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HomeMy WebLinkAboutTR-9552A S I ��sufFOLK�-_ Michael J. Domino, President Town Hall Annex John M. Bredemeyer, III, Vice-President y�� 54375 Route 25 Glenn Goldsmith c N 2 P.O. Box 1179 A Nicholas Krupski �y• • o��; Southold, NY 11971 Greg Williams `��ol , ��;f% 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 '/2 constructed When project complete, call for compliance inspection; I Michael J.Domino,President �Q� SOUrTown Hall Annex John M.Bredemeyer III,Vice-President ,`O ��� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �O �� Fax(631) 765-6641 �y�4UNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9652A Date of Receipt of Application: August 15, 2019 Applicant: Elizabeth Gardner SCTM#: 1000-47-2-30 Project Location: 1665 Shore Drive, Greenport Date of Resolution/Issuance: October 16, 2019 Date of Expiration: October 16, 2021 Reviewed by: John M. Bredemeyer, III Vice- President Project Description: Abandon and remove existing septic system, and replace with a new Innovative and Alternative, nitrogen reducing septic 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 Joseph Fischetti, PE, dated July 10, 2019 and stamped approved on October 16, 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 EXCAVATIONNOTES IIA Owns General Requirements SHORE D R. �• The Installer of I/A OWTS must hold a current Liquid Waste License pursuant to Chapter 563 Article VII (Septic Industry Businesses) and Endorsement J(Innovative and Alternative Treatment System Installer) through the Suffolk County Department of PUBLIC WATER IN STREETO Labor, Licensing and Consumer Affairs, pursuant to Suffolk County Code¢ 563-79l(J). The Department of Labor, Licensing, and Consumer Affairs maintains a list of licensed 1/A OWTS Maintenance Providers. Because of the clay soiIs and the perched water the contractor An executed Operation and Maintenance Contract between the Maintenance Provider and Property owner must be submitted F� , N50°38'30"E 100.00' �� will need to excavate through the clay to good soil down to tathe Department 9' EDGE OF PAVEMENT S• �� approximately 42 feet. The contractor needs to call for an 2. All Installed I/A OWTS are required to have an Initial 3-year warranty and operation/maintenance service contract. z excavation inspection from S C D H S. After good soil i s reached, e when an IIA of 6 Inches ea a vent, the unit shall a vented h the roof of the residence being served. Vent pipes shall extend a minimum of 8 Inches above the roofllne and the top of the vent shalt have a minimum horizontal separation of 12 QH Inches to the eloped portion of the roof. In cases where It Is not practical to vent the system to the residence roof, a vent pipe ❑H ❑H ❑H ❑H ❑H back f i I I the excavation w I t h c I e a n sand. I n s t a I I a monitoring may be piped to the exterior aide of the residence and terminate a minimum of 18 Inches above grade. These vent pipes shall be J Z Q PAVER APRON H ELECTRIC located a minimum of 3 feet from any window or doorway and must terminate with a carbon filter device. All vent pipes must XISTING CP TO BE REMOVED/ SERVICE pipe with the pipe end 12 feet below grade. Arrange with the have a minimum diameter of 2 Inches. W t �1 4. Garbage grinders shall not be emitted when an I/A OWTS Is utilized as means of sewage disposal. In addition, water N F� Health Department t o check the final depth o f water softeners shalll of discharge Into an I/A OWTS. / g W QQ.. o 1/ HYDRO-ACTION /j r L C �� AN-400 I 4`---��/ e 400 DD contained inside the pipe after a period o f time. 5. Install I/A OWTS tanks according to manufacturer's reaommendationa. All applicable recommendations' provided by the ~ a 1 to manufacturer shall