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TR-9086
*OF SO�jy Michael J.Domino,President h�� Ql0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 Charles J.SandersP.O. Box 1179 N Southold,New York 11971 Glenn Goldsmith ® a0 Telephone(631) 765-1892 A.Nicholas Krupski �i�`+oU 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 1 st day of construction /%2 constructed i/ Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES it SOUTHOLD, NEW YORK PERMIT NO. 9086 DATE: SEPTEMBER 20, 2017 N ISSUED TO: JOSEPH GRILLO PROPERTY ADDRESS: 365 MESROBIAN DRIVE, LAUREL L SCTM# 1000-145-4-12.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 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 September 20, 2017, and in consideration of application fee in the sum of$250.00 paid by Joseph Grillo and subject to the Terms 14 and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to replace in-place existing 2,180 square feet of first story wood decking; with the condition of the installation of gutters and leaders to drywells; and to establish and perpetually maintain a 10' wide non-turf buffer landward of bulkhead; and as depicted on the S., survey prepared by Nathan Taft Corwin H1,Land Surveyor last dated October 5,2017,and stamped approved on November 28,2017, IN 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. L�FFO� TERMS AND CONDITIONS The Permittee Joseph Grillo residing at 365 Mesrobian Drive, Laurel,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. 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. 2. 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. 3. 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. 4. 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. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 1 6. 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. 7. 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. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's 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. 9. 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. 11. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J.Domino, President ��O¢ S0(/T�o Town Hall Annex John M.Bredemeyer III,Vice-President �� 01 0 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A. Nicholas Krupski Ql a� Fax(631) 765-6641 �COUNT`I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2017 Glenn E. Just J.M.O. Environmental Consulting Services 121 Jessup Avenue P.O. Box 447 Quogue, NY 11959-0447 RE: JOSEPH GRILLO 365 MESROBIAN DRIVE, LAUREL SCTM# 1000-145-4-12.1 Dear Mr. Just: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 20, 2017 regarding the above matter: WHEREAS, J.M.O. Environmental Consulting on behalf of JOSEPH GRILLO applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 14, 2017, 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 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit for the structure, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 20, 2017, at which time all interested persons were given an opportunity to be heard, and 2 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, 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 requirement 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 JOSEPH GRILLO to replace in-place existing 2,180 square feet of first story wood decking; with the condition of the installation of gutters and leaders to drywells; and to establish and perpetually maintain a 10' wide non-turf buffer landward of bulkhead; and as depicted on the survey prepared by Nathan Taft Corwin III, Land Surveyor last dated October 5, 2017, and stamped approved on November 28, 2017. 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: $50.00 Very truly yours, Michael J. Domino _ Vice-President, Board of Trustees ^_ MJD/dd r SURVEY OF PROPERTY SITUATE LAUREL 69° N�'p0 TOWN OF SOUTHOLD N Zo• SUFFOLK COUNTY , NEW YORK 0��� `Jo° x S . C . TAX No . 1000 - 145 - 04- 12. 1 13 �� � o� 9 SCALE 1 "_209 ZG No° '0 1 9 x o DECEMBER 30, 2015 p�C 0 ; 1;b "TN OCTOBER 5, 2017 ADD BUFFER AND DRYWELLS o O pJ 1z TOTAL PARCEL 2 LOT AREA = 39,697 sq. ft. 0.911 a c. �a n / ° S.E C� p ° , ��' E oKEN ` 0 -M 1j DOUG E S SEETH vF • N 55p 15' C AC. 0014. 2 N Z o STa6KADE JANE j�`�F� S\ �� a��� �. FENCE �1 NOTES. wAY x18.0 FS 6>,o ` ` - _ Tt�° 1 . PARCEL 1 & PARCEL 2 ARE AS DESCRIBED IN THE LAST RECORDED DEED 12' p D FOU 0 A' 1.3S�f >> Sp,� LA N 9\ g\�!`� � W W SFOR THIS PARCEL (LIBER 9694 PAGE 88) 17.4' 'v 6�• d " ` `\ \ \ PLL �.7'N' '� `' ��N" - W W W W W W W `�O �� 2. THIS PROPERTY IS PART OF LOTS 6, 7 & 8 AS SHOWN ON MAP OF pPROPERTY OF ELIZABETH MESROBIAN AND FOREST HILLS 58 9 °'50" 1tS\ \ \ \� 10-._ 17.4 \ w 169 \ ' \\E F IMPROVEMENT CO. INC. FILED IN THE OFFICE OF THE CLERK 5° 45' Q0 w ��ti oc'f8 7" ° �� rs H 66'`32'�_2`� ORIV�AY 4�� 4� \1 \x �'o�°� OF SUFFOLK COUNTY, N.Y. AS MAP NUMBER 1381 ON S wUY 5a p'q \ ACT ' \ \n \ \\ / W W W S JANUARY 16, 1943. 14-4I �X-" .D /°: p . x) 3. