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HomeMy WebLinkAboutTR-9539A Glenn Goldsmith,President �QF SO(/Ty Town Hall Annex Michael J.Domino,Vice-President ,`Q ��� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III 1�[ Southold,New York 11971 A.Nicholas Krupski G Telephone (631) 765-1892 Greg Williams �� Fax(631) 765-6641 olyPOUNV,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION,: f �,I INSPECT D BY:' �' Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1 St day of construction constructed X Project complete, compliance inspection COMNTS: t�uf CERTIFICATE OF COMPLIANCE: 0�L% �-S S✓ Glenn Goldsmith,President " ��OF soUjyo Town Hall Annex Michael J.Domino,Vice-President 54375 Route 25 -_----------John M.Bredemeyer III _ Southold;New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams '� �� Fax"(631) 765-6641 �yCOUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD- CERTIFICATE OF COMPLIANCE 1757C Date: September 23, 2020 THIS CERTIFIES that the construction activity within 100' of flagged wetland line for installation of 15'x30' (450sq.ft) in-ground pool with 890.5 sq. ft. framed.deck with site- drainage and septic system with abandonment of the existing cesspools:increase the size of the - -890:Ssq:ft franneci rear deck 249sgA., for a-total of 1;139.5:sq-.ft.-6nd for,-2841f x 48" black wire mes-h fence with steel round posts and gate at dock, located-along west and east property lines,as well as along southerly side of property approximately 25 feet from creek: At 420 Glenn Road,,Southold" Suffolk County Tax Map#1OQk:782=22 Conforms to the,application for a Trustees-Permit herefofore.filed-in this office Dated June-14,_$01"9- pursuant to which Trustees-Administrative Per #9539A Dated September-18-2019,Was,issued and Amended on January 15, 2020 and,conforins 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 construction.activity. within 100' of flagged wetland line for installation of 15'x30' (450sq.ftl in- rg ound pool with,890.5 sq. ft. ffamed deckwitri site- increase the size of the 890.5sq.ft framed rear deck by 249sq.ft., for a total of 1,139.5sq.ft. and for 2841f x 48"high black wire mesh fence with steel round posts andatg a at dock, located along west and east property lines,-as well as along southerly side of propertygpproximately-25 feet from creek. The certificate is issued to Jeffrey Blum owner of the aforesaid property. Authorized Signature Glenn Goldsmith,President *0 SU!/T Town Hall Annex Michael J.Domino,Vice-President hQVv y�lO 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 �y1 Dou ,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: fi /1v* INSPECTED BY:' " s/ Ch. 275 Ch. 111 . INSPECTION SCHEDULE Pre-construction; haybale line/silt-boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection COMMENT 2 p.-G. JJL,0�4t� V4 'bv6i_,� ad u Z4,,414&01 CER IFICATE OFVCOMPLIANCE:a T �u X-2 420 Glenn Road Southold, NY 11971 415-902-4205 r ieblum@gmail.com {� ' SEP 2 2020 September 2, 2020 ,_, i,,,1'i,Q,-,. ii r 11 Ba Dear Trustees, I would like to amend Admirative Permit 9539A for an as-built outdoor shower(4.0'x4'2"x6') which ties in to an existing drywell for drainage and for an as-build 8 ft Wide x 4 ft high self locking gate which is located at the south west end of the property. Please see enclosed plans for as built shower and survey for gate location. Please contact me with any issues. Sincerely, ye�L�� Jeff Blum 5 U R :Y Of LOT 6 R 1 o- 19-0001 A5 SHOWN ON A CERTAIN MAP ENTITLED"MAP OF WEST CREEK E5TATE5" FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY AUGUST 19, 19G3A5 MAP NO.3848 SITUATE: 5OUTHOLD w E TOWN : 5OUTHOLD 5UFFOLK COUNTY, NY -- s SURVEYED 1 1 -08-2018 PROPOSED 12- 18-20 15 REVISED O 1 - 10-2019 i I _ REVISED 02-2G-2019, 04-02-2019 SEP 2 2020 04-05-2019, FINAL 05-08-2020 Q� SUFFOLK COUNTY TAX # 1 000 - 78 - 2 - 22 Rood of Trilskei s CERTIFIED T0: n� JEFF BLUM MELISSA KONDAK CHICAGO TITLE INSURANCE SERVICES,LLC = as /V� V 4-4,4 0 `�dr4iay �U 1 / 6 0 11 o O CO 6 N 3 2 p/ �(8> CO' e O O p c�-"'q_ pS 2\q.28S 'GB. q�a F�i Sro 302 S3 q 2 _-5a 6s 6a s G� '0 e�qq 3S S4 s6 S L! �RgGFSF G� 31 e_S2 S lOOE��S�U /S 3 rya ON (FF F '�4 6� SKF 1 4r)' O' 64 ,.0 040'O, 33a e4 / 4- NF op /00 coIV e4 a oN x43.1 e Fs 2 c co N�20 �R \ oo� S UN � 6 NOTE5: "Unauthorized alteration or addition to a survey mop bearing a licensed land surveyors seal is o PIPE FOUND violation of section 7209, sub-division 2, of the ° JOHN C. E H LE RS LAND SURVEYOR ®� E�j �® New York State Education Law." —A—X— CHAIN LINKFENGE �O\C•EH��^��j� "Only copies from the original of this survey marked with on original of the land surveyor's to seal shall be considered to be wild true -ELEVATION5 REFERENCE NAVD W DATUM copies" ON PROPERTY IS FLOATING DOCK 4'x 2A'E RAMP 4'xl I' G EAST MAIN STREET N.Y.5. UC. NO. 50202 "Certifications indlcaled hereon signify that this / survey was prepored In accordance with the ex- Area = 22,214 S Ft. RIVERHEAD N.Y. 11901 3G9-8288 Fax 3G9-8287 A y tng Code of Practice far Land Surveys adopted �.• s by the New York State Association of Professional Area = 0.51 Acres Land Surveyors. Said certifications shall run only e5urve o tonllne.net `� cc to the person for whom the survey Is prepared, G P I 5CA E I 30 Y@ p �'�� 502 2 and on his behalf to the title company, governmen- tal agency and lending institution listed hereon, and SSD LAN to the aasignees of the lending institution Certifico- 17-12 1 tions are not transferable to additional institutions i �suFFoc� Glenn Goldsmith, Pi '___`�ient v� CO w� Town Hall Annex Michael J. Domino, Vice- ident ��� G�� ` � 54375 Route 25 John M. Bredemeyer III o "` P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Greg Williams y ► �apl� Telephone o (63192 Fax ) 765 6-18 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 9 Completed in field by: JEFFREY BLUM requests an Administrative Amendment to Administrative Permit#9539A for the as- built 4'x4'2"x6' outdoor shower which ties into an existing drywell for drainage; and for the as-built 8' wide x 4' high self-locking gate located on the southwest end of the property. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2-22 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 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: / q Per- A �Qs'S� '4`:✓�S/-� j .5 a4 ter- e`er h a 4 e4lcGr �j/ s - I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other �'��'�" R�'v✓ ��A+n 5 w,��, ��PIoVA.9 O`f �� �Q.