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Home My WebLink AboutTR-9555A Michael J. Domino, President %opo 06o` Town Hall Annex John M. Bredemeyer, III, Vice-President ,�'_ < ; 54375 Route 25 Glenn Goldsmith c N z P_O. Box 1179 A Nicholas Krupski3 y Southold, NY 11971 Greg Williams �ol , �a:*% Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES r YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW n ' INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/2 constructed V When project complete, call for compliance inspection; l Michael J.Domino,President SD(/rTown Hall Annex John M.Bredemeyer III,Vice-President ,`O� �� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski N G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 U01 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9655A Date of Receipt of Application: August 20, 2019 Applicant: Tony & Maria Kostoulas SCTM#: 1000-21-2-13 Project Location: 1035 Aquaview Avenue, East Marion Date of Resolution/Issuance: October 16, 2019 Date of Expiration: October 16, 2021 Reviewed by: John M. Bredemeyer, III Vice- President Project Description: To plant 250 Native Switchgrass (Panicum virgatu) as groundcover and to retain existing trees; remove dead and invasive species. 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 Planting Plan prepared by Jennifer Garces, Landscape Designer, received on August 20, 2019 and stamped approved'on October 16, 2019. 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. l This is not a determination from any other agency. Michael J. Domino, President Board of Trustees ANY ALTERATION OR ADDI770N TO 77-IIS SURVEY IS A VIOLATION OF SECTION 72090F 774E NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICA77ONS SURVEY OF PROPERTY HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID"MAP OR COPIES BEAR THE IMPRESSED SEAL OF 774E SURVEYOR A T EAST MARION WHOSE SIGNATURE APPEARS HEREON. lo*o TO WN OF SO UTHOLD z4s,, SUFFOLK COUNTY, N. Y. .1J 1000-21-02-13 S�°4�4S�F ��U�1� SCALE: 1'20' 4 NOVEMBER 2, 2004 nFC/NF �s, NOVEMBER 18, 2004 (REVISIONS) FEBRUARY 9, 2006 (FINAL) ' 1 M RK y/GH 44, "e 4, "eR rjD AUG 2 0 2019 80770M OF BANK N 3 Guthold Town 16.8 ShfO y 3 BO of Trustees ~ N Lo N �B�C FR SHEO N V W O � Q Q O m eqy�o, j FE LLJ 0.41E cr_ c Q 10-01 B Z O FEX Ll 1. 1.8'W k � W Ir O Unum m HOT i i I POLE J 7UB L4 Q --� ---, DECK LL Jay 9.2• Luk INEOL U SECOND F(/�, DECK Z Z 2 2 sry3 � t CZ LINE OF`FL 7y FE 8.9' b 0.31E OVER 1sfyFLR. DECK PROPANE 0 aLR• DECK TANK �-•1 Ci 4 Wq.E v 702p b DO' o i SHED ��o 1.4'WOF 5 &q' 970• T. MI i a �I�jy' ; ' �, Y.S. LIC. NO. 49618 4 ho PECO -- ORS, P.c. ■=MONUMENT (631) 765-5020 FAX (631) 765-1797 AREA=10,872 SQ. FT. P.o. BOX 909 1230 TRAVELER STREET TO TIE LINE SOUTHOLD, N. Y. 11971 04-285 . r i_/fir 4 - ��--°—' KOSTOULAS RESIDENCE APpRV � B Y Aq,uaview Avenue "BOARD OF 1 .UST--17S E`List Marion Nein York TOWN OF SUr}._ SURVEY WORMATION TO N Pecorvc Surveyors Southold New York c G PLANTING PLAN SHED concrete .AUG 2 0 2019 l- / / � / \I — pad Existing Trees /I\ (250) Panicum virgatum (Native Switchgross) // \ DECK TO THE ROAD Jennifer Gorces Landscopp Designer Summer 2017 Scale P' = 10 - 0' ,r fr I L'_� JP E I ' AUG 2 0 Soul • :'n _: ''E held Toti�, �L •;.��'��,.,��s: B rd of & S 't ranicum vir�dyatu V Native 5witckgrass Description: Panicum virgatum,or Common Switchgrass, is a native grass to all of the United States except Califor- nia and the Pacific Northwest. It is a perennial sod-forming grass that grows 3 to 5 feet tall and can be distinguished from other warm- season grasses, even when plants are young, by the white patch of hair at the point where the leaf at- taches to the stem.The stem is round and usually has a reddish tint.The seed head is an open, spread- ing panicle. Erosion Control: Switchgrass is perhaps our most beneficial native grass on a wide range of sites. It is a valuable soil stabilization plant on sand dunes,dikes,and other critical areas. Once established, Native Switchgrass can grow roots as deep as ten feet making it one of the most effective erosion control plants available. Wildlife: Switchgrass provides excellent nesting, and fall and winter cover for pheasants,quail,and rabbits. It holds up well even in heavy snow.The abundant seeds provide cold season food for pheasants, quail, turkeys, songbirds,and other species of wildlife. Michael J. Domino, ident o��s>�FFO(�' Town