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HomeMy WebLinkAboutTR-11006A Glenn Goldsmith, President o�OcpfFOC�-CoG Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski y P.O. Box 1179 Liz Gillooly 0 • wry Southold,NY 11971 Joseph Finora 'fj� p���' Telephone(631)765-1892 . Ol �a . Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed %\ Project complete, compliance inspection Glenn Goldsmith,President ®F S®�/�� Town Hall Annex 54375 Route 25 Nicholas Krupski,Vice President �O� ��® P.O. Box 1179 Eric Sepenoski l�[ Southold, New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Joseph Finora Fax(631) 765-6641 c®UNT'1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 11006A Date of Receipt of Application: August 10, 2026 Applicant: Nicholas Edward & Katherine Shillo Beardsley SCTM#: 1000-9-4-11.5 Project Location: 810 Equestrian Avenue, Fishers Island Date of Resolution/Issuance: September 16, 2026 Date of Expiration: September 16, 2029 Reviewed by: Board of Trustees Project Description: Pump out and fill in existing cesspool with sand; remove existing trees in order to install a new Fuji Cen-5 I/A OWTS sanitary system; install silt fencing to be maintained throughout construction; and all disturbed areas to be loamed, seeded and stabilized. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by CHA, received on August 10, 2026, and stamped approved on September 16, 2026. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees 18" MANHOLE (TYP) 18" MANHOLE (TYP) 24" MANHOLE (TYP) DISINFECTION Drawing Copyright©2026 TEST HOLE DATA CYLINDER (OPTIONAL) FG ±22 OBSERVED BY: PETS PARENT, P.E. CI-IA _...}.. _.... PROVIDE CLEAN-OUT TO GRADE 04/13/2026 1"_O 2" 1 -2 /-2 FROM FOUNDATION WALL (TYP) EXISTING GRADE (TYP) :e> 34 . __ 0"-10" TOPSOIL WM PUMP CHAMBER PROPERTY LINE 10"-24" LOAMY SAND SUBSOIL (SM) 32 ; ... .. _._ ..... .__...._ _. _ .. _..._._._._-...._..._ _ ._ .__ .. _...__.._ _._.. :r- " " FC +3i0 5 24 -96 FINE SAND (SP) 30 : _... . . _... _. . . .. Mph)- DISTRIBUTION BOX ` F, '!' 9•5.{ --- Capital WATER ENCOUNTERED ® 60" 28 ` __-- F. + 7.0 fMIN) _G *27.0 (M N) G 400 Rocky Hill,CTr06067e 301 EXPECTED SEASONAL HIGH GROUNDWATER AT ELEV. 17 26 , _____ _. ._.... .._. .... . - 860 257-4557 1 www.chacompanies.com SOIL_CLASSIFICATIONS __,_.. 5'-5" NY Certificate of Authorization#0021745 PIC - PLYMOUTH LOAMY COARSE SAND 8-15% SLOPES 4'-4 �" 4'-3 " 4'-2 �" FOUNDATION WALL 25.01 m 24.91 -24.71 _._._^.F._.__. .__._....__.. ______.._.._................ _.. .... WEST ReC - RVVERHEAD VERY STONY SANDY LOAM 8-15% SLOPES -_ "" " I ±20 119,53 _ ELEiI!. 17 _..__..._. ..... _... . __... .......__..._..... �yC _. MAXIMUM ANTICIPATED I GRCUND��'ATER ELE1'ATION _ ....._.._ _ .._....._..__ SITE Q I/A SEPTIC SYSTEM FOR 6 BEDROOMS 19.115 19.15 14 !. _ . _ . _...._._ ..... _ . -...... _. PROVIDE 2 L.F. 4" C.I. PIPE BETWEEN HOUSE AND CLEAN-OUT. 19.36 12 LOCATE CLEAN-OUT 2' FROM FOUNDATION WALL. FUJI CLEAN CEN-15 - PROVIDE FUJI CLEAN WASTEWATER TREATMENT SYSTEM - MODEL CEN 5 10 _...._.___. (500 GPD CAPACITY - MAXIMUM 4 BEDROOMS) PROVIDE THREE ROWS OF TWO CONCRETE GALLERIES ' (6 GALLERIES AT 51 SF PER UNIT PROVIDE 306 SF OF SIDEWALL AREA) 7'-10 WASTEWATER TREATMENT SYSTEM SHALT_ VENT THROUGH THE SEWER PIPE. A HOUSE TRAP SHALL NOT BE INSTALLED UPSTREAM OF UNIT. NO ADDITIONAL VENTING IS REQUIRED FUJI CLEAN CEN-5 0+00 MAINTAIN r/FT PITCH 0+50 1+00 NOT TO SCALE �ON ALL SANITARY LINES PRIOR TO FUJI CLEAN TANK THREE ROWS OF TWO 30 LEACHING GALLERIES INVERT ELEVATIONS NOTE: RISER COVERS SHALL WEIGH AT LEAST 60 LBS. OR HEALTH CODE SYSTEM PROFILE BOTTOM OF LEACHING GALLERIES.-23.00 �O 6.0 ABOVE HIGHEST EXPECTED APPROVED SECONDARY SAFETY DEVICES SHALL BE PROVIDED � PREPARED FOR OUTLET AT HOUSE - 20.0 (VIE) SITE DEVELOPMENT PLAN ADAPTOR INLET - 19.70 SCALE: GROUNDWATER (ELEV. 17) y� ADAPTOR OUTLET/TANK INLET - 19.53 1 =10 O PUTATAN OUTLET - 19.36 INLET NICHOLAS BEARDSLEY PUMP CHAMBER INLET - 19. LOCATION MAP SCALE 1 "=400' 810 EQUESTRIAN AVENUE PUMP CHAMBER OUTLET - 19.1 D!STRIBUTION BOX INLET - 25.01 I� 40" -1 DISTRIBUTION BOX OUTLET - 24.91 -= _ �y DESIGN NOTES FISHERS ISLAND, NY LEACHING GALLERY INLETS - 24.71 "OM OF LEACHING GALLERIES - 23.0 1 I 1) EIGHT OUTLETS AND THREE INLETS MAP REFERENCES 2) INLET AND OUTLETS HAVE STATE OPEN A RII " I- 1{}�------ 15 IMP _ _0FUJIM C 80 a I I' ` --- --- 1. SURVEY MAP PREPARED FOR F.I. REALTY HOLDING CORP. APPROVED SEALS THAT ACCEPT I - BLOWER :. q. ... I I------ 15 AMP " ., , 4' S-40, 4'SDR-35, 3' AND 2" PIPE I EQUESTRIAN AVENUE FISHERS ISLAND, NEW YORK ; SCALE: 1 =40; 3) REINFORCED WITH #3 BARS i (] ----Q ALARM DATE: MARCH 12, 1996; BY CHANDLER PALMER & KING NORWICH, 20 AMP I CONNECTICUT 4) CONCRETE STRENGTH 4000 PSI ---- MIN. 28 DAYS i " FUJI CLEAIN " 3 = 2. SURVEY MAP PROPERTY TO BE CONVEYED TO VILLAGE SHOPS, CONTROL PAINEL LLC 14 EQUESTRIAN AVENUE FISHERS ISLAND, NEW YORK"; SCALE: I F- I / MAIN PANEL Q 1"=30'; DATE: 