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HomeMy WebLinkAbout47111-Z FFolKcoGy, Town of Southold 7/1/2023 P.O.Box 1179 C* • 53095 Main Rd �y�o 'Ar Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44242 Date: 7/1/2023 THIS CERTIFIES that the building ALTERATION Location of Property: 54305 CR 48, Greenport SCTM#: 473889 See/Block/Lot: 52.-1-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/9/2021 pursuant to which Building Permit No. 47111 dated 11/15/2021 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: alterations(new plumbing for new sanitarsystem relocation)to existing single-family dwelling as applied for. The certificate is issued to Rogers Grun,Susan of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-21-2778 6/26/2023 ELECTRICAL CERTIFICATE NO. 47111 2/9/2023 PLUMBERS CERTIFICATION DATED n �\ o \AVON---� h iz S ature o�su i TOWN OF SOUTHOLD aye BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • o� $ 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#: 47111 Date: 11/15/2021 Permission is hereby granted to: Rogers Grun, Susan 1458 Montauk Hwy Watermill, NY 11976 To: construct alterations (new plumbing for new sanitary system relocation) to existing single-family dwelling as applied for per SCHD & Trustees approvals. At premises located at: 54305 CR 48, Greenport SCTM #473889 Sec/Block/Lot# 52.-1-6 Pursuant to application dated 11/15/2021 and approved by the Building Inspector. To expire on 5/17/2023. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector pF SOUjyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin(a-town.southold.ny.us Southold,NY 11971-0959 �ycDUNT`I,Nc� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Susan Rogers Grun Address: 54305 CR 48 city,Greenport st: NY zip: 11944 Building Permit#: 47111 Section: 52 Block: 1 Lot: 6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Arnister Electric License No: 57185 ME SITE DETAILS Office Use Only Residential X Indoor Basement Septic X Commerical Outdoor 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED F-1 Exit Fixtures Sump Pump Other Equipment: Notes: Septic Inspector Signature: Date: February 9, 2023 S.Devlin-Cert Electrical Compliance Form SOUI yon 11'I S4 - -- -- - pF * # TOWN OF SOUTHOLD BUILDING DEPT. °`ycourm,N�'' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: -r­lnMk, DATE INSPECTOR pillIV S0l/lyo� # # TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 INSPECT N [ ] FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL ?/ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: �► DATE INSPECTOR FIELD:INSPECTION REPORT DATE COMMENTS ►'d FOUNDATION(1ST) y ------------------------------ FOUNDATION(2ND) . z 9V .ROUGH FRAlytING:& y PLUMBING' c INSULATION.PER N.-Y. STATE ENERGY CODE V . 92 viv, -o FINAL _ ADDITIONAL COMMENTS o ra �m L . . . 71�4 T J W Z LL y SON� HLA.' NEW YOLK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 7 SUNY.4 Story Brook,50 Circle Road,Stony Brook.NY 11790 U:(631)444-03651 F:(631)444-0360 ec,ny gov LETTER OF Ido JURISDICTION TIDAL WETLANDS ACT July 21, 2021 Susan Rogers Grun 1458 Montauk-Highway Wateemill, NY 11976 Re: Application#1-4738-03542/00003 Grun Property-54305 County Road 48 (North Road/Middle Road) SCTM# 1000-52-1-6 Dear Applicant: Based on the information you submitted the Department of Environmental Conservation has: deterrr ineo that t e;j roposec3 vvt rk�is4a i'dward,:of the topographic crest of a bluff, in excess of 1.0'; et its: .l vattan, s s town,c 11 the.puruey'prepaeed.by Joseph A. (ngegno, last revised Jahoary 8,:`°f 998. Therefore,:the property:?l ndvtard,cif the topographic crest of a.bluff(17' eIevat10*n-*ta ar}:'is beTid y rid al Wetlands pct(Article 25)jurisdiction and no permit is required for work landward of this structure. Be advised, no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary,,as.indicated above, without a permit. It is,your responsibility to ensure that all precautions are taken to prevent any.sedimentation or disturbance within Article 25 jurisdiction which may result from your project. -Succi precautions may include maintaining adequate work area between the jurisdictional boundary and your project(i.e. a 15' wide construction area) or erecting a temporary fence, barrier, or hale,bay berm. This letter shall remain valid unless site conditions change. Please note,that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or focal municipalities. Sincerely, Laura Star Permit Administrator cc: BMHP File :=. _ ULWYORK € Departmentof Environmental ���q„y;,aENtaar .'.conservation urF°� ems. TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 https://wwcv.southoldtownnYov Date Received APPLICATION FOR BUILDING PERMIT _ d �� LDI For Office Use Only PERMIT NO. Building Inspector: AUG — 9 2021 Application's and forIms.mg11st be filled out is their entirety.Incomplete BI1D•D IG DEPT. applications,will not ae accepted. 'Where the Applica6 is not the owner,an, �0;,���?43F 50�1'F rIa%�D Ownees Authorliatian form{Page 2)shall be completed. Date:$/5/2021 OWNER(S)OF PROPERTY: Name:,Susan•,Rogers Grun µ __._........__ ........ scTM#10,00-052,.00-,Q1.00 006.000 ... __. Project Address:54305 County Road_48 Phone#:631 727,4100 _........._ . ... .. . Email:sgrun@sfliy.com ___.. .. . .__...... .. Mailing Address:456 Griffing Avenue,,,Riverhead,, ,NY, CONTACT PERSON: z Name:Susan Rogers Grun Mailing Address: Phone#: Email: DESIGN PROFESSIPNAL INFORMATION. Name:B,eniamin Wright Chaleff Mailing Address:1514 Montauk Highway,,,Water Mill NY Phone#:631 726 4477 _ Emaii:ben@chaleffandrogers.com_.... CONTRACTOR"INFORMATION: Name:Sam Roc ers/Diversified„Services of Water Mill Mailing Address:PO Sox 1020 Water Mill NY 11076 Phone#:631 324 6933 __.........._.........,._ Email:sam diversifi_edli.com _..