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM 17.2 °e ° p o 2 A 5 \ I' p �. p \°. c°�, \ a W W W -o OJ .. . .,a • ...�... 10.0 � �. O� EXISTING ELEVATIONS ARE SHOWN THUS: W ° tL �� 5 15•�5'�� � � \ ° .' p p - ...� .�•.` .,... \ � � x-� W W W W ,9J, � EXISTING CONTOUR LINES ARE SHOWN THUS: - - - - -5- - - - - l� �9•g X 17.4 \ � 1.° ° • \ \ F.FL. - FIRST FLOOR 17.5 \ 15.0 \\� °' : D o ° 10.2 �W W W" moo: G.FL. - GARAGE FLOOR X o p \ \ TB - TOP OF BULKHEAD NOO I Pv� =4� 17.5 "'/ \ ��� x'124 °p. D ° A. t :° 10.7 \ \ \ A OW W _ IIII\ ee BOTTOM OF BULKHEAD O� `^Z�'c� 11.9 0�° pTW I x 9.5 \ \ \� 'Go SW - BOTTOM OFTOP OF WALL xts.715.x G�°p k P � \ \ \ W ?�� 4. FLOOD ZONE INFORMATION TAKEN FROM: OJ I 18.0 177 / \+ \ _ 170 �` G��•� 2; :. ' G G°p,�� \ \\ \ �W�mG W , 1 FLOOD INSURANCE RATE MAP No. 36103CO483 H FENS / 'S- z.�`"" �Y] / � ,, ° ry9. . . 1 \ \ �` • W c ZONE AE: BASE FLOOD ELEVATIONS DETERMINED c9` x �� \ �� P�"i ` ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARDWAVE ACTION I:o I tih 90r 1° �,y°e5 \ \ W W W 9'F� ��' BASE FLOOD ELEVATIONS DETERMINED HAZARD ( )� ': x� ZONE X: AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN. I• 0 3 W_2 1 I O.?� Ilk GV ..........X v_ M 17.4 ...... O O I \ 8.3 x i CD•�� �' h / `V 1 x1Zs :r'::':':.:::.... \ W W DRAINAGE SYSTEM CALCULATIONS: 17.2 `' X :::'::':::'::::' w. �^ 17.5 ...........v . .. I I 1 \\+ W W W W ROOF AREA: 3,397 sq. ft. A 3,397 s(� ft. X 0.17 = 577.5 cu. ft. O /� V I / W W W W W W `�• ,� .: / / I x '� W W 577.5 cu. ft. / 42.2 = 13.7 vertical ft. of 8' dia. leaching pool required '7"�o EnxI / WW PROVIDE (4) 8' dia. X 4' high STORM DRAIN POOLS `` 17.5 EQ �17.4 39 '.'.'.'... .......'......:"� / / \W W W ' ' / yOn o' 6 oag / / W W W PROPOSED 8 DIA. X 4 DEEP DRYWELLS FOR ROOF RUN-OFF ARE SHOWN THUS: O n �.......... �Gi JF�1. �FQ / 9.8 .$4x / W 6.2 / / / / - / / / / / / / / / / WWWWW APPROVED BY : : : � / / F��GVI• ' // / / / / G. 17.3 O WWWyW t BOARD OF T RUSTEES /17.5 TOWN OF SOUTHOLD 1-11 "'& OW W W W W ��� / / / / / / / / // / 4 Y W •Y •Y W W W W .Y .Y DATE gloveA 9-T2,or l 17 1 .2 / 9.6 9.6 (� }', � P'!0 V 2 7 2,')]7 No ��•n�/ / / / / /\ / Southold Town 00 ar f Tr ce 9 / / /"✓C`W W W W 1�3 Y .0. 'Co/� cp W W W `iI j p • �+ ��§i S v PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. NOF ,P �MM W V'• �j ►/ tea. , 'o N.Y.S. Lic. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION iy at h an Ta t C o r w i n 6�' , TO THIS SURVEY IS A VIOLATION OF 5 Q SECTION 7209 OF THE NEW YORK STATE Land Surveyor 6•0EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S. ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S. IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fox (631)727-1727 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 35-262A Michael J. Domino, President rf- ifFo1K oTown Hall Annex John M. Bredemeyer, III, Vice-President ;toy cG 54375 Route 25 y j Charles J. Sanders }So <Y P.O. Box 1179 Glenn Goldsmith Southold, NY 11971 W A. Nicholas Krupski t��y o�SFJ Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES q, TOWN OF SOUTHOLD TO: -J0W&C-P1t4_0 C/o - Please be advised that your application dated M6'0ST 1�{� �1� has been reviewed by this Board at the regular meeting of Pr zo , ?-Ol and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1" Day of Construction ($50.00) Y2 Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement(complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's 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. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: 5 TOTAL FEES DUE: $ 5042 ��g( BY: Michael J. Domino, President Board of Trustees Michael J. Domino,Pre., l` O��SUFF�1�COG Town Hall Annex John M. Bredemeyer III,Vice-President �� ��, 54375 Route 25 Charles J. SandersN z P.O.Box 1179 Glenn Goldsmith 7 Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 911711- S'00 Completed in field by: <�, Cv. 1c)5 M 5A J.M.O. Environmental Consulting on behalf of JOSEPH GRILLO requests a Wetland Permit to replace in-place existing 2,180 square feet of first story wood decking. Located: 365 Mesrobian Drive, Laurel. SCTM# 10000-145-4-12.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 y/ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment o/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: cn ijaCrS Ae�nb X) nq�w NJ Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino, Pre, S11FFQ(,� 0 COG Town Hall Annex John M. Bredemeyer III,Vice-President �� y� l` 54375 Route 25 Charles J. Sanders ro z P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski Oy p!� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: J.M.O. Environmental Consulting on behalf of JOSEPH GRILLO requests a Wetland Permit to replace in-place existing 2,180 square feet of first story wood decking. Located: 365 Mesrobian Drive, Laurel. SCTM# 10000-145-4-12.1 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 f. a J s t imp so Southold Town Board of Trustees ..:—✓'`°.r t r As .I i S e Il•,f .. `,�t� f Y J ro -- f ir .40 �� .