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TR-9979A
Glenn Goldsmith,President _`a�,�®g s®�� Town Hall Annex A. Nicholas Krupski, Vice President ®V� ®� 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly c✓s =s � Telephone(631) 765-1892 Elizabeth Peeples .e` ® y® Fax(631) 765-6641 C®UNTd,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1996C Date: JanuM 11, 2023 THIS CERTIFIES that the abandonment of existingsanitary system and installation of new I/A sanitary,stem; At 54305 C.R. 48. Greenport Suffolk County Tax Map#1000-52-1-6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 24,2021 pursuant to which Trustees Administrative Permit#9979A Dated September 15, 2021,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for abandonment of existingsanita!y system and installation of new I/A sanitary system. The certificate is issued to Susan Rogers Grun owner of the aforesaid property. f� Authorized Signature Glenn Goldsmith,President ®F ®�� Town Hall Annex A. Nicholas Krupski,Vice President .�®�v ® 54375 Route 25 . P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 C®UNTI,� ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: kk INSPECTED BY: L` l ;(\\d�� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction % constructed _ Project complete, compliance inspection COMMENTS: rZ7L.)V-10 8i S�w- b a ocz BVI 0C e Ca -P,� IRV "I ec+ cis aMLl cc cc OY-J tvt 1 v? . CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President �QF so(/ry Town Hall Annex A.Nicholas Krupski,Vice President ,`O� Ol0 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III JL [ Southold,New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 oIyCUUNT y,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72'HOURS PRIOR R TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pte-construction;"hayz6ale line/silt boom/silt.curtain 1St'day of construction- '-Vi %Z constructed" When..m'e'et coria tete `call for corn pliance ins- aotlon = . . Glenn Goldsmith,President �QF S0(/lTown Hall Annex A.Nicholas Krupski,Vice President V� O01 0 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J.Domino G • Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 �y�UUNT`l,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9979A Date of Receipt of Application: August 24, 2021 Applicant: Susan Rogers G'run SCTM#: 1000-52-1-6 Project Location: 54305 C.R. 48, Greenport - Date of Resolution/Issuance: September 15, 2021 Date of Expiration: September 15, 2023 Reviewed by: John M. Bredemeyer III, Trustee Project Description: , Abandon the existing sanitary system and install a new I/A sanitary 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 Chaleff& Rogers, Architects, received on August 9, 2021, and stamped approved on September 15, 2021. 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. Glenn Goldsmith, President Board of Trustees I INFORMATION FROM A SURVEY BY: � N MAP OF LLQ JOSEPH A. INGEGNO �_ � One Union Square ARSHAMOMAQUE L 10 2-1/2"VENT,i.ATION PIPE -- SPECIFICATIONS Aquebogue, New York 11931 TOWN OF SOUTHOLD <`) scun4n�HAWL B Manufacturer FujiClean USA CODED WORK NOTES Model CEN5 Last updated Jan. 8 1998 SUFFOLK COUNTYNEW YORK Hydrau is Ratmg 500 GPD , RECIRCULATION Anaerobic Media PP/PE Filling Rate 32% q, PROPOSED OWTS, CEN5 BY FUJICLEAN(500 GPD CAPACITY). �. Z AIR LIFE PUMP Board Type Aerobic Meta PVC PP PE Filling Rate 16/0 2. ELECTRICAL FEEDER AND AIR SUPPLY HOSE TO OWTS. LICENSE No. 49668 ° DISINFECITON Aerobic Media PP/PE Filling Rate 57 CYLINDER(OPTIONAL) Blower 2.8 c 3. 2"SCH. 40 PVC VENT PIPE FROM THE O'WTS TO THE SINGLE FAMILY DWELLING. CONNECT TO SEWER 0 Z 4"INLET PIP 4" 1J7T-ET PIPE �'� I' VENTING WITHIN RESIDENCE. SLOPE PIPE BACK TO OWTS. LOT AREA: 9,078.18 SQ. FT. = 0.208 ACRE S.C.T.M. No. 1000-52-01-06 p < AO Piping PVC/PP/PE 4. CONTROL PANEL AND REMOTE AIR BLOWER LOCATION FOR OWTS, APPROXIf 1ATE VERIFY WfTH OWNER -� a'-o" t � Access Covers FRP with Secondary Safety Cover , 4 / Approvals NSF/ANSI 40&245 PRIOR TO INSTALLATION, BUT SHALL BE IN VIEW OF OWTS. A, 5. SEWER CLEANOUT ON INLET SIDE OF TREATMENT SYSTEM, SEE DETAILS. EFFLUENT CHAMBER Volume(gal) L,L AIRLIUMP 6EXISTING WATER AfTER . E . IN[-ET HAFFT. PTP , �- © \� © Sedimentation Chamber 277 W_ (D Q Anaerobic Filtration Chamber 278 /1 I W © Aerobic Contact Filtration Chamber 127 f`� RECTRCULATTOAIPIPE PLOW BAFFLE J 12"AIR TNTAKE Storage Chamber 63 FLOW OPENING(TYP. (CLEAMNIG OPENTNG) B © Disinfection Chamber 4 .