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F0 TOWN OF SOUTHOLD F04 TOWN BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE "oy • � 7 SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48120 Date: 7/27/2022 Permission is hereby granted to: Zoumas, loannis 2050 North Country Rd Wading River, NY 11792 To: construct accessory in-ground swimming pool with spa as applied for per DEC & Trustees approvals. At premises located at: 3915 Stillwater Ave., Cutchogue - rJ ��� V010 SCTM # 473889 6-e-q— Lt (o Sec/Block/Lot# 137.-1-5.1 Pursuant to application dated 6/27/2022 and approved by the Building Inspector. To expire on 1/26/2024. Fees: SWIMMING POOLS-1N-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector a Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) I, '�'OAIV�✓! S �o14n� �C7 residing at jo5p JV, rnvAI?Rtt (Print property owner's name) (Mailing Address) oJAuY-,, Rl V Qk. M-1. 117 9&do hereby authorize -�A(P-1 N A (Agent) to apply on my behalf to the Southold Building Department. AL,0 /(Owner's Signa (Date) A tj ZD C)M (Print Owner's Name) FIELD INSPECTION REPORT DATE COMMENTS Xro OQ FOUNDATION(1ST) N y -------------------------------- FOUNDATION(2ND) 0 m c � W ROUGH FRAMING& PLUMBING V J r^ a , 1 INSULATION PER N.Y. y STATE ENERGY CODE C l , 4- o . O FINAL ADDITIONAL COMMENTS z2 - eoi%d 130o r-e- c 102L42,T ,O t� Z m HX 3 (A N � l z � d ro H Y''�ouoG TOWN OF SOUTHOLD-BUILDING DEPARTMENT y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 �y�oi Sao` Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtommu.g_ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector:ector: JUN 2 7 2022 Applications and forms must`,be filled out in their'entiretV 'Incomplete applications will not be accepted::Where the Applicant is not the owner,an BUILDING DEFT. Owner's Authorization form(Page'2)shall bem copleted.' .: TOWN OF SOUTH- ;LFD Date: (-0on OWNER(S)OF PROPERTY: Name: -'TOl_ � SCTM # 1000- I?J� 00_ 011 L)6 Dos-,oo Project Address: :��( �J Yl � &A-GAGquir N I 1 Phone#: Email: Mailing Address: ROD N VrA WC Y IJP -1q'D CONTACT PERSON: Name: Mailing Address: sldo� min! ryrJn6yN6\e-( Nk"� 494q Phone# Email: DESIGN PROFESSIONAL INFORMATION: :. Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: 30acl leaN Guy oq uc M,4t Lgt4 Phone#: • _ 6 _ Email: xs t c0rr) DESCRIPTION OF PROPOSED-CONSTRUCTION. ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition 4-7y-1 Estimated Cost of Project: 1X10ther w hcoLSSOW 5NNCANYrC l 4D Guntt&osm m inQ 004 Will the lot be re-graded? ❑Yes Ivo Will excess fill be removed from premises? Xes [--]No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Q this property? ❑YesPo IF YES, PROVIDE A COPY. heck Box After"Reading: The owner/contractor%design professionalis responsiblefor all drainageand"storm water issues as provided by apter 236 of the Town Code. APPLICATION IS HEREBY MADE to the BuildingDepartment for the issuance of a Building,Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for'the construction of buildings, additions,alterations or for removal or demolition as herein!described:The applicant agrees to comply with all applicable laws,-ordinances;building code, housing code and regulations and to,admit authorized inspectors:on premises,46d in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. YY1�CU`n. Application Submitted By(print name): 4i�vio,- [,Authorized Agent ❑Owner Signature of Applicant: 4kAL& s Date: wg-7 ),-M STATE OF NEW YORK) SS: COUNTYOF '��� ) 1 ► y being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the kl rlT (Contractor,Agent, Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this I-,-- R64A - � c day of o{fie 120 Notary Public MICHFIE A MEDUSKI PROPERTY OWNER AUTHORIZATION Notary Public,State of New York Reg. No.01ME6393343 (Where the applicant is not the owner) Qualifier!in Suffolk County Commission Expires June 17,2023 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 J, "+s BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.9866 DATE: APRIL 14,2021 ISSUED TO: IOANNIS JOHN ZOUMAS PROPERTY ADDRESS: 3915 STILLWATER AVENUE,CUTCHOGUE SCTM#1000-137-1-5.1 +' AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on April 14,2021,and in consideration of application fee in the sum of$250.00 paid by Ioannis John Zoumas and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to demolish and remove existing dwelling and detached garage;any excavation required for the removal/demolition will be backfilled and compacted with clean fill; existing water services and sanitary systems are to be disconnected and abandoned in place as per S.C.W.A.