HomeMy WebLinkAbout51630-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERKS OFFICE
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#: 51630 Date: 02/12/2025
Permission is hereby granted to:
Cedars 1883 LLC
316 W 79th St #11W
New York, NY 10024
To:
Construct additions and alterations to include legalizing a habitable third story and converting a two-
family dwelling back to a single-family dwelling as applied for per ZBA and SCHD approvals. A fire
sprinkler system is required.
Premises Located at:
825 Stephensons Rd, Orient, NY 11957
SCTM# 17.4-11.5
Pursuant to application dated 12/10/2024 and approved by the Building Inspector.
To expire on 02/12/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $3,088.50
CO Single Family Dwelling-Addition /Alteration $100.00
Total $3,188.50
Building Inspector
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 hUs L//wwwsoutholdggwnny.gQv
Date Received
APPLICATION FOR RU I'T
For OffiaMre Only � D�
51 93 O Building PERMIT NO.. G uildinfinspecitc►r
„ _
Applicafto�s aad forms must be filled out m their entirety Incomplete
�aplflications 4�ii11 not b ,agtec Where to Applicant is not the owrwe%aii
On�rrf2 s✓Authq"riia ldh tglma( a 2)shA be cemp�exed
Date: 1/12/2024
UWf�ER(S)
Name: Jonah and Katie Sonnenborn SCTM#1000- 17-01-11.5
Project Address: 825 Stephensons Road, Orient, NY 11957
Phone#: 917-951-6913 Email: ksonnenborn@gmail.com
Mailing Address: 825 Stephensons Road, Orient, NY 11957
'CONTD�CT PERSON. ,,
Name: Isaac Clay Coffey, R.A.
Mailing Address: 430 Main Street, 2nd Floor, Greenport, NY 11944
Phone m 347-276-6093 Email: clay@isaac-rae.com
DESIGN P!1tCIrIFiSl0 ►I.INFO.RMATIOIN:.
Name: Isaac Clay Coffey, R.A.
Mailing Address: 430 Main Street, 2nd Floor, Greenport, NY 11944
Phone#: 347-276-6093 Email: clay@isaac-rae.com
CONTRACTOR INFORMATION
Name:
Mailing Address:
Phone M Email:
e ✓r v( 7l✓,� 1 ,i ✓�/1 ✓, rp r
DStIPTIOIy OF PROPOSED CONSTRUCTION r
DNewStrupture MAdd`iti n MAlteration ❑Repair ❑ emolition Estimated Cost of Project:
❑Other .e. - ; w � k ,i�, „ $_750 000.00
Will the lot be re-graded? ❑Yes C4No Will excess fill be removed from premises? DQYes []No
i
PROPERTY INFORMATION "
Existing use of property: Residential Intended use of property: Residential
Zone or use district in which premises is situated: R-40 Are there any covenants and restrictions with respect to
this property? ❑Yes XNo IF YES,PROVIDE A COPY.
❑(beck Box After Reading: The owner/contractor/design professional Is responsible for all driilnage and storm water Issues as provided by
Chapter 236 of the Town Code.APPUCAlnON IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
additions,alterations or for remove or+dernolttlmrr as herein described.The applicant agrees to comply wit for�construction,ordiante, buildings,
*
Ordburm�ce of the Town of Southold,Suffohw.County,New York and applicable trwrs,OrdYnanm or Regulations,
p 6!e lavirs,ordinances,twug�bng+rerda,
housing code and regulations and to admit nrthorked Inspectors on premises and In bultding(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.,
Authorized
Application Submitted By(print n e)» ] Agent ❑Owner
J
Signature of Applicarilt. '� Date. � t
STATE OF NEW YORK)
S�•-//f
COUNTY OF �� pr � 1
kaac r(, O L �` being duly sworn,deposes and says that(s)he is the applicant
(Name of individual s gning contract)above named,
yn�
(S)he is the " �f/" �Ti�c. , C L
(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
a2�daY of
CIA10,tary P
I iPubIll!t3.