( Q Total Volume 749 \\yj ` �j PLAN VIEW HydraulicRatmg(GPD 500 GENERAL NOTES: ^` t�'( 18"MANHOLE(7l'P) 18"MANHOLE(I'YP 24'MANHOLP.(TVP) DISINFECTIONZz 1 \ \ �O O" �- ` CI Q CYLINDER(OPTIONAL) 24"MANHOLE 1. SURVEYOR'S ELEVATIONS REFERENCED TO N.A.V.D. 1988. \YJ 2. MAINTAIN 10'-0" MINIMUM HORIZONTAL SEPARATION BETWEEN WATER AND �� 1k` 21�F FLAW OPENING .G`I. �Y BOARD TYPE SANITARY UTILITY LINES. NEW WATER LINE IN SECONDARY PVC CONDUIT. � O` O tt, = - CONTAC'TMEDIA 3. THE PROPERTY IS LOCATED WITHIN GROUNDWATER MANAGEMENT ZONE IV. v � �OP - z © 4. NO DRINKING WATER WELLS ARE WITHIN 150' OF THE PROPOSED SANITARY ® SYSTEM. ALL NEIGHBORS WITHIN 150' ARE ON PUBLIC WATER AS CONFIRMED (D 5'-5" RECIRCULATION BY SCWA. ASSEMBLY j 1 -3„ 4.2„ 5. THREE (3) BEDROOMS TOTAL EXISTING. 4 BEDROOM SYSTEM PROPOSED. ' �� 70, z >, 6. THE DESIGN PROFESSIONAL SHALL OBSERVE THE OWTS PRIOR TO BACKFILL o���� G ° AEROBIC MEDIA AND DURING SYSTEM STARTUP. i o�� / 7. AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE AERATION ASSEMBLY MAINTENANCE PROVIDER AND THE PROPERTY OWNER SHALL BE PROVIDED TO / �° ,� / lf) SECTION A-A VIEW Fu iClean CEN5 SECTION B-B VIEW SCDHS. 0 1 8. MAXIMUM 5/o SLOPE WITHIN 20 OF SANITARY SYSTEM. , 9. NO SURFACE WATERS OR WETLANDS WITHIN 100'. ~� / �:1 `\ G �'► 'Y . O CIO 0[ LL s IZ 20"DIA. HDPE RISER BY TUF-RITE, TYP. S Soy of ' f <�a sicJ b/'N �P Sim 20 DIA. HDPE SECURE HEAVY COVER BY TUF-RITE,TVP. l S 6 20"DIA. RISER SAFETY SCREEN BY TUF-RITE TYP. `� �� �� °v �'A�'L C101 PRa ^� l. .'. T O (AQ 24" DIA. COMPONENTS THIS ACCESS ONLY y ° 19.7' F.F.E. 8"TRAFFIC-BEARING PRECAST CONC. SLAB 4" DIA. SDR-35 PITCHED CONCRETE COVER. CONCRETE CHIMNEY AS NECESSARY. PSP�P�o��°' ;�� f ���o� o 1/8" PER FOOT MIN. °°�o� �o ,A �` G ALL EXISTING SANITARY T o APPROX. ��°� e /� 1�� SYSTEM STRUCTURES TO BE NEW C.I. I 7g ELEV. 18.5' SSP MAINTAIN MIN. DISTANCE TO 4 PUMPED CLEAN AND TOPS a � CLEANOUT 2'C.I. EXTENSION I N ��\� \� ��\��� /\��\ \��\� \� \�\�\� \��\ o°P MEAN HIGH WATER MARK . 100' \\ ? REMOVED AND FILLED WITH \\`14 SUITABLE SAND AND GRAVEL. O s 16.5' I.E. - -- - \ l\///�/////• // / // / d Qom\//L . � \s , �, �o � ,J:.\ LJ \\ , Q xi zo /\ 1592LE • �4. S Z4- DIA. SDR-35 PITCHED 11 � ' 0 1/4" PER FOOT7_7 APPROX. LOC. EX. GAS LINE O 16.17' I.E. 16.0' LE.\ \ r.a,:. , �'' ❑ o o F=- o o 0 0 0 0 0 ❑ t,• \ APPROX.TEST ✓ �� i d v W Ln // a". w - // HOLE LOC. 5 1 `, • .': l�. ❑ 0 000 W o o to 0 o a 0 0 ❑ \ \ Ci \ �o a �y e U � \ a A. F3 W-,,�// • ,„' a ❑ o o o 0 0 0 0 0 0 0 ❑ .,.a' #,: ,-. ,jamLL ,\ �f� J A J J„ \ ° �. • -.4. •{;Q ,f ❑ 0 o Ito 0 0 0 0 0 0 0 13 ° z Q �Lb •^ 0 4t �T2 CM CI ., ,.. • °' NEW 10'x10' PRECAST is F�� - FdClean CEN5 a •. o; ,o•' �/ LEACHING POOL(TYP.) <t GRANULAR;• ❑ o 0 0 0 0 0 0 0 o I= ❑ 0' , . ,\ COLLAR AS �, a• d �, w REQ'D , ' ❑ o o a o 0 0 0 0 o a ❑ \ \ J v. °Z 3 Sanita Sys. Profile - --__-- / •'a . r /\ 1 S / •;• ., ,t ❑ o 0 0 0 0 o 0 0 0 ❑ e at.• / APPROX. EXISTING i�va �A �� a- 18 ' WATER LINE LOC. z N.T.S. \ a❑ o 0 0 ° 0 0 0 0 ❑ \/ \ v ❑ 0 0 0 0 0 0 0 0 0 0 ❑ � d N //• a .M ••e. .; // INSTALL NEW WATER LINE 6 0 ••'_ 10 MIN. FROM ALL o]`-la{` c ❑ 0 0 0 0 0 0 0 0 0 0 ❑ .a SANITARY COMPONENTS ��o �; ag ` a.= a - 19 p 10'-0" O YYY a I • •a; c ; �S ��� Q `• - _ LU ='••' • MATERIAL TO BE d , ° N _ - • ,4 I ,tl Off' v ��" O� A-g) -(�\ ,,t '• • t .f - - - - -CLEAN SAND& GRAVEL - - - - - " •S 0� �I O ^ IY11 _ xN1 3.0'Y HIGHEST d EXPECTED GROUND WATER I;F� P ud Q TYPICAL LEACHING POOL A Typ. LP 10x10 3/8" = 1'-0" z Y' p 141 n 1'l0�20�t�11Sanitary I 142 I 147 144 145 146 147 NOTE: V � -o I4e ALL ABOVE GRADE AND BELOW GRADE WIRING IN 0.0' APPROX. GRADE @ TEST HOLE ELEV. 18.5' �j Z �- 4- t ' �,"SI08 149 PVC CONDUIT, SCH. 80 MIN. DARK BROWN Suitable Cover to Grade V a �+ .0 :151, \\\\\\ LOAM (OL) Stopper or End Plug s° Co ' 15z -------------- 1.0' ELEV. 17.5' r -------- - 153 Tsu K� Py Ioac ro BB,wu I _ _ M(!nef ,• I ih]1 IB tI �r -------4'---- I - - I Sr:,r 154 Ie©--'.'TBI r� - --�-Q- ; BROWN SILT(ML) a, Q - - - - - - - - - - - - - - - - - - - - - - - - •V^)1 c� C Q vus 155 I I , .a '^ TB T" 'R 156 ' - ', - - VISUAL SYSTEM '� r V cz VJ KKa 157 1 i 1, o-1 ' i i BRANCH CIRCUIT PROTECTION.OVERLOAD PROTECTION. 