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Home My WebLink About51689-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S 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#: 51689 Date: 02/26/2025 Permission is hereby granted to: Dignans Realty LLC 445 Glen Ct Cutchogue, NY 11935 To: Construct a new modular single-family dwelling as applied for to include outdoor shower and HVAC system per Planning, DEC and SCHD approvals. Premises Located at: 2100 Dignans Rd, Cutchogue, NY 11935 SCTM#83.-2-7.4 Pursuant to application dated 01/15/2025 and approved by the Building Inspector. To expire on 02/26/2027. Contractors: Required Inspections: Fees: Single Family Dwelling-NEW MODULAR $5,274.50 CO Single Family Dwelling-New $100.00 Total $5,374.50 Building Inspector a Y.gJ? TOWN OF SOUTHOLD—BUILDING DEPARTMENT ,r Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone 631 765-1802 Fax 631 765-9502 htt ://www.soLitholdtownn c�rr , P ( ) ( ) Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only Q e' PERMIT NO. tp Building lnspectorJR�- JAN 1 5 2025 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:11/01/2024 OWNER(S)OF PROPERTY: Name: Dignans Realty, LLC SCTM# 1000-83-2-7.4 & 7.5 Project Address:2100 & 2240 Dignans Road, Cutchogue, NY 11935 Phone#: 917.355.3972 1Email:dasack@mac.com Mailing Address:445 Glen CT, Cutchogue, NY 11935 CONTACT PERSON: Name: Robert E. Herrmann, En-Consultants Mailing Address: 1319 North Sea Road, Southampton, NY 11968 Phone#:631 .283.6360 Email:rherrmann@enconsultants.com DESIGN PROFESSIONAL INFORMATION: Name: Resolution: 4 Architecture Mailing Address: 150 W28th Street, Suite 1902, New York, NY 10001 Phone#:212.675.9266 Email:rluntz@re4a.com CONTRACTOR INFORMATION: Name:Cruz Brothers Construction Mailing Address: 163 W Montauk Hwy, Hampton Bays, NY 11946 Phone#:(631 ) 594-5740 1Email:leocruz@cruzbrothersconstruction.com DESCRIPTION OF PROPOSED CONSTRUCTION BNewStructure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $2,000,000 Will the lot be re-graded? ®Yes El No Will excess fill be removed from premises? ❑Yes iiNo 1 PROPERTY INFORMATION Existing use of property:2100/2240 Dignans Rd Intended use of property: Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-80 this property? DYes❑No IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractorldesign professional Is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffok County,New York and other applicable Laws,Ordinances or Regulations,for the corom aeon 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 mind In budding(s)for necessary Inspections.False statements made herein are punishable as a Gass A misdemeanor pursuant to Section ZIOAS of the New York State Penal Law. Application Submitted By( t name):Robert E. Herrmann, En-Consultants ®Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK SS: COUNTY OF Suffolk Robert E. Herrmann, En-Consultants being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Agent (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 L—day of < k ��'� 5 �,� ZO-.� Notary P li 7NotaryPublic TEPHENS tate of New YorkPROPERTY OWNER AUTHORIZATIONufffolk ouffolk County20 (Wherethe applicant is not the owner) esAugust02„ Dignans Realty, LLC I,/We David & Stel2hanie Sack Members residing at 445 Glen Court, Cutchogue, NY 11935 do hereby authorize Robert E. Herrmann, En-Consultants to apply on our/ my behalf to the Town of Southold Building Department for approval as described herein. X 12/19/2024 Owner's Signature Date David Sack, Member, Dignans Realty, LLC Print Owner's Name X tephanie ack Member Digrta y 12/19/2024 Pr ' ns-Realty, LLC Date 2 119 suFFQ Albert J. Krupski, Jr. STORlMMA\TIER SUPERVISOR 1w1[A\NA\G1EM LENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold Cif ER 236 - STORM WATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE 1N AREA OR LARGER. ) APPLICANT: (Property � � Profess p y Design Profession , Age1 ntractor, Other) NAME: Raab E. Herrmann Date: January 17, 2025 Contact Information: rerrmann@enconsultants.com (E-Mall.8 Telephone Number) 631-283-6360 Pro2erty Address / Location of Construction Site: 2100 &2240 Dignans Road, Cutchogue S.C.T.M. #: 1000 District 83 2 7.4 & 7.5 Section Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT Area of Disturbance is less than 1 Acre. No S.P.D.E.S.Permit is Rec aired i ❑ - Project does Not Discharge to Waters of the State. No S.P.D.L,S, Perntiii is lic,c aired p ❑ - Area of Disturbance is Greater than I Acre&Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a. Building Permit. ❑ - Area of Disturbance is Greater than I Acre&Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P..D.E.S. Permit throe It the Southold. Town En2ineering Department Prior to Issuance of.a.Building Permit. Reviewed By: Date: FORM * SMCP-TOS December 2024 ' I / I i I w � I Suffolk County Department of Labor, Licensing & Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE NEW YO RK 11788 8 DATE ISSUED: 4/11/2018 No. 60021-H SUFFOLK COUNTY Home Improvement Contractor License This is to certify that JORGE A CRUZ doing business as CRUZ BROTHERS COiwTRUCTON UC having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk,State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR,in the County of Suffolk. License Category NOTVAL[DWITIIOUT 44dditaorsalSu` GC DEPARTMENTALSEAL AND A CURRENT CONSUMER 6_RFA[RS ID CA.RI' Suffolk County Dept of Commissioner Labor,Licensing 6 Consumer Affairs HOME IMPROVEMENT LICENSE Name JORGE A CRUZ Business Name , This aeNaes CRUZ BROTHERS CONSTRUCTION i the -' bearer is duly lice licensed LLC by the County of suffoac License Number H-60021 W"rv.T."ws Issued: 04111=16 Commissioner Expires: 04101I2026 � r� " 40 4ti Town Hall Annex „ Telephone(631)765-1802 54375 Main Road i", Fax(631)765-9502 P.O.Box 1179 Southold, NY 11971-0959 �� BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS"TYPE CONSTRUCTION PRE-ENGINEERED WOOD CONSTRUCTION ANDfOR TIMBER CONSTRUCTION Date: ,January 14, 2025 Owner: Dignans Realty LLC Location of Property: Dignans Road, Cutchogue Please take notice that the (check applicable line): ✓ New commercial or residential structure Addition to existing commercial or residential structure Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): V Truss type construction (TT) Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including girders and beams (F) Roof framing (R) ✓ Floor and roof framing (FR) Signature: Name (person submitting this form): David Sack, Member„Dignans Realty, LLC Capacity(check applicable line): V Owner Owner representative TrussRegl5.docx Effective 1/1/2015 .f NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION IN RESIDENTIAL STRUCTURES (In accordance with Title 19 NYCRR PART 1265) Local Authority having jurisdiction logo: TO:Name of Authority having jurisdiction.• OWNER OF PROPERTY: Sack SUBJECT PROPERTY(ADDRESS AND TAX MAP NUMBER): 2100-2240 Dignans Rd Cutchogue, NY 11935 Suffolk County PLEASE TAKE NOTICE THAT THE(CHECK ALL THAT APPLY): x� New Residential Structure Addition to Existing Residential Structure Rehabilitation to Existing Residential Structure TO BE CONSTRUCTED OR PERFORMED AT THE SUBJECT PROPERTY REFERENCE ABOVE WILL UTILIZE (check each applicable line): ❑ Truss Type Construction (TT) ❑ Pre-Engineered Wood Construction (PW) ❑ Timber Construction (TC) IN THE FOLLOWING LOCATION(S) (CHECK APPLICABLE LINE): APPROVED— ❑ Floor Framing, Including Girders and Beams (F) DATE 10/4/24 S, CORPORATION ❑ Roof Framing (R) Icaor� tsarr' , PA X Floor Framing and Roof Framing (FR) SIGNATURE: DATE: PRINT NAME: CAPACITY(Check One): ❑ Owner ❑ Owner's Representative NEW YORK STATE DEF:1A11R 11WEN r 0111:::o ENV11111RO III'QWE114 TAIL CONSEIRVATION Division of Environmental Permits,Region 1 SUNY ed Stony Brook,50 Circle Road,Stony Brook,NY 11790 P:(631)444-03651 F:(631)444-0360 www.dec.ny.gov September 6, 2024 Dignans Realty, LLC c/o David and Stephanie Sack 445 Glen Court Cutchogue, NY 11935 Re: Permit ID 1-4738-05020/00001 Dignans Realty LLC 2100 & 2240 Dignans Road Cutchogue Expiration Date: 9/5/2029 Dear Permittee.- In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6 NYCRR, Part 621), we are enclosing your permit. Please carefully read all 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. Please be advised that this permit does not relieve you of the responsibility of obtaining any necessary permits or approvals from local municipalities or other agencies. Sincerely, *ffle WW e*ni Environmental Analyst Distribution List: En-Consultants BMHP File NF;rp„Y.YORK Departmentof Environmental Conservation NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Raw Facility DEC ID 1-4738-05020 PERMIT Conservation Law !,' ` Under the Environmental C„onse...—. .��.. .......m._.._ m... .. w _... - . Permittee and Facility Information �. �.. __ - ... . _._.._..,..__ �......_ _..._. . _...mm_ .�..