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HomeMy WebLinkAboutTR-10193A � � SO/Goldsmith, President U Town Hall Annex A. Nicholas Krupski, Vice President ,��, � 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillool „ Elizabeth Peeples � ® � Telephone (631) 765-1892 Fax(631) 765-6641 Im WTI, 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 TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith,President .e�®F Soy Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President ®� ®�® P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 "OUN-N,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10193A Date of Receipt of Application: July 11, 2022 Applicant: Jonathan Rebell & Noah Levine SCTM#: 1000-74-1-35.56 Project Location: 4790 Blue Horizon Bluffs, Peconic Date of Resolution/Issuance: August 17, 2022 Date of Expiration: August 17, 2024 Reviewed by: Elizabeth Peeples, Trustee Project Description: Conduct construction activity within 100' from the landward edge of wetlands for the construction of a new 1,786sq.ft. two-story frame dwelling with a 241 sq.ft. screen porch, a 497sq.ft. deck with trellis and 69sq.ft. stairs to ground, a 255sq.ft. side porch with 121 sq.ft. stairs to ground, an 800sq.ft. swimming pool; one (1) 8' dia. by 10' effect. Depth discharge drywell for the pool, new I/A sanitary system and removal of existing conventional sewage disposal 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 survey prepared by Howard W. Young, NYSLS, last dated May 16, 2022, and stamped approved on August 17, 2022. Special Conditions: Installation of gutters to leaders to drywells to contain roof run-off to be installed more than 100 feet from the top of the bluff. 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 i nota deter ination.fron ny other agency. Glenn Goldsmith, President Board of Trustees (1)UNAUTHORIZED ALTERATION DR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LA",.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOTTO BE USED TO ESTABUSH PRDPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARINI: THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO TIE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION CEWIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W).SEPTIC TANKS(ST)&CES5POOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. N HEALTH DEPARTMENT USE • 400 Ostrander Avenue, Riverhead, New York IIc!OI tel. 651727.2305 fox. 651.72-7.0144 admin®youngengineering.com �jOVSP Howard W. Young, Land Surveyor Thomas G. Wolpert, Professlonol Engineer Engineer Dou las E. Adoms, Professlonol En g 9 Robert G. Tost, Architect Nab°oa'2211>= Nae 55 7JUL 1 2022 5.x51 Oct.35' \ N TIE LINE ALONG APPROX. ., �:__ MEAN HIGHwATER MARK S tlG101d S ON 6/2015 _ r �- �' " ' =�� \ Bn rd of , om TOE OF BLUFF� — ` . , �.� \ SITE DATA 1m�-Hama _._ AREA = 1.2178 ACRES OR 53,049 SQ. FT. - - — - OF THE 2 ° T 10 30 `r — \ *SUBDIVISION "MAP OF BLUE HORIZONS"FILED IN THE OFFICE O �q -- --30� \ CLERK OF SUFFOLK COUNTY ON SEPT.30,1985 AS MAP NO.7974. —40 _ J * VERTICAL DATUM =NAV DATUM(1988) ZONING USE DISTRICT =RESIDENTIAL - L LOW DENSITY 1 ACRE(R 40) �cREST of BLUFF &RESORT RESIDENTIAL(RR) 4S �p 7 - NUMBER OF BEDROOMS(DESIGN EQUIVALENT) =7 \ o `GEHA LIMIT 0 9 '� \° q7. ' MINIMUM REQUIRED I/A OWTS CAPACITY =770 GAL JZS 0 \o q 0 45 S ' o `� * PROVIDED I/A OWTS CAPACITY = 1,000 GAL - I o ao G 00 �,�9r �/ �Lo LDti LEACHING SYSTEM REQUIRED =475 SFSWA /6, _ s� �• ° •s /y \% s LEACHING PROVIDED =525 SFSWA I /0, —�-\ 150 LF �" J "� \ ENGINEER'S CERTIFICATION I SILT FENCE VED� _ _ I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL a STAKED 40— — — — — SYSTEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY \\ l HAYRACKS - ( _ y - \b o DIRECTION.BASED UPON A CAREFUL AND THOROUGH STUDY pF'=THS SOIL, SITE AND GROUNDWATER CONDITIONS,ALL FACILITiS;'-A ..PR7RQ,`t D n9 r;,P ra CONFORM TO THE SUFFOLK COUNTY DEPARTMENT,��,NEA�7J ERVIC�S\>`."..