3.0' ELEV. 15.5' BEACON CONTROLLER/ > I I ��// o 1 MON CISCONNFfT AND OVERCURRENT FBY OTHERS 156 1 I uro'It°»,K"�n K�a, , L- OF INCCM'12 FEEDER CIRCUIT PR7VIDED BY OTHE.45 I - - MAC 80R AIR -C ALARM -IN Sewer Pipe I ' AND MU51 OF SI7FD ACC06�'•;;TO PIMP/M,:TOR I Q 159 1 ---------- ---- � I MANLFACTU"Y',SFEUFICANONs I .fIT BROWN SILTY NEMA 4X BLOWER Q 160 I ' ' i, SAND (SM) ENCLOSURE APPROVED BY [BIRO TBI I I V �- n---�r--- , --------- GI , --------, I COMPRESSED a i' 15.5' -,' ELEV. 3.0' Q I BOARD OF 1 r�USTEES I J B,a„a u 62 1 HARDWIRE CONTROLLER AIR LINE TO 30 deg. Elbow 163 -'-'-�- .�`- „" A WATER IN BROWN FROM DEDICATED 20AMP 164 . ' - = BREAKER IN HOUSE MAIN OWTS eco I I '� M U "„a 1 165 1 1 w 0° ;' 20.0' `- ELEV.-1.5' SILTY SAND (SM) TOWN OF SOUTHOLD V -- `` - PANEL. HARDWIRE Q Lr) * Cn IA,A , S ITIt I; -____ - -_ - EXIERHLL COYBOM1'EN'Y$(c9VPBEssa+AND/OpI'<'VPS)PRrNmED lir OTHERS I - _ INSULATED > I 167 I AND MI BE UL APPRRED THERM4LY PRUTECIID PUMIS I �_ a�-=`�= BLOWER FROM 12CV BLOWER ° ► DATE S Z0� WATER IN BROWN __ ____oda == 15AMP BREAKER IN ENCLOSURE I ISS cure TBI TBI 168 I I I ^--{ --- �$12; -�------ r-- 169 1 if FINE SAND (SP) CONTROLLER. ON PAD "I - _ I I DRAWING NUMBER: cl""°r SNR° mr nm TEMPERATURE RATING OF FIELD INSTALLED COND'JCTCPS MUST BE AT LEAST 149 DEG. F. I ---;-- -<•'-- - Q 171 I (60 DEG. C.). TEFPINAL STRIP;AND GROUND LUG USE COPFLR CONDUCIURS UW Y. I. P 172 ' CONNECT GROUND LU-]IN PANEL TO A SECURE EARTH GPOIND '�' � ,'. . . GRADE 120 deg.Wye o w• 1 173 I DASHED LINES REPRESENT FIELD VIKING FIELD WIRING SECTION 28.0 ELEV.-9.5 174 ------------------- -- ----------------------�� V Wlrin Diagrams SOIL BORING BY: McDONALD GEOSCIENCE Blower Cleanout 5 N.T.S. SOIL BORING PERFORMED ON: 12/13/2019 N.T,S. 6 3/8" ' 1'-0" NTS GROUNDWATER ENCOUNTERED AT 15.5' BELOW GRADE C 10 1 L - - - - - - - - - - - - - - - - - - - - - - - - - --� * SCALE APPLIES WHIEN PRINTED ON A 2411 X 3611 SHEET PROJECT NO: XXX 8/2/2021 7:03:01 PM i Glenn Gold,' 'b, President SpFFO�� Town Hall Annex A. Nicho�d�'Xrupski, Vice-President ,�`�� _y�� 54375 Route 25 John M. Bredemeyer, III o =` P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams y�9p® �00�� Telex onFax (631) 765 6641-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ��O i�� Completed in field by: Afede7n (n er Alexsis Gordon on behalf of SUSAN ROGERS GRUN requests an Administrative Permit to abandon the existing sanitary system and install a new I/A sanitary system. Located: 54305 CR 48, Greenport. SCTM#: 1000-52-1-6 GH. 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 16. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 / Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: orhim TA I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other O SURVEY OF PROPERTY SI T UA TED A T 'o° h ARSHAMOMAQU . a � ` TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-52-01 -06 SCALE 1" =20' DECEMBER 2 199 i N6 7 j JANUARY 8, 1998 ADDED TOPOGRAPHICAL DATA AREA = 9,070.18 sq. ft. n �j �g� y ♦ / °�``3�35 `�03o G° ^� (TO TIE LINE) 0.208 ac. X G�P'y o• N CER TIFIED TO: PETER CHELICO ALIN CHELICO 41 AN a 3Q NOTES: �,°`�5 '0 �A 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM ��°� EXISTING ELEVATIONS ARE SHOWN THUS:?o_n °oo o ,� F� °� ~o EXISTING CONTOUR LINES ARE SHOWN THUS: — -- — —10— Jy9% �C) F v_ — FIRST FLOOR TOP OF BULKHEAD BOTTOM OF BULKHEAD YY 4, TOP OF WALL o y' $C°\ 5` \ �l O �� E tti — BOTTOM OF WALL off. ^°,• O G '$� \\ ��,s �� 2. FLOOD ZONE INFORMATION TAKEN FROM: 000 FLOOD INSURANCE RATE MAP COMMUNITY—PANEL No. 360813 0076 E �0 1nJ �o \ \/� i ZONE V9 (EL 13): AREAS OF 100-YEAR COASTAL FLOOD WITH VELOCITY (WAVE ACTION); BASE s � bY FLOOD ELEVATIONS AND FLOOD HAZARD FACTORS DETERMINED. o �1 0 2 �; ZONE C: AREAS OF MINIMAL FLOODING. C1 011 \ •sl� 63 49 ��� j ,c. � Y1 o \ \ g S 7x23'00 0 o \�U� Z Y \ NN n 18 01 lop" 19 UG G4 + f �� Southold IOW'3 C? n/ A 9. 0�1 � . 'L\JAY\\YY// ` ti3oani of Trusta° J, g,0Ap ) � a E 'P° ` UNATHORIZED ALTERATION OR ADDITION 1 y O ( TO THIS SURVEY IS A VIOLATION OF A 8) SECTION 7209 OF THE NEW YORK STATE LI SSC EDUCATION LAW. • QP�N,E , �,�i C,1'• (f .