll'i wilh an Adopted land use 111,111 (n /onlne r le'2�'111�I111>i15� (.� I Will tile plops -d action le!�llh 111.1 Chilnr(' Irl the LISe X11 11110151t_,'ill rlsc nl land" 3 Will the plopostd action Inlpail the characiel of gtlalil� if the existin-ccnnnuullil 4 Will tele proposed actmrl have an impact rill Ule cuv(lannlentnl ch;IMCICrlstics that causCd the ,;StabIishl]1e111 of a(_'riiic,-1 Envii-oninewal Arca(C_'lli%)? 5. Will the proposed Action result In an adverse change In the existing level ohumfic ul af';eci existing Infrastructure for plass transit, biking or walkway? I b Will the proposed action cause an increase ul the use of energy tmd a fails to inemr{_-nratc _ reasonably availablc energy conservation of renewable enemy opportur,tires9 7 Will the proposed acnoll nllpacl existing: - — I -- n a public/ptivatc water supplies% I--f 1 I__.1 1 b public/private\VaS CWEtCI-Ireatlllellt auli(IeF° L. 11,1-111 the proposed action impair U-10 Chic atter or'quallt� of inlportuni histol ie ar-:lmcologlcal. (� _ aicllttectural of aesthetic resootces" _ l^! F-1 9 !'1'iil the proposed action result in an adverse change to natural Icsourecs(e-e, wedands. f - waterbodies_orou ICINValer. stir qualit)', flora and fauna)? L❑ ❑ Page 3 oJ'4 No,or Moderate small to Iarge impact I impact r may may occue occur 10 WiII the proposed action result in an increase in the potential for erosion.flooding or drainage I problems? El 1:1 1 1 Will the proposed action create a hazard to environmental resources or human health? Pert 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 of 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 (� C'hecl, this box if you have detertrnned, based on the information and analysis above,and am•suppof tura documeatat=on, IJ that the proposed action may itsult in one or more potentially large or significant adverse irnpacts and ar environmental impact statement is rcquired Check this boy: ifynu have determined,based nn the information and analysis above,and am•Cuppuittng dcctnnentation. that the proposed action will not result in any significant ads-erse environmental impacts Town of Southold Nainc of Lead Agency Dale Prrnstdsnl Print of Type Nome of Respru;ible Oflicei in Lead Agency Title of I esponsibf,�Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different front Responsible Ofticer) PRINT � Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACK CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK COMMISSIONER MICHAEL RYAN , residing at 11280 PECONIC BAY BLVD. P.O BOX 1413,MATTITUCK, NY 11952 , being duly sworn, deposes and says that on the day of _ _ , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite 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 _ ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of 20 Notary Public NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: MATTITUCK PARK DISTRICT-BREAKWATER BEACH SCTM#1000-099.02-19.001 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: CONSTRUCT A SHADE SHELTER AND RE-FACE EXISTING CONCRETE PATIO WITH TIMBER DECKING 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: NORTH TERMINUS OF BREAKWATER ROAD,WHERE THE ROAD MEETS THE LONG ISLAND SOUND DIRECTLY WEST OF THE MATTITUCK INLET 3. That the project which is subject to Environmental Review under Chapters 96,11,1 and/or 275 of the Town Code is open to public comment on: DATE: You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME- MATTITUCK PARK DISTRICT MAILING ADDRESS: 11280 PECONIC BAY BOULEVARD P.O.BOX 1313,MATTITUCK,NY 11952 ` PHONE #: 631-298-9103 AGENT: L K.McLEAN ASSOCIATES,P.C. MAILING ADDRESS: 437 SOUTH COUNTRY ROAD,BROOKHAVEN,NY 11719 PHONE #:_ 631-286-a068 Enc: Copy of sketch or plan showing proposal for your convenience. Board of Trustees Application 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. Signae4ProOwner SWORN TO BEFORE ME THIS DAY OF Notary Public DAVID B.PROKOP Notary Public,state of NewYodc Qualified in Suffolk County No.4977533 My Commission Expires Feb.04,204 Board of Trustees Application AFFIDAVIT MATTTITUCK PARK DISTRICT COMMISSIONER N4GK DEEGAN BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE 'TRITE 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 ANIS 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 Propertyllowner SWORN TO BEFORE ME THIS DAY OF20 14 ------ DAVID B.PROKOP Notary P lie Notary Public,State of New York Qualified in Suffolk County No.4977533 My Commission Expires Feb.04,20-9 Board of Trustees Application AFFIDAVIT MATTTITUCK PARK DISTRICT COMMISSIONER GERARD GOEHRINGER BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SITE IS THE APPLICANT FOR THE ABOVE DESCRIBEID PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,ARID 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 I_D RING THE TERM OF THE PERMIT. Signature of Property'Owner SWORN TO BEFORE ME THIS 1 K, DAY OF _S t-� , 20 16 ' I -- Notary P B.lic Notary ublliic State of New York Qualified in Suffolk County No.4977533 My Commission Expires Feb.04,209 4,209 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) j, COMMISSIONER MICHAEL RYAN __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. (Ow e ' at e -- — ^- Board of Trustees Application AUTHOPJZA'TION (where the applicant is not the owner) 1, 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) Board of Truoteeo Application AITY'H®PJZATION (where the applicant is not the owner) I, COMMISSIONER GERARD GOEHRINGERreSlding at 11280 PECONIC BAY BLVD. (print name of owner of property) (mailing address) P O BOX 1413,MATTITUCK,NY 11952 do hereby authorize w_ (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) Town of Southold LWRP 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 proposed action will be evaluated as to its si ugi fieant benef civil and adverse etiects upon the coastal arca(which includes all of Southold 'To,"I1 . 