be Implemented c a) -1 00 I /� �\ w Fc4P A '11 O 6. The I/A OWTS tank shall be Installed at level In all directions(with a maximum tolerance In any direction of+/one quarter \JJ /�� i W a W 1 coo /I �F TO's' inch on a minimum 3-Inch thick bed of properly leveled and compacted sand free from rocks or ea W 1p O O O \ LP / / E` ��O ) P P Y P ( ) P grave O Z i F oCZ m /6 ��'' / �\ / 0'Z "o 7. The top of the I/A OWTS tank shall not be located greater than 2.5 feet or less than one foot below final grade. L_ jr 0 m ED d. I E 1 / oI (�f O rvr 1' / *I rr , ELOCATE EXISTING WATER / a W < BEND I y a / -"I W SERVICE 10.0' FROM E.P Electrical Requirements ` (D O C rill ml 1. Control Panels ,� C o I \ / A! o 0. All wiring and equipment are to be Installed by the electrical contractor in accordance with the National Electric Code(NEC) N C) D OAK I / I and local codes. m { I \ / / �I ►� b. The control panel box must be placed outside on a suitable pedestal near the structure that It serves. Alternatively, the Lo U m / m I CONCRETE panel box may be mounted on an outside wall of the structure (preferable a utility room, and not a living space). z (0 (n r LZi7 Z I r COLLAR 24� c. The control panel shall be placed of a comfortable height for access. (D w N PAVERS / I w STOPPER END d. The panel shall meet National Electrical Manufacturers Association (NEMA) 4X specifications. Q O I / I O Se PLUG PROPOSED s. The conduit must have approprlate ale to prevent gases and moisture from reaching the control panel or Junction boxes. p ) ELEC. f. Each system shall be equipped with o functioning warning system which will activate audible and visual alarms that can be X-X / / a N PANEL readily seen and heard by the occupant's of the building served. PVC 19.3' -X - -X�--i RISER dr COVER ICKET FE. 33.4 I 2. Pumps, Blowers, Level Sensors, and Controls 1 0 m o. The electrical Junctlon box serving the pump motor and floats must be watertight and located outside the I/A OWTS tank N c'9 S1)- ❑q YDRO-ACTION CONTROL PANEL 17BER JOINT chamber. o �e�9G' 11.7' P C + PUMP ON 3X3 PAD PACKING b. The Department shall observe the pump system operate through a normal operating cycle. AMP BREAKER C. Inspection for leakage of the force main fittings will be made during the pump test procedure. 1 STY. I 'SO S� ❑ q C/SEWER PIPE EXTERIOR RATED _ �GSF C (TYPICAL) ruNcnow eox eLLow I General Notes 11.6' 1 20.5' GRADE IN 41 13.0' 19.3' N C ?9 SPRINKLER BOX 2.1' PVC PIPE 03034 OG to y/fj U) CI SDR 35 1. LOT AREA: 12,872 S.F. OR .262 ACRES N -r BEND I 2 AHC OF HIRE C A O � p CEJ 70 SEP77C I DIREXT BURIAL 2. SCTM/1000-47-02-30 ,a9 O � 20.5' oD 14.9' f ?R FROM DWELLING TANK -I 1 y D 3. BOUNDARY AND TOPOGRAPHIC INFORMATION FROM A SURVEY BY Pel lc Surveyors lost dated May 9. 2019 F c} �A PLC__PANEL 4. ELEVATIONS REFERENCED TO THE Ill 88 DATUM /PFA 9�0 m C/. BOB PVC WYE HOUSE ADAPTOR W/HPBD COMPRESSOR A/R PUMP DECK 5. ALL MATERIALS AND METHODS OF CONSTRUCTION SHALL CONFORM TO THE STANDARDS AND SPECIFICATIONS OF THE TOWN OF SOUTHOLD AND THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES AS REQUIRED 6. THE CONTRACTOR SHALL FIELD VERIFY THE LOCATION AND DEPTH OF ALL UTILITIES PRIOR TO THE COMMENCEMENT OF WORK. THE� Sr STEPS � CLEAN OUT DETAIL ELECTRIC RISER DIAGRAM ACCORDINGLY INRTHE FIIS ELDED ALL SUBSURFACE INFORMATION SHOWN ON THESE PLANS IS CONCEPTUAL AND MUST BE CONFORMED 01 /P_� N.T.S. 7. THE CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL NECESSARY PERMITS BEFORE COMMENCING WORK. I s/y r l 0,cP4,SGS N.T.S. 8. ALL UNSUITABLE MATERIAL AND DEBRIS SHALL BE DISPOSED OF IN ACCORDANCE WITH TOWN, COUNTY. STATE AND FEDERAL /h O /! LAWS. CODES AND ORDINANCES. CONTRACTOR SHALL BE RESPONSIBLE FOR DISPOSING OFF ALL UNSUITABLE MATERIALS OFF