Loading...
HomeMy WebLinkAboutTR-9515A r Michael J.Domino,President SU[/TTown Hall Annex John M.Bredemeyer III,Vice-President ,`O� Ol0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith [ Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 �ycoUP1T`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 1661 C Date: November 27, 2019 THIS CERTIFIES that the removal of existing septic system and replace with Innovative& Alternative Wastewater Treatment System; At 1410 Truman's Path,East Marion Suffolk County Tax Map#1000-31-12-11 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 9,2019 pursuant to which Trustees Administrative Permit#9515A Dated August 14,2019,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of existing_septic system and replace with Innovative&Alternative Wastewater Treatment System. The certificate is issued to Edith M Berry Glynis M.Berry&Hideaki Ariizumi owners of the aforesaid property. a Authorized Signature Michael J. Domino, President �� SO!/Ty0 Town Hall Annex John M. Bredemeyer III,Vice-President h0 l0 54375 Route 25 P.O.Box 11 Glenn Goldsmith [ Southold, New York 11971 A. Nicholas Krupski G � O Telephone (631) 765-1892 Greg Williams �cou O Y Fax(631) 765-6641 � Pm,��' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: `� 7 V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction / . '/2 constructed . V Project complete, compliance inspection. INSPECTED BY: ire COMMENTS: S A/ A� sl� 24 oz/ CERTIFICATE OF COMPLIANCE: i Cantrell, Elizabeth From: hideaki@studioabarchitects.com Sent: Wednesday, November 27, 2019 8:10 AM To: Cantrell, Elizabeth Cc: Glynis Berry Subject: 1410 Trumans Path Attachments: 1410TrumansPath SCounty greenstamp.pdf Hi Elizabeth, Please find the attachment PDF:the Suffolk County Health Department's green stamp approving the I/A OWTS installation,which includes 3-pages of 11"x17" (stamped corner, layout, and section). Re: street address: 1410 Trumans Path, East Marion Tax Map#1000-31-12-11 Thank you, Hideaki Ariizumi,AIA ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i LAND N/F OF i WILLAIM FAINGLAS DEVELOPED VENT / PUBLIC WATER ` LAND OF GLYNIS M BERRY,HIDEAKI i f/ FUJI CEN 5 CONTROL PANEL ARIIZUMI BLOWER DRY SHED ONLY SHED ACCESS TO PUBLIC WATER ' N 64°05'40"a 142.00' r — — 2.8 t �R` ELIE •'° O \ SHED p ems_ D 6 2 SOD TERRACE DR TEST 0 ' j �– 7 y z CO I DRLec HOLE 463' 1I '1 Rii �— r� p 1 j j 710' r� °i � �114 D I� IT MIN C -�--- '-,-- 'SETBACK '�--- 74 o LAND N/F OF REINHARDT s' i(t i iL_i N DEVELOPED j C 0. W Ir,AI i , II II DECK 1 STY FRM `' PUBLIC WATER Q (2)ROWS 24' /t 2, -il DWELLING Lo i iv ELGEN GSF F"9i iE'3i II I ° of 2, li-il POWER SUPPLY CONNECTED TO(1)DEDICATED 115 V j Lj il* ii ii —;�� I N VOLT AC,SINGLE-PHASE,20 AMP CIRCUIT BREAKER y 10 J L J E III I ON HOUSE MAIN ZQ8 OVERHEAD ELECT LINES Y i S 64°05'40"W 143 00' 86°S6 ��t jj — _1 6405'-40_LE,96_13_ _� N g 00" 0 �w ww= w�' v zz w RIGHT OF WAY DIRT DRIVEWAY WM ' - Lo o of LAND N/F OF 1420 SS)g N TRUMANS PATH LLC — — — — — — — — �, cl) SITE PLAN BASED ON SURVEY BY DEVELOPED S 64°0640"W 100.00' LAND I v OF KENNETH M WOYCHUK,N Y S LISC NO 050882 PUBLIC WATER STAEPHANIE+ DATED 8/25,2014 -WILHAM GORGA ED S C T M NO DISTRICT 1000 SECTION 31 BLOCK 12 LOT 11 LOCA?ON DIMENSIONS AB 1 70' 20D ' AREA 8,122 5 S F OR 019 ACRES 2 197' 315 3 297' 390' 1 n ELEVATIONS BASED ON DATUM N AV D 1988,FROM SC GIS 5 340' 425 6 4D D' 477 l� 11 �•j/ ��S\1' FEMA FLOOD ZONE X,EXCEPT AT BASE OF BLUFF AE EL 6' a 438' 497 I LLL��111 11077 / 9424' 374' ,�it 10 493' 45,4' U'I I I� f DEC - 2 2019 I Southold Town Board of Trustees IMPLEMENTED. -I---- -------------------L--------- INIMUM 2 x 2 POST 2 THE SEPTIC TANK&IIA OWTS SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS(WITH A MAXIMUM TOLERANCE IN ANY DIRECTION OF+/-ONE QUARTER INCH)ON A MINIMUM 3 INCH --- —3 - THICK(OR MANUFACTURER'S RECOMMENDATION)BED OF PROPERLY LEVELED AND N WIRE FENCE COMPACTED SAND(FREE FROM ROCKS),OR PEA GRAVEL BACKFILL SHALL BE PLACED 10/10 WWF) r I AROUND THE SEPTIC TANK&I/A OWTS IN SUCH A MANNER AS TO AVOID DAMAGE AND COMPACTED IN 6-INCH LIFTS BACKFILL SHALL BE FREE OF LARGE STONES,STUMPS,AND 2 CLOTH Z CONSTRUCTION DEBRIS �i! 0 3 THE TOP OF THE SEPTIC TANK&I/A OWTS SHALL NOT BE LOCATED GREATER THAN TWO AND HALF FEET OR LESS THAN ONE FOOT BELOW FINAL GRADE FOR SEPTIC TANK&UA OWTS WITH DOMES,THE TOP OF THE DOME SHALL NOT BE LOCATED GREATER THAN TWO AND HALF FEET OR LESS THAN ONE FOOT BELOW FINAL GRADE c I GRAD GENERAL NOTE )FILTER CLOTH INTO GROUND I, ;; 1. BEFORE ANY EXECUTION,VERIFY ON SITE,IF APPLICABLE: �v GRADE ELEVATIONS AT THE HOUSE WHERE THE WASTE MAIN PENETRATES ? GRADE ELEVATIONS WHERE EACH UNIT-WILL BE INSTALLED. 