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HomeMy WebLinkAboutBennett, Benjamin & Carolyn ®� U Glenn Goldsmith,President s® Town Hall Annex®�� ��je®� A. Nicholas Krupski,Vice President ® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly � @ Telephone (631) 765-1892 Elizabeth Peeples ® �® Fax(631) 765-6641 C®UNTY,� BOARD OF TOWN TRUSTEES TOWN,OF SOUTHOLD March 3, 2023 Robert E. Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: BENJAMIN & CAROLYN BENNETT 1220 NINTH STREET, GREENPORT SCTM#: 1000-45-6-9.2 Dear Mr. Hermann: The Southold Town Board of Trustees reviewed your letter dated January 23, 2023, along with the survey prepared by Scalice Land Surveying, last dated January 20, 2023, and determined that the proposed construction of a single-family dwelling (to be connected to Greenport Sewer District), a swimming pool, and a tennis court on the captioned property are out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. All mature trees should be protected during construction activities. Any construction activity or disturbance seaward of the limit of Trustee jurisdiction will require an application for full permit. Additionally, any structure proposed seaward of the line of jurisdiction will require a permit as well. With any future permits it would be looked favorably upon if there was a plan for tree replacement and a non-turf buffer. Please be advised, however, that no clearing, no removal of vegetation, no cut or fill of land or removal of sod, no construction, sedimentation, or disturbance of any kind may take place within 100' landward from the top of the bluff, or seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without further application to, 2 and written authorization from, the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken,to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Glenn Goldsmith, President Board of Trustees GG:dd BEARINGS SHOWN HEREON ARE BASED �' {� _ o SYMBOL LEGEND D MONUMENT FND ® MANHOLE TEST HOLE ON FILE MAP N0. 10025 3 OPS 0��� e�o ® I.P. /I.B. FND 10 "A'-INLET TREE ■ j � (Jl < a r 9 I.P. /I.B. SET I "B"-INLET SHRUB _ Z *,p3 SPOT ELEVATIONS ® YARD INLET • BOLLARD f'"r""+"'-`"'*.°; z u �7yy1�{, o �z # _° L �,. JJ JJJ J JJJYA• toFw✓, �) UTILITY POLE ® YARD INLET ® WETLAND FLAG ._: p p p p p p p p p = Q $w > — GUY WIRE © ELECTRIC METER CANT. CANTILEVER U 2 r J 4 b i UTILITY POLE W/LIGHT © GAS METER FE.FENCE ( LIGHT POLE ❑W WATER METER MAS.MASONRYcN� N Ln to I- m m m m m SIGN M GAS VALVE PLAT.PLATFORM CEJ m m m m m CO —v- PVC FENCE (PVC) rn W.W.WINDOW WELLF im —�- STOCKADE FENCE (STK) D4 WATER VALVE B/W BAY WINDOW S f { —X— CHAIN LINK FENCE (CLF)O/H OVERHANG CV 15 ( ) C/E CELLAR ENTRANCE —— WIRE FENCE R/O ROOF OVER N w a FIRE HYDRANT D.C.DEPRESSED CURB Z A/C UNIT ® CROSS CUT G.O.L. GENERALLY ON LINE STAKE - 4 { O a � 6 O O/L ON LINE OO p y z � F z rr V ' $ (FOR HEALTH DEPARTMENT USE ONLY) < a �� 1 M 0 a o > _'.. a� Ld ~ Q Q n� n G,�o pwd yam ° Q � =�3 > Llwo Z Q o � X : � 05 5;< pm w w (n 0- w w0 y �� d0_ O � �ml- rc O � � ~ °pzLL Oz Op>- ?- O >-O wow° D w wwwwwwwu =�w� A NQIn(n » Y > YU N =W LRS 5W55DDQDQv> RAI wwww » Cnw(- w A1V D NNNNNNNNN arzom^ G jSL OONcli o 0y 1 _ f— NNNNNNNNN -aiai L _ — O O d CN 00 t7 COQ �OS< ) N O N O N - O p O o°aG _ _ _ o O O p N O O O V zdot'� I� CO to d r7 1'+0 N (18•) 37 x,a.az ._ I I p4 ? 8ON VACANT / WOWED (8") 1 1 LOT x se5 x+36' `x+~� (1z")s:r 554.39, _ , e . f \ c>IF P D 1 Pte,'w�m vii F No avn ,�°c°W" (iZ") �.sa� x,3.55 SO' `* J w N/O x i..,�7,` - a '(t� K � ia�€ CREENPORT, LLC (t2'j.r' (1�)`w�44')a a "''1'1.•��a SET tT3.93 x+y9gl w 3 THE MEADOWS AT RBR 1 Q� FM LOT 9.1 I ar!T^�r a •.(t fi")j 1 l� o TA/i W \L —_�r a —•a r (270.0') 5 t {u,"�n O 1 E W r v i r 13.5 Q w I i SET x q, r _ r (Z�Y) ., .