Loading...
HomeMy WebLinkAboutLove Lane Village LLC ELIZABETH A.NEVILLE,MMC /�' Town Hall, 53095 Main Road TOWN CLERK "" �� '�3 P.O.Box 1179 Southold New York 11971 REGISTRAR OF VITAL STATISTICS rp °� �� A, Fax(631)765-6145 MARRIAGE OFFICER "� � � � #t, Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER " ' FREEDOM OF INFORMATION OFFICER ���` �� �'•southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Southold Town Clerk's Office DATED: December 15, 2020 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4923 for a Cesspool/Septic Tank Construction Permit submitted by: Denise Guz ello for Love Lane Village LLC Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Signature Dated ' ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS pri01i) Fax(631) 765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER" Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ""° southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION r ALTERATION PERMIT CESSPOOL r SEPTIC TANK Residential @$10 or Non-Residential @$25 -X Application No. `l g23 Permit No. c-20-0275 Applicant Name_ Denise Guzzello - . ��. ...mm Applicant Mailing Address44 d Field Rd Setuaket NY 11733 Sep �. ..... .. __ ._.._ .. . __ tic Tank or Cesspool X_ Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Propert ':w_ aLLC Love Lane Village _. ......-.. _ _��..._..�. ...»w-_�..........�.�.-... Owner Mailing Address: 44 Old Field Rd„ Setauket NY 11733 Owner Property Address: 13650 Main Rd Mattituck NY 11952 Name and phone number of contact person . Denise Guzzello ...... ._. ,._ 1000 114 _ Block 11 t 24.3 � Tax Map No: Section ....� ., _. Cross Street Reeve ave NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL 12/15/20 Signature ITmm. of Appiyc . __ ate Received by: �_� .... _ ....�..... .._ ..._ o.w Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 12/15/20 Receipt#: 276797 Quantity Transactions Reference Subtotal 1 Septic Permit Construct. Non-resid. 4923mm._„ $25.00 Total Paid: $25.00 Notes: 114.-11-24.3 Payment Type Amount Paid By Credit Card-Ref# $25.00 Guzzello, Denise Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Love, Lane Village LLC 44 Old Field Rd Setauket, NY 11733 Clerk ID: JENNIFER Internal ID:4923 .= SEWAGE DISPOSAL CALCULATIONS, �s ?CIN f TES7_,0,F IJAi-A 771 — € _ :.. t l`x .- -�,• >._..�-�:.y: >.-�. _..x - _ .f' _ '' sus �<s E. _a a� KEY MAP s > "- "�?IC=tL EC.ION� z SAS TARY HODS CONN v a NERALNO mS CIEAFa-OUT DETAIL a k t 3 7 g i E tomin— ELECTRIC(SEWER CROSSING DETAIL A --� 3 I 4 � s i iii 7 � -K TANK DETAJL RR PRECAST�S& PROPOSED PRECAST n � jIh I �. � a I '—fie�a�.vi�s•s �. ;t'=- ®. . � :_. - — — ,x - „TRAP DEE'AEl a ;a 0. _ - i _-� ; � .' �,,.,�.� � �— �_z'•� _—___ v. —»_r__—_—_ — R_t�_— __—TF— _— __ LEACH NG P_..�.� .. ;mess PC)c%��fNL .! SYSTEM N0.3-SANITARY SEPTIC SYSTEM PROFILE � a a ..APPLICANT r - - to+�uae•.x�.uc LANE al zrH sr:�-r � r 1 Condon Engineering,P.C. L PROPERTY C 1 mAsamm(h-y.27 OF N..�„� d SANITARY PLAN T— UK- D TRIA- 1.378 5 -.GHTI-N US OC_DA y 3t-M-k-F-1 GLM' cr�z -AREA -CAL-N, 12, (D =7--7------------- Uff R N 3sd Sim —7 isi L4 ==E-= 0Cr,'ANCYCLASSlF,CA7,0-1 T, (D U L JA E N aM RN-9 L,C�-1�01LVRW J cc 01' CLASHAPE '10N F VW TOTAL ��FFRSD 'ZA OmEr A5 < Y C-ASS,-EA-ON:E T w I — < IT R0041 -Wa�f�y Rfy��' 10�X'2 nxl Condon Engineering,P.C. ACE OF AIR rf 3. i ROAD 2sl OF FLOOR PLAN ! FERE ALARA NOTES: PLUMBING SPECIFICATION -4- - I PLUMBING WASTE RISER CLEANING&ANTE ROOM a T _ { PLUMBING SU-,P-y RISER- CLAA\ &ANTE ROOM Ele PLUMBING WASTE RISER HC BATH = PLUMBING SUPPLY RISER HC BATH e ELEVATION—SIDEWALL ELE4ATION-BACK WALL TWICA :tO TING-IE.G ITS.OR i C,-0115TS S AGE OF AIR >, Condon Engineering,P.C. LOVE LAN" —CR0P7R``Y 3 9-�-ti 231 {'SYS 25)NGTES&SPEDRCA IONS OF (&91k c" 19%{61fl32'u`t fae 2 COUNTY OF