__... DESCRIPTION OF.PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Dother Upgrade sanitary system $$30,000.00 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? RYes ❑No 1 '.PROPERTY INFORMATI©N Existing use of property:single family residence Intended use of property:sing!P,f@M.ily residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Reslderl�lc`'' this property? ❑Yes ©No IF YES, PROVIDE A COPY. Q Check Box After Reading: 'rhe o,nuner/contractor/design professional is'responsibte for all drainage and storm,waterissuas as provided by Ciiaptei 236 of the Town Code:APPUCATION IS HEREBY,MADE to the St ildtag Department for the issuance of a Building Permit pursuant to the BuildingZone ordinance of the Towr'of Southold,Suffolk,Courcy,New,Ygrk and otherapplicable haws,ordinances or ftegutat'usns,for the construction of buildings, additions,alterationsor fol removat or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing rode and regulations and to admit authorized inspectors on premises and in building(s)for necessary Inspections.False statements made herein are punishable as a class A misdemeanor pursuant to Section 210AS of the New York State penal law. ' Application Submitted By(print name):Susan Rogers Grun g g ❑Authorized Agent i9Owner Signature of Applicant: �,�qDate: 8/5/2021 STATE OF NEW YORK) SS: COUNTY OF 5VFR91 — Q5W Q 0&CAS a,k Li being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the 6L W (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 thi 'i day of ,20—c>-9— Notary PubbwNA KLEVY7 Notary Public,State of NewYotk No,01 LE4875563-Suffolk Countl PROPERTY ®!A/fdEI2 AUTHORIZATION Commission Expires November 3&Q (Where the applicant is not the owner) 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 Glenn Goldsmith,,PresidentQ _ Town Hall Annex,.,_ A. Nicholas Krupski,Vice President 54375 Route 25 Nicholas P.O.Box-11,179: John M.Bredemeyer III Southold,New York 11971 Michael J. Domino, . Telephone,( 1)765=1892 Greg Williams, �� Fax(631,)765-6641. enumv, BOARD Of I TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.:'",9979A Date of Receipt of Application: August 24,.2021 Applicant: Susan.Rogers Grun: SCTM#: 1000-52-1-6 Project Location: 54305 C.R.48, Greenport Date of Resolutionllssuaned: Uptember:15, 2021 , Date of.Expiration:.Septeimber 159 2023: Reviewed by: .John IUI.faredem®yer. N Trustee Project Description:. Abandon the existing sanitary system and install a new PYA sanitarysystem. Finding' s-.'The project meets"ail the requirements for issuance of.an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The'.issuance of an Administrative Permit allows for the operations as,indicated on the site plan prepared,by: Chaleff& Rogers;"Architects, received on"August 9, 2021, and stamped approved on September�15; 2021: Special Conditions: None. Inspections: Final Inspection. If the proposed,activities'do not meet the"requirements,for issuance of an Administrative, Permit set forth in Chapter 275 of the Southold;Town Code;,'a Wetland Permit wil.(be required. This M' not a determination from;any"other agency. Glenn Goldsmith, President Board of Trustees: Glenn Goldsmith,President %Qf S®Ujy Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President �®� ®�® P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly G � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1996C Date: January 11,2023 THIS CERTIFIES that the abandonment of existing sanitary system and installation of new UA sanitary_system,• At 54305 C.R.48. Greenport Suffolk County Tax Map#1000-52-t-6 Conforms to the application for a TrustI ees Permit heretofore filed in this office Dated August 24,2021 pursuant to which Trustees Administrative Permit#9979A Dated September 15,2021,was ii sued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for abandonment of existing sanitary system and installation of new I/A sanitary s sy,tem• I The certificate is issued to Susan Rogers Grun owner of the aforesaid property. 00 ` Authorized Signature 'NEW,YORK STATE C3EPARTMENT:OF E.NVIRONMENTAL CONSERVATION t'SlviMon of!Eh Permits,Region,T St1NY,O Stony Braok;50 C rde Road,Stony.Bro'ok.NY 11790 N;.(fi31?,444 -(631)-44 60 NrvW.der.:ny<gnw LEITER O NO JURISDICTION, :` ft VVETLANDSACT Juiyr21, 2021 „ an Rrut', ._ Hi6P 1458,:.11110 #a k.an ,u.� Y woermllt, NY 11976. Re: Appli6ti6.n=#1-4736-03542L00663 d Ie.Road �GrurrP;roperty 54305`-County Road 48 (North Roa'ci/Mi c1_ ) . SCTM#10.O0-b2=1-6, . DearA )cant PP. - hos; Based on t i i2 fcirmation youa submi#tad the epartnrient of Enver nmerital:CoriSerua#it�rr s�f -thS„ :. :° ; e 'asd viarl€si's>laiiVil.,t1 ihe,topographic crest of a C {iafl in exees s sum `` iepwi: b"y;°;los ph A...lr�,gegna,,iasf revised ..;.... .; > •���; �-�:i�rt '{ vu�rcC:=t��ttie to 'ahic:crest:of-a.bfiuff;{'17' J�i'�ta�.i�`.s;r='1:9�t3:;: Tfl�fo�e,::�..:;. R,:.�:�;;,y::. q.��.�.,. :. •. .f?. �,ra.� _ A. ..............:...., lctloni and rio.periYiif 'rs - �;p,�s�t � .t��i�e�!