� � Idota�►i�ubi Stato of New Yod
li R l��'llf::"Ift NEll °ll ll°)' Rf l I �+I+OB2241ud
(Where the applicant is not the owner) Qualified In Suffolk Courdt
11AyCorrimisslon Expires June 2fe
� r
I, nNl at'AIf •e — residing at
do hereby authorize to apply on
my behalf to a of Southold Building Department for approval as described herein.
Owner( ( ature Date
�JKaln S.•.ht�s..H
Print Owner's Name
2
.µ
BOARD MEMBERS O& Southold Town Hall
,^ 53095 Main Road P.O. Box 1179
Leslie Kanes Weisman, Chairperson " Southold,NY 11971-0959
Patricia Acampora _Office Location:
Eric Dantes , Town Annex/First Floor,
Robert Lehnert, Jr. Oull 54375 Main Road(at Youngs Avenue)
Nicholas Planamento 71
iW
http://southoldtownny.gov jL- Y 6 3:42-TM
ZONING BOARD OF APPEALS O CT 2 i 2024
TOWN OF SOUTHOLD
'ups Tel. (631) 765-1809 Southold Town Clerk
JFINDINGS, DELIBERATIONS AND DETERMINATION
MEETING OF OCTOBER 17, 2024
ZBA FILE: #7945
NAME OF APPLICANT: Cedars 1883, LLC /Jonah and Katie Sonnenborn
PROPERTY LOCATION: 825 Stephenson's Road, Orient NY SCTM: 1000-17-1-11.5
SE RA Eg[ TE'I�MI g, J"LQ)N: The Zoning Board of Appeals has visited the property under consideration in this
application and determines that this review falls under the Type 11 category of the State's List of Actions, without
further steps under SEQRA.
SUFFOLK—COUNTY 1T VE CQ-QE—,,: This application was referred as required under the Suffolk
County Administrative Code Sections A 14-14 to 23,and the Suffolk County Department of Planning issued its reply
dated June 28, 2024 stating that this application is considered a matter for local determination as there appears to be
no significant county-wide or inter-community impact.
LWRP 1 E'1"EI MINArION. This application was referred for review under Chapter 268, Waterfront Consistency
review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards.The LWRP Coordinator issued a recommendation dated September 26,2024. 'Eased upon the information
provided on the I, RP Consistency Assessment Form submitted to this department,as well as the records available,
it is recornniended that the proposed action is INCONSISTENT with LWRP policy standards and therefore is
INCONSISTENT with the LWRP.
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal
location, and tninirnizes adverse effects of development.
The "as built" habitable third story is contrary to fostering a pattern of development in the Town of
Southold that enhances community character and negates Board review, setting a precedent in a
neighborhood.
The front yard setback is EXEMPT for review.
Should relief be granted for this application,the Zoning Board of Appeals detennines that the proposed
requested relief will be CONSISTENT with LWRP policy standards and therefore is CONSISTENT with the LWRP
for the following reasons:
1. A valid Pre-Certificate of Occupancy exists for a habitable third (3rd) floor in the dwelling built prior to
1957.
Page 2, October 17,2024
#7945, Cedars 1883, LLC
SCTM No. 1000-17-1-11.5
2. The applicant proposes to restore the structure to single-farnily dwelling from a non-conformingtwo-famil
use established by a prior Zoning Board of Appeals decision. y
1 The applicant shall install a Suffolk County Department of Health Services approved Innovative Alternative
(I/A OWT) Onsite Wastewater Treatment Systern.
