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HomeMy WebLinkAbout335 Hill LLC c/o John McCarthy-O'Hea 257.0` r EXISTING COVERAGE WITHIN DECADIACENT AREA O to A"CENT AREA(LANDWARD OF 25853 d ` TIDAL WETLANDS BOUNDARY) , V HOUSE 2.447 ST _ cy c OF DECCPORTIONSL. KSCOVEREDBY ROOFS&DECK STAIRS 1.410 sf 4,042 at OUTDOOR SHOWER 34 st f 7 I., / y cyf GRAVEL DRIVEWAY m ACCESS STAIRS Bid I y TOTAL E)aSTING COVERAGE 4.042stcris6% f.*,� DAL DS OUND YPE PROPOSED COVERAGE WffHIN DECADIACEM AREA L J 2 —� CONS! TANT ON 81118 v C1J ADIACENTAREA(LANDWARD OF 25863 sT g� .x PROP ED SI TFENC _ o ?San �$ TIDAL WETLANDS BOUNDARY) to to Cn = _ �rDURI G CONS RUCTId� a z o TOTAL EXISTING AREA 4,042 St �.• 1. I 1 Z PROPOSED PATIO 619 ST PROPOSED POOL 337 d 5•�e l I O PROPOSED POOLID E I1IPMENT 40 sf /1 I 1�, O j c.0D0 TOTAL PROPOSED COVERAGE 5,038 star 18.5% 1 102 w O r it 3 i- E h 1 psc.ro:a wA l � PROPOSED POOL EQUIPMENT PROPOSED POOL DRYWELL 5 -4,r" W PROPOSED AT-GRADE BRICK PAVER PATIO I PROPOSED 13.5'X 37 IN-GROUND POOL .0 i PROPOSED V TALL BLACK POOL CODE _ COMPLIANT ESTATE FENCE 11 m FF NYSUEC m 00 ( APPROVED AS PER TERMS 3 Tq AND CONDITIONS OF 2 g O PROPERTY OWNER: PREPARED BY: PERMIT NO./ 3�''� I, ip0�o 3 O �. 335 HILL LLC C/O JEFFREY PATANJO DATE_�p PVJohn McCarthy-O'Hea P.O. BOX 582 o < 121 EAST 22ND ST. #N302 BOHEMIA, NY 11716 J 31-484-9332 M _ New York, NY 10010 JPATANJO®GMAIL.COM NOTES: Pool Permit Drawings SCALE: 1. ELEVATIONS REFER TO NAVD 88 DATUM 1'=30' DATE 2. PORTIONS OF PLAN FROM SURVEY PREPARED BY: PROPOSED PLAN 5-10-21 JOHN GERD HEIDECKER, LS 6'1'21 PROJECT LOCATION 42 CROWN STREET KINGSTON, NY 12401 335 HILL ROAD '-4-21 . LOT AREA 27,634 S.F. 0.634 ACRES SOUTSUFFOLD, K CO OF SOUTSOLD 3 N.T.S. / SUFFOLK UNTY• NY SHEET: TAX MAP NO. 1000-70-4-31 1 OF 1 0 15 30 45 \`1 METERS FEET �Ea //�� HEIDECKER L 'SURVEYING o 30 60 eo 20 G D 6 C E GRAPHIC SCALE 7" = 30' FEB Q Southold Town HILL ROAD , Board of Trustees /,'POINT OF BEGINNING 57'50 45" _ 109.98' _ AREA= � �� FOUND MONUMENT27,634 SQ. FT. SECTION 70-BLOCK 4-TAX LOT 31 MONUMENT FOUND ' _ OR N/F RICHARD J., JOHN R., & PATRICIA A. SAHM 0.634 ACRES 1 / IBER 12025-PAGE 468 1 ? 1 \ £ CONC WALK /_ Lp \ { Ci Ln N / OPEN / pORCH \ m /GARAGE///////� STORE OOR=p SNCE / I 11 �_ Z FIRST 0 / I DOER / O 1 CE, PECK I { NOTES I.FIELD WORK WAS CONDUCTED DECEMBER I5,2018 BY HEIDECKER MEASURE LAND SURVEYING, / O` PLLC 16 ALL MEASUREMENTS WERE TAKEN ON THE GROUND. , �� — 1 FI 0G PROPERTY LINES ARE BASED UPON DEED / FILED WITH THE SUFFOLK COUNTY CLERK IN Q m N LIBER 12025-PACE 468. METAL PIN SAMID THE NORTH AMERICAN DATUMTH OF OW REFER R(rvALn SET '+ 83 U ZONE)AS DETERMINED BY GPS FIELD MEASUREMENTS PERFORMED BY HEIDECXER �_ �, _�5� / LO LAND SURVEYING,PLLC. ♦� / 1.SUFFOLK COUNTY TAX ASSESSOR J ;� DESIGNATION: •O '1 ' METAL PIN DISTRICT 1000-SECTION 070.00-BLOCK J 04.00-TAX LOT 031.000. - `i• ^ -� SET 5.71115 IS NOT A TITLE SURVEY AND IS SUBIECT TO ANY STATE Of FACTS A FULL METAL PIN AN CURRENT TITLE REPORT MAY REVEAL. CET 6.ALL EASEMENTS MAY NOT BE SHOWN. J_ ].THE LINE SHOWN ALONG JOCKEY CREEK IS PLOTTED AS PER DEED FOR LOT 31 ANO — DOES NOT REFLECT THE HIGH WATERLINE AT -� LINE _,_72 iS 2016 THE TIME OF THIS SURVEY.THE HIGH WATER . LINE AS OBSERVED IS PL07M AS SHOWN. -I �I.� 1 to.CO, 8.UNDERGROUND UTILITIES ARE NOT SHOWN. N`37'2' 44`W- — PRIOR TO CONSTRUCTION THE CONTRACTOR DOCK SHALL CALL'CALL BEFORE YOU DIG'AT(800) 271-4480 ANO HAVE ALL UTILITY LOCATIONS MARKED ON THE GROUND. 9.VERTICAL DATUM IS REFERENCED TO THE ORTH AMERICAN VERTICAL DATUM OF 1988 (NASD 86) AS DETERMINED BY GPS FIELD JOCKEY CREEK MEASUREMENTS.FLLC,NEO BY HEIDECKER LPND SURVEYING,PLLC. 10.HIGH&LOW WATER LINE WERE OBSERVED ON DECEMBER 15,2016. \ HIGH WATER AT ELEVATION 1.7• LOW WATER AT ELEVATION-1.5' B��k"EAP CERTIFICATION I JOHN GERD HEIDECKER,A LICENSED LAND SURVEYOR IN THE STATE OF NEW YORK (LICENSE NO.50719).00 HEREBY CERTIFY THAT THIS MAP Y/A$PREPARED IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.THIS CERTIFICATION E%TENDB ONLY 70 THE PARTIES NAMED BELOW AND IS NOT TRANSFERABLE. 1 John McCarthy-0'Hee John McCarth O'Hea FROJ N0. AIE: `/ 16HLS12E Unc'tne•aee aDve•on p. JOHN GERD HEIDECKER MY.STATE LAND SURVEYOR LIC.P 507tc DATE: TOP OG RAP111 C/BOUNDARY SURVEY SHEEOF N0. cI < A 7209.c 42 CROWN STREET DECEMBER 2a,2016 o—2.`p SECTION i0—BLOCK 4—TAX LOT 31 —.1 rl L1e+.Cep:ese pl KINGSTON,NEW YORK 12401 PRAWN BY:E M. JOE b •er m=P peL L�r;n9;rve 335 HILL ROAD 1 (845)-901-7629 r� snpi`noi p. �neC CHK ev:J.H. TOWN OF SOUTHOLD CAD FILE: cer6heieec4erls.cam - scALE� SUFFOLK COUNTY. NEW PORK NOTES Lu I- 1. NO SOIL SURCHARGE PERMIT-ED WITHIN 4 FEET OF EXCAVATION AT THE SHALLOW END,OR6 FEET OF EXCAVATION AT THE DEEP END. < 2. THIS POOL MEETS THE REQUIREMENTS OF AN51/APSP/ICC-5"AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROUND SWIMMING POOLS"AND1996BOCACOPE-SECTION 421. DIVING EQUIPMEN`15NOTALLOWED. 