�srtc� e . .. _ ,.. regtaired for wolt�}lanriintard of##%is:sfr-acture, Be-.advisee#,f) `construction;.sedirne atl rlx or:disturbance of any kind may take place seavi�a�d of tho tidal virellancis' irisdictiorial bouizdary;:•as indicated aboue,;:wifhiaut apermit fit'isoui- resporisl6llity.tc ensure that a!i preeautioi are taken to:prevent-any sedimentation or dis#urbarice vuitEiin Artioie:25 jurisdiG#I.Q.nwh_ici .rriay. result fromaiar,project: Such precautions may,ls�clu ie:inair)tainirig.atiequAte- rk area between the jurisdictional boundary,:and your projeiy#{ise.z:a 15''wine coristriict ori:area) Or,erectiri0.a temporary fence..Marr er,,.or ha(e baj+ This letter,shall i~emain valid;ur Less=si#e condi#tons cf anga, - P(ease rid:te tF a A is 7e#ter`does not relieve you of the:responsioility,of Ot0InJng°any necessa }I permi#s or approvals frcim'ottier.ag'eraciss:'or local r iunicipalltle� Sincerely, ;Laura-Star Perriai#Administrator cc BMHP ,. File", IAR, Depament!DfEnrtvironmental l .cogservatlpn` JAN 1 2 M1 U DING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD BUILDING DEPT - 1AFK1nCQn1M4MT®wn Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 .4,4 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(cDsoutholdtownny.gov - seand(a)southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: ljtojm)3� Company Name: Arnister Electric Electrician's Name: Brandon Arnister License No.: ME-57185 Elec. email:brandon@arnisterelectric.com Elec. Phone No: 516-380-1426 El I request an email copy of Certificate of Compliance Elec. Address.: 180 Blank Ln. Water Mill NY 11976 JOB SITE INFORMATION (All Information Required) Name:' Address: Cross Street: Phone No.: � Bldg.Permit#: 1l7/(/ email: rvl�,0 iAe�h Tax Map District: 1000 Section: p 131ock: Q Q Lot: 00 Q BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 5 //ubn ® � �A CW 11' Square Footage: Circle All That Apply: Is job ready for inspection?: M *ES ❑ NO ❑Rough In ® Final Do you need a'Temp Certificate?: ❑ YES 0 NO Issued On Temp Information: (All information required) 1 PhF-]3 Ph Size: A # Meters Old Meter# Service Size 1-1 ❑New Service[:]Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Uriderground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? FlyN Additional Information: PAYMENT DUE WITH APPLICATION ! 12I2-3 Tam q0 Rec4 lo--_2D4(pl -7111 SMITH,FINSELSTEIN, LUNDBERG, ISLER AND YAUAROSIKI, LLP ATTORNEYS AND GOUNSELORS AT LAW 456 GRIFFING AVENUE, CORNER OF LINGOLN STREET RIVERHEAD. N.Y. 11901-0203 (631) 727-4100 FRANK A.ISLER HOWARD M. FINKELSTEIN SUSAN ROGERS GRUN FAX(631) 727-4130 RETIRED GAIR G.BETTS JEANMARIE GUNDERSON PIERRE G. LUNDBERG DANIEL P. BARKER RETIRED GHRISTOPHER B.ABBOTT REGINALD G. SMITH 1897-1983 ALEXSIS J.GORDON August 5, 2021 Mr. Michael J. Verity Chief Building Inspector Southold Town Building Department Southold Town Annex 54375 Main Road P.O. Box 1179 Southold,New York 11971 Re: 54305 County Road 48 —Sanitary Upgrade_ Application Dear Mr. Verity: Enclosed please find the following documents: 1. Completed signed and acknowledged building permit application. 2. Survey of the premises. 3. Four sets of plans prepared by Benjamin Wright Chaleff. 4. Contractors Insurance forms and Suffolk County license. 5. NYS DEC statement of non jurisdiction dated July 21, 2021. Thank you for your attention to processing this application. Very truly yours, Susan Rogers G SRG:bp Enclosures SMITH,FMI�LSTEIN,LUNDBERG, ISLER AND YA_AABOSKI,LLP ATTORNEYS AND GOUNSELORS AT LAW 456 GRIFFING AVENUE. GORNER OF LINCOLN STREET RIVERHEAD. N.Y. 11901-0203 (631) 727-4.100 FRANK A. ISLER HOWARD M. FINKELSTEIN SUSAN ROGERS GRUN FAX(631) 727-4130 RETIRED JEANMARIE GUNDERSON DANIEL P. BARKER PIERRE G. LUNDBERG CHRISTOPHER B.ABBOTT RETIRED GAIR G.BETTS ALEXSIS J.GORDON RETIRED October 28, 2021 REGINALD G. SMITH 1897-1983 Mr. Michael J. Verity Chief Building Inspector Southold Town Building Department R Southold Town Annex 54375 Main Road NOV 0 1 2021 P.O. Box 1179 Southold,NY 11971 BUILDING DEPT. TOWN OF SOUTHOLD Re: 544305 County Road 48—SanitarUpgrade Application Dear Mike: I am forwarding the 8/5/21 package sent to the Building Department which had been returned to me. I am also enclosing a copy of the Town'Trustees permit issued on September 15,2021, and the Suffolk County Health Department approval and plans stamped 10/17/2021. As the plans show,the waste line will exit the basement with a 4-inch pipe. Frank Fenoy has agreed to do the electrical work on this project and indicated that he will file an application if necessary or request an inspection after he completes the work. Please let me know if an application is necessary prior to his work. The best number to reach me is on my cell 631-235-1919. Very truly yours, Susan Rogers Grun SRG:bp Enclosure SRUTH,FINEELSTEIIV, LUNDBERG, ISLER AND YAUAuOSKI, LLP ATTORNEYS AND COUNSELORS AT LAW 456 GRIFFING AVENUE. CORNER OF LINGOLN STREET RIVERHEAD. N.Y. 11901-0203 (631) 727-4100 FRANK A.ISLER HOWARD M. FINKELSTEIN SUSAN ROGERS GRUN FAX(631) 727-4130 RETIRED JEANMARIE GUNDERSON DANIEL R BARKER PIERRE G. LUNDBERG CHRISTOPHER B.ABBOTT RETIRED GAIR G.BETTS ALEXSIS J.GORDON RETIRED REGINALD G. SMITH 1897-1983 November 17,2021 Southold Town Building Department Southold Town Annex �p I� 54375 Main Road,P.O. Box 1 ®.179 E- l°l Southold,New York 11971 NOV 2 2021 Att: Susan Pontino, Sr. Clerk Typist BUILDING DEPT. - TOWN OF SOUTHOLD Re: 54305 County Road 48 Dear Ms. Pontino: Enclosed please find a check in the amount of$250.00 for Building Permit Application #47111. Very truly yours, Susan Rogers Grun SRG:bp Enclosures SMITH,Fnv1M11,STEIN, EUNDBERG, ISIMR AND YAAAROSKI, IJ IP ATTORNEYS AND COUNSELORS AT LAW 456 GRIFFING AVENUE, CORNER OF LINGOLN STREET RIVERHEAD, N.Y. 119101-0203 (� FRANK A. ISLER (631) 727-41 0 ® Il n D M. FINKELSTEIN SUSAN ROGERS GRUN RETIRED JEANMARIE GUNDERSON FAX(631) 727-4 JAN 19 20? DANIEL P.BARKER I RETIRED E G. LUNDBERG GHRISTOPHER B.ABBOTT BUILDING®EPS T01AIM 1:Rni THnur) GAIR G.BETTS ALEXSIS J.GORDON RETIRED REGINALD G. SMITH 1897-1983 January 12, 2023 Michael Verity, Building Inspector Town of Southold Building Department Town Hall 53095 Main Road P.O. Box 1179 Southold,NY 11971 Re: 54305 County Road 48. Dear Mike: The I/A OSWT System has been installed at the above referenced property. I am enclosing building permit 947111 and requesting the final