•. ' ���.. , i-. . .+` - _ +��'. � fes'.. . ; �-`.:• 1•�,>/ -, �.�. .. r � •yv' • M_. � �..Vr fE i � t• �a �t .1- 1 � � 1 ice,,, " ��.��S+I�� /,Z,�R•c.. � �"! ' .� � � f f..f �i"�'�' ^ "' ,.•^�� " W�l � �`/ .. 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Ali Environmental Consulting Services November 18, 2017 D E C E I V E Mrs. Diane DiSalvo NOV 2 7 2017 Board of Town Trustees Southold Town Town of Southold a Tru Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Grillo, 365 Masrobian Drive, Laurel S.C.T.M.No. 1000-145-4-12.1 Dear Mrs. DiSalvo: Enclosed please find are four copies of the survey of this property which have been revised to depict the 10' wide non-turf buffer that will be established landward of the existing bulkhead. Please feel free to contact me should you or any member of the Board of Trustees have any questions or comments regarding this matter. Sincerel , Gie ust Phone (631) 653-0607 - Email Giust10215@aol.com 121 Jessup Ave - 2nd Floor - P.O. Box 447 Quogue, New York 11959-0447 i J.M.0. Environmental Consulting Services September 27, 2017 Mrs. Diane DiSalvo Board of Town Trustees Town of Southold Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 E C .E A V E Re: Application for Joseph and Susan Grillo SEP 2 9 2017 365 Masrobian Drive, Laure S.C.T.M.No. 1000-145-4-12.1 Southold Town ar of Trustees Dear Mrs. DiSalvo; Enclosed please find are the additional letters of authorization for this project as requested. Best, Gle . Just Phone (631) 653-0607 - Email Giust10215@aol.com 121 Jessup Ave - 2nd Floor - P.O. Box 447 Quogue, New York 11959-0447 OFFICE LOCATION: ®� so 01 MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 ® a Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: September 18, 2017 Re: LWRP Coastal Consistency Review for JOSEPH GRILLO SCTM# 1000-145-4-12.1 J.M.O. Environmental Consulting on behalf of JOSEPH GRILLO requests a Wetland Permit to replace in-place existing 2,180 square feet of first story wood decking. Located: 365 Mesrobian Drive, Laurel. SCTM# 10000-145-4-12.1 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 action INCONSISTENT with policy 6.3. Protect and restore tidal and freshwater wetlands and therefore INCONSISTENT with the LWRP. 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 9. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The construction of the deck was not authorized by Board of Trustee permits. In the event the action is approved, require the establishment of a vegetated buffer, including existing vegetation. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. � r -- �Lag�pFFOCk�d Peter Young,Chairman y Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 f ' Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., September 13, 2017 the following recommendation was made: Moved by Caroline Burghardt, seconded by James Abbott, it was RESOLVED to SUPPORT the application of JOSEPH GRILLO to replace in-place 2,180 sf. of decking. Located: 365 Mesrobian Dr., Laurel. SCTM#145-4-12.1 Inspected by: Peter Young, Caroline Burghardt, Greg Williams, James Abbott The CAC Supports the application with the Condition of a drainage plan and all hazardous conditions on the property are addressed. Vote of Council: Ayes: All Motion Carried Michael J.Domino,President eb� p�, `z, Town Hall Annex John M.Bredemeyer III,Vice-President } �% 64375 Route 25 _ P.O.Box 1179 Charles J.Sanders '. .. Southold,New York 11971 Glenn Goldsmith . o t ` Telephone(631) 766-1892 A.Nicholas Krupski _.' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal ErosionPermit Application D E C E I V E Wetland Permit Application Administrative Permit Amendment/Transfer/Extension AUG 1 4 2017 Received Application: —'9,1 f-,11 Received Fee: $ 250,60 Southold Town Completed Applicatiom. Board of Trustees Incomplete: SEQRA CIassification: Type I` Type II Unlisted Lead Agency Determination: Coordination:(date sent): 94 9.17 �LWRP Consistency Assessment Form Sent: k��]CAC Referral Sent: $��• Date of Inspection: q,1Z•l7 Receipt of CAC Report: Technical Review: 2�Public Hearing Held: Resolution: Legal Name of Property Owner(s): Joseph Grillo Mailing Address: 3 Versailles Court, Glen Head, NY 11545 Phone Number: coo 516-702-3519 Suffolk County Tax Map Number: 1000-145-4-12 .1 Property Location: 365 Masrobian Drive, Laurel (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): JMO Environmental Consulting Mailing Address: P.O. Box 447, O. uogue, NY 11959-0442 Phone Number: 631 -653-0607 0l''- Board of Trustees Apples-,.ition GENERAL DATA Land Area(in square feet): 39,657 s Area Zoning: R-80 Previous use of property. Existing single family dwelling Same Intended use of property: Covenants and Restrictions on property? Yes x No If"Y&',please provide a copy. Will this project require a Building Permit as per Town Code? x Yes No If"Ye',be advised