M021 ER 1K LA C"L ' '
parcel
S/Q"_'C'_'P1lQN-� The subject, conforming 218,061-36 square feet, 5.36 acre, irregular-shaped,
waterfront pa (.Plot ref
ers
to the subdivision survey of"The Cedars" filed in the office of the Clerk of Suffolk
County on July 11, 1906 as file number 421 and consists of parcel I consisting of 5 acres where the dwelling is
located and parcel 2 consisting of.36 acres which is deemed roadway allowing for access to the subject dwelling and
those adjacent) located in the R40 Zoning District measures 449.37 feet along a tie line at the approximate mean high
water mark at the Long Island Sound, then runs southeast along a residentially developed waterfront lot to the north
312.03 feet, then runs northeast along the same residence 80,00 feet then continues southeast 160.60 feet along a
second residentially developed lot to the north, then follows a curvaceous line south, southeast, west and finally
southwest along 4 additional neighboring parcels as follows: R 175.00 feet L98.56 feet; R90.00 feet, L65.53 feet;
R90.00 feet, 60.42 feet; R38.00 feet, L63.53 feet; R1020 feet, L135.24 feet; R.245.25 feet, 103.17 feet; R125 feet,
L87.85 feet; R145.00 feet, L28.65 feet then runs 63.24 feet and returns to the waterfront 401.94 feet. The property
is developed with a wood-frame, 3-story dwelling with an attached front porch, entry stoop and two-car garage, a
wood deck, an inground swimming wimming pool with an attached wood deck, an on-grade solar panel array, easements and
various rights-of-ways (both pedestrian and vehicular) as shown on the survey prepared by Howard W. Young,
Licensed Land Surveyor and dated November 9, 2021.
BA51S_C F-APELICA]UQN: Request for 'Variances from Article IV, Section 280-18; arid the Building Inspectors
April 29, 2024 Notice of Disapproval based on an application for a permit to legalize an "as built" habitable third
-story and create additional habitable third story space in an existing single-family dwelling; 1) more than code
required number of stories Of two and a half, 2) less than tile code required ruin imum front Yard setback of 50 feet;
located at: 825 Stephensons, Road, Orient, NY. SC TM No. 1000-1 7-1-11-5.
MLLEEKE_Q�J�ISIL-p. The applicant requests three(3) variances for the "as built', habitable third(311) floor where
code limits to the maximnin of'2 1/z floors for a dwelling constructed in the late 19"'century,
roof expansion to contain a bedroom/playroom consisting of a.proposed
, an enlarged bedroom arid the addition of'a full bath, PLUS, the
conversion Of a former third (3") floor attic/loft in a rnid-201h century wing(known as the 'annex')consisting of tile
addition of a Trip' roof over the existing structure to contain a proposed bedroom/gym, home office, full bathroom
arid storage area, for a total of 411 square feet of additional habitable space. When completed tile entire third (311)
floor will consist of 1,819 square feet of living iving area, within the two roof structures of the proposed single-family
residence(main house; annex). All proposed work is within the existing structure that has a Pre-existing front and
setback of 2 1.11 feet where the Zoning Code requires a Fninimum of 50 feet.
ADDITIONAL FNFORM 1-10—N: The applicant icant provided architectural drawings, including title sheet,proposed site
plan, sky plane diagram, third-floor demolition and construction plans labeled T-00 1, A-00 1, A-002, D-103, and A-
103, prepared by Isaac Clay Coffey, Registered Architect and last updated May 30, 2024,
Prior Zoning Board of Appeals relief was granted in file #1844 dated November 2, 1973 granting the use of the
dwelling as a legal two-family home,
Improvements on the parcel are covered by the following Certificate of Occupancy:
#Z-6082 dated August 28, 1974
#Z-15615 covering a Private one-fiirnily dwelling 'With all addition.
dated April 9, 1987 covering an accessory inground swimming pool
#Z-24761 dated November 25, 1996 covering the PRE-Certificate of Occupancy for a structure
built prior to 1957—inspection notes indicate that the third(3rd)floor consists of three unconditioned rooms,
Page 3, October 17,2024
#7945, Cedars 1883, LLC
SCTM No. 1000-17-1-11.5
#Z4 1178 dated June 15, 2021 covering the correction of building permit#42674 to reflect
the dwelling as a two (2) family home instead of a single one,
The applicant's dwelling is among the most recognizable in the'I-Own of Southold and maintains a prominent position
overlooking Orient Harbor, the Peconic Bay and the Long Island Sound, Substantial evidence is readily available
relative to the home's history, chain of ownership and contribution to the character of the community.
The applicant has stated that they will be installing a NEW Innovative Alternative Onsite Wastewater Treatment
System ([/A OWTS), pending approval from the Suffolk County Board of Department of Health Services.