�. .... ......._. . Permit Issued To: Facility: DIGNANS REALTY, LLC DIGNANS.REALTY LLC PROPERTY C/O DAVID & STEPHANIE SACK 2100 & 2240 Dignans Rd 445 GLEN CT CUTCHOGUE, NY 11935 CUTCHOGUE,NY 11935 Facility Application Contact: EN-CONSULTANTS 1319N SEA RD SOUTHAMPTON,NY 11968 (631) 283-6360 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 708.9848637415071 NYTM-N: 4546.071435635689 Latitude: 41°02'20.6" Longitude: 72°30'49.4" Project Location: LI Sound Authorized Activity: Change the lot line by merging the two parcels as shown on the plan by Maresca & pp �.....Associates last revised 05.20.24 and stamped NYSDEC Approved on 9/6/2024. ARNO-DEP.....�._. The portion of the property landward of the "TOP OF BLUFF" more than 10 feet in elevation, as shown on the survey of the subject property by Kenneth M Woychuk Land Surveying, PLLC dated May 18, 2022, is beyond the jurisdiction of Article 25 Tidal Wetlands. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6 NYCRR Part 661), no permit is required for work occurring at the property landward of the jurisdictional boundary described above. Please be advised however, that no construction, sedimentation, discharge, or disturbance of any kind may take place seaward of the jurisdictional boundary without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within DEC's jurisdiction which may result from your project. Such precautions may include, maintaining an adequate work area .(i.e., a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Authorizations _wee ...-._—_.... .. ... ....... �. ...... .......�.._ ._ . ....�.Permit . .. . .....— ._.. .. _..-� ._.. ... ��. �. ...... _ .�_ Tidal Wetlands - Under Article 25 Permit ID 1-4738-05020/00001 New Permit Effective Date: 9/6/2024 Expiration Date: 9/5/'2029 Page 1 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05020 NYSDEC A .... ......_ ��_ . � ........._ ..... __ .--........ pproval 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: SHERRI L AICHER, Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony 13 ,00k,NY 1 1 790 -3409 Authorized Signature: Date m� _ ._. :..... ._._. . ....... .... d / _...... .... ...... .� ..I .�� ........._...._.__ �.. ... ...�...�__—......._.... . . �._Distr.ibution Llst....mm�.._ � .....�._ �._..... .._,.�._ � � .._.. EN-CONSULTANTS Marine Habitat Protection Wildlife Environmental Permits ... _Permit Com onen......_.A,_ p is NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following lowing Permits: TIDAL WETLANDS I. 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 Maresca & Associates last revised 05.20.24 and stamped NYSDEC Approved on 9/6/2024. Page 2 of 6 Am Iffibmw NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ill 1-4738-05020 2. Tidal Wetland Covenant The permittee shall incorporate the attached Covenant (or similar Department-approved language) to the deed for the property where the project will be conducted and file it with the Clerk of SUFFOLK County within 30 days of the effective date of this permit. This deed covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to Marine Habitat Protection NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook, NY11790 -3409 Attn: Compliance 3. No Easement for Structures 1 his permit does not authorize the granting of easements for the construction of water access structures, mooring facilities, or other structures. 4. Tree Clearing Prohibition for Long-eared Bats Due to the proximity of a known northern long- eared bat summer occurrence, tree clearing is prohibited between March 1 and November 30, inclusive, of any calendar year. 5. No Runoff down Bluff or onto Beach There shall be no discharge of runoff or other effluent on, in or down the bluff face or onto the beach. 6. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 7. 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. 8. 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. Page 3 of 6 Aft NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION lqww Facility DEC ID 1-4738-05020 9. 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. 10. Precautions Against Contamination of Waters All necessary.precautions stiall 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 _ . LLAp. plymm to ALL Authorized thoi-ized Pmm. ermits 1-111111-1 _ ... ---_ __._ ... ._.. _ ..n ._.. I. 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 in such order or determination. 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 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook, NYl 1790 -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. Page 4 of 6 Am oftwo NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05020 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. `NOTIFICATION OF OTHER PERMI � � .m_m___ OBLIGATIONS E.