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Home My WebLink AboutTR-6943 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May18,2011 Mr. Peter Drouzas Dmuzas Real Estate Development Corp. 36-26 Gmenpoint Ave. Long Island City, NY 11101 RE: DROUZAS REAL ESTATE DEVELOPMENT CORP. 54120 COUNTY RD. 48, SOUTHOLD SCTM#52-2-20.1 Dear Mr. Dmuzas: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., May 18, 2011: RESOLVED, that the Southold Town Board of Trustees grants the last One-Year Extension to Wetland Permit #6943, as issued on August 20, 2008. This is not an approval from any other agency. Sincerely, Jill I~. Doherty ~/ PreSident, Board of Trustees JMD:lms Jill M. Doherty, President James F. I~ing, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD July 21,2010 Mr. Peter Drouzas Drouzas Real Es(ate Development Corp. 36-26 Greenpoint Ave. Long Island City, NY 11101 RE: DROUZAS REAL ESTATE DEVELOPMENT CORP. 54120 COUNTY RD. 48, SOUTHOLD SCTM#52-2-20.1 Dear Mr. Drouzas: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., July 21, 2010: RESOLVED, that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit #6943, as issued on August 20, 2008. This is not an approval from any other agency. Sincerely, Jl~ lire sM e~°t ,h;?Y:rd~of Tm~ees JMD:lms Drouzas Real Estate Development 36-26 GREENPOINT AVENUE LIC, NY 11101 Office (718) 433-4030 May 13, 2011 Town Of Southhold 54375 Main Road P.O. Box 1179 Southhold, NY 11971 Reference: Permit Extension #6943 Property Address 54120 County Rd 48 Southhold SCTM #5202-20.1 Enclosed fifty dollar check Sincerely, Peter Drouzas Drouzas Real Estate Development Address Dollars AMT OF ACCOUNT DROUZAS REAL ESTATE DEVELOPMENT CORP. 36-26 Greenpolnt Avenue * Long Island City, NY 1 l June 14, 2010 Board of To~al ]'rusto~s Town of Southold Town Hall 53095 Route 25 $outhold, NY 11971 Middl~ Rd., Southold SCTM~.52-2~20...1 To whom it may concern: Kindly extend the Trustee pein'fit for the approved plans in connection with the above- v*ferenced prol~rty. Enclosed Lq the tee of $50 to extend tl~ t~rm~t £*t one (1) ye~c. Peter Drox~zas Address Dollars $ - BOA USTEES PERMIT NO. 694~3 ~ L~ / - ~ yATEf__A_U._GUST 20,2008 ISSUED TO: DRou~~'~q~E DEVELOPMENT CORP. PROPERTY ADDRESS: 54120 COUNTY RD. 48~ SOUTHOLD SCTM#52-2-20.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter t 11 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on August 20, 2008 in consideration of application fee in the sum of $250.00 paid by Drouzas Real Estate Development Corp. and subject to the Terms and Conditions as stated in the Resolution, the Southo of Trustees authorizes and permits the following: Wetland Permit to constr, uct a single-family dwelling, driveway and sanitary system, and to hand-trim a 4' wide path to the water,/with the condition dryweils and gutters are installed in accordance with Chapter 236-Stormwater Management of the Town Code, a line of staked hay bales and silt fence is installed along the 6' contour line prior to all construction activities and maintained until completion of the construction project, and the entire area seaward of the 6' contour to remain as a non-disturbance buffer,/and as depicted on the plans prepared by Zambrano Architectural Design, LLC last dated September 17, 2007. IN WITNESS WHEtLEOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. 51t~ATE.. A~AMOMA~UE TOI~IN: 50U'I'HOLD ~R~EO_ 06-i6-02 0~-21-200~ ~,~. ~~ ~'~'~ ", ', I g - ss ~ ~ ~OPO~ ~EPTIO TO ~ ~E ~'~EP ~ '~ .' . ~' . /_~ ~ --~ - I~O ~ALLON 5E~,O TANK PEEP ~FE~N . I1~ cp.6DI ~O~ ZONE ~ - ~ ~*~,o.~ ~..~.¢.~ To .~'=. JOHN C. EHLER~D SURVEYOR 6 EAST M~ S~ET N.Y.S. LIC. NO. 50202 O~HIG ~GA~E I"= ~O' ~, N.Y. 11~1 369-8288 F~ 369-8287 ~FA~Compaqse~erXpmsX02~02-202E.pro James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 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 V'" Pre-construction, hay bale line V/ 1st day of construction ½ constructed t,/ Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6943 DATE: AUGUST 20~ 2008 ISSUED TO: DROUZAS REAL ESTATE DEVELOPMENT CORP. PROPERTY ADDRESS: 54120 COUNTY RD. 48~ SOUTHOLD SCTM#52-2-20.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on Aueust 20. 