\\ \ c , D�G� CONSTRUCTION STANDARDS IN EFFECT AS OF T, DA) NOTES FOR ABANDONMENT OF \ y �, ani SANITARY STRUCTURES s >?; �,�o �I ABANDONMENT IN-PLACE \ t '(;R) s �.' q �o� EXISTING SYSTEMS SHALL BE ABANDONED BY REMOVING ALL oning Use Distric e� r� Ryz w w �o P �_ //�`• _C�� t�:A ( Z IZ 40) Q 9> 3' o. ` � RESIDUAL SEWAGE WASTES BY A LICENSED WASTE HAULER, \ Use District ( _ O .S HOWARD W.YOUNG,N.Y.5.L.S.NO.45893n Zoning 20 �-- THOMAS C.WOLPERT,N.Y.S.P.E.N0.61483 i REMOVING THE TOP OF THE STRUCTURE(S),BACKFILLING WITH 6 v� co p� -y � TEST HOLE 1 - L �•• -^>°• s SUITABLE SAND AND GRAVEL MATERIAL,AND PROPERLY \ A� �� FROM FILED MAP DOUGLAS E.ADAMS,N.Y.S.P.E.NO.80897 �t ' COMPACTING. \ ,- a �F ?d �� CONVERT Z �'9?�S fl 5TRUGTURE TO 0.0' WINDOW 0" N F,�o GARAGE/POOL ABANDONMENT BY REMOVAL o % 9 na ti�L ? E — — — — TOPSOIL 3 EXISTING SYSTEMS MAY ALSO BE ABANDONED BY REMOVING \ W iq�b o °os LOAM SURVEYOR'S CERTIFICATTOt '.'` �A (OL) ALL RESIDUAL SEWAGE WASTES BY A LICENSED HAULER, �Diq'` on' co �R p 4, �- P;,Ty. '\ � ° � _ d�o� v 013 " WE HERESY CERTIFY TO JONATHAN R�BEL''CL;�THAT REMOVING THE ENTIRE STRUCTURE(S),BACKFILLING WITH \ �/0� overs �'c°a�J Z� `5AND, SURVEY WA5 PREPARED IN ACCORDANCE .1TH`THE CODE O o0( SUITABLE SAND AND GRAVEL MATERIAL,AND PROPERLY q o�, s s`;-' �' ` C'LAY PRACTICE FOR LAND SURVEYS ADOPTED THE•NEW YORK,,.5TA,T>w o COMPACTING. isd \\ 5�9Kq �. PROPOSED WATER /FE'1 !- �D \ ti°'� (5N ASSOCIATION OF PROFESSIONAL LAND S RVEY`OKS`..,. v' SERVICE �/:\ J� \ 1\ 10.0' s ABANDONMENT OF SEWER PIPINGAo X �6 a �14THE ASSOCIATED SEWER PIPING SHALL BE CUT AND CAPPED AS9� 5� 0 0 E1 DB ° ° �o LF3 A MEANS OF ABANDONMENT.THE DEPARTMENT SHOULD BE .o S \ 0 9 OS, -/' \� \ V DIA.x 6'ED q�/ \ `G5 SAND (z CONTACTED FOR FURTHER ABANDONMENT REQUIREMENTS,IF 0 2 Q .b l� LP1 , \ GRAVEL FUTURE CONSTRUCTION IS CONTEMPLATED IN THE AREA OF s�qy° \ \. LP3 i \ \ (SN HOWARD W.YOUNG,N.Y.S.L.S.NO.45893 THE ABANDONED SEPTIC SYSTEM. EX.SANITARY SYSTEM TO BE 2 `• \ - // \ ABANDONED IN ACCORDANCE CERTIFICATION REQUIRED J WITH 5CDH5 STANDARDS ` / 56 \\\ \\\ c0 00 16.0' �P1 !° .W U Ir THE ABANDONMENT OF EXISTING SEWAGE DISPOSAL SYSTEMS, EITHER IN-PLACE,OR BY REMOVAL,MUST BE CERTIFIED BY �., \\ \9s. Si No)�,ESURVEY FOR EITHER A LICENSED DESIGN PROFESSIONAL OR LICENSED PROPOSED \��� \\ 9 . c o ENCOUNTE -D BOARD F 1 RUSTEES CONTRACTOR AS INDICATED BY THE DEPARTMENT ON THE SANITARY SYSTEM TOWN " SOUTFiOt D J NATHAN REBELL PERMIT TO CONSTRUCT.FOR PROJECTS SERVED BY MUNICIPAL \ \ q 9 �+ SEWER DISTRICTS,THE APPROPRIATE MUNICIPAL AGENCY WITH \\ PROPOSED / h \\ \\ 0� MAP OF BLUE HORIZONS° JURISDICTION SHOULD ALSO BE CONTACTED. \ DRIVEWAY 5tilMMINGPPOOL 1 \ \\ \\ cs DATEDI A 7 SLY \ 8'DIA.x 4'ED w \ �� Peconic, Town of Southold ws� uffolk County, New York NOTES \ PROPOSED WATER — o \ SERVICE 5> \\\ 1.THE OWTS SHALL BE MODEL CEN-10 MANUFACTURED BY FUJICLEAN USA. \ � \� ---- "---- ---BU LDII�IG PERMIT SURVEY r EXISTING WATER O \\ 2.THE DESIGN ENGINEER,FUJICLEAN USA REPRESENTATIVE,AND SCDHS \ SERVICE TO BE O, A, \\ REPRESENTATIVES SHALL OBSERVE THE INSTALLATION OF THE OWTS AND LEACHING \ ABANDONED ry qp \ County Tax Map District 1000 Section 74 Block 01 Lot 35.56 SYSTEM. APPROVAL FROM ALL THREE PRIOR TO BACKFILL. , g �jL 6 WELL FIELD SURVEY COMPLETED DEC.10,2019 a 3.THE SYSTEM START UP WILL BE COMPLETED UNDER THE DIRECT SUPERVISION OF A RGA DRIVEWAY TC BE e MAP PREPARED AUG.19,2021 FUJICLEAN USA REPRESENTATIVE. RELOCATED ,0 b Record of Revisions 4.AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE \\ �J h S °fi REVISION DATE MAINTENANCE PROVIDER AND PROPERTY OWNER MUST BE SUBMITTED TO THE LOT COVERAGE GENERAL AMENDMENTS SEPT.08,2021 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES(SCI)HS)PRIOR TO APPROVAL OF - EXISTING g, SCDHS NOIR#1 OCT 26 2021 THE I/A OWTS REGISTRATION BY THE SCDHS IN ACCORDANCE WITH ARTICLE 19 OF 1 STORY FRAME HOUSE = 867 SQ.FT. = 1.6% \ GENERAL AMENDMENTS APR.13 2022 THE SUFFOLK COUNTY SANITARY CODE. \ ' AMENDED BUILDING PERMIT DATA MAY 16 2022 0` � 5.ARCHITECT TO VERIFY FINISHED FLOOR ELEVATION(S). TOTAL=867 SQ.FT. = 1.6% DKPROPOSED 2 STORY FRAME HOUSE = 1,786 SQ.FT. \ LFI ° 6.THERE ARE NO EXISTING OR PROPOSED GAS SERVICES. SCREEN PORCH = 241 SQ.FT. \ (2)V DIA,x IO'ED /1\ DECK =497 SQ.FT. 7.EXISTING ELECTRIC SERVICE IS BY OVERHEAD WIRES. PORCH = 255 SQ.FT. \ POOL = 800 SQ.FT. \ Q 40 0 20 40 80 120 TOTAL=3,579 SQ.FT. = 6.7% \\ '�pP4 SCale: 1" — 40' a. JOB NO.2021-0241 DWG. 2015_0067_2021_0241_bp 1 OF 3 (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY 15 A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EMSTINC STRUCTURES ARE FOR A SPECIFIC PURP,SF AND ARE NOT TO BE USED TO ESTABIJSH PROPERTY LINES OR FOR ERECTION OF FENCES.