3. SWIMMING POOL SHALL BEGDMPLETELYAND CONTINUOV5LYiURROUNDEDWITH ABARRIER CONSTRUCTED IAW'REQUIREMENT3(OF Q SECTION 8326.4,2.1 THROUGH 8326.4.2.6 OF THE NEW YORK STATE RESIDENTIAL CODE(2020)AND IN CONFORMITY WITH ALL SECTIONS O g OF THE SOUTHOLD TOWN CODE.DWELLING WALL(5)MAY SERVE AS PART OF THE POOL BARRIER AS PER SECTION R326.4.2.8 AND CONDITION(1)ARE MET.OPERABLE WINDOWS IN THE WALL(5)USED AS A BARRIER SHALL HAVE A SELF LATCHING DEVICE.ACCESS GATES b SHALL COMPLY WITH SECTION 8326.5.2 OF THE NYS RESIDENTIAL CODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY LOCKED WHEN POOL IS NOT:N USE OR SUPER%ISED.ALL GATE5 ARE TO OPEN AVVAY FROM THE POOL AREA. 7� 4. DURING CONSTRUCTION THECONTKACTOR SHALL ERECTA TEMPORARY BARRIER AROUND THE EXCAVATION IAW THE CODE OFTHE ` TOWN OFSOUTHOLD. o. '4E :0 6'-0" 5. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DEFECTING ENTRY INTO THE WATERANm SOUNDING AN AVDIBLEALARMUPONDETECTIONTHATISAVDIBLEATPOOLS-DEANDINSIDETHEDWELLING. THEALARMMUSTBEINSTALLED, N w } ° MAINTAINED AND USED INACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS. THEALARM MUSTMEETpSTM F2206 Z A ° "STANDARD SPECIFICATION FOR POOL ALARMS. THE DEVICE MVST OPERATE INDEPENDENT(NOT ATTACHED TOOIR DEPENDENT ON)OF V Q O y ¢ PERSONS. o g 6. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS)MUST BE PROVIDED WITH A COVER THAT CONFORMS TO ASME/ANSI OO O 3,. I I A112.19.8M ORA MINIMUM 1E"x 23"DRAIN GRATE ORA CHANNEL DRAIN SYSTEM. POOL CIRCVLtiTION SYSTEM MU/ST BE EQUIPPED WITH r ATMOSPHERIC VACUUM RELIEF IN THE EVENTTHE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OR BROKEN. SUCH J Lf) 10" PLAN 1O. VACUUM RELI EF SYSTEM5 SHALL CONFORM WITH ASME A112.19.17 OR BEA GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD. POOL SHALL BE PROVIDED WIFH A MINIMUM OF 2 5UCTION FITTINGS OF THE ABOVE MENTIONED TYPE. THE SUCTION FITTINGS SHALL BE N.T.5. SEPARATED BY A MINIMUM CF3'AND MUST BE PIPED SUCH THAT WATER 15 DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITT]NG5 SHALL BE IN AN ACCESSIBLE POSITION,MINIMUM OF 6"AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BEAN ATTACHMENTTO THE SKIMMER/5KIMMERS.A REQUIRED POOL ATMOSPHERIC VACUUM RELIEF SYSTEM SHALL BE INSTALLED AS PER NYS RES[PENTIAL CODE VINYLCOVERED 8326.6.3(2020)AND IN ACCORDANCE WITH TOWN CODE. CONCRETE STEPS 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF NFPA 70(NEC)PRINCIPALLY ARTICLE 680 AND THE NYS 4 RESIDENTIAL CODE SECTIONS 4201 THROUGH 4-206.ALL ELECTRICAL DEVICES MUT BE APPROVED BY UNDERWRITERS LABORATORIES AND B E PROTECTED BY A GRO V N D FAULT CURRENT I NTERRUPTER(GFCI)CURRENT CARRY[NG ELECTRICAL CON D VCTORS EXCEPT FOR THOSE QJ PROVIDING POWER TO POOL LIGHT]NG AND POOL EQUI PM ENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4203.5.ALL V METAL ENCLOSURES;FENCES OR RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHARGiE[) � ?"70 4`$AND BOTTOM v DUE TO CONTACT WITH AN ELECTRICAL CIRCVITSHALL BE EFFECTIVELY GROUNDED. 8. WATER SOURCE FILLING THE DOOL SHALL BE E2UI PPED WITH A BACKFLOW PROTECTION DEVICE IAW NYS P Q) SECTION A _ 9. ALL PIPING is DIAGRAMMATIC VNLESSOTHERVNISESTATED. D E ol N.T.S. Ql10. WALKS IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM POOL EDGE. _ Z 11. A MEANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED LAW ANSI/APSP/ICC-5 SECTION 6. O 0 TOP OF WALLWATERLINE FEB 2 = w 12. CONTRACTOR TO PLACE THE POOL IAW TOWN OF SOUTHOLD CODE SETBACKS. 'py N Q) Ln 13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SUBJECT PROPERTY. ' Southold:Tauun. 15, THE DESIGN 15 BASED ON A DRAINAGE 501L WITH 410%SILT. GROUND WATER SHALL NOT EXIST WITHIN TH EXCAVATION. IFS/ cr 'a - WATER EXISTS WITHIN 6'O"FROM GRADE,DEWATERING FACILITIES WILL BE RECIVIRED. _ -- N 16. ALLGASANDOILHEATER5(1=INSTALLED)FOP.THEINGROUND5WIMMING POOL SHALL BE NATIONAL APPLIANCE ENERGY SECTION B CONSERVATION ACT(NAECA)COMPLIANT. FOOL HEATERS SHALL BE TESTED IAW ANSI Z21.56 AND SHALL BE INSTALLED IAW MANUFACTURERS SPEC FICA-IONS. OIL FIRED POOL HEATERS SHALL BE TESTED IAW VL726. POOL HEATERS SHALL BE LOCATED OR N.T.S. GUARDEDTOPROTECTAGAINST ACCIDENTAL CONTACT OFHOT SURFACES BYPERSONS. POOL HEATERS SHALL BE]PROVIDED WITH TEMPERATURE AND PRESSURE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPASS SYSTEM. A BYPA55 LINE SHALL BE INSTALLED FROM INLET TO O'JTLETTO ADJU5T WATER FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE V FOLLOWING ENERGY CONSERVATION MEASURES: 4 2,-2" CHECK VALVE 0000 COPING AND WALKWAY 1O„ 16.1 AT LEAST ONE THERMOSTAT SHALL BE PROVIDED FOR EACH HEATING SYSTEM. 00 (BY OTHERS) 16.2 ALL POOL I-EATERS SHALL BEEQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW 5HVTTIING OFF THE (� o PUMP FROM SKIMMER GRADE OPERATONOFTHEHEATERNITHOUTADJU5-INGTHE THERMD5TATSET`lNGANDTOALLOWRESTARTINGWITHOUTRELIGHTINGTHE z WATERLINE a. PILOTLIG117 �. roDlSPosnv 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQUIREM ENT ARE OIVTDOOR POOLS Qi m DRYWELL d Y DERIVING20%OFTHEENERGYFORHEATING FROM RENEWABLE SOURCES AS COMPUTED OVER AN OPERATING SEASON) w 0I� UNDISTURBED EARTH p N N a 0 16.4 TIME CLOCKS SHALL BE INSTALLED SO THE PUMP CAN BE SETTO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIIOD5 AND CAN BESET wy a r coc c 3500 P5I POVRED CONC. TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN A CLEAN AND SANITARY CONDITION IAW APPLICABLE Ian c q VALVE R O 3/8"REBAR 2)TYP. SANITARY CODE OF NEW YORK STATE. d.I Y n n o VINYL LINER \ 17. THIS DRAWING 15 FOR STRUC-URAL SHELL ONLY. ALL ACCESSORIES AND APPURTENANCES ARE DEFINED BY OTHERS. Z 0 O^^d a TMMC) 2"Toa^SANDLu to FILTER 