this application will be reviewed by the Building Dept*prior to a Board of Trustee review and Elevation Plans will be required. Does this project require-a variance from the Zoning Board of Appeals? Yes x No If"Yes",please provide copy of decision. Will this project require any demolition as-per Town Code or as determined by the Building Dept.? —yes x No Does the structure(s)on property have a valid Certificate of Occupancy? x Yes_ No Prior permits/approvals for site improvements: Agency Date Toan Trustees 1985 Togn Trustees 1996 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): Applicant proposes to replace in place 2,180 sf. of ,deckina -- -------- Board of Trustees Appl.:,.ation WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Deck restoration Area of wetlands on lot: 0 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands:_ 6 4 feet Closest distance between nearest proposed structure and'upland edge of wetlands: 6 4 feet Dues 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 'Depth of which material will be removed or deposited: _ 0 feet Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: n/a Statement of the effect,if any, on the wetlands and tidal.waters of the town that may result by reason of such proposed operations(use attachments if appropriate): The proposed project shall have no negative impacts upon any wetlands or tidal caters of the Toan. ` I Short Environmental Assessment Form Part I -Project Information Instructions for ComWetin� 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: Deck board replacement Project Location(describe,and attach a location map): 365 Masrobian Drive,Laurel,location map enclosed Brief Description of Proposed Action: Applicant proposes to replace in place 21 BO sf.of deck boards Name of Applicant or Sponsor: Telephone: c/0 516-702-3519 Joseph Grillo E-Mail: Address: 3 Versailles Court City/PO: State: Zip Code: Glen Head NY 11545 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 0✓ ❑ 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: ❑ ❑ Southold Town Building Department 3.a.Total acreage of the site of the proposed action? 0.991 acres b.Total acreage to be physically disturbed? 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.991 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban m Rural(non-agriculture) [:]Industrial ❑Commercial El Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic El Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES I 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:Great Peconic Bay ❑ ✓❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO j YES b.Are public transportation service(s)available at or near the site of the proposed action? 7 ❑ 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: ❑✓ ❑ 11.Will the proposed action connect to existing wastewater utilities? 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? � Elb.Is the proposed action located in an archeological sensitive 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? ElIf Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: Deep Hole Creek 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ® Wetland ❑Urban ❑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? 7 ❑ 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 YES If Yes, ❑ Ela.Will storm water discharges flow to adjacent properties? E]NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: E NO YES Page 2 of 3 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: Fv—/] ❑ 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: W1 ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor enn us gent Date: 8�2/17 Signature: PRINT FORM Page 3 of 3 Agency Use Only[If applicable] Project: Date: uSI-lFiI i L,i'Jiiol—&uientaI As'3es0,ii2it i�'v'",iii Part 2 -Impact Assessment Part 2 is to be completed by the Lead Agency. 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning E]regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? E4 0 3. Will the proposed action impair the character or quality of the existing community? [21 El 4. Will the proposed action ham an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect 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 in-pact 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, ❑ architectural or aesthetic resources? EA 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, Elwaterbodies,groundwater,air quality,flora and fauna)? 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage F1problems? 