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. Theis, csacli answer insist be explained in det.aal, lasting both supportiaar and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards mid 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. D Board of Trustees I. Category of Town of Southold agency action(check appropriate response): n (a) Action undertaken directly by Town agency(e.g. capital l_J construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval, license,certification: 1E Nature and extent of action: THE MATTITUCK PARK DISTRICT IS PROPOSING TO INSTALL A 25'WIDE X 40'LONG STEEL (POWLIFEGUARD-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 OTHE$I 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 AVE DUNE-OR-C@AtTAt:-F-E:ATtfRE-THA-Vtl TING-- 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( 1_T_631-298-9103 (d) Application number, if any:__._ Will the action be directly undertalcen,require funding, or approval by a state or federal agency? Yes E 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 POLICE' Policy I. Foster a patterns of development in the Town. of Southold that enhances community character, preserves open space, snakes efficient use of infrastructure, snakes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III- Policies; Page 2 for evaluation criteria. [:x]Yes ❑ No F-] Not Applicable THF PRnSFD SHADE sHFLTFR AN TIMBER DECKING WILL INCREASE THE BENEFICIAL USE OF AN EXISTING COASTAL PUBLIC PARK BOTH WILL BE DESIGNED AND CONSTRUCTED IN A 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 T ) C -- — 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 E 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 ❑ loot 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 THE IXISTING CONCRETE PATIO AND ENHAN-05-IBE-VJSUALpu IA iTY nFT PARK Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimizze loss of life, structures, and natural resources from flooding and erosion. See LWRI? .Section III—Policies Pages 8 through 16 for evaluation criteria 1-1 Yes ❑ No FLIJblot 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 LVVW Section III—Policies; Pages 22 through 32 for evaluation criteria. El ❑ Ex] Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the 'Town of Southold. See ]L` RP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ Noy❑ 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. 1:1 Yes 1:1No Fx 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 LWIgP Section IFI—Policies; Pages 38 through 46 for evaluation criteria. Ye❑ No❑ Idiot 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 TIMBER DECKING WILL SERVE TO COVER THE EXISTING CONCRETE PATIO THEREBY REDUCING TRIP AND FALL HAZARDS AND THE POTENTIAL FOR 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 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 ❑ Tho 0 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 0 Not applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold, See LVVRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ 'des ❑ No❑ Not applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources, See LVd1RP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ Into E Not applicable PREPARED BY CHRISTOPHER F DWYER,L.K.McLEAN ASSOC-TITLE ASSOCIATE DATE 8-31-2016 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: MATTITUCK PARK DISTRICT (Last name,first name,tftiddle 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 ffi Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(ot through your aunpany,spouse.sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship-includes by hlood,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 ofiicci ur cmploycc 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 SubmitteVMATTI y f S 2W Zdtb Signatur PrintNa I"-- &� Form TS I R OF PARKS DISTRICT APPLICANVAGEmTTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethicsrohibits conflicts of interest on the nari of town officers and emnlovees.The uuru s4,c cif this form is to�mvide infomtation which can alert the town of possible conflicts of Interest and allow it intake whatever action is necessary 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 w— 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 Df Southold? "Relationship"includes by blood,utarriage,or business interest."Business interest"means a business, including n partnership,in whi4h the town officer or employee has even a partial ownership of(or employment by)a corporation in which tate 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); 13)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 , d of Signature Print Name I EG N Form TS I COMMISSIONER OF MATTITUCK PARK$DISTRICT APPLICANT/AGENT/REPRESENTATIVE TRANSAC'TIONAL DISCLOSURE FORM The Tawn of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and ernpioyees.The purpose of this form is to provide inforinntion which can alert the town of possible conflicts ofintereat and nilow it to take whnteser action is ne scary to avoid same. YOUR NAME: MATTITUCK PARK DISTRICT (Last name,first name,griddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's'or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone _ Coastal Erosion _ 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,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 5%of the shares. X YES _ NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(tile 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); 13)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 *** Signatory is a member of the Town of Sou o' Zoning oar o Appea s Submitted this da q ,{ k,--WLt- 299?°l6 slgnallue Print Name GERALD C,QZ41J-F-R (�o ettir:nN er Form TS l COMMISSIONER OF v 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 employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow,t to take whatever action is necessary to avoid same. YOUR NAME: _ L.K.McLEAN ASSOCIATES, P.C. (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 ctivity.).—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? "Relationships'includea by blood,nlaii iage,or business interest."Business interest"means a business, including a partnership,in which the town officer o, employee has even a partial ownership of(or employment by)a corporation in which the town office, or employee owns mole 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 day of 200_ Signature Print Name CHRISTOPHER F.DWYER,✓ASSOCIATE_ Form TS 1 L.K.McLEAN ASSOCIATES,P.0