� �. ...��_._____—.r— —���__ sN ►" s r(8 a six .' �()�,>3g' , (2°) —` _ _ 3 ' x 'r pltopo5ED TO&W -_-___-___� STK -Y -- STK ((61r S)bq x,st1 IS`l] Oi (74" #t+°aryry'20s. T (72.)�� OcO1 K 33W„O Wp< m +z0 -- VACANT \v / (81�Q Q �� W WOODED \ ;// a LOT \ K6�`' x,3r F' CIDN N Q' uc 1 , } i 1 n A8• \�� 320' 1 -- \ rcu jN�9 (18). m 5Pj 5(\� 1k9� 1 06.)I�(o i (}a O J o w a�o SE 5� 14• 1 ~ Q FM LOT 2 (4•) _r'( ) x 1 ' I,3 h ! �' O I N SQ�a` TAX LOT 9.2 (t > ; (1°") ,S.a� 1 1,3 3 z p 0 � s w E. ; ', 1 { 100• x n es , eFt { 42D aea x o a I I ,_ J 1 LI 14 1 1 ++75 ' 65 m 1 1 j �i � =Jam 1 ,eO 8 PR 1 I I O ° WETLANDS ;6• , I I f e %A. srnc wi Kmr OPOSEp t I I 1 F w r I � I r ► 1 'zz aj x,3. PR��D xo aI.-M e9' oL ZRT ee x ! I � w 6 6 E5 TAX LOT 8 I rnuc tnrlJlm�eovnuQ I E'�t 1 ►e x\� 5 r pECA \ \ ;t3. 1 O O P a nur AAs ao>d (t8) i A (18" s p q �c 206 gtK \ \ I 01 X .- .- -W • I 1 ' L ) \ LLJ a di 20.0' azx \ (t°'� ! © C�) M< CN '� EyS ,3+�x \ , IM I^1 H d ►7 Z #J�� (121)it PROP. as.u' •'N�ID4e x a O w U o W w I 11 l a B _ x sa 1 I x,a `� 12.0' \ 1 �I I (n CY- o��z (3c~)+-' 1 T` x+>50 \\ � o (ta') _,(t°•) c .� (10 � _� 1 1 \\ N SET O O T o . T lq x 13.9 RBR cv 1 O Z U o (245.0) x,3 i 1 1 w m g ° (18$.8') r i(.40.0�' — I/tl /�,,.�,r�s) 0`�1��+tee q`5 } r r .�r.i� w.r0 r w r r X r3 r r..�r r r y I,S.zo m N ° � / [ ` to 1 , V �, t� kwa-5°15'10”yV SET 91p $ C';) a (�) alaexO sRBR+ STK STK ' 1F 2rnc xor ase r 533.56' I F ViE1L m Bl!'Fm PER mWR SM\49CN xo avu a[.[caro oocu+rrr I � -WH- 1:111 ! ruc ANP MADE FCR NN MARE NL"DATEDt�v 1 i N z E r MAY 2Z 1995 AND PCOM THE Waw CF N10 IF r I O 0 U SNMD ME%'1937. CASCO ATLANTIC BEACH, LLC � j � � J yFM LOT 3L0 TAX LOT 9.8 p35 ,Ss F— Ld o iY 5 w WOODED ,�t Q O O `a �O (36") LOT ® W Z N Z O Z p pm V) Lij NOy j/�Z w —j Ld V) Ljj W ? >_ z L'' O mom /� \ 2= LLI M < Zoe I=— ~� w ()LL �tnQ�(n05 3s Q 0 � �� ~U =asp }_ Z o F-- _ NOTE: W Z Iii 0 __J g o NO VISIBLE WELLS WITH IN 150' > Q Q O _ OF SUBJECT PROPERTY Lt_ a a, LOT COVERAGE w Z LOT AREA �1 O J W _is-8z 71,004 S.F. = 1.63 AC. J LL_ Ld Z 8 GRAPHIC SCALE Q 0 °_�� WETLANDS AREA = 21,568 S.F. � 0 BUILDABLE LAND = 49,436 S.F. ffi 40 0 20 40 q o, k = MAX LOT COVERAGE = 9,887 SF LOT AREA �� � �o 20% OF BUILDABLE LAND W ;OF PROPERTY IS TO BE CONNECTED TO GREENPORT 71,004 S.F. SEWER DISTRICT FOR SANITARY SEWAGE DISPOSAL PROPOSED LOT COVERAGE = 8,458 S.F. 1.63 AC. W g Z< ( IN FEET ) ALL ELEVATIONS REFER TO NAVD88' DATUM 17% OF BUILDABLE LAND OS OWW 1 inch = 40 fL 1 Fw; =US A s NOTES: _- 1. STORAGE VOLUMES CALCULATED BASED ON TOWN OF SOUTHOLD §236-7-A STORMWATER COLLECTION SYSTEMS DRAINAGE LEGEND SPECIFICATIONS 2. MINIMUM DRYWELL SIZES AND CAPACITIES ARE SHOWN IN A-X - DRAINAGE AREA LABEL STORMWATER STORAGE SCHEDULE. - DRAINAGE AREA BOUNDARY `' i DiLa1 dro 3. DRYWELLS SHALL BE PROVIDED FOR ALL ROOF RUNOFF AND - - - '•PROPOSED IMPERVIOUS SURFACES - � '°A �I"1CP' 'V1/S ..................•-••• - DRAINAGE CONNECTIVITY4. WHERE SUITABLE MATERIAL IS ENCOUNTERED THE STRUCTURE oAP -- - E n g in Pe.r in g SHALL BE INSTALLED ON UNDISTURBED GROUND p - PRECAST DRYWELL ILF ,/5. DRAINAGE STRUCTURES TO BE WRAPPED WITH FILTER FABRIC A / 158 County Rd. 39 6. ALL CONCRETE FOR DRAINAGE STRUCTURES TO BE MINIMUM - STORMWATER FLOW /�/ I Suite 10 4,000 PSI AT 28 DAYS DIRECTION Southampton, N.Y.11968 -TRAFFIC RATED DRAINS /�PARCEL INFORMATION: °`° ISLA Office/Fax (631) 259-3959 SURVEY OF PROPERTY ® - LINEAR DRAIN v /�/ LOT 2 MAP OF MINOR SUBDIVISION MADE FOR ANN ��' N tiF LO /� o Profes ' a MARIE NELSON 3 m /'/� $��1�'� Dj 0 1'a• 9 FILED: JUL 8, 1997 FILE NO. 10025 SITUATED IN GREENPORT ''s s �p TOWN OF SOUTHOLD �� (�a»} PROPOSED CATCH =! SUFFOLK COUNTY, NEW YORK BASINS PIPED TO ' '� FNO r` tZ LOT AREA: 71,004 FT2 OR 1.63 ACRES {1g») {10") �B} 4 ,39 �. 