&S.C.DM.S.standards; construct a proposed 2,600sq.ft.two-story residence with basement;576sq.ft.detached garage;2,800sq.ft.stone driveway;2,030sq.ft.paver patio; 390sq.ft.covered porch; and a 720sq.ft.in-ground pool;connect proposed dwelling to public water and underground electrical services; install a S.C.D.H.S.approved I/A septic system; \ there is no expected fill to be needed for this project due to how much material will need to be excavated for construction;the total excavated material is estimated at 850 cubic yards; any ' unused material will be removed from the site to a suitable facility; the overall disturbance for the project will be 30,500sq.ft.(0.70acres); establish and perpetually maintain a 20'wide non- turf buffer;and as depicted on the site plan prepared by L.Y-McLean Associates,P.C.,received on April 12,2021 and stamped approved on April 14,2021. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Sea]to be affixed,and these presents to be subscribed by a majority of the said Board as of the 14th day of April,2021. w e ; ` e COD fr 1 ,J � 5 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY 0 Stony Brook,50 Circle Road,Stony Brook.NY 11790 P.(6311)444-03651 F.(631)444-0360 wwwdec.nygov August 11,2021 Via email only: John Zoumas 2050 N Country Road Wading River,NY 11792 Re: NYSDEC#1-4738-02770/00002 Zoumas Property,3915 Stillwater Ave.,Cutchogue Replace House,Garage, Septic 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. 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, Kevin Kispert Environmental Analyst II Enclosures KAK/file cc: NYSDEC MHP LK McLean Associates PC NEW„a5� Department of Emironmental Conservation NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-02770 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: IOANNIS ZOUMAS ZOUMAS PROPERTY 2050 N COUNTRY RD 3915 STILLWATER AVE[1000-137-01-5.001 WADING RIVER,NY 11792 CUTCHOGUE,NY 11935 Facility Application Contact: CHRISTOPHER F DWYER LK McLean Associates PC 437 S COUNTRY RD BROOKHAVEN,NY 11719 (631)286-8668 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: CUTCHOGUE Facility Principal Reference Point: NYTM-E: 712.747 NYTM-N: 4543.32 Latitude: 41100'48.0" Longitude: 72°28'11.9" Authorized Activity: Replace the existing house, septic system,garage and other associated structures with a new house and associated patios,pool,garage, driveway and UA OWTS all as shown on the attached plans prepared by L.K.McLean Associates P.C., sheets C1,dated April 2021, S1 last revised 7/26/21,and S2 dated January 2021,all stamped"NYSDEC Approved" on 8/11/2021. r- Permit Authorizations Tidal Wetlands-Under Article 25 Permit ID 1-4738-02770/00002 New Permit Effective Date: 8/11/2021 Expiration Date: 8/10/2026 F- NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable regulations,and all conditions included as part of this permit. Permit Administrator:KEVIN A KISPERT,Deputy Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY 11790-3409 Authorized Signature: _ Date Page 1 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-02770 .Distribution List CHRISTOPHER F DWYER Marine Habitat Protection KEVIN A KISPERT Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Permit Attachments Site Plan 7/26/2021 NATURAL RESOURCE PERMIT CONDITIONS- Apply to the Following Permits: TIDAL WETLANDS 1. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by L.K.McLean Associates P.C.,sheets C 1,dated April 2021, S 1 last revised 7/26/21,and S2 dated January 2021,all stamped"NYSDEC Approved"on 8/11/2021. 2. