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AJCC2606PT0NLTNE.NET
Glenn Goldsmith, President Town Hall Annex�°'"�� � „�'" . �
ski,Vice President
54375 Route 25
A. Nicholas Kru
p P.O. Box 1179
Eric Sepenoski 1 Southold, New York 11971
Liz Gillooly "
p Telephone(631) 765-1892
Elizabeth Peeples
Fax(631) 765-6641
u� j '�
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Chapter 275-8 A. "Presubmission conference. Applicants are encouraged to schedule a
voluntary presubmission site visit to discuss the proposed operations with the Board.
Discussions in the field are purely advisory and nonbinding, but this meeting is intended to
facilitate communication between the applicant and the Board. There will be a $50. for this
conference, which may be applied to an application fee for a wetlands permit made within six
months of the site visit and which application involves structures that were the subject of the
site visit."
I HAVE READ THE FOREGOING AND AM AWARE OF ITS CONTENT:
Glenn Goldsmith,President Town Hall Annex
A.Nicholas Krupski,Vice President `�p� ��� 54375 Route 25
Eric Sepenoski ; 'ti P.O.Box 1179
Liz Gillooly
Southold,NY 11971
Elizabeth Peeples { Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time: ferIZZ Completed in field by: �' G'
Suffolk Environmental on behalf of JAMES &VICKY VAVAS to discuss a proposed area of
placement of fill and keep the fill and grade it out. Located: 3165 Bay Shore Road, Greenport.
SCTM# 1000-53-6-7
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland Sound C�Bay
Part of Town Code proposed work falls under: 2Chapt.275 Chapt. 111 other
Type of Application: Wetland Coastal Erosion Amendment
Administrative Emergency X Pre-Submission Violation
Notice of Hearing card posted on property: Yes No "4 Not Applicable
Info needed/Modifications/Conditions/Etc.: A oto rce vi o ki
r�
Present Were: G. Goldsmith ) N. Krupski E. Sepenoski
y L. Gillooly _E. Peeples
Suffolk Environmental Consulting, Inc.
Newman Village • Suite E • 2310 Main Street • PO Box 2003 • Bridgehampton IVY 11932-2003
t 631.537.5160 • f 631.537.5291
Bruce Anderson,M.S.,President
March 24%, 2022 HAND DELIVERED
Board of Trustees
Town of Southold
P.O.Box 1179
Southold,NY
11971
RE: VAVAS Property—Proposed Fill Storage/Request for On-site
Situate: 3165 Bay Shore Road •Greenport,NY• 11944
SCTM#: 1000—053.00—06.00—007.000
Dear Members of the Board,
This firm represents the owner(s)of the above referenced property,who will be seeking a
wetland permit for the storage and/or usage of the on site excavated material thereon.Prior to
making an application,we hereby request a Pre-submission On-Site Meeting in order to illicit
comment from the entire Board pertaining to this project.Attached herewith,please find the
following:
1) Pre-submission On-Site Meeting Acknowledgment,(one[11 original);
2) Owner Affirmation,(one[1] original);
3) Owner Endorsements,(one[1]original);
4) Owner's Open Government Disclosure Form,(one[1]original ea.);
5) Agent's Open Government Disclosure Form,(one[1] original);
6) Sketch depicting the proposed locations of stored top-soil/excavated material,(one(11
original)and;
7) Check made payable to the Town of Southold in the amount of fifty-dollars($50.00)in
satisfaction of the requisite fees.
Thank you for your time and consideration regarding this matter.Should you have any
questions or concerns,please feel free to contact this Office at any time.
Yours truly,
Robert W.Anderson
(enc.)
C.C. J.Vavas
Michael J.Domino,President OF SO(/�y Town Hall Annex
John M.Bredemeyer IIT,Vice-President 54375 Route 25
Glenn Goldsmith P.O.Box 1179
Southold,New York 11971
A.Nicholas Krupski CA • Q Telephone(631)765-1892
Greg Williams ax(631)765-6641
17
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Chapter 275-8 A. "Presubmission conference. Applicants are encouraged torschedule a
voluntary presubmission site visit to discuss the proposed operations with the Board.
