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HomeMy WebLinkAboutTR-10842A n ® 54375 Route 25 Town Hall Annex �� �s,<✓® Glen Goldsmith, President Z �® P.O. Box 1179 A. Nicholas Krupski, Vice President �® Southold, New York 11971 Eric Sepenoski Telephone (631) 765-1892 Liz Gilloolv �O Fax (631) 765-6641 Elizabeth Peeples COUNT` ,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU AR E REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUST OFFEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITS BE` INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 15t day of construction '/2 constructed When project complete, call for compliance inspection; - Town Hall Annex Glenn Goldsmith, President ®� S® � 54375 Route 25 A. Nicholas Krupski,Vice President ,`O� ®�® P.O. Box 1179 Eric Sepenoski l�i Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 ®1�COU ,N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10842A Date of Receipt of Application: September 15, 2025 Applicant: John & Roberta Jaklevic SCTM#: 1000-117-5-21.2 Project Location: 900 Old Harbor Road, New Suffolk Date of Resolution/Issuance: September 17, 2025 Date of Expiration: September 17, 2028 Reviewed by: Board of Trustees Project Description: Abandon existing collapsing septic system and install an I/A OWTS septic system. Findings:. The project meets all 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 TG Engineering, PLLC received on September 15, 2025, and stamped approved on September 17, 2025. 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 will be required. This is not a determination from any other agency. 411.1- Glenn Goldsmith, President Board of Trustees I � _ g N I o 30 0 30 60 o scale 1"=30' feet �d goo OLD HARBOR _P0 ROAD w l� APPt�OVER EY •rA ` , " � ;•, '�' ` � HAMLET OF m N/F ENDEMANN �1� aM1hp BOARD ,� r �• O NEW SUFFOLK OF USTEES � TOWN OF TOWN OF SOUTHOLD �Q SOUTHOLD N/F KWI7 DATE '\ �V" �"- TO REMAIN ELEC LINE %! Prepare By: kTFgineering,PLLC P.O.BOX 596 TREE pt �� SAG HARBOR,NY 11963 ' *7y CG .1 TO IE1111M1 Qt \ 631-740-7273 N/F RAYNOR v N/F WICKHAM •` PROP ROOT OF NE e�.r�rAo ,,(,_EL 6.0' EDDST WATER SUPPLY J / 347' BARRIER. a S 8T53' _I10.00' LINE TO REMAIN �vnnn TAR _ ^9� EXIST SEPTIC SYSTEM/ y w SEPTIC ENVELOPE N •'� J�k TO BE STANDARDS PER kAMb'' ��� SIpH1 STANDARDS N/F LOCKWOOD J ^� Q/ k7OST 11EE TO EXI TREE \ ON o N�1 o 6:V / BE REMOVED TO REMAIN \\ 09,09,025 11:1919 AM 5 eT5-, g�'E SCALE:PER PLAN I � � � �• w� .5"_ 'S' � ` \ JOB NUMBER: 25-222 - '1?� EL 6.0' z5 G'� SEPTIC CONFIGURATION EXIST I-STORY SINGLE ti g R� .'_` SCALE 1"_10' CIT, -1 FAMILY DWELLING W/ + �i.•,�4+�, q 11.46 EXIST SEPTIC SYS7EMFP CRAWLSPACE TO REMAIN `') 'g`�0�. TO B STMD�- FFE 7.0'n O �s £ i ,� �B �, • o $a ELEVATION Ed _ J oc� NBTS7'00"'W 1 £9t "'F ! Q+ ^� SLpADjAY N OWNER;JON JAKLEVIC c _ 13.21' / + SHIP-TBD SCTM•1000-117-5-2I.002 = ; HIGH WATER LINE AREA,42,729 SF(0.98 ACRES) OBSERVED PER SURVEY q SILTY SAND b DATED SEPTEMBER 17,2002 'HATER }l EXIST 5 BEDROOM DWELLING TO REMAIN(550 GPO) PROPOSED SEPTIC SYSTEM FOR 5-BEDROOMS(550 GPD) - '�• ll)OEENCO AX20(550 GPD)MODE 38 lA INFILTRATOR IM-1530 TAN!W/(4)PRECAST CONCRETE DEADMAN(8'X 1.5) ! FXlS7iNG GW-0.5 $1 MIXED SAND H (1)ORENCO PF200511 PUP BASIN W/CASTAWPLACE CONCRETE DEADMAN WOOD (66 LF)INFILTRATOR DUCK 4 STANDARD PLUS DISTRIBUTION TRENCHES DOCK AND AALK*A),S NO EXPANSION PROPOSED NO DATE DESCRIPTION