SUFFOLK STEVEN BELLONE SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES GREGSON H. PIGOTT, MD, MPH Commissioner PERMIT Project Name: Love Lane Village LLC Property Health Services Reference#: C-20-0275 SCTM#: 1000114001100024003 Revision#: 1 The attached plan, when duly signed by a representative of the department, in conjunction with these conditions, constitutes a permit to construct a water supply, sewage disposal, and/or collection system for the property as depicted. The applicant should take note of any conditions of approval,which may be indicated on the plan or enclosed herein. Construction must conform with approved plans as well as all applicable standards including Standards for Approval of Plans and Construction for Sewage Disposal Systems for Other than Single Family Residences. Omissions, inconsistencies or lack of detail on the plan do not release the applicant from the responsibility of having the construction done in conformance with applicable standards. Issuance of this permit shall in no way relieve the design professional of responsibility for the adequacy of the complete design. The permit (plan)expires three (3)years after the approval date.Any modification to the approved design requires the submission of a revised plan and additional fees (if applicable)for approval prior to construction. No inspections will be performed by the department if a copy of the approved site plan/survey is not on site during construction or if the permit has expired. Permits may be renewed, transferred, or revised in accordance with the procedures described in Instructions to Renew, Extend, or Transfer an Existing Permit for Other than Single Family Residences (Form WWM-081). It is the applicant's responsibility to schedule an inspection of the sewage disposal and/or water supply facilities prior to backfilling. This includes inspections of the sewage collection and disposal systems, water supply system components and piping, and final grading as shown on the approved plans. This can be done by calling the department at (631)852- 5754, or through the ACA Portal at t tt : .I ca, caffollc oa n.tyny.00v/CitizenAcces . In certain cases, inspections of the soil excavation may be required to determine the acceptability of the soils for sewage disposal systems. Excavation inspections must be confirmed by calling (631) 852-5700 between 8:30a.m. and 9:30 a.m.,the morning of the inspection.Article VII of the Code, "Septic Industry Businesses," requires that all installers of septic systems within shall possess a valid license from the Office of Consumer Affairs. This office will not perform inspections for or grant final approval for construction of projects that are installed by an unlicensed individual. It is, therefore, in your best interest to utilize a cesspool contractor with a valid license to avoid substantial delays in your project. Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to existing buildings, or for the use of sewage disposal or water supply systems. WWM-016 Page 1 of 2 Project Name: Love Lane Village LLC Property Health Services Reference#: C-20-0275 SCTM#: 1000114001100024003 Revision #: 1 CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT As a condition of this permit to construct, the following items must be completed as a minimum, prior to building occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Other Than Single Family Residences (Form WWM-019). 1.) Satisfactory inspection by Office of Wastewater Management of the sewage disposal system /sewage treatment system. (Call 852-5754 to schedule an inspection.) 2.) Four (4) prints of an As-Built plan. 3.) Certifications from the licensed sewage disposal system installer. 