SITE. J I FR DEBRIS SHALL NOT BE BURIED ON THE SITE. T I P 9. ALL PRECAST STRUCTURES SHALL BE APPROVED BY THE COUNTY AND COMPLY WITH THEIR REGULATIONS. O I I 2R Tq�Oo� x 10. ALL PRECAST STRUCTURES SHALL BE MANUFACTURED WTH 4000 PSI 28 DAY STRENGTH CONCRETE N yr tiF I 11. SANITARY PIPE TO BE SDR-35 PVC OR AS SPECIFIED ON PLANS W OCG/p I I x 12. DURING CONSTRUCTION, EROSION AND SEDIMENT CONTROL MEASURES TO BE UTILIZED AS NECESSARY TO PREVENT THE n O7 ll I TRANSPORT OF SEDIMENT TO OFF SITE AREAS. PONDS. DRAINAGE INLETS. THE METHODS AND MATERIALS EMPLOYED IN THE CL W F/y0 I I x INSTALLATION AND MAINTENANCE OF EROSION CONTROL MEASURES SHALL CONFORM TO THE NEW YORK GUIDELINES FOR EROSION A` I AND SEDIMENT CONTROL _ _^ z _ x 13. ALL BACKFILL SHALL BE SELECT GRANULAR MATERIAL COMPACTED TO 95%MAXIMUM DENSITY AT THE OPTIMUM MOISTURE I WOOD RAILING ON TOP OF BULKHEAD CONTENT AS DETERMINED BY STANDARD PROCTOR TEST. (^ Z DECKING 7v EL 8.3' TOP OF BULKHEAD PVC-WOOD BULKHEAD MHWM ALONG BULKHEAD Z o�� SANITARY DESIGN = W o F � o N50'39 59"E 100.00' Q `@G�yF U qo 3 BEDROOM C/) z ti o (� _ (2) 8' DIA X 6' DEEP LEACHING POOLS (LP) O (p CO (1 ) 8' DIA X 6' DEEP EXPANSION POOLS (EP) � x PIPES C Q vE Map of Greenport Shores W W co Filed map June 29, 1950 #1759 O v O 0 O m SCALE: 1 "=20 ' 057 AUG 1 5 2019 -- arNEL "fit 10 G /IreD carlsssas U%70NGa`Ca ER rc�.[,Q ��jLq Q��,A• ��.r� '1 D-D3 Owed! TEST HOLE DATA MCDONALD GEOSC/ENCES�'o 4/30/2019 EL. 11.6' DARK BROWN J e CLAYEY LOAM OH K F APPROVED BY 1 DRAWN BY: JF LH BROWN CLAY CH C2 BOARD OF TRUSTEES / HOUSE 12.6' CONCRETE COLLAR WATER TIGHT FRAME a LbwL EL. 10.4' 1.2' A TOPPER END PLUG W/APPRM LOCKING DEVICE DDIICRETEWIM TOWN OF SOUTHOLD BELOW GRADE 66 CLAY CH ocM� &I &I"I JULY 10, 2019 EL. 11.6' RNISNED GRADE EL 11.8 WATER IN BROWN 71 DATE I.E. BEARIMMMIMIMP Pl7ta'I GRADE 5X 10.8' 8'm7n. 1'MIN. s SLABS 2 MAX BILL OF MATERIALS 97R PPE I.E. I.E. _ 1Z2 l%�s DEAN CUT 10.6' 10.5' 's}? I.E. � ,' NA-1800568 TANK,AN500245 NITROGEN REDUCTION ,y' / A O 160055 TANK AN500 T45 PRETREATMENT 1/4'PER F00T MIN.PITCH X014 1/e'PLR FOOT TIN. 10.3' '� � � � '�^'=�•� Oi MIN.4'DIA. SANITARY PIPE PIC WASTE 35 �z _D, a !Daae ,AN500 2 4•SCT 35 SXS 1 W SDR 35 LINE `.;,Y C T4001I ......COUPLING, 4'S 35 P 2 SCALE : AS NOTED 8 '-•-y .r'1',•'"':..'.:" -'I'- CI 160028 ADESIVE,CMrRMGE -•- •1 C2 240031 SCREW,1'010 SELF TAP PPH ZINC 2 ,C,C. 3MIN D 760066 FAS EPIER,3/9.16 x 8 3/4'AT HHCS 1 IRrORO-ACIIa HYDRO-ACTION AN400 DETAIL WATER IN PALE BROWN m 2DDD13 NUT,3/e-16 ss 3 SHEET NO. / GROUND WATER V EL 1,3' TO BE DETERMINED FINE TO MEDIUM SAND SP n 2020N34 0006 v^�R�SS a e�LaxWASHER i `HIGHEST RECORDED GROUNDWATER (2) 8' DIA X 6' DEEP HIGHEST EXPECTED E 1Do110 A66EMBLY,RICIRCULATION245COMPLETE 1 GROUNDWATER F AP600-P AP600 ATU W'PLATFORM COMPLETE 1 BACKFILL MATERIAL TO BE CLEAN SAND RGRAVEL -LEACHING POOL DETAIL 481 G EC60�30 Ill PLC EC50.30-100-PLC 1 H 100023 PIPE,4'PVC SaM d1 M.LONG Al: NO CUT OR RLL REOUIRLD i 100023 PIPE,4'PVC SCM a1 2s''LOG SANITARY SEPTIC SYSTEM PROFILE NOTE WATER ENCOUNTERED 1.2' BELOW SURFACE 180111 TEE,STRAIGHT 4'Sass 1 1665 SHORE RD, GREENPORT N .T.S. K 100023 PIPE,`'PWC SEH35 Cu 10, SCTM# 1000-47-02-30 ANe00 E!4a NITROGEN REa11CTIDN SYSTEM I dr cti0d' HA-!80056 AN-400=440 GPD SURVEY OF PROPERTY N A T GREENPORT TOWN OF SOUTHOLD • SUFFOLK COUNTY, N. Y. 1000-47-02-30 SCALE: 1'--20 LIJ MAY 9, 2019 0 EL 11.5' ALL PROPERTIES WITHIN 150' ON PUBLIC WATER �p EL 11.8 _. O `O GMF 0.6' DEEP ^�\1 / T FRONT OF TREE WATER ON\ METER `2� v'O •40 \ �s �O .i PVC-PICKET A` \ AREA O ARCH AREA OFTH i- �p� \ SEPTIC EL 11.6\ I/ EL 10.9' QP \ O AC VENT PIPE p• AC B 0 PAVER \ 9 F MF WALK 2 STY. FR. J� S HOUSE 0 9� .o• FF=12.8 oG o� CHIM.G FF-1 ph Q�G h, \UIG -- — �/ �' ? y` PROPANE • .?o TANK \+� � p• OUT SHOWER FE.END �G`I' 19 5 R/0 SUMMER LOT 24 I ROOM ON FE.END 0.8'W PAVER PATIO \ DECK 0.7'W PK ON TOP F BULKHEAD TEST HOLE DATA FIRE PIT \ ,r� p EL=8.2' MCDONALD GEOSCIENCE STONE \ o�0J� � 4/30/2019 MASONRY \ Q 0 PIERS EL. 11.6 DARK BROWN N/O/F A• o� CLAYEY LOAM OH YUTIAN DON NI XpU OOO 1 BROWN CLAY CH LOT 25 \\�000 �\Q ! EL 10.4' 1.2' oD oeJ� WAA7ER� BROWN ,WSJ '� s�� O 42' CURB END WATER IN PALE BROWN O.s'W FINE TO MEDIUM SAND SP FF—END 0.2'E 48' NOTE: WATER ENCOUNTERED 1.2' BELOW SURFACE ` � n n tz KEY PD " REBAR AUG 1 5 2019 I`� Q = 1 ® = WELL � SauthoW To;vn = STAKE Board of Trustees = TEST HOLE = PIPE AREA= 12,872 SO. FT. ■ = MONUMENT TO LINE ALONG BULKHEADA = WETLAND FLAG CZL = U77UTY POLE � �o Ek1l I am famillar with the STANDARDS FOR APPROVAL AND CONS7RUC710N OF SUBSURFACE SEWAGE ` ; DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth 's therein and on the permit to construct. The location of wells and cesspools shown hereon are td from field observations and or from data obtained from others. LOT NUMBERS REFER TO "MAP OF GREENPORT SHORES, SEC77ON ONE" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON JUNE 29, 1950 AS FILE NO. 1759. /NVn AG NO. 49618 ELEVATIONS REFERENCED TO NAVD 88 PECd P.C. ANY ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209OF THE NEW YORK (631) �V- WX (631) 765-1797 STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CER77n7,`AWNS HEREON ARE P.O. BOX 909 VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR 77iT IMPRESSED SEAL 1230 TRAVELER STREET 19-017 OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 - _ Y c,�FFi?(� Michael J. Domino,PrF nt 0 CCG � � � •,---_-Town Hall Annex John M. Bredemeyer III,Vice-resident - �� yJ, `-= 54375 Route 25 Glenn Goldsmith co P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams y p! Telephone(631)765-1892 �Ol �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: - lay ELIZABETH GARDNER requests an Administrative Permit to abandon and remove existing septic system, and replace with a new Innovative and Alternative, nitrogen reducing septic system. Located: 1665 Shore Road, Greenport. SCTM #: 1000-47-2-30 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: 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: i,-"/J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other GARDNER PROPERTY Situate: 1665 Shore Road • Greenport, NY • 11944 SCTM#: 1000—47 —02—30 i • (pgN a,n GARDNER Property Situate: 1665 Shore Road • Greenport, New York • 11944 SCTM#: 1000- 47-02- 30 (Photographs taken August 7, 201.9) Aew r' i � I wG ti .1 N • i ff " 1 The photograph above (taken facing south) depicts the approximate location of the proposed IA/OWTS system to be installed at the subject property. oil .•, low ' �. _,..ted► , i�- CA RDNER Property Situate: 1665 Shore Road • Greenport, New York • 11944 SCTM#: 1000-47-02-30 (Photographs taken August 7, 201.9) OA "+art`� �i'' � l j•• •fir -^a' . 05 - , r a Y � y _- - •�,i��`�� moi',. r r.�• � "SKr-� '."• R - l� ,�. � s f� a The photograph above (taken facing east) depicts the approximate location of the proposed IA/OWTS system at the subject property. GARDNER Property Situate: 1665 Shore Road • Greenport, New York • 11944 SCTM#: 1000- 47-02 -30 (Photographs taken August 7, 2019) i 40 1 i The photograph above (taken facing east) depicts the bulkhead located on the southern portion of the subject property. Note that the high water mark is about 1' above the sand, demonstrating the absence of a beach at the subject property. >e op. 2 E � an SILVER O 19 __; 3 36 W 9 m cc u J 9 19 y N I9w m s Iwr p m 1 iN�l 13 11 12 QQ 2.3V�1 y ]7 1 P / ]3.1 0/ .;e •. e 5 � r � Q�5 3 ,..,...� .. COUNTY OF SUFFOLK © K °� +tea sausecrKkl No L NOTICE TROln E G �� _�_ Real Property Tax Service Agency r 47- co..n am.rwwm..s,xv rnm M E -..