5.s' PIK �} ,� i w S.C.T.M. #1001-45-6-9.2 , ,> �c DRYWELL TYP4p1 5 x13 w 5,�1'S ^, tn� �„� (14") ( a IX 'c, i +1�i..i} 7 SITE PLAN BASED ON SURVEY PREPARED BY: x�t 10„� 4») }(1s»} 96d�i � +�Z6 SCALICE x,,6s {12")`' ( 5x L6 OPESSIO � LAND SURVEYING VACANT PROPOSED 13 270 0') ( � W OLOT D WATER LINE ( (:;;($„1� 1xljso MJSLANDSURVEY.COM ; .($ 631-957-2400 �P' RT, LLC A-9 ,.r SURVEYED: OCT 11, 2021 N� EEN §, x LLUPDATED: 1/20/2023 S 0 p0 20} �. 65� AT 1 :°,.,- �a") 1363 a � 7 p e) ELEVATIONS SHOWN ARE BASED ON NAVD 1988 PER REFERENCED SURVEY E MEADOW FM LOT 1 1 �, (� ,:( oR� WP FM LOT 2 7) "" •. 14 � u [�, 1 d \ / ...... ' x TH OT 9 z. ...... A-8 ,� ........... � ,. LOT 9.2 (f,.. „�-a{�") II (s"1� � ,•sa, T TAX I' \ SrC 5 5x lA� RECORD°OCUTAENT wAT ALL STORMWATER STORAGE STRUCTURES \ r' ¶°"°T"�°EE' �' -WTER-w .R-® » \ SE / S•(K 8� 'S'I NO APPIL�ABIl: WATER_�WATER�•WATER-�WATER + 1..� I In , \ I ....... W t� 1 • f W SHALL BE OFFSET AS FOLLOWS: �� s ; (60.0 )s \ 13 _ Q �A ��> T1s")IIr- FROM MIN. DISTANCE \\ "` ;° r i ( ) A MAIN HOUSE AND GARAGE 10' �E-55 /O �% ----- 11 1 � n „ �J 1 \ + I t50. / iy 11,5" ('44n�W.JT)��- °1 ry�• OO WATER WATER-��P ( (4}.a,E 1j' y �� PORCHES AND OVERHANGS 5 SET V wEn.nN° \ ` ( 4"j o� x• 1� ° r'- WATER SERVICE LINE 10' 4 ` ` \12 e 5 •� < 1 E d' `� + S \ �� ti UNDERGROUND UTILITIES 5' \I+ `` `` \` 11�� 116y I \ ® 1'S"� (� ») 14 1A�a� o' t~S' W >- OI �........ 4 A SANITARY LINE 10 I \ A-1 z 10 I 1 1 105.5' 174 4 ) As ;,I, ++ 5 \ 9 '1 II Q4�s�°�yc A 2 TEST TENNIS a PROPERTY LINES 5' I ri' ( I -3 $" (� �I F'- O I 2 LANDS BOUNDARY, ! ,�E�A,1D I` I+ s I I \ � COURT 1 'i \ T��( ) x lI cc 8o1 TIDAL wDELINEATED1BYS-2022. , 1 i (1$")1 � .r HOLEt0" 1 J SWIMMING POOL 10 + s8 1 f CONSULTANT €�' � 71>g ,' . 116ky \\ A-5 1 \.....................II 1\ +\ \ 5+ 115 `I ,�11(>J I x1•S3 A-DRAINAGE CALCULATIONS: ° ' \11 \ \Y. Al 1 1 +I 1 5 100.0'yE G "''• / EEG\ 11;15 ++ I v `+ SQ00�' 1g a1 X••.....................• SWED J/ 1"511 SINGLE STORY RESIDENCE FLAT ROOF (A-1): 3,653 FT2 x 1.0 x 2" =609 FTs h (�4`, »` ` I z2 / �'•(10") O? F- USE 3 8'-0"0 x 5'-0" DEEP DRYWELL = 633 FT3 O � ( 0 ', {a 11 I f � ;v.• A 6 SET CLF z . O � U 2 11 _ 3 O I �.'� E io`I i I i»i II ' ' X 135 RBR e, � :13 � J N O ........... ,• 4 �3 (ta") TENNIS COURT(A-5): 1,920 FT x 1.0 x 2 - 320 FT .� m , is .` ( (tia). :x===' x1' Z 1 U) SWIMMING POOL PATIO (A-2): 922 FT2 x 1.0 x 2" = 153 FT I ' 4 I ~ 0 ^� X 13.84 1 v SHED ROOF (A-6): 96 FT2 x 1.0 x 2" = 16 FT3 213 I i 1 °" ii 3k 1- ry = USE (2) 8'-0"0 x 6'-0" DEEP DRYWELL = 506 FT r , � i21) I, x33 I 1 (2q5' ) 7"} 633.66 OYSTER SHELL DRIVEWAY AREA 1 (A-7): 1,560 FT2 x 0.8 x 2" = 208 FT3 L iEi i ; 1081 � N to OYSTER SHELL DRIVEWAY AREA 2 (A-8): 1,240 FT2 x 0.8 x 2" = 166 FT3 OT 8 'I ' iii(bQ ) i ' e� 5 0 5 y 1j�1 OYSTER SHELL DRIVEWAY AREA 3 (A-9): 2,760 FT2 x 0.8 x 2" = 368 FT3 TAX USE (4) 8'-0"0 x 5'-0" DEEP DRYWELL = 848 FT �Ta I �}��el ',1 �° �sTK N�O� g C T r°I 1 1 I ' 16 .b , SET F PATIO UNDER PERGOLA(A-3) 923 FT2 x 0.8 x 2" = 153 FT3 c0� rl 1d SET 1 CO ATLANTIC BEACH' LLC POOL BACKWASH W USE (1) 8'-0"0 x 4'-0" DEEP DRYWELL = 169 FT �" RBR ;�I ����p�M��SpA� CAS TAX LOT 9. DRYWELL. LOCATE NEAR POOL v I O (183.6') EQUIPMENT Q POOL BACKWASH VOLUME (A-4): 2,900 FT3 x 5%VOI = 145 FT3 cD 6' 1 f �° 1�•T VACANT z 'Z LOT USE (1)8'-0"0 x 4'-0" DEEP DRYWELL = 169 FT3 WOODED 7°15 10ttW � PIPE SPECIFICATION NOTES: N8 PROPOSED STORMWATER \' 2 3 1. ROOF LEADERS TO DRYWELL CONNECTION TO BE 4"0 SMOOTH �- ( 6 ) DRAINAGE PLAN �� p � INTERIOR HDPE PIPE. L 2. CATCH BASINS TO DRYWELL CONNECTION TO BE 6"0 SMOOTH E INTERIOR HDPE PIPE. 30 0 30 60 3. DRYWELL TO DRYWELL CONNECTION TO BE 15"0 SMOOTH mom INTERIOR HDPE PIPE SCALE: 1" =30' ELEVATIONS SHOWN ARE BASED ON USC AND GS DATUM (NAVD 1988) G � O Z w � Q ALL