4" -HOUSE WASTE LINE MAIN LOCATIONS AND INVERT ELEVATIONS. =i -" ANY UNDERGROUND UTILITIES,INFRASTRUCTURES,AND/OR STRUCTURES ANY TREES WHICH MAY AFFECT TO THE UA OWTS INSTALLATION 2 GARBAGE DISPOSAL UNITS SHALL NOT BE USED WITH A I/A OWTS 3. TANKS SHOULD NOT BE PUMPED WHEN'GROUNDWATER IS HIGH OR FLOOD CONDITIONS PROJECT )nce Detaills EXIST Innovative and Alternative Oasdic Wastewater"Treatm e nt 'Sptem (I/A O-WT V)2 1410 Trum-a SLATE OR OTHER — MALE THREADED MALE THREADED $5 Y SUITABLE COVER ADAPTER AND CAP ADAPTER AND CAP 's W Cr ` / 0 - vE t AS-BUILT c c e 5 T h� �'c.�� s No .�� qTE OUj ff' J-1 � I/A OWTS Layout SEWER PIPE -- --°`�y _ _ ( WS c:r "� 0 + DOUBLE SIDED s <E-- m t:•x -- 45 DEG ELBOWS �. J WYE U 9(4 i Ea6a°.g: _'�✓ `: LASCO D448-040 C4 d n 0 0 as E 30 DEG ELBOW F" 60 DEG WYE OR EQ u, - ,q EM -- _ y p w C w- Projectnumber —-- _——- 1913 1,A - `'r`t. I!--- JI_y �; i '`) Es EDate --- 10/22/19 ;NATE A FOR BENDS ALTERNATE B1,FOR USE WITH ALTERNATE B2.FOR USE WITH tai sv p (/? Drawn by GB M BLDG EXTENSION/CONNECTION BLDG EXTENSION/CONNECTION 'y q Checked by HA n W/DOUBLE SIDED SWEEPLZ R AREAS NOT SUBJECT TO VEHICULAR TRAFFIC — f� L 1:3 ^ .O e Q f /v' 'I LS i i"" LJ a VV EPQ { / Scale As indicated '' LJ I OF - 2 2019 Sout,e,d Town Eoard of Trustees POWER SUPPLY CONNECTED TO(2) DEDICATED 115 VOLT AC, SINGLE-PHASE,20 AMP CIRCUITSBREAKER ON HOUSE PANEL 4"WASTE CAST IRON WITHIN 2'FROM FOUNDATION WALL,CONTINUED TO CLASS 2400 OR SDR 35,(OR SDR40) 1/4"PER 12"SLOPE MIN 4"(2"MIN)DIA HDPE VENT W/CHARCOAL FILTER 1B"MIN ABOVE GRADE, 36"MIN FROM ANY WINDOW OR HOUSE DOOR FUJI CEN 5 CONTROL PANEL W/6"RISER POLYLOK D-BOX EL 19 88'+/_ W/12"RISER ROWS,EA 24' EL BLOWER IN COVER ELJEN GSF EL 16 51'+/- CO l F ON PAD 3 0'MIN — - EL 1575'+/- CONNECTFOR EQUALIZATION r EL 15'+/- - -- m N ------ -------------------- - - -- F73 � 1 CELLAR - EL 12 34' c - I 12„ 12„ r� z U Q rc Q � b N M bt r O~i LL LL LL t0 v v c2 O M y n� O'+ 0+ n'4 W W W W r W W r'1 oN GROUNDWATER EL 0' > > o LL > > o > > o- o i z mow z z m z z mw mw SECTION DIAGRAM 3/16"= 1'-0" ^i l r, - L D Er, - 2 2019 you"�oi�iavan Michael J. Domino, President Town Hall Annex John M. Bredemeyer, III, Vice-President ,r=� y1 54375 Route 25 Glenn Goldsmith ,? P.O. Box 1179 A Nicholas Krupski y • ?;�'r Southold, NY 11,971 Greg Williams ,�ol , ,, ���+% Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES,CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed When project complete, call for compliance inspection; r Michael J.Domino,President ��F SO�jTown Hall Annex John M. Bredemeyer III,Vice-President �Q� Ol0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 COUNTI,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9515A Date of Receipt of Application: July 9, 2019 Applicant: Edith M. Berry, Glynis M. Berry & Hideaki Ariizumi SCTM#: 1000-31-12-11 Project Location: 1410 Trumans Path, East Marion Date of Resolution/Issuance: August 14, 2019 Date of Expiration: August 14, 2021 Reviewed by: John M. Bredemeyer, Vice-President Project Description: Remove existing septic system and replace with Innovative & Alternative Wastewater Treatment System. 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 site plan prepared by Glynis M. Berry, RA dated July 7, 2019 and stamped approved on August 14, 2019. Special Conditions: None. Inspections: Final Inspection. 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. O , Michael J. Domino, President Board of Trustees Michael J. Domino, Presidr� �QSCO 1 _ Town Hall Annex John M. Bredemeyer III, Vice-Presfbent ��� G'��` �' 54375 Route 25 Glenn Goldsmith cz Z P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 7�� `�17 <�S Completed in field by: _T, ������ CY EDITH M. BERRY, GLYNIS M. BERRY & HIDEAKI ARIIZUMI, request an Administrative Permit to remove existing septic system and replace with Innovative & Alternative Wastewater Treatment System. Located: 1410 Trumans Path, East Marion. SCTM#: 1000-31-12-11 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet i✓� �/ 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 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment ' 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: 7"D eAW,0,�' ire -- �;�J7 s 4441 s k I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other SANITARY SYSTEM DESIGN: GENERAL CONDITIONS: studio a/b architects RESIDENTIAL 1. INSTALLATION SHALL COMPLY WITH SUFFOLK COUNTY DEPARTMENT OF HEALTH 651 West Main Street #OF BEDROOM: 1+1 SERVICES'REGULATIONS,STANDARDS,AND REQUIREMENTS,AND SHALL BE STRICTLY IN Riverhead NY 11901 ADVANCED TREATMENT UNIT: FUJI CEN 5 BY FUJI CLEAN USA ACCORDANCE TO THE MANUFACTURER'S INSTRUCTIONS. 