11. Will the proposed action create a hazard to environmental resources or human health? ❑ PRINT FORM Pagel of2 Agency Use Only[If applicable] Project Date: Short Environmental Assessment Form Part 3 Determination of Significance 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 pro os(e�d action pill �not t resiAt to any,signs cant a verse environmental i cts. ame of Lea d�-Agen Date Jf PA Print or T �e Nam f Responsi le O r in Lead Agency Title of Responsible Officer Signature of ResponsibV Officer in Lead Agency Signature ofPreparer(if different from Responsible Officer) PRINT FORM Paget oft ' gOfFO(,� � Michael J.Domino,Presiuu„i O�Q 00 Town Hall Annex John M.Bredemeyer III,Vice-President h� vJ, 54375 Route 25 Charles J. Sanders co P.O.Box 1179 I z Glenn Goldsmith %.v_1 fry Southold,NY 11971 A.Nicholas Krupski y p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of JOSEPH GRILLO COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, GI ftr\ 1` �US� , residing at/dba a-`s� c��e 9 eALLC bei g duly s rn, d ose and say: That on th ,day ofS� , 2014,-1 personally posted the property known as JoS-e by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, September 20, 2017. Dated: �n Ir<r - lt_z�///l z� (signature) Sworn to before me this 2oL4day of 20 r7 GINA A.LOCKE NOTARY PUBLIC,STATE OF NEW YORK Notary Public RegistmdonNo-OIL06057960 Qualified in Suffolk Co U 20 f_/ Commission Exp'uma pr. i S PROOF OF MAILING OF NOTICE ATTACH,CER'T'IFIED MAIL RECEIPTS . Name: Address: Jane Seeth Irrv. Trust & Douglas S. Seeth Rev Liv Trust 1937 SE 33rd Ter Coral, FL 33904 John J. Harrington & Agata Harrington 190 Mineola Avenie Roslyn Heights, NY 11577 Thomas A. & Elinore Eschmann 46 Kenaood Road Garden City, NY 11530 S'T'ATE OF NEW YORK COUNTY OF SUFFOLK --< residing at being duly sworn,deposes an says that on the � -�da�of 20_g,deponent mailed a true copy of the Notice set forth in the Board of Trustees Application,directed to each of the above named persons at the addresses set opposite there respective names;that the addresses set opposite the names of said-persons are a oat ress of said said Notices w persons mailed of the United States Post assessment roll of the Town of Southoln on the current d; that Office at ,� _� that said Notices mai d to h of said persons by ,CERTIFJ D M /RETIURN RECEIPT. Sworn to before me this 2-0�= Tray of_s2c �0�-til Notary Public GINA A.LOCKE NOTARY PUBLIC,STATE OF NEW YORK Registration No.OIL06057960 Qualified in Suffolk County Commission Expires Apr.30,20B i 0 0 ® ° ErLn o. .D C3 CAPS GOEt u. R051rY1 fIGS� 1:77 ° m' " Certified Mall Fee . 095q $3.35 ¢ _ 0959, Certified Mad Fee$3.35 r`- $ n r-� $ 01 ..D Extra Services&Fees(check box,add fe dp date) -1 �y�pwnate I I ❑Return Receipt(hardcopy) $ „p Extra Services&Fees(check box,add fe ir{� >1 V ) ❑Return Receipt(hardcopy) $may.i postmark I� 5 O ❑Return Receipt(electronic) $ j�� [I� Postmark 'p ❑Return Receipt(electric $ �� �f1 •F]Certified Mail Restricted Delivery $' Here Here I p C3 ❑Certfied Mail Restncted'Delrvery $.�.�s-�� p ❑Adult Signature Required $ $ ❑Adult Signature Restricted Delivery$ ' 'r� ❑Adult Signature Required �.,.y-••� i C3 ❑Adult Sgnaiure nestricted Delivery$� 0 postage p Postage $1.70 $0.70 09/1212017 09/12/2017 m Total Postage and Fees fit'► Total Postage and r.4v0 $ $ Y�tOO rp Se t To Sent To M - JC 1,_. ------------ ,p Street and Apt.No,or PO Box o Peg%AP a.: 'A#O Q a s�CZ-_ V 2A� ------------------------------ ��f `` AA�yl�. 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FLOI• B C3 +'co Certified Mad Fee 0959 `I`- $ $2.75 01 .El Extra Services&Fees(check box,add fes$(fpnate) E]Return Receipt(hardcopy) $�y— p ❑Return Receipt(electronic) - $ V•lJ'V Postmark 0 ❑Certified Mail Restricted Delivery $ .[i[�yI Here C-3 ❑Adult Signature Required $�-�µ C3 ❑Adult Signature Restricted Delivery$ i C3 Postage $0.70 r%_ 09/12/2017 MTotal Postage andf8 es8o rp Sent To ° q T�j��iS_ .�- �, -C�s5n- �inn vwx -- jC3 Street and4 No.,or PO ox No. r` -`- -� �.+J a�---�-d---------------------------------------- C State, tP+4®�` �. / ' 530 � `I JOJ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS ecl Name= V3 . . t STATE OF NEW YORK COUNTY OF SUFFOLK , residing at being duly sworn,deposes and says that on the ® day of , 20--, deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of i i Notary Public ; _ H 'LARING NUTILk: U . NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: JOSEPH GRILLO SUBJECT OF PUBLIC HEARING : For a Wetland Permit to replace in- place existing 2,180 square feet of first story wood decking. Located: 365 Mesrobian Drive, Laurel. SCTM# 10000-145-4-12.1 TIME & DATE OF PUBLIC HEARING : Wednesday, September 20, 2017 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 i Hoard of Trustees Applicatio 5- jSEP 2 9 2017 AFFIDAVIT Smhuid Tcwn Board of Trus ee SLZ (1 -11C) BEING DULY SWORN DEPOSES AND AFF'IR.MS 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 WORT{WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY TILE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGI')-..EES TO MOLD THETO`VL'N OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FRET; 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 INSPEC'T'ION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDI'T'ION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUS'T'EES DURING THE TERM OF THE-PERMIT. `Z int ature Property