SCHOOLHOUSE BOUNDARY 8Y FIELD MEASURE)OIT BY STAND J.ISAKSEN JR,DATED t71,lA QQLHOT r�� BOG N SEPTEMBER 17,2002. DRAWN BY: EDZ U CREEK VERTICAL DATUM 1929 NOVO BASED OFF SUFFO.K GIS. DESIGNED BY: EDZ SITE PLAN 1 (; To N(7LE INFORMATION I _ C_1 TEST HOLE BY 7F ENGINEERING PLLC, PROJECT COMPLIES WITH 2'SEPARATION TO GROUND WATER CHECKED BY: DATED AUGUST 26,2025. PIPES BETWEEN HOUSE AND THE DINTS SHALL BE 4'PVC DATE: SEPTEMBER 9,2025 HIGHEST EXPECTED GROUNDWATER 2.6 D3034 SOR35 WITH A MINIMUM SLOPE OF S•0AM � TIDAL. PROVIDE FLUSH CLEANOUT AT POINT OF CONNECTION WITH CAST IRON PIPE NOTES PIPE BETWEEN OWTS AND LP STALL BE 4'PVC D3034 SCTM•1000-117-5-21.002 NATIVE BACKFILL - I EXIST THE 1. AREA BENEATH DISTRIBUTION TRENCHES SHALL 0335 a ROPE•0.0I04 MIN BE OVER EXCAVATED TO SP LAYER AND HOUSE IE-4.5't I NATIVE SOIL I BACKFILLED WITH ASTM C33 SAND. I DO NOT DISTURB ST FGEL-6S FINISHED IE IN-2.17' -- IE OUT-3.05' DOT EL--17' '. INFILTRATOR 04 i >o ; r� RI� OWNS EMERGENCY PLUS STANDARD- I I L��- V FG EL-65 I ID FIE IN OU- 4,O SEPTIC FIE WT-4.00' W GOT EL-4.0 REPLACEMENT EL 6-1 _ 36" 36"MIN S E P 1 5 `UW IRE IN-3S9' 1 1 ~ 30"WIDE 60 MIL DEEPR007 WATER FIE OUT-450' BARRIER/BAMB 00 BARRIER GEOMEMBRANE DOT EL-OS a BY CSP FORESTRY(APPROVED BY SCUM DT j ROOT BARRIER FG EL-VARIES 6.0'TO 6.3' 3 IE IN-45 NTS C 1 C 1 Southold Town BOT EL-4W N Board of Trustees I C-1 SCOH APPROVAL rro : I ogy a A Issued .ts 0 EES UTHOLD T us] 0 iq: TaKlev;c _7 i- ess�, 0 ova uG�bo� Ro �.a , lJew 5w��1K THIS NOTICE MUST BE DISPL�►YED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,T011VN OF SOUTHOI.D SOUTHQLQ� N.1�. 11971 TE L.: 765.1892 . . Glenn Goldsmith,Presider. �pv0 ea __ Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski — P.O.Box 1179 Liz Gillooly �y • o�� Southold,NY 11971 Elizabeth Peeples � �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Z 'S Completed infield by: �✓ -go JOHN & ROBERTA JAKLEVIC request an Administrative Permit to abandon existing collapsing septic system and install an I/A OWTS septic system. Located: 900 Old Harbor Road, New Suffolk. SCTM# 1000-117-5-21.2 Type of area to be impacted: ,Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: .,�Chapt. 275 Chapt. 111 other Type o Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: 5-,��<<Gf� .rd�• Goe�d� ��F-' �0 40JII -►- iM � M refD1,223 ✓tIIS- Present Were: ✓ G. Ggjdsmith N. Krups E. Sepenoski L. Gillooly Peeples --r SURVEY OF GUARANTEES INDICATED HERE ON SHALL RUN DESCRIBED PROPERTY ONLY TO THE PERSON FOR WHOM THE SURVEY = IS PREPARED, AND ON HIS BEHALF TO THE SITUATE 777LE COMPANY, GOVERNMENTAL AGENCY, LENDING INS77TU770N, IF LISTED HEREON, AND NEW S U FFO L K, TOWN OF SOUTH 0 L D TO THE ASSIGNEES OF THE LENDING INS777U770N. ' GUARANTEES ARE NOT TRANSFERABLE TO S U FFO L K ' COUNTY, N.Y. A00177ONAL INS777UTIONS OR SUBSEQUENT OWNERS - UNAUTHORIZED ALTERA77ON OR ADDITION TO THIS SURVEY IS A VIOLATION OF SEC77ON 7209 OF THE NEW YORK STATE EDUCAnON LAW /'1 ; SURVEYED FOR: WILLIAM J. JAKLEVIC ROBERTA JAKLEVIC COPIES OF THIS SURVEY MAP NOT SEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. f� , UTIL POLES �y , GUARANTEED TO: 005 WILLIAM J. JAKLEVIC FD ROBERTA JAKLEVIC cm UTIL TM# 1000-1 17-05-021.1 POLE �1 c� N/F ENDEMANN P19� tK N/F KW1T APPROX. HIGH WATER LINE THIS DATE 1. S 24 59'06"W 3.30' = N 87'55'00"W 2. S 60 56'20"W 27.79' 12.23' 3. S 14'20'23"E 24.10' POLE 4. S 723846"E 