18. BACKFILL WITH CLEAN EARTH,FREE OFROOTSANDDEBRIS. DO NOTALLOW THE HEIGHTOF BAC KFILL TO EXCEED THE HEIGHTOF THE N p"ki C WATER IN THE POOL BY MORE THAN 8", OR THE WATER TO EXCEED BACKFILL BY'MORE THAN 8" •�- OF�IF.h w \ \/ 19. PLACE CONCRETE ON 5ANDYTO LOAM SOIL. REMOVE ANY CLAY DEPOSIT AND REPLACE W/COMPACTED CLEAN BACKFILL. w / TO RETURNS 20, THERE IS NO MAIN DRAIN IN TH 15 POOL.SVCTON FOR POOL WATER CIRCULATION IS PROVIDED B,Y THE SKIMMERS ONLY.TH 15 MEETS -° ►,I E W Y CHECK VALVE) VERTICAL3/8'REBAR 03'O.C. REQUI REMENTS OF TH E NYS RE5I DENTIAL CODE-SECTION 8326.5 FOR ENTRAPM ENT PROTECTION. PLUMBING SCHEMATIC (NOT SHOWN) THOry� 21. THE POO LIA'ASDESIGN EDIAVVTHE FOLLOWING: N.T.S. WALL SECTION 21.1. THE NEWYORK5TATERESICENTIALCOPE-SECTION R326(2020) Q 'V, 21.2. THE NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE-5ECTION Z403.10(2020) K - N.T.S. 21.3. THE NEW YORK STATE FUEL GA5 CODE(2020) � v cq J s-A -I W �q/ 21.4. THE NEW YORK STATE SANITARY CODE ® E c E V E I fT W 21.5. ANSI/AP5P/ICC-5 STANDAR)FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. 21.6. BOCA CODE-SECTION 421. v - -J 21.7. CODE OFTHE TOWN OF SOVTHOLD. JAN I 3 t�B�� (C C-;��r °t, 22. ALL BACKWASH TO BE SELF-CONTAINED ON-SITE. �C O n SAl5 23. POOL TO BE EQUIPPED WITI-ANAUMMA11CPOOL COVER. BUILDING DEPT. O��OC[SS\o\- TOWN OF SOUTHOLD 1 i Glenn Goldsmith, President Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice:President �T P.O. Box 1179 John M. Bredeme4er III r 3 Southold, New York 11971 .y , , Dr Michael J. Domino �' " �. Telephone(631) 765-1832-- - fi a Greg Williams BOARD OF TOWN TRUSTEES 10 TOWN OF SOUTHOLD This Section For Office Use Only Board of Trustees Coastal Eros•'imn Permit Application Wetland Permit Application Administrative Permit Amendment/Tran sfer/Extens ion Received Application: 2.10•Z?/ �LReceived Fee: $ ZQ-00 Completed Application: Z' •TiJr Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: �oord mation:(date sent): �WRP Consistency Assessment Form Sent: AC Referral Sent- ►o Date of Inspection: Receipt of CAC Report: �Technical Review: �11i' a� PubI1C Hearing Held: lyi]V��QL!/�� 0113/alaot Resolution: we� Ot IPerKf!Igv S ,� •r �4 ffn LL— Ltic." 0Ow-ner(s) Legal Name of Property (as shown on Deed): n �A Mailing Address: VAN F=- Phone Phone Number: to Lk l0 •- Suffolk County Tax Map Number: 1000 - -]D —4 Property Location: 3 S >o (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): �-��� �s�ah d- Q�t� � -� C-of Mailing Address: Sv1 0v v �Ct-� Phone Number: � � �� —8 t � Email:_ J�C � ' �� Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: & ,v� Previous use of property: Zes��`�-''� Intended use of property: -k"C, 4 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 V-' 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 '4 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?—X.No Yes If yes, provide explanation: Project Description use attachments if necessary): V p ( y) s��� 13 L 3Z F ieo,4L —5 d, o�7 Por--,t p.;,4,.o S' 0,1 f 5, Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: `-) '%\'� S w %W\m i r1 Area of wetlands on lot: 0 _ square feet Percent coverage of lot: Q % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or tilling? No •� 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: �v _ feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 'C,r �c�tic�e� 1464 oUi- 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): 617.20 Appendix B Short Lttviron►rtentttl Assess►rtenf Form Instructions for C'omhletin-' 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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part I. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information _T Cad Name of Action or Project: Polve Project Location(describe,and attach a location map): 3=:� ZQ, Go�-)44�uICA Brief Description of Proposed Action: — - POO Name of Applicant or Sponsor: Telephone: ° r- to�1 E-jMail: C_�. Pc�c:1 C`' ''I yam, Address: --_.__ --- ` rjC7 OC7C� JI-l�`�sn �-� City/PO: State: Zip Code: lJt) tj 1. Does the proposed action only involve the legislative adoption of a plan, local law,ordinance, NO YES administrative rule,or regulation? ❑ If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? I NO VIES If Yes, list agency(s)name and permit or approval: I ID IC-7C 3.a. Total acreage of the site of the proposed action? (� acres b.Total acreage to be physically disturbed? 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 E]Rural (non-agriculture) ,❑,, Industrial Ll Commercial I�Residential (suburban) El Forest ❑Agriculture [9/Aquatic ❑Other(specify): _ El Parkland ---- Page 1 ofd l � } 5. Is the proposed action. NO YES -N/A - a. A permitted use under the zoning regulations? ( ❑ I 0 ❑ b.Consistent with the adopted comprehensive plan? i ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ a- 7. Is the site of the proposed action located in,or dues it adjoin:a state listed Critical Environmental Area? NO YES If Yes, identify: E�r ❑ S. 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 tileNr1:1 proposed action? (- ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 4.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: W 05uu ��"�-�— _ ❑ 11. Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: � `�W' � �� `�� ❑ 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? u -- — -— _ ❑ 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? Elb. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identily 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: N'thoreline ❑Forest ❑AencultUraVgrasslands ❑Early mid-successional [Wetland ❑Urban CRe-burban 15. Does the site of the proposed action contain any species of animal,or associated habitats.listed j NO YES by the State or Federal government as threatened or endangered? ❑ 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge,either From point or non-point sources? NO YES If Yes, �y a. Will storm water discharges now to adjacent properties? [j�NO ❑YES U El b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES j — I Pa�ze. 2 ot'a I 3. 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,danr)? r If Yes.explain purpose and size.: 'I." I.-, ❑ 1?r � i 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: _ 1 F1 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: � F] AFFIRM TIIAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE + t Applicant/sponsor n.me: Lin 5` Pc`�!1 tart �.t�C'� Date: 5- -- - --- - Signature: 9 _.: .__ �,;• 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 I small to large impact impact may may occur occur, f I. Will the proposed action create a material conflict with an adopted land use plan or zoning i regulations? a 2. Will the proposed action result in a change in the use or intensity of use of land? R Li 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 ❑ establishment ora Critical Environmental Area(CEA)? S. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure tier mass transit,biking or walkway? i 6. Will the proposed action cause an increase in the use orenemy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a. public/private water supplies) b. public i private wastewater treatment utilities? Ful 3. Will the proposed action impair the character or quality ol'important historic,archaeolozical. ( ❑ ff ,architectural or aesthetic resources? 1 9. Will the proposed action result in an adverse change to natural resources(e.g., wetlands. ❑ i waterbodies,groundwater, air quality, flora and fatma)? i Paye 3 of'4 i — — -- No,or i Moderate small to large impact impact may may occur occu r 10. W i I I the proposed action result in an increase in the potential for erosion, tloodirig or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3- Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above.andany supporting dOCLimentatlon, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. 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 l_,ead Agency Date L �f� MCA- r`� 1���_r C.�� President Print or Type Name of Res�_' cer in Lead Agency Title of Responsible Officer Sitf I esp„n�ihle fficer in Lead Agency Signature of Prcparer(if different from Responsible Officer) PRINT I'aoe 4 of 4 A APPLICANT/AGENT/REPRESENTATIYE TRANSACTIONAL DISCLOSURE FORM JIM Town of t hi 'tsconnicts ofinterestond this form is to pmvidt information which can alert the town of wasible cgnflim of interesl nd allow it to take whatever action is necessary to avoid same. i YOUR NAME: Al C 6falh - O WEA I"- .4 (Last name,futt name,4 iddle initial,unless you are applying iri 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,rrlarriage,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 S%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 applicantlagent/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 dw 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when.the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day s 20 Signature Print Name GM o lq Form TS 1 0gslw000 01� s Itu�Utte�� 't tot +1 B�ox �niQ)` 51M II AIN IM) i !4! i)1 1010 \S 01101 i).ia<i:utl ,uii.u,! �ca:Tall l .!n 1'n:,tSt (,�.�,) lslutll(tuti .�t!) ural! t,))nu.(a:f.n+! s>:,ac,tJ uuOI;.zli�iilat.pili {!)L�t liani„�tu �t„til nt{:,�a:-+au ,;h rti Iu r III'vP alt"r Iar,l) IWOI %)I\! )1 ,c h,,{ it(i it,,,t?mw y c ;ti•,u,a+11 luu•,{ Iitt�;{ ,I(h� .nii .,n,l;1' NJOITY/M01 H. 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SA'P.1`)1' .I.N1 .)I'1(I,IY A11.1 'SAATS' 11I LAO MIWAI NAMA.(1'1011.1 )M;•Iil.L MI (1:•1.10)I.I,1V:1111 AVtV ti\' UKV KM IS )1"Id.11 5111.!.NI 11-1.1104 1AS HANNV1\ ;(ILL NI :1`'0(1 ,, '1'II,tA \01041 'YJV .JAIII.(I0 ':1:11'1:111 (11!\' 1:)((:•1 I:i1()\�I11'111itit11 •101'n"•Ii1 :1111 ()111'•1 DI I AIt1' `1.1IIAll (I'Al"MIA0).) ti I.N'•IWAA V 1 ti"I'IV 11'11.1 (1'a1' 601.11111;•Id (IAIII1t IA()11V :111.1. 110211'0.)1'i4I4iVAt1.1.~1 •1115;:11! 1.1'11.1 til 1J! t�11 (1!.t 1115(>�t;I(I \110115 1'1.1(1 :)511.•111 _ l.INWEg:1V ttot_)ra�T7dd� caa�Lnz1, 3n p.�eo� t� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. i YOUR NAME: Lo n S (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance �� Trustee Change of Zone Coastal Erosion Approval of plat _ Mooring Exemption from plat or official map _ Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.'Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO ✓ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 536 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 RELATIONS141P Submitted this_�0 day of 20-2/2 Signature - Print Name— _-6 V) Form TS 1 i Town of Southold LWRP CONSIS'T'ENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its sioificant 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 ANIAND PROPOSED ACTION SCTM# ( - `T - PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Rept. ljl*� 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: n Location of action:_ 3 � �` so Site acreage: Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant.: 7YJ�A n 0 (b) Mailing address: k 2 S AIV C N �O �J`l 0Q) l o (c) Telephone number: Area Code( ) (d) Application number, if any: /VI Will the action be directly undertaken,require finding, or approval by a state or federal agency? Yes ❑ No 3 If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Pest 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, snakes 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 [X No ❑ Not Applicable 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 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 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 ❑ Yes ❑ No © Not 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 ❑ Yes S No ❑Not Applicable 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. ❑ ❑ L—t' 2 , 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 Fj Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ® No ❑ Not Applicable 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. ❑ Yel-'N No❑ Not 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. [I Yes [� No ❑ Not Applicable Attach additional sheets if necessary Policy It. 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 �u Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes Ft] No❑ 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 'tH No ❑ Not Applicable PRE,PARED IIS' �`��.t—� � T�N rci TITLE W Ad DATE S t U . / ! e� '���r.tip r `• „�C�''.:2,.`"" � f,a' `'F".,." d��A'+t'a '- ,a�-Y,ct.y�„ -"''��� ��3'i '.�t-. �. }r�'.:T ttiJ$.(ry'�X� .••,s_�,Ly�Sf`Y r ,7c1 �- �*RR � t c s3• _ :�- as •�!y yY. �' y',�• `:rt + ., ry J. 1 'Y s,< "T:4�1.+1�- / -. 3r8 •r.c=� �„� � :�`- .;.: :J - :'� f .�' ,� � � i, !f %"�K:q, +S y.` j�f��.,�>�x tir�G.a-� H/ �•k. ``:�,��• ��Z.�� ,t�. �' 'alc_ r':'i�A•'R"!✓"` r � f n+�¢% �I 1a'Y � '�� '�; ,' .a_ Y+ai�1 '� �a ''� Jo; �� �+4 }¢` �i^' ! lam. ri7g � b,ASvV[ '� i '• �k. ,� '� � '� ` 'T;:��'�'C "!. T'+ , _ d �p o)'.. ..r�kgj.< �7"�,� ,�..�'ti� 4 i�� � ,��'�� V � � fit'' + �z � r `" -` Z�'. `t. �•i� A • �'• :� ij,.��. 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'i�"��aT '11� ,Y`7��j+,�W��c'�a'4• 'Ci"Y,R,�,`. �i"*p ' �'� ��� �� �E�t"'��,�/ v�'.�, �'l"�'' �'f*� .� �L•�AtO' � •�_',/i�r.Y_ I'� ,�A /Cn�� •, q� � ��s �{{�� 1 ,�... �.u�: �'-. .,},. + -' w.. f •T� y1 , '151 +;, .jta j >.• 1 d.�' ,�. ,, ' P ., pip St S r 5"is �>�fT�� aid• ''* ��{�'�; ,.°t- ;y Y: ,w5.;{._ � a:.� �� .rY : � y n 7M-4— NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY•9 Stony Brook.50 Circle Road,Stony Brook,NY 11790 P:(631)444-0365 I F:(631)4440360 www.dec.ny.gov October 21,2021 Via email only: 335 Hill LLC c/o John McCarthy-O'Hea 121 E 22nd Street Apt N302 M I 'VE E New York,NY 10010 1! L� Re: NYSDEC# 1-4738-04515/00003 2022 335 Hill LLC Property,335 Hill Rd., Southold Construct Pool, Patio, Drywell, Fence es Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL)and its implementing regulations (6NYCRR, Part 62 1)we are enclosing your permit. I Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions,please contact us at the above address. Also enclosed please find a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, r Kevin Kispert Environmental Analyst I1 Enclosures KAK/file cc: NYSDEC MHP Jeffrey Patanjo. NEWYORK Departmentof STAIEOf Environmental OP�0.7UNRY Conservation NEW YORK STATE DEPARTMENT OF ENVI.RONMENTA,.L.CONSERVATION � Facility DEC•ID 1-4738-04515 PERAUT Under-the CA.Altoniraen#al Couservatioft Law ECL Permittee and Facility information Permit Issued To; -Facility: 335IlILL LLC 33:5.HILL LLC C/O.JOI-N MCCARTHY-041EA: 335 HILL.RDISCTM# 1:000-7.0-4-31 121 E 12ND ST APT W302 SOUTR%-D,NY 11971 NEW YORK,NY 1001:0 Facility Application Contact: JEFFREY PATANJO PO.BOX 592 BOHEMIA,.NY 1.1716-0582 (631) 4.84-9332 Facility Location: in.S:OUTkI01:D in..SUI=FU1 LK-COUNTY' ' Village; SOUTH.OLD Faeiility Pe icipal Ref6reiice.Point: I\IYTM-E: 716.58*6' NY-TM-N: 4548.522 Latitude: 41°03'32:9" Longitude: 72°.2.5'.21.1" Authorized Activity: Construct.a.13.5"ft by 32 ft pool with associated patio,equipmerit,dtywell and fence, all as sliawii on.'the attached:plans.prepared by Jeffrey:Patanjq, last revised 7/4/21.,.stainped "NYSDEC:Approved" on 1012112021' Permit-.A.uthorizatibus Tidal Wetlands.-Under Article 25 Permit-ID 1-4738-04515/000..'03 New Permit Effeet ve Date: lN2.1/202:1 Expiration Date: 10/20/2076 NYSDEC.Approva.l By acceptance,of this permit, the permittee agrees that the permit is contingent upon strict, compliance with the ECL,:all applicable regulations; and all eonditions-ineluded as part of this permit. PeriTiit.Administrator:.:KEVIN A KISP.E.RT,Deputy Petniii Administrator Address: hY.SDEC Region,I Headgaarters. .SUNY cr:Stony Brook]50 Circle Rd .Stony Brook.