�, o COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR Q'1 TO BBE SA D ALO TRUE SEAL SHALL NOT BE CONSIDERED n CERTIFICATIONS INDICATED HEREON SHALL RUN fiU 1 s ONLY TO THE PERSON T PREPARED, ANDON HIS BEHALF THE IS LENDING COMPANYNSTITUT ON LISTED HEREON, ANTITLE , GOVERNMENTAL AGENCY DND TO THE ASSIGNEES OF THE LENDING INSTI— TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. O THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF 0 ANY, NOT SHOWN ARE NOT GUARANTEED. .11 y PREPARED IN ACCORDANC KITH THE MINIMUM SL BY THE USE ANDTITLE E OVED AND STATE LA DSTANDARDS FC U 'EYS AS D Jos ■ I r FOR SUCH USE BY THE ]N YORK STATE LAND �de ano TITLE ASSOCIATION. %0- .....and Surve � ' � I , � Title Surveys — Subdivisions — Site Plans — Construction Layout � t PHONE (516)727-2090 Fax (516)722-5093 OFFICES LOCATED AT �S� MAILING ADDRF_SS N.Y.S. Lic. No. 49668 One Union Square P.O. Dox 1931 —� Aquebogue, New York 11931 Riverhead, New York 11901 b 97--495A t\ t INFORMATION FROM A SURVEY BY: �� N tj ! JOSEPH A. INGEGNO MAP OF L, NO One Union Square ARSHAMOMAQUE ,O 2-I/2"VENTILATION PIPE SPECIFICATIONS Aquebogue, New York 11931 TOWN OF SOUTHOLD SC'IIMBAPPL 13 CODF_D WORK NOTES Manufacturer FujiClean USA T `Taa, I 3 Madel CEN5 Last updated Jan. 8 1998 SUFFOLK COUNTY, NEW YORK _ ad _a ' od Hydraulic Rating 500 GPD RECIRCULATION Anaerobic Media PP/PE Filling Rate 32% 1. PROPOSED OWTS, CEN5 BY FUJICLEAN(500 GPD CAPACIT)7. ATR NEE PUMP Board Type Aerobic Media PVC/PP/PE Fillin Rate 16% a © DISINFECTTON Aerobic Me is PP/PE Filling Rate 57R/° 2. ELECTRICAL FEEDER AND AIR SUPPLY HOSE TO 0117S. LICENSE N o. 49668 CYLINDER(OPTIONAL) slower 2.8 cfm 3. 2"SCH. 40 PVC VENT PIPE FRO" THE OWTS TO THE SINGLE FAMILY DWELLING. CONNECT TO SEKIER e z 4"INLET PIT'; "OUTLET PIPE TSP VENTING WITHIN RESIDENCE. SLOPE PIPE BACK TO OWTS. LOT AREA: 9,078.18 SQ. FT. = 0.208 ACRE S.C.T M. No. 1000-52-01-06 4'. Access Covers FRP with SecondaSafety Cover pA Piping PVC/PP/PE 4. CONTROL PANEL AND REMOTE AIR BLOWER LOCATION FOR OWTS, APPROXIMATE, VERIFY WITH OWNER � -J " t � ry � J Approvals NSF/ANS140&245 PRIOR TO INSTALLATION, BUT SHALL BE IN VIEW OF O"VTS. - ' 5. SEWER CLEANOUT ON INLET SIDE OF TREATMENT SYSTEM, SEE DETAILS. c� 2: EFFLUENTi CHAMBER Volume(gal) TVET DAFFT,•, � © \ © 6. EXISTING WATER METER. � Sedimentation Cham er 277 �P I W 0 © Anaerobic Filtration Chamber 278 © Aerobic Contact Filtration Chamber 127 `D I- RECIRCULATION PIPE. FLOW BAFFLE _j 1/2"AIR INTAKE ® Storage Chamber 63 PLOW OPP.NING(TYP. (CLEANING OPE.NFVG) B © Disinfection Chamber 4 ,( Total Volume 749 PLAN VIEW Hydraulic Rating Soo GENERAL NOTES: 191,MANHOLE Cr Is"MANED LE:(:T:V:P:��20121(TYP DISINDERON I 1. SURVEYOR'S ELEVATIONS REFERENCED TO N.A.V.D. 1988. CYLNDER(OPTIONAL) 24"MANHOLE 'f 2. MAINTAIN 10'-0" MINIMUM HORIZONTAL SEPARATION BETWEEN WATER AND FLOW OPENING 2" BOARD TYPE. SANITARY UTILITY LINES. NEW WATER LINE IN SECONDARY PVC CONDUIT. CONTACTMEDIA3. THE PROPERTY IS LOCATED WITHIN GROUNDWATER MANAGEMENT ZONE IV. y �0 s 14 TT- -uIT © 4. NO DRINKING WATER WELLS ARE WITHIN 150' OF THE PROPOSED SANITARY SYSTEM. ALL NEIGHBORS WITHIN 150' ARE ON PUBLIC WATER AS CONFIRMED 5'-5" Q 5'-5" RECIRCULATION BY SCWA. 4 -\© 42 ASSEMBLY 5. THREE (3) BEDROOMS TOTAL EXISTING. 4 BEDROOM SYSTEM PROPOSED. ��\�l 1p, z 6. THE DESIGN PROFESSIONAL SHALL OBSERVE THE OWTS PRIOR TO BACKFILL '`j © © AND DURING SYSTEM STARTUP. AEROIIC MEDIA 7. AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE ti AERATION ASSEMBLY MAINTENANCE PROVIDER AND THE PROPERTY OWNER SHALL BE PROVIDED TO - / �� `'1 N �,� / lf) SECTION A-A VIEW FujiClean CEN5 SECTIONB-BVIEW g. MAXIMUM 5% SLOPE WITHIN 20' OF SANITARY SYSTEM. 9. NO SURFACE WATERS OR WETLANDS WITHIN 100'. 0' F i LEF �O - o - C') LL 20"DIA. HDPE RISER BY TUF-RITE,TYP. Sim 20"DIA. HDPE SECURE HEAVY COVER BY TUF-RITE,TYP. 6 20"DIA. RISER SAFETY SCREEN BY TUF-RITE,TYP. �°` �z���� i y,' ���2�0 � oC101 � . < � 19.T F.F.E. 24" DIA. COMPONENTS THIS ACCESS ONLY 8"TRAFFIC-BEARING PRECAST CONC. SLAB °s�°P�� �� 4" DIA. SDR-35 PITCHED CONCRETE COVER. CONCRETE CHIMNEY AS NECESSARY. S�Po�°'� j o � o rj 1/8" PER FOOT MIN. c S�o�Q�°� �.C�� 'o ALL EXISTING SANITARY p APPROX. o ,tiSYSTEM ti PUMPED CLEANTURES TO AND TOPS NEW C.I. ELEV. 18.5' S MAINTAIN MIN. DISTANCE TO 4 CLEANOUT "� �� �� �� / �� / \ / N / / °oP = F.� vs o a 2 C.I. EXTENSION N ��\ ���/� /���� MEAN HIGH WATER MARK- 100 0 \ �� REMOVED AND FILLED WITH \� \ \- �� \� �\ \ .' \ a \ SUITABLE SAND AND GRAVEL. O ,L 16.5' I.E. l\ I� ° a � ° O • 4a ..d-, (O '..d' c-e` 1_ �:•_, • , i` 1 1`i 1 '� \ 0 0 O r v \ • d s�� • 5. � Z4' DIA. SDR-35 PITCHED "115.92' 1.E.