Loading...
HomeMy WebLinkAboutTR-9611 �, Michael J. Domino, President %opoTown Hall Annex John M. Bredemeyer, III, Vice-President ''� y 54375 Route 25 1 Glenn Goldsmith �<N z r P.O Box 1179 A Nicholas Krupski y ;' Southold, NY 11971 Greg Williams A01 O.Z. �a�_c 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; •,� �^^:'""f`s:."-'—^� /v�a..::.'u;Li.;�� iF - �,•"(,j,5ui6i.4u•" ,r'f;,.--.�.:,,;;i};,.y,--,.,,�\ ',�".`.��-,.`'. ,:-�1 S S _ J rr nr•'%$+.::�Sn:NL(nrA:LV%�rMtipRA?0.*Ib'^"'':V A,Tr�y..., r t\\\ .n,r..:mm�:,• •mx ronawn•.nr ,nin.nr,.mrrw,,,n . .nrvnwmxn,,.rgram,.,,.n.rn„r:,.n,.n,.nnrrr.»„ r,nnrn,.rr:.,;.nr-oy,�n„xmm�•r. )'; J'I:3� 1 b. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT N0. 9611 DATE: DECEMBER 11,2019 ISSUED TO: STEPHEN CARROLL I PROPERTY ADDRESS: 3825 WICKHAM AVENUE,MATTITUCK -? SCTM# 1000-107-9-5 I AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on December 11, 2019, and in consideration of application fee in the sum of$250.00 paid by Stephen Carroll and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: i Wetland Permit to install a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system; and as depicted on the site plan prepared by Condon Engineering, P.C., received on November 15, 2019 and stamped « approved on December 11, 2019. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 11 th day of December,2019. 0 C 113111 114, C*coo I •. ,wuau::uwun.......y•.,.."a:JLm w.•!•i•,..:•,<9'•iniwnu••u'i+w:....a.w,unueon.o,.•:.,.w,..".•ao..,•.,•.....,v.•y.:w,ua.... u.x:om.wa+o w.i..rOuw w.u• oinYw.v a.auv '.✓ `-:. ............. ."y �,.!m.,,m......,,,,myS. _m.,my: �Si{smmr,�..,,rm�i "�___--_ .:.� �,,, - ' "".• � N�;:!" i S� 4����:. - ..t;;; �, ” t•ftt Ott;::• •�: �t� - 4•.' � .v, :,• � '.t s,: .fir: •.."' ' ,,,.. m „� ;,,1,t`" '/ TERMS AND CONDITIONS The Permittee Stephen Carroll residing at 3825 Wickham Avenue Mattituck New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6 That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J.Domino,President QF so(/ry Town Hall Annex 54375 Route 25 John M. Bredemeyer III,Vice-President P.O. Box 1179 Glenn Goldsmith l Southold,New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams �� Fax(631) 765-6641 � M`I,�ct\1, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 13, 2019 John J. Condon Condon Engineering, PE 1755 Sigsbee Road Mattituck, NY 11952 RE: STEPHEN CARROLL 3825 WICKHAM AVENUE, MATTITUCK SCTM# 1000-107-9-5 Dear Mr. Condon: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 11, 2019 regarding the above matter: WHEREAS, Condon Engineering, PE on behalf of STEPHEN CARROLL, applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated September 9, 2019 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application December 11, 2019, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees APPROVE the application of STEPHEN CARROLL to install a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system; and as depicted on the site plan prepared by Condon Engineering, P.C., received on November 15, 2019 and stamped approved on December 11, 2019. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Michael J. Don ino President, Board of Trustees MJD/dd PUMP/C__OM__��PRESSER POWER CIM'WIT MODEL NO. 120105 TEST HOLE DATA H LOCATION @J __11' �� M1 PAGE EL.10.6 Q_ R. 7 Buc 0- BLK G, Buc SP v SPRAY ? DARK BROWN LOAM(OL) PUMP 0.5' e E N MOTOR PUMP RATINGS: LO 3/4HP @ 115V ROWN SILTY SAND(SM) O ?� C82 M2 CSR 6 LOOPS 'I G 15.0 F.L.A. BLK p-_-- BLK BLK p RECIRC PUMP RATINGS: B v Q N �' ' C = 9G _ PUMP 4HP @ 115V ' PALE BROWN FINE SAND(SP) p o' "�---d `�"r N MOTOR 15.0 F.L.A. � Nkl/ � �I G LO C83 M3 '�o SILT FENCE/HAY BALE LINE N BOK O-- BLK BLK P MIXER PUMP RATINGS: G / ly�o 8.6'(EL 2.0 HIGHEST EXP.GROUNDWATER) AIrF U V 9.3'(EL.1.3 GROUNDWATER ELEV.) N PUMP 4HP @ 115V v ,� �� �, �, j ti ` 'r N MOTOR 15.0 F.L.A. 'AO ' �,' ,' j WATER IN PALE BROWN FINE(SP) a O '�`K ~ GRY U- GRY C1 COMP.RATINGS: ' ,' ,' i' j ll,� i� TESTHOLE BY MCDONALD GEOSCIENCE yq� COMP 1/4HP @ 115V / s �1 ,' � ,' ,' �� �S DATED NOVEMBER 12,2019 VMT MOTOR N i GROUNDWATER ENCOUNTERED 9.3' y` N 5.4 FLA. ,' ,% � '9C�. •0� BELOW GRADE t� NOTE:ALL MOTORS MUST �rM HAVE INTERNAL i' � , -----� �% • O�^- LOCATION MAP OVERLOAD PROTECTION. ' 6 '' ��,<• -I/ 1"-600' LRl-Q1 BLU REDhN1 M1 WNf \ ti t LR1-Q2 PINKA4" M2 "� ( 6��0 ' '�, GENERAL NOTES BLS NO WATER ,syr 6' _ PI"""'" A DRY BLDG ` �� ` ��/J' 1. ALL MATERIALS AND METHODS OF CONSTRUCTION SHALL CONFORM TO THE RECIRC RUNNING �� `� STANDARDS AND SPECIFICATIONS OF THE TOWN OF SOUTHOLD AND THE SUFFOLK BLU LR1-Q3 YELMM WHT s �i i COUNTY DEPARTMENT OF HEALTH SERVICES AS REQUIRED. EXISTING CESSPOOLS TO BE PUMPED DRY ' yF0 � / - PROPOSED HYDRO-ACTION CONTROL � 2. BOUNDARY&TOPOGRAPHIC INFORMATION FROM SURVEY BY G&A LAND SURVEYING E:�tMI�XERRUI -_ __-' O Fp -- a snnn � INC.PETER A.GROBEN LAND SURVEYOR DATED APRIL 21,2019. ELEVATIONS ARE NING AND REMOVED IN ACCORDANCE WITH THE -- s �o PANEL AND AIR PUMP ON A 36 X 36 X 6 BLU LR 1 WM SCDHS STANDARDS �.