– �.., —_— o.�r.. —_�__ n..i..—_._— enr A N err• - W ____ __.—_ o.r.u.--nu-- t ss v P ,9W PROPERTY MMP U r.a x,MU -- -- mrrvcnvox nrt.a xrn� OFFICE LOCATION: �®f S® �® MAILING ADDRESS: Town Hall Annex �® �® P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) res �e Southold, NY 11971 ® �� Telephone: 631 765-1938 ® Fax: 631 765-3136 com 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: October 11, 2019 Re: LWRP Coastal Consistency Review for ELIZABETH GARDNER SCTM# 1000-47-2-30 ELIZABETH GARDNER requests an Administrative Permit to abandon and remove existing septic system, and replace with a new Innovative and Alternative, nitrogen reducing septic system. Located: 1665 Shore Drive, Greenport. SCTM#: 1000-47-2-30 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 ToAn Hall Michael J.Domino,President 54875 RouteAnnex 25 John M.Bredemeyer 111,Vice-President �(I P.O.Box 1179 Charles J.Sanders Southold,Now York 11971 Glenn Goldsmith Telephone(631)76591802 A,Nicholas Krup9ld Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: -ReceivedFee:$ 100.00 11 Completed Application: Incomplete: SEQRA Classification: Type II t iiI Type I Unlisted y D I P, -Coordination:(date sent) r-), LWRP Consistency Assessment Form:—", ��1 CAC Referral Sent: AUG 15 2019 Date of Inspection: Receipt of CAC Report: Sotitho!d Town Agency Determination B0 of Thistnnq Technical Review: -Public Hearing Held: Resolution: Name of Applicant Elizabeth A. Gardner Address 2932 Davis Street * Oceanside, New York * 11572 Phone Number: (516) 567-4994 Suffolk County Tax Map Number: 1000— 47 —02 - 30 Property Location: 1665 Shore Road * Greenport,NY * 11944 south side of Shore Drive (provide LILCO Pole#, distance to cross streets, and location) AGENT: Robert W. Anderson- Suffolk Environmental Consulting, Inc (If applicable) Address: P.O. Box 2003;Bridgehampton,NY 11932 Phone: (631) 537—5160 Board of Trustees Application GENERAL DATA Land Area (in square feet): 12,872.0 s. f. ± Previous use of property: Residential Intended use of property: Residential w/ IA/OWTS septic system Covenants and Restrictions: Yes X No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes X 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 X No If"Yes",please provide a 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 Southold Town Trustees Permit 06/20/12,01/19/11, 02/27/08,12/21/01 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description (use attachments if necessary): Applicant proposes to abandon and remove existing septic system, and replace with a new innovative and alternative,nitrogen reducing septic system(IA/OWTS). WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed operations: to replace the existing septic system with a new IA/OWTS septic system to reduce nitrogen output in a coastal location. Area of wetlands on lot: 0.0 square feet(burkheaded rat) Percent coverage of lot: 0.0 % Closest distance between nearest existing structures and upland edge of wetlands: 0 feet (bulkhead) Closest distance between nearest proposed structures and upland edge of wetlands: 93.0 feet (bulkhead) Does the project involve excavation or filling? No X Yes If Yes, how much material will be excavated? 2150.0± (cubic yards) How much material will be filled? 0.0± (cubic yards) Depth of which material will be removed or deposited: 5.0± Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: Applicant proposes to use a back hoe to excavate area for septic install. Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): The proposed septic system is to reduce the levels of nitrogen emitted from traditional systems, consequently reducing the levels of nitrogen emitted into Pipes Cove. Short gi;vironmenitol Assessthent Forin Part I -Project Inforihirtion = Instructions for-Corn0led" Part 1-Project Information.