06/22/2007; BY CME ASSOCIATES N =O N L L L - - J J WIRING SCHEMATIC NOT TO SCALE 0 1. THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE 6" SCHEDULE 40 END CAP ADAPTER d3c PLUG DE IN 2„ INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE MUST INSTALL CLEANOUT TO GRADE IN EXISTING 2 STORY. f2.440 SF PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR ACCORDANCE WITH SCDH!S STANDARDS (SEE INSTALLATION GUIDANCE NOTE 7) COMMERCIAL BUILDING EXCEEDS THE SCOPE OF THE ENGAGEMENT. w : , , ' TO BE CONVERTED INTO DISTRIBUTION BOX /W BAFFLE ` 2 STORY, 3 BEDROOM I" / 2. IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY OF NE " NOT TO SCALE f2,440 SF GFA W PERSON UNLESS ACTING UNDER THE DIRECTION OF A LICENSEDl- 6 SDF2 35 PVC RISER PIPING SINGLE FAMILY RESIDENCE o EXTENDED TO GRADE (TYP) EXISTING CESSPOOL TO BE 688' r LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. ,�P �� M. pAR C7,p PUMPED & FILLED WITH SAND PROVIDE FORM WWM-080 3. ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND * �A SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL -7.6 '= ARE THE PRODUCT OF THE LAND SURVEYOR. to ' :' w 50X EXPANSION AREA (TYP) z � , � � � 2.4" " PROVIDE & MAINTAIN A CONTINUOUS LINE OF tE 4. COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND �O 099531 (�� 7.02 SILT FENCE THROUGHOUT CONSTRUCTION GEODETIC SURVEY TRIANGULATION STATION "PROS" ARDfit;SS10 (TYP, SEE DETAIL) 5. SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000 SECTION 009 BLOCK 4 LOT 11.5. ACTING UNDER THE DIRECTION OF A UCENSED PROFESSIONAL " ~6.24"-" � . � .. �, ^ � _. • '�!a.��_'A, � � � IT IS A vlaunoN OF LAW FOR ANY PERSON,UNLESS THEY ARE ENGINEER,ARCHITECT,LANDSCAPE ARCNnECT OR LAND 6. TOTAL AREA = 0.18f ACRES (8,132f S.F.). TO��AN ITEM IN ANY WAY.IF AN noa BEARING THE STAMP OF A LICENSED PROFESSIONAL IS ALTERED,THE ALTERING J 45" 4.53" _ 4.53" ` SURVEYOR SHALL b�TM1P TN LANDSCAPE ARCHITECT OR LAND DOCUMENT AND INCLUDE THE 7. SITE IS LOCATED IN ZONING DISTRICT HB . DATE of SUCH ALTERATION,AND A SPECIFIC DEscRIPnaN / --- • " "" NOTATION'ALTERED BY"FOLLOWED BY THEIR SIGNATURE,THE I O OF THE ALTERATION. 5.4" TOP VIEW SIDE VIEW / ` � 1' MIN. (ELEV. 7.0) t. 2.5' MAX. (ELEV. 8.5) FUJI CLEAN 45' a 1 / GRADE INLET ADAPTOR _ NOT TO SCALE COVER � � �_3r 0� (� 4" INLET PIPE / I - -- .,._ � . . ). � CONCRETE TYP X N / I.t Q) 0 2 " o ELEV. 6.0 APPROXIMATE WETLAND LINE a' I �^ / X W W 4" PIPE 100 o -- -- - - 0 - - - - - 0 FLAGGED BY COLE ENVIRONMENTAL i9 J NEXT GALLEY INSTALLATION GUIDANCE FUVICLEAN SCHEDULE 40 PVC 45-DEGREE INLET ADAPCy TER SERVICES ON 07/19/2026 /' / `` 1. THE FUIJICLEAN 45-DEGREE INLET ADAPTER HAS (4) OPENINGS (3) INLETS AND (1) OUTLET. ALL OF THESE / / z I ®®® ®® ® I ,n WILL ACCEPT STANDARD SCHEDULE 40 FITTINGS. E. L 2 CTHE AP ASPAOCLEAN OUT. ADAPTER HAS A 6 OPEMIING THAT CAN BE FITTED WITH AN 6 SDR RISER PIPE AND j " " / ` /• I D BY BOARD OF 'I t�USTEES 3. ANY UNUSED ENTRY PORTS ON THE FUJICLEAN INMILET ADAPTER SHALL BE CAPPED WITH A 4" SCHEDULE 40 0 7 -6 ELEV. 3.5 TOWN OF SOUTHOLD ADAPTER & PLUG OR A SCHEDULE 40 SLIP CAP' THAT IS SOLVENT WELDED TO A SHORT STUB OF PIPE / ER _ INSERTED AND SOLVENT WELDED INTO THE ADAPTrER PORT. " / s -o .. DATES // E E__ /' COARSE SAND-GRAVEL (SW) v C'elE'm�er IlD r�d.7�1� 4. THE FUJICLEAN INLET ADAPTER SHALL BE SECURED TO THE FUJICLEAN UNIT USING A 4" LONG STUB OF 4" - -, I --`--1C. SCHEDULE 40 PIPE THAT IS SOLVENT WELDED INTTO THE ADAPTER OUTLET END AND FUJICLEAN INLET SO I _ / O) / EXISTINGREMAIN SERVICE CONCRETE THAT THE ADAPTER FITS FLUSH ON THE FUJICLEJAN UNIT. / _ a 4 L-:- _J L` -.-_J ;/. / LEACHING GALLEY GROUNDWATER 5. THE INSTALLER SHALL ENSURE THAT THE SOIL BENEATH THE ADAPTER IS BACKFILLED AND COMPACTED I r /.. / (4 x 8 x 30") SUFFICIENTLY TO SUPPORT THE BOTTOM OF THE ADAPTER AND PREVENT ANY SETTLING OR STRAIN ON THE w- NOT To SCALE ADAPTER OR FUJICLEAN UNIT.. 6. METAL FITTINGS, PIPE, AND CAPS ARE NOT TO BE USED FOR INSTALLATION OF THE ADAPTER. T / 1 NOTES:BASIS OF DESIGN IS 30" GALLERY AS MANUFACTURED L.._...-.. J I -�!. J ` - BY JOI.LEY PRECAST, DANIELSON, CT. 7. MUST INSTALL A CLEANOUT TO GRADE IN ACCORDANCE WITH THE STANDARDS FOR APPROVAL OF PLANS AND LIMITS OF CLEARING & i %�.... / EXISTING ELEC/TELE/DATA SERVICES No. SubmittallRevision App'd. By Date GROUND DISTURBANCE LINE ' CONSTRUCTION FOR SEWAGE DISPOSAL SYSTEMS IFOR OTHER THAN SINGLE-FAMILY RESIDENCES" AND THE r. ` . •. �. TO REMAIN 2. 