\ �F9 �' h ��� P.C.SLAB WITH 6X6 W1.4XW1.4 WWM REFERENCED TO THE NVAD 88.DATUM. LR1-Q4 BLU RED I6 PLC INPUT Notes: ��O �61 .0 P.C. 3. THE CONTRACTOR SHALL FIELD VERIFY THE LOCATION AND DEPTH OF ALL UTILITIES n PRIOR TO THE COMMENCEMENT OF WORK. THE CONTRACTOR IS ADVISED ALL BLU AS-1 PINK ' All wiring and equipment are to be be provided and installed by the Electrical ` 'y�sjO fro .j PROPOSED VENT EXTEND 18 MIN.ABOVE SUBSURFACE INFORMATION SHOWN ON THESE PLANS IS CONCEPTUAL AND MUST BE contractor(EC)in accordance with the National Electric Code(NEC)and Local LP \�� / �/ +' �� �Q� ro , GRADE WITH A CHARCOAL FILTER CONFORMED ACCORDINGLY IN THE FIELD. 5 6 ALARM - cQ '9 4. A MINIMUM SEPARATION OF TEN(10)FEET HORIZONTALAND EIGHTEEN(18)INCHES BLU RED RUN AUD. Electrical Codes. e / CP �1 2,C� !y cy. C F DRG �,, ' The EC will file all necessary forms and pay all fees for the electrical work ( O ) h , ���'S ��jL ?S ? VERTICAL IS TO BE MAINTAINED BETWEEN WATER LINES,STORM DRAINAGE AND/OR MUTE shown on these drawings.The contractor will arrange for all inspections and / . � st c O ELECTRIC LINE TO BE PLACED IN CONDUIT I-ryl/q n9 . ng pecti _ � G� � �,, SANITARY LINES OR STRUCTURES. BLU secure a Fire Underwriters certificate which is to be turned over to the owner at • TEST the completion of the work. s �S 5' 5. THE CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL NECESSARY PERMITS ALARM ' 16 '�qT T� (a0 �,. _ N PROPOSED HYDRO-ACTION AN550 IIA OWTS BEFORE COMMENCING WORK O lb LIGHT 'All foundation penetrations for entry of directly buried feeders are to be equipped ^- ' \ /p __ ►��' �>`-- RED BLK Wrrr with galvanized steel sleeves. RMC is to be used at all other foundation and floor "v �' A -! \ _ PROPOSED 8.5'X 4.75'X 4'DEEP 6. ALL UNSUITABLE MATERIAL AND DEBRIS SHALL BE DISPOSED OF IN ACCORDANCE WITH RED penetrations. .Q LL TOWN,COUNTY,STATE AND FEDERAL LAWS,CODES AND ORDINANCES.CONTRACTOR "'° F � �' �N'F !`` � � LEACHING GALLEY/�/P.OF 3 �6� s .�' �� `' ' ) SHALL BE RESPONSIBLE FOR DISPOSING OF ALL UNSUITABLE MATERIALS OFFSITE. 'Furnish and install new service equipment and circuit breakers as shown in 0 ,'� /' Fy DEBRIS SHALL NOT BE BURIED ONSITE. BLU ENABLI_ YEL these drawings. All panels and breakers are to be labeled. The electric panels 0'' \ ,' I �� L' PROPOSED 50%EXPANSION 8.5'X 4.75'X ? < 2 I1 PLC INPUT are to be installed and grounded in accordance with the NEC and Local Electric '!� �' �� _. ,-- - , 7. ALL PRECAST STRUCTURES SHALL INCLUDE SUFFICIENT STEEL REINFORCEMENT FOR Codes. /� �i (� t ►��' 4 DEEP LEACHING GALLEY(TYP.OF Z) TEMPERATURE AND SHRINKAGE,TRANSPORT,AND TO ALLOW THE STRUCTURE TO •O \� TEST ` WITHSTAND AASHTO H-20 LOADING AT THE COVER CONDITIONS SHOWN ON THE PLANS. BLU OVERRIDE Y 'All switch and outlet boxes,junction boxes,and pull boxes installed on the •� '�' 5'MIN. 3 4 CSR 12 PLC INPUT exterior are to be galvanized steel and rated for exterior use. �i� ?� HOLE �\ ��� �� 7 MIN. 8. ALL PRECAST STRUCTURES SHALL BE MANUFACTURED WITH 4000 PSI 128 DAY BLU W WPINK _ _ -_ 14 PLC INPUT *All exterior outlets are to be housed in weather proof enclosures. �� O�� ��/ i Oy F� �i / y^><� 5'MIN. STRENGTH CONCRETE. EX.WELL TO BE T^" 1 �� \ ��� f�,� p,01 ABANDONED 9. SANITARY PIPE TO BE SDR-35 PVC OR AS SPECIFIED ON PLANS, TIME DOSE I7 PLC INPUT so tiFs y �` BLU �_ DEMAND .9^ EX.GAS SERVICE SFR �� <` < i �A PROTECT MAINTAIN EX. 10. DURING CONSTRUCTION,EROSION AND SEDIMENT CONTROL MEASURES TO BE UTILIZED AS NECESSARY TO PREVENT THE TRANSPORT OF SEDIMENT TO OFFSITE AREAS, rnN�„ "!�� ►�� ��- `/-F MIIV \ i ��ti F Q GAS SERVICE PONDS,DRAINAGE INLETS,ETC. THE METHODS AND MATERIALS EMPLOYED IN THE SPRAY I8 PLC INPUT EX S� Gi r 3.T I �� y (HAND DIG GAS LINE WITHIN INSTALLATION AND MAINTENANCE OF EROSION CONTROL MEASURES SHALL CONFORM ELEC , TO"THE NEW YORK GUIDELINES FOR EROSION AND SEDIMENT CONTROL'. NOTES:F"COAT SWITCH TO BE RATED 2 AMPAT 120V MINIMUM. PANEL G��� .�L '. ' (5 MIN.) /�� 5 OF LEACHING GALLEYS) W1 61 MAIN PANEL DISCONNECT MUST BE PROVIDED BY INSTALLER. W1 i �.:_ ;; LINES / �6 11. ALL BACKFILL SHALL BE SELECT GRANULAR MATERIAL COMPACTED TO 95%MAXIMUM DASHED LINES INDICATE ITEMS NOT CONTAIN/N THE PANEL. i,o DENSITY AT THE OPTIMUM MOISTURE CONTENT,AS DETERMINED BY STANDARD REQUIRED TORQUE FOR TERMINAL BLOCK SCREWS IS 16 in-lbs. �� ! ,' PROCTOR TEST. FIELD WIRING MUST BEA MINIMUM OF 60°C COPPER WIRE. EXTERIOR RATED JUNCTION - :��L'• � ,-' � ' 12. LOT AREA:14,1021.63 S.F. CHANGES TOLERANCES DRAWN BY DATE 20 AMP BREAKER ; `, O ,'' BOX BELOW GARDE INA ,.� �. �• F DECIMALS a BARRICK 111W6 SCHEMATIC, ELECTRICAL r y cJ. 13. THERE ARE N(0 WELLS WITHIN 150'OF THE SEWAGE DISPOSAL SYSTEM. '==k005 SPRINKLER BOX .