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project,the bottom portion of the form must also be signed and returned, along with photographs of the completed work. 3. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 4. Tree Clearing The proposed project is within the 1.5 mile buffer from an acoustically detected summer occurrence of the Northern long-eared bats.To avoid a"take" of this species which is listed as "threatened"by both New York State and the US Fish&Wildlife Service,the clear cutting of trees is prohibited between March 1 st and November 30th of an calendar year. Page 2 of 7 NEW FORK STATE DEPARTMENT OF ENVIRONMENTAL.CONSERVATION Facility DEC ID 1-4738-02770 5. Concrete Leachate During construction,no wet or fresh concrete or leachate shall be allowed to escape into any wetlands or waters of New York State,nor shall washings from ready-mixed concrete trucks,mixers,or other devices be allowed to enter any wetland or waters. Only watertight or waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms. 6. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be completely removed from the adjacent area(upland)and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 7. Materials Disposed at Upland Site Any demolition debris,excess construction materials, and/or excess excavated materials shall be immediately and completely disposed of in an authorized solid waste management facility.These materials shall be suitably stabilized as not to re-enter any water body,wetland or wetland adjacent area. 8. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 9. Storage of Equipment,Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 75 linear feet from the tidal wetland boundary. 10. Seeding Disturbed Areas All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate vegetation(grasses,etc.)immediately following project completion or prior to permit expiration,whichever comes first. If the project site remains inactive for more than 48 hours or planting is impractical due to the season,then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. 11. Clean Fill Only All fill shall consist of clean sand, gravel,or soil(not asphalt,slag,flyash,broken concrete or demolition debris). 12. Department Jurisdiction The department retains jurisdiction of all regulated lands where fill has been permitted. Placement of fill shall not be used to alter the department's Tidal Wetland jurisdictional area at the project site. The area remains a regulated area subject to Tidal Wetland Land Use restrictions of 6 NYCRR Part 661. 13. Install,Maintain Erosion Controls Necessary erosion control measures,i.e., straw bales, silt fencing,etc.,are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good and functional condition until thick vegetative cover is established. 14. No Drywells in or near Wetland Dry wells for pool filter backwash shall be located a minimum of 100 linear feet landward of the tidal wetland boundary. 15. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 16. Driveway/Parking Area of Pervious Material Driveway and parking areas shall be constructed of NYSDEC-approved pervious materials. Page 3 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 14738-02770 17. Authorized Innovative/Alternative Onsite Wastewater Treatment Systems(I/A OWTS)Septic Systems This permit authorizes the installation of any models of I/A OWTS septic system which have received the approval of the Suffolk County Department of Health Services(SCDHS). If SCDHS rescinds its approval of one or more of these models during the term of this permit,DEC will no longer approve new installations of that model.The list of I/A OWTS systems which have received approval by SCDHS are found on the Suffolk County Website under the Reclaim Our Water-Homeowner section at: Overview of Provisionally Approved Technologies. 1s. Maintenance of Installed Innovative/Alternative Onsite Wastewater Treatment Systems(I/A OWTS) The permittee must maintain,service and repair the installed UA OWTS in accordance with the maintenance schedule set forth in the Suffolk County Department of Health Services(SCDHS) permit issued for the system. 