4.) Design Professionals Certification of Constructed Works (form WWM-073)for: Sub-surface sewage disposal system Sewer/utility crossing WWM-016 Page 2 of 2 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION FORM f`D" for a State Pollutant Discharge Elimination System (SPDES) Permit (A SPDES Application When Signed by a Permit Issuing Official Becomes a SPDES Permit) PLEASE PRINT OR TYPE APPLICATION TYPE IF RENEWAL OR MODIFICATION,GIVE PREVIOUS NUMBER lA New ❑ Renewal ❑ Modification NY— o.Z-C� O/-�L' O 1-20) L OWNER'S NAME(Corporate,Partnership,Individual) [T)'P F OWNERSHIP COrporape ❑ Individual El Partnership F-1 Public c transferred 10-13-2020 to: f LOVE LANE VILLAGE LLC TELEPHONE NUMBER 44 OLD FIELD ROADr"m (8/) -e Y!/0 7 SETAUKET, NEW YORK, 11733 CATION(Street or Road) CITY,TOWN OR VILLAGE PI ,,...._.,•- s:7)rm COUNTY GIVE EXPLICIT DIRECTIONS TO LOCATION �u��c3��C �d orJ;�°•6 ��f.G?� �" f•J ,c�� ,.�� �"`•°�4 �i ' � � `/ m. f ,�� r" t"" o +''� � r ,t*°" �✓ rI� � ,t'�tJdy" t W .:"" NATURE OF BUSINESS OR FACILITY POPULATION SERVED(See Instructions) FREQUENCY OF DISCHARGE All Year? Yes 0 No If No,Specify Number of Months All Week? Yes 0 No If No,Specify Number of Days DOES YOUR DISCHARGE CONTAIN OR IS IT POSSIBLE FOR YOUR DISCHARGE TO CONTAIN ONE OR MORE OF THE FOLLOWING SUBSTANCES ADDED AS A RESULT OR YOUR OPERATIONS,ACTIVITIES OR PROCESSES? Please Check❑Aluminum ❑Ammonia ❑Beryllium ❑Cadmium ❑Chlorine ❑Chromium ❑Copper ❑Cyanide ,,-,/ ❑Grease 1:1 Lead ❑Mercury 11 Nickel ❑Oil ❑Phenols 1:1 Selenium 1:1 Zinc LJ None of These DISCHARGE DATA (Use additional forms,If necessary) (See Instructions) OUTFALL NO. ❑Proposed ❑Replacement TYPE OF WASTE :B�077C YPE OF TREATMENT D_51 FLOW ❑Existing 19 Ex ansion 7 C �" ,9CH fl , G il/Da SURFACE DISCHA GE If YES,Name of Receiving Water Classification Waters Index Number ❑Yes IN SU URFACE DISCHARGE If YES,Name of nearest surface waters r3 D+°trance SOIL TYPE Depth of Watjr Table s ❑NO AG >5 ! �QFl. Q` OUTFALL O. ❑Propos ed ❑Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGN FLOW Z 13 Existing Ex ansion lEr C• C--t-t6kCH F I E&D GaUDav SURFACE DISCwf � GE If YES,Name of Receiving Waters Classification Waters Index Number Yes q r�eU CfRFACE DISCHARGE IF YES,Name of nearest surface waters Distance _ SOILTYPE Depth of Water Table Yes ❑No ISS 1- 4a' 1 7- ',C- -M c- f7. +l Ft. C y/f 1 / OUTFALnNO.. ❑Proposed ❑Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGN FLOW ❑Existing ❑Expansion GaVDav SURFACE DISCHARGEI If YES,Name of Receiving Waters Classification I Waters Index Number ❑Yes ❑No SUBSURFACE DISCHARGE If YES,Name of nearest surface waters 1:71slaurr.a S011_I YPE" Delptli of Wai 'i able ❑Yes ❑No Ft. I hereby afdrm under penalty Of PWjur'y that the lnforrtaartlon provided on this form and any attached supplementM forms is true to the best of my knowledge and belief. False statemenlsmade herein are punishable art a Clio,A msrternearrrr pttrrUant to sqctlon 210;45 of me Penal Law DATE i ,. • TITLE AA AP tfwfd � Irr zkr PRIIV 11 ff fui Mfy F apartment of Environmentai Conservation N APPLICATION NUMBER PERMIT VALIDATION SEC 77 (D tton Use t �` r Conservation Lays of tI h Arol f fl �ti r, r r nlrr rrt*sl Y This SPOES ermtl isa issued fry compliance with t talc d Naw York State and iur cornpilxsnc:e rvrC9.i Chc�provls�irans of the Federal WNsts�r EFFECTIVE DATE iwXPIRATION DATE Pollu Uan Control Act,as arnLnded by The Fedeial Wales Pralla.itilon Contra)Act Anrr.ndnienlsof 1972, 1,, LX 16 y � -'50 � P L,32.500,October 18, tgfi (33 U S.0at, sett.) (hLrr to I r ferre Io rs t;Pa Act') areal suab(„ct to the attached conditions, ma?v .gym,°� f ATTACHMENTS: rn ut rea 4 AO Dare W '"'� of Per�mil Iss�uing Agent CARD Tyµa Type SIC CDDE rk B�sv. 