� _ O E roc=:.opo MATERIAL SPECIFICATION: D FRACTIONAL SCALE PARTNO. 12 AWG OF WIRE IN SEPTIC PRenoursIMC a ANGLES AS NOTED 920905 3/4"PVC SCH 80 SITE PLAN A FULL CONDUIT SCALE:1"=20'-0" CIO lost PLC CONTROL PANEL � 1 W/HP80 COMPRESSOR AIR PUMP REMOTE PLC CONTROL PANEL X` o�P* 36'X 36"X 6"P.C.SLAB WI HP80 COMPRESSOR K , FCIVO ELECTRIC RISER DIAGRAM WITH6X6WIAXWIAWWM �011- NOT TO SCALE a a ALL ELECTRIC TO BE PLACED CONTROL PANEL&AIR PUMP ELEVATION IN SCH.80 PVC CONDUIT API�ROVED B�° BOARD OF I RUSTEE TOWN OF SOUTHOL m y . DATE pFcMeW I I t 2pl Q � . z 0 � 00 0 Inlet Outlet M m -I z - m Z C r =.1 0 D > / Z D 2'VENT Z CARBON FILTER THE VENT TO BE TERMINATED 0) 00 DEVICE 18"MIN.ABOVE GRADE WATERTIGHT FRAME&COVER W/ WATERTIGHT FRAME&COVER W/ IJ 0 V a 2019 Z "0 APPROVED LOCKING DEVICE APPROVED LOCKING DEVICE M REMOTE PLC CONTROL PANEL PLC CONTROL PANEL WIHP80 COMPRESSOR WATERTIGHT FRAME ICOVER W/ (p WITH AIR PUMP. HS-20 LOAD RATED BOLTED APPROVED LOCKING D7EL TRAFFIC = O MAY BE MOUNTED ON UNIT TRAFFIC CAST IRON COVER. F.F.EL.11.43 BEARING SLAB In Z OR REMOTELY. MAXIMUM OF T OF EXTENSION " CLEANOUT BEARING SLAB °D EL 9.8 EX.GRADE 11.0� N COLLARS MAYBE USED TOEL.11.5 EX.GRADE EL.12.0 EL 12.5 O BRING CASTING TO GRADE. TRAFFIC M = " 1'MIN. 1'MIN. 1'MIN. M 1W.EL 8 2 2'MAX BEARING SLAB -0 INV.EL 8.5 T MAX T MAX 0 o BUTYL RUBBER GASKET INv.EL a.1 ALL LEACHING POOLS SHALL BE PLACED IN HEALTH DEPARTMENT APPROVAL STAMP 'Op m RUBBER PIPE CONNECTOR 4"SANITARY WA PIPE ®®®®1 ®®®® 0®®®® 3 ACCEPTABLE LEACHING SOILS AS APPROVED RE M PITCH 114 INCH P R F00T � THE SCDHS. IN THE EVENT POOR Outlet 4'PVC WASTE LINE 8'EQUALIZATION 2-0' 50®® 2'-0' '�®® LEACHING MATERIAL IS ENCOUNTERED, 11/15/19 RELOC.SEPTIC O Inlet FL LINE INV.EL.8.3 PITCH 118 INCH OL ®� PIPE ® EL 4.5 9 MIN. MIN. EXCAVATION IS TO BE CONTINUED TO 8/24119 TRUSTEE COMMENTS O m IN. PER FOOT (3)4FEETDEEPGALLEYS SUITABLE MATERIAL AND BACKFILLED AS 8115/19 SCDHS COMMENTS n EL 2.28 z_ DETAILED. CUTTING RINGS MAY BE REVISIONS O PROPOSED 'MIN. REQUIRED. p HYDRO-ACTION- PITCH 118 INCH PER F 0 WATER EL 1.5 _ _ D D - AN Sn=k0WTS- - GROUND WATER - - 0 6'MIN.PENETRATION INTO SAND NOTE: -U _ Y n (HIGHEST EXPECTED) AND GRAVEL STRATA LEACHING GALLEYS TO BE THIS PROJECT IS A BEST FIT REPLACEMENT t r��� .,�t'` - Till TRIBUTION LEACHING LEACHING LEACHING MANUFACTURED BY LONG ISLAND r- y HYDRO-ACTION AN-500C DEP PRECAST OR AN APPROVED EQUAL AND NO WORK IS PROPOSED IN THE EXISTING Z Z = DETAIL GALLEY DETAIL GALLEY DETAIL �-°.. GALLEY DETAIL RESIDENCE. , -0D C-0ASTAL PIPELINE � - _ ,� + �r`�a O 0 (631)369-4000 PRODUCTS CORP.' g Q P.Q. Bax 575, 55 Twomey Ave. , Calverton NY 11933 SANITARY SEPTIC SYSTEM PROFILE ., �� � 4, n PRECAST CONCRETE Project: S.C.T.M.: DIST. 1000 SEC. 107 BLK.09 LOT.05 "gin' "� NZ MONOLITHIC TANK J NOT TO SCALE O • I HS-20 LOAD RATED 0 +B B EARTH COVER:0.50-3.0 FT. Contractor: • .0 O Plans are prepared by Condon Engineering,P.C. It is a violation of the Scale:AS SHOWN Condon Engineering, P.C. CAR RO L L RESIDENCE O • • HYDROACTION AN500-C NITROGEN REDUCTION SYSTEM Product: New York State Education Law,Article 145,Section 7209,for an hydr CtIOII WEIGHTS: Precast AN500-C Nitrogen Reduction Unit y �ti,.d.�-P person unless acting under the direction of licensed Professional 3825 WICKHAM AVENUE BASE UNIT:12,250 LBS. Engineer,Architect,or Land Surveyor,to alter any item in any way.If an1755 Sigsbee Road ROOF SLAB:4,100 LB. Scale date dwn. by dwg. no. item bearing the seal of an Engineer,Architect,or Land surveyor is Drawn by:JJC Mattituck, New York 11952 MATTITUCK, NY OF None 9/26/16 D.O.R. HA-01 R2 altered,the altering Engineer,Architect,or Land Surveyor shall affix to 631 298-1986 631 298-2651 fax the item his/her seal and the notation"Altered by"followed by his/her Date:8/1/2019 signature enaturatran the date of such alterations,and a specific description of www.condonengineedng.com SANITARY PLAN ;r` SUFF�t I O kC Michael J Domino, President ��i,�o�. °y,;':1 Town Hall Annex John M Bredemeyer, 111, Vice-President o 54375 Route 25 Glenn Goldsmith o P O. Box 1179 A Nicholas Krupski yg dor ' Southold, NY 11971 Greg Williams ' =Y ` Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: STEPHEN CARROLL c/o CONDON ENGINEERING Please be advised that your application dated September 9, 2019 has been reviewed by this Board at the regular meeting of December 11. 