Hall Annex John M. Bredemeyer II1, Vice-President �� ,,,` 54375 Route 25 Glenn Goldsmith y P.O. Box 1 179 A. Nicholas Krupsid Southold,NY 11971 Greg Williams y p� Telephone(631)765-1892 `��l X Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: AD A 9"70 Completed in field by: Patricia C. Moore, Esq., on behalf of TONY & MARIA KOSTOULAS requests an Administrative Permit to plant 250 Native Switchgrass (Panicum virgatu) as groundcover and to retain existing trees; remove dead and invasive species. Located: 1035 Aquaview Avenue, East Marion. SCTM#: 1000- 21-2-13 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet 'Public Notice of Hearing Card Posted: Y / N Ch. 275_ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / M. Domino �G. Goldsmith / N. Kru ski Present were: J. Bredemeyer p /G' . Williams Other AA 41 •; ;!l r-I XV - � 5 Kz _ f _ tol ,rc k IR IP • Ott}. `, ��:��, � � � e +�� y / #Y „�f..fir � ,..� ,�(,'�•}:} f..4/• �ti' Y�, ;, .. �j- � a�i11`r4�„�. °'t•. '7� _ 10/ A 2019 9 : 53 r Tony&Maria Kostoulas > , 1035 Aquaview Avenue,East Marion r f Y ;- SCfM#: 1000-21-2-13 P ` 10/9/19 r / PIP 31 IN 1 44 t� tom_+;.i - ; *• '^ s t - klr `+. d ,a. _ •-fit -_'s:. y.. '- t ! a` r a W .urs #. _ � na • i '1 •ri' ♦6 - �- ans J��', y. •l ,. ♦ r..��'�C r1Y�� t �.. �s y.%' 'A •Ai�t�� ,'�+ ... ° � 11 t ' 1J 'w tic , .�.. �,. � 1 ��► a t w J � �- � � I ,Y jai t�"{'9► � �,,, .rrx ,a � , Michael J. Domino, t UFFO(/�o -Town Hall Annex John M. Bredeme er III Vice. resident G -54375 Route 25 Y �. y,a Glenn Goldsmith y a P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams ��?, p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ylru V� �'Sa Completed in field by: J-. k Patricia C. Moore, Esq., on behalf of TONY & MARIA KOSTOULAS requests an Administrative Permit to plant 250 Native Switchgrass (Panicum virgatu) as groundcover and to retain existing trees; remove dead and invasive species. Located: 1035 Aquaview Avenue, East Marion. SCTM#: 1000- 21-2-13 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA TYp e: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non=Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for-outside review/consultant/application completeness/comments/standards: Loy, o /h At d 41) Ge rein Oy-ttj P✓� eY �o- Q1� /l✓S c �m + it-u�o �y I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredem6yer M. Domino G. Goldsmith N. Krupski G. 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N3TEsw,E�6oeo.No.a.\o9En w w 9 � w w ,e IO 5� 5 m Sm 10 \" , e \T• y0 ,\P I6' w\9 BLJO 30 lrt� M 12 2a W 2 % 1"w �+ A e / 11A m rxOPoT oPEx>s.cc 11 8 2 e 10 9 w 11A�- I 1BA ^� 16e w T 1 3 w' 1.OA / ♦ 5 T 18 a Q w" N OB �m r.0 OZO"w OPFa etxcE POR PCL.N 9 y SEE SEC N FOR PCL,N ry. 21 16 31-01-0013 SEE SEC.NO ,y yN ]0-01013 w ♦ s s° �° 8 ` 19 m' g ,3 fo MATCH —� LINE SEE SEC.NO 030 +i b 1 A2rV 7 O N SI SECTION NO NOTICE �90,� COUNTY OF SUFFOLK E °` .9 L Real Property Tax Service Agency Y ,o"� 21 E a.x.aae.� —_�_ mm R71 .x Gxnry GnMr IIr9Tx0,N111.1 M a0 . M-a arra a r•• —_— ^""" --•-- o•�•`••--•••-- r,x x m P ® comhwox n.re sw�utm� PROPERTY MAP OFFICE LOCATION: ®� q ® y®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) crs Southold,NY 11971 ® a� Telephone: 631 765-1938 ® Fax: 631 765-3136 C®UNTy,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: October 10, 2019 Re: LWRP Coastal Consistency Review for J SCTM# 1000-21-2-13 Patricia C. Moore, Esq., on behalf of TONY & MARIA KOSTOULAS requests an Administrative Permit to plant 250 Native Switchgrass (Panicum virgatu) as groundcover and to retain existing trees; remove dead and invasive species. Located: 1035 Aquaview Avenue, East Marion. SCTM#: 1000-21-2-13 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of,Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department,'as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP provided the following is considered to further Policy 6. 1. Require survival rates for the planted vegetation. Will temporary irrigation be installed? 2. Clarify which species are to be removed. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Michael J. Domino,President 0� soyo Town Hall Annex John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 coo A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams a,ycDUNTFax(631) 765-6641 Y,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only nn Coastal Erosion Permit Application D E C E L etland Permit Application Administrative Permit AUG 2 0 2019 Amendment/Transfer/Extension /� Received Application: g�O•I7 Received Fee: $ 100,00 Soutliold Town Completed Application: I -( Poardo Trustees Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: �Coordination:(date sent): LVYFRP Consistency Assessment Form Sent: CAC Referral Sent: _74Date of Inspection: Receipt of CAC Report: t Technical Review: Public Hearing Held: D Resolution: Owner(s) Legal Name of Property (as shown on Deed): iond S-ov 145 Mailing Address: 2 3 ;t �� t2eoaz� &,q I7 /2lrS'Se_1' �� X�D Phone Number: J 1 G 7;;?y " O/ y 5� Suffolk County Tax Map Number: 1000 - A/ — Property Location: (If necessary,provide LILCOO Pole#, distance to cross streets, and location) AGENT (If applicable): /u-/�✓eCec, /! �D/LG �- A Mailing Address: 0?,CD AY A(97/ Phone Number: 6 31 74J ' 13 00 Board of Trustees Ap] cation GENERAL DATA Land Area(in square feet): 1 6& J Area Zoning: ya Previous use of property: /loac e zti,IA a27d Sk7i-c Intended use of property: tia17,�Y /45/y�5 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? Yes X 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 Y, No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date /a- as-9a /%/ a�-�� C--bH,4 ,Oe�44' 47 T u� s--gl r-5py No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X, No Yes If yes, provide explanation: Project Description (use attachments if necessary): T/ # Alai v,� ��w,fz�r vtu �/��4 JG 1If Gra 41vn ) al's APe awel te�fZP/owd ely/sfM Board of Trustees ApI cation WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 10 f��'!'l P C�'¢ awo/ /!'Warr/ -e '5.'neG/ic Area of wetlands on lot: CI " square feet Percent coverage of lot: S*i� Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: fee Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: O feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 159cl //ted /rirn71-elol 171P;z 1af7J;r 160,S1W 4y 4-c eyAaA��in� 5v�i��zl�rlSS �o 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): Board of Trustees ApI cation COASTAL EROSION APPLICATION DATA Purposes of proposed activity: wGi/pw- nkat 1 k&"gw - c4cf �/G�1/ G2 // i1d'(l/� S�lP�/�S �'C'��C��Gi� �CC • f�)tos iW �7OTA ad �i�OU�7G� Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: 1941 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) 04�Wd f l7jW "CJ' `/VV09 See res 10ah ip -w,h- VSs 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 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 I-Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): CO"3SP Got / )4, ./ Brief Description of Proposed Action: /cry+t o?s o p f Name of Applicant or Sponsor: Telephone: 7/ v f /l�(L /Gt /C(� ��U t S E-Mail: Address: oZ 3 2 Doge 1�?or Cl City/PO: - - State: Zip Code: - - 114"hg_(fe/- I /`y 4/030 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: ❑ 3.a.Total acreage of the site of the proposed action? SO/ acres b.Total acreage to be physically disturbed? -00/ acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? r 0/ acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural (non-agriculture) ❑Industrial ❑CommercialResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. is the proposed action, NO YES N/A a A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ Pr ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 0 Elb.Are public transportation service �4 s)available at or near the site of the proposed action? 2r ❑ 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: A/ ❑ 10. Will the proposed action connect to an existing public/private water supply? I NO YES If No,describe method for providing potable water: Z�/� ❑ 11.Will the proposed action connect to existing wastewater utilities? LL// NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Q ❑ b.Is the proposed action located in an archeological sensitive area? a ❑ 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 w__ater_b_o_dy? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: T f2��.