4' X 8' X 30" UNITS PROVIDE 51 SF OF SIDEWALL "STANDARDS FOR APPROVAL OF PLANS AND CONSTRUCTION FOR SEWAGE DISPOSAL SYSTEMS FOR (LCGD) t4.000 SF I AREA PER UNIT. SINGLE-FAMILY RESIDENCES." ONTROLS & ALARM MOUNTED TO BUILDINGEXTERIOR 1 PROVIDE WEATHER PROVIDE SYSTEM CPROOF ENCLOSURES AS REQUIRED (TYP (ALL COMPONENTS TO BE HARD WIRED) 8. THE FOLLOWING ARE INSTRUCTIONS ON HOW TO IMAKE A SOLVENT WELD FOR ATTACHING PIPING TO THE o FUJICLEAN INLET ADAPTER. I � 28 1. SQUARE PIPE ENDS, CHAMFER AND REMOVE ALL DIRT. w 2. CHECK DRY FIT OF PIPE AND ADAPTER. PIPE SHOULD EASILY GO 1/3 OF THE WAY INTO THE ADAPTER. IF REMOVE & DISPOSE OF EXISTING / I � / PROVIDE FUJIMAC 80RII BLOWER IN VENTED El�r = PIPE BOTTOMS, IT SHOULD BE SNUG. TREES AS REQUIRED (TYP) / / ENCLOSURE ON CONCRETE PAD I In /' So . " ' / INSTALL PER MANUFACTURER'S RECOMMENDATIONS AUG 1 0 2026 3. USE A SUITABLE APPLICATOR AT LEAST % THE SIZE OF THE PIPE DIAMETER. FOR LARGER SIZE PIPE /-� 11 SYSTEMS, USE A NATURAL BRISTLE BRUSH OR RIOLLER. PROVIDE THREE ROWS OF TWO / / ( PROVIDE �4 SCH 40 PVC AIR LINE TO BLOWER / I INSTALL PER MANUFACTURER'S RECOMMENDATIONS Soatlloldlovn Z 4. CLEAN PIPE AND ADAPTER WITH A LISTED PRIMER. (DO NOT USE PRIMER ON ABS PIPE AND FITTINGS. USE 30" LEACHING GALLERIES / I ep�r'of T77I,`.^�s - CLEAR CLEANER ONLY! (TYP. SEE DETAIL) 30 5. APPLY LIBERAL COAT OF CEMENT TO PIPE TO THE DEPTH OF THE SOCKET; LEAVE NO UNCOATED SURFACE. / G PROVIDE FUJI CEN-5 WASTEWATER 6. APPLY A THIN COAT OF CEMENT TO THE INSIDE OF THE ADAPTER; AVOID PUDDLING OF CEMENT. PUDDLING / ;` °: ' /�� ..r"'/ , I � P TREATMENT SYSTEM (SEE DETAIL) o CAN CAUSE WEAKENING AND PREMATURE FAILURE OF PIPE OR ADAPTER. APPLY A SECOND COAT OF /�� " \ / WITH 45 DEGREE INLET ADAPTOR / LEGEND SEPTIC I CEMENT TO THE PIPE. /�1` '?/ \\ / 3 I, PROVIDE DUPLEX PUMP CHAMBER PROPERTY LINE SITE PLAN o/ 7. ASSEMBLE PARTS QUICKLY. CEMENT MUST BE FLIUID. IF CEMENT SURFACE HAS DRIED, RECOAT BOTH PARTS. ABUTTERS LINE -- O (LIBERTY PR0680-SERIES OR EQUAL) o / EDGE OF PAVEMENT 8. PUSH PIPE FULLY INTO ADAPTER USING A 1A TURNING MOTION UNTIL PIPE BOTTOMS. EDGE OF GRAVEL ------------------- coo 9. HOLD PIPE AND ADAPTER TOGETHER FOR 30 SECONDS TO PREVENT PIPE PUSH-OUT - LONGER AT LOW Q EXISTING CONTOUR --- XX --- TEMPERATURES. WIPE OFF EXCESS. LOAM. / �# / / RETAINING WALL ^ ^ Designed By: Drawn By: Checked By: SEED & STABILIZE ALL � 10. ALLOW 15 MINUTES FOR GOOD HANDLING STRENGTH AND 2 HOURS CURE TIME AT TEMPERATURES ABOVE 60 t4f',. •/� ` . � � DEGREES FAHRENHEIT BEFORE PRESSURE TESTING UP TO 180 PSI. LONGER CURE TIMES MAY BE REQUIRED DISTURBED AREAS (TYP) v N` . / 2�� / FENCE �5' �'; r... r ' ' /�P \+� PMP PMP r AT TEMPERATURES BELOW 60 DEGREES FAHRENHIEIT OR WITH PIPE ABOVE 3 INCHES. DO NOT TEST WITH °`' ;:' /�,� "` \� / -\ PROVIDE DISTRIBUTION BOX (SEE DETAIL) OVERHEAD WIRES - -- _ _ __ Issue Date: Project No: Scale: Z AIR. <`; : >, ,,, ,�^.;,_ /S� - •� / \�(/ / NOW OR FORMERLY NIF 07/21/2026 106344 1"= 10' v NOTE: THE SET UP/CURE TIME IS DEPENDENT ON SEVERAL FACTORS. THE PIPE SIZE, SOCKET FIT, AMBIENTr1V / UTILITY POLE -!- TEMPERATURE, RELATIVE HUMIDITY, SOLVENT CEMENT USED AND THE SYSTEM OPERATING PRESSURE SHOULD ALL \"`►►►„/ / BOUNDARY POINT O Drawing No.. o BE CONSIDERED WHEN DETERMINING SET UP CURE TnMES. �po _ . V 10 5 0 10 DRILL HOLE DH O GRAPHIC SCALE IN FEET MONUMENT o SHEET 1 IRON PIPE IP! r SOUT HOLD TRUSTEES No. IIOo issu ed To Address. Ave.. ��s�•ers is1w., .THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN, OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 Glenn Goldsmith,President �o�OSOF FBI,�cOGy Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski W ,? P.O.Box 1179 Liz Gillooly �.y • ��� Southold,NY 11971 Joseph Finora �l �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: ZR 2 4 Completed in field by: Al•( e����1� Cole Environmental Services on behalf of NICHOLAS EDWARD & KATHERINE SHILLO BEARDS LEY.requests an Administrative Permit to pump out and fill in existing cesspool with sand; remove existing trees in order to install a new Fuji Cen-5 I/A OWTS sanitary system; install silt fencing to be maintained throughout construction; and all disturbed areas to be loamed, seeded and stabilized. Located: 810 Equestrian Avenue, Fisher Island. SCTM# 1000-9-4-11.5 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt. 275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: U IILelt Owy �I�t Flve? = WWLj �y Ste ghua }rtif A'A-0 e1 ail' Mfr+lmw� n(6Lc4 Present Were: G. Gold mith _N. Krupski E. Sepenoski G Ilooly --7ZJ. Finora Drawing Copyright 0 2024 F r k V NI IF AUG 1 0 2026 NIFQ 400 Capital Boulevard,Suite 301 DEBORAH S It -EST STREETgUK Rocky Hill,CT 06067 SHILLO 86 -257-4557 1 www.chacompanies.com Ecuffiold own NIF —rorard o"Trustees HENRY L FERGUSON SITE MUSEUM INC. NIF It VILLAGE C LL GREEN / /' pep SHOPS SURVEY MAP PROPERTY TO BE CONVEYED TO: POLE t /,4- 0 #251 ICHOLAS BEARDSLEY L (15 (N I J 0 U F_ L(-,�, _1e & I.PIPE LU _J L_"I < KATHERINE SHILLO 3� BEARDSLEY LL. 100-46* 0 S 82*23'00- E iv �'' LOCUS MAP: NOT TOALF 011 (� MAP REFERENCES STEPS EDGE OF PAVEMENT 3 Z) 0 Lill Go I_ C)I I, - 1. "SURVEY MAP PREPARED FOR F.I. REALTY HOLDING CORP. EQUESTRIAN AVENUE FISHERS ISLAND, NEW YORK", SCALE: 1"=40'; DECK DATE: MARCH 12, 1996; BY CHANDLER PALMER & KING NORWICH, O� NEB X20,99 CLEV., CONNECTICUT ,31. 