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Home My WebLink AboutTR-6627A James F King, President ��OF soyoTown Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson l Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. �� O Telephone(631)765-1892 �y coUFax(631) 765-6641 NTY,N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6627A Date of Receipt of Application: June 8, 2007 Applicant: Silver Sands Motel, Inc. SCTM#: 47-2-13 Project Location: Silvermere Rd., Greenport Date of Resolution/Issuance: June 20, 2007 Date of Expiration: N/A Reviewed by: Board of Trustees Project Description: To remove soil only from the storm-damaged, landward side of the bulkhead, install untreated plywood behind bulkhead, and refill with soil. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the application received on June 8, 2007. Conditions: A full Wetland Permit must be obtained in order to conduct any further activity on the entire bulkhead. Inspections: See attached schedule. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jardeps7oZng, Pres' ent Board of Trustees C '�` J � �, r �/T" i � � � , ..�. . , _. � .- _ _ . . ,,, - . ,�« s, � - , - - -. �; . . - � � w. � _ -;, 1 Y � '+��:� � - N _, ._ - m a. .. �� )ya v �- :YI11 � M 1 � Sh� ��.) \ _. _ i'� .. � ! � C ✓'. `, h �_ � .I ? �1�F s"Y.� J � � I , c � �.... � 1„ '' :, �.: ', �.,� ,�-F �f f �. r �� M �; _ '�� ,, ,. E o �� .. 1 i�� \l James F King, President ��0f SU(/ryo Town Hall Jill M. Doherty,Vice-President ,`O l0 53095 Route 25 P O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen Bob Ghosio, Jr. �� Telephone(631) 765-1892 �C,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 1" day of construction '/2 constructed ✓ Project complete, compliance inspection. d James F. King, President *0f SU(/rTown Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G Bob unosio, Jr. �� Telephone(631) 765-1892 Z2 Aum Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only- -Coastal Erosion Permit Application - _Wetland Permit Application Administrative Permit J _4 PQ`4` �_Amendment/Transfer/Extension 1.1 C0ived Application. 6 Viol --Rtrceived Fee:$ _Completed Application _ _Incomplete _SEQRA Classification: Type I Type II Unlisted —Coordination:(date sent) LWRP Consistency Assessment Form _CAC Referral Sent: _Date of Inspection: _Receipt of CAC Report: GY40 _Lead Agency Determination: Technical Review: /Public Hearing Held. Resolution: Name of Applicant. '` T- Address CM Phone Number:6 Suffolk County Tax Map Number: 1000 - 4 7 �`5 Property Location: Q,' i (provide LILCO Pole#, distance to cross streets, and location) AGENT:_' - - (If applicable) Address: - Phone: Board of Trustees Appli ;ion GENERAL DATA Land Area (in square feet): 2 $'Q �5 P Area Zoning: Ce. t — e15I t Previous use of property: I—�N- Intended use of property: 6_0�_c Covenants and Restrictions: Yes _No If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date I I No prior permits/approvals for site improvements Has any permit/approval ever been revoked or suspended by a governmental agency? _>G No Yes If yes, provide explanation: Project Description (use attachments if necessary):C" C i Board of Trustees App] Ltion WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: - hl� Area of wetlands on lot: -4� square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? -3 cubic yards How much material will be filled? J cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: -�-- 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): PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1 APPLICANT/SPONSORQ�L, C—k C�� 2.PROJECT NAME Ll �J V LV 3.PROJECT L ATION: Municipality County 50��o (� 4 PRECISE LOCATION: St et Addess and Road Intersections, Prominent landmarks etc -or provide map 5 IS PROPOSED ACTION ❑ New ❑Expansion modification/alteration 6 DESCRIBE PROJECT tBRIEFLY 7 AMOUNT OF LAND AFFECTED- Initially c 8' acres Ultimately acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? 9'Yes ❑ No If no,describe briefly- 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) Residential ❑Industrial ❑Commercial 1:1 Agriculture ❑Park/Forest/Open Space Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑Yes KNo If yes, list agency name and permit / approval: --T1—DIIES ANY—AS AID PERMIT OR APPROVAL? ❑YesNo If yes, list agency name and permit J approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT INFORMATIO PROVI D ABOVE IS TRUE TO THE BEST OF MY KNOWLED E Applicant / Sponsor Name Date Q� Signature r a If the action is a Costal rea, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION CEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617 4? If yes,coordinate the review process and use the FULL EAF ❑Yes WN0 B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING.(Answers may be handwritten,if legible) C1 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. rieflyC2. 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 rieflyC4 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 likely to be induced by the proposed action?Explain briefly- C6 rieflyC6 Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly C7 Other impacts(including changes in use of either quantity or type of energy? Explain briefly- D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA)? If X es,ex Iain brieFl Yes No E. IS THERE,OR I$eTHERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex Iain: Yes I Yj No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. 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�he determiraatiofl o"nifisafase-must-evaluate4he-potentiaNrnpaet e€the prepesed aetien erg the env ir-onmental-ch-meterfstk=f-the-C—EA—. 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 actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting the determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) i Board of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS TEAT RE/NI-W IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIBER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH W OF T AP LICATION i 1 Signature SWORN TO BEFORE ME THIS DAY OF ,20 — a1t ry Public CYNTHIA M. MANWARING NOTARY PUBLIC, STATE OF NEW YORK QUALIFIED IN SUFFOLK COUNIjI( COMMISSION EXPIRES OCT.20 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: k —JQ ? !� �"`� T�Te (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 Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES � NO If you answered"YES",complete the balance of this formanddate and sign where indicated. Name of person employed by the Town of Southold SLID-a-" Title or position of that person so Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) �A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. 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