19. Dewatering Discharge Regardless of the dewatering method employed(wellpoint system, "mudsucker"pump,other)and the point of discharge(direct to surface water or into storm drain),it is the permittee's responsibility to ensure that the discharge does not visibly increase the turbidity of the receiving water body or result in the scour or erosion of the bed or banks of the receiving water body. Appropriate measures such as the use of geotextile filter bags to remove solids from the discharged water and the use of a diffuser or other energy dissipator to prevent bottom scour must be used. 20. Dewatering Permit If dewatering is conducted using a well point system with a collective capacity (i.e.pump capacity)greater than 45 gallons per minute,or if dewatering is conducted without the use of wellpoints,but the rate of pumping will exceed 100,000 gallons per day as averaged over a 30-day period,a Long Island Well Dewatering Permit,or a Water Withdrawal permit respectively, is required prior to dewatering. 21. Contain Exposed,Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybaies/silt curtains(or other NYSDEC approved devices)placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 22. Maintain Erosion Controls All erosion control devices shall be maintained in good and functional condition until the project has been completed and the area has been stabilized. 23. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes,and no claim or right to compensation shall accrue from any such damage. Page 4 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-02770 24. State May Order Removal or Alteration of Work if future operations by the State of New York require an alteration in the position of the structure or work herein authorized,or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health,safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State,the owner may be ordered by the Department to remove or alter the structural work,obstructions,or hazards caused thereby without expense to the State,and if,upon the expiration or revocation of this permit,the structure,fill, excavation,or other modification of the watercourse hereby authorized shall not be completed,the owners,shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 25. State May Require Site Restoration If upon the expiration or revocation of this permit,the project hereby authorized has not been completed,the applicant shall,without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 26. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids,sediments,fuels, solvents, lubricants,epoxy coatings,paints,concrete,leachate or any other environmentally deleterious materials associated with the project. GENERAL CONDITIONS -Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility,including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit,including all referenced maps, drawings and special conditions,must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department,issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms,conditions or requirements contained ih such order or determination. Page 5 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION � Paeffity DEC ID 1-4738-02770 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal,modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal,modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal,modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC Region'l Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY11790-3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification,suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions,orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 6 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4735-02770 NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee,excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York,its representatives,employees, and agents("DEC")for all claims,suits,actions,and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with,or