631 591 2402 I/A OWTS CAPACITY REQUIRED: 400 GAL PER DAY,AS PER TABLE 3, 631 3231426 SCDHS RESIDENTIAL STANDARDS 2.THE INSTALLER MUST HOLD A CURRENT LIQUID WASTE LICENSE PURSUANT TO CHAPTER glynis@studioabarchitects.com I/A OWTS CAPACITY DESIGNED: 500 GAL PER DAY 563 ARTICLE VII (SEPTIC INDUSTRY BUSINESSES)AND ENDORSEMENT J (INNOVATIVE AND ALTERNATIVE TREATMENT SYSTEM INSTALLER)THROUGH THE SUFFOLK COUNTY mailing address: LEACHING SYSTEM: GRAVELLESS ABSORPTION TRENCH SYSTEM DEPARTMENT OF LABOR, LICENSING AND CONSUMER AFFAIRS, PURSUANT TO SUFFOLK PO Box 444 ELJEN GSF ON CLEAN SAND AND GRAVEL COUNTY CODE§563-79(11)(J).THE DEPARTMENT OF LABOR, LICENSING,AND CONSUMER Orient NY 11957 LAND N/F OF EXISTING CESSPOOLS TO BE REMOVED REQUIRED: TOTAL 46 LF REQUIRED FOR SP/SW SOIL,AS PER SCDHS AFFAIRS MAINTAINS A LIST OF LIQUID WASTE LICENSE HOLDERS. WILLAIM FAINGLAS RESIDENTIAL STANDARDS TABLE 11 r DEVELOPED FUJI CEN 5 EXACT LOCATION OF WASTE DESIGNED: (2) ROWS EACH 24 FT LONG;TOTAL LENGTH 48 FT, INSTALLED ON 3.ALL INSTALLED I/A OWTS ARE REQUIRED TO HAVE AN INITIAL 3-YEAR WARRANTY. LINE UNDERGROUND UNKNOWN LAND OF EDITH M. BERRY, GLYNIS CLEAN SAND AND GRAVEL FILL ON REPLACED SOIL WITH CLEAN PUBLIC WATER VENT ENTRY ANGLE FUJI FOR STRAIGHT M. BERRY, HIDEAKI ARIIZUMI SAND AND GRAVEL ABOVE EXISTING SW OR SP LAYERSOIL 4.ALL INSTALLED I/A OWTS ARE REQUIRED TO HAVE ACTIVE O&M (OPERATION AND CONTROL PANEL DRY SHED ONLY 50%EXPANSION: (1)ROW 24 FT LONG. MAINTENANCE)AGREEMENTS BETWEEN THE PROPERTY OWNER AND SERVICE PROVIDER. BLOWER SHED ACCESS TO PUBLIC WATER 4 N 640 05' 4011 a 142.00' 5.SERVICE PROVIDERS MUST REPORT ALL O&M ACTIVITIES TO SCDHS (SUFFOLK COUNTY d' DEPARTMENT OF HEALTH SERVICES). 6. COVENANTS MAY BE REQUIRED ON PROPERTIES WHERE I/A OWTS ARE INSTALLED ,. t E 0 REQUIRING; SYSTEM REPLACEMENT IN EVENT OF FAILURE;O&M REQUIREMENT;ACCESS TO - o SHED Ai R h DRY DHS INSPECTION/SAMPLING ON QUARTERLY BASIS IF NEEDED; OTHER REQUIREMENTS THAT DOD TERRACE B LID TEST SCDHS DEEMS NECESSARY. HOLE GROUND ELEVATION 20'+/- ii l!, " R Owner: O I 23.6' a 5.2' 1C = 7. PERFORMANCE STANDARDS FOR I/A OWTS TECHNOLOGIES: asz 11 s'MIN CO R I/A OWTS MUST MEET TREATED EFFLUENT CONCENTRATIONS FOR TOTAL NITROGEN OF Edith Berry LO 71.0' r,-,1 / �[ DARK BROWN � ,,. pa, - NINETEEN 19 MG/L OR LESS. SETBACK 7.4' p LAND N/F OF REINHARDT �- 1' LOAM OL ( ) II II II �I N DEVELOPED � - - - I� I�,it li_ii DECK 1 STY FRM. PUBLIC WATER LU 2 R WS 24' II f II II h DWELLING Z O I I oC BROWN SILT ML SEPTIC/TREATMENT CONSTRUCTION CRITERIA: 14.01 4.0' (4.0'I 4.0'14 0' N� ELGE GSF ° 1. SEPTIC/TREATMENT Oi IF-'1 I� I POWER SUPPLY CONNECTED TO(2)DEDICATED 115 I. d ,--I 5.3' CV O _ _ _ 3_ I ALL NON-CONCRETE TANK WALLS, FLOORS, ROOF AND ACCESS COVERS SHALL RESIST IF, 11 II W VOLT AC SINGLE-PHASE 15 AMP CIRCUIT BREAKER F- �I L 1--I AN APPLIED FORCE OF 300 POUNDS PER SQUARE FOOT PSF .IL ii-Ii ON HOUSE MAIN; EXISTING PANEL NEEDS UPGRADE ( ) \ II. NON-CONCRETE PREFABRICATED SEPTIC TANK&I/A OWTS SHALL CONFORM TO THE 0 i- LOCATED IN 1ST FL BEDROOM). INTERNATIONAL ASSOCIATION OF PLUMBING AND MECHANICAL OFFICIALS"AMERICAN �' L J ( ) PALE BROWN FINE Cy 13.3' - M I -s BASEMENT BELOW TO COARSE SAND SW NATIONAL STANDARD FOR PREFABRICATED SEPTIC TANKS"ANSI Z1000-2007 AND ANY Z ( °' ' "' OVERHEAD ELECT.LINES UPDATES THERETO. property Tax Map#: LU s� ° 111. EACH SEPTIC TANK&I/A OWTS SHALL BE IDENTIFIED BY THE MANUFACTURER AND 1000-31-12-11 ° 05' 40" 6 `�s' DISPLAY THE FOLLOWING INFORMATION PERMANENTLY MARKED AT THE INLET END OF �Q�. LU NO WATER ENCOUNTERED THE TANK: site street address: N 6" F 1. MANUFACTURER NAME OR LOGO 1410 Trumans Path Y S 640 05' 40" W 143.00' 86°Q ���'�t� _ -N 640 05' 0_!-E_�_96_.13_ - _ b 17' 2. CAPACITY AND NUMBER OF OPENINGS East Marion, NY 11939 TEMP. SILT FENCE 76 0 3. MAXIMUM DESIGN LOAD z DURING INSTALLATION 0��� RIGHT OF WAY W DIRT DRIVEWAY W 0 4. THE DATE MANUFACTURED. ° _ TEST HOLE IV ALL CAST-IRON AND HDPE COVERS SHALL BE SET AT FINISHED GRADE, BE LOCKING, Q LAND N/F OF 1420 SS, N BY: MCDONALD GEOSCIENCE TAMPER-RESISTANT,WATERTIGHT, INSECT-PROOF, FLAT, SKID-PROOF,AND BE TRUMANS PATH LLC - - - - - - - - - - APPROVED FOR SEWAGE USE. COVERS AND RISERS SHALL BE CAPABLE OF DATE: 1/2/17 SITE PLAN BASED ON SURVEY BY DEVELOPED S 640 05' 40" W 10000' LAND N/F OF WITHSTANDING A TRUCK WHEEL LOAD (36 S IN.OF 2500 LB FOR 60 MIN WITH A MAX. . PUBLIC WATER HIGHEST EXPECTED GROUNDWATER VERTICAL DEFLECTION OF 1.5 IN. KENNETH M.WOYCHUK, N.Y.S. LISC. NO. 050882 STAEPHANIE+ + V. HDPE COVERS AND RISERS ARE REQUIRED TO BE USED ON NON-CONCRETE SEPTIC DATED: 8/25,2014 WILt1AM-GORG-AELEVATION 0' BASED ON USGS LI S.C.T.M. NO.DISTRICT:1000 SECTION:31 BLOCK: 12 LOT: 11 �` GROUNDWATER CONDITIONS TANKS.THEY SHALL BE SET AT FINISHED GRADE, BE LOCKING,WATERTIGHT, INSECT- No. Description Date r PROOF,AND BE APPROVED FOR SEWERAGE USE. AREA: 8,122.5 S.F OR 0.19 ACRES VI. IF A RISER COVER WEIGHS LESS THAN 60LBS A SECONDARY SAFETY LID OR DEVICE SHALL BE PROVIDED. ELEVATIONS BASED ON DATUM N.A.V.D. 1988 FROM SC GIS c TEST HOLE DATA - " 2. SEPTIC TANK&I/A OWTS SHALL BE WATERTIGHT AND CONSTRUCTED OF SOUND AND `►`"� - DURABLE MATERIALS THAT ARE NOT SUBJECT TO EXCESSIVE CORROSION OR DECAY. FEMA FLOOD ZONE X,EXCEPT AT BASE OF BLUFF AE EL.6' 1/4" 1'-0 A. ALL SEPTIC TANK&I/A OWTS MUST BE CERTIFIED AS WATERTIGHT BY MANUFACTURER USING EITHER VACUUM TESTING OR WATER TESTING METHODS. I. VACUUM TESTING MUST PULL 4"OF MERCURY(HG), FOR 2 MINUTES WITH A LOSS OF 10%OR LESS. 11. WATER TESTING:SEAL TANK; FILL TANK WITH WATER TO OUTLET INVERT ELEVATION FOR 24 HOURS. REFILL THE TANK TO OUTLET INVERT AFTER 24-HOUR PERIOD AND LET STAND FOR 10 HOURS.APPROVED IF WATER LEVEL IS HELD FOR 10 HOURS. 