The applicant has stated that they will completely remove the second kitchen in the dwelling and will restore the
structure to a single-family residence, thereby extinguishing the two-family use.
The hearing was closed subject to the receipt of supporting documents. On October 3, 2024, the applicant provided
the following, per the Board's request.
• Historic Habitable Third Floors within the nearby Historic Orient neighborhood
1. 500 Stephensons Road
2. 900 Birds Eye Road
3. 100 Maple Lane
• The Cedars (historic photographs taken from the house)
• Renderings of the project design
No member of the public or an immediate neighbor spoke in favor of or against this application.
El NLD LN Q5_()L!�'A %QA�1�1)&C Tj[ON,.
The Zoning Board of Appeals held a public hearing on this application on October 3, 2024 at which time written
and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property
and surrounding neighborhood, and other evidence, the Zoning Board finds the following facts to be true and
relevant and makes the following findings:
I- f own Law `2167-1_ . — Grant of the variances will not produce an undesirable change in the character of
the neighborhood or a detriment to nearby properties. The subject parcel, known locally as 'The Cedars' has defined
the community character since construction in the late 19"' century. The existing two-family dwelling has a pre-
existing non-conforming front yard setback of 21,11 feet, where 50 fieet is required by code, and the proposed
setbacks atthe ground level will remain 'as built' nearly 150yearsago,retaining the original footprint of the exteriorwa1s walls. Proposed improvements to the existing third floor/roofline are further back from the foundation's front yard
setback and are more code conforming. Additionally,by slightly expanding the roof on the original house and adding
a small dormer to allow additional light and ventilation to i;he existing third-floor living space, the structure's original
design will be enhanced. The addition of a 'hip' style roofon the annex portion of the dwelling will further enhance
the coastal New England design and link the mid-201h century addition Stylistically to tile original dwelling,
Additionally, by converting the residence back to a single-family home and legalizing the pre-existing and
nonconforming third floor with an additional 411 square feet of habitable Gross Floor Area(GFA) there will be no
encroachment on any of the setbacks as required by code. This project enhances the existing house by improving
the roofline at the exterior. There is no perceived change in character or detriment to the community.
2. Town Law s267-k'(11"k " The benefit sought by the applicant cannot be achieved by some method, feasible
fbr the applicant to pursue,other than an area variance. Due to the pre-existing conditions of the siting of the existing
house, with a 2 1.11 faet front yard setback where a minimum of 50 feet Is required by code and the lot's irregular
Page 4, October 17,2024
#7945, Cedars 1883, LLC
SCTM No. 1000-17-1-11.5
additional
,rag as the addition occurs over the existing second and
not change the existing building lot cove se
shape, it is not possible to expand or alter tile home without some f�()rm Of Board relief: 'he proposed
third-floor area will el
last floors. e
Moreover, the recognition of the pre Certificate Of Occupancy status Of the third floor Containing 3
roorns and the expansion of this area along with redesign of the 'annex' roof further recognizing third floor living
space can not be achieved without Board approval.
3, Town Law The variances granted herein are mathematically substantial,representing 58%relief
from the code relative to a reduced front yard setback and 1'00% relieffrorn the code relative to a habitable third-
floor living space, However, the applicant has illustrated that the pre-existing, norl-conform ing front yard setback of
21.I I feet, as originally constructed nearly 150 years ago will not be altered and the current setbacks for the as-,built
structure will be maintained'as part of the proposed roof alterations. Furthermore, the applicant has provided a copy
of the Pre-Certificate of Occupancy that illustrates third-floor living space, which while uncommon to homes
constructed after the adoption of the zoning code, was historically there" Relative to the additional third-floor living
area over the 'annex', as a result of the addition,as built in the mid-20111 century,
appears more like a traditional second Story vs the requested third flo and because of the natural terrain, it
or as defined by the Town of Southold Building
Department and will have little to no impact on file community, nor set a precedent of any kind, as this dwelling is
among the most unique ill town with a rich and well-documented history.