inspection. Please forward the certificate of compliance to me at the above address. Thank you for your attention to this matter. Very truly yours, Susan Rogers Grun SRG:bp Enclosure 7 ® DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 08/05/2021 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 have ADDITIONAL INSURED provisions or 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 Wendy Verity NAME: Dayton Ritz&Osborne AHONN Ext): (631)907-3112 ac,No: (631)324-0165 78 Main Street E-MAIL wverity@droinsurance.com ADDRESS: P.O.BOX 5099 INSURER(S)AFFORDING COVERAGE NAIC q East Hampton NY 11937 INSURERA: Merchants Mutual Insurance 23329 INSURED INSURER B: Diversified Services of Water Mill Incorporated INSURER C: PO BOX 1020 INSURER D: INSURER E: Water Mill NY 11976 INSURER F: COVERAGES CERTIFICATE NUMBER: CL20101916177 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 AUUL bUtJK1 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DD MM/DD X COMMERCIAL GENERAL LIABILITYEACH OCCTOE RRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea=",) occurtence $ 100,000 MED EXP(Any one person) $ 5,000 A X CONTRACTUAL LIAB. Y CMP9153370 11/09/2020 11/09/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY JECT PRO- F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CAP9267886 11/09/2020 11/09/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident H $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CUP9145309 11/09/2020 11/09/2021 AGGREGATE $ 5,000,000 DED I I RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured with regard to General Liability coverage as required by written contract and is subject to all policy terms& conditions. This is in regard to job location of 54305 County Road 48,Southold NY 11971. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Susan Rogers Grun - ACCORDANCE WITH THE POLICY PROVISIONS. 54305 County Road 46 AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ': : Nj 'I: ttem+i.York.5tate`Insctraiice Fund 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE D � AAAAAA 460855153 LOVELL SAFETY MGMT CO.,LLC 110 WILLIAM STREET 12TH FLR ' ■ NEW YORK NY 10038 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DIVERSIFIED SERVICES OF WATER MILL TOWN OF SOUTHOLD INCORPORATED PO BOX 1179 P.O. BOX 1020 SOUTHOLD NY 11971 WATER MILL NY 11976 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 22090 227-6 750109 04/01/2021 TO 04/01/2022 8/5/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2090 227-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. SAMUEL H ROGERS 1 OF 1 SOLE E/O OF DIVERSIFIED SERVICES OF WATER MILL INC THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:628171089 U-26.3 N ' JF: new4otk'3l�to;insurance Fund 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE D ^^""^^ 460855153 LOVELL SAFETY MGMT CO.,LLC . 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 il SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DIVERSIFIED SERVICES OF WATER MILL SUSAN ROGERS GRUN INCORPORATED 54305 COUNTY ROAD 48 - P.O. BOX 1020 SOUTHOLD NY 11971 WATER MILL NY 11976 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2090 227-6 750107 04/01/2021 TO 04/01/2022 8/5/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2090 227-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. SAMUEL H ROGERS 1 OF 1 SOLE E/O OF DIVERSIFIED SERVICES OF WATER MILL INC THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND wio DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:782770260 U-26.3 Y� workers' CERTIFICATE OF INSURANCE COVERAGE STATE Corrtpensa€ran Board._ DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured DIVERSIFIED SERVICES OF WATER MILL, INCORPORATED 631-324-6933 PO BOX 1020 WATER MILL,NY 11976 1 c.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) 460855153 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 SUSAN ROGERS GRUN 54305 COUNTY ROAD 48 3b.Policy Number of Entity Listed in Box"1 a" SOUTHOLD, NY 11971 DBL391204 3c.Policy effective period 12/31/2020 to 12/30/2022 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. E] B.Disability benefits only. ❑ 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. E] 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 8/5/2021 By (�W, hf (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that 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 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 4C or SB of Part 1 has 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 with respect to all of his/her 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. DIB-120.11 (10-17) 1111111111111111 111in 111111111111111111111111 Yo,:K Workers' CERTIFICATE OF INSURANCE COVERAGE STATE COtronsbition Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured DIVERSIFIED SERVICES OF WATER MILL, INCORPORATED 631-324-6933 PO BOX 1020 WATER MILL,NY 11976 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) 460855153 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 PO BOX 1179 3b.Policy Number of Entity Listed in Box"1 a" SOUTHOLD, NY 11971 DBL391204 3c.Policy effective period 12/31/2020 to 12/30/2022 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. E] B.Disability benefits only. Q 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 8/5/2021 B �l%< 9 Y (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that 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 4B,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 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 4C or 5B of Part i has 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 with respect to all of his/her 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 (10-17) III IIIP1°°111°211°°1°°111°11°1111°1°I�III SUFFOLK COUNTY DEPT OF LABOR, LICENSING&CONSUMER AFFAIRS ry "x COMMERCIAL,INDUSTRIAL RESIDENTIAL,SEPTIC LICENSE Via: NME SAMUEL H ROGERS This certifies that the 9USNESSNAME bearer is duly DIVERSIFIED SERVICES OF WATER MILL licensed by the INC. L Inn••Number ryCounty of Suffolk D-1*11—d J.