2008 in consideration of application fee in the sum of $250.00 paid by Drouzas Real Estate Develonment Coro. and subject to the Terms and Conditions as stated of Trustees authorizes and permits the following: Wetland Permit to construct a single-family dwelling, driveway and sanitary system, and to hand-trim a 4' wide path to the water, with the condition drywells and gutters are installed in accordance with Chapter 236-Stormwater Management of the Town Code, a line of staked hay bales and silt fence is installed along the 6' contour line prior to all construction activities and maintained until completion of the construction project, and the entire area seaward of the 6' contour to remain as a non-disturbance buffer, and as depicted on the plans prepared by Zambrano Architectural Design, LLC last dated September 17, 2007. 1N WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee, Drouzas Real Estate Development Corp, located at 36-26 Greenpoint Ave., Long Island City, NY, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD August 20, 2008 Mr. George Drouzas Drouzas Real Estate Development Corp. 36-26 Greenpoint Ave. Long Island City, NY 11101 RE: DROUZAS REAL ESTATE DEVELOPMENT CORP. 54120 COUNTY RD. 48, SOUTHOLD SCTM#52-2-20.1 Dear Mr. Drouzas: The Board of Town Trustees took the following action during its regular meeting held on Wed., August 20, 2008 regarding the above matter: WHEREAS, George Drouzas on behalf of DROUZAS REAL ESTATE DEVELOPMENT CORP. applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, application dated June 24, 2008, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: the installation of gutters and drywelis in accordance with Chapter 236-Stormwater Management of the Town Code, the placement of a line of staked hay bales and silt fencing along the 6 'contour prior to all construction activities and maintained until completion of the construction project, and the entire area seaward of the 6' contour to remain as a non-disturbance buffer, and, 2 WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 20, 2008, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of DROUZAS REAL ESTATE DEVELOPMENT CORP. to construct a single-family dwelling, driveway and sanitary system, and to hand-trim a 4' wide path to the water, with the condition drywells and gutters are installed in accordance with Chapter 236-Stormwater Management of the Town Code, a line of staked hay bales and silt fence is installed along the 6' contour line prior to all construction activities and maintained until completion of the construction project, and the entire area seaward of the 6' contour to remain as a non-disturbance buffer, and as depicted on the plans prepared by Zambrano Architectural Design, LLC last dated September 17, 2007. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $150.00 Very truly yours, Jam F.~King, Preside'e~ Board of Trustees JFK:lms Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 16, 2008, the following recommendation was made: Moved by Don Wilder, seconded by Jack McGreevy, it was RESOLVED to NOT SUPPORT the Wetland Permit application of DROUZAS REAL ESTATE DEVELOPMENT CORP. to construct a single-family dwelling, driveway and sanitary system. Located: 54120 County Rd. 48, Southold. SCTM#52-2-20.1 Inspected by: Glen McNab, James Ecker[, Don Wilder The CAC does Not Support the application because trees over 8" DBH have been cut down and the proposed dwelling is too close to the freshwater pond. Vote of Council: Ayes: All Motion Carried James F. King. President Jill M. Doherty, Vice-President Peggy A. Dicke~on Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Southold. NY 11971 Telephone(631) 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: DROUZAS REAL ESTATE DEVELOPMENT CORP. requests a Wetland Permit to construct a single-family dwelling, driveway and sanitary system. Located: 54120 County Rd. 48, Southold. SCTM#52-2-20.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Administrative__Emergency Coastal Erosion Amendment Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: __&King __J.Doherty __P.Dickerson __ __ D. Dzenkowski __Mark Terry__other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: Environmental Technician Review- OFFICE LOCATION: Town Hall Annex 54375 State Route 25 Main Rd. & Youngs Ave. Southold, NY I 1971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 To: From: Date: LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD Jim King, President Town of Southold Board of Trustees Scott Hilary and Mark Terry, LWRP Coordinators July 16, 2008 /,uo - 7 Be,¥d of Trustees Re: Chapter 268: Waterfront Consistency Review Request for Wetland Permit for DROUZAS REAL ESTATE DEVELOPMENT CORP. SCTM#52-2-20.1 DROUZAS REAL ESTATE DEVELOPMENT CORP. requests a Wetland Permit to construct a single-family dwelling, driveway and sanitary system. Located: 54120 County Rd. 48, Southold. SCTM#52-2-20.