--NY- 11790-3409 :Authorized Signatu;-e: j Date 1.0%21/2021 Page 1 of 6 Am NEVI`YORK.STATE--bEP-ARtiN.I]tNT OF ENWIRONIkBINTAL C0N, ,9#,4VA'f10N. Facility DEC ID:i-473&--04il5 Distribution List JF,VFREV-PATANJO -Mariiie Bdbitat Pr6fe!ction 'KEVIN A KI$'.PERT Permit Components. NATURAL RESOURCE, PERMIT CONDITIONS GENERAL:CONDYTIONS, APPLY TO ALL AUMORIZED.PERMITS NOTT171CATIQN.'OF OTHER PERMITTEE.0)3LIGATIONS Permit Attachments .Site Plan. 7/4/2021 'NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following -Permits: TIDAL WETLANDS f. Conformance-With Plans All activities authorized by this permit must be in.strict,conformance. with.the appfoved'plins sdbmittdd by tbd,.app.licaht or-applicant's agent as part Qfthe-permit appikation. Such approved plans were prepared:by Jeffrey Pkanjo, last revised 7/4121.s' rnp ta. ed "NYSDE:C Approved" on 1,0/21/2021. .2. Notice of Commencement ncernent Atleast 48*Hours prior to commencement Of the project; the'petrnittee and contractor shall.:signand return the lop.portion of-the-enclosed notification form.certifying that-they are fi.illy Mv.are of and tibdetstand a11'tdrm9-and`conditi6ns' of this permit. Within 30 days of cumpl�,don- Qf.projqct,the bottom portion:of-the form rnustalso be-.signed and reiumne&alongwithplio.f9graphs..of the completed work. 3. Post Perrnit-$ign The permit sign enclosedwi. this pprnft shall.b .posted'in-q conspicuous lo'catiori.'an the work-site and adequately protected.from the weather: 4.. Conerd Leachate During con struui6h_i1o.Nk7ct or fresh concrete,or leachate shall be Allowed.to. escape into any wetlands or-waters of New'Yo' rk-S-tate-nor shall washings ftoni-ready-mixed concrete trucks;mixers, or other devices bedllbwed to"enter:any wetlarid or waters: Only watertight or waterproof forms shall be used. Wet;con.crete shall not be-poured to displaw.water N�.,ifh.in the forms. i.. NP C6nstru-cticfn DOfis in WiatlAndbr.Adjatefit Area. -Any,debris t ok'exle6ss material.from construction of this.project-shall be completely remq.yed-frorn the adjacent.are (upland)upl' nd) qn4 removed to a an approved uplarid-area for disposal. No debris is porniitted in wetlands and/or protected buffer areas: Page 2 of 6 NEW YORK STATE DEP-,�,RTMENT'OF I Nti'TRON?VIFN'CAL CON$tRVATION Facility D.ECII)1=4738-64515 6. Materials Disposed at Upland Site Anydeal.olition debris; excess.'construdtion materials,-and/or excess excavated materials shall be immediately and completely disposed of in an authorized slid waste.management facility.These.materials shall be.suitably stabilized.as not to re-enter-any water.. body,.wetland de Wad and..adjacent area. 71 No Disturbance.td Vegetated Tidal-Wetlands There shall be no disturbance.to,ve-etated tidal wetlands or protected'buffer areas-as a result of the permitted activities. 8. Storiige-.of Equipment, Materials The-storabe'ofcoristruction equi.pmerit and itiaterials shall be confined within theproject work area and/or upla.nd.areas greater-than 75 linear.fect from the tidal Wetland boundary:- 9.:Department Jurisdiction The department retains jtirisdiction-of all regulated latids where till has been.permitted. Placement of till shall not be-used to alter the department's Tidal Wetland jurisdictional area at theproject site. The-area remains a regulated area subject to Tidal Wetland Land Use*:restriations of G NYCRR.Part 6 6 L 1tl. Straw Bales or Other at Tidal Wetland A roW of staked straw bales or.apptovable orosion control devices shall.be..placed at1he landward edge.ofthe boffer area or 7.5.littear.feet from..the tidal wetland boundary, oras.per-the NYS'DEC-approved plan, prior to commencement of any to itlated activities and teraaini ir, place and in food, functiona].condition until the..projectIs.completed and'all distarbed areas are stabilized with vegetation. 1.1. No Drywells in or-near Wetland Dry Wel Is,for pool filter backwash shall be located'a min irniim of laa:linear feet landward of-the tidal wetland.-boundary. 1.2. No.Pool Discharges to Weiland There shall be-no-dtaining,of sWitrimhig pool water SireCly or in&ectly into wetlands oi-protected:buffer'-aceas. 13. Contain Expased,.Stockpiled Soils .All disturbed areas where:soil. ill be:ternporarily exposed or stockpiled for Longek than 48 Hours shall be contained by a continuous fine.of staked haybales/silt curtains.(or.other NYSDE(I approved devices) placed on the.seaward:side between the fill and.the wctland:Ut:pr..otectcd buffer area. Tarps�are authorized to.supplement these approved methods. 1.4. Maintain Erosion Controls All erosion control devices.sliall be maintained in good.and funcEional condition antil.-the project has been completed and the area has been stabilized. ts. State,Not Liable for Damagb Thi State of N.etiv York sball in no case be liable for any damage or .inj itry to the structure or wo&bere.in authorized which maybe caused.by or result from future operations undertaken'by the State-.for the'conscNat'ion or improvement ofn<ivigatioti, or for other purposes, and'no claim or right to compensation shall accrue from any such damage. Page of 6 AOL NEW YORKSTATEIDEPARTMENT OF ENIVIROINTMENTAL CONSERVATION lqw Facility DEC ID 16. State lily Order Removal or Alte'ratio'n of Work If fiftbre Operations by the Steit6 OT N6K York, require an alteration in the position of the structure-or work herein authorized,or if, in the.opjn' iQn of the. Department of Environmental Conservation it unreasonable abstraction td the free navigati.en-.of said waters or flood.flows or endaijger.theheal.th.