2019 and your application has been approved pending the completion of the following items checked off below. Pre-Construction Hay Bale Line Inspection Fee ($50.00) — 1St Day of Construction ($50.00) 'h Constructed ($50.00) xx Final Inspection Fee ($50.00) Dock Fees ($3 00 per sq ft.) 30- Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES- TOTAL FEES DUE $_50.00 BY- Michael J Domino, President 5 Board of Trustees Michael J. Domino,Pre ��OS�EFQ(,�COG Town Hall Annex John M. Bredemeyer 111,Vice-rresident ¢ham y� 54375 Route 25 Glenn Goldsmith C z P.O.Box 1179 A.Nicholas Krupski r Southold,NY 11971 Greg Williams y p! Telephone(631)765-1892 71 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: V Completed in field by: Condon Engineering, PE on behalf of STEPHEN CARROLL requests a Wetland Permit to install a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system. Located: 3825 Wickham Avenue, Mattituck. SCTM# 1000-107-9-5 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 Notige 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 read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski A. Williams Other C�Michael J Domino, Presi � S x rir Town Hall Annex John M Bredemeyer 111, Vice-Fresiaent ���� Gyp? 54375 Route 25 Glenn Goldsmith y z P O Box 1179 A Nicholas Krupskiw� J Southold,NY 11971 Greg Williams �L p! r� Telephone(631)765-1892 �1 �a 1 . Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: /g�19 3 i5 Completed in field by: G. Co IdSM 11+� Condon Engineering, PE on behalf of STEPHEN CARROLL requests a Wetland Permit to install a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system. Located- 3825 Wickham Avenue, Southold. SCTM# 1000-107-9-5 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 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 J 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: n � 6fe_ wo s IL +e4 L le -1 Yes' hoe «tece.nc,-_S edeyo .on bJ Agre.5 no 19 do Sut;\/'eY \'Ay can 'T Tie- SY_5T'e" be. rno\ked 4y Prc)D Vafa ? I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / / Present were. ✓ J. Bredemeyer ✓ M Domino ZG. Goldsmith ✓ N. K r u p s k i ZG. Williams Other Nv o' --- - `� J s -Xi ,oy� �a9�o�•�ryy Q O0 � S O , b lb O a O= J� , _.. SEP 9 2019 Carroll residence • Picture #1 '4i41f Picture #2 L•r .� 7 �' . .�#fir mss`'' %"�-.k. _ J''`^�' �j' T q +ii� u' r. �ry Legend Carro • . - • ' 3825 Wickham Ave �.. X3825 Wickham(Ave . t ASO- r x ` Google Earth ca 2018 Gooyli. �, 600 ft R u C�1 SEE SEC.RO.1W SEE SEC.NO.1W .„o,m yA MATCH LIRE MATCH. i. IINE NnO,m 1 P 1S i Y 11 101A fOR PCL NO g _ 1 aA(<I 2a w SEE SEC NO i � 1.1 AtrN,D WMdDa2 �J u tO.eA \ rt0e++a•sovnlan � J M)`' OGletowr>+Gmnrsl «� 6 24 2. on•Ltasrhrn m.'+nA ,1.1p, SaA u o w 25 13.1A O .e Sal [B�SON,�U 1 1.3 i 22A 21AA A, 28 e -1 A' s �• 1 ` of l 10A a.•, '!++ i 0•va0wlal ^ l 12 1r- a3A SzpA 21A y / \ O • S1 J\ ' `6\1 y7 10] C aelaualerraYm9 eP \ 2 \> ♦sPLc �C �i ^ SN 2SA 11 I 21A1d ; P P � as 241 r• 51L n oma\ y �• +5 p �Ow Z12 Sa. 12 y C i GOR PCL.NO 2 I 11A(<) 1 'YO a �✓, ^ r` :h a Iw 41 SEE SEC_NO. IyI.1 y IIy, 1 � \ •!+A aI�\ � 10601 X01 1 i za wTTnUCR I 23A(cl 211 SpA PARK 01ST \ e 1 e+ \ l 2 M I O 1 Im I I u \l J' o + +0N') TowN OP 1 ^, � � A(cl aa.ao�A•rAw,rn Iii M.1 f \ m i � a Rlw a sow16 0 tW<) Q a .}�'/7✓ �I \ 1 �" • �m e s 18A(c) /, ;�1' tM � �� � WRxv up �I \ � © � � 1 P i � , z1Ae<) / °° •s s7• N \f. �./�>E�w. A / q1 ,a e i e + �•1 � 0 +�� ti+ sir ea PIA 13 6 p? I \ � � \� +• ,+J\FiV, ++ B,�9�O •11 i�w -1 214Y) �� O 3 J.3 m j \ 1 �� M $-11 i 4 m M i© es • ;°•�, `9. 1O ep. RxrPa.No ry1 ' SEE SEC NO. '. i y .p N • , p� 4 P3 iiA II alio( � a �T�_ ♦- +- E+ u"' ,s�A a2 PO 1a.3A(.) 4 r/ a ++ ,e �� la•'w, o s 'e et ,+ d^ • +es t y. y._ � ,^RH' �?_ m, A.as�,r ,B, e�•.' e I� 1� /e�7 >a ---- • ,o +e i s � + O. •s✓,1 � �pA 1"" "'z``� A w .sI1"/-- .r J' ----- ir1E MAICN 1e � Yn, �:_ � �,.,,. �.i vE0 �° " � INTCNt� sEY SEC.At0.111 1, I a�- _�_ �u� w 1z11 w O � _—�-- ""ems•^^ -- NOTICE gaiµ�. COUNTYOFSUFFOLK © E 01 OG souTHGLD SECTION NO rice Y 1a 1pG tW NuwOEK uN FMMx 06 ww Rx _ _ e�sr i•aNw +Eu 98�fp�e(�G�T�SENI 107M _ Service Agency a. A —T- loan -- _: T _. ... _.... - _. •.w.,.. PROPERTY MAP 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 15, 2019 Ms. Elizabeth Cantrell, Clerk Board of Town Trustees Town Hall Annex Building 54375 Route 25 Southold NY 11971 Re: Trustees Wetlands Permit— Carroll residence—3825 Wickham Avenue, Mattituck, NY SCTM: 1000-107-9-5 Dear Ms. Cantrell: Attached please find (4)-four sets of the revised site plans. The plans were revised as requested by the Trustees at the October hearing to relocate the proposed sewage disposal system to the front yard. The system is now greater than 100' from the tidal wetlands. Yours tru y, n J. Condon, P.E. NOV 1 5 2019 OFFICE LOCATION: �o�*OF SO -olo MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) N Southold, NY 11971 pQ Telephone: 631 765-1938 O Fax: 631765-3136 �y�OUNTY,Nct� 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 STEPHEN CARROLL SCTM# 1000-107-9-5 Condon Engineering, PE on behalf of STEPHEN CARROLL requests a Wetland Permit to install a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system. Located 3825 Wickham