- • ° o o - ,°o ao o Eo 0 0 0`❑ '►,• J \ �3 y 1/4" PER FOOT \ -15.92 I.E., _ - , \ ti �// \�j\ o p APPROX. LOC. EX. GAS LINE • ,\/ APPROX.TEST O ° 16.17LU 16.0' I.E. �� ..a: `+' : , : ❑ o o do x 0 0 0 0 0 0 ❑ ° \ \ 8 y ` HOLE LOC. , 5 1 ,•,,•,• •': -j•, ` -`❑ O O 0° j C� [� [� [� L� [� O O ❑ , _ ¢? 0.G ^\ L 1 4 "c Y4° c A Lu U_ A. a ' 3 49 .. ?s J 2_' B r �-- \/ .° .�• N.a• ❑ o o LL o 0 0 0 0 0 0 ❑ /� T 1 1o�m4 d Z Q �, ^• A.I ;•. ' NEW 10'x10' PRECAST i g F � • \ �;% FujiClean CEN5 \/ �� o; f LEACHING POOL(TYP.) \ = GRANULAR; ❑ 0 0 0 o o a 0 0 0 ❑ ° -COLLAR AS °. ;�: ary LU Uj APPROX. EXISTING e -� t$ SanitarySys. Profile \� ••a•. ••: -� ,. -+ a �\ e WATER LINE LOC. \c; ` T- ���. aA. •a- >• .; INSTALL NEW WATER LINE 6 0 • 10 MIN. FROM ALL � �� cv-"° • M ., ❑ 0 0 0 0 0 0 0 0 0 ❑ ., ,a .' .- ,: SANITARY COMPONENTS foo �- a w t 9 0 o }: _' � •'. • , lk„G'Pte. ,��' .I / . •, � a 1 rpt \ / d° a 10'-0" -: ,4. ._., ,•_; ; • s� � SLE ° • _ 1D o ' •,• _ 14 LU `V •' MATERIAL TO BE p ! cn n � _ CLEAN SAND &GRAVEL s - J. � O�ti Off+ R • Q 0 • `_ --- - - - - - - - - - - - - - - - - - - d -3.0'Y HIGHEST EXPECTED GROUND WATER 1' od TYPICAL LEACHING POOL 11 T P. LP 10x10 }' 3/8" - 1'-0" 11'0- 20't0e,Sanitary z 141 < 1 I fr I I I 143 y n I 144 145 145 � 1►.. ,47 NOTE: SII rttT.,wNi,S,SSNa 148 ALL ABOVE GRADE AND BELOW GRADE WIRING IN 0.0' APPROX. GRADE @ TEST HOLE ELEV. 18.5' ,� „I Z n- (D 3 ceoe t co 149 - ._ ."sly PVC CONDUIT, SCH. 80 MIN. ��\�\� DARK BROWN Suitable Cover to Grade v �+ I `I`" ""•` I N 151 /�\ �\ LOAM (OL) Stopper or End Plug C t. •Nw 151 ------------------------------- ----- 1.0 ELEV. 17.5 r . CU 152 ------ - '-1 'a.,, -F vsuz I ,m 153 MPt4i[ „ - LII,N 15, BROWN SILT(ML) • - - - ° Q LPIIS PPI rsu co TPI 155 i I I I I I `a i i - - VISUAL SYSTEM C r-- �., 156 1 I L I I I I I -� CONTROLLER/ � ° w �, ,-I I I I BRANCH CIRCUIT PROTECTION,OVERLOAD PROTECRON, I 3.0 ELEV. 15.5 BEACON > I I N o ,A,K '• I L- MAIN DISCONNECT AND OVERCURRENT PRortCTION I - - - - - MAC 80R AIR •c Sewer Pipe 1 ( I"'1 ISS I a�o';N.rote •wN rtat I , OF INCOV'NG FEEDER CIRCU'T PROVIN BY OTHERS ^ ALARM - IN '-• P 159 I I I AND M'J'>I BE SIZED ACWFDING TO FlIMP/MOTOR `IP P[I PI2t0»U- PI Ii;' I _____ ,�_ nwMn"a, P1 ,;I '"P•'' _ •- - 4BROWNS � NEMA4X BLOWER MAN, sPEuncATtors SAND (SM) ENCLOSURE II (I :a -, r__ ______ „ 161 _______ ' COMPRESSED a ELEV. 3.0' rO LU ,662 15.5' HARDWIRE CONTROLLER 30 deg. ElbowETO 3 FROM DEDICATED 20AMPWATER IN BROWN OWTS . . I I U') r- Q j 64 ' "`"� � P == BREAKER IN HOUSE MAN I I U ! 1G5 I P i= �T ELEV. -1.5 ( ) 1 1 e o 20 0' %' SILTY SAND SM 166 1 „N„ PANEL. HARDWIRE 'v^J EIOEPNAL COMeNEMTS(COMRRESSOR RID/OR PUWv)PRONDED EY 01"ERS I - -- INSULATED ; I I * _ 1 167 I AND M7SI LE UL.APPRWED THERMAIY PROTECTED PUMP; BLOWER FROM 120V a 15AMP BREAKER IN RE a 168 ; A-=° _�,�a->-==- WATER IN BROWN E OWES O cPlzP PPI rPl I I ,- - -- rslze _ , .--u--- • -- ------TI r-- N 169 �� _ - -_- FINE SAND (SP) CONTROLLER. ON PAD a claurt 6f:wC1 a, 17D I TEMPERATURE RATING OF FIELD INSTALLED CONDUCTOPS MIST DE AT LEAST UO DEG F. I - - - Q I I DRAWING NUMBER: 171 I (60 DEG. C). ILRMINAL STRIPS AND GPJ'1ND LUG USE COPPER CONDUCTORS UNLY. P 172 I CONNECT GROUND LUG IN PANEL 10 A SECURE EARTH GPI 14D p -'_-= GRADE PW 1 173 DASHED LINES REPRESENT FIELD WIRING FIELD MIRING SECTION ' 20'0' ELEV•-9.5' 17, -- -----------------------------� 120 deg.Wye U I I 5 Wirin Diagrams SOI BORING ON.: 12DONAL�D GEOSCIENCE n Blower v N.T.S. SOIL BORING N.T.S. n Cleanout 1Cl 01 NTS GROUNDWATER ENCOUNTERED AT 15.5' 1 BELOW GRADE 1 r Cl01 ,n;t;r/ r'll, * SCALE APPLIES WHEN PRINTED ON A 24° X 36° SHEET PROJECT NO: XXX 8/2/2021 7:03:01 PM r � ' Y, r ^ . ,{R� _. � /� .yea M1 •\� , • 4r \ 1 M7:z, r .--r.'Y. .-• .- �r , r • r , \ Ile Glo` 1 i ' 1 -x FORK-0, w •� .. . � SEv BcC a0 w 9i 1 Jute RO at't' � 1W4c1 O.' Acc Jt' N^ � 2,' l • f, .'jOQ`v, r n 0 Ry ` ai\D p,,\rORdiNDI• 12.Nc1 E "u y- • e,. r, 4a @4 .. t '(he R. '; �,n eo ySJsG''s j, '\t 2 9 ] �� •� If . 0 j•, y0 J�o �A •`-r' eB i t. L S._ m, i - ,ow t f ^ , .I''��^p, W..t A , ll `N t,f awn r'Mrxs "°L° .0 `]A i'GF'` lk \ ..-...-'- W sesta t' �?- ��� ..'•c,Fw �-�$"��,8\'0 _ �, a ,.eNa '" C�O,ye 1a- �^ f�coarc urvD*ausr W t. Ii ' — • USnAt4f,.t2 � .... ter. '.Fon]�CL.nq. i. •f<F..,W..,•.,.,,..,.„,.•,..,.. ..,...«.,�.,...,�..�....,.. ..�.. --- �. >a COUNTY OF SUFFOLK(QNOCE n •K.., sEcnon Nu K 1000 E .,. __ _ _ a.�ya Kwl P-pwy Ta:Sc vl ,4gency wiMuwu,+'eu*�«sucw v E �...