operation and maintenance of,the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims,suits,actions,or damages to the extent attributable to DEC's own negligent or intentional acts or omissions,or to any claims,suits,or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors,employees,agents and assigns of their responsibility to comply with this permit,including all special conditions while acting as the permittee's agent with respect to the permitted activities,and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals,lands,easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. Page 7 of 7 YORKWorkers ATE Compensation' CERTIFICATE OF INSURANCE COVERAGE ST Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured PATRICK'S POOLS INC 631-941-4113 PO BOX 3024 EAST QUOGUE,NY 11942 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e., Wrap-Up Policy) 262929943 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 54375 Main Rd 3b. Policy Number of Entity Listed in Box"1 a" PO Box 1179 DBL318565 Southold, NY 11971 3c. Policy effective period 05/13/2022 to 05/12/2023 4. Policy provides the following benefits: A. Both disability and paid family leave benefits. B.Disability benefits only. E] C.Paid family leave benefits only. 5. Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 6/23/2022 By (Wo. 4t (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (only if Box 413,4C or 56 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) I 111 1111111 Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage (Certificate) to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c, whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder. This Certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. D13-120.1 (12-21) Reverse ,eco CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DDlYYW) 1_1� 05/10/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nicholas Zulkofske Brookhaven Agency,Inc. PHONE 631 941-4113 FAX 631 941-4405 100 Oakland Ave,Ste 1 EA -MIL certificates brookhavena enc .com Port Jefferson,NY 11777 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Philadelphia Indemnity Insurance Co. INSURED INSURER B: Merchants Mutual Insurance Co. Patrick's Pools,Inc INSURER C: Wesco Insurance Co. PO Box 3024 INSURER D: East Quogue NY 11942 INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS L POLICY NUMBER D D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE OCCUR DAMAGE TO RENTED $100,000 x Contractual Liability X PHPK2385555 02/28/2022 02/28/2023 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT F LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $500,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED XX CAP9267113 07/12/2021 07/12/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS $ X HIRED AUTOS FX NON-OWNED PROPERTY DAMAGE AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X PERTUTE OTH- AND EMPLOYERS'LIABILITY IFR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100,000 C OFFICER/MEMBER EXCLUDED? Y❑ N/A WWC3587728 05/13/2022 05/13/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Town of Southold is included as additional insured per written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold,Town Hall Annex SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE <NSZ> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD e'NF YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 631-996-4687 Patrick's Pools,Inc PO Box 3024 1c.NYS Unemployment Insurance Employer Registration Number of East Ouogue NY 11942 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,Le.,a Wrap-Up Policy) Number 262929943 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Company Town of Southold,Town Hall Annex 3b.Policy Number of Entity Listed in Box"1a" 54375 Main Rd. WWC3587728 Southold,NY 11971 3c.Policy effective period nrujaign92 to nSNa1702a 3d.The Proprietor,Partners or Executive Officers are Included.