't')Gs. CARD oa rrr 'County PoMali it Sub CompactFCAR. CARD Lim Indasin Area6 T8It ® r' .59 1 ®I 57 NtULIV D RK Department of Application For Permit Transfer OCT2 2020 oamATeo t and Application for Transfer of Pending Application r ortruwt . Environmental NY,9DEC REGION 1 Conservation NOTE: Please read ALL Instructions before completing ENVIR0NMEi\f T•,t�,a'_PERMITS this application Ptease TYPE or PRINT clearly to ink ,g% d rmmtc r Ei.'i' ) '," 8"�ry7 •:�I&u°.Mot';"+:esm"',�3"„N�w',�wrN.� .�", l,ypxcG,,cmf,aty^”m C}'rfllLga. �}i �'rI r y}r1„ GJv'mI IAS S gx 4aymh rw4 1 a t`p 1, List Permit NumbersOAnd Their Efe0-01-20 Ex9-30-30 g PP s): NY--0292044 Eff. wI. None Loge Lane Village LLC p Number Da tme t Transferee is alan: 2. Name Of Traaasfers:e: Telephone ( yt 9 (check all that aPPIY) y p ( I)4� n -4 - L n Owner ❑ Operator MailingAddress: L�^�-1 0Lb9�L-b Q L) Emaii:�Con to P ❑ Lessee ❑ Applicant If other than an individual,provide Post Office City,Slate,Zip Code: S_�� t }ICf'_�) \T I I�� z Tb a rlid Numb 6 )q] 3. Name Of Facility/Project: 4. Facility Contact Name: Telephone Number(Daytime): � �0 I � :. SC07 CC)L.���r1 fFr3l ll� -- �03(v LocaafEon(or Street Address,P.0,,Qty,State,Zip Cade,it applicable): Mailing Address: Email: J �V;0 fv1 AWQ C)AD qui OLD F)ELD 0. S-CM0 2MrW.(ON. Town/Village/City:M-A rnTVC K/N\ County`1 FFO Z K Post Office City,State,Zip Code:S&T)\L�-`Tj Nq I I 5. Has Work Begun On The Project? Yes ® No 0 If'No,”proposed starting date Approximate completion date: Colmole tett. if there wi1i ba an modrflU lic,ns lo'tha currant arra Dead o erallan orr cans'laualiann.Vh fransfarae must attach a statement s ecl in_tile detaifs 6. CERTIFICATION: This corlifies Haat the Transferee seeks to be the tego0y responsibie party for operations or project development eplher outhordred by the permits Identified above or proposed in applications identified above" Tite Transferee has a copy lot the pwm1q%)and/or applicalion(s)and understands.and will comply with all condition's in the referenced pe'rmil(s)and supports the content of referenced apoftcation(s), Faculty operations/project scopeldischargWernissivis wIlli remain the same as authorized or as proposed In pending, appifeaflons, Further, I hereby affirm,that Udder penalty of peajuryat�hat Information provided on this:form and aft suac:hments submflied herewith is true to fhe bust of my Printed Name and Title of Transferee �� { — IN P 210.45 of a Pia A�v✓. knowledge and beltaf.False statements rpado hateln arts hanislaabia as a Class A mWarnenn r tars aumt to Section 210.45 mat th CLL, � Signature of Transferee �- Date ` 20 21L' .,1��y„`� �' n,+ �' 'aid ,a:,C!� p, " �rj +xgyure r MMn� 0 4� %.r�,lrilk@ '.,w,.rc „:«m= r �.a ,rr�of+or�„ ., ��a r��,a�t4 1. Name Of Transferor: Telephone Number(Daytime): IF other than en Individual,provide JKNK, LLC ( ) 631-943-8440 Taxpayer ID Number: Mailing Address: P,o, Box 607 Email: 11-3558370 nancykardwell@yahoo.com Post Office City,State,Zip code: Orient, N.Y. 11957 2. Name Of FaciliWPmject,if different from Facility Name In Part 1: KARDWELL PROPERTY 3. CERTIFICATION:This certifies that ownership,operaUon,or a lease far the facility identified In Part 1 of this form ❑will be! ®was conveyed to , the party Identified as the Transferee on c n (date), f affirm that this conveyance Includes the rights and obligations of the permlts,approvals,or applications e:nflfied ahcvo. PrintedNameandTlne fad Nancy J. Kardwell, managing Member Signature of Transferor ez Up.September 21 ,2 r ! nF �'. GG � eal +A" �7"�srdw vb.,r t';b 'M1, s rrrtw tr,,b c a riii mx n iwrttai *r,'" G 1( P q< R lDe�, m n „J (ransfisrcrf pemftii appro'v,jd„e#taalive as of t�:,t ( ransferea subject to r„onditlaru:s:of original permit, thnu,at'excAplinn. : .. 