57' zi DECK 2. "SURVEY MAP PROPERTY TO BE CONVEYED TO VILLAGE SHOPS X21.29 X , GRASS AREA -Kc/ RAMP LLC 14 EQUESTRIAN AVENUE FISHERS ISLAND, NEW YORK"; SCALE: o I METAL 1"=30'; DATE: 06/22/2007; BY CME ASSOCIATES C) PAVED PARKING i C O 0 C FENCE 1w-it o- . AREA D LL NOTES osi ONE 1. THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE LANO d 4 INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE RES'I)ENT14L PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR X21.49 UNIT 0 IT IS A�ou-nm of LAw FOR,my PERSON.UNLESS THu ARE EXCEEDS THE SCOPE OF THE ENGAGEMENT. ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL lYS28 SQ. ® 0 ENGINEER,ARCHITECT,LANDSCAPE ARCHITECT OR LAND FT. 0 9 SURVEYOR ALTER AN ITEM IN ANY WAY,F AN ITEM BEARING THE W M N S_0 of LICENSED PROFESSIONAL IS ALTERED,THE ALTERING (on two floors) z 2. IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY ENGINEER,ARCH TECT,LANDSCAPE ARCH17ECT OR LAND 0; 0 SURVEYOR SHALL STAMP THE DOCUMENT AND INCLUDE THE I P I) , UNLESS ACTING UNDER THE DIRECTION OF A LICENSED NOTA 0/ C) PERSON UE TN TION"WERM BY FOLLOWED BY 7WR SIGNATURE.THE DATE OF SUCH ALlmnON,AND A spEanc DESCRIPTION 01 LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. OF THE ALTERATION. b 10 __ — ID�I I waft 0) W i 0 0 22 z 3. ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND 0 FULL z Lu U HOLE SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL (FOUND) ARE THE PRODUCT OF THE LAND SURVEYOR. 4. COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND PROJECT LOCATION: CONC. WALL METER GEODETIC SURVEY TRIANGULATION STATION "PROS" 810 EQUESTRIAN AVENUE z X30.20 X"')52 5. SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX V MAP 1000, SECTION 009, BLOCK 4, LOT 11.5. FISHERS ISLAND 18" 6. TOTAL AREA = 0.18± ACRES (8,132± S.F.). NEW YORK SYCAMORE 7. SITE IS LOCATED IN ZONING DISTRICT 'HB". 24" ------ MAPLEW X /I \��\ � � I LLJ X170.86 X30.95 CL POLE CERTIFIED TQ* C2 7 NICHOLAS EDWARD BEARDSLEY AND KATHERINE SHILLO BEARDSLEY No. Submittal/Revision App'd, By Date J LL- 26— FIDELITY NATIONAL TITLE INSURANCE CO. \ 0 \\26" IN ACCORDANCE NTH THE MINIMUM STANDARDS MAPLE FOR TITLE SURVEYS OF THE NEW YORK STATE Q01 LAND TITLE ASSOCIATION. TI TLE NO. 4- " / v�. MAPLE 14'\ — MAPLE LPIPE (FOUND) LEGEND PROPERTY LINE ABUTTERS LINE EDGE OF PAVEMENT 4, EDGE OF GRAVEL ------------------- 01V 18" EXISTING CONTOUR TITLE SURVEY GRAVEL MAPLE 110, FENCE RETAINING WALL A 70Y PARKING 0 OVERHEAD WIRES NOW OR FORMERLY NIF Designed By: Drawn By: Checked By: UTILITY POLE NIF BOUNDARY POINT 0 --- NBC CB, HENRY L FERGUSON X33.81 DRILL HOLE DHO MUSEUM INC. WOOD TIE Issue Date: Project No: Scale: IRON PIPE IPO 01-05-2026 , 106344 1" = 10' MAPLE MONUMENT E) MONUMENT Drawing No.: 10 5 0 10 GRAPHIC SCALE IN FEET SHEET 1 0F 1 425 Montauk Highway --- East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management PHOTO SHEET NICHOLAS EDWARD BEARDSLEY & KATHERINE SHILLO BEARDSLEY 810 EQUESTRIAN AVENUE FISHERS ISLAND, NY 06390 SCTM No.: 1000-009.00-04.00-011.005 PHOTO 1—AERIAL FROM ABOVE 41 .. `♦ �,r�1 ' �' * '','��� (., yr- - !. �'� .W a ,.- -,I► J R" V 4. T * � 5 ♦ ,n�L�J..fit....v � :�.Jt _..'..I -,M ^.- �� 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management PHOTO 2—AERIAL FROM ABOVE , �; +" •rho .,,t` ' � SN, r , PHOTO 3 —AERIAL (FACING EAST) •fS.4 ,iR. 1 .. 4� \tit �` � • Cole E vim me tal Servic •, • WGIVI I I IN � . kN. r h p v .•' d ' 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management PHOTO 6—GROUND LEVEL (FACING EAST) r,+"• 4 e✓ 3 ti s. is s; i �� J ♦ 4006 p PHOTO 7—GROUND LEVEL (FACING NORTHWEST) 4 1 dp oo-,>BB W r a B ' w 98 Bw,sr � O BTNcI B.. � ' d• �1x p, s ; M o°'I�12 ap n � ..w... �� z n � m. 1 • p�'�"..bi �2 3..:, s i),n r � mo ,zu � Ip "CT ynS 2. z-za IT_citwcr s .. +� ('VESY ST Owl '�p1 Dg1 sl•nwew i i t, 0 7 r. 5, t y �P• �. p..,... 3 s0'fe i 1 '4 HAY HARBOR �a4<I `"1 ¢ s w E✓� v' �` _ a om uz•'� (2) aB•c .z P � °t<, }: � ar`.� � _u_�dfw�F •a�eh, a• 'i;�i� 'rM`.;S. )+a 34 25A x 31Nc1 3 t i �.,e ` H R8k 32 M1 e Jw r. 3 riMc) p s.Wg11)\ 'mow 1111 1 •R .i.x 3 why :8' 24)v) 1> g}Mi (12) $ s ` s y �� ��.' � l w • .. z }w� .. r• gl �q.' ETTRICK > ,. �„�<) w r r ALI r ) B• A ,• i IAi, Zr• 2A 8, }A t 24 1 ILI 21� 'b A 1•'M S zP� _s +d .1 M • b S °y, I.rA : •, t.•Ta 'A .y�P •(p y, F 1Bi t 4irm) ,Irulel J < it iN •)s r A 1P .off >♦ '.t ,1a B.1 ' A X Y ...... >,.....�.r. — / COUNTY OF SUFFOLK U N NOTK;E K 100p srcrKsl No U ,�— �.�, Rcil Ru err Tax Service:l enc .+rerac4 suson v �> r.. .rw..r _. P _ Y R Y - E yy srNnns,na+nrr.wrwncK ` n — Pne..a,e.W R En M 009 J. OFFICE LOCATION: ��OF SD yO MAILING ADDRESS: Town Hall Annex ,`O lO P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 . Q Telephone: 631 765-1938 wu�m,��' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees Cc: Honorable Lori Hulse, Attorney From: Heather Lanza, AICP, Planning Director LWRP Coordinator Date: September 14, 2026 Re: LWRP Coastal Consistency Review NICHOLAS EDWARD & KATHERINE SHILLO BEARDSLEY, SCTM #1000-9.