+�eref�.� �:• 59080-LW 08/31/2017 I Cemrlmbn•r ExanArcN GATE •• 08/01/2019 I SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPROVAL OF CONSTRUCTED WORKS FOR SURVEY OF PROPERTY A SINGLE FAMILY RESIDENCE SITUATED AT 100 ARSHAMOMAQUE 6hti f�° Il Date 612612023 H.S.Ref. No.— R-21-277a yay �' TOWN OF SOUTHOLD a `^ The sewage disposal arld water supply facilities at this location leave been SUFFOLK COUNTY, NEW YORK inspected and/or certified by this Department or other agencies and found S.C. TAX No. 1000-52-01-06 �O ��• to be satisfactory FOR A MAXIMUM OF 4 BEDROOMS. SCALE 1"=20' DECEMBER 2, 1997 JANUARY 8, 1998 ADDED TOPOGRAPHICAL DATA CV, MARCH 26, 2011 UPDATE SURVEY <y Otfice o. 'astewa[er Management MAY 31, 2023 UPDATE SURVEY AREAE 10,684 ft. + (To TIE uxr:)0.245 cc. CERTIFIED TO: SUSAN GRUN 0 �� ie � V. �� SEPTIC SYSTEM TIE MEASUREMENTS AS HOUSE HOUSE f, - �r,C+ �p� '�'s,�.�0 CORNER aA CORNER fB • •?+ ��r "{6-foL'+). �,a�" op �'on I/N OWATS UNIT @° �r ;•�, os�„ s�y4 G1,o FUJI CLEAN CEN 5 22' 13' -g� �+' c •. ,� o �o OUTLET COVER lot- ro �Q��c"•P,. COVERING POOL 33' 21' �—J,\J� m� 1`_%'5�, 4i. \''fir•. •06'. .y'�v: 6.3.49' -- V l_.+ ce - 5 „23'0°" w JUN 2 7 2023 - y 9 � AdPAND N/4M0W2 Mull TIE la1✓•LLY ..' ran SUOI 115E 9Y T2 MEM Yax SWE 1Axp t�y- y[� '• tE 3r QQ 41 Y a�• ti•ti \ %% Ori �O A,V� I.•.' 9£t 9 Q �n z1x� Z ''/Q•/�+•7..+'•O��� N.Y.S.U.N..50467 oaf ,��e8 IravnulaaDa AIIETDIOH ox Aa0xR1 SUP ro nus sum+Y e A Ma.aDH v Nathan Taft Corwin III xo uauo9D111Ac N•� Op,m 6 T6 SNM1EY 11N IDf aNa¢ Land Surveyor aExlnaan,s.wTa�,9u1.DN aar ro 99:Pf1WN rax�xaY ra sumEr 6 R6PAI6q AID W Sus BEIWT ro M S—T.SIaNry J. SLS TnE COIPANl.OalOpx6TD1 N.DE.T AID JmpPa • IFImeD amxlncx ISrD ImS0l1 ANO 110u1vialo�maiamA,rsf�Ev�nE. To. s..eys—s6awNu—sm Pwo— Cautrlla6'm E mud PHONE(631)727-2090 1.(631)727-1727 THE OOSTE110E K x105116 Or MAY OI770ES IOGiED AT MUM AORRSS 1566 EI®1 BOad P.O.Bat 16 •NOf LRE NO7 J--p lk Nn Ya,n 11947 J--pA Nn YM 11947 i INFORMATION-FROM A SURVEY BY: JOSEPH A.INGEONO MAP OF ILI One Union Square ARSHAMOMAOUE' Aquebogue,New York 11931 TOWN OF SOUTHOLD ated 1. _ Lest updJan,81998 o !oorr� r_ex6r.va+0,,,roe ,•, a SUFFOLK COUNTY,NEW YORK �Ftvar xr'rn`>cai'1: 7 LICENSIE No.49668 r is x.�ccY.i.l yn�ta t..r:zss: L _ � cat.sm J a s. •t ra raNc;,a s.:Ton rS t�a:.x:r0 n� i COT AREA:9,078.18 SO.FT.=0.208 ACRE S.0 T.M. No.1000 62-01-08 ra:cs'a/r::i.e::avxJike+` a•rrS< n::n. o \, :..,.. ':xA•Pee:eAKeurarzet• :r;JF!A£t!Ni-7t._r-:�.s�.sTAy,;.' - i i Abandonment „•= of the eXisling sanitary system must be in w aS � conformance with the Depaitmenrs requirements: - Q �•�. �• a.... GENERAL NOTES; $uI)md Completed fOnn V1NVM-Ot3QaS prODf - .�+'3 a t.. .SURVEYORS ELEVATIONS REFERENCED TO N-&V.D.1988. Aps - 2 MAINTAIN 1 V-0•MINIMUM HORIZONTAL SEPARATION BETWEEN WATER AND - ,' 4`�� y0• /, _ SANITARY UTILITY LINES_'NEW WATER LINE IN SECONDARY PVC CONDUIT• O� v- f,/ :.Design,Professional's Certification Required. _ A THE PROPERTY IS LOCATED WITHIN GROUNDWATER'MANAGEMENT ZONE N. O O .- . 4. NO DRINIONG WATER WELLS AREWIrHIN.150'.OF THE PROPOSED SANITARY '' v �r�e s' ' Submit P.E:or RA:Certification For - a -Z _ e - SYSTEM.ALL NEIGHBORS WITHIN 150 ME O_N PUBLIC WATER A9 CONFIRMED 5 - `i .- .. -. 14 �• ° ° "' ' The Installation and Construction or the SeWage_Disposal System. —1 5. ,THREE(,)BEDROOMS TOTAL OOSTI N's.4 BEDROOM SYSTEM PROPOSED. I !4 <- 0. THE DESIGN PROFESSIONAL SHALL-OBSERVETHEOWTSPRpR L / +,o-�'' o; UseFoirRV1/WM-073 - - ° AND DURING SYSTEM.STARTUP:::. 'P,.� c •r`�I /7- ,-' 7. AN EXECUTED OPERATION AND MAIM1cNANCE CONTRACT BETYVEEN THE �Y y_ '' • "_.. - U . MAINTENANCE PROVIDER AND THE PROPERTY OWNER SHALL BE PROVIDED srnav A.A NFCY .. FrnMLAZM TO '`/ i_�• s F ICI bGE 5B . e. MAXIMUM 5%SLOPE WITHIN 2(r:OF SANITARY SYSTEM, : - SURFACE1w. - 9� N08U WATERS OR VIIETL11Nf)B WITHIN .. _ .' ? � 'meq,• �> � - ,}\�,ct '�.�o - - . J F tlA HDPE RISER BYTUF-RM TYP: � _ .. _. •��- .(.. ' _ 'a 'ae arou�HDvesEivREelFAwcwEiierTur.!mE.TrP. - - . '.i'�•' ,';'e ,� d(o . : . Sk'ETYSCREEYBYTUF VTa TW. - "d�` •'U, tr, i�c. 5 tar F.F.E. _ COY .. 2P OY\ PONaJr;TNSA6E�OtLY _ rTiuFEr_.eEA,va vREwrcoee.alAe -:�,yy ~■c„`.'^�• �°j;,• y�` �,�4 i'_'� .. _ . .. .. YRL COMCNETECCYLRCONOtM AONECESSARY y APgtQK �.�' •� ALL'E]nSTOq 'q`Q O-..'A _ CL EZTEfLgON M1 {�,/�(,•�A ELEv.mS WYNTAWYx M%AWETo ♦ sv3TEwBTRUMIRESTow PLIMPEDDTOPS -• � - --- _ I I `.T♦`A\N YEM MIUN WATeiYMK-1lDFLEO YNNI O'•• -t. ..- ,! /fes• .. e r T A \`S &MfAREIIANDANO GRAYFl .. .. PON EOR•76gT01ED •.q... r Y` •:b.rv1�li t • .._ ♦ • :^Yi J wPEnraor aGRrtE = _ �•, d ♦AY: °�2�'4` . ISOI �`.•• _ e o o Aa �• ••APPROK LOC.ER GAS UNE APPRO4�! 16171E - •.-• .,'., - K TM .. :1.,1.•r��' .b �o � � � � � ,� NaELac—�R '° ;. s ♦♦: , �t � ' t is l'; Aai _ a o,o o e. :b i•'_ tf F 1 _ .'f.�'H••.Y r. r. r. r. � � •}' t • \ is !� � .T .,,T'• {Y FuiiCl,m CENS :.r. :-'•'• 6 .7.::. 3 ` ♦ - ' /19mR,nrSri.Pmril, NEW IV PRECASTIvb •.:, t• ....................................... ..:.................................. ..•:>.-' •r. APPR\ • bel rt. . •,{ .!a �b r• r• r. � r. r.r. b• � 1�\ WATER LINE LOC_ ••'L.• � �n - ol° e e to 6 EXCALATION INSPECTION REQUIRED .}°r �_ j Bt6TALLNEWYATER TUNEIVUPLFRCY LC} . - SANITARYOpYPONENiS •• . FOR SANITARY SYS•iETd .° •_. =9 0� ——= BY HEALTH DEPARTMENT - - VL -� �_,.. '�11 Wat.rlines mwt be'inioeRod by tfie av /n EsrE-wEcrmaRoumvw--------� JBL••�: w �Ot D• 1 SuC. FFclk coL_* Goat of till(631)852-5754, TYPICAL LEACHING POOL 08 hour;In advame,to;ch•dUl inspection(;). r�rnLPTano A ALLA C i...r+ -�^•. �SMOE N)Wb LOW GRADEN111NON N-•. _.. Y" -...