�� �^� ����10�� �� AOWe_, 11`1120 Gose Glenn Goldsmith,Prey_`nt QF SUUr,�, Town Hall Annex 54375 Route 25 Michael J.Domino,Vice-rr sident ,`O l0 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski y G Q Telephone(631) 765-1892 Greg Williams �O �� Fax(631) 765-6641 �'y00UMV,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 16, 2020 John J. Condon, P.E. Condon Engineering, P.C. 1755 Sigsbee Road Mattituck, NY 11952 RE: JEFFREY BLUM 420 GLENN ROAD, SOUTHOLD SCTM#: 1000-78-2-22 Dear Mr. Condon: The following action was taken,by the Southold-Town Board of Trustees at their Regular Meeting held on Wednesday, January 15, 2020. RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit#9539A to increase the size of the 890.5sq.ft framed rear deck by 249sq.ft., for a total of 1,139.5sq.ft. and for 2841f x 48" high black wire mesh fence with steel round posts and gate at dock, located along west and east property lines, as well as along southerly side of property approximately 25 feet from creek; and as depicted on the site plan prepared by Condon Engineering, P.C., last dated November 20, 2019, and stamped approved on January 15, 2020. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, f5k, 4�" Genn Goldsmith President, Board of Trustees GG/dd SOFFQ(� t Michael J. Domino,P ent , �Q ,�0 Town Hall Annex John M. Bredemeyer III,Vi4:-rresident ��� G��`� 54375 Route 25 Glenn GoldsmithC-0 ` P.O.Box 1179 A.Nicholas Krupski � Southold,NY 11971 Greg Williams Telephone(631)765-1892 dx� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: tti Completed in field by: Condon Engineering, P.C., on behalf of JEFFREY BLUM requests an Administrative Amendment to Administrative Permit#9539A to increase the size of the 890.5sq.ft framed rear deck by 249sq.ft., for a total of 1,139.5sq.ft. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2-22 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 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: I have feacl& ackn �Iedgedregoing Trustees comments: Agent/Owner: /M. Present were: J. Bredemeyer Domino G. Goldsmith N. Krupski G. Williams Other la Condon Engineering, P.C. New York State Licensed Professional Engineers 1755 Sigsbee Road 631-298-1986 Mattituck, New York 11952 Fax 631-298-2651 www.condonengineering.com November 20, 2019 Ms. Elizabeth Cantrell, Clerk Board of Town Trustees Town Hall Annex Building 54375 Route 25 Southold NY 11971 Re: Trustees Administration Permit#9539A—420 Glenn Road, Southold, NY SCTM: 1000-78-2-22 Dear Ms. Cantrell: Attached are the following documents for the above referenced application: • Four sets of the revised site plans The plans were revised to increase the rear wood deck by 249 SF. The new additional deck will be located landward of the 100'setback off the wetlands. Yours truly, Ar ' /Tondon, .E. '`I NOV 2 5 2019 j� 1 ` DiSalvo, Diane From: condon <condon77173@optonline.net> Sent: Monday, November 25, 2019 3:02 PM To: DiSalvo, Diane; condoneng@optonline.net Subject: Re: FW:420 Glenn Road Diane, It is our intention to amend the permit#9539A to increase the size of the rear deck. A $50 check will be dropped off to your office in the next week. Thank you. John Condon On November 25, 2019 at 12:00 PM condoneng@optonline.net wrote: From: DiSalvo, Diane Sent: Monday,November 25, 2019 10:16 AM To: 'condoneng@optonline.net' <condoneng@optonline.net> Subject: 420 Glenn Road See attached which was dropped off today. I assume that you are asking to Administratively Amend Permit#9539A. Please confirm that this is your intent. Also, we need a$50.00 check made payable to Town of Southold. p�awe p�saLvo sou.tlnoLd Towo, Trustees 54375 R-0ute 25 C�� ) Michael J_ Domino, Pdent � Town Hall Annex John M_ Bredemeyer `Vice-President 54375 Route 25 Glenn GoldsmithP.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams Telephone (631) 765-1892 Fax (631) 765-6641 SO(fTffOLD TOWN BOA-RD OF TRUSTEES TO- SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BU[LD[NG DEPARTMENT PERMIT REQUIREMENTS -7 S CTM#: Property Owner Name: FW M Date Sent to Bldg_ Dept: 12 �.rq The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO - Will the proposed project require a Building Permit? :z Will the proposed project require a variance determination from the Zoning Board of Appeals? Wfl! any part of this application be considered a Demolition as described under Town Code? COMMENTS: - _ -- &gatu4reoeviewer Date DEC - 62019 til/ C c �12� r'S W i // I S T CC-41- 12O� ( -�- ,,0 `l l � 4T LrN6. JAN F 2ng0 JAN 6 2020 GENERAL NOTES POSTS-STEEL,T OR U SHAPE TYPE1. ALL MATERIALS AND METHODS OF CONSTRUCTION SHALL CONFORM TO THE STANDARDS AND OR' HARDWOOD SPECIFICATIONS OF THE LOCAL TOWN OR VILLAGE AND THE SUFFOLK COUNTY DEPARTMENT OF 6*MAX.MESH OPENING FENCE-WOVEN WIRE 14.5 GAUGE 314"JERSEY SHORE GRAVEL Cn t HEALTH SERVICES AS REQUIRED. (RATE OF 25 LBS/SY) FILTER CLOTH-MIRAF1 140N OR APPROVED EQUAL 2. TOPOGRAPHIC SURVEY BY JOHN C.EHLERS LAND SURVEYOR DATED APRIL 5,2019. VERTICAL DATUM IS NAVD 88. 4"MIN.STONE BLEND 3. THE CONTRACTOR SHALL FIELD VERIFY THE LOCATION AND DEPTH OF ALL UTILITIES PRIOR TO THE 36"MIN.FENCECOMMENCEMENT OF WORK. THE CONTRACTOR IS ADVISED ALL SUBSURFACE INFORMATION SHOWN 0 i z z ON THESE PLANS IS CONCEPTUAL AND MUST BE CONFORMED ACCORDINGLY IN THE FIELD. 12 =4 N 4. A MINIMUM SEPARATION OF TEN(10)FEET HORIZONTAL AND EIGHTEEN(118)INCHES VERTICAL IS TO BE X UNDISTURBED GROUND MAINTAINED BETWEEN WATER LINES, STORM DRAINAGE AND/OR SANITARY LINES OR STRUCTURES. FLOW A MINIMUM SEPARATION OF TWENTY(20)FEET TO BE MAINTAINED BETWEEN DRYWELLS AND SILT FENCE NOTES: > SANITARY STRUCTURES. COMPACTED BACKFILL S X X X 1. WOVEN WIRE FENCE(MIN.141/2 GAUGE MAX 6'MESH SPACING) 6'MIN.STABILIZED SOIL BASE WITH FILTER CLOTH OVER FENCE. "X6"TRENCH5. THE CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL NECESSARY PERMITS BEFORE Xy EMBED FILTER NOTE: COMMENCING WORK 2. FILTER CLOTH TO BE FASTENED SECURELY TO WOVEN WIRE FENCE WITH TIES SPACED EVERY 24"AT TOP AND MID SECTION. CLOTH 6"MIN. oo THE PROPOSED DRIVEWAY STONE WILL INTO GROUND PROVIDE A STABILE SURFACE THAT WILL 6. ALL UNSUITABLE MATERIAL AND DEBRIS SHALL BE DISPOSED OF IN ACCORDANCE WITH TOWN, 3. WHEN TWO SECTIONS OF FILTER CLOTH ADJOIN EACH OTHER THEY PERVIOUS DRIVEWAY DETAIL PROVIDE A MINIMUM OF 0.3 VOID SPACE AS COUNTY,STATE AND FEDERAL LAWS,CODES AND ORDINANCES.CONTRACTOR SHALL BE SHALL BE OVERLAPPED BY SIX INCHES AND FOLDED. V SPECIFIED ON THE DRAINAGE PLAN AND RESPONSIBLE FOR DISPOSING OF ALL UNSUITABLE MATERIALS OFFSITE. DEBRIS SHALL NOT BE 4. MAINTENANCE SHALL BE PERFORMED AS NEEDED AND MATERIAL THAT WILL NOT YIELD DUE TO USAGE. BURIED ON-SITE. REMOVED WHEN"BULGES'DEVELOP IN THE SILT FENCE. SECTION 7. ALL DRAINAGE PIPING MATERIAL TO BE PVC PERFORATED PIPE OR AN APPROVED EQUAL. ALL PIPING WOVEN WIRE FENCE(MIN.141/2 TO HAVE MINIMUM 12"OF COVER. 