18'-0"MAX, B. ALL PENETRATIONS PIPES SHALL BE CONNECTED TO TANKS WITH A WATERTIGHT, C, to C. SEALED FLEXIBLE JOINT AND THE PIPE GASKET SHALL BE FASTENED TO THE PIPE WITH U A STAINLESS STEEL RETRACTABLE CLAMP. 1 I/A OWTS LAYOUT I O LL 3 .THERE SHALL BE A MINIMUM ONE-FOOT AIR SPACE MEASURED FROM THE OUTLET INVERT _ M TO THE BOTTOM OF THE TANK COVER. �UJI 1 w-4 4.ACCESS TO EACH TANK OR COMPARTMENT OF THE TANK SHALL BE PROVIDED BY AN ABBREVIATIONS. y` „ r =LL ACCESS COVER WITH AN INSIDE DIMENSION OF AT LEAST 20 INCHES IN DIAMETER,AND IN y 4 y` N COMPLIANCE WITH 5-111 AND 5-11413-7 OF CDHS RESIDENTIAL STANDARD 2016.ALL & AND LP LEACHING POOL (� 4 OPENINGS SHALL MEET THE FOLLOWING REQUIREMENTS: .� A. OPENINGS SHALL BE PROVIDED OVERALL INLET AND OUTLET PIPES @ AT MAX. MAXIMUM ,0 B. WHERE EXTENSIONS ARE REQUIRED,THEY SHALL BE WATERTIGHT B.C. BOTTOM OF CURB MIN. MINIMUM 0`� C. SEPTIC TANK&I/A OWTS MANUFACTURERS SHALL PROVIDE A LABEL OF NONCORROSIVE BW BOTTOM OF WALL N.T.S. NOT TO SCALE CONC. CONCRETE PROP. PROPOSED MATERIAL IN PROMINENT LOCATION AT EACH ACCESS OPENING TO WARN"ENTRANCE INTO TANK MAYBE FATAL" C.O. CLEAN OUT REQ. REQUIRED PERSPECTIVE VIEW DB DISTRIBUTION BOX SCDHS SUFFOLK COUNTY DEPARTMENT OF SEPTIC TANK& I/A OWTS INSTALLATION STANDARDS E or ELEC. ELECTRIC HEALTH SERVICES 1.ALL APPLICABLE RECOMMENDATIONS PROVIDED BY THE MANUFACTURER SHALL BE ELEV.or EL. ELEVATION ST SEPTIC TANK IMPLEMENTED. G GAS T.O. TOP OF 36" MINIMUM 2 x 2 HDPE HIGH-DENSITY POLYETHYLENE T.C. TOP OF CURB FENCE POST 2.THE SEPTIC TANK& I/A OWTS SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS (WITH A I/A OWTS INNOVATIVE AND ALTERNATIVE ONSITE TW TOP OF WALL MAXIMUM TOLERANCE IN ANY DIRECTION OF+/-ONE QUARTER INCH)ON A MINIMUM 3 INCH WASTEWATER TREATMENT SYSTEM W WATER THICK(OR MANUFACTURER'S RECOMMENDATION) BED OF PROPERLY LEVELED AND INV. INVERT W/ WITH WOVEN WIRE FENCE COMPACTED SAND(FREE FROM ROCKS) OR PEA GRAVEL.BACKFILL SHALL BE PLACED LG LEACHING GALLEY (6 x 6 - 10/10 WWF) AROUND THE SEPTIC TANK&I/A OWTS IN SUCH A MANNER AS TO AVOID DAMAGE AND COMPACTED IN 6-INCH LIFTS. BACKFILL SHALL BE FREE OF LARGE STONES,STUMPS,AND z CONSTRUCTION DEBRIS. FILTER CLOTH g 0 3.THE TOP OF THE SEPTIC TANK&I/A OWTS SHALL NOT BE LOCATED GREATER THAN TWO N AND HALF FEET OR LESS THAN ONE FOOT BELOW FINAL GRADE. FOR SEPTIC TANK&I/A POWER SUPPLY SCOPE OWTS WITH DOMES,THE TOP OF THE DOME SHALL NOT BE LOCATED GREATER THAN TWO CONNECTED TO(2) AND HALF FEET OR LESS THAN ONE FOOT BELOW FINAL GRADE. DEDICATED 115 VOLT AC, SINGLE-PHASE, 15 AMP CIRCUITS GJUL 9 Z�19 RAD GENERAL NOTE i BREAKER ON HOUSE PANEL EMBED FILTER CLOTH E 1. BEFORE ANY EXECUTION,VERIFY ON SITE, IF APPLICABLE: i I MIN. 6" INTO GROUND -GRADE ELEVATIONS AT THE HOUSE WHERE THE WASTE MAIN PENETRATES. ? 4"WASTE 4 -GRADE ELEVATIONS WHERE EACH UNIT WILL BE INSTALLED. " -HOUSE WASTE LINE MAIN LOCATIONS AND INVERT ELEVATIONS. CAST IRON WITHIN 2'FROM -ANY UNDERGROUND UTILITIES, INFRASTRUCTURES,AND/OR STRUCTURES FOUNDATION WALL,CONTINUED TO -ANY TREES WHICH MAY AFFECT TO THE I/A OWTS INSTALLATION CLASS 2400 OR SDR 35, (OR SDR40) SECTION DETAIL 1/4"PER 12"SLOPE MIN. 2. GARBAGE DISPOSAL UNITS SHALL NOT BE USED WITH A I/A OWTS. 3. TANKS SHOULD NOT BE PUMPED WHEN GROUNDWATER IS HIGH OR FLOOD CONDITIONS PROJECT Stormwater Silt Fence Detaiils EXIST. 4 (2 MIN.) DIA. HDPE VENT 14 N.T.S. Innovative a n d W"MIN.ACHARCOAL FILTER RAD Alternative Onsite 18"MIN.ABOVE GRADE, 36"MIN. FROM ANY WINDOW OR APPROVED BY HOUSE DOOR FU I RESER .. Wastewater Treatment CONTROL PANEL POLYLOK D-BOX BOARD OF 1 RUSTEES EL. 19.88'+/- W/ 12"RISER (2) ROWS, EA.24' BLOWER IN COVER ELJEN GSF TOWN OF SOUTHOLD System (I/A OW-17S) DATE -P L. 18.51'+/- _ - C.O. ON PAD � 3.0' MIN. Q f - - EL. 15.75'+/- CONNECT FORS /����% 1410 T ru m a n s .P- S M. ��y/ f� _ ____ ____ _�__��� z b EQUALIZATION vy " rM - - EL. 15'+/- MALETHREADED SLATE OR OTHER MALE THREADED MALE THREADED _ ADAPTER AND CAP SUITABLE COVER ADAPTER AND CAP ADAPTER AND CAP '9 ~O d2184� OQ CELLAR EL. 12.34' - _i Q - I/A OWTS Layout SEWER PIPE DOUBLE SIDED r W U 45 DEG. ELBOWS WYE z Q W Z 30 DEG ELBOW 60 DEG WYE R EQ D448-040 q U_ U_ F- Protect number 1913 N M r LL 00 I� V , 0 i (0 st �t M O M M O+ + Date 7/7/19 r r � Y_ r r C r r 2N g (V w w rn w w L0 w w r Cl) r 04 ALTERNATE A: FOR BENDS ALTERNATE B1: FOR USE WITH ALTERNATE B2: FOR USE WITH Drawn by GB Q GROUNDWATER EL.0 j 0 -i j j j j BLDG. EXTENSION/CONNECTION BLDG. EXTENSION/CONNECTION (0 m O w z z m z z m w m w Checked by HA LP - - - - W/DOUBLE SIDED SWEEP 0) CLEAN OUT DETAIL FOR AREAS NOT SUBJECT TO VEHICULAR TRAFFIC o _ _ - _ _ _ - _ - _ _ - _ _ - _ _ C . 