Avenue, Southold. SCTM# 1000-107-9-5 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 �����gUfFDt,�coG Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 y' Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 9, 2019 the following recommendation was made: Moved by John Stein, seconded by Caroline Burghardt, it was RESOLVED to SUPPORT the application of STEPHEN CARROLL for the installation of a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system. Located: 3825 Wickham Ave., Mattituck. SCTM#107-9-5 Inspected by: Caroline Burghardt, James Abbott, John Stein Vote of Council: Ayes: All Motion Carried Michael J.Domino,President ,'"i �Q� $O(fp - Town Hall Annex John M.Bredemeyer III,Vice-President '``� l4 54375 Route 25 { r P.O.Boa 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas HrupsId 4i G ;�. Telephone(631) 765-1892 Greg Williams CoFax(631)765-6641 YID I'11 v BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application ✓ Wetland Permit Application - Administrative Permit LAmendment/Transfer/Extens4.0 SEP 9 2019 ✓ Received Application: `' 9•� Received Fee: $-Z-0—,0V _ - - Completed Application: Incomplete: ._ SEORA Classification: Type I Type 19 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: .,L Coordination:(date sent): ✓ 16#4 LWRP Consistency Assess ent Fon Sent: CAC Referral Sent: Date of Inspection: B Receipt of CAC Report: Technical Review:— Public Hearing Held: Resolution: Owner(s)Legal Name of Property(as shown on Deed): 0-4 mac-4- Mailing Address: 3 f?ZS wICk l✓i Av ,QE- MTT-/7,jC-& r�Y I19rZ Phone Number: S��o 90 - 70y 2- Suffolk Suffolk County Tax Map Number: 1000-I o 7 - q Z g- Property Location: , ,'S- P-I ckkim du+5se vF No217t S lD c 47&" 6 S e04z4-A (If necessary,provide LILCO Pole#,distance to cross streets,and location) AGENT(If applicable): 6,.j 6%,j �i�` �N P� �o h/.•� �'�tiGlr.� Mailing Address: 17i"<' Q&5 i 6-4-P )1h,4MIT- 11'9j Z Phone Number: �4I' 9po I Board of Trustees Application GENERAL DATA Land Area(in square feet): . /16Z463 Area Zoning: 12 Yo Previous use of property: �'wS C.6 Intended use of property: 5'F Covenants and Restrictions on property? Yes v,-' 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 No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _-No Does the structure(s)on property have a valid Certificate of Occupancy? (//- 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? ✓No Yes If yes,provide explanation: Project Description(use attachments if necessary): j���g/�,4 n�,� pf i4 ,-Ear ;T;LA V p eG.r-,nJ i��aTrn � r/,r t'T W nt- A f F i CrRa i v2 J grzi'l Ac- /9+h �i� . S��CTiE+/Y�`r Ala /�Pt �5 J JAC Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: U6-2/4pE T'v A" 'k !�c-c.A&e Area of wetlands on lot: /23 square feet Percent coverage of lot: •. S� _% Closest distance between nearest existing structure and upland edge of wetlands: Zz' y feet Closest distance between nearest proposed structure and upland edge of wetlands: 56,j- feet Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? LS- cubic yards How much material will be filled? Q cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: __95cC_A,Arl..+3 L�itL A's 4)e A,,J Ec CAVr9tOX.. !qr (?ACk c(U�60 �1 Fr,Ft� /o•�STALc�4T7a,^' OF AJZ A SFy,966 i2d&4L �. sT_��i L r.�►%LL /�E SQE'f4� oN 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): �1CL gF' No y.e2k_ P. i r T�ItE W�TLr9�D-S� A �l LrFf.;, .9 AL-k, Ll__JF wIt4- 13,6 SST JyTpAe':r� -INC: &*rL.46,ds 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information C�R2�z� �si��ac Name of Action or Project: 3K25' b1,l C/6#4y 1 v c / ✓E:� 7- v�Ec7'� Project Location(describe,and attach a location map)- Brief Description of Proposed Action: 26Mar.4` ©F 6r c., 6 C65;5Pooe 5 AMO rN�- J•v s;Au-AT/� Ong f/TE I.145'i,6W 4 T1!�2 T�rm,-=jT s� � 4—O , X -n 5vf-fvvk SFp�'iG� 1/'•10 €i"e.yt- Mc.L121.4; . Name of Applicant or Sponsor: Telephone: S �j 41fZ E-Mail: , /� ' CL'✓i C&4 Address. 3e?s' mcilL:*m 4 u-t City/PO: State: Zip Code: A Tr/Tucle- Air j/9 s'L 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rale,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that D 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: T744L ❑ PE2rh/T iv sD�G u•�r�NDs 3.a.Total acreage of the site of the proposed action? D, 5L Z- acres b.Total acreage to be physically disturbed? A/0() acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? Qe 37,] _acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban [_-]Rural(non-agriculture) ❑11 dustrial E]Commercial Residential(suburban) EJ Forest ❑Agriculture f✓JAquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO N/A a.A permitted use uYES the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YE landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 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? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10_ Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water- _ _ � ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: _,..___ ❑ 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? v ( 1:1If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: J 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 ❑ ncultura l/grasslands ❑Early mid-successional VWetiand ❑Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO A 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 1f Yes, a.Will storm water discharges flow to adjacent properties? NO DYES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES Page 2 of 4 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: ❑ 9 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 Applicants "name: Fi✓ �.o[_t- 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 1. Will the proposed action create a material conflict with an adopted land use pian or zoning a regulations? F!- 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? a 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or a affect existing 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? 7. W ill 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? 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? 11. Will the proposed action create a hazard to environmental resources or human health? ff— 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. ElCheck 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. Q/Check 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 imp is. Town of Southold-Board of Trustees e© 5 Name of Lead domino ency Date Michael J. President Print or Type Nam of Responsible Offic in Lead Agency Title of Responsible Officer Signature of Responsi e Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT P�r172�c1qC��u2��.L CA 12,eo 1,4-- BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. C.—sz�Q *nature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF0/� N Public ROBERT RUBEL NOTARY PUBLIC dTATE OF NEW JERM W COMMISSWN EXPIRES FEB.7.2W Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, !�T� 0,462,L.1—, VAT/2)G C-1 I , owners of the property identified as SCTM# 1000- /l -7— �— 5'- in the town of GNew York,hereby authorizes_ xo///J 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. Pro rty Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF -I C-y7r-rz 20/2_ Notary blic ROBERT RUBEL NOTARY PUBLIC STATE OF NEW JERSEY W CONAIISSION EI�M FEB.7,XX APPLICANWAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the on of town officers and emnlovees.The purpose of this form is to tmovide information which can alert the town of oossrbk conflicts of interact and allow it to take whatever action is neceWly to avoid same. YOUR NAME: e��`o'O,o� S c��u•9"'� (Last name,fust name,Aniddle 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 intercom"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 S day of CIN `5 Signature Print Name Ttip�5--� c�o.Qaas� Form TS I P CAftj, APPLICANT/AGENT/REPRESENTATIVE h2,5- 0J1C4,-f*M TRANSACTIONAL DISCLOSURL FORM The Town of Southold's Code of Ethics Prohibits conflicts of interest on the part of town officers and employees.The pumose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to tape whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,ipiddle initial,unless you are applying in the name of - - — --- ----someoneELse o[Sgller entity,-such as a company.If so,indicate flee-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 ofle loyce of the Town of Southold? "Relationship"includes by blood,njarriage,or business interest_`Business intetesY'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 I f ydu 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/agcnt/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,pareat,of 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 offic cr;director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Dated: \`\ Signature — Print Name :—�- Form TS 1 APPLICANUAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and em to ees.The puM2se of this form is to provide information which can alert the town of pgssible conflicts of interest and allow it to take whatever action is necessary to avoid same. _ YOUR NAME: .^/DUB Yo � _ (Las name,first name,ipiddle initial,unless you are applying in the name of - — - — someone-else ar_other entih±,_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 ibterest."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 I/ Ifyou 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(wheft 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 a n1 c• Form TS 1 CERTIFIEDU.S. Postal Service'" U.S. Postal Service'" O . ■ CERTIFIED MAILP RECEIPT Domestic Mail Only m Domestic Mail Only ..