Owner _ Signature of I'ropei ty Owner ,d SWORN TO BEFORE ME THIS ;� � _ DAY OF �U �J _ , 201 T - _ Notary Public u ^------ --i- 51�; 1, c7v,) . �2� APPLICANU GENT/REPRESlENTATIV TRANSACTIONAL DISCLOSURE FORM The'Town'of SouthoId's Code of Fithics prohibits conflicts of intorest on 111012,11 t of town office r and em la-)Lcs_'I'hc tmnrmoosc of this fprm is to provide infotmntion which can alert the town oJ�otisible conflicts of interest and•llow it to take whatever action is. necessary to avoid same. YOUR NAME: C a P 74 �tL4 a, — (Last name,first name,rpiddle 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 --•-_ Tnfslee Change of Zone T•__—_____ Coastal Erosion Approval of plat ---_-- _--� Mooring __-----___-_-- Exemption from plat or official map ` Planning Other (if"011ie(",name the activity.) f)o you pusonally for through your company,spouse,sibling„parcrit,or child)have a ielat(onship with any ofli(ei or empioyce aCthe TOw11 01 Snutlold? "Itelalionship"includes by blood,nlarnage,or busurces Interest "BoKiness interest"means a business, inciud(ng a par(nership, in which the town office, vi ernployee/has even a panful Ownership ol'(or employment by)a corporation in which the town off icer or employee owns mor0 than 5%of the shares. , YES ---- --- NO ----- - if you answered"YES",complete the balance of"s,form and date and sign where indicated. Name of person employed by die Town of Southold------_-------_--___— __-_• Title or position of that person`__—_•_______________—-_— __---____. Desct rbe the 1 elationship between your self(the applicwhtlagent/representapve)and the town officer or employee.lather check the appropriate line A)through D)and/or describe rn 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 S%of the shares of the corporate stock of the appl(cint (when the applicant is a corporation); B)the legal or bencficiai owner of any intcrest,fn a (wren applicant is nota(orpowLion); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this`d ,of 2 = Sig,nature - - Print Name . Form TS I APPLICANT/AGENT/Rt,PRESENTATIVE TRANSACTI®NAL DISCLOSURE FORM . The'Town of Southold's('ode of Ethics prohibits conf]icis of interest on the Hart of town officers rind cm Ip�ecs_"lh��irPose of tl f rr is to tcrvitle information which can alert the town of jossible conflicts n1'interest and allow it to take whatever action is necessary to avoid same, '36('74 G-711 YOUR NAME; _— �v_ ^..� (Last name,first name, piddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance �_- Building —_ Variance _- Trustee Change of Zone _____ Coastal Erosion Approval of plat ^- _- Mooring Exemption from plat or official map _ Planning -_M_,_--T Other (If"Othct",name the activity.) Do you personally(or through your company,spouse,sibling,panmt,of child)have a relationship with fury office, or employee of the Town of Southold? '-Relationship"includes by blood,nittrrrrige,at businces interest "Business interest"means a business, including a partnership, to which the town officer or employer.lira:even a partial ownership of(or eniploynwnt by)a co,po,aUou 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,clationship between yourself(the applican t/agenUrepresentative)and the town officer or employee.h=ither check the appropriate line A)through D)andlor 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)tho owner of greater than S%of the-shares of the corporals stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any inlci,est iii,,,non-corporate entity'when Ilm applicant is nota(.orporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant, DESCRIPTION OF RELATIONSIIIP Submitted this �� d4olSignature_ ,�Pririt Name RSI Form"I'S Board of Trustees Application AFFIDAVIT 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 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 ATHORIZE 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. 016 ig ature Wroperty Owner Signature of Property Owner SWORN S TO,BEFO9E"ME THIS DAY OF Notary Public Sl��,��J /k �,D�E2„4 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, `J(nSz570" 65> a-a l.—1--o owners of the properly identified as SCTM# 1000- 14 9-a—2-1 in the town of Laurel ,New York, hereby authorizes JMo Environmental Consulting 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. Pr p rty Ow is Signature Property Owner's Signature SWORN TO BEFORE ME THIS � DAY OF L1 ,20,Ll-� Notary Public 6zo �ZO APPLICANT/AGENT/REPRESLNTATI VE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town afficem and emplovecs.Tltctt u pose-oC this form it to provide in£orination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. �^ YOUR NAME: (Last name,fust name,tpiddle initial,unless you are applying to 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'',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 mvnership of(or employment by)a corporation in which the town officer or employee owns more than 5%or 