-4-11.5 This application is to pump out and fill existing cesspool with sand as per SCDHS; install I/A OWTS System; install system controls and alarm on dwelling exterior in weather proof enclosure; install system blower in vented enclosure on concrete pad with 3/" PVC airline to blower; & remove trees as needed to install I/A system. The proposed action has been reviewed under Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the policies of the LWRP as follows: Policy 5. Protect and improve water quality and supply in the Town of Southold. 5.1 Prohibit direct or indirect discharges that would cause or contribute to contravention of water quality standards. C. Ensure effective treatment of sanitary sewage and industrial discharges by. 3. modifying existing sewage treatment facilities to provide improved nitrogen removal capacity. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction The proposed installation of an Innovative/Alternative Onsite Wastewater Treatment System (I/A OWTS) is consistent with Policy 5.1.C.3 which calls for the replacement of existing sewage treatment facilities with one that has improved nitrogen capacity removal. The proposed I/A OWTS will reduce nitrogen inputs into adjacent waters. The proposed I/A OWTS system and leaching pools are consistent with Policy 6.3.A, which states that actions must comply with the Southold Town Board of Trustees' laws and regulations.. The proposed I/A OWTS meet their wetland setbacks in Town Code Chapter §275-3(D)(1)(a)[4] Septic tank: 75 feet. The proposed leaching pools are inconsistent with Policy 6.3.A, which states that actions must comply with the Southold Town Board of Trustees' laws and regulations. The proposed leaching pools are within the 100 ft. required setback and they should be moved back as far as possible. The proposed action has been reviewed under Chapter §268, Waterfront Consistency Review of the.Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. 2 Glenn Goldsmith,President Town Hall Annex{�,�` ��,� �i;,,ry, `;_, A.Nicholas Krupski,Vice President �S'Fly�.. 54375 Route 25 ti r :l P.O.Box 1179 Eric Sepenoskit i Southold,New York 11971 Liz Gillooly } cn S: ) �{ G , Telephone(631) 765-1892 Elizabeth Peeples 4.,``,i� '�► r°f' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only --~ P Coastal Erosion Permit Application D i, Wetland Permit Application C Administrative Permit AUG 1 0 2026 ` _Amendment(Transfer/Extension Received Application: V 10 I '� Received Fee: S '15*n . 0 b Southold Town Completed Application: Board of Trustees Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: _Coordination:(date sent): __)(_LWRP Consistency Assessment Form Sent: OiWA CAC Referral Sent: Date of Inspection: Receipt of CAC Report: _Technical Review: Public Hearing Held: �— Resolution: Owner(s) Legal Name of Property (as shown on Deed); Nicholas Edward Beardsley&Katherine Shillo Beardsley Mailing Address: 614 Fillmore Street, Denver, CO 80206 Phone Number: (303)880-7973 Suffolk County Tax Map Number: 1000 - 009.00-04.00-011.005 Property Location: 810 Equestrian Avenue, Fishers Island, NY 06390 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable):Cole Environmental Services Mailing Address:425 Montauk Highway, East Quogue, NY 11942 Phone Number: (631)369-9445 Email: iWo N Coe 2tiyrro imenlilyeryices. Coin. , 1 i i + 1 i h, ES- 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631) 369-9445 _ Wetland Project Management Nicholas Edward Beardsley& Katherine Shillo Beardsley 810 Equestrian Avenue Fishers Island, NY 06390 SUM No.: 1000-009.00-04.00-011.005 Project Description Existing cesspool to be pumped and filled with sand as per SCDHS. New Fuji Cen-5 OWTS with 45 degree inlet adapter to be installed. OWTS to include hard-wired system controls and alarm mounted to building exterior in weather proof enclosure. FUJIMAC 80RII blower to be installed in vented enclosure on concrete pad with %" SCH 40 PVC air line to blower. Cen 5 to connect to duplex pump chamber and three rows of two 30" leaching galleries. Temporary silt fencing shall be installed and maintained throughout construction. Existing water and electric services to remain. Existing trees to be removed as required for system installation. All disturbed areas to be loamed, seeded, and stabilized. Existing cesspool is 52.0' away from the approximate wetland line and the new proposed system is 69.6' away from the approximate wetland line. www.ColeEnvironmentalServices.com Board of Trustees Applica"wn GENERAL DATA Land Area(in square feet): 8,132 sq. ft. (0.18 acres) Area Zoning:HB Previous use of property: Commerical Intended use of property: Residential Covenants and Restrictions on property? Yes __Z_No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? LiYes _ZLNo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. is project re any demolition as per Town Code or as determined by the Building Dept.?rT Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: - Agency Date Q✓ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_L'L No_n Yes If yes,provide explanation: Project Description(use attachments if necessary): Please see attached project description. Board of Trustees Appli.catxun WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To install new septic system to meet today's standards and improve water quality. Area of wetlands on lot: 0 _square feet Percent coverage of lot: Approx. 