� rinformation, at .0 l.llR.l For delivery information,visit our website at www.usps.com'. r LONG .SEACHY NY 11561 O C3 IT" Certified Mail Fee $3.50 0952 Q' Certified Mail Fee � i u952 ..n $3.51 $ tib r� $ 116 Extra Services&Fees(check box,edd lee 9p Ip. 6� Extra Services&Fees(check box,add/ee are) 7VI i A' O ❑Return Recelpt(hardcopy) $ "�J 0 ❑Return Receipt(hardcopy) $ C3 ❑Return Receipt(electronic) $ 1 _ E ❑Return Receipt(electronic) $ $0-00 mark C3 ❑Certified Mail Restricted Delivery $ H r3 ❑Certified Mail Restricted Delivery $ 6 0 ❑Adult Signature Required $ / Y r3 E]Adult Signature Required $ 9 ❑ Adult Signature Restricted Delivery$ `' V0 - � ❑Adult Signature Restricted Delivery$ �O Ir Postage $0.55 � Postage $ x.55 /�_ 1 $ J ,� $ 0 Total Postage and F c 0 119 r3 Total Postage and Fees 85 .8.t 11 S ' A Cc!u S MA?i,f(,c�L ---------------------------------------, ' S Ar _� h'16. ���� ®vl /� 1 _y --------------- 0 enif,apt:iVo. i C So;Y No.n �� p�� Q treat a„ pt. "o�e 76 Yl / P I �t_y -'------------------- ` � --------- / ------------------------ City Sf te,ZZIIP1+4 / City State16 ,ZIP+4� &A C lO 4i - PS Form 3800,April t 7530-02-000-9047 ISee Reverse for Instructions PS Form 3800,April 2015r. ...•r Postal C3 CERTIFIED MAILP i RECEIPT u•1 Domestic X11 For delivery information,visit our website at wimmusps.com". I [:3 X.. FM I• Certified Mail Fee $3.50 ♦ 119 r` $ $2.80 �C Extra Services&Fees(check box,add/as a#IRprarAate) O ❑Return Receipt(hardcopy) $ / .•{ r3 ❑Return Receipt(electronic) $—•.1•UU r L' r ❑Certified Mail Restricted Delivery $ t7 I.[1[1 ` 0 n 0 ❑Adult Signature Required $ $0 U0 ❑Adult Signature Restricted Delivery$ C3 Postage $0.55Er 0 , rq $ 10/08/2019 C3 Total Postage and 9w.85 S Csea T 3 �sA � � �� �I� '2 - .p treat andApi No.,o b ffox No. ; ;IPS=� (�_h --- V --------64-L a t . 000-9047 I I I PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS lq Name: � /aY STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAILIRETURN RECEIPT. Sworn to before me this Day of , 20 Notary Public 0 0 Michael J Domino, President iy"�O �'� Town Hall Annex John M Bredemeyer 111, Vice-President y',4�� liyJ,`,I, 54375 Route 25 Glenn Goldsmith ` o . PO Box 1 179 too A. Nicholas Krupski t� ✓? Southold.NY 11971 Greg Williams �L pl ,;Y Telephone(631)765-1892 ��� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of STEPHEN CARROLL COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DA YS PRIOR TO THE PUBLIC HEARING DATE I, J 6 hr) C 6 n bpi , residing at/dba St < 3 Q f7� r �f C- being duly sworn, depose and sa That on the 7 day of CG�O h r 201 , I personally posted the property known as 0 6 e t2,2 l/ & erg L(-) I C-16 A A !22 4 VQ M Q A I i " C kf i l l jr� by placing the Board of Trustees official poster where it can easily be seen, and that I 1 ve checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, October 16, 2019. Dated: tuI Sworn to before me this day ofol adW0�G MELISSA R DEBOER NOTARY PUBLIC STATE OF NEW YORK SUFFOLK COUNTY C uUt4- CAP--x-C4 _ LIC. #01 D 6349898 Notary Public COMM. EXP. (013 k 2U2O C )J)" � PROOF OF MAILING OF NOTICE ATTACK CERTIFIED MAIL RECEIPTS Name: Address: r(�?q4-/1 /c- ri �l 3 1;� 7f— {U .c � h .a61 SGJ� cJ�oyTVi. H� hoy1 fnei ,� bh `I /I 1-C Lc S � , f�c� (2—p c Tr h G n STATE OF NEW YORK COUNTY OF SUFFOLK h�1 DYt d o), CJ residing at t 7jT- 1 being duly sworn, deposes and says that on the day of 20( deponent mailed a-true co py set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at I f f 11that said Notices were mailed to each of said persons by CERTIFIED MAIL/RFTU REC Sworn to before me this �- Day of�. r , 20_x_ I MELISSA R DEBOER ( i - NOTARY PUBLIC STATE OF NEW YORK n o � SUFFOLK COUNTY Notary Public LIC.#01 DE6349898 COMM. EXP.�B(Jag-e ■ Complete items 1,2,and 3. A. Signby t ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. ReName) =of or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from Item 1? ❑Yes If YES,enter delivery address below: ❑No Q a t 6 K � ti r6, II IIII IIIIII(VIII II II IIIIII I I I 3 Service Type ❑ Mail EWress* 13 Adult Signature ❑Registered MaIITM ❑Adult Signature Resiced DeyIIIIIII VIIIIII Cl Ragiatared Mail Restricted 9590 9402 3253 7196 9000 14 CeMftd o Certified MMail Restricted Dei Delivery ivory ❑Retr,m Receipt for ❑Collect on Delivery Mer frandise 2. Article Number(iansfer from service libel) ❑Collect on Delivery Restricted Delivery ❑Signature CoMlrtnation- 7 017 0190 0000 7690 2636 � l Restricted Delivery ❑SReestricteed ignature�iverryy on Ps Form 3811,July 2015 PSN 7530-02400-ww Domestic Return Recut DELIVERY ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addresses ■ Attach this card to the back of the mailpiece, B. Received by(Punted Name) C.Date of Delivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes n n y M, JG� v If YES,enter delivery address below: ❑No 3. II I I I II I