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 applicwit/ageiiYrepresentative)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)tho 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 1 Submitted thi; day of ;Signature _ , i AP7PLICANT1AGENTIRE SENTATIVE AT1 TRANSACTIONAL DISCLOSURE FORM e n of uth 'E Q—ded Ethics-prohibits confl Idsf interest on the f5art of toft 45cers and-eMplao.The numose-of t is f iso provide ifl&dMion which cap j1drf the townoft(kssibld c6nf lictsofinteres.t and allow it to take whatever aotionis necessary to avoid sakne. YOUR NAME: Just, Glenn, E. (Last name,first name,Middte initial,Oless you are applying in the name of someone else orother'entity,such as a company.If so,indicate tate 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 T Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other'',name the activity.) Do you personally far through your company,spouse,sibling,parent,or child)have a MAtionship-with'pny officer or employee of the Town ofSoathold? "Relationship"%ncictdes hyl�tdod,hjFuriogc,-cn T�uainess interest "lltrrsiness Interest"means business, including a partuembip,in whiclrthe town officer or employee:has even a partial owncrsitip of(or eniplaya*nt by).a corporWou in which the town officer or employee owns more than 5%ofthe shares. x YES NO _ If you answered"YES",complete the balance of this form and date and'sign where indicated. Name ofperson employed by the Town of Southold Title or position of that person Describe the relationship between yourscif(the applicantlagunT/representative)and the town officer or employee.Either check the appropriate;line A)through D)andtor dcscribe in the 9paw provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner ofgmWer than 5110 of the shares of tate corporate stack of the applicant (when the apttcant is a'corporation); B)the legator beneficial owner�of any interestsin a non-corporateentity(whet the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSIRP Submitted this 2nd day of August 2017 Signature_ Print Nairte enn au s Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. Irl' STRIUCTIONS I All applicants for permits* including Town of South6ld agencies. shall complete this CCAF for proposed actions that are subject,to the Town of Southold'Waterfront Consistency Review LaNv. This assessment is intended to supplement other information used by, a Town of-Southold agency in making a determination of consistency. *Except minor exempt actioi,45 including Building Pernifts and other adnisterial permits not located ivithin the Coastal Erosion-Hazard Area. 2. Before answering the questions in Section C, the preparer of this form, should reNiew the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local fic Waterfront Revitalization Program. A proposed action 'IS_will be evaluated _ to -its significant beneficial mid adveiNse affects i Dcides all qf Southold`town) 3. N any question in Section C on tris form is answered "Yes" or "no", then the proposed action will aff&t the achievement of the LNNrRP policy standards and conditions contained in the consistency review law. 11-us, each .111swer must he explainW in detaillisting both-supportinghnd_non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it-,hall not be undertaken. A copy of the UWRP is available in the folloN'ving places: online at the Town of Southold's website(sotitholdto,,v-ii.nortt-,Sork-.net), the Board of Trustees Office. the Planning Department, all local libraries and theToNvn Clerks office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 14 5 4- 12-1 P-ROJECTNAVIX Deck restoration The Application has been submitted to((check appropriate response)-. Town Board Planning Board 1:1, Building Dept. El -Board Of Trustees Pxj 1 Category of Tomm of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agencyg (e.g. capital El construction,p'lanning,activity,agency regulation--land transaction) El (b) Financial,assistance(e.g.grant,loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action: Applicant proposes to replace in place 2180 sf. of decking Locationofae'tion: 365 Masrobian Drive, Laurel Site Present land use: Existing single family dwelling Present zoning classification: 'R-80 2. If an application for the proposed action his been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Joseph Grillo (b) Mailing address: 3 Versailles Court Glen Head, NY 11545 (c-) Telephone nwiiber- Area Code f > e/o 51 6-7 0 2-3 51 9 (d) Application nuniber,if w)y:_Unknown Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 1:1 No tM-1 If yes, Nvhich state or federal 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 pokey. Incomplete answers wi 11 require that the form be returned for completio-n, DEVELOPED COAST POLICY Policy I. 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 2 coastal location, and minimizes adverse effects of development. See LN1W Section III-Policies; Page 2 for evaluation criteria. 