01 2 SECTION DIAGRAM n CLEANOUT DETAILS N 3/16" = 1'-0" 1/2" = 1'-0" Scale As indicated t LAND N/F Q It S.C.T.M. NO. DISTRICT: 1000 SECTION: 31 BLOCK: 12 LOT(S): 11 OF v HEDGE TIMBER WALLS FAINGLAS! 4LAND N/F r I N 64005 40 E _ 6' STOCKADE ALONG LINE 142.00 GIUGOF TTI 9r,3 MON. 0 r I 10.0' FRM. 2.8'o JUL . 9 2019 PNI LU WOOOD I _ SHED POST ON GRADE L(J $outhd( Town STOWOOOP S R PIPE Boardof rastees ' FC 4' STOCKADE r yam. 16.0' 40.6' 0.5'S w ,,, 1.3'E w J � DECK rn i STY FIRM. ° O J i Ic u+ DWELLING C\2 LAND N/F z OF 9 7.4' d' o to REINHARDT r ° J I oa CELLAR ENT. LCA w un CONC. WOOD w r C I ^ STOOP POST ° FC ¢ Z I 1.3'N 30.96' °O.2'E S n r ° 0.5'N S6- o r r S 6405'40" W 143.00' ME' j ° °� IPE zQ 6001, � N r POST° F o O ° N 64°05'40" E 96.13' w LAND N/F S6 S6 p0 ! / %d °° / / / / / / / / / / / / / / / / / / / / / o OF !ti / / / °/° /° / /RIGHT%OF/ WAY / / i i i` /4/ o GIUGLIANOTTI °SS a DIRT° DRIVEWAY° ° C S 64°05'40" W LAND N/F 100.00' +I C/) OF STEPHANIE & WILLIAM GORGA � 1AN0 N�� JOHN &TERRY OORGA 'allWAfF1ESATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL 1 LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA. 8,122.5 S.F. OR 0.19 ACRES ELEVATION DATUM• _________________________ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUeTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: EDITH M. BERRY; GLYNIS M. MAP OP BERRY; HIDEAKI ARIIZUMI• FILED. FIDELITY NATIONAL TITLE INS. CO.; SITUATED AT: EAST MARION TOWN OF:SOUTHOLD ��// KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK � Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE #14-122 SCALE: 1 "-20' DATE AUG. 25, 2014 PHONE (631)298-1588 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk BERRY RESIDENCE I/A OWTS INSTALLATION PLCTyUR,E5.QF SITE 'fop Vol l 10 t Looking West at area just past the deck, where existing cesspools are,to be replaced with a FUJI CEN 5 wastewater treatment system A, Area where shallow leaching field(Elgen)will be installed +rE,r+tliilt.- fieldArea where leaching will be installed, Marion Lake beyond. --- �- A SEE SEC.NO O22 Sff SEG.No.022 L ? p e .^� a MATCN UNE \g\M1° MATCH LIME $ �rMATCM _ VIIE � 11.20°. 1123 p ci --�—__ • _ _�__� —_�.---- — Y �• +g\\ 4 \ SEE SEC.MO. 1]A a d 022-0aOIsm y'a 1118 •�O I �. w ♦ 1mM15M1�1 1]A ,2 O a '✓ $ �L\ n,e :5t'♦ b I pal ItA _ w b w \ L^ r0•M soum0cn 4 a e� �,p,f•� ,w` ; m 14 i •s b ® t • \aoP.° may' p ° 1 WUI b 4zw 6 P • 4 q \ 111] �w a 113 R r. w O f^q§ f w �b • I ✓ x'l2 4 ' S b $ g \ +gam° '+4.r ^� i �O a ♦ P & 9�, ° a n a d f m b \3�1 • f zz q° \ 32 tNU t t g a • 6, ♦ O$ 1115$Y m bw I 6 b T•` F1✓rt ' \g� �' f2aT \ al ? ,wo 2 y ^ a q ♦ ♦ ♦ 1t] n�g 5�� �g' `r 26 Y a 1.6A1°1 _ m • ► e'•/. rj]? b I • ^I °f !�'"t'."" Y \ze MAIN a 1 11 14 ♦ . •♦ (s0 s a p 4 ® 10.6 11 to 19 \ l+°r°p41 m a ;�\ w 9 � S pfb• a ^i„\za '� p9 •. a ' 7-1 ♦ 1® Q / 1 V los R • m b e� ,a ara S • 1 la ,g seN 1 / ♦ e sbt I+,,, +,,� oA•� $'gi F M1$ ° 64µ\m soy, yW1 42 e \S .201 4 t b, n n, 'P d ryy a g P $ �• (of41l SUFFOLK COUNTY 0P+\ AaE o a $ O %� ♦ a \ P 6 g / M1 ° a ♦ $ e YMTERAU010RIiY p p ,1.02 ~ ♦ $$ $ yL1 S 17.9 g a Q •Cs / ♦ ,1J, d . ea. g , T' a ♦ �l FORPCLNo. g�\ ° O $ ♦ $ ♦Aed ° d d '�e ♦♦ a X3190 ,0• g e� d g$ ,AI ��� P d $ % s $ '° &+ T °' as i •�1\♦ +, * d ea e'� P eaE,eM ♦♦ +,N'Ls 6 � , ,-,A b e d a � � °° ♦ ,9A,- $ a b ♦ a • b\ SOF 301D A? 0Vn1 ♦ M1 S/ mss.] '�- t m p ♦ o ee ^• a \ ♦. ♦ ♦�a p I a O b '. y,a ♦♦ e ea• \, ♦ ♦ ♦ MARION LAKE ♦ z i t w ♦ ,r d � • ♦ s���,��+�}$ • \ P d,pa ^ dvF ♦ � w t�U ~.` / ��� 14 mI ��♦ee d °A • a '&P' 9 a a ,yea d♦ • e? Jd* ^"FF�a ,cj ���_ M ♦ O b ¢'♦ ♦ @ $ d 255A a ' ♦®♦ d "''1, d a Qg g 13 p+ iiw 228A }° ♦ 'C ♦ d T�rT e d ♦ P ed 'e ^ \ 0• TAk ,Ip o Aa zo2 d � "P a ♦�� 3 ° • + ' ` \ 2.>A $ Ary, ��\ i a • ♦ ^� a $ 20J y�� b 'e ]Pe NLS—A F a ,p e a , ♦ ,� � e. ,p ° spu>:t-1ov if $ �$ ♦ MARION DIKE ♦P 16 f a • ♦ ..4.)) •P a Fac PCL No. L4 b �? '9 ♦ '4 .+a $ 20.4 wo l sEc. t.1u . $ ♦ ♦ e $ z.OA w / t�..�sacrtlloln w 021 A422 � ai © Za.a ,�'! p, ♦ 1.n / M1 en n,n♦ d°$ '� F Iz 11 g w' 9! .a ♦ '�' • ♦ Q4' / Fac Pc�No. ,aA a • ` a m SEE SEC.No. v m032-ta0 .dam A ,; �arwvrrecxry d �♦ � 14 e a � \g d \ N�♦ .♦ ~• P M1a b 28tH • 8 S F';$ a 1 a P ♦ � a ♦ L NOTICE COUNTY OF SUFFOLK © x m' *° 4° SOUi110LD E ♦"�'""”" RtIIP ax Service E �-� Q ♦..y x a Property Agency v � _ 031 _ asrn anrwn or M,.�Ar o.oFr� Re m0 mt E rr - surFru cwixrvru Mw svxosdreo Ca.MY Gn ,NYtl1Nt M 102 U "-" wrwour wurru cemu sswn or mE P m] narlxrra low PROPERTY MAP ms - r :-�.�:.., A•rF ^:air ..'vT �y.n-.