PROPERTIES WITHIN 150'ARE VACANT 0 i OR IMPROVED AND SERVICED BY PUBLIC WATER Q- Revisions PRECAST 8"THICK CONCRETELIFT HOOK No. Date Description TRAFFIC BEARING COVER CONCRETE TAPERED COVER NOTES 1 1/23/2023 SURVEY TEST HOLE DATA FINISHED GRADE 1. ALL DRAINAGE STRUCTURES SHALL BE 2 1/24/2023 NOTES DATE: OCT 27, 2022 PLACED IN ACCEPTABLE LEACHING HEAVY DUTY SQUARE 9:23 A.M. %%;". ,`.' ° 1'MIN. `., >, > r INLET PIPE FROM DRAIN SOILS APPROVED BY THE TOWN 3 /--/-- --- \\ CAST IRON GRATE 4 ��,:• 2'MAX. , .' '. /; SEE NOTES FOR SIZE. ENGINEER. IN THE EVENT POOR EL: 13.5' 0.0' % $ �!/� LEACHING MATERIAL IS ENCOUNTERED, 5 - PALE BROWN MOIST FINE SILTY SANDS EXCAVATION IS TO BE CONTINUED TO PRECAST CATCH WITH ORGANICS INTO FINE DRY SANDS ® ® ® ® ® ® ® ® SUITABLE MATIERIAL & BACKFILLED AS BASIN , \/ DETAILED 4.0 /\ ® ® ® ® ® ® ® ® OUTLET PIPE TO '.'� Designed By . PD j 2. 3' MIN COLLAR AROUND LEACHING DRYWELL c Drawn By : JTS - LIGHT BROWN FINE TO MEDIUM SANDS / cHEDULE ® ® ® ® ® EJ ® ® /, STRUCTURE. COLLAR TO CONSIST OF v °e Checked By : PD a' ^ WITH SOME FINE TO SMALL GRAVEL (SW) �\ ._ ® ® ® ® ® ® ® ® 3' MIN. CLEAN SAND AND GRAVEL CONSISTING CLEAN SAND H.E.G.W. ;�\ ® ® ® ® ® ® ® ® *� OF LESS THAN 15/o FINE SAND, SILT AND ® ® ® ® ® ® ® ® ? ��� CLAY. BACK-FILL EL. 1.5 /i• / ,,.... . 17.0' ® ® ® ® ® ® ® ® COMPACTED / ...:... :. :. .•. . '::: :::::::::::: .......... "> 3. DRYWELL COMPONENTS ARE TO BE _ Date: 1/17/2023 SUB GRADE �/ = : REINFORCED PRECAST CONCRETE AND /\\ /�\ - LIGHT BROWN FINE SAME SIZED 2' IN TO :. Scale : NOTED GROUNDWATER.` EXISTING SAND CAPABLE OF SUPPORTING AASHTO \�\4\MIN\/ / \ \10"/ \\/ !�\\/\/ SANDS WITH TRACE GRAVEL (SP) LAYER HS-20 HIGHWAY LOADING , 4 MIN. 4. ALL CONCRETE FOR DRAINAGE 27 0' STRUCTURES TO BE MINIMUM 4,000 PSI AT 28 DAYS. e COMMENTS: GROUND WATER ENCOUNTERED C2 TYPICAL PRECAST DRYWELL DETAIL TYPICAL CATCH BASIN DETAIL AT 13.5' BELOW GRADE TEST HOLE BY: SLACKE TEST BORING Sheet# DRAWING IS INTENDED TO BE 34"x22" TO SCALE NOTES: 1. VILLAGE OF GREENPORT REQUIRES THAT ALL SEWER PIPE TAPS USE TAPPING SADDLES OR SLEEVES 2. WHEN TAPPING IS DONE BETWEEN 22.50 AND 45° FROM THE SPRING LINE, A ROMAC CB SEWER SADDLE OR EQUAL IS TO BE USED. >, 3. WHEN THE TAP IS DONE VERTICALLY, A ROMAC SST TAPPING SLEEVE OR EQUAL IS TO BE " USED DiLandry 4. THE TAPPING SADDLE/SLEEVE SHOULD BE DESIGNED FOR TAPPING SEWER PIPES " '.. Androws ows 5. THE SADDLE/SLEEVE MUST SUPPORT THE PIPE ABOUT ITS ENTIRE CIRCUMFERENCE ;-- -� n i n c ring 6. THE SADDLE/SLEEVE MUST NOT HAVE ANY SERRATIONS THAT MAY DAMAGE THE PIPE. 7. THE SADDLE/SLEEVE MUST NOT HAVE ANY DISTORTED BEARING POINTS AFTER TIGHTENING. 158 County Rd. 39 8. VERIFY DIAMETER OF SEWER MAIN AND LATERAL PIPE TO CONFIRM SADDLE SIZE o AP ,�� Suite 10 9. PLUMBING TO COMPLY WITH THE 202 NEW YORK STATE PLUMBING CODE 702.2 L /' Southampton, N.Y.11968 UNDERGROUND BUILDING SANITARY DRAINAGE TAABLE 702.3 An n ,-�"/- Office/Fax (631) 259-3959 /� I /" VILLAGE OF GREENPORT SEWER TAPPING PROCEDURE LAN ,/" I Profes ' eaN 1. CALL FOR MARKOUTS PRIOR TO ANY DIGGING/EXCAVATION. VERIFY THE TAP WILL BE IN AN APPROPRIATE LOCATION. #�' � 't -/ CO 2. A TAP MUST BE AT LEAST 24 INCHES FROM THE END OF THE PIPE, AT LEAST 36 INCHES FROM �O / 230 LFT(3 LFT Cl +227 LFT) OTHER TAPS AXIALLY (ALONG THE LENGTH OF THE PIPE). MULTIPLE TAPS ON OPPOSITE SIDES OF 3 m /- 4" PVC SCH 40/D3034/SDR35 x'.� a� THE PIPE MUST BE STAGGERED AT A MINIMUM OF 18 INCHES APART. �s �� �� S=1" PER FT. r- Cc 4 z fUl 3. CHECK THE DIAMETER OF THE MAIN AND BRANCH PIPE TO MAKE SURE YOU ARE USING THE s �'�- CORRECT SIZE SADDLE GASKET. ALSO CHECK THE GASKET TO MAKE SURE IT IS THE SIZE NEEDED. 