�j _ __ -- -_ ___ '+u• „• mlrn n,clenrMH Av,nn, W svroan�w aF.wf wfnoa of nc s, " a SOVI]gL0 a ,.• R. s•,._ - "• .�W� »... .f <anrv..wwv ofaco,Eo a 1'a S2 n • __.-_ ..�, —_ .,.__ ", __ ..,w 1211 — a �reT OFFICE LOCATION: �� MAILING ADDRESS: Town Hall Annex V w; P.O. Box 1179 54375 State Route 25 , Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 � f LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: September 14, 2021 Re: LWRP Coastal Consistency Review of SUSAN ROGERS GRUN SCTM# 1000-52-1-6 Alexsis Gordon on behalf of SUSAN ROGERS GRUN requests an Administrative Permit to abandon the existing sanitary system and install a new I/A sanitary system. Located: 54305 CR 48, Greenport. SCTM#: 1000-52-1-6 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 EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins, jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); This is an upgrade for water quality protection. 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 _ r - Glenn Goldsmith,President Town Hall,Annex A.Nicholas Krupski,Vice President 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 9 Southold,New York 11971 Michael J.Domino 'Izz Telephone(631) 765-1892 Greg Williams Fax(631)765-6641 ]BOARD'OF TOWN TRUSTEES TOWN OF SOUTHOLD Thi's Section For Office Use Only Coastal Erosion Permit Application E O E V E Wetland Permit Application Administrative Permit Amendment/Transfer/Extension AUG 2 4 2021 Received Application: Q •Z(. Received,Fee: $ 160. Completed Application: ZI Southold Town Incomplete: Board of Trustees SEORA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency'Determination Date:, oordmation: W,RP Consistency A L � y-Assessment te � LForm Sent: � EAC,Referral Sent: Date of Inspection: •a� Receipt of CAC Report: Technical Review: Y Public Hearing Held: • IS�Z( Resolution: Owner(s)Legal Name of Property(as.shown on Deed): 5-11 S/�(�►I l� G"!: S U'�C Mailing Address: 45& 6RLEOWO _V�10 0 G C V 014CAJ A 1 /701 Phone Number: 3 f 7e�7 `► Suffolk County Tax Map Number: 1000 -.,, 0 Property Location: X05 COUNTY R O AQ "I (If necessary,provide LILCO Pole#,distance.to cross streets,and location) AGENT(If applicable):_ f�l���S($ -P(-' W1V Mailing Address: q 5.6. c-1 2l Fpov 6 4v CYV U'6 l V e k /v y_ al 0 ............. Phone Number: �. 127 d Email: Odd®�sT k f�C19M Board of Trustees Application GENERAL DATA Land Area(in square feet): "1 , Q u , l � .50 Area Zoning: lrA U1 C — R— 7 D Previous use of property: S(11 f -Aa m re ,den n Intended use of property: S-f,1<: ty 51,rJenc e Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? __ __Yes No If"Yes", be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes 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 � �N0 Does the structure (s) on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: "Agency ou-rijo lb I wA l3Lb 90 Datet y 1u Z r 7 3 0g ' -3 q a1 y &ONO r,) TWA -PWT66-5 �3 he-06 IV6 EC; qlu,/m# 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): '4g,(V 1/0 qr Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the propos d operations: oqna CJ67 /" Area of wetlands on lot: 0 square feet Percent coverage of lot: d % Closest distance between nearest existing structure and upland edge of wetlands: ® feet Closest distance between nearest proposed structure and upland edge of wetlands:. 0 feet Does the project involve excavation or filling? No V'l Yes If yes,how much material will be excavated? , cubic yards How much material will be filled? �® cubic yards Depth of which material will be removed or deposited:`;:t-- feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: � l Va ir'l MQ 0' a-/ l/ewd 719 K 5; vc%r-'- he ma -IT19M :�! 'Nla 5��'ff d 'q:L4.) alaw-1 -k2 �4w 4'v(�6'w 5&&h' thoj '�l Per '5'H-1211 nlallfXC15a 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): i ble 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information ;�A4 Arf VY 14/19 044V�� Name of Action or Project: o � Project Location(describe,and attacg a location map): Brief Description of Proposed Action: i Vp7ylaje Name f Applicant or nsor: /' Telephone: �%v` A"d L%1-vlq Address: it Ci St tZp iCd e: 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 n 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: ❑ sc ' ' G%l ec f 7n�cAl P eMt,,Y 15' ill %w4 13J 4 �� fi 3.a.Total acreage of the site of the proposed action? i W acres b.Total acreage to be physically disturbed? 