6"PIPE MAY BE USED TO CONNECT ROOF DRAIN LEADERS POS GAUGE MAX.6'MESH SPACING)- 36"MIN.FENCE POSTS. DIRECTLY TO DRYWELLS. 10'MAX CENTER TO CENTER\ -DRIVEN 16 MIN.INTO THE ALL ROOF DRAIN DOWNSPOUTS SHALL BE CONNECTED DIRECTLY TO THE PROPOSED ON-SITE IT"A t GROUND I PROPOSED LOT COVERAGE INFORMATION8. DRAINAGE SYSTEM. DOWNSPOUT LOCATIONS SHOWN ON THE PLANS ARE APPROXIMATE,ADDITIONAL . . . . . . . TAX MAP# (ZONE R-40) 1000-72-2-22 C7 ROOF DRAIN LATERAL PIPE AND FITTINGS TO BE PROVIDED AS NECESSARY TO CONNECT ALL ROOF . . . . . . . . . . . . . . LANDWARDFLAGGED WETLANDS DOWNSPOUTS. 0 7�7 r LrFEN L'. PROPOSED 491 SF X 4" DEEP 9. DURING CONSTRUCTION,EROSION AND SEDIMENT CONTROL MEASURES TO BE UTILIZED AS -S I * , %* * , , , , I, * ., * ., , M: I j • . . . . . - EXISTING COVERAGE D W 11/C7 NECESSARY TO PREVENT THE TRANSPORT OF SEDIMENT TO OFF-SITE AREAS,PONDS,DRAINAGE INLETS,ETC. THE METHODS AND MATERIALS EMPLOYED IN THE INSTALLATION AND MAINTENANCE OF . . . . . . . . STONE PERVIOUS DRIVEWAY co EXIST. HOU5E GARAGE I,G45 S.F. 0 TT EXIST. DECK 387 5.f. (SEE DETAIL THIS SHEET) EROSION CONTROL MEASURES SHALL CONFORM TO"THE NEW YORK GUIDELINES FOR EROSION AND 6"PENEMTION INTOOr� SEDIMENT CONTROL". GROUND PROPOSED * EXIST. COVERAGE (SEE SECTION) ELEVATION DRAINAGE CALCULATIONS: EXISTING H0U5E I,G45 S.F. PRpPps0 THE PROPOSED ON-SITE DRAINAGE SYSTEM TO PROVIDE STORAGE FOR 375.G S.F. C? " o A 21 RAINFALL. STORAGE TO BE PROVIDED IN 6'0 PRECAST DRYWELLS /01 SILT FENCE DETAIL PROPOSED ADDITIONS PROVIDING 22.3 CF/VF OF STORAGE. THE DESIGN IS BASED ON THE PROPOSED POOL 450 5.f. NOT TO SCALE - FOLLOWING RUNOFF COEFFICIENTS:ROOF 1.0,PERVIOUS DRIVEWAY 0.5 PROPOSED DECK 1,150.7 5.F. 40 41/ � TOTAL PROPOSED COVERAGE 3,623.7 5.f. or 17.G% DRA"A"-HOUSE ROOF AREA CO STORAGE REQUIRED: C()* A IN, FP P ROOF AREA: 2,028 SF X 1.00 X 2"/12= 338 CF PROPOSED 6'0 X 4' /0 (SEE ARCHITECTURAL PLANS) PPv, , DOWNSPOUT ------ DEEP DRYWELLpS�TING 62.3' 338 CF/22.3 CF/VF=15.2 VERTICAL FEET REQUIRED 41z yv STORAGE PROVIDED: DOWNSPOUT ADAPTER(ADS 40q) USE 4-6'0 X 4'DEEP DRYWELLS PROVIDING 16.0 LF>15.2 L.F. OR APPROVED EQUAL) moFF (SEE CHART FOR PART NU BER) Tf_5T HOLE DATA Ot DRA"B"-PERVIOUS DRIVEWAY 0 olve 11�1�5 13Y SURVEYOR STORAGE REQUIRED: G) of:- -1 /001 11 -08- 18 DRIVEWAY AREA: 491 SF X 0.50 X 2112 40.9 CF 0, 0Y Al, ts I Y Al OL BROWN LOAM PROPOSED GRADE 1`0N P, - - 15' STORAGE PROVIDED: ;��bp .3' PROVIDE 4'STONE=491 SF X 4/12 X 0.3=49.1 CF>40.9 CF A 450 BEND(MAX) O C� 6 Ov 5W PALE BROWN FINE TO COARSE SAND 40PR /V Q/ 6-ADS PIPE(LENGTH VARIES) 2po li�j J=- 4(1* POO �SeD 7.3' SNAP CONNECTION z / \ 5W WATER IN PALE BROWN FINE 4500 BEND(MAX) PROPOSED 6'0 X 4' TO COARSE SAND PART# PIPE SIZE A B C 0 0 0364AA 3* 2.50. 3.25- 4.75* PROPOSED FENCE X 12.3' DEEP DRYWELL 0464AA 48 .50- 3.25- 4.75' 0465AA 4- 3.25" 4.5K 5.00' >1 J. 4vzs 0466AA 48 6'ROOF DRAIN LATERAL 0 0 _gE 2.56" 4.63' WITH WYE(TYP.) PROPOSED 8'0 X 4' COMMENTS: WATER.ENCOUNTERED 7.3' BELOW SURFACE 0664AA 6" 3.62" 5.63" 6.43' 0664AC* 6* 3.62" 5.63' 6.431 •Part 0664-AC is PVC NOTE:6'ADS PIPE MAYBE DISTANCE VARIES t/A(t BACKWASH DRYWELL (SEE X OF CONNECTED DIRECTLY TO THE DRAINAGE PLAN) CULecru EC DGE JL//R/,qD/C ts USED WHEN A DOWNSPOUT IS 001 j # WETLAND FLAGS SHOWN THU5 WERE 5ET 13Y SURVEYOR STRUCTURES. -0) c0 oy 170N ON tz I If.E.M.A. FLOOD ZONE SHADED X * AE(EL G) FROM F.I.R.M. PANEL 3G 103c0 1 CGH I ROOF DRAIN ADAPTER DETAIL X -311� 0 NOT TO SCALE 11�� % SILT FENCE AND HAY BALE 6'-0" 0 LINE AT 100' SETBACK SEE PRECAST STRUCTURE NOTES FOR REINFORCING REQUIREMENTS. INSTALL DUMMY RINGS AND/OR DOME AS 0 NECESSARY TO BRING PROPOSED STRUCTURE TO GRADE HEAVY DUTY MANHOLCAMBELL FOE FRAME AND PROPOSED FENCE SLOTTED COVER UNDRY CO. MIN.2 BRICK PATTERN No.1383 OR SOLID MANHOLE 0 COURSES COVER PATTERN No.1012A-TYPE C OR AN APPROVED EQUAL CONCRETE COLLAR /If AS NECESSARY FINISHED GRADE 0 SEE PLANS BY NANCY DWYER, DESIGNER X APPROVED BY NOV 2 5 2019 _Z41 en FOR ADDITIONAL INFORMATION BOARD OF 1 RUSTEES U_(0 SEE PRECAST STRUCTURE to -J TOWN OF SOUTHOLD NOTES FOR REINFORCING PLAN VIEW REQUIREMENTS f* X &R - LEACHING BASIN NOTES: 2,3 OR 4 FOOT SECTIONS '9, DATE 20.?o AS NECESSARY 1.ALL DRAINAGE STRUCTURES SHALL BE PLACED 7- WRAP WITH 6 OZ.(MIN.)NONWOVEN ry 0 IN ACCEPTABLE LEACHING SOILS AS APPROVED GEOTEXTILE(FILTER FABRIC)AND AT 0 BY THE ENGINEER. IN THE EVENT POOR LEACHING MATERIAL IS ENCOUNTERED,EXCAVATION IS TO TOP OF COLLAR BY MIRAFI OR AN BE CONTINUED TO SUITABLE MATERIAL AND APPROVED EQUAL PRECAST DRAINAGE K CO 11/20/19 REV.REAR DECK < 9/5/19 REV.REAR D < CD ECK/POOL 2. NO TRENCH,PIT OR OTHER EXCAVATION SHALL LU a- < .:. , : .. I BACKFILLED AS DETAILED. SHEET PILING AS REQUIRED RINGS BE LEFT OPEN OR UNATTENDED. EXCAVATIONS EXCAVATE AND BACKFILL 3 FEET AROUND LU< REVISIONS 0 rY TO BE PROTECTED AS DIRECTED BY THE LEACHING RINGS WITH SUITABLE POROUS • • Uj MATERIAL AS APPROVED BY THE ENGINEER. > ENGINEER WITH FENCES,BARRICADES AND LU OTHER APPROVED METHODS. 12"MIN. 0 3. ALLOW FOUR(4)INCHES FOR FINAL ADJUSTING OF CASTING. ADEQUATE BEARING WILL BE . velSITE PLAN PROVIDED USING CONCRETE BLOCK BRICK AND/OR 1:2 MORTAR MIX. 4 SCALE:1*=20' Plans are prepared by Condon Engineering,P.C. It is a violation of the New York State Education Law,Arfide 145,Section 7209,for any person unless acting under the direction of a licensed 4. THE CONTRACTOR SHALL PROVIDE ADEQUATE Professional Engineer,Architect or Land Surveyor,to after any item in any way.if an Rem bearing SHEETING AND SHORING DURING TRENCHING TOJ. the sea]of an Engineer,Architect or Land Surveyor Is altered,the afte ngE n r, it or d ng! ee Arch ect, INSURE THE SAFETY OF WORKMEN AND THE 0 Land Surveyor shall affix to the item hMer seal and the notation'Altered by'followed by his/her - GENERAL PUBLIC EXPOSED TO THE HAZARDS OF FALLING AND SLIDING MATERIAL IN EXCAVATE A MINIMUM OF 6 INTO signature and the date of such alterations,and a specific description of the alteration. S.C.T.M.: DIST. 1000 SEC.78 BLK 2 LOT.22 VIRGIN STRATA OF SAND AND T sit, CONFORMANCE WITH THE REQUIREMENTS OF THE TITLE 29 CODE OF FEDERAL REGULATIONS,PART GRAVEL OR TO BOTTOM OF DRYWELL ELEVATION VIEW 1926,SAFETY AND HEALTH REGULATIONS FOR WHICHEVER IS DEEPER. CONSTRUCTION(OSHA). Scale:AS SHOWN Condon Engineering, P.C. B L U M RESIDENCE 5. BACKFILL AND COMPACTION SHALL BE IN 6' 420 GLENN ROAD LIFTS. ALL BACKFILL MATERIAL TO BE DRYWELL DETAIL Drawn by:JJC 1755 Sigsbee Road COMPACTED BY JETTING OR OTHER APPROVED Maftituck, New York 11952 SOUTHOLD, NY OF MEANS. Date:6/10/2019 (631) 298-1986 (631)298-2651 