-safety orwelffire ofthe.pepp-le.of the State,-'br cause loss-or dostrUciion of the.natural resources of: the.State,the or -may be ordered by the. Department to*remove or alter the structural Work.-obstnidti.bris,or hazards caused thereby without expense-to.the State.and if upon the expiration or revocation of this permit,the-structure, till, excavation,.of other iiiodifidatibn of the watercourse hereby authorized shall not be completed,the- pNvne.rs.,.sli.dU,-withoiLt.expen!iq to the.,Siate,-and to such extent and imstich time-and manner as the Department of Environmental Conservation-rday require,remove.all or-any portion of the--.uncdrftpleted structure.oi-fi.11 and restore to its former.conditibri'the naviCr:4bje.4i14 flood capacity of the watercourse. ercourse. No.,claim shall:be made against-the State of New'Y6&on account.6f anysuch-Tern6val or.afteration, .1-7. -StaWMaY Require Site Restoration If upon thd-bxpiratib.h or revocation'o*f.thi"perrhit;-th-e%. prq.iqct hereby-authorized has no.t.been,.cqmpleted- the app .licantshall,without expense to the State and to such.extefit and-ItT such.time gild matt—Nr'ds-the Departm'6nt of Environmental Coh*§er-,/Atioh may lawfully require, remove.allorany portion.of--the uacQmpleted.siructure-or fill and restore the.-site to its on-fier condition. No claim shall be made agairistth-e-State.of New York bh-ac-*c.ount--'.6f any such .reinova.1 or alteration. 184 Precautions Againgf Contamination of Waters All necessary precautions AM] be taken to preclude c6fifamination'of any weildnd or ixaterway.by suspended-'solids.sedimot t9ju Is,solvents; 'lubricants,-epoxy watings, paints,concrete..fecichate or any other erivironmental.I.y.delet&iOUSmateria materials -associatdd-NVith'the project: 'GENERAL CONDITIONS'-Apply to.ALL Authorized Permits: A 1. Facility Inspection by.The-Department The.permitted site or facility;including relevant records'. 'is subject to.inspection aLreasonable hours and'intervat.s by on authorized representative of the. Department of Environmental Conservation(the Department)todeterrnihe whether the permittee is complying with this permit and the ECL.. Su h.xepreseniative may order the worl<.sus en ed pursuant .to.ECL 71-030.1 and SAPA 401(3). The permittee shall prQvide.a..pers0n tb-aceoinpany.tb.e.Departmegt's:repr.efs6ntatiN.,e during-,an inspection to the permit:area when ibdu6sted by the Dep4ftrneht. A copy 6ftl it, i IV i g all t6eeenc�l maps,.dta;t,ings4nd's special conditions,must he available. y lisperini..ine dpi for inspection by.the Department at all times at-the project site U io fiacil' i�!. Mlure to produce a copy of 'the permit upon request by a-Depallyftept.representative.is-a violation of this-permit. 2. Relationship of this Permit to.Other Department'Orders and Determinations. Unless expressly -.pr.6.v1dbd for by the Departmetit,issuance of this permit does not rim odify,*saper8ede-or rescind otiy order or determination previously issued ed by the Department or any of the-terms, conditions or.requifements- contained in such-order or deter.ftiination. Page 4--of 6 Ask 1AW'V0kK STATE DEPARTMENT OF tNV1R0NMtrlTA,L CONSERI ATIONlawo Facility DEC ID 1-4738-04515 3. Applications-For Permit Renewals,lM.odilaeations or Transfers The.permittee const submit-a separate written application to the Department for-permit renewal,modification or.transfer-of this pexmit. Such application must include any:forms or supplemental information the Departmerit.regiiires. Any renewal,modification or transfer granted by the Department must be in writing;. Submission of applications for permit renewal, modificat'ion or transfer.are-to be submitted to: Regional Permit Adn.iinistrater NYSDEC Region.1 l�eadnuarters StTNY @.Stony Brookj5:b Circle Rd Stony Brook ;NY11.10 0-3409 4. Submission of Renewal Application The.permittee must submit a renewal-application.at.least-30 days.bef6re permit expiration. 'For-the following permit autl-iorizations:Tidal Wetlands. S. Permit 1Modifications,Suspensions.arad.Revocatiorrs.by the:Department T`lie Department 'reserves the right tri exercise all available:authority to modify; suspend or ievoke this permit. The grounds for modification,.suspension or rey ocation.include: a.. materially false pr inaccuratestatements in..the permit.application or;supporfing papers; b. failure by:the perrnittee'tp corn ply with any terms:or conditions of the.permit; c.. exceeding.the:scope of the project as descyihed in.the:permit application; d. newly dis.cov.eied material information;or a material chap p.in-envirojtinental conditions. relevant:technology of applicable la-,v or regulations siince:the issuance of the existi;tg-pertnit; e. noncompliance with previously:issued permit-conditions,orders of the commissioner., any provisionsaf`the Emviron.men aI Codservation UWor regulations of the Department related to the-permitted activity. 