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with LWRP policy standards and therefore is INCONSISTENT with the LWRP. 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 requiremenls of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply wilh Trustee regulations and recommendations as set forth in Trustee permit conditions. The application is incomplete and therefore the potential impacts from the proposed action cannot be adequately assessed at this time. The survey does not indicate all wetlands within a two hundred foot radius from the proposed action and is not in compliance with § 275-6 (8). Furthermore~ during a field visit to the site~ the location for the proposed action was not staked nor was the freshwater wetlands delineated (flagged). § 275-6 Application. A. Contents of application. A permit may be issued upon the written, verified application of the person proposing to perform operations on wetlands. Three copies of the complete application, including all written descriptions, pictures and surveys, shall be submitted to the Clerk. Such application shall contain the following information: [Amended 10-11-2005 by L.L. No. 17-2005] (8) Such apph'cation shall be accompanied by a survey and topographical map, created no more than one year prior to the date of application, with contours at two-foot intervals, showing all wetlands within a two-hundred-foot radius of the area from which the removal or in which the deposit of materials is proposed, or in which structures are to be erected, certified by a registered land surveyor or registered professional engineer, licensed by the State of New York. Such survey and topographical map shah show the soundings of the area in which operations are proposed to be conducted. The horizontal control of said survey shah be based on an approved local coordinate system. The vertical control for elevations shall be based on the United States Coast and Geodetic Survey datum. [Amended 1 O-11-2005 by L.L. No. 17-2005] 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 SouthoM Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulalions and recommendations as set forth in Trustee permit conditions. The distance from freshwater wetlands to the proposed action is approximately 60 feet {see figure #1); a minimum setback distance of 100 feet from the wetland boundary is required pursuant to Chapter 275-3. In the event the action is approved following compliance with § 275-6 {8) Application standards~ please require that the applicant amend the proposed action to meet policy 6.3 to the greatest extent practicable. § 275-3 Findings; purpose; jurisdiction; setbacks. Setbacks. [Amended 10-11-2005 by L.L. No. 17-2005] (1) The following minimum setbacks apply to any and aH operations proposed on residential property within the jurisdiction of the Board of Trustees: (a) Wetland boundary. [1] Residence: lOO feet. Figure #1 Freshwater wetland, Cattail Marsh (Typha spp.) If the Agency~ (Board of Trustees) makes a contrary determination of consistency~ the Agency shall elaborate in writino the basis for its disagreement with their recommendations Pursuant to Chapter 268 Waterfront Consistency Review. § 268-5. Review of actions. H In the event the LWRP Coordinalor's recommendation is that the action is inconsistent with the LWRP, and the agency makes a contrary determination of consistency, the agency shall elaborate in writing the basis for its disagreement with the recommendation and state the manner and extent to which the action is consistent with the L WRP policy standards. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~wOaStal Erosion Permit Application etland Permit Application Administrative Permit Amendment/Trans fer/Eatension ~Rece~vved App lication.'~/12~~ v/Received Fee:$ c~)'~ ~ _. 2~_Completed Application Incomplete SEQRA Classification: Type I__Type II Unlisted__ Coordination:(date sent) --.'L'WRP Consistency Assessment Form (~[~ ~'eAC Referral Sent: --4~ate of Inspection: "] Receipt of CAC Report: __Lead Agency Determination: Technical Review: ,~'Public Hearing Hel~.'--~ Resolution: Address Phone Number:~ ) Suffolk County Tax Map Number: Property Location: 12 o c& q-8 (provide LILCO Pole #, distance to cross streets, and location) (If applicable) / ~X Address: Phone: q 17- o - ~rd of Trustees Applicati( Land Area (in square feet): Area Zoning:. GENERAL DATA ~.