001 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban [:]Rural(non-agriculture) ❑Industrial ❑Commercial M.Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ Z ❑ b.Consistent with the adopted comprehensive plan? ❑ F/,l ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES 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: 0 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NQ 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? ❑ El 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: 14144 ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: R 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:' !, ©rV T5, o- 12. ❑ 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? ❑ 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 on the project site. Check all that apply: [Shoreline ❑Forest ❑Agricultural/grasslands El Early mid-successional ❑ Wetland ❑Urban B'S'uburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year{food plain? NO YES TX 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO I YES If Yes, 12" Ela.Will storm water discharges flow to adjacent properties? EJ NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: � ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ApplicanUspo or name: Ce ZkV Data �, � , 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 1 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 action9" 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 plan or zoning F]regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El E]establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ 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 El o reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: �I a.public/private water supplies? —J b.public I private wastewater treatment utilities? F] S. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? El 0 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ Llwaterbodies,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 ❑ Elproblems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-teen,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F] 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 impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT 1 Page 4 of 4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL.DISCLOSURE FORM Tha Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town affieers and employees.The rstiroase pf this form is to provide information which can alert the town of possible conflicts of interest dnd allow it to take whatever abtion is necessary tib avoid same: r YOUR NAME: V (Iasi name,first name,giidd(e initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name,) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,njarriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO if you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee,Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 73 day o 2ee—_ Signature Print Name U 0 c-U Form TS I Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000 52 —if — ©.1Q in the town of New York,hereby authorizesTl����5 (✓O���� to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signati qr Property Owner's Signature SWORN TO BEFORE ME THIS r� DAY OF ,20_0 _ 14e2vza Notary Public DONNA M LEVY Notary Public,State of New York No.01LE4875563-Suffolk Count(n Commission Expires November 3, err Board of Trustees Application AFFIDAVIT -5"a-5 A vj 0!9,e4S GI'L) A) 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 BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF _ GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Propert weer Signature of Property Owner SWORN TO BEFORE ME THIS ,o��r� DAY OF 20 Notary Public DONNA M LEVY Notary Public,State of New York No.OILE4875563-Suffolk Countr Commission Expires November 3, . I z Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I., 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" 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- supp6rtin�facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shalt.not be undertaken. k, 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# 10 0 0 - �j 2 �� 0 PROJECT NAME 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 ac 'on: 05WT i / ep— Location of action: 5 1305 coo -,�� RocLi g� , 50 0+ko ( CL Site acreage: Present land use: PC-X- So^ Present zoning classification: _y- - 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: (b) Mailing address: (c) Telephone number:Area Code( ) (d) Application number,if any: 1A r Will the action be directly undertaken,require funding,or approval by a state or federal agency? YesF] No If yes,whic state or federal agency? Q4? c doh - , r , , ' a bo� of he C. Evaluate the project Co the follow policies by analyzing how the proj�et 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. ` eC\V\Un - Carrvv\Un Yes ❑ No F-1 Not Applicable cvc' o �ur \�'1& 2 W c.L kc-� 5-1iS A v1r^ W\\ adv-�;A- -A-ane nvlfa.