fax www.condonengineedng.comDrXM0 A INAGE PLAN i - �y Michael J. Domino, President S�fFO(A-c ��o� o�y Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith r N z P.O. Box 1179 A Nicholas Krupski y o�r' Southold, NY 11971 Greg Williams �01 , , �glsl 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- i Michael J.Domino,President �� S0(/jTown Hall Annex John M.Bredemeyer III,Vice-President �Q�v O1 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 'rouff ,� ` BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9539A Date of Receipt of Application: June 14, 2019 Applicant: Jeffrey Blum SCTM#: 1000-78-2-22 Project Location: 420 Glenn Road, Southold Date of ResolutionlIssuance: September 18, 2019 Date of Expiration: September 18, 2021 Reviewed by: Michael J. Domino, President Project Description: Conduct construction activity within 100' of flagged wetland line for installation of 15'x30' (450sq.ft) in-ground pool with 890.5 sq. ft. framed deck with site drainage and septic system with abandonment of the existing cesspools. Findings: The project meets all the requiremen#s 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 Condon Engineering, P.C., last dated September 9, 2019 and stamped approved on September 18, 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. Michael J.,Domino, President Board of Trustees GENERAL NOTES POSTS-STEEL,T OR u SHAPE TYPE 1. ALL MATERIALS AND METHODS OF CONSTRUCTION SHALL CONFORM TO THE STANDARDS AND OR 2'HARDWOOD SPECIFICATIONS OF THE LOCAL TOWN OR VILLAGE AND THE SUFFOLK COUNTY DEPARTMENT OF FENCE-WOVEN WIRE 14.5 GAUGE '{ 3/4'JERSEY SHORE GRAVEL `` 6'!A4X."",ESHODcnnn Cl) (P.ATE OF 25 LBS' HEALTH SERVICES AS REQUIRED. FILTER CLOTH-MIRAFI 14ON OR APPROVED EQUAL 2. TOPOGRAPHIC SURVEY BY JOHN C. EHLERS LAND SURVEYOR DATED APRIL 5,2019. VERTICAL DATUM IS NAVD 88. 4'MIN.STONE BLEND 3. THE CONTRACTOR SHALL FIELD VERIFY THE LOCATION AND DEPTH OF ALL UTILITIES PRIOR TO THE COMMENCEMENT OF WORK. THE CONTRACTOR IS ADVISED ALL SUBSURFACE INFORMATION SHOWN 3V•IYIII V.1 LIVUL�VJT \ ~' z z VT C ON THESE PLANS IS CONCEPTUAL AND MUST BE CONFORMED ACCORDINGLY IN THE FIELD. If _J Zo 4. A MINIMUM SEPARATION OF TEN (10)FEET HORIZONTAL AND EIGHTEEN(18)INCHES VERTICAL IS TO BE \ \\ \\ \\ \\ \\ \ \ \ \ \ \ \ \ MAINTAINED BETWEEN WATER LINES, STORM DRAINAGE AND/OR SANITARY LINES OR STRUCTURES. UNDISTURBED GROUND F�LOW LL \//\//\//\//\//\//\//\//\//\//\//\//\//\/ A MINIMUM SEPARATION OF TWENTY(20)FEET TO BE MAINTAINED BETWEEN DRYWELLS AND \ \ \ \ \ \ \ \ \ \ \ \ \ \ SANITARY STRUCTURES. SILT FENCE NOTES: \//\//\//\//\//\//\//\//\//\//\//\//\// COMPACTED BACKFILL \\ \\ \\ \\ \\�\\�\\/\\�\\�\\�\\�\\�\\/\\. `\ U� �� \ \ \ \ \ \ \ \ \ \ \ \ \ \ ' V' IYIIIY.S I f1 O1 LIL�D JOIL Df1JE 1. WOVEN WIRE FENCE(MIN.1412 GAUGE MAX.6'MESH SPACING) 1X6'TRENCH \/\/\/\/\�/\�/\//\//\�/\�/\//\�/\�/\�/ WITH FILTER CLOTH OVER FENCE. \/\/\/\/\/\/\/\/\/\�\/\/\/\ 5. THE CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL NECESSARY PERMITS BEFORE \ \\ \\ \\ \\ \\ \\ \\ \\ \\ \\ \\ \\ \\ COMMENCING WORK. EMBED FILTER NOTE: (n 2. FILTER CLOTH TO BE FASTENED SECURELY TO WOVEN WIRE FENCE CLOTH 6'MIN. \\j�\ ��\\��\\��\\j�\\ THE PROPOSED DRIVEWAY STONE WILL "J WITH TIES SPACED EVERY 24"AT TOP AND MID SECTION. INTO GROUND `° PROVIDE A STABILE SURFACE THAT WILL 6. ALL UNSUITABLE MATERIAL AND DEBRIS SHALL BE DISPOSED OF IN ACCORDANCE WITH TOWN, 3. WHEN TWO SECTIONS OF FILTER CLOTH ADJOIN EACH OTHER THEY PERVIOUS DRIVEWAY DETAIL PROVIDE A MINIMUM OF 0.3 VOID SPACE As COUNTY,STATE AND FEDERAL LAWS,CODES AND ORDINANCES.CONTRACTOR SHALL BE SHALL BE OVERLAPPED BY SIX INCHES AND FOLDED. ' SPECIFIED ON THF DRAINAGE PLAN AND RESPONSIBLE FOR DISPOSING OF ALL UNSUITABLE MATERIALS OFFSITE. DEBRIS SHALL NOT BE THAT WILL NOT YIELD DUE TO USAGE. BURIED ON-SITE. 4. MAINTENANCE SHALL BE PERFORMED AS NEEDED AND MATERIAL REMOVED WHEN'BULGES'DEVELOP IN THE SILT FENCE. SECTION 7. ALL DRAINAGE PIPING MATERIAL TO BE PVC PERFORATED PIPE OR AN APPROVED EQUAL. ALL PIPING WOVEN WIRE FENCE(MIN.14 12 TO HAVE MINIMUM 12"OF COVER. 6'PIPE MAYBE USED TO CONNECT ROOF DRAIN LEADERS GAUGE MAX.6'MESH SPACING) ^ DIRECTLY TO DRYWELLS. POSTS(TYP.) 36'MIN.FENCE POSTS. 10'MAX CENTER TO r_.EnrfER DRIVEN 16'MIN INTO THF 8. ALL ROOF DRAIN DOWNSPOUTS SHALL BE CONNECTED DIRECTLY TO THE PROPOSED ON-SITE GROUND PROP05ED LOT COVERAGE INFORMATION <C� / DRAINAGE SYSTEM. DOWNSPOUT LOCATIONS SHOWN ON THE PLANS ARE APPROXIMATE,ADDITIONAL w TAX MAP# (ZONE R-40) 1000-72-2-22 cls�•-, ' V ROOF DRAIN LATERAL PIPE AND FITTINGS TO BE PROVIDED AS NECESSARY TO CONNECTALL ROOF DOWNSPOUTS. AREA LANDWARD OF FLAGGED WETLANDS 20,551 S.F. PROPOSED 491 SFX 4" DEEP ro ILT' E' E'. EXISTING COVERAGE 9. DURING CONSTRUCTION,EROSION AND SEDIMENT CONTROL MEASURES TO BE UTILIZED AS "►� • '� "+��• •'^ ^ "^�• •*�•• " • ` �` NECESSARY TO PREVENT THE TRANSPORT OF CEDMIENIT TO OFF-CITE AREAS, PONDS DRAI�lAGE J I�JNt t'tK�/IIVUJ UKIVtV1�H •4' v �`p /S 4y INLETS,ETC. THE METHODS AND MATERIALS EMPLOYED IN THE INSTALLATION AND MAINTENANCE OF EXIST. HOUSE�GARAGE I,645 S.F. v DQST. DECK 387 S.F. (SEE DETAIL THIS SHEET) ;� �� ;:' 3Mr EROSION SEDIMENT COONTROLMEASURES SHALL CONFORM TO'THE NEW YORK GUIDELINES FOR EROSION AND 6'PENETRATION INTO GROUND PROPO5ED f- EXIST. COVERAGE ; ` / `.: (SEE SECTION) ELEVATION P o :. �,. DRAINAGE CALCULATIONS: IXISTING t10USE I,645 S.F. ROA_ i0:: `2 /�� THE PROPOSES b ON-SITE DRAINAGE SYSTEM TO PROVIDE STORAGE FOR DETAIL PROPOSED ADDITIONS 378.6 S.F. gpSrOS�D �' "�� /o' s til/N ' Opp SILT FENCE Dir,RY / : ' ,� Q��. /(,//� A 2"RAINFALL. STORAGE TO BE PROVIDED IN 6'(�PRECAST DRYWELLS PROPOSED POOL 450 S.F. O/V ' �" �O� 1 -�' ;: i PROVIDING 22.31 CF/VF OF STORAGE. THE DESIGN IS BASED ON THE NOT TO SCALE /,.:.:°a) ° i Fp t CP ��_�: t _- -- �I`t• I� FOLLOWING RUNOFF COEFFICIENTS: ROOF 1.0, PERVIOUS DRIVEWAY 0.5 PROPOSED DECK 890.5 S.F. , i , ,. y�:' � �, \ � `1 lea, fl-''y/ P TOTAL PROPOSED COVERAGE 3,364.1 S.F. or I G.4% , - :..,;�(;�/)� / 't/ _ /p C/� /P -\ F/ 8 �'I SEP g 2�)� DRA A -HOUSE ROOF AREA �' _ i I� (p tp •T STORAGE REQUIRED: ,� , -__ ..._-_•_-._.� ROOF AREA. 2,028 SFX 1.00 X 2712= 338 CF A PROPOSED 6'Q� X 4' - CP �,�' sFRop r _ yr _ DOWNSPOUT DEEP DRYWELL M°� Sr 338 CF 122.3 CFNF= 15.2 VERTICAL FEET REQUIRED (;SEE ARCHITECTURAL PLANS) / 62,3, n O v A//�/G C/C /O, STORAGE PROVIDED: DOWNSPOUT ADAPTER(ADS � � 'moi / � 41/ vti USE 4-6'0 X 4 DEEP DRYWELLS PRO VIDtNv=16.0 LF>15.2 L.F. OR APPROVED EQUAL) p (SEE CHART FOR PART NUMBER) o, /� F qRG� `�'I�O�ee TEST HOLE DATA EL=8.0' /x'01, F e4.