(S)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INS11TUP.ON CERTFICAnONS ARE NOT TRANSFERABLE TO ADDITONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)@ CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. HEALTH DEPARTMENT USE p qdq \ to X PROPOSED WATER 5ERVIGE S FE. `o ��,�� Boa✓ * New00 Ostrander Avenue, Riverhead, York I1a01 •9 O J S o , � d \ 5 tel. 631.727.2303 fax. 631."72 .0144 co \/ ra , h� f oB \\ �'' 16ti admin®youngenglneering.com O O E:1 1 \o $• LF5 S \ p c S �-t Og'� 8'DIA.x b'ED 9 XSg�rE \ BOJ��OOS�, LPI �� \ LP3 \ qoma\ / \ \ Howard N. Young, Land Surveyor 0,Y \ EX.SANITARY SYSTEM TO BE 2 Thomas G. Nolpert, Professional Engineer ABANDONED IN ACCORDANCE \ WITH 5,-'CHS STANDARDS Douglas E. Adams, Professional Engineer \ A ,\o \\ \\6- 7c Robert G. Tost, Architect \ 9 0 \ PROPOSED ` \ ,9\ \ a '� � .' \ SANITARY SYSTEM ) \ \ RIVEHAY 5WIMMIN6 POOL \ PROPOSED D15GHARISE ; \ \ sus SITE DATA \ e'DIA.x 4'ED WSo AREA 1.21-I8 ACRES OR 55,04a SQ. FT. N PROPOSED WATER SERVICE *SUBDIVISION-"MAP OF BLUE HORIZONS"FILED IN THE OFFICE OF THE \ 90 R \\\ CLERK OF SUFFOLK COUNTY ON SEPT.30,1985 AS MAP NO.7974. \ \\ O \ EXISTING WATER �\ * VERTICAL DATUM SERVICE TO BE =NAV DATUM(1988) � \ \\ �,� \ ABANDONED Pay qp s *ZONING USE DISTRICT =RESIDENTIAL LOW DENSITY 1 ACRE(R-40) o�C � &RESORT RESIDENTIAL(RR) t �G6 *GAS SERVICE NOT AVAILABLE RGA DRIVEWAY TO BE e RELOCATED r� *FINISHED FLOORS ELEVATION TO BE VERIFIED BY ARCHITECT qAM \ ) _! S 10 \ LFI Try / 4 _ \ (2) 8'DIA.x 10'ED �— \ ENGINEER'S, CTERTIFICATION I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL \ �Y SYSTEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR,UNDER MY DIRECTION.BASED UPON A CAREFUL AND THOROUGH.STUDY t7FTHE--SOIL, SITE AND GROUNDWATER CONDITIONS,ALL FACILITES,AS`PROPOSED;,, \ t,Q- CONFORM TO THE SUFFOLK COUNTY DEPARTMENT of HEALTH SERVICES K' CONSTRUCTION STANDARDS IN EFFECT AS OF TI fI5 DATE." ro " a 0� of �` .�(/ \jam •(` � O,(, `gas 1 p Q HOWARD W.YOUNG,N.Y.S.L.S.NO.45893n / THOMAS C.WOLPERT,N.Y.S.P.E.NO. /f / DOUGLAS E.ADAMS,N.Y.S.P.E.NO.80897 ~`�• ,_ _, -''` N � N SURVEYOR'S ERTIFICATIQIU---..-- PNE HEREBY CERTIFY TO J O NATHAN I j ~ v Y R B E L•L\'1'HAT�T�f15 SO' 5URVEY NA5 PREPARED IN ACCORDANCE IT"P'laT'HE COVE',OF`' �i PRACTICE FOR LAND SURVEYS ADOPTEDNEW'YORK'S,TAT I A55OCIATION OF PROFESSIONAL LAND SUi \pe HOWARD W.YOUNG,N.Y.S.L.S.NO.45893 `s ID —�, SURVEY FOR JONATHAN REBELL 96 3� a LOT 6, "MAP OF BLUE HORIZONS" \ ""w at Peconic, Town of Southold Suffolk County, New York BUILDING PERMIT SURVEY \ \ County Tax Mop District 1000 Section 74 Block 01 Lot 35.56 o \\ FIELD SURVEY COMPLETED DEC. 10,2019 a y MAP PREPARED AUG.19,2021 6�0 o Record of Revisions REVISION DATE GENERAL AMENDMENTS SEPT 08 2021 SCDHS NOIA#1 OCT 26 2021 GENERAL AMENDMENTS APR.13.2022 AMENDED BUILDING PERMIT DATA MAY 16.2022 N �\� Q ,9 m 40 0 20 40 80 120 Scale: V = 40' JOB NO.2021-0241 DWG. 2015_0067_2021_0241_bp 2 OF 3 (1)UNAUTHOR17ED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EMSTINO STRUCTURES ARE FOR A SPECIFIC PURPOSE AID ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT REARING THE LAND SURVEYOR'S INKED SEAL OR EMROSSFD SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY 4 CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTIUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)h CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHE S. HEALTH DEPARTMENT USE -1/2' VENTILATION PIPE SCUM BAFFLE 400 Ostrander Avenue, Riverhead, New York 11401 -11 -6' 3'-3 �g1 CHAMBER Volume al tel. 651.727.2505 fox. ngi 51 Bring com 3' ' '-6' Q Sedimentation Chamber 558 Q Anaerobic Filtration Chamber 556—REC � � h} RCULATION Q Aerobic Contact Filtration Chamber 248© AIR ILIFT PUMPg Stora e Chamber 125 �J ISINFECTION © Disinfection Chamber 11 Howard W. Young, Land Surveyor . ® CYLINDER (OPTIONAL) Total Volume 1,498 Thomas C. Hol ort Professional Engineer Douglas E. Adams, Professional Engineer 4' INLET PIPE ' OUTLET PIPE :=!