•.-.� C01AIAr,SOt WY,L6MR91LAILADE07ESTHOLE ELEV.18! W Low I S:61Y Cw+bq.a '�1 Tz ' ELEIF.17.W 3.°"'E°"q FUJICLEAN I/A OWTS •''� = - SYSTEM 3:+y'8i.__.._•icy..._.. �` -: - �..; .. - BRQhH 51LTML) ,:1 -- rr "s`�nzP S -- - Te•F�A oN '-; ,. ... .::_>'::>>::�.:�:;::::: :'>;;>�>.: m I .-..._.._....�_-. j, rnRROLLEnJ :.• ..•...3.••....•.•.•-,r:.,•......:. '. ; 1�.a .,. 3.' �o E&TI ALARM-IN Ymow+ `,.,�Fp •--SUFFOLX COL'NTY.DHPARTFENr-OF H(rLTH SE vicm __ —`� thL�'•A ELEYSe (SYJ JWipVgE CaHfROl1E11 °xi�E PE - 4 _ 1: W TTreswIIIROW - n Nw ZAMP AIRLINETo '0'6 mOY STN.L E MARY REsiuwS ONLY Ftxt A Z O - y: +a¢ _ i ..•.•w.r.- ... PAN�HWtOW'FE INSLILATBLOWER RION LFI ALowEx (� T OR fUi' 1 Y'(�7I3i N BRg1TJ E OATR F V • d'•• _� Iwl v .e•m., FIEISANUIS•) 1s9Y apR1 A)EpM .. n , �.:..•.::.�Viz, .: .. w..,...,. ::. -- Mat L.....,...... � lrmzt., H N :R zt.277B:: ........... .... .........._...1 �e GRADE ... ::.. .�ymnaDleomm. Y 1a1E,4W,• :: APPRcrVED,.. :..:...b� .. .... .---.'. tNGWINO Nur�Elt SOIL BORING P ®BORING w:1�7rt°NUD,0eoscIENCE ,�e � r ..: FOR MAr1MilM OF ... ..4..... ..... l3gun6j�t$':. . 1111 GROUNDWATER ENCWNita®AT lss �N.T.9. �CI„nout ...................: eaowaRADe �11e.t'•a• :: EXPiRESTHREEYEARS RC]tri'pfLTEOFAPPRCI:AI ' It SCALE APFUES WHEN TROTTED ON A 2W X,36'am ' . :(: i moi....t?:li�`:i D•w sr Nom. i • , I , • INFORMATION'FROM ASURVEY BY: JOSN PH __......__......_._........_. ........__.._....._.__..._.._._..._....... OneEUn�n s ue a �19�4E w — { """"' Aquebogue,New York 11931 1,o AR HAMOMAOUE' Last updated Jan.81998 TOWN OF SOUTHOLD U a F:._._--------- xwo:r;as ••_.._.... SUFFOLK COUNTY.NEW YORK , -1 01.zn,_ LICENSE No.49668 L :•YCh 1JF:T.:^_".•:TT.'�F.^M!�:,;;.w'fT :L Lh�,:1r.:vK.S Ji1F�.,L...t:.r:r;b(.[ISYit T LOT AREA:9,078.18 SO.FT.=0.208 ACRE Z i .:r:rtrzva:recara:e_':�rE,:acx:on=z;.xArw:rac:;was. •M:•onrtr2=:r.:.a :n::tt.w+r•� I S.C.T.M. No.100052-01-06 . !PrLa:�:Tt.AilAT.O.V 9U•1,lA�. Mm ,-a I •,•. O`� -,,,.• t2+NLfi C:.EAmA_ A:£:.wE:T rK2:t}S•i3t`5!:=M _a:axy. . o _ ` ""�wx AME^ Abandonment of the existing sanitary system must be in w Iz P. `1 GENERAL NOT�tl < conformance with the Department's requirements. SURVEYOU7 Q -.� �• ` V Submit completed form VWVM-080 as proof 3 .... 1. RS ELEVATIONS REFERENCED TO NAV.D.1988, l� / I win P - 2. MAINTAIN 10�•MINIMUM HORIZONTAL SEPARATION BETWEEN WATER AND •�� h0' =ILI in SANITARY UTILITY LINES:NEW WATER LINE IN SECONDARY PVC CONDUIT. �Ol_ �Q� 3. THE PROPERTY IS LOCATED WITHIN GROUNDWATER MANAGEMENT ZONE IV. O•F' Design Professional's Certification Required. 4. NO DRINKING WATER WELLS ARE WITHIN 150 OF THE PROPOSED SANITARY s' Submit P.E.or R.A Certification For • • p SYSTEM.ALL NEIGHBORS WITHIN 150 ARE ON PU BLIO WATER AS CONFIRMED <DrJi� /~ _ i W= �o BYSCWA /.- The Installation and Construction or the Sewage Disposal System �• 5. THREE(3)BEDROOMS TOTAL EXISTING,4 BEDROOM SYSTEM PROPOSED. Q S. THE DESIGN PROFESSIONAL SHALL OBSERVE THE CWTS PRIOR TO BACKFILL Use Form W1A'M-073 1q,2a.+ 'o, 0 AND DURING SYSTEM STARTUP. C, . 7, AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE �• ,.Erna:A-A\TFa' MAINTENANCE PROVIDER AND THE PROPERTY OWNER SHALL BE PROVIDED TO .rcncx2 as vee SCDHS. FuiiChan G N 8. MAMMUM 5%SLOPE WITHIN 20 OF SANITARY SYSTEM, 9. NO SURFACE WATERS OR WETLANDS WITHIN 100. � `.. w S DA HOPE RISER BYTVF{ili$TIPle . S Sin arDYI HDPESEURE XEAVY COVER BYTUF3aT�TYP. �7 Ct t MDUI Rigg SAFETY SCREEN BYiUFA2TE TYP• ✓�dC:` �� , � . 10.T F.F.E 9f Dill COMPONENT9TNSACC65ONLY � 1'1RAFnGBESA1q gLECAgTCONC.SLAB Y•r't•+? _ �'s 4� .•pllR FOC PRCNm CDNQ2ElE COVE0.0012 NEW" �� S� 11S PER FOOT YIN. CRE2E piNNEY,l9 NECESSARY - QEANIXlT APPROC V' ALL E,ILSIING SANnART CIL MEN510N w EBFI.,rS �rw 2WNTANUx IxSrANCETO sYsrm UCTUR BE s •'i+ PUMPED CIESTO I SU ANp FILLED WRN -+ feSl. l l a � YEAH MpN WAT9I YARK-19e _„?I b� \`\ RABLE OVESANDAXO(iU1VF1 O,,a� r . �_- --- _ s- - - - IIYAWIPRCNE :.�'.r ':b. '1.•.�L : `, . )-,_-• it�_w \ ` y1%J ,If PER FOOT :1197 LE• A. /\a a 1&1TLF f40 - / _�•��•, •�APPROR LOC.DL SAS ME0. •��°� . ~ �'. ul>>� �� a• HOLE LOG- .`i:•i Ftp ,� e o o EG- ,! ^7•n Ub F 009 CENS o _ � � � �� ti \ �:_._- i�'• �`�. Q /-� 'SIRANUI ..b, b NEW 1Di1C MECASr LE101rq /FFT \``\ 0 SeneBry 3vs.Pt9ili• �_ �_ �_ �_ \qYP") — •Gat,w As'' new APM WATER UNE LOG 1 ''ti.• w-N • '• er^ e o 0 0 0 ;.' i\�\ INSTALL NEW WATERLINE 0' EXCAVL TION INSPECTION REQUIRED a 10' KFROU •• tUN1TARYCOMPONENig —,) FOR SANITARY SY5[E?d — BY HEAt.iii De PARTMENTMATERIAL TO BE 1p'P— _ _ ►� tis V CLEAN SAND Wat•rtine'imustbeinspecte byth* ---ao XgHESFBRIFI4D-------------- •' aGMVE1 ,i C: aRou2rowATs2 \ \ `` (C. aa.1r ` h" RD: _Suffolk County Dent.of Call(631)852-5754,488 bo tl2rs IServicer TYPICAL LEACHING POOL - harl � - advanw,to Idwdufe inspedion(t), y. 1 1 } 1 L10.0 Sib Santa 1 2— .•.r�•.................._'.`. ALLLAABOVE DRADEAND BELOWGRADE WRNO N �...:_ CONOLIT,SCIl69YN 6222=2WIDE G TEST HOLE ELEV.1a9 DARK �....:1t,.....CKa:..._g... - --- -----------------'•-----•----1 (OL) B+drr cwt<ea.a. Z d .. d r- 6EV.1T.5' Sbgvw En!pw N _ BROWNSIL M) OWTS W T L FUJICLEAN IIA O w _ w ; -= '�'-� S^ L.'a'G''. •'•��+P HEV.OGT mat CCRMo FA/ YAC E9Li AIR -SySrEM 7=777 .. .7777777777777777-777777 � ` 1 x......a........................... e± ALARM-W p n ....,...... i I }J' ;�py BROWN MW NEwQ BLOWER `Swv.,Pp V'JrrGLK fiC3L7iTY De..ARTf Nr Or HFr:LT.^I S[k-ill C:[`; -��: �" 4L'•� E]Ev.aA 6Arm IBY1 KIURDWRE__ 2NCLOSURE CAYP2IESSE 'PER?/:T I ' • �i $1L5: FOP,fV^PRCJF.I OF CONS-Pkr ION FoR A WATER IN gL��p�NE��A IP BET° r°°°a m°' SINGLE FAMILY REST ._ ONLY eo..nau.wn vw ELEY._L9 ) P i". E i , i....,.i•,.,...y1......jv....'