-Z:- GF DRA B'-PERVIOUS DRIVEWAY o t/ke q �Q �D �,O 5' �/ BY SURVEYOR STORAGE REQUIRED: /00+°F rR�sr 20�/'' �i,� O�l F I I -08-18 DRIVEWAY AREA: 491 SFX 0.50 X 2/12 = 40.9 CF R/Sol FFS I �� D' OL I F3RnWN LnAM STORAGE PROVIIDED: PROPOSED GRADE--,_ vN 10.31 PROP 2C �� � � 1.51 PROVIDE 4"STONE=491 SF X 4/12 X 0.3=49.1 CF>40.9 CF \ \ \ \ Cp 450 BEND(MAX.) \� .S FcK P 30 �q �D ^• 1 (L SW PALE BROWN FINE TO COARSE SAND 46 a ac 6'ADS PIIPE(LENGTH VARIES)Lu O• \ 4 P0/'ps �v 7.3' SNAP CONNECTION WATER IN PALE BROWN FINE SW J v I` PROPOSED 6'0 X 4' TO COARSE SAND / �O 450 MEND(MAX.) z �� PART# PIPE SIZE A B C T 1 0364AA T 2.50' 3.25' 4.75' PROPOSED FENCE / F�( / " ° DEEP DRYWELL ,2.3 0464AA 4' 2.50' 3.25' 4.75• D 0465AA 4' 3.25• 4.56' 5.00' _' X / TO p. / PROPOSED 8'0 X 4' COMMENTS: WATER ENCOUNTERED 7.3'BELOW SURFACE 0466AA 4' 2.56' 2 56' 4.63' 6'ROOF DR/uIN LATERAL o 05^,:.A.". � 3 C2' S 63' 6 43• WITH WYE(TYP.) , � � � / , 0664AC' 6' 3:67 563' 6.43' � ; M°�Fo �iNEo1- BACKWASH DRYWELL • Part D664-AC is PVC NOTE: FADS PIPE MAYBE DISTANCE VARIES � � USED WHEN A DOWNSPOUT IS {SEE GRADING AND X4 s ��`' \► /°� JLI,o�SrFEs WETLAND FLAGS SHOWN THUS # WE S B CONNECTED DIRECTLY TO THE DRAINAGE PLAN) � �i p� STRTECDRAINAGE / `(p / \; \ /��O/V ISL ET Y SURVEYOR STRUCTURES. F.E.M.A. FLOOD ZONE SHADED X AE(EL G) FROM F.I•R.M. PANEL 3G 103C0166t1 n nr nn � � nnn rn r u �� / % � FC .� / ROVI- DTII 11 /'' LJMPTr DCTAIL NOT TO SCALE � / FX?, // � X S SILT FENCE AND HAY BALE LINE AT 1 SETBACK 6-0 Fpm 00 S T CK SCE PRECAST STRUCTURE IW 1 ES FOR ' REINFORCING REQUIREMENTS. / // e4 3.2 \� o INSTALL DUMMY RINGS AND/OR DOME AS / NECESSARY TO BRING PROPOSED 2 / STRUCTURE TO GRADE HEAVY DUTY MANHOLE FRAME AND PROPOSED FENCE SLOTTED COVER CAMBELL FOUNDRY CO.MIN.2 �/ I COURSES SIS COVERRN No.1383 OR SOLID MANHOLEP PATTERN No..1012A-TYPE C OR AN \ ` " �7/G+y 0) APPROVED BY CONCRETE COLLAR APPROVED EQUAL. �'9rO(� rn�/�J BOARD OF TRUSTEES / AS NECESSARY FINISHED GRADE V6 p X \ � L 2 � TOWN OF SOUTHOLD `J' , r r1 2a' 9 SgQ//, X DATE Ssfi � 119 Zol�' - U- W w �- SEE PRECAST STRUCTURE 11 CD 6 NOTES FOR REINFORCING pLAN VIEW a ��• F�O.q �- REQUIREMENTS t •ee olz, ���t# ': aD i� X Utf7ED•.: ,., :t5 LEACHING BASIN NOTES: 2,3 OR 4 FOOT SECTIONS / '9, AS NECESSARY 1.ALL DRAINAGE STRUCTURES SHALL BE PLACED .. z NXt7e0 tn_nTu 6 n? +�Alnl\nVlnnNnl/Cn1 .• n IN ACCEPTABLE LEACHING SOILS AS APPROVED �"""')`•`•,"'" ' z:; 3'.CQLLAf2•- 0 0 BY THE ENGINEER. IN THE EVENT POOR LEACHING GEOTEXTILE(FILTER FABRIC)AND AT Cn w MATERIAL IS ENCOUNTERED,EXCAVATION IS TO TOP OF COLLAR BY MIRAFI OR AN z APPROVED EQUAL. � BE CONTINUED TO SUITABLE MATERIAL AND ":<' : PRECAST DRAINAGE BACKFILLED AS DETAILED. RINGS ? ° SHEET PILINGASREQUIRED i'..• ; Q �. 9/9/19 REV. REAR DECK/POOL 2. NO TRENCH,PIT OR OTHER EXCAVATION SHALL J D z BE LEFT OPEN OR UNATTENDED. EXCAVATIONS EXCAIVATE AND BACKFILL 3 FEET AROUND o LEACHING RI"I^S:"11TH SUITABLE POP.OUS REVISIONS TO BE PROTECTED EU AS UIREC I EU BY THE ;..<' :' '' v ENGINEER WITH FENCES,BARRICADES AND MATERIAL AS APPROVED BY THE ENGINEER. u' a w OTHER APPROVED METHODS. 12'MIN. ILL 6 LU y 3. ALLOW FOUR(4)INCHES FOR FINAL ADJUSTING J OF CASTING. ADEQUATE BEARING WILL BE :" :"'" ' . PROVIDED USING CONCRETE BLOCK,BRICK ".:• ': - SITE PLAN AND/OR 1:2 MORTAR MIX. '' .' SCALE:1'=20 Plans re prepared her Cnnr#nn F��inocnnn .•� I_.._are prepared_.___ _ _ P(;- It is a%ripIatinn of+ho flow Ynrk Sin+o Education yL ye �'.•�o. :`�:•',+: Law,Article 145,Section 7209 for an person unless actin under the direction of licensed o�:•. ' •. •�; 4. THE CONTRACTOR SHALL PROVIDE ADEQUATE Professional Engineer,Architect,or Land Surveyor,to alter any item in any way.If an item bearing SHEETING AND SHORING DURING TRENCHING TO : the seal of an Engineer,Architect,or Land Surveyor is altered,the altering Engineer,Architect,or �Cc INSURE THE SAFETY of WORKMEN AND THE `o Land Surveyor shall affix to the item his/her seal and the notation or by'followed by his/her �sed `� signature and the date of such alterations,and a specific description of the alteration. S,C.T.M.' DIST. 1000 SEC..78 BILK 2 LOT.22 pRn�FS" GENERAL PUBLIC EXPOSED TO THE HAZARDS OF EXCAVATE A MINIMUM OF 5 INTO ` '`- g sP P FALLING AND SLIDING MATERIAL IN CONFORMANCE WITH THE REQUIREMENTS OF THE VIRGIN STRATA OF SAND AND F� TITLE 29 CODE OF FEDERAL REGULATIONS,PART GRAVEL OR TO BOTTOM OF DRYWELL ELEVATION VIEW _ P.C.Scale:AS SHOWN Condon engineering, � BLUM RESIDENCE 1926,SAFETY AND HEALTH REGULATIONS FOR 'r'rri1Cn�'JEn IS DEEr=En. CONSTRUCTION(OSHA). 420 GLENN ROAD 5. BACKFILL AND COMPACTION SHALL BE IN 6' DRYWELL DETAIL Drawn by 1755 Sigsbee Road LIFTS. ALL BACKFILL MATERIAL TO BE :JJC SOUTHOLD, NY OF COMPACTED BY JETTING OR OTHER APPROVED Mattituck, New York 11952 MEANS. Date:6/10/2019 (631)298-1986 (631)298-2651 fax www.condonengineering.com DRAINAGE PLAN Michael J. Domino, PresiderO�QSUFFQ(�-C Its Town Hall Annex John M. Bredemeyer III,Vice-Pren...,.it �� _ yJ` 54375 Route 25 Glenn Goldsmith ro z - P.O. Box 1179 A.Nicholas Krupski Pft Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: 1h Y Condon Engineering, P.C., on behalf of JEFFREY BLUM requests an Administrative Permit to conduct construction activity within 100' of flagged wetland line for installation of 15'x30' (450sq.ft) in- ground pool with 890.5 sq. ft. framed deck with site drainage and septic system with abandonment of the existing cesspools. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2-22 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 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: 1041.1-4 d z A4-' AWI „ ott er”"� ` q4 I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith ' N. Krupski G. Williams Other _ r .A Michael J. Domino, PresicrlS�FFO[,� / y' ,{I��O C'� � Town Hall Annex John M. Bredemeyer 111, Vice-_cau,ent ��4 Gy�� 54375 Route 25 Glenn Goldsmith Cl a P.O. Box 1179 A.Nicholas Krupski wC� � Southold,NY 11971 Gre;Williams yo�r,, Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: U4, R6 �d ! Completed in field by: -7K �. Condon Engineering, P.C., on behalf of JEFFREY BLUM requests an Administrative Permit to conduct construction activity within 100' of flagged wetland line for installation of 15'x34' (510sq.ft) in- ground pool with 1523.6sq.ft. framed deck; construction of 12'x20' one-story addition with site drainage and septic system. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2-22 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 Ch. 111 SEQRA Type: I 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: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: ` Present were: J. Bredemeyer J/ M. Domino G. Goldsmith N. Krupski G. Williams Other r T��,� f� 1z1 N=1 >m ru - SEE Stc SEE SEG NO. Se WTCN LINE 116yq - ^���°""u�F .