(Only check box if all partnerarofficers included) �X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"Insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 39 on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the Insurance carrier or its licensed agent,or until the policy explration date listed In box 13c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy Indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business Is complying with the mandatory coverage requirements of the New York State Workers',Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the Insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Nicholas Zulkofske (Print name of authorized representative or licensed agent of Insurance carrier) Approved by: s//) Z Z (Signature) (Date) Title: Authorized Agent Telephone Number of authorized representative or licensed agent of Insurance carrier. 631-941-4113 Please Note:Only insurance carriers and their licensed agents are authorized to Issue Form C405.2.Insurance brokers are NQI authorized to issue it. C-105.2(947) www.wcb.ny.gov Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or'required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-17)REVERSE BUILDINGS: PPOPOSID 2 ROP!PESeENIY 5 m R00Y 20NINC R-ao DEsm2RIW SITE DATA• smu! 1Gao-lnaG-5l eo-wsool � SYS er' f da 1,S�ce r�9 RiE AJEA O]51 KRE At S. 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V E i 9G1EEI 40' `\`- ' - rswwcrs r- vim a mxvc o.tvaKnl Lc-FD AS NOTED JANUARY 2021 Sl `aa j 2GG92.000 auawe acwaur ` ® r�j°F^ r` APv.•`A g RGD I4.xe BUILDINGS: PROPOSED 3 SPOT'RESIDENCE 5 BEMOD", ZONING N-KO(NOxCONFaUYNG) ((��jj rr�� n SITE DATA: // F 11_ E � � E SCtu/: 1000-13].00.01..^,0-005.001 `. ;'+J;}/L• I'v^ ll /� ti / sRE AREA o.751 ACRE - `rS� FGgJ'J` GENERAL NOTES '`,•" D'C�F /� JUN 21 272 iNEA AR£NO YNwm WELLS(DEEP OR SH410W)W2THIN 150'OF PROPOSED SANRARY STRUCTu0.f5.]HERE ARE NO R.-SiORu D-NS WOHW 20'OP'PRWOSfO CESSPOOLS ,,`S O C,)3�F.L / ]. ALL IX6TWG WATER YELLS ANO SER CES ON YYE<RE TO BE ABANCONED G OKONNECIEO I.S PER SCw REaPAEUFNTS. � "1 s PRG—EYNERE ADSAMLARY SYS(E.S. ..E.FOR A TOTK OF s REnlmouc. ���1'?�%A'�\�3�JJ69• �J SURVEY NOTES: BU!LDINr DEPS uEAswENENn u1E m ACCORDANCE Y,TH u.s.srANwRDs. u¢ORED wNm �,r,:�' 2. BEARmGS SHOWN ARE W NEM YORK STAif Pl/J1 CCOflDDUTE SSLEu,LONG G-D—E. PUB UR - •. r _ TOWN OF SOUT;il) .0 NS i E�ATM —HERE ON PEFEPfl1LE W.VD 1988. 1r'�il - - '� ORtREO ALTEMTION OR ADaOON TO A SURVEY YAP BFMWG A LICENSED LNND SURVMCRS SFAL 5 A YIGAibx OP SECTION Y ]]OR.SLI—CO z,OP THE NEW YORK STATE EOUGTON WY. i b 5. ONLY COPIES TROY ME ORWIH4.OP TH6 SURVEY IDANW WRH AN ORp0N4 OFTHE WN BURIEYOR'S'E.—CO'OR INKED' y".'O• ~�'\\\ - - �� \ 6. CERTIOGRON6 mOD� TO 8 HOERON5O 1 THAI THIS SURfY WAS PREPARED w ALCOR EE WRH bE EY6TRIG CODE OF OR IAND SURVEYORS ADOPTED RY THE NEW YORK STATE ASSOCMTON OF PROPESSONAL U,ND SURW:YORS SMD CERRNGTONS SwLL WON ONLY TO THE PERSON FOR ON THE SUR1'fY IS PREPARED AND ON HIS SO-F W YNE TRLE CORPNNY• le\ FQhANNENTAL AGENCY AND UD.'aNG WSTRUTIION LISTED HEREON AND TO THE ASSGNEES Qi tHE lOOYNG WSTITUMN. n LERTIRGANS ARE NOT 1RANSERAaE TO AW IRO WL WSiIIUTpNS OR SU85EOUEHT ). RIGNIS-OP-nAY NOT$MOWN AIiE NOT—TRIED. 8. TNC SDRYEY CLOSES vA1HEWTIwkY. - h' PROPOSED—1SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES / Po RE�ASN.xW°EDTss P�o„°s `�'�� •9.�1,. , /'" UNE OP OFNWSHED eu¢DVK 4ANO+RM \`\� -RO'o \ '• / UNE OF DENDUSNED BWLOWD - P0.0POSED 11 CUFAN PN.W NEUA xY ENClDSUNE �e \ \ �"- e 6TL SANRARY SYSTEM 10 _- ISm rANt O+u(0.) PROPOSED uAC•F•uR BLOWEA uGOEL R vF,"` 'PO,p �O / OOHED AS PER SCONS , _i -- _ _ _- I, flROWx L uAC80Rli 10 BE NARDnwED TO CONTROLLER 1rL G'Tl0 OS STANwADS. 