^ 5-91 SPECIFICATIONS Robert G. Tost, Architect i Anaerobic Media PP/PL' Filling Rate 46% AIR L UFTT PUMP Board Type Aerobic Media PVC/PP/PE Filling Rate 170/0 Aerobic Media PP/PE Filling Rate 54% INLET BAFFLE © Blower 3.0 cfm Tank FRP Piping PVC/PP/PE RECIAccess Covers Plastic/Cast Iron LOW OPENING PIPE (CLO ANINGFOPENING)LE 1/2' AIR INTAKE Disinfectant(Optional) Chlorine Tablets FLOW OPENING (TYP. B ( p ) PLAN VIEW METER 18' MANHOLE (TYP 16' MANHOLE (TYP 24' MANHOLE (TYP ISINFECTION 4' MANHOLE INCOMING SERVICE CYLINDER (OPTIONAL) LOW OPENING DEDICATED 1'-4' 1-61 OARD TYPE 15 AMP BREAKER CONTACT MEDIA X. 120V AG, 10, 601-11Z, 15 AMP POHER SUPPLY #12-2 AWG WITH GND IN I" PVC CONDUIT MAIN ECIRCULATIDN SERV ICE ASSEMBLY PANEL 6'-5' 5'-2' © 4' ' ® 4'-11 ' HARDV'iI RE © © © EROBIC MEDIA ERATION ASSEMBLY ENGINEER'S CERTIFICATION 6ROUND SIM RHOMBUS AIR BLOWER "I HEREBY CERTIFY THAT THE WATER SUPPLY(5)AND/OR SEWAGE DISPOSAL CONTROL SY5TEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY SECTION A-A VIEW SECTION B-B VIEW PANEL DIRECTION.BASED UPON A CAREFUL AND THORYGHDY"� iCw4iQIL, SITE AND GROUNDWATER CONDITIONS,ALL FA s�xs FR0MStD,,,, CONFORM TO THE SUFFOLK COUNTY DEPARTME 'FAL, SEFI1/ Cf"5� FUJICLEAN USA CEN-10 ELECTRICAL ONE-LINE DIAGRAM CONSTRUCTION STANDARDS IN EFFECT AS OFL "` NOTE: ALL CONDUITS CONTROL PANEL MOUNTED o BETWEEN PANEL AND N 4"x4" PRESSURE �i 1 �• TREATED WOOD P05T5 TREATMENT TANK MUST BE ((%%'/« vv r •, f:'"t .:r. ,_.. ? ALARM/CONTROL SEALED TO PREVENT 6A5 7 • . t PANEL MDL#1041412 LEAKAGE INTO PANEL. HOWARD W.YOUNG,N.Y.S.L.S.NO.45893n CONTROLLER "A„ AIR BLOWER \\ 'OI MFG BY SJE RHOMBUS FOR HIM COMMUNICATION DOOUGLAS E ADAMS,N.Y.S. .E.NO. 08983 t �, N INSULATED WEATHER DEVICE; ` --- v ONGLOSURE SISTANT BLOWER USE ALARM/CONTROL PANEL MDL#1045040 SURVEYOR'S CERTIFICATION-- i € 4;� L CONTROLLER "C" MFG BY 5JE RHOMBUS r-WE HEREBY CERTIFY TO JONATHAN B' LIL THX,[YIHJ5Z ' SURVEY WAS PREPARED IN ACCORDANCE 1714 E'GoQ>= Qf= .P PRACTICE FOR LAND SURVEYS ADOPTED P,�Y/ THF�'NEk YORt:�S ,AT , N �� I AIR LINE TO ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.- FUJICLEAN OHTS FIN. GRADEEz ELECTRIC, SUPPLY �! • F ' ", ` -' Y ELECTRICAL HOWARD W.YOUNG,N.Y. .L.S.NO.45893 ' 2 STORY SWEET AIR VENT GAP TO BLOWER TO LL FRAME HOUSE MFG BY TUF-TITE SUPPLY FUJICLEAN r },, (-1 BEDROOMS) (5' MIN FROM ANY OHT5 SPLICE BOX FFEL=47.0 [POOR OR WINDOW) CONTROL PANEL $ BLOWER 57' SCALE: NTS SURVEY FOR 4" PVC, T 2.00% MIN. JONATHAN REBELL z 5' 5' 24' „ 4" PVC ® RISERS d COVERS 4„ PVG ® LOT 6, MAP OF BLUE HORIZONS,( ao LOCKING WITH SAFETY LIDS LOCKING 4 PVC CASTING TO 2.0096 MIN. MFG BY TUF-TITE OR 1.0090 MIN. CA5TING TO I.00% MIN. at P2COntC, Town of Southold EL=35.0 GRADE APPROVED EQUAL GRADE Suffolk County, New York N RIM=55.-T RIM=35.5 RIM=53 3 PRECAST TOP SLAB FROM r STORY N .-____„ y EL=33.0 OR DOME BUILDING PERMIT SURVEY 1 HOUSE GONG. COVER 1 — ------AIR LINE---P County Tax Mop District 1000 Section 74 Block 01 Lot 35.56 IE=31.0 FIELD SURVEY COMPLETED DEC.10,2019 a IE=24.86 IE=24.-16 5" VENT IE=24.44 - HOLE IE=24.44 _ IE=24.34 IE=2x.10 MAP PREPARED AUG.19,2021 CONNECT 5" PVC, VENT LINE 4 IE-24.66 -4, Record of Revisions TO VENT HOLE IN OWST POURED CONCRETE INVERT SEE DETAIL FOR REVISION 4' DIA. D15TRIBUTION BOX DATE OWTS COMPONENTS GENERAL AMENDMENTS SEPT 08 2021 PROVIDE GLEAN OUT AT 4' DIA. DISTRIBUTION BOX PROVIDE END GAP LEVELING DEVICE LP2 FACE OF BUILDING SCDHS NOIR#1 OCT 26 2021 MDL#5L-4 MFG BY 7UF-TITE OR GENERAL AMENDMENTS APR.13.2022 AIR LINE TO BLOWER APPROVED EQUAL FOR ALL AMENDED BUILDING PERMIT DATA MAY 16,2022 DISTRIBUTION BOX CUTLET PIPE5 1,000 GAL. I/A OWT5 MDL. GEN-10 MFG. BY FUJICLEAN USA a N In 8 40 0 20 40 80 120 HYDRAULIC PROFILE a SANITARY LEACHING POOL -- Scale: 1" - 40' TOTAL OF (5) POOLS 525 5F51NA JOB NO. 2021-0241 DWG.2015_0067_2021_0241_bp 3 OF 3 Glenn Goldsmith,President S11FFl.�a Cp "w= Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski ti a Liz Gillool o P.O.Box 1179 Y ti p! Southold,NY 11971 Elizabeth Peeples �Odr �, ' 631 Telephone 765-1892 P ( ) Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 1311122- Completed in field by: ECIZ44e �eelp�t� Thomas C. Wolpert, P.E., on behalf of JONATHAN REBELL & NOAH LEVINE requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a new 1,786sq.ft. two-story frame dwelling with a 241 sq.ft. screen porch, a 497sq.ft. deck with trellis and 69sq.ft. stairs to ground, a 255sq.ft. side porch with 121sq.ft. stairs to ground, an 800sq.ft. swimming pool; one (1) 8' dia. by 10' effect. Depth discharge drywell for the pool, new I/A sanitary system and removal of existing conventional sewage disposal system. Located: 4790 Blue Horizon Bluffs, Peconic. SCTM#: 1000-74-1-35.56 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Typp of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: No -tt \ ad vve is - h ; + 1 c ble Ye IDT housr_ hack C 1 oy�slde of iurisdicEian? And no+ iW�back adiaceW a�rell� Probev� WOLs 5-6UA �r ,tw�((i staler �vwel(, Present Were: G. Goldsmith N. Kr pski E. Sepenoski L. Gillooly N. Peeples � •+�f u�F�' 4 t�y����1SV K�r _ i t r Ar r f� . '` rt �t�� .