35 Closest distance between nearest existing structure and upland edge of wetlands: 52 feet to existing cesspool Closest distance between nearest proposed structure and upland edge of wetlands: 69.6 feet Does the project involve excavation or filling? ❑ No ✓ Yes If yes, how much material will be excavated? 90 cubic yards How much material will be filled? 50 cubic yards Depth of which material will be removed or deposited: 6 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Typical construction equipment to be used. Excavated material to be used for backfilling. 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): There should be no effect on wetlands. The limit of construction to be contained by silt fencing. 6]Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: 810 Equestrian Ave— I/A Sanitary System Project Location(describe,and attach a location map): 810 Equestrian Avenue, Fishers Island, NY 06390 Brief Description of Proposed Action: Please see attached project description. Name of Applicant or Sponsor: Telephone: 631 369-9445 Cole Environmental Services E-Mail:Info@ColeEnvironmentalServices.com Address: 425 Montauk Highway City/PO: State: Zip Code: East Quogue NY 11942 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ NYSDEC, SCDHS 3.a.Total acreage of the site of the proposed action? 0.18 acres b.Total acreage to be physically disturbed? 0.01 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.18 acres 4. Cher I land us at occur on,adjoining anpliar the prop action. Urban Rural(non-agriculture) Industrial Commercial Residential (suburban) [:]Agriculture Agriculture Aquatic QOther(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: IF] 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: N/A ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: _New I/A OWTS t0 be ❑ installed per SCDHS standards. 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? Project is located in archaeological buffer area. 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ✓ b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. ntify the typic bitat types that oc n,or are likely to be found on t�roject site. Check all that apply: HShoreline Forest Agricultural/grasslands Early mid-successional Wetland HUrban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? ✓ 16.is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO DYES a El b.Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,briefly describe: 5O 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: _ Z ❑ 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: Z ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY. KNOWLEDGE Applicant/spo soar name: Chris Cole,Cole Environmental Services Date7/27/26 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? El ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? S. Will the proposed action result in an adverse change in the existing level of traffic or ❑ El existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ . reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ El or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? El El 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. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees r 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 i 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631)369-9445 Wetland Project Management Nicholas Edward Beardsley& Katherine Shillo Beardsley 810 Equestrian Avenue Fishers Island, NY 06390 SCTM No.: 1000-009.00-04.00-011.005 Proiect Description Existing cesspool to be pumped and filled with sand as per SCDHS. New Fuji Cen-5 OWTS with 45 degree inlet adapter to be installed. OWTS to include hard-wired system controls and alarm mounted to building exterior in weather proof enclosure. FUJIMAC 80RII blower to be installed in vented enclosure on concrete pad with W SCH 40 PVC air line to blower. Cen 5 to connect to duplex pump chamber and three rows of two 30" leaching galleries. Temporary silt fencing shall be installed and maintained throughout construction. Existing water and electric services to remain. Existing trees to be removed as required for system installation. All disturbed areas to be loamed, seeded, and stabilized. Existing cesspool is 52.0' away from the approximate wetland line and the new proposed system is 69.6' away from the approximate wetland line. www.ColeEnvironmentalServices.com Board of Trustees