4. MAKE SURE NO FOREIGN MATERIALS LODGE BETWEEN THE SADDLE GASKET AND THE PIPE. {}e") ((e) 3g \ ;cam �K �t� ") t• 554 • `-5.6' PK eA ��7252 4� 5. PLACE THE SADDLE IN POSITION ON THE PIPE AND MARK A GUIDELINE FOR THE HOLE CUT-IN �.. {�2") ( j USING THE SADDLE HOLE AS A TEMPLATE. REMOVE THE SADDLE FROM THE PIPE x;A p1 {}a"j 6" I t`,.a, 7" sES - ,i'SSIO 6. USING THE HOLE GUIDE MARK, CUT THE HOLE THROUGH THE PIPE USING A SABRE SAW OR - y`3 {12") RBR CONNECT RESIDENTIAL POWER DRILL DESIGNED FOR PIPE MATERIAL WITH A HOLE SAW. THE HOLE SHOULD BE NO �a {}p"�,y�. ,� gLATERAL SEWER LINE TO LARGER THAN THE INSIDE DIAMETER OF THE SADDLE GASKET. {}2" x EXISTING MAIN LO 7. PLACE LUBRICANT AROUND THE HOLE AND PLACE SADDLE INTO POSITION. SECURE WITH VACANT PROPOSED 2gp.0�) STRAPS, NUTS AND BOLTS. WOODED WATER LINE , \ x`' 8. TIGHTEN NUTS EVENLY, ALTERNATING BETWEEN THEM UNTIL THE APPROPRIATE TORQUE IS LO CLEAN OUT :{s") {} " PROPOSED [T� ,g:. �I REACHED. OVER TIGHTENING CAN DEFORM THE PVC AND IS TO BE AVOIDED. LLC ■ WATER METER 9. HEAT THE AREA IF THE SADDLE GASKET IS BELOW 45°F. N/T GREENpORT' 10.BEVEL ON ROUGH EDGE D EDGES OF THE MAIN LINE TO REDUCE THE CHANCE OF SEWER HANGING UP E MEADOW FM LOT 1 1 "` FM LOT 2 7 ) ® 14 TH LOT 9.1 d� \ TAX LOT 9.2 (.:,.t, {s„) x•3'' w 4� sE,•( TAX I \ sTK / ® 8 j�9 x NO AVAlABL1:RECORD DOCUMENT \ T'l,,i wnrea-WA PARCEL INFORMATION: '� ssc 0-o'), w a wA \ I SfP w_T _�WATER�-"nR�_ CD I P v 11 SURVEY OF PROPERTY LOT 2 /q\E`75 ,, I ` k.• ? �,E { '"j3 UJ 1 � MAP OF MINOR SUBDIVISION MADE FOR ANN � 1 1 + .\ \ 1 1" 1 f / n 1�,'s4` (1 1 , '1• .. wArea�.waren_/� { �t")',.a.s 1'S �� � � 1 � MARIE NELSON sEt rynAND , 1 ( ¢"j , ��°g �1yo� 9y , s {t0") 7 y,% 1�y� z O FILED: JUL 8, 1997 FILE NO. 10025 § 12 �{ SITUATED IN GREENPORT11�, e� } „) 14 TOWN OF SOUTHOLD I 10 11�» , 0 ® { i 105.5' �� TENNIS O J SUFFOLK COUNTY, NEW YORK �� (174.4 ) DARY• As p , "1\ ' 9 , ,I , Q BSc ar;L " TEST couRT r I LOT AREA: 71,004 FT OR 1.63 ACRES o w A BOUrr I �o i`� (g) {}q° O 17 20 I D \ 7 a I ,9 (1s")'\ \ � .+ >> HOLE C 3 8 TIDAL DELINErAI jT$D 10Y9"�p22 1�+ A \ I i c S.C.T.M. #1000-45-6-9.2 SV CO?SULTA �;3\ \ " ,jati� (, f i = G EN' \ wEh�d `. ao I 0� ;{22) i r? % o �;' L ^� E+tis 5 ', I 1 \ ' "ta" q^). ") �`` �o� O r.SITE PLAN BASED ON SURVEY PREPARED BY: \` \ ",11 \ , 1 \ I \ �� G { • • 0 o � \y. 1 � , 1 � 100.0' 1 � 'v' '� `�EnaND, \ \ \ I , 1 � 1 I � W N SCALICE o �. ' (��, , \ Igo { LAND SURVEYING o s I I �,� X5.6 , RBR eC� z SET -1 EXISTING SEWER MAIN. 'wuNb ' I I ; • MJSLANDSURVEY.COM O \`� cY;o'I ; Iii „ (18") X 33 }�„), . z,;{}o^) "l. Z x; ax VERIFY PIPE DIAMETER & 631-957-2400 = �� ; 4 ��1$" ', III; ,2" (1s") I { I Z CONFIRM SADDLE SIZE I I � I 56SURVEYED: OCT 11, 2021 X 13,64 C 3 3.2 " , UPDATED: 1/20/2023 (12;) i- w¢1Arao EOC ELEVATIONS SHOWN ARE BASED ON NAVD 1988, PER REFERENCED SURVEY I I 110 I I „4Px,331 SANITARY SYSTEM INFORMATION: X LOT 8 .x `75 0 TOTAL NUMBER OF BEDROOMS: 4 TA (� ( I I Ix ' 1s" ~�1^ 0�6 1 sE�c N/O/F 3 LL v WASTE DEMAND: 440 GPD I rs1 'a %�\ I\ I LOT C ,A?�� I �� v TLANTIC BEACH, z C\2 aN SCOALL .3 ^O 183.6') �� v FCR PM1 MPS 1�VM CIF _.._� �. SEI sTic vs CA OT RBRfft PER M E tFl DAZED TA ( .. MPDS y�l l. 9 wp ',} sFD}�� VACANT I D A 6 O E_, WOODED „y� LOT . JAM 2 7 l-3 F- N87°15 10 PROPOSED SEWER ALL PROPERTIES WITHIN 150'ARE VACANT CONNECTION PLAN OR IMPROVED AND SERVICED BY PUBLIC WATER 30 60 n/ SCALE: I" = 30' F_ z ELEVATIONS SHOWN ARE BASED ON USC AND GS DATUM (NAVD 1988) W Q 0 J cr_ W 0- FINISHED CL FLOOR 14.75'± (2) CLEAN OUT 230 LFT 4" PVC SCH 40 D3034 SDR35 Revisions COVER TO GRADE S= 1/4" PER FT. ; GRADE No. Date Description STOPPER OR END PLUG SEE NOTE 1 ,•EL. ±13.9' GRADE 1 1/23/2023 SURVEY TEST HOLE DATA `�' / }' ROMAC STYLE "CB" �; EL. ±13.6' 2 1/24/2023 NOTES �- DATE: OCT 27, 2022 DEPTH SEWER PIPE SEWER SADDLE OR 3 9:23 A.M. VARIES EQUIVALENT 4 EL: 13.5' 0.0' 30° ELBOW VERIFY SEWER SEE NOTE 2 _ IE 11.39'± 5 .afi tqf MAIN 0 IN FIELD � � - PALE BROWN MOIST FINE SILTY SANDS PVC SCHED. 