��-�� ` '�. __ �r� , _� • ,C ^ •tis -. alt. tL•w p 7 kIW�MA,irwn..r/1�„�+Il�/Af. i� •'� iermr+�.lL�'{:►e..r..... ifsw'-/p li1►,r�_ ,,•1 °; �� bb1,4 �•[f����� �..µ +ms J Y. a Sol rye' 334 44 k. 11� - _ t3 �-f'�'4 yam•.I Y`F fes? 'r;'�. / . r ► t� ������ -. t � .ice ` "•� •� _ � `9[ - . r .,• - ,. � .��, `e F ; �,s ;.., '454' sk e,�Y' 'acs...: _ -,_ _'_ urea w.•y '�, H �� -[ 4.�+ . PHOTO • NOAH LEVINE AT • • SOUTHOLD, 45.E �A `4 1 1 PHOTO NO. 5 JONATHAN REBELL & NOAH LEVINE AT PECONIC, T/O SOUTHOLD, NY JUNE, 2018 MB9> f�3" �r�.•. � _ ,.tE>Ec No P3tl xz 9 �•-'N,� z aarcN � nt _ _ - Bzmar , Bowl- WSOD1�� iNNI... a 3EW6i1Y4A'nnC a>a - ,'L-.. Sm(0 o>. �, �� rWc., •"___. ... .._"..... 4P f. e• NE��l - " J �w- � °� r' � ,'� '-s_ v-__ � "- .'Jl �,i1 J •, tiJ e ! A $0 J J w k f 1 c za4 1 k ., ..W,. a.SNc) y A 9 t yG J P� ,e ,, Q5o y u NwILLUL �" s' Broo-u g J $'�D w ;2: SBS w �.k .,.r w $�o• M t J i'mow .«, .�'w.rc, r y �•�ia ' te„�� �4;i' ,�,o...", e �3 'e 3i �9�o.• X � w • �%� 4�" •R i��'..- as J 2 ,EM1;% t % IOVM OFSW1N0.0 WO �d _ e.51 ��✓' k ryas' v� �'' 31, d�' z w 4: a ce.aw a,nw� Im vn.No. 61MIo1 Y „a BEF 8B a N4 44t M t e \ S FO � � ..,� .-. �,,,- •., mar,�.. ... `. ,, � �„� � aEE BEL MO.O°6 COUNTY OF SUFFOLK CoN ranee ,ow secria+rn to __�_ _ _y5•n_ —_ O y”' .._ ••` '�1vQ ` Real Pr p ry T..8—i-Agency ,S.mre+Nz�.nta nw sxc an v W E o-s uN or>HE M1.4 �' I�- ,awn WYIIWLD U'�• A 1211 OFFICE LOCATION: h *0f SU(/ryO! MAILING.ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold,NY 11971 Telephone: 631765-1938 �';teft 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: August 10, 2022 Re: LWRP Coastal Consistency Review for JONATHAN REBELL & NOAH LEVINE SCTM# 1000-74-1-35.56 Thomas C. Wolpert, P.E., on behalf of JONATHAN REBELL & NOAH LEVINE requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a new 1,786sq.ft. two-story frame dwelling with a 241 sq.ft. screen porch, a 497sq.ft. deck with trellis and 69sq.ft. stairs to ground, a 255sq.ft. side porch with 121 sq.ft. stairs to ground, an 800sq.ft. swimming pool; one (1) 8' dia. by 10' effect. Depth discharge drywell for the pool, new I/A sanitary system and removal of existing conventional sewage disposal system. Located: 4790 Blue Horizon Bluffs, Peconic. SCTM#: 1000-74-1-35.56 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 proposal is CONSISTENT with LWRP Policies. 1. This recommendation takes into account the permits and work to stabilize bluff erosion. 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: Honorable Lori Hulse, Attorney Michael J.Domino,President ®; Town Hall Annex John M.Bredemeyer III,Vice-President ~ ' 54375 Route 25 P.O.Box 1179 Charles J.Sanders i, Southold,New York 11971 Glenn Goldsmith `'. - �=-.v,..... '��: Telephone(631) 765-1892 A. Nicholas KrupskiC Fax(631)765-6641 I30ARI) OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only ,Coastal Erosion Permit Application Wetland Permit Application 11 _Administrative Permit --��c Amendment/Transfer/Extension V Received Application: 7.11 AX Received Fee: $ ✓ Completed Application: Incomplete:. .. .. ._ 5EQRA Classification: Type I_ Type II_ Unlisted ' ®e Lead Agency Determination: D M _ oordination:(date sent):._ _ ... WRP Consistency Assessment Form Sent: V XAC Referral Sent:. JUL 1 1 2022 Date of inspection: . ►-7,9X: Receipt of CAC Report: Southold Town Technical Review: Board of Trustees -Public Hearing Held: zZ. Resolution:_____ .. Legal Name of Property Owner(s): L20Q1th= &10! t i- Nloet h L-t!Offing,, 36® cen-rott pgrtc wesf.1 AP-11. MOE Mailing Address: Phone Number: . 917— A93 — j 4 66 Suffolk County Tax Map Number: 1000- Property Location: . R1,!a of. Wav C)Orffi. ®ic tjidj2k Road C �• �. �� (If necessary,provide LILCO Pole#,distance to cross streets,and location) 47 90 51kWe Hvrl71-An AGENT(If applicable):. YOB 4- YOVl,1� r.]