Application AFFIDAVIT Katherine Shillo Beardsley 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. ignature of Property Owner vSignature of Property Owner SWORN TO BEFORE ME THIS 3 �ol .DAY OF _Jam_ , 20� Notary Public PETER CARAMANTE Notary Public My Commission Expires 4/30/2030 i board of Trustees Application AFFIDAVIT Nicholas Edward Beardsley 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. r Signature of Prope4 Owner' Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF J ;20 Notary Public PETER CARAMANTE Notary Public my Commission Expires 4/30/2030 = - - Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, Katherine Shillo Beardsley owners of the property identified as SCTM# 1000- 009.00-04.00-011.005 in the town of Fisher Island New York,hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. ropert wner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS a3 DAY OF J U `1 , 20 a 6 Notary Public PETER CARAMANTE Notary Public My Commission Expires 4/30/2030 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, Nicholas Edward Beardsley owners of the property identified as SCTM# 1000- 009.00-04.00-011.005 in the town of Fisher Island New York,hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Sidbilture Property Owner's Signature SWORN TO BEFORE ME THIS r-Z�J`t DAY OF , 20 Notary Public PETER OARAMANTE Notary Public My Con mission Ex Tres 4/30/2030 - . APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM { The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees,The Purnose of this form is to provide information which can alert the town of nossiblc conflicts of interest and allow it to take _whatever action is necessary to avoid same. YouRNAME: Nicholas Edward Beardsley (Last name,first name,diddle 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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other",name the activity.) __— Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the'l'owri 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 awns more than 5%of the shares. YES NO Ifyou 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 2,� y�of 20 4, Signature '�`- Print Name Form TS 1 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The ToNvn of Southold's Code of Fthics prohibits conflicts of interest on the part of town officers and employees.The nu se of this form is to Drovide information which can alert the town of nossihle conflicts of interest and allow it to take whatever action is necessary to avoid same. YouRNAME: Katherine Shillo Beardsley (Last name,first naine,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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any'oficer or employee of the'rown 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 �o 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)andlor desc4be,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 applicrnt (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 �-� y of Signature Print Name .L�rri�o the. t� Form TS 1 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emnlovees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same, YOUR NAME: Cote Cb e I d o her Cr. (Last name,first name,;nidd(a 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.) i NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other,name the activity.) Do you personally(or through your company,spouse,sibling,parent„or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,.or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES F. NO ! If you answered"YES",complete the balance of this form and date and sign where indicated. jName 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 i 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): f,A)the owner of greater than 5%of the shares of the corporate stock of the applicant EL (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the EIapplicant is not a corporation); C)an officer,director,partner'.or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this r/ day of_ u Ud 20,Z6 Signature Print Name e{irrs Fonn TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this.CCAF;for;, proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in; making a determination of consistency. *Except minor exempt actions including Building_ Permits ;= ' and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt -minor action list, policies and explanations of each policy contained in the Town of Southold Local, Waterfront Revitalization Program. A`proposed action will be evaluated as to its significant' beneficial and adverse effects upon the coastal area(which includes all of Southold Town)...... 