-\w^e-VVA-",a S i #- S c►. s--abVe o ?L+( c�^�- ice" se s ine d in c:t ;�o^ eS=fiC s reu�t-1-1� -KS;te Lua�1y_ %1r, Cnv1YLY�v�r - f, (tw IOC a-t� -, e iMu�\ala� �� 7 ' ie cd uL t' � 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 .11 Yes ❑ No of Applicable 1 / 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 El Yes Q No R Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III-Policies Pages S through 16 for evaluation criteria( ,U Yes u No &I Not Applicable Attach additional sheets if necessary- Policy 5. Protect and improve water duality and supply in the Town of.Southold. See LWRP Section III - (Policies Pages 16 through 21 for evaluation criteria tv ' Yes F1 No ❑Not Applicable +e. (educe -wo i1 J.isr-lir �S d,Gt f, \ve Cktra L rvnw'. 'Cry --)I, Cion , - - 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. F] R Yes No Not applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes ❑ No M Not applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in 'Town of Southold from solid waste and hazardous substances and wastes. See LV*r"Section III—Policies; Pages 34 through 38 for evaluation criteria. FAYes ❑ No ❑ Not applicable r't'C, an�ti�-r �t vra • PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the 'Town of Southold. See LWRP Section III--Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye�] No D9Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No M Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ®, Not Applicable PREPARED BY : 4 7►' ��' � �y°'" TITLE �� HATE 2 220M 1 SNaTH, FINHEESTEIN, EUNDBERG, ISMER AND YAKABOSKI, ET.P ATTORNEYS AND GOUNSELORS AT LAW 456 GRIFFING AVENUE, GORNER OF LINGOLN STREET RIVERHEAD, N.Y. 11901-0203 (63 I) 727-4100 FRANK A. ISLER HOWARD M. FINKELSTEIN SUSAN ROGERS GRUN FAX(631) 727-4130 RETIRED GAIR G. BETTS JEANMARIE GUNDERSON PIERRE G. LUNDBERG DANIEL P. BARKER RETIRED CHRISTOPHER B.ABBOTT August 23,2021 - REGINALD G. SMITH ALEXSIS J.GORDON 1897-1983 �( E E Southold Town Trustees 54375 Main Road AUG 2 P.O. Box 1179 4 2021 Southold,New York 11971 Southold Town Att: Elizabeth Cantrell, Sr. Clerk Board of Trustees Re: 54305 County Road- Gran Residence SanitM Upgrade Application Dear Elizabeth: Enclosed please find the following in connection with the above referenced application. 1. Check payable to the Town of Southold in the sum of$100.00. 2. Original and Copy of Completed Application. 3. Original and Copy of Affidavit,Authorization and Disclosure Form. 4. One Original and three(3) copies of the survey. 5. One Original and three (3) copies of the project plans. 6. Current photos of the property showing the location of the proposed work. Very truly yours, r 1 Susan Rogers Grun SMITH, FIN 1,STEIN, EUNDBERG, ISLER AND YAUAROSKI, LLP ATTORNEYS AND GOUNSELORS AT LAW 456 GRIFFING AVENUE, CORNER OF LINGOLN STREET RIVERHEAD, N.Y. 11901-0203 (631) 727-4100 FRANK A. ISLER HOWARD M. FINKELSTEIN SUSAN ROGERS GRUN FAX(631) 727-4130 RETIRED GAIR G.BETTS JEANMARIE GUNDERSON PIERRE G. LUNDBERG DANIEL P. BARKER RETIRED GHRISTOPHER B.ABBOTT REGINALD G. SMITH 1897-1983 ALEX.SIS J.GORDON August 5,2021 Mr. Glen Goldsmith,President AUG - 9 2021 Southold Town Trustees ' Southold Town Annex 54375 Route 25 Board of Trustors P.O. Box 1179 Southold,New York 11971 Re: 53405 County Road 48-Sanitary Upgrade Applications Dear Mr. Goldsmith: Enclosed please find the plans prepared by Benjamin Wright Chaleff for the proposed sanitary upgrade for the above referenced property. As the proposed location is in excess of 100 feet from the mean high water line,please confirm in writing the waiver of the requirement of obtaining a Trustees permit for this project. Thank you for your attention to this matter. Very truly yours, Susan Rogers Grum SRG:bp Enclosure / ke- C-C71eln /USS' N,;