=- .- r,Z0/YdCr� C. �/0 olp -4-, P.ff. -- LL Mailing Address: . 40.0_ Win. fiwn der . Ave,."._r-9_i 1�-ecid 1 NY .119, 01 Phone Number:-_ Board of Trustees Application GENERAL DATA Land Area(in square feet):_ j.9, 04- !rC Area Zoning: RR R-eSor+ Rens cle/'?4f al Previous use of property: 5 I nA ►M i�l� re51 G�cam. Intended use of property: S% i q pmt Cl'CnGG 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 No Does the structure(s)on property have a valid Certificate of Occupancy? 1/ Yes No Prior permits/approvals for site improvements: Agency Date -50 fb.o(d Trusfee s .Tiny l8, 2�2 D e�c�i rcr-f iOn aPaY1 t r S-fvaf'%✓C (arm 4 NO. : 924 1A 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): cofCrfFetchr'ncr94 d 'T 3oard of Trustees Applica- in WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Re-Per- Area �-F'« d at-e� -.Tiny � 2a2Z Area of wetlands on lot:_ o square feet Percent coverage of lot: $ 3 _ % ( 4-14 4-& sF Closest distance between nearest existing structure and upland edge of wetlands: 26 3 feet Closest distance between nearest proposed structure and upland edge of wetlands:: 1e2 feet Does the project involve excavation or filling? - No Yes If yes, how much material will be excavated? 317 cubic yards How much material will be filled? . 317 cubic yards Depth of which material will be removed or deposited: . 3 feet Proposed slope throughout the area of operations: 46 Manner in which material will be removed or deposited: A bockh oe—, w-111 b-e- used Jv reranave and deposit wcrfcricd w'rteon -fG�-c c�rec� � oo�er�3oo�s 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): Th e rG will fx. np e-FF'c4 1>n -th c VV eV cruel and -I dctl wajev nyr -Mc- 7-owr7 -fh,r- preposed oyer o-hon s , 1 July 9, 2018 Revised July 7, 2022 ATTACHMENT TO BOARD OF TRUSTEES APPLICATION prepared for Jonathan Rebell & Noah Levine at Peconic, T/O Southold, New York Proiect Description The project consists of constructing a new 2 story frame house (1,786 sf), screen porch (241 sf), deck with trellis (497 sf) and stairs (69 sf), side porch (255 sf) and stairs (121 sf), pool (800 sf), one (1) 8' dia. by 10' effect. depth discharge dry well for the pool, new sanitary system (IAOWTS), and storm water control structures, ie. LF 1 — (2) 8'dia. by 10' effect. depth leaching pools, LF 2 — (1) 8'dia. by 10' effect. depth leaching pool, and LF 3 — one (1) 8' dia. by 6' effect. depth leaching pool. The project also consists of removing an existing conventional sewage disposal system. 617.20 Appendia:B Short Environmental Assessment Form Imtrudions_for_CbIn liWi nR. Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part I. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. if additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information Name of Action or Project: Ton o-than Feb..--11 4- N o h Le vi r)-- Project Location(describe,and attach a location map): Right o-f w-m y nor l-A o-F Hiddle- woad Cc. R.48) appr-ox.. Wes+ o-F Hen r 's Lan e- cls -Pec-onic T/o Soc rl%lotd Brief Description of Proposed Action: Name of Applicant or Sponsor: Telephone: 631-7,17—:2-30-3 l�Ou :_ T O S . W0 er4 E-Iv1ai1 fc,W ocr a inePrl veyl Address. Dova �Pcr o vim )�� i �/�erh ead' y City/PO: State: Zip Code: i Verh<ced N~Yark 1 ( gof 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-narrati-v -description of the intent of the proposed action and_the_environmentaLresources that ® El maybe 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: 5Ca 45_Approvoct -bQ con-,7iwct Wgfcf' Sapp/y. + S-eww DNP0501 0 NYSDG C - Tid WeHaAd PerMff Ar Lair', o-' NoJer's4ic`hon 3.a.Total acreage of the site of the proposed action? /. 