28.50' 5. S 33 09'31"E 10.07' 6. S 30'27'05'E 66.14' 7. S 30 27'09"E 47.45' s 8. S 23'38'38"W 9.42' a 9. S 25'22'07"W 11.91' �s 10. S 81 41'18"W 21.37' _ 11. N 8159'31"W 57.19' F 12, N 84'16'40"W 8558' 13. N 82' 51'07"W 25.21' ��, sue- 14. N 28'25'29"W 66.32' �. moo. N/F RAYNOR N/F WICKHAM N V BULKHEAD S 87055'00 'E 110.00' •U(IL �, FD cm y FD FO POLE a o� '0,- Boa° cm FRAME � n cry (s. o� �'°� GARAGE A���� p< 24.3 2� o N/F LOCKWOOD o Q' o G p o �� o� Ao��y �o'. Ip S 87'55'00'$E 108.82' ' so O I-'2 CONC.STOOP BATHOUSE 00 WOOD N RAMP lZ a �LKH�O ti� �s o ° F cl 0 S pow ` BULKHEAD `<10 N8''3�Oa"yy� SEP 1 5 20 _ 14 �-� SoUlh-old T v'fn FoF,-d c,t _WATER �e ' -•.- --"2- LINE i EX>ST 1N0 WOOD DO C SURVEYED: 17 SEPTEMBER 2002 K AND WALKWAYS s SCALE 1"=40' u AREA = 42,729.37 S.F. SprrV : ��.i j � ��'E oR uj-�EEK 0.981 ACRES SURVEYED BY STANLEY J. 15AKSEN, JR. f P.O. BOX 294-` NEW SUFF LK.'"N.Y.,/ ' 1-1956 631 -7 4=5835 CENSED RVEY -9273 2C 1172 NYS Lic. o. 4 - i A&A S �4 ~d Drain A & A Sewer and Drain Maintenance Inc. INc 12 Whitewood Drive I Rocky Point, New York 11778 _0 631-849-1599 1 AASEWERDRAIN@GMAIL.COM https://www.aaseweranddrainmaintenance.com/ RECIPIENT: T (� I� ll ll Estimate #2687 -- v John Jaklevic Sent on Sep 11,2025 PO Box 613 SEP 1 5 '025 SHIP ID 25-00701 New Suffolk, NY 11956 Total SERVICE ADDRESS: SoutholdTown Board of Trustees 900 Old Harbor Road New Suffolk,New York 11956 Product/Service Description Oty. Unit Price Total Scenario 3(5 bedroom Supply and install an Orenco AX20 I/A OWTS 1 $34,788.06 $34,788.06* design)Orenco AX20 System with Infiltrator IM-1530 tank, start-up, excavation and backfill,electrical connections, Pump tank,3 22'rows of Infiltrator standards, 3 year maintenance contract($1200.00), pumping and decommissioning of old system. Sales tax for Orenco AX20 TAX IS ON MAINTENANCE CONTRACT ALL 1 $105.00 $105.00* PSD 3 year maintenance OTHER WORK IS TAX EXEMPT*CAPITAL contract IMPROVEMENT FORM TO BE SIGNED* SOQ line item 21 *Concrete concrete anti-floatation system 1 $1,300.00 $1,300.00* Deadman for Infiltrator tank SOQ line item 20 2 tanks with 2 digging boxes 1 $2,500.00 $2,500.00* *Dewatering SOQ line item 28*Sand per ton 50 $40.00 $2,000.00* (C33) imported SOQ line item 30*Fill per yard 60 $25.00 $1,500.00* removals export and dispose of fill SOQ line item 29*Grading per yard 15 $55.00 $825.00* material import *** ***TREE REMOVALS DONE BY OTHERS*** *Non-taxable Total $43,018.06 Once signed this estimate acts as a contract between A&A and client for the outlined work described in the estimate. Estimate is valid for the next 30 days,after which values may be subject to change.All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control.Owner to carry fire, tornado,and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. EXCLUSIONS: PRIVATE MARKOUTS,SURVEYING, ENGINEERING, DEWATERING, HAZARDOUS FILL REMOVALS, HISTORIC FILL REMOVALS, PERMITS,TAP FEES, FINAL RESTORATION, IRRIGATION REPAIRS,TREE REMOVALS, DAMAGE TO ANY CONCRETE OR BRICK FLATWORK, BURIED UNMARKED UTILITY WIRES 1 of 2 pages A&A Sid Drain A & A Sewer and Drain Maintenance Inc. Inc. 12 Whitewood Drive I Rocky Point, New York 11778 631-849-1599 1 AASEWERDRAINCa GMAIL.COM https://www.aaseweranddrainmaintenance.com/ Signature: Date: S E P 1 5 2025 Southold Town Board of Trustees 2 of 2 pages r t Project Number: 25-222 Project Name: 900 Old Harbor Road