4. Town Law 8267- • No evidence has been submitted to suggest that a variance in this residential
COMMUnity will have an adverse impact on tile physical or environmental conditions in the neighborhood. The
applicant must comply Nvith Chapter 230 of the "fown's Storrn Water Management Code and install a NEW
Innovative Alternative Onsite, Wastewater Treatment ystern (1/A OWTS) appropriate to the structure, as approved
by the Suff'61-k County Board of Health.
The difficulty has been self-created. The applicant purchased the parcel after the
Zoning Code was in effect and it is presurried that the applicant had actual or constructive knowledge of the
limitations on the use of the parcel under the Zoning Code in effect prior to or at the time Of purchase.
6. Town LAW 8167-h (3rant of the requested relief is, the r1lininlurn action necessary and adequate to enable the
applicant to enjoy the benefit of alterations and additions to a residence including recognition of a pre-existing third
floor within the original structure and the expansion of this area to include, a bedroom/playroom, all enlarged
bedroom and the addition of a full bath, PLUS, the conversion of a former third (3rd) floor attic/loft in a mid-20th
century wing (known as the 'annex ) consisting of tile addition of a 'hip' roof over the existing structure to contain
a Proposed bedroom/gym, home office, full bathroom and storage area, for a total of 411 square feet of additional
habitable space. When completed the entire third (3rd) floor will consist of 1,819 square feet of living area, within
the two roof structures of the proposed single-family residence (main house; annex). All proposed work is within
the existing structure that has a pre-existing front yard setback of 2 1.[ I feet.
KE—,SQ-L LJ[I0N OF THE BOA � In considering all of the above factors and applying the balancing test under New
�RQ
York Town Law 267-B, motion was offered by Member Planarnento, seconded by Member ,and dui carried to
y ,
GRANT the variances as applied for, and shown on the Architectural Drawings, including title sheet, proposed site
plan, sky plane diagram, third-floor demolition and construction plans labeled T-00 1, A-00 1, A-002, D-103, and A-
103 prepared by Isaac Clay Coffey, Registered Architect and last revised May 30, 2024.
SUBJFC'T T() T"'t, L--r LOWING CoNinTiONS:
I. Prior to the issuance of the building permit for the requested relief the applicant shall remove, to the Town
Of Southold Building Department Building Inspector's satisfaction, the kitchen in the 'annex' wing, thereby
converting the dwelling back to a single-family dwelling,
Page 5, October 17, 2024
#7945, Cedars 1883, LLC
SCTM No. 1000-17-1-11.5
2, The applicant's dwelling, recognized as 'The Cedars' is to remain a single-family, home and all future
Certificates Of Occupancy is to reflect this. The two-family use will be pennanently extinguished,
3. The installation of a new Innovative Alternative(1/A OWTS) Onsite Wastewater Treatment System ([/A
OWTS)appropriate to the structure, as approved by the Suffolk County Department of 14ealth Services.
4. The applicant must apply to the Building Department for a building permit for the "as built" third floor
improvement(s) within 90 days of the date of this decision and submit same to the Off-ice of the Zoning
Board of Appeals, or submit a written request for an extension to the Board OCAppeals setting forth the
reason(s) why the applicant was unable to obtain a building pen-nit in the time allotted.
I
-nit same to the Office ofthe Zoning Board of Appeals within 24 niontlis of this
improverrient(s)and SUbi a u It,
5. The applicant must obtain a Certificate Of Occupancy from the Building Department for the s b i
p
decision or submit a written request for an extension to the Board of'Appeals setting forth the reason(s)
why the applicant was unable to obtain a Certificate of Occupancy in the time allotted.
6. The "as built" improvement(s)may not be used until a Certificate of Occupancy has been obtained.
This approval shall not be deemed effective until the required conditions have been met. At the discretion of
the Board of Appeals,failure to comply with the above conditions may render this decision null and
void
That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued.
The Board reserves,the right to substitute a similar design that is de minimis in nature for an alteration that does
1101 increase the elegree of nonconformity.
IMPORTANT I Myrq
ON TIIE APPROV"All is"I I Gl". NTE A��D�11ER�EIN
Any deviation from the survey, site plan and/or architectural drawings cited in this decision, or Work exceeding
lite scope of the relief granted herein,
4 will result in delays and/or a possible denial by the Building Department
of a building permit and/or the issuance of a,'"top Work Order, and nu v require a new application and public
hearing before the Zoning Board of Appeals.