3:` If any question in Section C on this form is answered "yes" or"no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. ,Thus, each answer must be explained in detail, listing both supporting and no supporting facts. If an action cannot be certified as consistent with the LWRP policy standards ah 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 -9. -4 -11.5 PROJECT NAME 810 Equestrian Ave— I/A Sanitary System The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑✓ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ - construction,planning activity,agency regulation,land transaction) ❑ ` (b) Financial assistance(e.g.grant,loan,subsidy) k; (c) Pemut,approval,license,certification: ❑ Nature and extent of action: Please see attached project description. Location of action: 810 Equestrian Ave, Fishers Island, NY 06390 Site acreage: 0.18 acres (8,132 sq. ft.) . Present land use: Commercial Present zoning classification:H B 2: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: 4. - (a) Name of applicant: Chris Cole, Cole Environmental Services (b) Mailing address: 425 Montauk Highway, East Quogue, NY 11942 (c) Telephone number: (631) 369-9445 = _ 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, SCDHS C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. ' Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,::: preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes '[:] 'No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria - `❑ Yes 0 No❑ Not Applicable Minimal excavation is proposed. No historic structures, materials, or features are proposed to be altered or demolished. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ✓❑ Not Applicable 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 0 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 0 Yes ❑ ron No LJNot Applicable Existing cesspool to be pumped and filled with sand as per SCDHS and the building will connect to a new I/A sanitary system, which will protect water quality by reducing nitrogen. 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 Z Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria.❑ WE] ] No ✓❑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 0 Not Applicable Attach additional sheets if necessary - Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages i 62 through 65 for evaluation criteria. F1. Yes ❑ No Z 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-Chris Cole TITLE Agent DATE 7/27/26 425 Montauk Highway - -. East Quogue, NY 11942 Environmental Consulting (631)369-9445 Wetland Project Management Nicholas Edward Beardsley& Katherine Shillo Beardsley 810 Equestrian Avenue Fishers Island, NY 06390 SUM No.: 1000-009.00-04.00-011.005 Proiect Description Existing cesspool to be pumped and filled with sand as per SCDHS. New Fuji Cen-5 OWTS with 45 degree inlet adapter to be installed. OWTS to include hard-wired system controls and alarm mounted to building exterior in weather proof enclosure. FUJIMAC 80RII blower to be installed in vented enclosure on concrete pad with W SCH 40 PVC air line to blower. Cen 5 to connect to duplex pump chamber and three rows of two 30" leaching galleries. Temporary silt fencing shall be installed and maintained throughout construction. Existing water and electric services to remain. Existing trees to be removed as required for system installation. All disturbed areas to be loamed, seeded, and stabilized. Existing cesspool is 52.0' away from the approximate wetland line and the new proposed system is 69.6' away from the approximate wetland line. www.ColeEnvironmentalServices.com 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting ; (631)369-9445 Wetland Project Management Town of Southold Board of Trustees � � � � n� 54375 Main Road ® �Vf P.O. Box 1179 Southold, NY 11971 AUG 1020 Re: 810 Equestrian Ave—I/A Sanitary System Nicholas Edward Beardsley& Katherine Shillo Beardsley Southold Town Board of Trustees 810 Equestrian Avenue Fishers Island, NY 06390 SCTM No.: 1000-009.00-04.00-011.005 To Whom It May Concern, The client seeks an administrative wetlands permit to abandon existing cesspool, 52.0' away from the approximate wetland line,and install new I/A OWTS per SCDHS standards 69.6' away from the approximate wetland line. While the existing commercial building is being converted to a residential space, all the work is to occur within the existing footprint and there will be no additions/exterior changes to the building besides the proposed septic system. Please find the enclosed items: 1. 1x Application Fee of$250.00(Check#3916) 2. 1x Original Affidavit,Authorization, and Applicant Transactional Disclosure Forms signed by Nicholas Edward Beardsley& Katherine Shillo Beardsley 3. 1x Original Agent Transactional Disclosure Form 4. 3x Application with attached project description 5. 3x SEAF with attached project description 6. 3x LWRP with attached project description 7. 3x Survey by CHA Solutions dated 1/5/26 8. 3x Site plan by CHA Solutions dated 7/21/26 9. 3x Photo Sheet Please let us know if you need anything additional. Thank you. Sincerely, Summer Looney SummerCaDColeEnvironmentalServices.com Cole Environmental Services, Inc. www.ColeEnvironmentalServices.com