Suffolk County#: 1000-117-5-21.002 TF Engineering Civil Engineer Roth 1000E Septic Tank M Depth 4.58 ft D C u E Length 14.67 ft Width 5.17 ft SEP 1 5 2025 Water Density 62.4 lb./cf Weight of Tank 501 lb. Southold Town Tank and Groundwater Elevations Board of Trustees Top of Tank Elevation 6.50 ft Bottom of Tank Elevation -1.70 ft Groundwater Elevation 2.00 ft TuF-FLEW GM ElEY � JJ;LS IOT li E MORETE OEM" (2)LMATIOM Buoyant Force Groundwater Penetration(GW Elev-Bot Elev) 3.70 ft Length of Tank 14.67 ft Width of Tank 5.17 ft Volume of Displaced(Width x Length x GW Penetration) 280.4 ft-3 Buoyant force(Vol x Water Density) 17496 lb. Concrete Deadman Force Width of Deadman 1.50 ft Height of Deadman 0.67 ft Length of Deadman(Total length of Deadman) 16.0 ft Concrete Density 145.0 lb./ft-3 Submerged Conc.Density (Conc. Density-Water Density) 82.6 lb/ft-3 Deadman Weight(Vol x Submerged Concrete Density) 1322 lb. Soil Forces Dry Soils Width of Soil Column 1.5 ft Dry Soil Density 110 Ib./f'3 Depth of Dry Soil(Top Elev-GW Elev) 4.5 ft Length of Deadman 32.0 ft Dry Soil Anti-Buoyancy(Vol x Density) 23760 lb. Saturated Soils Width of Soil Column 1.5 ft r Saturated Soil Density(Dry Density-Water Density) 47.6 Ib./ft^3 R l4J if_ �f J Depth of Saturated Soils(GW El-Top of Deadman Elev) 3.03 ft Length of Deadman 16.0 ft Saturated Soil Anti-Buoyancy(Vol x Density) 3465 1b. S E P 5 ?025 Force Summation Buoyant Force 17496 lb. Southold Town Board of Trustees Resistant Forces Tank Weight 501 lb. Deadman Weight 1322 lb. Dry Soils 23760 lb. Saturated Soils 3465 lb. Total Resistant Forces 29048 Ib. Buoyancy Factor of Safety Calculations of NEW Buoyant Force 17496 lb. A J�O -- Resistant Forces 29048 lb. co Factor of Safety(Resistant Force/Buoyant Force) 1.66 OK Input Field ys� 092730 Calculated Field FESSONP� Previously Input or Calculated Field 09/09/2025 1:12:41 PM Project Number: 25-222 Project Name: 900 Old Harbor Road Suffolk County#: 1000-117-5-21.002 TF Engineering Civil Engineer Pump Basin Diameter 2.00 ft Water Density 62.4 Ib./ftA3 Weight of Pump Basin 0 lb. Negligible Depth of Pump Basin(Top Elev-Bot Elev-Deadman Penetration) 5.50 ft Tank and Groundwater Elevations Top of Pump Basin Elevation 6.SO ft Bottom of Pump Basin Elevation 0.50 ft Groundwater Elevation 2.00 ft Ti--p ,;Lw V 3 vV ELEV 5 El j ELE V -"-J--L-I [ `. 12" Y Buoyant Force Groundwater Penetration(GW Elev-Bot Elev) 1.50 ft Area of Pump Basin(PI x DA2/4) 3.14 ft Volume of Displaced(Width x Length x GW Penetration) 4.7 ftA3 Buoyant force(Vol x Water Density) 294/b. D C E U Concrete Deadman Force(Square deadman) U i Deadman volume(cb)(3'square) 9 ft-3 S E P 1 5 203 Jul Pump Basin Diameter(pb) 2.00 ft Depth of deadman(d1) 1 ft Pump Basin Penetration(d2) 0.5 ft Southold'Town Volume of concrete(deadman volume-(PI'pbA2)/4'd2) 7.43 ftA3 Board of Trustees Concrete Density 145.0!b./ftA3 Submerged Conc.Density (Conc.Density-Water Density) 82.6 tb/ftA3 Deadman Weight(Vol x Submerged Concrete Density) 613.7 Ib, Soil forces Dry Soils Deadman Area 9.0 ftA2 Pump Basin Diameter(pb) 2.0 ft Area of Soil Column(Area of Deadman-Area of Pump Basin) 5.9 ftA2 Dry Soil Density 110 Ib./ftA3 Depth of Dry Soil(Top Elev-GW Elev) 4.5 ft Volume of Dry Soils(Area of Soil Column.Dry Soil Depth; 26.4 f A3 Dry Soil Anti-Buoyancy(Vol x Density) 2900 lb. Saturated Soils Area of Soil Column(Area of Deadman-Area of Pump Basin) 5.9 ftA2 Dry Soil Density 110 lb./ftA3 Saturated Soil Density(Dry Density-Water Density; 47.6 Ib./ftA3 Depth of Saturated Soils(GW El-Bot El-Depth of Deadman; 1.00 ft Volume of Saturated Soils(Area of Soil Column`Saturated Soil Depth. 