Any deviation from the variance(s)granted herein as shown on the architectural drawings,site plan andlor survey
cited above, such as alterations, extensions, demolitions, or demolitions exceeding the scope oJ'the relief granted
herein, are not authorized under this application when involving nonconji)rndties under the zoning code. This
action does not authorize or condone any current or future use, setback or otherftalure of the subject property
that Mfly violate the Zoning Co(je, other than such uses,setbacks and other features as are expressly addressed in
this action.
TIME LIMITS ON THIS APPROVAU Pursuant to Chapter 280-146(B) of the Code of the Town
Of Southold any variance granted by the Board of Appeals shall become null and void where a
Certificate Of Occupancy has not been Procured, and/or a subdivision map has not been filed with
the Suffolk County Clerk, within three (3) years from the date such variance was granted. The
Board of Appeals may, upon written request prior to the date of expiration, grant an extension not
Page 6,October 17, 2024
#7 45,Cedars 1883, LLC
aC' "M No, I000-17-1-1 1.5
RESPO iRif i-r TO ENSURE i?, COMPLIANCE PROPERTY T +CJ�i�;l�'
o e three (3) consecutive one 1 year terms. IT i TIJE l
r lAii D "lfBf. ii ;Bi Failure to omply inia iman eF li. i1iiF 1 "i I
timely r may result in the denial by
the Building Department of a Certificate of Occupancy, nullify the approved variance relief, and
require a new variance application with public hearing before the Board of Appeals
Vote of the Board:Ayes: Members Weisman(Chairperson), Dantes, Planamento, Lehnert, and Acampora. (5-0)
leslie Kane eisman'
,;Chairpersoh ��
Approved for filing /0 / 6 /2024
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I/A OWTS DESIGN
REQUIRED: NINE(9)BEDROOM=990 GPD SYSTEM
PROPOSED: ONE(1)FUJI CLEAN MODEL CEN10
SCnowor0d0-17y 2 S35°03'55"W SCTM#'1000-171-1�
n^ ¢ OF ThE RDA25 J
now or formerly (1,000 GPD)TANK
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Ron A,h110n"bG�d '� ..
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1 SANITARY
SYSTEM
625 SQ.FT.OF SIDEWALL AREA �;w^„
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625 SQ.FT.125.1 SF/LF=24.9 LF ISAAC-RAE STUDIO
` now or formerly —11 rf l 430 MAIN STREET 2ND FLOOR
y R�90, 0, Beverley L.Greene& `r REQUIRED
fr` � L�30„qy r � GREENPORT,NY 11944
Charlotte Jordan Greene
Improved with Private Water a PROVIDED: TWO(2)8'!?1 X 13'EFF.DEPTH LEACHING
825 STEPHONSONS ROAD
..�,LINE�
. I I POOLS—
, 26'OF IDEWALL
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WELL I/A OWTS
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825 STEPHONSONS ROAD
ORIENT,NY 11957
OVERALL SITE PLAN FFOLK COUNTY DEPARTMENT F HEALTH SERVICES suFFOLKcouNTY
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0 100 200 PERMIT FOR APPROVAL OF CONSTRUCTION FODP
SINGLE FAMILY PIL-sIDENCIE ONLY OVERALL
SCALE: 1"=100' SITE PLAN
EXCAVATION INSPECTIONREQUIRED
Design Professional's Certification Required.
Submit P.E.or R.A.Certification For DATE 10/23/2024
SANITARY
� The Installation and Construction of the Sewage Disposal SystemFOR —F. O, R-24-1153 :• —
use Form wwM-073
APPROVED � Ci 7
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Y HEALTHDEPARTMENT Abandonment of the existing sanitary system must be in FOR AXIMUM F 9 BEDROOMS ,
Conformance with the Department's requirements. �`
1 a
EXPIRES THREE YEAR FRO DATE OF APPROVAL �
Submit Completed form WWM-080 as proof ISR2401 "
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