40 1 °' MIN. . 74 WITH ORGANICS INTO FINE DRY SANDS FROM a IN/FT MINIMUM SLOPE a; BUILDING-.- _ATO SEPTIC 45° MAXIMUM ANGLE - BOT OF Designed By : PD 4.0' SYSTEM 45° MAX. SEWER MAIN SEWER EL: 6.60'± Drawn By : JTS - LIGHT BROWN FINE TO MEDIUM SANDS CAST 120 - • �• : WITH SOME FINE TO SMALL GRAVEL (SW) CAST IRON THRU IRON °WYE Checked By PD71-477777777 -"77-7777-- 0 -'' - BUILDING FOUNDATION TO HOLE SAW CUTTO NOTE: H.E.G.W. &TO EXTEND 2'-0" PVC HAVE SMOOTH EDCES 1. NEW CAST IRON THRU BUILDING FOUNDATION &TO BEYOND FOUNDATION ADAPTER EXTEND 2'-0" BEYOND FOUNDATION WALL MIN. 17.0' WALL MIN. 2. VENT THRU ROOF OF PROPOSED BUILDING, EXTEND A Date : 1/17/2023 STEEL STRAPS MIN. OF 6"ABOVE ROOF LINE AND HAVE A MIN. Scale : NOTED - LIGHT BROWN FINE SAME SIZED t HORIZONTAL SEPERATION OF 12"TO THE SLOPED CLEAN OUTS ARE TO BE INSTALLED: PORTION OF THE ROOF. SANDS WITH TRACE GRAVEL (SP) 3. ALL JOINTS TO BE SEALED WITH CONSEAL CS-10 OR 1) AT FACE OF BUILDING OR WITHIN TYPICAL ROMAC "CB" SADDLE SCHD APPROVED SEALANT 27.0' BUILDING BEFORE EXITING. NOT TO SCALE COMMENTS: GROUND WATER ENCOUNTERED (SEE SEPTIC ELEVATION FOR WITCH). C �3 AT 12.0' BELOW GRADE 2) BEFORE A BEND,SWEEP OR WYE. 3) , EVERY 75 FEET OF SEWER LINE. TEST HOLE BY: PROPOSED WASTE LINE ELEVATION SHAWN M. BARRON, M.S. NOT TO SCALE Sheet# DRAWING IS INTENDED TO BE 34"x22" TO SCALE Glenn Goldsmith, President Town Hall Annex A. Nicholas Krupski, Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly coTelephone(631) 765-1892 Elizabeth Peeples � ® y® Fax(631) 765-6641 ® COUNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON-JURISDICTION INSPECTION DATE OF INSPECTION: INSPECTED BY: Ch. 275 Ch. 111 COMMENTS: 61 01 r C_ 1 EN-CONSULTANTS January 23, 2023 Glenn Goldsmith,President Board of Trustees i JAN 2 7 2023 Town of Southold P.O. Box 1179 Southold,NY 11971 Re:Beniamin and Carolyn Bennett, 1220 Ninth Street,Greenport; SCTM 1000-45-6-9.2 Dear Mr. Goldsmith: We represent Benjamin and Carolyn Bennett,who are proposing to improve the above referenced vacant parcel with a single-family dwelling(to be connected to the Greenport Sewer District),a swimming pool, and a tennis court, all as depicted on the enclosed survey/site plan prepared by Scalice Land Surveying, last dated January 20,2023. As all proposed structures and construction related site disturbance will be located more than 100 feet from the adjacent tidal wetlands and thus outside the permitting jurisdiction of the Board of Trustees pursuant to Section§275-3(C)(5)of the Town Code, I am writing to request a Letter of Non- Jurisdiction stating that a Town Wetlands Permit is not required for the proposed work. In support of our request and for your additional reference,I have enclosed the following materials: 1) Two (2) copies of the above referenced survey/site plan, and a "Sewer Main Tapping Plan" and "Stormwater Drainage Plan," both prepared by DiLandro Andrews Engineering, last dated January 24, 2023; 2) Greenport Sewer District connection availability letter from Village of Greenport; 3) Letter from North Fork Woodworks attesting the proposed construction can be implemented as shown on the site plan without causing disturbance within 100 feet of the wetlands boundary; 4) Site photographs taken on October 3,2022; 5) Copy of Wetlands Permit No. 10164A, issued May 26, 2022, which authorizes specified landscape maintenance/restoration activities within the 100-foot wetlands setback; and 6) A copy of the deed; a check payable to the Town of Southold for $50; and authorization forms signed by the property owners, authorizing En-Consultants to act as agent and the Trustees to access the property for the