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HomeMy WebLinkAboutTR-10869A Glenn Goldsmith, President _.`*Qf S�(�j Town Hall Annex A. Nicholas Krupski,Vice President ®V� �l� 54375 Route 25 P.O. Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly Q Telephone(631) 765-1892 Elizabeth Peeples • �O Fax(631) 765-66441 cou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10869A Date of Receipt of Application: September 3, 2025 Applicant: JOSEPH PATRICK VERMAELEN & KATHLEEN POWERS- VERMAELEN SCTM#: 1000-144-3-40.1 Project Location: 2020 Bay Avenue, Mattituck Date of Resolution/Issuance: September 17, 2025 Date of Expiration: September 17, 2028 Reviewed by: Board of Trustees Project Description: Clear a 28' wide area; to expand existing pathway and install a 240' x 10' stone blend driveway; to conduct construction activity consisting of installation of an,I/A OWTS septic system, a 994 sq.ft. two-story dwelling with a 288 sq.ft covered porch, and a 64 sq.ft. deck with stairs. 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 Joseph Vermaelen, received on November 10, 2025, and stamped approved on November 10, 2025. Special Conditions: Establish and permanently maintain a 50' non-disturbance buffer seaward of the driveway. 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. Glenn Goldsmith, President Board of Trustees I (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AID ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTTUTION.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS('W),SEPTIC TANKS(ST)k CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. DRAINAGE CALCULATIONS HEALTH DEPARTMENT USE NOTES VOLUME REQUIRED(ROOF AREA 1) 400 Ostrander Avenue, Riverhead, New York IIcf01 1.HE OWTS SHALL BE MODEL CEN-5 MANUFACTURED BY 635 SF x 2/12 x 1.0 = 106 CIF FUJICLEAN USA. VOLUME PROVIDED tel. 631 adman you fax. 631 acing. I44 USE NEW DW#1: adman®youngengineering.com 2.HE DESIGN ENGINEER,FUJICLEAN USA {ormer\y I 8' DIA.x3' DEEP DRYWELL = 127 CF ,Y) f '- a OBSERVE HE INSTALLATION OF THE OWTSND SCDHS REPRESENTATIVES SHALL now e E Sn,der,lr' _ -ACMF VOLUME REQUIRED ROOF AREA 2 }�}�� � 0, �01m� �� 9:0 � ED I Georg Q ( ) LEACHING SYSTEM. APPROVAL FROM ALL THREE PRIOR TO ' ,- 635 SF x 2/12 x 1.0 = 106 CIF Howard W. Young, Land Surveyor ' BACKFILL. I VOLUME PROVIDED Thomas C. Wolpert, Professional Engineer BOARD OF i r:USTEES USE NEW DW#2 Douglas E. Adams, Professional Engineer 'TOWN OF SOUTHOLD 3.THE SYSTEM START UP WILL BE COMPLETED UNDER HE 8' DIA.x3' DEEP DRYWELL = 127 CF DIRECT SUPERVISION OF A FUJICLEAN USA I Robert G. Tast, Architect � I� REPRESENTATIVE. LOT COVERAGE Robert Stromski, Architect DATE ���e��t r 10► JOv�-� BUILDABLE LAND AREA = 35,606 SF 4.AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE MAINTENANCE PROVIDER AND PROPOSED PROPERTY OWNER MUST BE SUBMITTED TO THE