°Clcla,�G �Cv�- S ✓e�y,�c/ fOt�ia' fJ'�P/�Z/�'./a'PSS 14. Id tify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest ❑Agri cultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban F1 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? D� ❑ 16.is the project site located in the 100 year flood plain9 NO YES d ae)dAglniv ) ' 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? [✓]ANO DYES ❑ b.Will storm water discharges be directed to established conveyance systems(runo nd storm drains)? If Yes,briefly describe: [v 0 AYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: E?f ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE y Applicant/sponsor nam Date: 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 l 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 ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ El 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 1 El 5. Will the proposed action result in an adverse change in the existing level of traffic or El 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 El ❑ 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? El 8. Will the proposed action impair the character or quality of important historic,archaeological, El ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage El ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? ❑ 0 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. EICheck 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. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 i Loard of Trustees Application County of Suffolk State of New York TONY KOSTOULAS AND MARIA M. KOSTOULAS BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. tYSTOU' LAS MARIA M. KOSTOULAS ��p�f<- �'°', p °r �,�'cs� /v,2�L °G692� Sworn to before me this WC J7y-1-j day of � J-7, 2019 , / ° � do9 Notary Public CONSTANTI G KARRAS Notary Public,State of NewYork No.01KA4882380 Qualified In NewYork County ]D Commission Expires January 05,20-:�:/ D E E 7 SEP ® 4 2019 Southold Town Board of 1rustees Board of Trustees Apl_ nation AUTHORIZATION (Where the applicant is not the owner) I/We, G4.vL -6V/ S &,.Uj 'Inn 5f-ovk-� , owners of the property identified as SCTM# 1000- in the town of New York, hereby authorizes to act as my agent and,handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. roperty Owner's Signature -- - ---- --'Pt/,rt O s-Si re - - - SWORN TO BEFORE ME THIS DAY OF , 20 Notary Public " ` J 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 necessM to avoid same YOUR NAME: ,�/IG4,Lta (Last name,fust name,piddle Initial,unless you are appl ing in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION:. (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",none the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.`Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO 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 rovided: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 y o ,20= Signature Print Name Form TS 1 Location of action: as% lVaI110A) Site acreage: ' Present land use: 110Ztd4- AA6�GeP� � /� ��eG�' r- eew 119ad. Present zoning classification: 0 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: -:P— _Gd (b) Mailing address: C;?3J De/ey' �c�. mom hafScl //O_5r'® (c) Telephone number: Area Code( ) (L�(� �a y" O (d) Application number,if any: Will the action be directly undertaken,require funding,or approval,by a state or federal agency? Yes ❑ No 11J/� If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require'that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Pies ❑ No ❑ Not Applicable t � �e�x /. ,�.VrV,,ry d®gid "ey 11VV iU+/ ae�cc�rrhJ , 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 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 non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME^ o�y t �Q��G 'p - as 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 El construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action: - �'` AA-tlA e2M oVa7`71VP 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 01 r`c SaGr 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 2Not 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 1:1No u Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. { Yes No `dxiof Applicable Attach additional sheets if necessary Policy 7. , Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wasdNot es. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 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. ❑ n Yep--1 No MNot Applicable Attach additional sheets if necessary WORKING COAST FouICIES 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 0Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages 62 through 65 forevaluation criteria. F-1Yes El No 'U Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Polic=pplicable 65 through 68 for evaluation criteria. [:] Yes ❑ No PREPARED BY4 TITLE DATE