'F _ __ - - LOCATION I' mu.N suY s,ee ax ExlsrWe aL TAnx TD RE RENevED _ P.S Ea vE1R W/cxeRCOAL PnrtR x r.,�faspFfOq $� / - _� 18pONOR. E. OR fes. `\�J 9f . P E B n.NFINE 36'(1wNEn exPEnEn wDON TEAT a° / 467 / 'O—RED qA 1.l! `e� ' PVBLiC WATER 1r -T 1Tw IN PNE BRrAx ruE sAxD(sot0- ST E ST xcwNNn PADr oxE-12/.7/21 i/ J`"•Yr0 ' / 20 'e TEST gHOLE o NN— a 0 / /Ae�2R LOCATION MAP r'•ti < ;'`= — // .J S r000 W'°°D»<11.x c.uN vA OWrs swl.E:1-Soo: *"v F L_J uoo¢ STORMWATER DRAINAGE CALCULATIONS 1 `^ , '-- TO Dw1[DL _ SE F ' C.) NF NOR, lu ERWDus(ROOF)-ZOW r �F O A. i 20((2.600Tx/1i !2 uu60O HAC T O—DUS(D—NRDDF)-576 OF AC 1Z REOU— I PER C-(STB x T)-367 yN HOUSE 1— TO 15 9 1- M TSRO SEie.LE. j<r�9```` 9�O• r/r<i H rJJ(rcv°RsmiDN A1�I,C R P(OPOI Duro e•:o FRT♦rRi Lam- TP AS PER COUNEi:TS RECEIVED ON 7-23-z1 VH EMM C3D / PROWDE:(3)80 LE—RIG STRUCTURES0 8'DEEP �[{��` •6 I 0.5 PER CDMNENR RECEM1'FD ON 5-26-21 NA EI.WL CPO ESlEl.D Lm CONERALES CFC < / A-12-21 uF ADDED C—L NON-TURF RUr-PER CFD �jA9 •: _ ../...V:, y F PCF qEW Cf/25.1 CPM-SBB VR 2-23-z1 .1 As PER C...—FROM SCOHS wTED 2/23/21 CFD .OE:(3)EK IU—NG STIOUD URES O C cP _ DESOM IMPERVIOUS LOT COVERAGE CALCULATION wTE REVISIONS F % EYnONG WATER METER `.H7� / , 3915STILLWATER AVENUE NONE-2.K60 SIT IWIRE-2,—SF COxc S E-.1 SF —E- 0 sF I CUTCHOGUE NY 11935 vEAS- T SF 12D Sl oE�ucN=Mac SOD Er -i:o°sr PROPOSED RESIDENCE 141'SSMIS i ' TOLL=K,bSl I.—Sr .71356 OF PROPOSED SANITARY PLAN SITE°.PLAN PROPERTYENTw32MWED w W THE-vcENT R.) swLE:1'=.0• '2m/ vY°LOmP.LOT—RAGE- sDpz. L.K.McLEAN AS_S_OCIATES,P.C. ERAGE-6.uc/Sz.nu6=Sz Ex: � A wPlw�xiMF/CFD'm r AS NOTED N .^ ..e,: MF JANUARY 20211 S 1 °-` ^" AP—w RAS 20092.000 BUILDINGS: PROPOSED 2 STORY RESIDENCE 5 BEDROOM ZONING R-40 (NONCONFORMING) SITE DATA: SCTMj: 1000-137.00-01.00-005.001 SITE AREA: 0.751 ACRE g \l GENERAL NOTES: �,; >�_-•_-•_••�Q•- - �.9� ��' 1. THERE ARE NO KNOWN WELLS (DEEP OR SHALLOW)WITHIN 150' OF PROPOSED SANITARY STRUCTURES.THERE ARE NO KNOWN STORMr `` �'Lb S-"�\ > DRAINS WITHIN 20' OF PROPOSED CESSPOOLS. 2. ALL EXISTING WATER WELLS AND SERVICES ON SITE ARE TO BE ABANDONED&DISCONNECTED AS PER SCWA REQUIREMENTS. J V p, n ^^�^ 3. THERE IS A WATER MAIN AVAILABLE ON STILLWATER AVE I\1V11 L llll '/1 4. PROPOSED SANITARY SYSTEM IS DESIGNED FOR A TOTAL OF 5 BEDROOMS. .h� y �- t �'•; rT i SURVEY NOTES: N/F ; � rFJ MILDRED DAVID r %`,yam 10'F _� BUILDING DEPT 1. MEASUREMENTS ARE IN ACCORDANCE WITH U.S. STANDARDS. DEVELOPED t - 7p� -0 �e TOWN OFSOUl4-]U?sD 2. BEARINGS SHOWN ARE IN NEW YORK STATE PLAN COORDINATE SYSTEM, LONG ISLAND ZONE. PUBLIC WATER i\ ��c' _ - tide 3. ELEVATIONS SHOWN HERE ON REFERENCE NAVD 1988. '-:Z ^' ;�^~� - 4. UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAW. - - - 5. ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE LAND SURVEYOR'S "EMBOSSED"OR "INKED' O % Nz +-.1 \ _ �'> ��•+'`b�,,a _ y SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES. 6. CERTIFICATIONS INDICATED HERON SIGNIFY THAT THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE ",` FOR LAND SURVEYORS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. SAID CERTIFICATIONS -_13' SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, \ 8 ;�.0''✓:" GOVERNMENTAL AGENCY AND LENDING INSTITUTION USTED HEREON AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. fl „Qp" �° i�` -/ ,•./ 7. RIGHTS-OF-WAY NOT SHOWN ARE NOT CERTIFIED. /; \ _ —\\ p�r•-., ; 8. THE SURVEY CLOSES MATHEMATICALLY. ,� S �1a� / PROPOSED GRAVEL SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES EXISTING SANITARY SYSTEM TO BE ABANDONED AS PER SCDHS ! •�,.� .o�^O \ "�T U •STANDARDS.NE OF DEMOLISHED BUILDING A OO(/6?+v� LINE OF DEMOLISHED BUILDING PROPOSED FUJI CLEAN CONTROL 5'� - O -VDEPTH GRADE / :Av' EXISTING SANITARY SYSTEM TO - _ _ - PANEL IN NEMA 4X ENCLOSURE / (, / A - •�, _ ,- - „'RROJECT 15.90'DARK BROWN LOAM(0L) / "pS,, / o '9T0 - BE ABANDONED AS PER SCDHS 14.90' PROPOSED MAC "R"AIR BLOWER MODEL �- / �� \ S '� \ STANDARDS. SII;; MAC80RIT TO BE HARDWIRED TO CONTROLLER BROWN SILTY SAND(SM) EXISTING OIL TANK TO BE REMOVED /SAF 3, 12.90' PROPOSED VENT W/CHARCOAL FILTER / /T�.Y`FOS/�F��,P 18" MIN.ABOVE GRADE, 36"MIN. FROM / '�/ B tiC o' +� ANY WINDOW OR DOOR. �\4oSF�! ,� /� \ •�• _ ._� PALE BROWN FINE SAND (SP) /' ' \� O`�H \\ T r'`•r(-y ffV' �K- � �VC) J '? �'`� `��}:,, ✓`✓'\ ' , 1.30'(HIGHEST EXPECTED GROUNDWATER) ° / / 1 / d �� N/F v ~`'/ �aC,� ,\ •� JOYCE E DEWAAL 14.9' 1.0' fl'/ y (�A� \ A 1 DEVELOPED / � , •Pq4 (:; J AQ ) i� PUBUC WATER WATER IN PALE BROWN FINE SAND(SP) � 17' I - TEST HOLE BY MCDONALD GEOSCIENCE- 12/07/21 Oyj.O f / TEST HOLE 7c ro ops J �/ irt `� LEGEND _) , ���• � C�/Y \r/ I 1� —PROPERLY LIM1E EXISTING CONIC R LOCATION M A P PROPOSED CONTOUR SCALE: 1"=500'± < TOO O PROPOSED FUJI CLEAN I/A OWTS 0 250 Sao ( S 2 MODEL CENT },/ �`� •6 e % o L--)PROPOSED eR SAMPLING/DST DISTRIBUTION STORMWATER DRAINAGE CALCULATIONS S�P�E oFN Feel MANHOLE(INSTALLED TO ID STING GRADE \a <<,� �...,� S` �O ELEVATION REQUIRED2-RAIDRAINAGE CALCULATIONS: .,q rL TA• \a 7j �` } / (v PROPOSED SANITARY LEACHING POOL ( » A� S.