6. Permit Transfer. Permits.are transferrable unless specifically prohibited bystatute. regulation or another permit condition. Applications far permit transfer should:be submitted prFor.ta actual transfer of ownership: Page 5 of-b. j i i -AM NEW YORK STATE DEPARTMUNT OF ENVIRONMENTAL CONSERVATION FkM4, DEC 1,D-1-4738-04515. NOTIFICATION OF DTHER PERMITTEE OBLIGATIONS .Item.A.- Perrnitteekix6pts Ugal Responsibility. and:Agrees to Indemnification The:permittee,excepting state or.federal-agen:6qs,-expressly agrees to indei-an'ify and hold harmless the Department of Environmental Conservation Of the State of.New Yorkjts-tepresentatives,employees, And agents("DEC")for all clAirris,sti.its. actions, and da-Mages to;the extent attributable toAhe. Permittee's acm-or.ornissions'in con.nection-with the permitteel's undertaking of activities in oonhettion with.,or operation arid4nainteniince of,-the facility or fd6ilifies authorized by'the permit whether in compliance or not in compliance with.the teims.aad:conditions of the permit. This.indemnification does not dktehd,to'any'clabm-,suits;ad.tibns,or'damag&s.to" the..bxtent attributable to:DEC's own negli&ritoi ifilentional Ads or.omissions, or to-Any claims,suits, or actions-naming the-,,DE.CAnd-arising tinder Afticle-'-79 of the New York Civil Practice Laws.alid,Rules orany-citizensuiif-otcivil rights provision. cinder foderal or-state.laws. Item B.: Perniftt6e's Contractorsto Co.m'P.y with Permit 1 with The permittee is-respo.nsible for informing' , its independent contractors,.employees, agents.and Assigns of theii�responsibilityfo-c:bn�ply',v�itli this permit, including allspecialedilditions*whilei-acting.as,the permittee's agent- L-e. with respect t.o.:the permitted.artivi ties,and stich persons shall be subject to the,sable -8anctioii§for-Vio I ations Of the Environmental Conservation Law-as-those prescribed for the pet.mittee-. Win C.: Peetnittee . Resp-onsibtefox Obtainfng Other Required. POrmi.ts The-per.mittee i�.responsible for obtaining any oihe peripiis,approvals,Ian ds,easements andrhgt 7of way that may be required to-.carr -'Out the activities that.are authorized by'tfiis permit. rmit. 1. y Item b: No kight.to Trespass or Interfere with-Ripariah Rights- This.p6rnnit.does.'.not con*vby to.th.eperinittee any right.to.trespas.s-upon the lands or interfere with the: x.ipariatl rights of others in-or&r to.perform the--perinitted work nor doe's it authorize the impairtilentbf any ri,,ht§, title; or interest in real or person a f proo.erty held or vested in-dpprson-nota.party toil e� .5 perm it. Pace 6*of 6 OF 0010,AM!" ,bF CONSTRUCTION RETURN THIS FORM TO.COMPLIANCE-. OR FA/11.T0: 63.1-444-0272 Marine I labitat llrotedi;ori E-Mail: doc.srn.Rl MHP—BEH@)doc.ny,gov NYSDEI,-, 50 Circle Road SUNY@ Stony Brook Stony Brook,NY 11790-3409 EXPIRATION DATE PERMITTEE NAME&P130JECT ADDRESS: CONTRACTOR NAME&ADDRESS: ONE: Dear Sir: Pursuant to special conditions of(fir-, referenced permit,you are hereby notified that the authorized activity shall commence on 'Ale certify that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions.We have inspected the project site and can complete the project as described in the permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions-The permit,permit sign, and approved plans will be available at the site for inspection in accordance with general Conditio6 No_ 1 (Both signatures required) PERPAITEE: DATE CONTRACTOR: DATE THIS NOTICE MUST FE;SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR' TO COMIVENCEMENT OF THE PROJECT AND/OR AN Y A SSO C fA TED REG ULA TED AC T1 1/1 17E S. FA IL URE TO RETURN THIS NOTICE,POST THE PERMIT SIGN, OR I LAVE THE PE RMf T AND APPROVE=D PLA NS AVAILABLE ATTf/E WORK SI TE FOR THE DURATION OF THE PROJECT`fVAY SUBJE=CT THE" PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS, Cut along_tl)!-,ling X x x x x NOTICE OF COMPLETION OF CONSTRUCTION RETURN THIS FORM TO:COMPt-IANCE OR FAX TO: 631-444-0272 Marine I labitat Protection E-Mail:dec.sm.Rl MHP—BElq@dec.ny.gov NYSDEC 50 Circle Road SUNY@ Stony Brook Stony Brook,NY 11790-3409 PERMIT NUMBER: EXPIRATION DATE: PERMITTEE NAME&PROJECT ADDRESS: CONTRACTOR NAME-&ADDRESS: --------TELEPI-IONE: Pursuant to special conditions of[fit,referenced Per"Ift,you are hereby notified that the authorized activity was completed on We have fully complied with the terms and conditions of the permit and approved plans. (Both signatures required) PERMITEE: DATE: CONTR/�CTOR: DATE: 1-HIS NOTICE, 'All 171 I-11 ()G,-'<Al]IS OF T1 IF CO.-VI'l.!-7C-0 VIORK ANDAOR A COM,,PLE TED SJI&LY, AS AIPPH101 ,Nil!I7 PeJUS T BE SEIV T TO THE A B 0 VE ADDRESS M/i THIN 30 DAYS OF CO4.17PLE-TION OF THE PROJECT. STATE 0 IF Conservation .I „mss 0 '"'�'c E0. .P 1 The Department of Enviro-nmental Cons.ervatIon �'��D : : � ) has Issued: permit(s) pursuan.t-too the:Envire,nmentai Conservati®n Law. for work be.ing conducted at .this. site. For further 'inforrna,ti:eir� r�. a.rt�i:n the nature J and extent of work approved Ond any: Dopa.rtrhenta.l' conditions on it, the-Regional Pernlimcontact o oease Wer to th.e pe-rmit I t' number shown when conta.ctin.g the DEC. t � Regional Permit Adm'inist�ator f?errn:i.t Nu:rnber SUSAMACKERMAN i Expiration Date NOTE! This notice is.NOT a permit f i -,..9e SEE SEL NL 99J wd.Bt --�- ,PtPee - r.9. 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