-The appikant or project sponsor is responsible for the completion of Part 4. Responses become part of the application for approval or funding;are subject to public review;and may be subject to further verification. Complete Part I 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 I=Project and Sponsor Information Name of Action or Project: GARDNER Property Project Location(describe;and attach a location map): 1665 Shore Road • Greenport,New York • 11944(see attached location map) Brief Description of Proposed Action: Applicant proposes to abandon and remove existing sanitary system and install in its place a new, innovative and alternative, nitrogen reducing 1A/OWTS sanitary system. Name of Applicant or Sponsor: Telephone:(631)—537—5160 Robert W Anderson—Suffolk Environmental Consulting, Inc. E-Mail:robert@suffolkenvironmental.com Address: P.O. Box 2003 CWPO: Bridgehamp ton State: Zip Code: NY 11932 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 ihe'proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agericy(s)name anis permit or approval: NY SDEC Tidal Wetlands Permit Suffolk County Department of Health Services Approval 3.a.Total acreage of the site ofthe'proposed action? •30± acres b.Total acreage,to be physically'disturWd? <0.01± acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? .30+ acres 4. Check all land uses that occur on,adjoining and near the proposed'action. ®Urban '0 Rural(non-agriculture) [:]Industrial ❑Commercial ®Residential(suburban) ®Forest E,3' ®Aquatic []Other(specify): ❑Parkland 6 5. Is the proposed.,action, NO" YES N/A a.A permitted use under the zoning regulations? f""'1; fv i f�1 T J LJ b.Consistent with"the adopted`comprehensiveplan? �J', ED 6. Is the proposed action consistent with the'predoinirianf'character of the existing builfof natural NO . YES landscape? 121 ?. Is the site of theproposed action located in,or does it adjoin,a state listed Critical Environmental Area? ,NO, YES, If Yes,identify: S. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 'YES D. b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? [2-1] Q 9.Does the proposed action meet or exceed the state eiiergy-code requirements? NO, _YES If the proposed action will exceed requirements,describe design features and technologies: ❑ N/A 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water. ❑ X 11.Will the proposed action connect to existing wastewater utilities? NO, YES If No,describe method for providing wastewater treatment: 0 IA/OWTS Sanitary System 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? Q b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? Q El If 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_bn'the,pmject site. Check all that apply: ®Shoreline ❑Forest DAgricultural/grasslands ❑Earlymid-successional ®Wetland ❑Urban ®Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? O 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either froth point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO [DYES b.Wilt storm water discharges be directed to established conveyance systems runoff and storm drains)? If Yes,briefly describe: UNO ❑YES 7 IS?Does the proposed action include construction or other-activities that result in the`finpoundinent of NO YES water or otlfcr liquids(e.g,retention pond,-waste lagoon,dam)?