-1-11----..-.-.-.-............... ... .._ ......-.-.______.._ _ ...�.._- -- w TTEE OBL m_ ........... 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 Enviromnental Conservation Law as those prescribed for the permittee. Page 5 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05020 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 6 of 6 NOTICE COVEN ANT TO '['HE DEED DECLARATION THIS DECLARATION, dated day of................................. 20—Js made by (hereinafter the "Declarant"), whose address is WITNESSETH WHEREAS, the Declarant is the owner of certain real property located in-the Town of County of State of New York, Tax Map # District—, Section , Block Lot(s) „._..............a,,..... which real property is more particularly described in Exhibit A annexed hereto (hereinafter referred to as the "Property"); and WHEREAS, the Property is situated in or adjacent to regulated tidal wetlands which have been inventoried and mapped by the New York State Department of Environmental Conservation (hereinafter "Department"), pursuant to Environmental Conservation Law (hereinafter"ECL") Article 25 (also known as the "Tidal Wetlands Act") and Part 661 of Title 6 of the New York Code of Rules and Regulations (hereinafter"6 NYCRR"); and WHEREAS, various activities conducted both in and adjacent to tidal wetlands are regulated by the Department pursuant to ECL Article 25 and Part 661 of 6 NYCRR and require written authorization from the Department prior to being conducted; NOW, THEREFORE, in recognition of the Department's jurisdiction as set forth above, it is the responsibility of a party having any right, title, or interest in the Property, to obtain from the Department or any successor organization, a current description of all activities which are regulated pursuant to ECL Article 25 and Part 661 of 6 NYCRR, and to obtain written authorization from the Department prior to such regulated activities being conducted on the Property. Regulated activities include, but are not limited to clearing of vegetation; application of chemicals; excavation; grading and filling; dredging; erection of structures; construction or reconstruction of shoreline erosion structures; and construction and reconstruction of docks and bulkheads. By: STATE OF NEW YORK ) ss. COUNTY OF ) On the—day of in the year 20_, before me, the undersigned, a Notary Public in and for said state, personally appeared wwwwµITmmmmmmmmpersonally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the person or entity upon behalf of which the person acted, executed the instrument. NOTARY PUBLIC IEW Department o YORK STATE Environmental Conservation iNOTICE i The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please j refer to the permit number shown when contacting the DEC. i s Regional Permit Administrator SHERRIACHER _ 3 Permit Number: 1-4738-05020/00001 NYSDEC Region 1 Environmental Permits 50 Circle Road Stony Brook, NY 11790-3409 Expiration Date: 9/5/2029 Email: dep.r1@dec.ny.gov E i I r Note: This notice is NOT a permit > O �d LU s �P t Cut 0q V North Fork ountr�'t lit � - s 1*10 O at I uck uator %# Now Suf fol W o W Q O W rn VJ S vI I11 :D W ALL SITE DATA SUPPLIED BY KENNETH WOYCHUK SURVEYORING, co x AQUESOGUE NY 01.20-23 REVISED 02.01.24 N N SCTM#1000-83-2-7.4 & 7.5/92,322 SF /2..21 ACRES +115,177 SF/2.64 ACRES c o H ELEVATIONS NAVD 1985 DATUM o 0 0 PROPOSED SITE PLAN SUPPLIED BY RESOLUTION 4 ARCHITECT SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT FOR APPROVAL OF CONSTRUCTION FOR A SINGLE FAMILY RESIDENCE ONLY ftow" LA U (D DATE 10/11/24 S. *"� _C = - • R•24-0945 APPROVED C FOR MAXIMUM OF 5 SEDROOMS W o (j EXPIRES THREE YEARS FROM DATE OFAPPROVAL M '.r""., - c .0 co Design Professional's Certification Required. O 00 Ct! Submit P.E. or R.A. Certification For LLJ I The Installation and Construction of the Sewage Disposal System Use Form WWM-073 f ' NEIGHBORING WELLS ASSUMED U D SHALLOW HEALTH DEPARTMENT AND NYSDEC FOILS PRODUCED NO RESULTS F154331-332 YO)y� AR 50.0 CRUSHED ` STONE 1 � 0.5o PALE BROWN � 0 RRO _ SILTY SAND [UST BE SM 6.0 ;VEY BROWN FINE TO COARSE SAND NO GROUNDWATER SW 17.0' . EI COUNTEL-,�L - 20 30 40 arD AR i 52 0F SRC}AREAS 68UND .. E 0 '" l all 00 LL f r -- co LJL ' es) +r " - ~—"" PROPOSED LIMIT OF CLEARING, GRADING AND GF O DISTURBANCE 42,537.5 FTz; AREA S og EAWARD OF 100' BLUFF SETBACK TO REMAIN UNDISTURBEI ems- � �WAY ��, ' S -- .. - - I ,rS - r 1>0 68 6 ro /cl, 4 1.8�� - 68 r ; < r PROPOSED (1) 8' x ' DRYWELLS FOR SM SEE S-2 FOR DRAINA 60 / P Ir PO.. � RO SED 141 x 241 t