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Home My WebLink AboutTR-6628A . w .-1 • .r r y . ,• r James F.King,President �*oF so�ryoTown 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. �Q Telephone(631) 765-1892 100 11 � 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 _,,,00" 1St day of construction Y2 constructed _� Project complete, compliance inspection. James F. King,President �� soujyo 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 G Q Bob Ghosio,Jr. �0 �O Telephone(631)765-1892 COUNTI,NcFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6628A Date of Receipt of Application: June 8, 2007 Applicant: Silver Sands Motel, Inc. /Edward Jurzenia SCTM#: 47-2-15 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. Jam F. King, Presi Board of Trustees 2� s 2 3 S��E 1s4 sc J sc siza�i SILVER a LA• n O ni so s 7 � 16___ 5 6 �r 17 m sn ns _ o _--- d 10 0 Ss n � 1*1 ry l50'1 14 0 20 m 1.lAlc1 .o n ie 13 12 11 21 0 15 va r71��M�n us 2.5A(c) 6 m �Q•A yioPEUXE us x �ti 24 _— �Q• 25.1 Q• ns SGS• � a \ \ 1 141 \ \\ c Gal \ o \ c, Q� e a a s � r i� r :l kms- 1.r1 / r K I 4 i1 ,t g�``,, ti James F. King,President �*OF SOV�yO 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 CA �r Bob Unosio, Jr. �Q Telephone(631)765-1892 COUNry'� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Application Applic��Adr�nniini�stratilivePerrniiit o _Wetland Permit Application Amendment/Tra fer/Extensio deceived Application: Received Fee:$ 5D' _Completed Application ® _ (� E2 n p UIncomplete lJ _SEQRA Classification. Type I Type 11 Unlisted _Coordination:(date sent) J U N - 8 2007 _LWRP Consistency Assessment Form _CAC Referral Sent: _Date of Inspection: Southold Town _Receipt of CAC Report: Board of Trustees _Lead Agency Determination: Technical Review: ---P"ublic Hearing Held: Resolution: Name of Applicantt� �llr" 7,PJYL�� S 11,lel— S"— M6-Q Address S/ er Phone Number45b 47 7— 00 Suffolk County Tax Map Number: 1000 - 7 Property Location: e"'f— ' 0 (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: t Board of Trustees Applica n GENERAL DATA Land Area (in square feet): SF 2•`� Gt(�� Area Zoning: I ckcs&r-t — Q�—'s(TLAi Previous use of property: Intended use of property: keP 5 k7eiYt,L aS— Covenants and Restrictions: Yes __k(_No If"Yes",please provide copy. Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen ed by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): A,,,, J', P � p Board of Trustees Applic- - on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: - — 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? cubic yards How much material will be filled? ' ,3 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: -G-- Manner in which material will be removed or deposited: -4-4 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/SPONSOR �>LV -En S�/ PROJECT NAME SU Z �/_ L, 3 PR� LO� � r l Municipality County 4 PRECISE LOCATION Street Addess and Road Intersections, Prominent landmarks etc -or provide map 5 IS PROPOSED ACTION ❑ New ❑Expansion modification/alteration 6 DESCRIBE PROJECT BRIEFLY. Imo' 7 AMOUNT OF AND AFFECTED Initially / acres Ultimately I acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? 19-yes ❑ No If no,describe briefly 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) Residential ❑Industrial ❑Commercial ❑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 R No If yes, list agency name and permit / approval HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes 0 If yes, list agency name and permit / approval- 12 AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes No 1 CERTIFY THAT THE IN�FIMATION PRO ED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant ! Sponsor Name Signature 2&67, If the action is a Costal Area, d you are a state agency, complete the Coastal Assessment For before proceeding with this assessment i 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 o 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 0 Yes E] No C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING*(Answers may be handwritten,if legible) 01 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 likely to be induced by the proposed action?Explain briefly: C6. Longterm,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 es,ex Iain bnefl El Yes ON E IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex Iain 0 Yes i J- PART 111-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 the4eterm1rtatio,offsignific evaluate-the-petential4m-paet of the proposed aetien an the environmental chafaeteristics of the OEA. 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 thi determination Name of Lead Agency Date Print or Type Name of Responsible icer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) Board of Trustees Application County of Suffolk State of New York ulj 1Jkr -2 Y\f C, 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/BER 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 VIEW OF APPLICATION t Signature SWORN TO BEFORE ME THIS DAY OF ,20 No aty,Pu lic CYNTHIA M. MANWARING = NOTARY PUBLIC, STATE OF NEW YORK NO:01 MA6100507 QUALIFIED IN SUFFOLK COUN j,],,, -- - - 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: ✓ Elaa HAJ (Last name,first name,Viddle 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 form and date and sign where indicated. Name of person employed by the Tqjwn of Southold �� L/ Title or position of that person_ Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): J�A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP ---- ------��-P-O-mss-� Submitted this of 0 Signature t Print Name Form TS I