++ ..n _ u,y r, ,. -u.xv,P ": -v M„as:, .v.;y:..., .a... kTx "= ,^'C;3'L �1' 4..._•+4 �. ,4 . .._._... tea, OFFICE LOCATION: ®��®f S®Ury®� 'MAILING ADDRESS: Town Hall Annex °` ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) 'e � ® a� Telephone: 631765-1938 Southold, NY 11971 ® Fax: 631 765-3136 c®UNT`I,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: August 13, 2019 Re: LWRP Coastal Consistency Review for EDITH N. BERRY, GLYNIS M. BERRY & HIDEAKI ARIIZUMI, SCTM# 1000-31-12-11 EDITH M. BERRY, GLYNIS M. BERRY & HIDEAKI ARIIZUMI, request an Administrative Permit to remove existing septic system and replace with Innovative &Alternative Wastewater Treatment System. Located: 1410 Trumans Path, East Marion. SCTM#: 1000-31-12-11 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 CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney ' Michael J.Domino,President rAf.SID Town Hall Annex John M.Bredemeyer 1H,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 co A.Nicholas Krupski = Telephone(631)765-1892 GregWilliams Pax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only IF Coastal Erosion Permit Application Wetland Permit Application Administrative Permit AmendmenttTransfer/Extension qr`q JUL 9 2019 --/)7-Received Application: Received Fee: $ /V61#0 Completed Application:. Incomplete: SEQRA Classification: Type I_ Type H Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: 2tCoordination:(date sent): '� Sent: LWRPConsistency Assessment F CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: 7!DPublic Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): Edith M. Berry, Glynis M. Berry,Hideaki Ariizumi Mailing Address: PO Box 444, Orient,NY 11957 Phone Number: 631680 9656 ,Suffolk County Tax Map Number: 1000_ 31-12-11 Property Location: 1410 Trumans Path,East Marion (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable): N/A Mailing Address: Phone Number: Board of Trustees Applin 'ion GENERAL DATA Land Area(in square feet):._ 8,122.5 SF Area Zoning: R-40 Previous use of property:, RESIDENTIAL Intended use of property: RESIDENTIAL Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Has access right-of-way .Will,this project require a Building Permit as per Town Code? Yes X . No wastewater +elec.permit If"Yes",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 for list of pre 2014,see attached list 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): replace existingcue spools with I/A OWTS and shallow leaching field Board of Trustees Appli,_' ,ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:, improve water qualms around Marion Lake Area of wetlands on lot: --- _.03 A,. 1,307square feet Percent coverage of lot: 12.5 % Deck 71' Closest distance between nearest existing structure and upland edge of wetlands: feet Note:location of existing cesspool is assumed;proposed is roughly same distance to wetlands Closest distance between nearest proposed,structure and upland edge of wetlands: 46.2 feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? cubic yards I/A OWTS: 12.2; ELGEN: 17.8;EXIST. CP: 22.38 (ASSUMED) How much material will be filled? CP 22.38 cubic yards Depth of which material will be removed or deposited: feet I/A OWTS: 5.5,ELGEN: 2.5',EXIST CP UNKNOWN UP TO 13' Proposed slope throughout the area of operations: 16: 1 Manner in which material will be removed or deposited: - REUSE ON SITE,TEMP.USE OF SILT FENCE 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): IMPROVED WATER QUALITY DUE TO NITROGEN MITIGATION.MARION LAKE CURRENTLY EXPEREINCES BLUE GREEN ALGAE Short Environmental Assessment Form Part 1 -Project Information Instructions for Comipletina 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: I/A OWTS FOR 1410 TRUMANS PATH Project Location(describe,and attach a location map): 1410 Trumans Path,East Marion,NY 11939 Brief Description of Proposed Action: remove existing cesspools and install new FUJI CEN5 Innovative/Alternative Onsite Wastewater Treatment System(UA OWTS)with shallow treatment dispersal(Elgen) Name of Applicant or Sponsor: Telephone: 631 680 9656 Glynis Berry,AIA E-Mail: glynis@studioabarchitects.com Address: PO Box 444 City/PO: State: Zip Code: Orient NY 111957 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 ❑ 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 government Agency? NO YES If Yes,list agency(s)name and permit or approval:SCDHS and Town electrical permit ❑ 3. a. Total acreage of the site of the proposed action? 0.19 acres b.Total acreage to be physically disturbed? 0.015 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.19 acres 4. Check all land uses that occur on,are adjoining or near the proposed action: 5. ❑Urban ❑ Rural(non-agriculture) ❑ Industrial ❑ Commercial m Residential (suburban) ❑Forest ❑ Agriculture ❑ Aquatic ❑ Other(Specify). ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ GZ-11 ❑ b. Consistent with the adopted comprehensive plan? 1:1 W1 NO YES 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? ❑ 0 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES Name:Peconic Bay and Environs,Reason:Protect public health,water,vegetation,&scenic beauty, If Yes,identify: Agency:Suffolk County,Date:7-12-88 ❑ W1 NO YES 8, a. Will the proposed action result in a substantial increase in traffic above present levels? W1 ❑ b. Are public transportation services available at or near the site of the proposed action? ❑ c. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed Elaction? IZI 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: N/A r7i ❑ 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: installation of new I/A OWTS a ❑ 12. a.Does the project site contain, or is it substantially contiguous to,a building,archaeological site,or district NO YES which is listed on the National or State Register of Historic Places,or that has been determined by the ❑ Commissioner of the NYS Office of Parks,Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places? b.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑ archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? 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? ❑✓ ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: ]Page 2 of 3 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: OShoreline ❑Forest ❑Agricultural/grasslands " ❑Early mid-successional [Z]Wetland ❑ Urban ❑ Suburban 15. Does the site of the proposed action contain any species of animal,or associated habitats,listed by the State or NO YES Federal government as threatened or endangered? Northern Long-eared Bat El Z 16. Is the project site located in the 100-year flood plan? NO YES area of work is outside the 100-year flood plan,Zone x ❑ 0 17. Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑✓ ❑ a. Will storm water discharges flow to adjacent properties? ❑ ❑ b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? ❑ ❑ If Yes,briefly describe: 18. Does the proposed action include construction or other activities that would result in the impoundment of water NO YES or other liquids(e.g.,retention pond,waste lagoon,dam)? If Yes,explain the purpose and size of the impoundment: wastewater held in plastic treatment tank before dispersal ❑ Z 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NO YES management facility? If Yes,describe: r7l ❑ 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: � ❑ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE c Applicant/sponso n ✓. e. Date: 7 A r Signature 6Title: 4w-YLtA `r cG 4414 PRINT FORiUI Page 3 of EAF Mapper Summ Report Monday,July 08, 2019 9:38 AM Disclaimer: The EAF Mapper is a screening tool intended to assist I} - X project sponsors and reviewing agencies in preparing an environmental 3100-1200-m601 ' 4i assessment form(EAF).Not all questions asked in the EAF are {, 3100-1300-$001 answered by the EAF Mapper.Additional information on any EAF 31.001200-6000 ., I1 question can be obtained by consulting the EAF Workbooks. Although 3100-1300-9001 the EAF Mapper provides the most up-to-date digital data available to 3100-120077000' `° DEC,you may also need to contact local or other data sources in order to obtain data not provided by the Mapper.Digital data is not a substitute for agency detemmnations. L 3100-120000\ '3100-1300=7®02 3100-12oo_'�sobo% - _ .100'1200-1.0000 fly i<mal Y,"� � 1. ..✓`, 4t•--•- � 39.00=92 00-13000 ouglo '107-12 -91000 ! Toronto 31'0®=1100=,ROQO 3'100-1200-12000 oRo if 3141-120 00-1 00® ;`f' iota T�" � �ston Idy.v,Yor i r� ' —; `B ice.EshERE.Gaamin, S135d C9� rs a+;cPe4d w j.)ti: ;� ,Ila��rtrlcnta �� p.,ltmerrl{7 $, 0-6060 Y_ wi_ ,� ,, , , ':,�1�•r (1 �A `�µ',�.k �1700u1 It,ani Sana �x 7i ZE Ja ETI,EseiChins n Kcn Esri S {t r Gsamin, qt do ' '. " - mr;., f" Korea ri Thailand.N&61 P�at�beargh` ,:�t1 G27Uritk j'�IS,INCRElNEh4T { } -Columbus- n5t<e�tfJle a�ntri30 X5000 11.0— i ti_�_ _ PMKRCan.Esr!Ja an,-fv1ETl„ -- - 'User Cer6unity. �v-1� 4t1�. cfnrta>a "lCA 4 su ris ne{FFant3r OA;, r; \ �tc.itiint.��- •.f 9fd�.m Part 1 /Question 7 [Critical Environmental Yes Area] Part 1 /Question 7 [Critical Environmental Name:Peconic Bay and Environs, Reason:Protect public health, water, Area- Identify] vegetation, & scenic beauty,Agency:Suffolk County, Date:7-12-88 Part 1 /Question 12a [National or State No Register of Historic Places or State Eligible Sites] Part 1 /Question 12b [Archeological Sites] No Part 1 /Question 13a[Wetlands or Other Yes- Digital mapping information on local and federal wetlands and Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15[Threatened or Yes Endangered Animal] Part 1 /Question 15 [Threatened or Northern Long-eared Bat Endangered Animal - Name] Part 1 /Question 16 [100 Year Flood Plain] Yes Part 1 /Question 20 [Remediation Site] No Short Environmental Assessment Form - EAF Mapper Summary Report 1 APPLICANT/AGENUREPRESENTATIn TRANSACTIONAL DISCLOSUn.FORAM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The nuroose of ibis form is torrovide information which camalett the town of possible conflicts of interest and allow it to take whatever action is nemsary to avoid same:, YOURNAME: Berry, Glynis M, Berry,Edith M.,and Ariizumi,Hideaki _ (Last name,first name,.tpiddle initial,unless you are applying ut the name o �� ((0 ; r.