� P \ /� A �-7/'/ <•f j / D 5LEEPY r HOLLOW mea S 1 IWO 1.OAlc) _ IoAS a 102x O m A f0.1 o'P�C\ ♦ • 'A4. \ TOINN OE e \ ° e ♦ 1.N m ^ Jx 33 ryl, A 1920 SOUTIIgp ♦wn S O � "� Iso1 � v1N,1�: / o a ,02,QO" / ,a.Wcl ♦ '\ ,2 �. \35 \ SEE SEC.NO.M / F 1P 22 - couN OF SNEEae A. 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"' "� s ♦ 1 N,1eN 9EE 9EC.N0.OA � �>c�u w N om 1>t SOIlIlIDLO SECTION NO L w,wy u� q ..W ___ NOTICE � oa& COUNTY OF SUFFOLK © E ° E ,_,_w.. —�— �-�+� tx+) „ 2 """` --•-- — �,� _ Real Property TaxSernceAgenq v /W/1/� ®�,avN 078 Cwnry 01nM 11M9W,NY 1,101 M°n V pfe E %..`___ oo.+.� u O_ emu ——�—— cru.— _ . •n.,1h•7yp, P lxsrxicl rm 1000 PROPERTY MAP Utim n w 13.1 N11w 1,t. —__ Owu. --•-- emu..--1m-- rx. mxt9mOx W0E,w m.Aw OFFICE LOCATION: ��OF SO(JPy® MAILING ADDRESS: Town Hall Annex '`® l® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) css Southold, NY 11971 ® �Q Telephone: 631765-1938 ®�ycOUNrI 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: September 18, 2019 Re: LWRP Coastal Consistency Review for JEFFREY BLUM SCTM# 1000-78-2-22 Condon Engineering, P.C., on behalf of JEFFREY BLUM requests an Administrative Permit to conduct construction activity within 100' of flagged wetland line for installation of 15'x30' (450sq.ft) in-ground pool with 890.5 sq. ft. framed deck with site drainage and septic system with abandonment of the existing cesspools. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2- 22 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 Maim Diane From: John J. Condon, PE <condon77173@optonline.net> Sent: Monday, September 09, 2019 1:49 PM To: DiSalvo, Diane Subject: RE: Blum Diane, Below is the revised subscription: Condon Engineering, P.C., on behalf of JEFFREY BLUM requests an Administrative Permit to conduct construction activity within 100' of flagged wetland line for installation of 15'x30' (450sq.ft) in-ground pool with 890.5 sq. Ft. framed deck with site drainage and septic system with abandonment of the existing cesspools. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2-22 Thank you. John J. Condon, PE Condon Engineering, PC 1755 Sigsbee Road Mattituck, NY 11952 631-298-1986 From: DiSalvo, Diane<diane.disalvo@town.southold.ny.us> Sent: Monday, September 09, 2019 1:25 PM To: 'co ndon77173@optonline.net'<condon77173@optonline.net> Subject: Blum Please revise accordingly. Condon Engineering, P.C., on behalf of JEFFREY BLUM requests an Administrative Permit to conduct construction activity within 100' of flagged wetland line for installation of 15'x34' (510sq.ft) in-ground pool with 1523.6sq.ft. framed deck; construction of 12'x20' one-story addition with site drainage and septic system. Located: 420 Glenn Road, Southold. SCTM#: 1000-78-2-22 Thank You D'OVue Di,&2LVO SouthoW TowvL Trustees i 54375rzoute T>.0. gox :L:L79 1 Condon Engineering, P.C. New York State Licensed Professional'Engineers 1755 Sigsbee Road 631-298-1986 Mattituck, New York 11952 Fax 631-298-2651 www.condonengineering.com September 5, 2019 Ms. Elizabeth Cantrell, Clerk Board of Town Trustees Town Hall Annex Building 54375 Route 25 Southold NY 11971 Re: Trustees"Administration Permit—420 Glenn Road, Southold, NY SCTM: 1000-78-2-22 Dear Ms. Cantrell: Attached are the following documents for the above referenced application: • Four sets of plans prepared by Nancy Dwyer • Four sets of the site plans The plans were revised to reduce the size of the swimming pool and surrounding wood deck and increase the rear addition by 30 SF after the building department determined a variance would have been required for the combined side yard setback. Under the revised plan, the applicant proposes to install a new sewage disposal system, swimming pool with a surrounding deck, site drainage and two one story additions all located landward of the 100' setback off the wetlands. Yours truly, � Joh on, P.E. �� � SEP 9 2019 ar of im to^s I Condon Engineering, P.C. New York State Licensed Professional Engineers 1755 Sigsbee Road 631-298-1986 Mattituck,New York 11952 Fax 631-298-2651 www.condonengineering.com September 5, 2019 Ms. Elizabeth Cantrell, Clerk Board of Town Trustees Town Hall Annex Building 54375 Route 25 Southold NY 11971 Re: Trustees Administration Permit—420 Glenn Road, Southold, NY SCTIVI: 1000-78-2-22 Dear Ms. Cantrell: Attached are the following documents for the above referenced application- • Four sets of plans prepared by Nancy Dwyer • Four sets of the site plans The plans were revised to reduce the size of the swimming pool and surrounding wood deck and increase the rear addition by 30 SF after the building department determined a variance would have been required for the combined side yard setback. Under the revised plan, the applicant proposes to install a new sewage disposal system, swimming pool with a surrounding deck, site drainage and two one story additions all located landward of the 100' setback off the wetlands. Yours truly, 4n '� Joh on, P.E. SEP 2019 Southold Town r of Trustees SUFFOC,t- Michael J. Domino, Pf__.dent _-oy Town Hall Annex John M. Bredemeyer, III, Vice-President o 54375 Route 25 Glenn Goldsmith N P-O. Box 1179 A Nicholas Krups(A y Southold, NY 11971 Greg Williams l ,� dao Telephone (631) 765-1892 Fax (631) 765-6641 SOGTR OLD TOWN BOARD OF TRUSTEES TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT R U[qE ESN'1/7 �n SCTM#: y(� JUL 1 6 2019 Property Owner Name: 171IT-DYNG PUT. Bw� Date Sent to Bldg. Dept: The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO V Will the proposed project require a Building Permit? �Z Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered a Demolition as described under Town Code? COMMENTS: A ad P Date nature of Reviewer Michael J.Domino,President Town Hall Annex CIS,John M.Bredemeyer III,Vice-President ' 54375 Route 25 q . „ �,"- *, `,,:_��,��-;;� �• � P.O.Box 1179 Glenn Goldsmith s i Southold,New York 11971 A.Nicholas Kru ski ` per+ Telephone(631)765-1892 Greg Williams � � J�'ggsc Sig L*4 .� ' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application E ' II � Wetland Permit Application InD \ Administrative Permit Amendment/Transfer/Extens'o7 JUN 2��� Received Application: �' ��lq l Received Fee: $ 10®,0 Completed Application: 7• Soutliolc!Town Incomplete: Board ofTrustoes SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: ('- Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): 3�6 y 12 G L,-s•ti Mailing Address: U C L��;v 12U A:' Som/OoZ4 /01' %/ q Phone Number: Z0_5` Suffolk County Tax Map Number: 1000- W— Z— Z Z e Property Location: 50' - I 64,0- MA ice' I�Ayyi.cG� (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): Jopry Cc�,y 1,v�� LIC ev i� �,v s.