purpose of making the requested determination. Should you have any questions or require any additional information to process this request, please do not hesitate to contact me at your earliest convenience. Resp ct lly yours, Ro emnann Coastal Management Specialist Enclosures 1319 North Sea Road Southampton,New York 11968 p 631.283.6360 1 f 631.283.6136 www.enconsuitants.com environmental consulting OCTOBER 21, 2022 po 236 THIRD STREET Suffolk County Department of Health Services GREENPORT, NY 11944 360 Yaphank Avenue Yaphank, NY 11980 Tel: (631)477-0248 Fax: (631)477-1877 Re: PETER DEPASQUALE villageofgreenport.org 1220 NINTH STREET, Greenport, NY 11944 TAX MAP ID# 1000-45-06-9.2 MAYOR GEORGE W. HUBBARD, JR. To whom it maconcern: Ext 215 y TRUSTEES The possibility for a sanitary sewage disposal connection for the above- JACK MARTILOTTA mentioned structure have been inspected by the Greenport Sewer District and DEPUTY MAYOR found to be satisfactory. PETER CLARKE MARY BESS PHILLIPS If I can be of any further assistance, please contact me at (631)477-0248 JULIA ROBINS Kind Regards, VILLAGE ADMINISTRATOR PAUL]. PALLAS, P.E. EXT 219 CLERK Adam Hubbard SYLVIA PIRILLO, RMC Village of Greenport EXT 206 Waste Water Treatment Plant INTERIM TREASURER STEPHEN GAFFGA EXT 213 To whom it may concern, I, Scott Edgett, President of NFWW Inc., have reviewed the proposed construction survey/site plan prepared by Scalice Land Surveying, last dated January 4, 2023. On the site plan it indicates that there is a five to six foot set back from the wetlands 100' boundary. It is in our experience that this is adequate for us to do our 3' over dig and construct the building without creating any disturbance seaward of the project-limiting fence to be installed along the 100-foot wetlands setback prior to construction. Thank you. Fro , Sco Ed ett 9 PO Box 1407 Southold NY 11971 * Telephone: 631.298.7900 * Fax: 631.298.7899 * nfwwinc@aol.com 1 Glenn Goldsmith,President ®� so(��� Town Hall Annex A.Nicholas Krupski,Vice President ,`®� ®�� 54375 Route 25 - P.O.Box 1179 Eric Sepenoski' 3 Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples y® Fax(631) 765-6641 cou Ti BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10164A Date of Receipt of Application: May 26, 2022 Applicant: Benjamin & Carolyn Bennett SCTM#: 1000-45-6-9.2 Project Location: 1220 9t" Street, Greenport Date of Resolution/Issuance; June 15, 2022 Date of Expiration: June 15, 2024 Reviewed by: Eric Sepenoski, Trustee Project Description: Remove non-native species and dead tree limbs from 100' buffer area and replant with native grasses for a long-term rehabilitation of land. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of lthe Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Carolyn Bennett, received on May 26, 2022, and stamped approved on June 15, 2022. Special Conditions: The five (5) mature trees in a line along the landward edge of the property remain undisturbed; the twenty-five (25) or more trees along the seaward edge be minimally pruned of dead limbs only; and the invasives— bittersweet, poison ivy sweet briar and wineberry be removed and replanted with native grasses or shrubs. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees .� v 1� .... '?a• * ...: �` � .�t ear ��� • i" a1 � '` T, •� ,, ..-t .yam ��� . �1 •� � �^. �. :1,r11 � . - Y fl .- • i. 1 cis, -•r'•r •'� ,`r.*. !1 , �. t r. � ..� \� � S'h _ wlf • 'fir' �� "`""STi'S�4 ,l•n."T" t ��_ �-^ � _•.'mac � �.. - '� � r+-. �•,� - - aim .. � ��� • ' • s '' .r-� rJ ,�- h, y 4 Oct 14 Ir ii •i � ii i i i� ii � 11 �� i i i i i i � i �i� �i i � wo -46 1p ip- t It rur ' DIY � �. � '� A y �.