1XI Yes - [] No M Not Applicable -The--pr-o-j-e.c-tsha.1-1--njQ-t--b.aye--a-xiy--,negative--impacts upon the s--th-(5---i—h-k-ibd—f�e—grd-digrrfe-ff t7-- of decking. It 1—s—f—eft—f-Ka—t with this policy. Attach additional sheets if necessar}, 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 0 'des El No 0 lett The project shall have no impact upon any historic or archaeological - resources, it is felt is consistent -with this policy Attach additional sheets ifnecessary i Policy 3. Bnhance visuna quality and protect scenic resources throughout the Town of Southold. See LWRF'S ectiou HI—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ loot Applicable The project wi-ll have no impacts upon az2y SCen�_�__re_Go1�Y�Qs nor impact the visual quality of th�`�o,wm e Tt i s fPl t that ` s i. Attach additional sheets if necessary j i NATUR L COAST POLICIES r. Policy 4. Minimize e loss of life, structures, and natural resources from flooding and erosion. See LWRk '. Section 1I—Policies Pages 8 through 16 for evaluation criteria x Yes Q No 0 Not Applicable The project :wi,11 not cause acral Brat ed erosion of ad-jarpnf Y1Qi C- ate any shall he nn loss ,of marin�r_sTP''lar,� hahita} ail. —_i 'nor��11 n no loss ofubliv recre ion 1 0 1 a project is consistent with this policy r Attach additional sheets if necessary Policy �. Protect and improve mater quality and supply in the Torsrn of Southeld,See 11IVR11 Section Policies Pages 16 through 11 for evaluation criteria � Q Yes 1:1 No ❑Not Applicable � i The project will have no negative impacts upon the quality of or t 1 s fplt that this- project is consistent with this r I i i i Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the To--,Yn of Southold ecosystems includin Significant Coastal Fish and Wildlife,Habitats and wetlands, See L*VRP Section In--Policies; Wages 22 through 32 for evaluation criteria. D No Yes Not pplicable The project .shall have no negative impacts upon the quality or function of any glands ecosystems or ar-aa' Qf Significant- Coastal Fish and Wildlife Habitatsit is Telt that this project is consistent with this policy Attach additional sleets if necessary May 7. ProteNt,and- impro ve,air q �affity in the Towm of Southold. See LVR,- 'Seeflon H FoRdes Pages�2 through 341 for evaluation criteripa. YeS F-Jrjo ?Jai Aj,-O ie The project shall have no impact upon air quality. It is felt that this project is consstentwith this,-policy Attach additional sheets if necessary -policy 80. RE&mize onvirolmmental degradat-lon of Soj7_fl_-#,gjd fro�e Sofid vrasm-d haza a-dous 'Subs xalaces and wastes. Yes 0 No illot ApplIcablo The project does not involve the. usp—of or th�L--d L o F2,al of f , solid waste or hazardous substances and wastes. It is felt that this project is consistent with this policy P UIBije-11COAST-1 POLICIES Policy 9. Provide for access To, apd recreatioFiral use afrq coast�d vvaters, purolic and publak resources ofthe'Tow m-- of Southold. See L-W-RP Sec Evan MI-PeMcies; Pages 38 earough 4%,,&for viraluafla m ,Ex-] YJI Ne 11 Nota Applicable. The prolect will have no imoact upon public access tog and tlae recreational use of coastal waters, public lands or the public resources of': the Town. It is felt that this, project-lis consistent with this policy Attach additional sheets if necessary WOR-MUNIG COASTA P'S LIUI.JS --vr- P P e t uses infle end a PaRey 10. Protect Sou ski's water-41ependent uses and promote Ain-, of new Ta e sultible locations. See LSV Section M—PoRides; Pages 47 throu6h 56 for evakafloa crktvk iq- YesNo L Not Appflcable The project will have no impact upon Southold' s water-dependent uses of othe siting-jQf- water-dependent uses in suitable locations Tt is felt that this project is consistent faith this policy Attach additionalL sheets if necess-miry PoKey 11. -Promote sustalnaYte use of R-4ng -a e resources in Long IsImid Sound, the Feemic Estuary and`comm viaters.'Bee 11,WRP Section M-Policies;Pages 57 through 62 for eval-nadon erken.'s. Yes F1 No� Not Applicable The Project will have no impact unnn the Sjihc:f-;;jn;;h1 ,= iic:4= nf t. living marine resources. It is felt: :that i-b; sp-rajcact is consistent with this policy Attach adOdmial sheets if ecessary Policy 12. Protect agricultural ian M- -in the Toym of Southold. See -'9.VV P,,P Sec�-Om M, - P011CWS; pages 62 through 65-for-e-vaiundon' criteria. F1 Yes F-1 qo Fx] Not Applic-p-ble The Project does not involve agri mll tilra l Tt i -- fol f-- that this poli cy. is , not applicable to this project Aftch additional sheeU if necessary PoRey 13. Promote appropriate use amd dev -kopmem. of energy tad minerag resources. See L-*VRP- See-Hom M-Poikeies; Pages 65 through 63 for eval�Latieu criteria. F1 Yes F-1 Tqo D Not ApplIcable The -oroigct- does nbt "involve the use of or development of energy or mineral resources., It is felt that this..,p-Qjicy is not applicable to this. project FRAPAURED BY_.f�, � TMJF,_a42jLt_DAT-2-