-~o Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes4/ Prior permits/approvals for site improvements: No Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? /No Yes If yes, provide explanation: Project Description (use attachments if necessary):. - g~ / ~. '~ ~,~'~ ~,~ ~:'~ ~ i~/,~ ~~~ ~ ~ ' d [ ' ~ _ .~ ..... ~:.. ,,,- -, ~ .... of Trustees Applicatic WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: _~,r~dl¢ ~r~,~] r~fg,~(/~ce Area of wetlands on lot: ,-~, 200 square feet Percent coverage of lot: -?.S' % Closest distance between nearest existing structure and upland edge of wetlands: D [it feet Closest distance between nearest proposed structure and upland edge of wetlands: I ~6 feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? How much material will be filled? ..~g~cubic yards Depth of which material will be removed or deposited: ~ feet cubic yards Proposed slope throughout the area of operations: 6-- ~'e~lc Manner in which material will be removed or deposited: 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): ~rd of Trustees Applicati~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No v/ Yes If Yes, how much material will be excavated? How much material will be filled? (cubic yards) 2~(cubic yards) Manner in which material will be removed or deposited: I Describe the nature and extent of the environmental impacts reasonably anticipated resultin§ fi.om implementation of the project as proposed. (Use attachmeuts if necessary) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT / SPONSOR 2. PROJECT NAME ~-J~/"0U~- ~C~'t ~;~ 'L~v~'~°p~'3L~)¢· County 3 PRQJECT LOCATION: 4 PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map Po0¢: . £c-rm iced - 5z - z - '7.0, i 5. IS PROPOSED ACTION: [~'"~ew [] Expansion [] Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 7, AMOUNT OF ?.AND AFFECTED: Initially)/~ acres Ultimately acres 8. WILL P OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~ [] NO If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~ential []Industrial E~]commercial E~]Agriculture E]Park/Forest/OpenSpace []Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ]Yes ~ If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? I~s ~No yes, agency name and permit / approval: list 12. AS A RES~ OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE iNFORMATION PROVIDED ABOVE iS TRUE TO THE BEST OF MY KNOWLEDGE / Sponsor Name ~l'%001'Z~r,~ J2'~<:;;Li ~,'~-~--, ':i~--¢U'~-/~-Op~'~£~'~C~D~'~- Date: 612slo, Signatu,e fftho action lB a Costal Aroa, and you aro a statB agBncy, complete the Coastal AasesamBnt Form Before proceeding with this as$o$Bment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. B WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 6t 7.6? If No, a negative declaration may be superseded by another involved agency, J---] Yes E~No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C 1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4~ A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5 Growth, subsequent development, or related activities iikely to ~b~'ind~ced by the proposed action? Explain briefly: C6 Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C70 her impacts {including changes in use of either quanti or t e of ener ? Ex lain briefl ' D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AR~A !~_A)~. t!f Y?! ~xP!~!n ~!~fi~/: E. IS THERE, OR IS THERE LIKELY TO E~]Yes E~No BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE E~V!RONMENTAL iMPACTS? If ~/e~ e.x.~!~!~: I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~Ve~determineWhetheritiss~bstantia~~Iarge~imp~rtant~r~therwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi~ determination. Name of Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK "~r, "~lxgu2'cTq' , residing at 2c~ u) (-c~/~) ,-.tb~e.+~ 9~42t~ .la,'lc, )q ~.'-/' i clg~L~ , being duly sworn, deposes and says that on the /~- day of ..gbt/.~! ,200 ~, deponent mailed a tree copy of the Notice set forth in the Board of'l~'ustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the To ~wn, op/~outhold; that said Notices were mailed at the United States Post Office at -ICislr'~ ~_ ~) /~'N"C, that said Notices were ~nailed to each of said persons by (certified) (r~g:.;tcrcd) mail. Sworn to beforexae this / ~ '~ ~ ~... - J~.U._NK..U. t LEE No. 01LE~O~N~ Oulfllfied in Na~l~u CountY C.~te filed in New Yo~ County Commission Ex~i~ July 30, 2009