� '•r _h. � \I R.' � ' � �.,` KGF �:... ..z ,�• '��'�- ,� W �3' y, Board of Trust( Application AUTHORIZATION (Where the applicant is not the owner) I/We Benjamin Bennett owners of the property identified as SCTM# 1000- 45-6-9.2 in the town of Southold New York, hereby authorizes En-Consultants 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. N/A Property r s Signature Property Owner's Signature Benjamin Bennett SWORN TO BEFORE ME THIS DAY OF j , 202/1- ZETA 0 ?/Z ZETA J CHEN NOTARY PuSLIC,STATE OF NEW YORK Notary Public Registration No.01CH6305856 Qualified in Kings County Commission Expires June 16,2026 Board of Trusts i Application AUTHORIZATION (Where the applicant is not the owner) I/We Carolyn Bennett owners of the property identified as SCTM# 1000- 45-6-9.2 in the town of Southold New York, hereby authorizes En-Consultants 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. N/A Property OwWrl Signature Property Owner's Signature Carolyn Bennett SWORN TO BEFORE ME THIS 0�(-DAY OF , 20 Z Z Notary Public ZETA)CHEN NOTARY PUBLIC,STATE OF NEW YORK Registration No.01CH6305856 Qualified in IGngs County Commission Expires June 16,2026 Board of Trusti Application AFFIDAVIT Benjamin Bennett BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. N/A Signatur operty Owner Signature of Property Owner Benjamin Bennett SWORN TO BEFORE ME THIS IC?�t DAY OF , 202/ ZMAJ CHI=N NOTARY PUBLIC,STATE OF NEW YORK Registration No.OICH6305856 Notary Public Qualified In Kings County Commission Expires June 16,2026 Board of Trusts Application AFFIDAVIT Carolyn Bennett BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. N/A Signature Pro e y Owner Signature of Property Owner Carolyn Bennett SWORN TO BEFORE ME THIS DAY OF ZETA J CHEN NOTARY PUBIC,STATE OF NEW YORK Registration No.01 CH6305856 Qualified in Kings County Notary Public Commission Expires June 16,2026 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart 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 tale whatever action is necessary to avoid same. YOURNAME: Bennett,Benjamin (Last name,first name,g►iddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business 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 A If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shams 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 of sw 4 20 Signature Print Name Be. in Bennett Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The To%%m of Southold's Code of Ethics prohibits conflicts of interest on the Dart 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. YOUR NAME: Bennett,Carolyn (Last name,first name,giiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business 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 K — If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicilnt (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 thi da of 20 Signature Print Name Car �nnett Form TS l s 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 ouroose 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: IHPrr conn, Robextt E, (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business 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 X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person_ Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer;director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Aa 2o2.3 Signature Print Name E. Hernnann Form TS 1 aD a ;` - .. — _ 't ,. .1 ,'K;�`'�', a"' � ,iu��rn.•x � i ..'1;'htaara•a.`: NIP,.. �e«b>rie) a n•x•+zaw isbw•. ulmra .�xAamm��. 8;sEe aEe.No.wo # `t'�tll y� ANiLN. `LINE��� •:;\ 1'biMnW :^aoot.Sf -� SawAN46 .:fx•S�W IYN N(%' `.rnAm16, •rMO.>AM "' �..•'-.i-''!•��\t,MATCH> __ ,=?!,Jez__, l UNE - .+.I _ .\'<l,�w i ''' S"tGc28L^F � foolY'' `xx21,Ya. +x.aclb n xNF' 'bcbAR' Yte«a,') ';«gmtza ?�,..�� ,t,! �- •� PoUN0. 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