- IfYe's,'explain puigose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active o'r closed NO YES solid waste management facility? If Yes,describe: 24.Has the site of the proposed action bran adjoining,property been the subject of'remediation(ongoing or NO YES completed)for hazardous vraste?' If Yes,describe: a ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE I5TRUE AND ACCURATE'TO THE BESTOF MY KNOWLEDGE Applicant/sponsor obert W Anderson-Suffolk Environmental Consulting,Inc. Date: 0-6-11—?0147 Signature: 8 Board of Trustees Application County of Suffolk State of New York Elizabeth Gardner BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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 TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Si nature SWORN TO BEFORE ME THIS << DAY OF 20_ ry Public MATTHEW D. IVANS NOTARY PUBLIC-STATE OF NEW YORK No.01 IV6053859 Qualified in Suffolk County My Commission Expires 01-22-20t$'O Board of Trustees Annliaatilon I � Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) We, Elizabeth Gardner residing at 2932 Davis Street • Oceanside.NY • 11572 do hereby authorize Suffolk Environmental Consulting_Inc. to apply for permit(s) from the Southold Board of Town Trustees on our behalf. izabeth Goner) v ' APPLICANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees. The purpose of this forst 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: Elizabeth Gardner (Last name,first name,middle initial,unless you are applying in the name of someone else of other entity,such as a company. If so, indicate the other person's or company's name.) NATURE 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 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 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 then 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 day of .201 Signature �--�✓ Print name Eliza th Gardner APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME- Robert W.Anderson (Last name,first name,middle 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 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 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 14th day of Au ust 2019 Signature A0�0000­ Print Name Robert W.Anderson Form TS 1 Town of Southold LWRP 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 Town). 3. If any question in Section C on this form is answered"yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus,the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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# 24 - 02.0 - 28.1 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ Building Dept/ZBA. ❑ 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: Nature and extent of action: Applicant proposes to abandon/ remove existing septic system and replace the system with a New Innovative,alternative nitrogen reducing water treatment system. Attach additional sheets if necessary Location of action: 1665 Shore Road * Greenport,NY * 11944 Site acreage: (0.29 acre±total) 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: Elizabeth Gardner (b) Mailing address: 2932 Davis Street • Oceanside,NY • 11572 (c) Telephone number: Area Code(516)567-4994 (d) Application number, if any: N/A Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No ® If yes, which state or federal agency? 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 The above policy is not applicable to this project in that, all improvements to be under ground (IA/OWTS system) and not visible from any angle upon completion of the proposed improvements. 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 Policy 2 is not applicable in that, the surrounding area does not include any structures that can be classified as an historic or archaeological resource. 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 5 through 7 for evaluation criteria ❑ Yes ❑ No ❑ Not Applicable The above policy is not applicable to this proiect in that, all improvements to be under ground (IA/OWTS system) and not visible from any angle upon completion of the proposed improvements. 