5.9 f A3 Saturated Soil Anti-Buoyancy(Vol x Density; 279 lb. Force Summation Buoyant Force 294 lb. Resistant Forces Pump Basin Weight 0 lb. Deadman Weight 614 lb. Dry Soils 2900 Ib. Saturated Soils 279 Ib. Total Resistant Forces 3,792 Ib. Buoyancy Factor of Safety Calculations pf N(;IV Buoyant Force 294 lb. Resistant Forces 3792 lb. Factor of Safety(Resistant Force/Buoyant Force; 12.90 OK r Input Field 09273o � Calculated Field �tFsSioNP� Previously Input or Calculated Field 09/09/2025 1:12:48 PM p C " YE 0 S E P 1 5 2025 A&A Sol L d Drain D E C E WE Ma�nteN lInc. 12 Whi ewood Drive S E P 1 5 2025 Rocky Point,NY 11778 Phone 631-849-1599/516-491-8738 Southold Town Fax 631-228-4443 aasewerdrain@gmail.com Board of Trustees 8-25-2025 John Jaklevic 900 Old Harbor Rd New Suffolk, NY 11956 Upon completion of the cesspool inspection at the above property we found a concrete cover sitting ob 6" of roots from the top of course of blocks being pushed out or disintergrated. The second course of blocks has started to fall in as well. This block pool is next to a walking path to the boat dock. System is in catastrophic failure and needs to be replaced asap to new standards. ��� vt'R .v M�-y � r'�`.ate .+`? ��s •-��o��.k. � i�' .. Thank You, Jo-k K., CraM.d� John Crandell President Our Website AASEWERANDDRAINMAINTENANCE.COM Thankyou foryourbusiness! • ; s 1 low .,�rA ^k 4 yw q` t{ r;, W� .r 1t✓ S E P 15 ?Q2`' F�Southold A I G J s 7} as l 'f � y r�. Y Ssy i - 1' A' err o AM-» Dana. s uraeoz , 2 wTcl, UE m.naz � — ---- IaKlriKa tfycl 11 oax,a / f.,,Yq aafV ��ol J fo A.t p S '. 11 O ✓f 'Al IM I J 12 HI 2 2.]NA O WII1'Gi KD. � f'fMq ,�,Ncl ry j: O MIMm1 u zM 4' le lid ,�Nq . i T U •4 T cEaecE eao Im. tr ',I © e '� a ,e2 Ja GJTpKK'UE HARBOR f f 21 .E a n a s _ .. _v�,•w -7 NN FA1FR W.•y T' � - •R 2 J ,N1c1 1• -� y a, • cJ anz - o . L ,p1 ia2 a 12 _ O1M - p.a a a s as ad a ae-� L ,eae M If t'W 2]Ncl - s e u n R • 9e { ..i FD 22 SAY �...`...i.._ .J...— PEA "s GREAT NOTICE COUNTY OF SUFFOLK © K ,a..• p 1ECT1oK uo E ��.d.. —.�— - R,) 2 .,,,,- --.-- r.. -- -- E Q F rW Real Properly Tax Service Agency r 117 E...��.� —Y---- trr _ e.•u. -- — -- -- ^ti e.wly�r.lwn,.a.v n.n ,» ,n p xo low IM n2 PROPERTY P OFFICE LOCATION: QH�_ 1►4' ,, MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 'r 4 � Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) � d Telephone: 631 765-1938 Southold, NY 11971 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees Cc: Honorable Lori Hulse, Attorney From: Heather Lanza, AICP, Planning Director LWRP Coordinator Date: September 17, 2025 Re: LWRP Coastal Consistency Review JOHN & ROBERTA JAKLEVIC SCTM#1000-117-5-21.2 JOHN & ROBERTA JAKLEVIC request an Administrative Permit to abandon existing collapsing septic system and install an I/A OWTS septic system. Located: 900 Old Harbor Road, New Suffolk. SCTM# 1000-117-5-21.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposal is CONSISTENT with the LWRP policies. Policy Standard 5.1 A.2. Reduce nitrogen discharges sufficient to achieve dissolved oxygen levels that would limit the occurrence of hypoxia. And also, Policy Standard 6.1 Protect and restore ecological quality throughout the Town of Southold. This action supports these policies because it will improve water quality by treating the effluent from the existing development to a lower level of Nitrogen, thereby causing less Nitrogen pollution to enter the surface waters from this site. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Glenn Goldsmith,President Re��� so Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski 96 Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 00UNil,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD f F: n rp n n n ra This Section For Office Use Only Coastal Erosion Permit Application S E P Wetland Permit Application 1 2�25 Administrative Permit Amendment/Transfer/Extension Southold Town Received Application: Board of Trustees Received Fee: $ Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): Mailing Address: P e OOx l 3 1 nu.- So- (IA 11 1 J 6 Phone Number: Suffolk County Tax Map Number: 1000 - 119,00 06'00 O Zl 00a Property Location: goo D 1_(. �°������ c� 9 n,-w S,441*,nA, 1 19 D (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Email: Board of Trustees Applic- )n GENERAL DATA Land Area(in square feet): Area Zoning: �Ql Previous use of property: Sr d ►L� Intended use of property: Re Sr drr�►-h�� Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes _,K_No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes __ —No Does the structure (s) on property have a valid Certificate of Occupancy?_fie Yes No Prior permits/approvals for site improvements: Agency Date s(rus s , A c)0 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): �'�� Board of Trustees Applica m WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: AQ-'Qf 0 r\ 0� Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands:„ feet Closest distance between nearest proposed structure and upland edge of wetlands: 31 ,Z� feet Does the project involve excavation or filling? No +/ Yes If yes, how much material will be excavated? -- _cubic yards How much material will be filled? __cubic yards Depth of which material will be removed or deposited: b feet i( Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: ex(!a r Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): `�o 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Pr 'ect: 1 fl �'� Project Location(desc be,and attach a location map): goo oI& �6f6r ek ew &.8it, V oil, m Brief Description of Proposed Action: 5-AC, SAS l 'rrt Cv_ LJA mo-Ts Name of Applicant or Sponsor:: ` Telephone: 31 2` co93 ��ridgy JCI�ICiA t- E-Mail: i"�� Address: City/PO: State: Zip Code: S A\ 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? ❑ If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? it l acres c.Total acreage(project site and any contiguous properties)owned I or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. �/ ❑Urban El Rural(non-agriculture) ❑Industrial ❑Commercial dResidential (suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ff ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES Il b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ©�� ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a..Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YE wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 1.00 year flood plain? N YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? E' NO DYES b.Will storm water discharges be directed to established conveyance systems(ru off and storm drains)? If Yes,briefly describe: [�NO DYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: M ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 1;i] ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE \ Applicant/sponsorname: ® ��"�`�`�� Date: Oct 'j ZJ Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage El ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? ❑ Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 3oard of Trustees Applica" �`!n AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,.I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature otvAp4yOwner Signature of Property Owner SWORN TO BEF E THIS �l DAY OF , 20 Richard D.Noncarrow Notary Public State of New York No.01W06224106 Qualified in Suffolk County otary Public My Commission Expires June 2 3oard of Trustees Applica in AUTHORIZATION (Where the applicant is not the owner) I/We, � owners of the property identified as SCTM# 1000- t i-1 a- 1-00 in the town of �V J 0 U , New York, hereby authorizes ewe~ OAA, D ru,c n mck A& e rt f\c,. to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property OwnVASIVature Property Owner's Signature SWORN TO BEF ME THIS - DAY OF , 20 �- Richard D.Noncarrow, Notary Public,State of New York No.01 N06224106 Qualified in Suffolk County My Commission Expires June 21,2 Notary Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The puMose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: < ►°� ,! l�1 Q X/t Ci (Last name,first name,.giiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate.the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%/of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted th' ��a f � 20&5 Signature Print Name sf�Ci Form TS 1 Y Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its si ing ficant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: C�1 �i. �. < (� Location of action: q l Ld Site acreage: --T A Present land use: �Co,leey�iaA Present zoning classification: 2$r�'Un �C 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: ?.O' �o1C new 5dw1k N* (c) Telephone number: Area Code ( ) 3_( (2() (d) Application number, if any: A Will the action b directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No l If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY 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 minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No [:71 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No f� Not Applicable i Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ❑�Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria ❑ Yes ❑ No [� Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria, ❑ Yes ❑ No [�Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ M Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No � Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ a No u Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of.Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Yes[] No� Not Applicable Attach additional sheets if necessary WORKING COAST POLICii L' Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 1� Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of Paving marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No [� Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No[A Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No F� Not Applicable PREPARED BY TITLE QUyy kx DATE