2- acres b.Total acreage to be physically disturbed? (�,2:, 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 Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic 0 ther(specify): Oo,"am SA dr c-'-_ ❑Parkland Page 1 of 4 5. Is the.proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ L1 b.Consistent with the adopted comprehensive plan? El ❑ ❑ 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 does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10.. Will the proposed action connect to an existing public/private water'supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providin wastewater treatment: a ElN.ew Sctnifarte, Sys ZA Vi/rn 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Z ❑ 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? a 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 ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ® ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES 1f Yes, ✓ F-1 ❑ a.Will storm water discharges flow to adjacent properties? ❑NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES IV,-w aPryw�!!s -�or� rov,F rano F-F 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:, s 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:, F/I a 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: a I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE You. + young " Applicant/sponsor name:. f��-�-n ; f]�jy�q S c. VV O A� f �-- Datet .TU 7 2 2 2. 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 action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning a 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? (� -4Wilt-the proposed action have an impact on the environmental c-harac eras ics that caused the ❑� n establishment of a Critical Environmental Area(CEA)? L-1 5. Will the proposed action result in an adverse change in the existing level of traffic or 1:1affect existing infrastructure for mass transit,biking or walkway? El 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? FI 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? El 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 p 11. Will the proposed action create a hazard to environmental resources or human health? :El 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 ifyou 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. 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 Mage 4 of 4 Board of Trustees Applic - 'Lon AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000-_ 74- O 3Sa �5 Co in the town of So u4iol d ,New York, hereby authorizes Young Yount, Afin ; Th(2mas (f, l.'i/a/.r�-ei - , FE, 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. t Property Owner's SignaturePr erty Owner's Signature SWORN TO BEFORE ME THIS DAY OF —� --- 20 Notary Public BARBARA H.TANDY Notary Public,State Of New York No. 01TAeo86001 Qualified In Suffolk Count' Commission Expires 01/13/20 L3 t Board of Trustees Appli<—-,ion AFFIDAVIT Jon aiG�n Rebe-1N/octh L-eVinC_ BEING DULY-SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED-PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF,HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE -M 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 PLRMIT(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 ENTERONTOMY 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 Property Owner - Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF +\e ;20 ZZ MARTIN KRASNOFF V log (I Notary Public,State of New York No.01KR5048735 Qualified in.New York County Notary Pu iC Certificate Filed in New York Coun Commission Expires August 28, APPLICANVAGENTAREPRESENTATM TRANSACTIONAL DISCLOSURE FORD Tie fiovVn ofSouthoid's Code of Ethics pmhibits'conflicts ofinterest-o»ibo gart ofWm Mftrsand•emoTWds.The Mggggpof this form is to-provide ibforination which can alio the toivvi of liossible obnflicts Df intetesrand allow it to fake whatever action is Eecessary,to avoid saitiie. YOURNAAM. Rtfb'ell , Tuna mon I- i–eUin_ E__�_ A1Qor� (bast name,first name,4piddle initial,unless you are apptyin i®the name of someone else or other entity,such-asa company.If so,indicate.'the other person's or compatry's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Tnistee Change of Zone Coastal Erasion Approval of plat Mooring -Exemption from plat or official reap Planning Other (if"Other';name the-activity:) Do you-persoaaaliy(or-through you%coinpany,spouse;sitiIing,patenii or ehild)have:a relationship with fury offtcdr or employee of the Town of Southold? "Relationship"includes.by blood,tgauri C or business interest"Business interest'means a business, including A partnership,io which the'town oificer or employee has even a partial ownership of(or employment by)a•eorpoiab6n in which the�towa offiCer or employee owns more than.Mof 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 cheek 