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 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable Policy 4 is not applicable in that the proposal does not involve any potential for loss of life, structures and natural resources from flooding and erosion. Attach additional sheets if necessary 4 ' 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 ❑ Not Applicable The proposed improvements are consistent with the above referenced policy in that, the INOWTS system will reduce the levels of nitrogen effluent that leaches into Pipes Cove effectively improving the quality of town waters 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 ❑ Not Applicable The proposed improvements will be of benefit to Southold Town ecosystems in that the new Septic system will reduce the levels of nitrogen effluent being released into the environment. Consequently, this project is consistent with the above referenced policy. 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 This project isnot applicable to this Policy. 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 ❑ No ® Not Applicable This project is not applicable to this Policy. Attach additional sheets if necessary 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 ❑ Yes ❑ No ® Not Applicable This policy is not applicable to the proposed project. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependence uses in suitable locations. See LWRP Section III—Policies;Pages 47 through 56 for evaluation criteria ❑ Yes ❑ No ® Not Applicable This Policy is not applicable to the proposed project. 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 ❑ No ® Not Applicable This project is not applicable to this Policy. 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. ❑ Yes ❑ No ® Not Applicable This project is not applicable to this Policy. 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 ❑ No ® Not Applicable This project is not applicable to this Policy. Attach additional sheets if necessary ' t i Suffolk Environmental Consulting, Inc. Newman Village,Suite E,2322 Main Street,P.O. Box 2003,Bridgehampton,New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson,M.S.,President August 14 2019 � C Board of Trusteesr—__- Town Hall � U' AUG 1 5 2019 P.O.Box 1179 I Southold,NY 11971 See`^�ki Town d Re: GARDNER Property Boar of Tr ctae Situate: 1665 Shore Road • Greenport,New York• 11944 SCTM#: 1000-47-02-30 Dear Members of the Board, This Firm represents the above referenced property owners,whom are seeking your regulatory approval to abandon and remove the existing septic system and install a new innovative and alternative nitrogen reducing IA/OWTS sanitary system.Attached herewith you will find: 1. Wetland Permit Application:original and three(3)copies; 2. LWRP:original and three(3)copies; 3. SEQRA Short EAF:original and three(3)copies; 4. Authorization form signed and notarized:original and three(3)copies; 5. Agent Authorization Form signed and notarized:original and three(3)copies; 6. Open Government Transactional Disclosure Form:originals and three(3)copies; 7. Location Map:original and three(3)copies; 8. Photographs of current site conditions:original and three(3)copies; 9. Survey of the subject property prepared by John Metzger-Peconic Surveyors dated May 9'2019:four(4)originals; 10. Site Plans prepared by Joseph Fischetti P.E.dated July 10'2019:four(4)copies and; 11. Check made payable to Southold Town made out in the amount of two-hundred and fifty dollars($250.00) Kindly commence your review of the above application materials at your earliest availability. Thank you for your anticipated cooperation on this matter. Sincerely, Robert W.Anderson cc: E.Gardner