1� "1 rarasfew smt perrmtt"a(lptonrad,wvttia ilia foffervring modaficaUons or corat`rngr�ncles reTaltdd to Urur Permktl Tmarasder: ' cla aisacld omavidjwmit a e rm a. ❑-Transfer of appff6auon approved, See attached for adrWc,,L1l information required. t a,ll�ofl reclutrecl Pfessfi,cort,p 1 permit application and return it to the undersigned Regional Permit P a �C�• �n f"� dallied p1e�W epallc " T mor at the addreds ddsted an the heyi ' eise side of t �farrrh � minPstw ` �Tf J i' NQ D C PERMI AO lt� ,tRATOR 3lONAT RE _..._.,„ DATE �rr __� ,__ ..,,oma, ..�.... '� �M_, _. . . _.�ri,m. ",,..�.�.»_.�.....,, ._.�._ ..•,___ ., ,. ... m . copies (rev. (rev.8/16) r • . N OW HOLE N 7CA WE way" OUTFALL 001 �,.warm LAT. 40.9923 I YM LONG. -72.5312 MMULw N Y 4 spAm OUTFALL 002 LAT. 40.9916 LONG. -72.5306 V*ro f w i W a , NIT ,'Y Leg, ow VOL DOW 0Q 1 r$-f.8�+ '* 47 jw-01101VaL � i.¢TYL-cWPT.S 1SX-$14 MK 11 WZU KARDWELL PROPERTY " 1• CondonEngineeflng, P.C. . 13650 MAIN ROAD(NYS 25) y MATTMIM NY Y S1 t xI DM�40rgm SPDES SITE PLAN SPID S- E IT . NY-0292 (C-20-01291 1).That design and,construction of all sewage and waste disposal systems be in accordance with the applicable standards of the Suffolk County Department of Health Services. 2) That use of the disposal facility not take place without the written approval of the Suffolk County Department of Health Services. 3) That the system be maintained to the satisfaction of the Suffolk County Department of Health Services. 4) That no industrial wastes be discharged into the sanitarysystem or anywhere else without written approval of the Suffolk County Department of Health Services. 5) The applicable groundwater standards not be violated. 6) At the discretion of the Suffolk County Department of Health Services, a means of flow measurement of wastes shall be provided. 7) That a representative of the Suffolk County Department of Health Services shall inspect the excavation, construction and backfilling operations for all non-residential sewage disposalfacilities to ascertain that the system has been constructed in accordance with the approved plans. 8) That the approval of the waste disposal facilities does not constitute the approval of the structural stability of the system by the Suffolk County Department of Health Services. 9) That if change or irevision to the approved plans are contemplated',, such changes or revisions are to be submitted in writing to the Suffolk County Department of Health Services prior to any further approvals. 10) That the sewage disposal system is designed and the permit issued for the following type building: INDUSTRIAL BUILDING approved e.g., dry store to wet store) will require a new submittal of plans and specifications to the Suffolk County Department of Health Services prior to said change. 11) In the event that a municipal or communal sewage disposal system or facility connecting therewith becomes available, any building or premises shall' be connected to such municipal or communal sewage disposal systems and immediately thereafter the use of any other sewage disposal system or facility shall be discontinued. 12) Where plans and construction have been approved for the installation of a private well supply, and subsequently a public water source is made available, said building or premises shall connect to such public water source and the use of the private well supply discontinued. 13) That if transfer of the permit and its attendant obligations to another permittee is desired, the permittee of record and the assuming permittee shall so petition the Suffolk County Department of Health Services and the New York State Department of Environmental Conservation in writing. Transfer shall become effective on the date prescribed in the written notification of such transfer to be furnished to both the original and the assuming permittees by the New York State Department of Environmental Conservation.