� . PC Mailing Address: 65 49,z5_-- 6 AP MAe-rlre_r y 51-LL-�Q,L %/9S-Z= Phone Number: � '--Z• - �9s6 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the m of town officers and em to ees.The PuWse of this form is to provide information which can alert the town of pLmsible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first flame,-;riddle 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 ,X___— 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 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 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 Dated: Signature Print Name Form TS I 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics rohibits conflicts of interest on the part of town officers and employees.The puroose 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. �g �� YOUR NAME• UK (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 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 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 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 Submitted this o2(Pda of 201 Signature Print Name t Form TS l y Board of Trustees Appl ation AUTHORIZATION (Where the applicant is not the owner) I/We, AOA I,Ka &naak owners of the property identified as SCTM# 1000- _72'oR —92 in the town of SA � ,New York, hereby authorizes �C.�'9�1nrlon 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. Property wne Signature Property Owner's Signature SWORN TO BEFORE ME THIS 21a'th DAY OF TUq , 20 l q fia-aw )s *-- Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. 0I D1475593 ®U®Ilfled in Suffolk County SAY Commission Expires Aprll 30, 20Zy' Board of Trustees Application AFFIDAVIT a�w 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-7 - -----T 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. Signa a of Propddy Owner Signature of Property Owner SWORN TO BEFORE ME THIS X4 1 DAY OF T , 20 9 Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. OID1475593 Qualified In Suffolk County My Commission Expires April 30, 20ly Board of Trustees Application GENERAL DATA Land Area(in square feet): Z7� Z/ LJ Area Zoning: fit,-'/1b Previous use of property: S M,C,C/--- rA/s,It- Intended LIntended use of property: S/.c&t-,,c Covenants and Restrictions on property? Yes �No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? >/Yes No 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 i/ No If"Yes",please provide copy of decision. Will thi project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s) on property have a valid Certificate of Occupancy? 1/ Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?—ZNo Yes If yes,provide explanation: Project Description(use attachments if necessary):_ 1,1'5 FAc.�4.UQ,,y A i9 1_ SFOs(/ 6Ui4A ,G AWl /L l 1&J/174 A i v ' Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: r • Area of wetlands on lot: Z J q6 square feet Percent coverage of lot: 7; q1 % Closest distance between nearest existing structure and upland edge of wetlands: ZL2 feet Closest distance between nearest proposed structure and upland edge of wetlands: /oo,.s" feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated s q cubic yards How much material will be filled? a cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: ,s G Manner in which material will be removed or deposited: & (Sgy,aya" RE12fo-41M Wi7)E �� 5((i4ti� r�/� R-✓(� CESS r'hA R-g rrvc f Si7� 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): Nv WOK-r- is 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l-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 PJ_UpK fc'ES1p,C'C_m — �'C ivy► Nae of Action or Project: 01 t/;1 I& s�'A�vc� Project Location(describe,and attach a location map): q l c> (CJI N rJ o A0 .50, -i—NOLQ, 97/ Brief Description of Proposed Action: 1-5 T-A LtA.M0,0 of- ,¢,NF_ty fjv (v , /iT,1oroS io sQn/ 3ISlrav� pt,..FLLr�u� i.r['G�iJ.-�(� 2av� ��c�4irr9 CF A->0 4 ,.vEGclr�y.ST n� Name of Applicant or Sponsor. Telephone: E-Mail:j—,,pp Address: U r Cc 1 r�[c, , G.- 1170 c;rye1170 City/PO: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinanc7resources Tthat YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental 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: rdwN s�r��,�� tnt�i.E�r� ❑ C '' 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? g2, 7-9 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? OSI acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial (residential(suburban) ❑Forest ❑Agriculture, E2rAquatic ❑Other(specify): ❑Parkland Page 1 of 4 5_ Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? El F] Consistent with the adopted comprehensive plan? - 1:1 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? i � ❑ � , 7. Is the site of the roposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: aFCo-iC n�Q tea G2 r�c,4 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ' b.Are public transportation serviceDs)available at or near the site of the proposed action? El❑ 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 If YES ElZ0'�tPe proposed action will exceed requirements,describe design features and technologies: 1rYES 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 210 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:_A NCt- S�GvAfv� ®rv3�IL ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.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: 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 ❑ ncultural/grasslands ❑Early mid-successional [J Wetland ❑Urban ZSuburban 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? ❑ - 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, a.Will storm water discharges flow to adjacent properties? _ O'NO OYES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and sto drains)? / If Yes,briefly describe: ❑NO S G gd.veF� fig/L/ yn �Q.u_; Er ii, Page 2 of 4 I l 8.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: ❑ 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: 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ,.^ Applicant/sp nsorn4e: �y //c) Date: ` Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I 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 I. Will the proposed action create a material conflict with an adopted land use pian or zoning regulations? ❑ 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? rx ❑ 4. Will the proposed action have an impact on the environmental characteristiStraffic aused the I� ❑ establishment of Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level ofr ❑ affectexisting 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? J. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ 8. Will the proposed-action impair the character or quality of important historic,archaeological', ❑ architectural or aesthetic resources? F, [�T 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? pf 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. 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. 1 i 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. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President 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) J PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT/��y {�C:�✓yd 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/IIER 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 SO OLID 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 CONJUUNCTION 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. i ture of Property Owner Signature of Property Owner 0 SWORN TO BEFORE ME THIS DAY OF , 20 f Not ublic - - - - - - - - - - -- - PHILIP ZHOU Notary Public-State of New York N0.01ZH6310093 Qualified in New York County My Commission Expires Aug 18,2022 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, �F� owners of the property identified as SCTM# 1000- 79- Z- ZZ in the town of v.4 0 Lo New York,hereby authorizes (01\j&-j to act as my agent and handle all necessary workinvolved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Pope y wner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF v VAI V 20 otar PHILIP ZHOU Notary Public-State of New York NO.01ZH6310093 Qualified in New York County My Commission Expires Aug 18,2022 � f APPLICANT/AGENT/IRXPRIiESENTATIVE TRANSACTIONAL DISCLOSE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employee.,- 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: yVr— (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 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 ofthe Town of Southold? "Relationship"includes by blood.marriage,or business interest."Business interest"means a business, including a partnership,in«hick the town officer or employee has even a partial ownership of(or employment by)a corpontiun 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 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. DESCRIPTION OF RELATIONSHIP Submitted t �Idf Vtf 20jjSignature Print Nam �/dk Form TS I s PHILIP ZHOU � � �(��,1 Notary Public-State of New York NO.OIZH6310093 ,fin Qualified in New York County �`r/ -� � `7 My Commission Expires Aug 18,2022 1 �� � �1 • Town of Southold LVVRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. 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 significant beneficial and adverse effects upon the coastal area which includes all of Southold Tow . 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 SuMporting and non_ supporting facts. If an action cannot be certified 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#_ 7 _ Z _ Zz, PROTECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. Z Board of Trustees (VI 1 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 assistancee.g. ( grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: I� i A)Etv S�&1A 6-'� r Location of action: �2 6 Site acreage: 0,51 14 C,24�S Present land use: S,f,, L—9-- F,rrl Present zoning classification: �-- 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: p C v,, (b) Mailing address:_ RA/9' SovTlioL�`,�gr //97/ (c) Telephone number:Area Code( ) J S� — Z Os- (d) S(d) Application number,if any: AM Will theactionbe directly undertaken,require funding,or approval by a state or federal agency? Yes Ll No❑ If yes,which state or federal agency? L .s 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. DEVELOP FD 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 �/� ��P�F'`r ��N w�F C T� Ei i C-r�u/,-,j �rte/ 7� lrYil ti'e'hAL /.1l Srud'�s•¢,tl�' 70 � � r��� fi✓� 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 u Yes 0 No ❑ Not Applicable /�I} ICA/. O, AX, (ly,0t--0 zg.it �4L 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 ZYes ❑ No ❑ Not Applicable si�-L — c EGE�v F G To /S,VA L 6�u�4 L 7rJil✓N Q f .Si+�TJ{p civ 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 ❑ti Yes ❑ No ❑ Not Applicable �1511 SF.� oa•Ts�D� r�F',fir J�j a FLcx D Z0,.JC 1✓/may d �ELy C 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 0Yes ❑ No ❑Not Applicable F eR,p lZ 7-U is �4- InLS{a2 M' 645 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 2 through 32 for evaluation criteria. ❑ 0 Ces) No Not Applicable (� x'12 Fri /.��� NvT ��t JAAAcl 77IE ADJAC---_ , 1_.4 V/J 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 ❑ No Not Applicable ME 84��/,b,c�D Al>o ct�T i � �/� n.nT �.ny,E A�yV ryEG-�T�✓ A(R ao Attach additional sheets if necessary Policy S. 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 ❑ No ENot Applicable &T�GT Le/1U A�l A"i ZVO ,v4e1qZ/V izk2ACT �S A,�iicrP,g i PUBLIC COAST POLICIES 1 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. ❑ YeO No 1Not Applicable tn!.�,c L— E�2 S A �• c .ES Attach additional sheets if necessary WORKING COAST POLICIES 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 ❑ No 2Not Applicable _ �✓0 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. ZYes ❑ No ❑ Not Applicable Na /V477( FL it j.-.t�4C7` ,NIAI'/..1� U� %Li4rJ4S A,iL' ltl,LC� 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. EJYes El No 1 Not Applicable n/o TSE /�l� s�,7 y C>lc TLS P41 �.�4.a,�, e /��p.�crs r� �Ca/'rc �..�[.. 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. ErYes ❑ No ❑ Not Applicable 7W F- 226rM r✓ i0�124cT r2 PREPARED BY TITLE DATE ��� C)WPVC12. &P2410t Conch Engineering, P.C. New York State Licensed Professional Engineers 1755 Sigsbee Road 631-298-1986 Mattituck, New York 11952 Fax 631-298-2651 www.condonengineering.com June 14, 2019 E '_ �:/r , �� F "' JUN 1I U 2019 Ms. Elizabeth Cantrell, Clerk Board of Town Trustees Souihold Town Town Hall Annex Building Bgard 54375 Route 25 Southold NY 11971 Re: Trustees Administration Permit—420 Glenn Road, Southold, NY SCTM: 1000-78-2-22 Dear Ms. Cantrell: Attached are the-following documents-for the-above referenced application: • Three sets of the Trustees Application, short EAF, LWRP Form and Transactional Disclosure Form • Check for$100.00 for application fee • Three Sets of the site plans The applicant proposes to install a new sewage disposal system, swimming pool with a surrounding deck, site drainage and two one story additions all located landward of the 100' setback off the wetlands. Yours trul , /J - on, P.E.