� -� someone else or other entity,such as a company.If so,indicate thb other ECE fi 4� person's or company's name.) 91D �j NAME OF APPLICATION: (Check all that apply.) JUL 9 20t9 Tax grievance Building Variance Trustee X Southold Tome Change of Zone Coastal Erosion Board of Trustees Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through y6ur 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 cinploynienl by)a corporation in which the town officer or employee owns,more:than 510 of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check 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 die applicant (when the applicant is a corjroration); 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 L Submitted this day of 200 Signature Print Name Form TS l Board of Trustees Appli :ion 1 -AFFIDAVIT. [�I w� ewlC��d �G'iAe(r 1 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 AUTHORIZE 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. Sij,affire of Prop Owner S4pkure of Property Owner SWORN TO BEFORE ME THIS DAY OF 20-L�—� Notary Public CUNNIE D.BUNCH Notary Public,State of New►York No.01BUs185050 ©ual''ji d in Suffolk Coia, �� Commission Er)ires Rn� . Q Board of Trustees Appli :ion AFFIDAVIT . � BEING DULY SWORN DEPOSES AND AFFIRMS THATHE/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 AUTHORIZE 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. Signature-of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF , 20�® Notary Public •�;ONNIE C.BUNCH ,jn.qry Public,State of New York No.01 BU6185050 �,5uaiified in Suffolk County ":,,)"mission`rxoires April 14,2 d�0 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS L, All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its, si cant beneficial and adverse effects upon the_coastal area(which includes allof Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing,both supporting and non- -supporting§Sets'. If an action cannot be ccrtified-as consistent with the LWRP policy standards and conditions,it,shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000 31 ' ..12 11 PROJECT NAMEI/A OWTS for 1410 Trumans Path The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. 0 Board of Trustees 1.. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan, subsidy) (c) Permit,approval,license,certification: 0 Nature and extent of action: Removal of existing cesspools and replacement with I/A OWTS (FUJI CEN 5 and shallow dispersal system (Elgen) Location of action: 1410 Trumans Path,East Marion,NY 11939 Site acreage: 0.19 Present land'use: Residential Present zoning classification: R-40 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Glynis M. Berry (b) Mailing address: PO Box 444, Orient,NY 11957 (c) Telephone number: Area Code( ) 631680 9656 (d) Application number,if any: Z. Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ NoR' If yes,which state or federal agency? 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 policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. 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 a coastal location, and 'minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria, ®Yes ❑ No ❑ Not Applicable Minimizes adverseeffects -of development by treng wastewater removinnitro, en which impacts algal .—blooms Attach additional sheets if necessary 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 ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ® Yes ❑ No ❑ Not Applicable contributes to cleaner water,which if more do this,will reduce frequencey of blue/green algae blooms Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria ❑ Yes © No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No F]Not Applicable Treats wastewater to NSF 245 standards,reduces nitrogen,TSS,BOD,etc. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No P Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑X No❑ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes 2] No ❑ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye� No❑ Not Applicable Attach additional sheets if necessary WORKING COAST PO—_"IES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III.—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes 0 No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 0 No ❑ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. E] Yes ® No❑ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes Q No ❑ Not Applicable PREPARED BY TITLE AI 16 DATE �J