IIII IIIIII II IIII I I II(IIII I I I I I II II III Service Type ❑Priority Mail Express® 13 ❑Adult Signature ❑Registered MaiITM ❑Adult Signature Restricted Delivery ❑Reglstared Mail ReetrkMd 13 Certified Mail® De��Y 9590 9402 3253 7196 9005 95 0 coicer�eed Ml erchand Restricted Delivery ❑ct on WNWMR eoelpt for 2. Article Number/Transfer from smrvlrw rahon ❑Collect on Delivery Restricted Delivery ❑Signature ConfirtrretionTM eured Mail ❑Signature Confimratbn 7017 0190 0110] 71�9R1-M. Ii;;t,t;, i11R°"YI97°�Ri',",�1Rea"'oter'De""er' Ps Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ,NUTILL Ulm HtAKINU NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: STEPHEN CARROLL SUBJECT OF PUBLIC HEARING : For a Wetland Permit to install a new I/A nitrogen treatment unit with an infiltrator leaching system to replace an existing septic system . Located : 3825 Wickham Avenue, Southold. SCTM# 1000-107-9-5 TIME & DATE OF PUBLIC HEARING : Wednesday, October 16, 2019 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 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 prolapsed 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" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail. listing both supporting and non- supporting 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# 107 PROJECT NAME P The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ 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: pN t A6 iNS�L! i�lnJEcv 1/� I.yASTw�4ic`2 112�TtM,�vT ��� ANS J� FrLj2A'r��I,��Q��/•u6 SsrST�r-+. 'fJ4ls Location of action: 47-1 �-r CX 114ryl Aut, Site acreage: 0, 3 ZZ Present land use: Siu(�� ,�/ s�r1�fiG�-'►e-'E Present zoning classification:_ b 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: S�1�o/��N A o,2o&-- (b) Mailing address: AVc--/+A iYJAMN� /l1 Z (c) Telephone number: Area Code (d) Application number,if any: Og Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes RfNo❑ If yes, which state or federal agency? p nL WZE-tLA"J+9S 11 C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. ❑Yes No ❑ Not Applicable 20 SSG rt-o •v ,t, !- AWICq LvIL� IN cr�s�S� 0476 L4- &.,ALc t'35 ro 2 17W C&rse,k Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Not Applicable gf S* PkSFcr &-14-L /�,�cid N o _f/ 41C-E Tl� �lL cl /4��UGIC�L 2�Soy �FS /.� Zjt3E tZ5a iy OF So 7710 Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III-Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable yW6 jL,&-w '&E4-rm, y-r S�//S'T�E� I,,Y44- /,6vr'at.E 1v4� Q✓4 L!� 1`02 ��o C-a&gZr= 6�Qucl v N/TGr'ln6,F,.,/ fl-F Al2,j42st0 ,EorrG SX T4W%e 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 E�TNot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - (Policies Pages 16 through 21 for evaluation criteria RYes ❑ No ❑Not Applicable it (C 20 ly lGL- J 4d A&VE 6y A-r6G 62,,-4 U']'t�t e, P--- Toiu-✓ -OF 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 th2 for evaluation criteria. rong ❑ ❑ . cf�- ) No Not--rplicable ! A.T i2�- W,--, 1 411 u .v -<yj7rot 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 7�flf 4easL-L7- h44f vvc, //,���✓er,477yA lv�t&C-7-s TLS A(,P IQLIAL r7Z Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LRP Section III-Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 1"I Not Applicable -- Y JCL v v—'.6-47-'t1Z LA-1, g=KS Tt-1 ,Ct1�T1�-E 7ou,.y 6 So.�Tt10 L�. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III-Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye�j No ZrNot Applicable 22 Ic ,evMC� v 14CCf5s TZ 40ASa& Attach additional sheets if necessary WORKING COAST POLIutES 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. ZYes ❑ No ❑ Not fApplicable 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. nYes ❑ No ❑ Not Applicable i !S -0,6m,97-ZS 5✓S I.gi�,,�l�C� �l S 01� �I••►G /y�,E121•�t� , fog 2GS 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 2Not Applicable ats' &-rEc=T414s /Vr, 77wr- fes,DSS 77� ��rrA�Tu/lAL G� i-� 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 ONot Applicable pec Tk-c7— /9S /V46 6A 77 u e /tel T 3 1 o F 6f.0 6�i 1n!-u 62.4 6- PREPARED PREPARED BY ��,y,1 TITLE DATE / 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 6, 2019 Ms. Elizabeth Cantrell, Clerk Board of Town Trustees Town Hall Annex Building 54375 Route 25 Southold NY 11971 Re: Trustees Wetlands Permit— Carroll residence—3825 Wickham Avenue, Mattituck, NY SCTM: 1000-107-9-5 Dear Ms. Cantrell: Attached are the following documents for the above referenced application: • Four sets of the Trustees Application, short EAF, LWRP Form and Transactional Disclosure Form • Four Sets of the site plans The applicant proposes to install a new I/A sewage disposal system under the Suffolk County Septic Improvement Grant program with no work proposed on the existing residence. Yours trul fon, Jo J . SEP 9 2019 i BCeid