�_,.i� PROPOSED FUTURE EXPANSION POOL IMPERVIOUS (ROOF) = 2,600 SF A. 'D ``-�' t C=(2,600 X 1)= 2.600 s ED �O —PROPOSSANITARY PIPE 2.600 X 2"/12" (RAINFALL)= 442 CF ''�' PROPOSED 2f"o HDPE VENT PIPE \\g � °i IMPERVIOUS (GARAGE ROOF) - 576 SF s / `•� PIPE FOR Md"R"NR BLOWER AS PER H� W 6'� C� r• '' �../// l ---PIPE REOUIREMEMS ( ) C=576 X 1 567 \ 9 576 X 2"/12" (RAINFALL)= 100 CF PROPOSED U.G.ELECTRIC SERVICE 9+ PROPOSED U.C.WATER SERVICE PROPOSED DRAINAGE CALGULeTIONS• 9 1 - MF MOVED MAIN HOUSE & GARAGE TO 15' CFD DEPTH AAS 8'0LEACHING CALCULATIONS) 4442 CF REQUIRED 7 LF SIDE YARD SETBACK ( V{� PROPOSED 6'0 LEACHING POOL(OPEN CRATE) R'0 I= 442 CF/25 1 CFP AS PER COMMENTS RECEIVED ON 7-23-21 VIA EMAIL CFD CF/VF= 17 6 VF J� (DEPTH as PER CALCULATIONS) PROVIDEIDE:: ((3)80 LEACHING STRUCTURES® 6' DEEP o 1 MF AS PER COMMENTS RECEIVED ON 5-26-21 VIA EMAIL CFD 0 TEST HOLE LOCATION G ('a - 4-21 MF ADDED EXISTING LOT COVERAGES CFD ,p GARAGE ROOF �e3/0(1„'•5 ��•-+ E•.y WOOD PILES 100 CF REQUIRED 12-21 MF ADDED GRAVEL NON-TURF BUFFER CFD UTILITY MANHOLE 8'0 DRYWELL= 100 CF/25.1 CF/VF= 3.98 vF 2-23-21 MF AS PER COMMENTS FROM SCOHS DATED 2/23/21 CFD \ i WATER METER PROVIDE: (3)80 LEACHING STRUCTURES® 4' DEEP DATE BY DESCRIPTION APPROV. BY WELL IMPERVIOUS LOT COVERAGE CALCULATION cREVISIONS \ C/ r oc� \ G W WIRE EXISTING PROPOSED 3915 STILLWATER AVENUE �• EXISTING\ATER METER , -` FLAG POLE HOUSE = 2,480 SF HOUSE =2,600 SF GAS METER CONQ. SLAB = 880 SF GARAGE =576 SF CUTCHOGUE NY 1 1935 CONIFEROUS TREE PAVERS A 180 POOL = SF BRICK WALK 300 2,30 SF PATIO =2,390 SF PROPOSED RESIDENCE OECIOuous TREE DECK 470SF STAIRS = 140 SF STAIRS*D CONIFEROUS SHRUB = 4F . -•:j�� TOTAL = 4,.44 50 SF 6,426 SF \ - UTILITY LIGHT POLE PROPOSED SANITARY PLAN UTILITY POLE PROPERTY = 32,713.56 SF S I T E�P LA N •p,, - -ELECTRIC METER (ENTIRE LOT IS LOCATED WITHIN THE ADJACENT AREA) p r EXISTING LOT COVERAGE = 4,450/32,713.56 = 13.6Q7a L. K. McLEAN ASSOCIATES, 1 .C. SCALE: 1 =A0' - -- OVERHEAD WRES PROPOSED LOT COVERAGE = 6,426/32,713.56 = 19,64% CONSULTING ENGINEERS 437 SOUTH COUNTRY RD.,BROOKW,VEN,NEW YORK 11719 20 40 -- ;-- UNDERGROUND GAS TTAGIW uv ar n<srrz v xnr.wx rAaxpR Designed Snell No. 1 Fe01 J ROUND DRAIN INLET am nm wrzsw wmoa wraouvrs 9 Br• MF/CFD stele: AS NOTED wo/nvesivva oiw4nlsr�x.arz uo SANITARY Dra.n By, MF Dole: JANUARY 2021 sawITARY CLEANOUT ra n oOL®C ra niu OnfM v M AVVAttw M ra oAarc���iraiol rno-4 m'w Approved By. RAS File No. 20092.000 oa APPROVED AS NOTED DATE: xx P.# FEE: U BY: NOTIFY BUILDING DEPARTMENT AT RETAIN STORM WATER RUNOFF 765=1802 -8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: PURSUANT TO CHAPTER 238 1. FOUNDATION - TWO REQUIRED OF THE TOWN CODE. FOR POURED CONCRETE 2. ROUGH ;- FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRU:TION MUST BE COMPLETE � C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ELECTRICAL NSPECTION REQUIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF V TOWN PLANNING 9= SOUTHOLD TOWN TRUSTEESe�� t" � ` '��Yr^-.l ENCLOSE POOL TO CODE; N.Y.S.CEC Uf?ON COMPL Iv Y Lj pRE VAT R OCCUPANCY OR pool USE IS UNLAWFUL WITHOUT CERTIFICA` OF OCCUPANCY -( rr1 alt I&f- 4-cr i i I q I �►I Y . S G2 1 , : — , — , 1 4 F i Ul I i I i _i.. t v ' t - i • i` ,q - r , { i f f I 1 _ , i t i G , i t + _! s i_ I s s , : f , t i I 1 f 'I xo"�o i , 1. i f I i 1 ! -- r i -+7•-•.L.f _ _ -�:r�.i'`i: r I f I t � , I , � ! j 'I�, f i I i i r r i i .•t ( Y I i 77, i � , —�"V`✓'w� ✓_i' E 9 % its 1 p I - t ` i t I I I r < c i f i : • I V i f , : i 3 , I ' i i i 1 r i 1 _ } ! 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