�...._... �: MOWER FRaOi S�.r NSIMTE � (� .2t I,.....• WAIN BROWN BLOWER ' -- . •I u, ••va�.. �-.,ww,R<a Fig SAND(SP) N 1 D/�TE.:.10/172021.::t.l g R 27 ENCLOSURE CONTROLUM CNPAD - lL /1 WNrW DiaOrania ••.. ..• .-.:•.•• .._..! .E��V.89 GRADE APPnCYVED. •. r •'2778 ... DRAWING NUHIM n.T.S. sa aGRNa e1:Yrpo2wn cEOSCMNCE .. ... _,. l SOIL BORING M,0RMMC'N 11/1Y 19 a �"' F1Cya gut FOR tUtAYIMLIM OF. 4,. .... BEi,>YCYJAIS NTS GROUNDIBELOWG,WT2A�2C011NTEAEAr,IL1' N,T.s. �• 318•.1'-0' 1 EXPIRESTHREE YEARS kOh1DG.?E"OFAPPROYAL C1 01 ...........:...:..:.:.:.:..:::.:....:.:.::...:...:.:: •SCALEAPILIES WHEN F"NTED ON A 26•X 36'sHEET I .._'••i'4?f r.1l MVA �^' oY,..<•.a1... 0 SURVEY OF PROPERTY �o°Nk SI T UA TED A T ARSHAMOMAQUE 5 ,3 s TOWN 0 F S 0 U T H 0 L D SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-52-01 —06 ,y TLIO �� c //� / / <1\ SCALE 1 "=20' vl DECEMBER 2, 1997 �� ° ,Nh1/ / JANUARY 8, 1998 ADDED TOPOGRAPHICAL DATA �' /1� ♦ X AREA = 9,070.18 sq. ft. �y°°� ♦ a �. (TO TIE LINE) 0,208 CIC. �� ♦ �°vS 1.y5 �o O X Z °�`s CERTIFIED T0: PETER CHELICO ALI N C H E LI CO POQ�N" 1�0 0 so 9 c°NQS may. Pte° °�Z��� / / �`, 9�s 'o s� �,�� °_:y O NOTES: X y° 0 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM `°ti °2, '�& fflo C; ` <" `� EXISTING ELEVATIONS ARE SHOWN THUS: 10.0 A X 17 °�F EXISTING CONTOUR LINES ARE SHOWN THUS: — — — —10— — — — G°Pc��P app° \ 0 2 �o �y °�^ � � ,r. ! >,� O F.FL. - FIRST FLOOR .� � Q \ y� TB - TOP OF BULKHEAD n �' BB - BOTTOM OF BULKHEAD 9!C01 �F 9 0� Pqc� TW - TOP OF WA,. F�� BW - BOTTOM OFLWALL 9 \ 1 A c• ,r°s�o� ti�� O.N 2. FLOOD ZONE INFORMATION TAKEN FROM: yG. 0 FLOOD INSURANCE RATE MAP COMMUNITY—PANEL No. 360813 0076 E ZONE V9 (EL 13): AREAS OF 100—YEAR COASTAL FLOOD WITH VELOCITY (WAVE ACTION); BASE co FLOOD ELEVATIONS AND FLOOD HAZARD FACTORS DETERMINED. Gy���j ZONE C: AREAS OF MINIMAL FLOODING. X a - - ' ------ - - ------ ------ 00 63.49 19 q4 NN � \ \� ryF.• � �A�o a S O., '` p" 4 V� \ WIRD• • __ 19 UNATHORIZED ALTERATION OR ADDITION �I0Y5 Off. G o�YYYY � �jJ LA TO THIS SURVEY IS A VIOLATION OF SECTION 72OF THE NEW YORK STATE EDUCATION LAW. 'd COPIES OF THIS SURVEY MAP NOT BEARING THE LAND OR'S EMBOSSED SEARL SHALL SEALINOT BE CONSIDERED (C'g. TO BE A VALID TRUE COPY. 4 a CERTIFICATIONS INDICATED HEREON SHALL RUN S ONLY TO THE PERSON TSURVEY PREPARED, ANDON HIS BEHALFTO THE ' • TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- n TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. �O THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. - O PREPARED IN ACCORDANCE WITH THE MINIMUM �. STANDARDS FOR TITLE SURVEYS AS ESTABLISHED ,p BY THE LI.A.L.S. AND APPROVED AND ADOPTED Joseph A. Ingegno FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. Land Surveyor Title Surveys — Subdivisions — Site Plans — Construction Layout PHONE (516)727-2090 Fax (516)722-5093 OFFICES LOCATED AT MAILING ADDRESS N.Y.S. Lic. No. 49668 One Union Square P.O. Box 1931 Aquebogue, New York 11931 Riverhead, New York 11901 97-495A INFORMATION FROM A SURVEY BY: �Ln N JOSEPH A. INGEGNO MAP OF tl -' One Union Square ARSHAMOMAQUE "0 } z-In"VENTn ATrON PIPE SPECIFICATIONS A quebo ue f New York 11931 SLUM EAFFUTDI BManufacturer FujiClean USA CODED WORK NOTES TOWN O F S O U T H O L D 0d' , 3 Model CEN5 Last updated Jan. 8 1998 SUFFOLK COUNTY, NEW YORK b � - O3' 7i' Dd Hydraulic Rating 500 GPD RECIRCULATION Anaerobic Media PP/PE Filling Rate 32% 1. PROPOSED OWTS, CEN5 BY FUJICLEAN(500 GPD CAPACITI). Yl AIR NTT P ON Board Type Aerobic Media PVC PP/PE Filling Rate 57% LICENSE N o. 49668 � � s © D1sTNFELTTON Aerobic Media PP/PE Filling Rate 57% 2. ELECTRICAL FEEDER AND A/R SUPPLY HOSE TO OWTS. CYLINDER(OPTIONAL) Blower .8 c 3. 2"SCH. 40 PVC VENT P/?E FROP,1 THE OWTS TO THE SINGLE FAMILY DWELLING. CONNECT TO SEVIER `�� �' e Z 4"TNLETP ,' 4"OUTLET PIPE Tank FRP VENTING V'l/TH/N RESIDENCE. SLOPE PIPE BACK TO OWTS. LOT AREA: 9,078.18 SQ. FT. = 0.208 ACRE S.C.T.M. No. 1000-52-01-06 A 4 A Piping PVC/PP/PE ' 4. CONTROL PANEL AND REMOTE AIR BLO141ER LOCATION FOR OWTS,APPROXL"?ATE VERIFY WITH OWNER J � Access Covers FRP with Secondary Safety Cover A © Approvals NSF/ANSI 40&245 PRIOR TO INSTALLATION, BUT SHALL BE IN VIEW OF OWTS. O - x - 5. SEWER CLEANOUT ON INLET SIDE OF TREATfl9ENT SYSTEM, SEE DETAILS. V � � � Ant"PUMP CHAMBER Volume(gal) 6. EXISTING WATER METER. � LLQ of rNLETBAr'FL -� © \. © � Sedimentation Chamber 277 �- (D Anaerobic Filtration Chamber 278LU © Aerobic Contact Filtration Chamber 127 "' r`� I- RECIRCULATION PTFE FLOW BAFFLE I2"AIR INTAKE ® Storage Chamber 63 C FLAW OPENING(TYP,Y/ (CLEANING OPENING) B © Disinfection Chamber 4 .••-i Total Volume 749 PLAN VIEW Hydraulic Rating(GPD 500 GENERAL NOTES: '- 16"MANHOLE(TYP) 18"MANHOLE•(TYP z4"MANNJLE(TYP DISINrELTION 1. SURVEYOR'S ELEVATIONS REFERENCED TO N.A.V.D. 1988. 00� - � ?• Q CYLINDER(OPTTONAL) 24"MANHOLE ( '� ✓� 2. MAINTAIN 10'-0" MINIMUM HORIZONTAL SEPARATION BETWEEN WATER AND FLOW OPENING BOARDTYPE SANITARY UTILITY LINES. NEW WATER LINE IN SECONDARY PVC CONDUIT. �' `�' CONTACT MEDIA � ` V 3. THE PROPERTY IS LOCATED WITHIN GROUNDWATER MANAGEMENT ZONE IV. - © 4. NO DRINKING WATER WELLS ARE WITHIN 150 OF THE PROPOSED SANITARY SYSTEM. ALL NEIGHBORS WITHIN 150' ARE ON PUBLIC WATER AS CONFIRMED c� ® BY SCWA. S'-5" ® 5'-5" RF.CIRCULATTON , - ASSEMBLY 5. THREE (3 BEDROOMS TOTAL EXISTING. 4 BEDROOM SYSTEM PROPOSED. �1�1 1O, z ^� y 6. THE DESIGN PROFESSIONAL SHALL OBSERVE THE OWTS PRIOR TO BACKFILL `� © © AND DURING SYSTEM STARTUP. 2 �o� �F / / 3 , } AER0I3IC MEDIA O V 7. AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE AERATION ASSEMBLY MAINTENANCE PROVIDER AND THE PROPERTY OWNER SHALL BE PROVIDED TO �� `'' �.