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 ofll_to applicant (when the apolicant isa, corporation);—___— B)the legal or beneficial owner of any'ioteiest 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 6 da of lune 0 22 Signature e Print .Tori�:rrr�rra f2e�e(1 d� .l�loaf� L-_Vi0e_ Form TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. 'Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# l o o o - 7¢ - 01 — 3,9 , S The Application has been submitted to(check appropriate response): Town Board D Planning Dept. 0 Building Dept. 0 Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital 0 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: C4+'15"f rU of a new fin"SG . Strcen P,o r=6 G��cf c S-{�a i r5 Stv) JY) (.L4 .D f oo-P rcm c oVC `+ 'IC X3 Cort vc h nark �.Fewa9,e o+rspp0Sot S y,s4e/r . � 'Y r �o �'ff i�h ry�craf daft Tu/g 7. 2024 ) R 9h+ of wc+y Location of action: Opp ro x . 510 UVcsf a7-^ �4e n ry l s Lan q--- crf- R—can iG Site acreage: 53 O 4-`) r 1. 12. Q cres Present land use: 5i r)g(,c -Pem i Iy resiotemli a Present zoning classification: RR— Pr s orl- P-cSiden*a 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: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes Z No❑ If yes,which state or federal agency? N YS D E G 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. Q Yes No Not Applicable Consfrwcf et new 2 s-fone i5wme housa arld re(crtec( Sfnw frdre-s a nn j n i M N N1 c�t s�anc C- a¢ !UQ ' I and r erp-d cf -fh� c'r-rs-F aF bl�rF 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 0 No 0 Not Applicable l � 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 0 No 0 Not Applicable f?-e-Fcr -F7 Po f ig\ I Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria © Yes El No © Not Applicable �P,��cr �bltcy ! respons� . 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 0 No 0 Not Applicable Reare ri -ry ?Fyl tc x l r'csyan s,— Attach cAttach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes 0 No 0 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® 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 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. © YesCl 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. ❑ 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 RP-re✓' +0 Fol(5�'e l re s p n Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No® Not Applicable 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 Fre(tea re d 73 y : T h v nrrn cr s C. I NOper`f' j P. E. /�1 den t -For ©+pp!i c+gl)-A Jo ' 7 2022 Created on 512510511:20 AM - tb YOUNG &YOUNG Telephone (631) 727-2303 400 Ostrander Avenue Facsimile (631) 727-0144- Riverhead,New York 11901 admin@youngengineering.com HOWARD W. YOUNG,Land Surveyor THOMAS C.WOLPERT,Professional Engineer DOUGLAS ADAMS,Professional Engineer/Geolo ist ROBERT C. TAST,Architect ROBERT STROMSKI,Architect July 7, 2022 Town of Southold Board of Trustees Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 . D RE: Proposed Residence & Pool jot 1 2022 JONATHAN REBELL & NOAH LEVINE Lot 6, "Map of Blue Horizons" Southo►dTown at Peconic, T/0 Southold, NY Board ofTrustees (21-0241) SCTM No.: 1000-74-01-35.56 Dear Members of the Board: Enclosed are the following items: 1. application fee —Jonathan E. Rebell check no. 346 payable to 'Town of Southold' in the amount of One Hundred Dollars ($100.00), 2. one (1) original & three (3) copies—Administrative Permit Application and Attachment dated July 7, 2022, 3. one (1) original & three (3) copies—Short Environmental Assessment Form, 4. one (1) original & three (3) copies—Authorization Form, . 5. one (1) original & three (3) copies—Affidavit, 6. one (1) original & three (3) copies—Applicant Transactional Disclosure Form, 7. one (1) original & three (3) copies— LWRP Consistency Assessment Form, 8. four (4) color copies— Photograph Nos. 1-5 dated August, 2017 and Planning Engineering Land Surveying tY J 1 Page 2of2 July 7, 2022 9. four (4) prints —Building Permit Survey (Sheets 1-3 of 3) last dated May 16, 2022 depicting the existing conditions and proposed improvements. We understand that submission of these documents enables you to complete your review of this application. If you have any questions, please contact us. Very truly yours, Thomas C. Wolpert TCW/cw Encl. cc. Mr. Jonathan Rebell + encl. + 1 print