Discussions in the.field are purely advisory and nonbinding, but this meeting Is intended to
facilitate communication between the applicant and the Board. There will be a$50.for this
conference,which may be applied to an application fee for a wetlands permit made within six
months of the site visit and which application Involves structures that were the subject of the
site visit."
I HAVE READ THE FOREGOING AND AM AWARE OF ITS CONTENT:
Board of Trustees Application
County of Suffolk
State of New York
James Vavas and Erckv Vavas ,BEING DULY SWORN DEPOSES AND AFFIRIVIS
THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT
ALL STATEMENTS'.CONTAINED HEREIN ARE'TRUE TO THE; BEST OF 'HISMR
KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET
FORTH IN THIS APPLICATION AN' MAY BE App"-- BY THE SOUTHOLD TOWN
BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD
AND THE TOWN TRUSTEES HARMLESS AND FREE FROMANY AND ALL DAMAGES AND
CLAIMS ARISING UNDER OR BY V_ IRTUE OF SAID PERMIT(S), IF GRANTED, IN
COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE.THE TRUSTEES, THEIR
AGENT(S)OR I2EPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIE OF THIS APPLICATION.
1/
Sgaety"r`e.
Signature
I
SWORN TO BEFORE ME THIS DAY OF _Z"_1cyc-4 20 a
ELAINE STAMAS
Notary;Puillc NOTARY PUBLIC STATE OF NEWYORK
KINGS COUNTY
LC.#01 Sit 4880 31
COMM.EXP, -a-a-
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
We, James D. Vavas and Vicky Vavas residing at 152 831d Street. •BrooklynNY • 112o9
do hereby authorize Suffolk Environmental Consulting Inc
To apply for peimit(s)from the Southold Board of Town Trustees on our behalf.
v�
es D.Vavas Vicky Vavas
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of ,hies prob bits conflicts of iriterest on the cart ofthe town officersa ,
which can alert th town of possible conflicts of,nf�r d ens cr v,h�is r , provide information
S end allow rt to take whatever action is Tiecessary to avo�i ,,d aan,y
YOUR NAME: James D.Vavas
(Last name,first name,middle initial,unless you are applying in the name of
someone else of other entity,such as a company.If so,indicate the other
person's or company's name.)
NATURE 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 Town of Southold:
"Relationship"includes by blood,marriage,or business interest."Business interest"means a business,including a partnership,in which the town officer
or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares.
YES NO X
If you answered"YES,"complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check appropriate line A)throug
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 then 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B) the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C) an officer,director,partner,or employee of the applicant;or
D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this day of 202D-
Print name James D.Vavas
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
To oudtold's Code of Ethics prohibits conflicts of interne on the part of the town officers and emnlovees The numose of this
alert c own at m le c flicts of interest and allow take whatever action s to arovide information
void ame.
YOUR NAME: Vicky Vavas
(Last name,first name,middle initial,unless you are applying in the name of
someone else of other entity,such as a company.If so,indicate the other
person's or company's name.)
NATURE 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 Town of Southold?
"Relationship"includes by blood,marriage,or business interest.`Business interest"means a business,including a partnership,in which the town officer
or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares.
YES NO X
If you answered"YES,"complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check appropriate line A)througl
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 then 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B) the Iegal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C) an officer,director,partner,or employee of the applicant;or
D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this day of ala 20
StgnAture tetA (/�_
Print name`ViciwVavas
APPLICANTIAGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSIURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees. The pumgre of
this form is to provide information which can alertthe town of possible conflicts of interest and allow it to take whatever action is
necess •to avoid same.
YOUR NAME: Robert W.Anderson
(Last name, first name,middle initial,unless you are applying in the name of
someone else of other entity,such as a company.If so,indicate the other
person's or company's name.)
NATURE 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 Town of Southold?"Relationship"includes by blood,marriage,or business interest.'Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of the shares.
YES NO X
If you answered"YES,"complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check
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 then 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 of 20 ZZ
Signature�,f
Print name Robert Anderson