� / � � LC) SECTION A-A VIEW SECTION B-B VIEW SCDHS. FujiClean CEN5 8. MAXIMUM 5% SLOPE WITHIN 20' OF SANITARY SYSTEM. / 9. NO SURFACE WATERS OR WETLANDS WITHIN 100'. o. � QA, y 20"DIA. HDPE RISER BY TUF-RITE,TYP. ��0�°9 ;y, 1 � ^�^�c �� �� ttl ' ✓� '� 4 `I 20"DIA. HDPE SECURE HEAVY COVER BY TUF-RITE,TYP. P�S 50� ^ Sim „ ���� � 1 `' 9nc). (iS' °. 6 20 DIA. RISER SAFETY SCREEN BY TUF-RITE, TYP. o �o�' �� a/ C101 PtiPve'�b 5 �� T -: ,(P" 24" DIA.COMPONENTS THIS ACCESS ONLY �,�P$�' '� y O 19.7' F.F.E. 8"TRAFFIC-BEARING PRECAST CONC. SLAB 4" DIA. SDR-35 PITCHED CONCRETE COVER. CONCRETE CHIMNEY AS NECESSARY. Z�P�PtioR�°' �> „ ooP r` °� �'� ` o ALL EXISTING SANITARY 1/8 PER FOOT MIN. APPROX. os�° Q� �� �' � °�' ��R T SYSTEM STRUCTURES TO BE o NEW C.I. ELEV. 18.5' zea MAINTAIN MIN. DISTANCE TO 4 ' 1�y PUMPED CLEAN AND TOPS ���� • � CLEANOUT �? P 2 C.I. EXTENSION N �� �� �� �/ ��\� � °° MEAN HIGH WATER MARK- 100' '' �� REMOVED AND FILLED WITH ��'� ,c, - SUITABLE SAND AND GRAVEL. O s o„' 16.5' I.E. \ \ �\ � / / ° �/�z /�,\���\�j/ �i�j/, 24 All �G��� d Z4- DIA. SDR-35 PITCHED d - ❑ o o� ao ao C� o 0 0 0 0 ❑ro '► 5' ° s 0 id 1/4" PER FOOT \/\ 15.92r LE., _ _ + • �j o O J 17�` APPROX. LOC. EX, GAS LINE o��� ! Q _ ' ' �� APPROX.TEST O � ). //' ° �t 16.1T LE. 16.0' LE\ \' . : ''� = ❑ o o F- o 0 0 0 o o ❑ ta. \ \ AI��[}n�j �. d � , : ❑ =1 O w D O O O O O D ❑ • s Mr" 11V i/ED AS NOTED HOLE LOC. �`� 5 a 1 ° ry \ 6 � ze XX • i• ❑ o 0 0o j o C� 0 0 0 0 o ❑ �, j\ DATE: B.P.# �'� �� ,o d \/� a s ❑ o o c� 0 0 0 o a ❑ •' 9 \// FEE: D�� 1 L� 1 ;�� �+� W \ ❑ o o w o o 0 0 0 0 0 ❑ `;a. ., t \ NOTIFY Bili BY: f y° sr?, 19 , r,3. LL a t� = G DEPARTMENT AT 1 . �� 23'° cli Q �' 765-1802 8 ' TO 4 PM 1 �" Z FOR THE F' , d°LL III 0 0 0 0 0 0 0 0 ❑ ''�,o / FOLLOWIN -,PECTIONS: NEW 10'x10' PRECAST 1 a F \ ° \ O 1. FOUND; s FujiClean CEN5 \/ °GRANULAR o• 'o• \/ FOR C } TWO REQUIRED LEACHING POOL(TYP.) y` JI � j Re' ❑ o 0 0 0 0 0 0 0 0 ❑ < �-' /\ CONCRETE ` w W COLLAR AS \ W AMING & 1 ,23 0 ❑ o 0 0 o 0 0 0 0 0 ❑ 3. INSULA Sanita Sys. Profile • REQ'D , •,- �� �, 2• ROUGH PLUMBING � ° �>j, ° , ° APPROX. EXISTING \ 'a 4. FINAL �TRUCTION MUST WATER LINE LOC. \ ``v�T° 2 1 $ N.T.S. � :" • - = ❑ o 0 o I� o 0 0 0 0 0 ❑- •. �•- . . \/\ ' ' \/\ BE CO' FOR C.O. O, > ° ALL CON 6 a N \ %: ❑ o o� 0 I� o o I� 0 0 0 ❑ '�•�;' " , ' � INSTALL NEW WATERLINE °° `0 a a- TION SHALL MEET THE ° REQUIR i, OF THE CODES OF NEI` 10 MIN. FROM ALL 4 J SANITARY COMPONENTS o° °. 19 0 0 ❑ , ; YORK ST/ NOT RESPONSIBLE FC`F. - - ° ° • DESIGN On '' •• ,a. ❑ o I � 0 0 0 0 0 0 0 0 L JNSTRUCTION ERRORS. _.: O • = • �'-� _ -' COMPLY WITH ALL CODES OF c NEW YORK STATE & TOWN CODES itis lD o _ �, • ; '., AS REQUIRE- .-.-�D CONDITIONS OF LU !' MATERIAL TO BE s_p 10 - - - - -CLEAN SAND&GRAVEL - - - - nmmZBAR0 AD ° ° �d (\ _. HIGHEST EXPECTED GROUNDWATER r - GBOARD ° ° D TOWN TRUSTEES `` °d Q TYPICAL LEACHING POOL n Typ. LP 10x10 4 3/8" = 1'-0" m } 141 OCCUPANCY 01 �1,0_o sate„Sanitary z 142 USE IS UNLAWFUL 1 - 20 0 Of Q I 1Of 43 " ' 14 WITHOUT CERTIFIC�, , PLUMBER CER TIFICATION �d ON LEAD CONTENT BEFORE 145 147 NOTE: OF OCCUPANCY CER TIF/GATEOF.00CUPAN(-- V -� 148 ALL ABOVE GRADE AND BELOW GRADE WIRING IN 0.0' APPROX. GRADE @ TEST HOLE ELEV. 18.5' PLUMBING N Z ' 149 PVC CONDUIT, SCH. 80 MIN. • ALL PLUMBING WASTE SOLDER USED/N WATER Suitable Cover to Grade V -a iw' �rHs,os � DARK BROWN SUPPLY SYSTEM CANNO Sto er or End Plug 1"4 � ( ) &WATER LINES NEED 1 pp • ,. • s) 1.0' ELEV. 17.5' LOAM OL EXCEED o -------------- 152 r----- ------------- -----------I - TE `ING BEFORE COVERING 2/10 OF 1/ LEAD, _ Q .mu,B m ro-u �'BB+ 153 xi°�i°�i _ - - V ,. l54 j R , 5--n- i n, - - r� - -- -T--�-_---� - - - - - - - - - - - - - - - - - - ^, �,,,3 155 I 1 I 1 I I I P BROWN SILT(ML) m • ° r- - - - - - - - � -� _' " *t „ R , 156 I I I I I 9 1 VISUAL SYSTEM V c 157 1 I 1 ,� I BRANCH CIRCUIT PROTECTION OVEPIOAD PROTECTION, ELEV. 15.5' BEACON CONTROLLER/ MAIN DISCONNECT AND OVCRCU°RENT PROTECTION 1`.B j I IItlMK ouRR xwn nwr I L_ Of INCOMMC FEEDER CIRCUIT PROVIDED BY OTHERS .I - - MAC 80R AIR -� o-_ - ALARM -IN Sewer Pipe I AND MUST BE S17ED ACCORDING TO PUMP/MOTOR -I Q N 160 1 'I N° MANUFACTURING SPECIFICATIONS i •:..�; ,' �� _ - BROWN S BLOWER O I � tBJB r6, I -�`�-`' -'='-- SAND (SM) ENCLOSURE _ o--� --------, r---------- ISI -----, 1 I COMPRESSED [Ix,li R`wtR ,GZ , 15.5 ELEV. 3.0 HARDWIRE CONTROLLER 30 de Elbow I I O W ,� 9• A 164 FROM DEDICATED 20AMP AIR LINE TO < U') � J P }� tE4 ••," A , I � ':= WATER IN BROWN BREAKER IN HOUSE MAIN OWTS I I �,� U mu,6165 i+• ®O 1 , - -" ._ r•_, , 1 m 20.0 ELEV.-1.5 SILTY SAND(SM) 6 E%fERNIt COMPONENTS(couIREssoR ANProR PUMPS)PROVIDED BY OTHERS "`� ,,�_ PANEL. HARDWIRE INSULATED Q 167 1 AND MUST BE ILL.APPROVED THLRUtdY PROIECTED PU4PS I {- BLOWER FROM 120V I I = - -- - BLOWER O I C6,2B rBi r6, _ 1E8 I I -_��°==��a-^=== WATER IN BROWN RE ' --- x$12:--� --- FINE SAN 15AMP BREAKS ENCLOSURE M R IN U 179 DSP CONTROLLER. ON PAD I I DRAWING NUMBER: tlennM1°iren¢Rw, 170 I TEMPERATURE RATING DF FIELD INSTALLED CONDUCTORS MUST BE AT LEAST 140 DEG F. I Q 171 I (60 DEG. C). TERMINAL STRIPS AND GRUJND LUG USE COPPER CONDUCTORS ONLY. P 172 I CONNECT GPO'JND LUG IN PANEL TO A SECLP.E EARTH GROUND I �- nw 1 73 III DASHED LINES REPFESENT FIELD WIRING FIELD MIRING SECTION I 28.0' -�•--�a - ELEV. -9,5' GRADE 120 deg.Wye 0 174 L�------- ------------------------------------ U Wiring Diagrams SOIL BORING BY: McDONALD GEOSCIENCE n Blower N.T.S. N PERFORMED ON: 12/13/2019 N.T.S. n 3/8"Cleanout t 0 SOIL BORING _ ,. TS GROUNDWATER ENCOUNTERED AT 15.5' 10 1 BELOW GRADE Cin, 51E AP PROJECT N0: xxx ~ * SCALE APPLIES WHEN PRINTED ON A 24" X 36" SHEET 8/2/2021 7:03:01 PM