SUFFOLK FRAME HOUSE =994 5F SITE DATA ��' - -= ^ V7 -�-• COUNTY DEPARTMENT OF HEALTH SERVICES(SCDHS)PRIOR COVERED PORCHS = 288 SF _ TO APPROVAL OF THE I/A OWTS REGISTRATION BY HE {ormer\`I i AREA - 40,086 SQ. FT. SCDHS IN ACCORDANCE WITH ARTICLE 19 OF HE SUFFOLK W ae\e I DECK&STAIRS =64 SF COUNTY SANITARY CODE. �° RV Vertu 5� o TOTAL=1,346 SF-3.8% * VERTICAL DATUM =NAVE)(1988) 0T °°ab\e�rU I o GROSS FLOOR AREA GFA *SEE FLOOD INSURANCE RATE MAP PANEL NO.36103CO481 H LAST DATED 5.ARCHITECT TO VERIFY FINISHED FLOOR ELEVATION(S). R I SEPT. 25,ZOOS. g MAXIMUM GFA(LOTS UP TO 40,000 SF)I * ZONING USE DISTRICT =R-40 M 4,350 SF+(5,606 SF x 0.075)=4,770 SF PROPOSED GFA=1,988 SF * WETLANDS AREA =4,480 SF 4"PIA. PERFORATED PIPE TEST HOLE NYSDEC ADJACENT AREA * BUILDABLE LAND AREA=40,086 SF-4,480 SF =35,606 SF I BY MCDONALD GEOSERVICES * PROPOSED FILL = 200 CY PERMEABLE BAGKFILL DATE:o2i2aizoz3 (lot area within 100' of wetlands) GEOTEXTILE CMF * DEPTH TO GROUNDWATER = 2 FT GEOSYNTHETIC BARRIER EL=3.1 0.0' ADJACENT AREA(AA)= 21,678 SF AGGREGATE PALE 6RAY& _ / * NUMBER OF BEDROOMS(DESIGN EQUIVALENT) =4 BROWN SILTY NATURAL VEGETATION WITHIN AA=18,345 SF * MINIMUM REQUIRED I/A OWTS CAPACITY =440 GAL (sM1 USABLE 501L SAND NATURAL VEGETATION TO * Q I (1-60 MIN/INCH 15' o REMAIN WITHIN AA=13,799 SF PROVIDED I/A OWTS CAPACITY =500 GAL PERCOLATION RATE) BROWN FINE - *GRAVELLESS ABSORSTION TRENCH REQUIRED USING SAND o PERCENT OF NATURAL VEGETATION TO TABLE 11 OF THE SCDHS STANDARDS FOR A 4 BEDROOM =61 LF o REMAIN WITHIN AA =75.2% DESIGN&1-5 min/in PERCOLATION RATE) DD b - - - GW EL 1.2 1.9' {Orm row or & *GRAVELLESS ABSORBTION TRENCH PROVIDED =64 LF WATER IN A5\1e1`' gar'iGh I ENGINEER'S CERTIFICATION r BROWN FINENE z ff `^ �W 4 ;i"� 4'TO ADJACENT _ (SP) cMF "I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL ' ,I!I€ ( TRENCH _ -� SYSTEM(5)FOR HIS PROJECT WERE DESIGNED BY ME OR UNDER MY o I DIRECTION.BASED UPON A CAREFUL AND THOROUGH STUDY OF Cli 8.0'HI6HE5T EXPECTED ro �r� • €,€ €_€!,--;-;i i - w AS PROPOSEQ;\, i----; --:° HIGHEST EXPECTED GROUND WATER �0\.15 01 �� � SITE A GROUNDWATER A ACILI„ 5; GW EL=2.5 CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES'•, - EL=2.5 BASED ON OFFICE RECORDS& E�EVA \J CONSTRUCTION STANDARDS IN EFFECT AS OF THIS DATE.'; p I U565 MONITORING WELL DATA F�00D aASE y LINEOD Wr E / UNSUITABLE SAND SHALL OVNpAR R0MF1- ) i C� c T� f. BE REPLACED WITH SAND B CA\,Et)F I , o' t'cn „r .., RATED AT SP OR 5W ANSVRANCE RA � - _. 4' er\ T AO E C-D r7_ y ff LEACHING TRENCH SHALL SAND MEETING ASTM hOW Mae\ N7 �98, / vI a I HOWARD W O G,N.Y.S.L.S. ,45893n ;: `�7 SANBD RATED ATD POOR SW SPECIFICATION C33 Q terE've�er aatej ,.1% EASti►�EN�,_,�1 m p I I THOMAS C. OLP PT,N.Y.S.P.E.N0.61483 e II i on Mar Qublic`N / , _/ INAc'E _ a S DOUGLAS E.ADAMS,N Y.S.P.E.NO,80897 v:y j GRAI/ELE55 A55ORPTI ON TRENCH 5ECTI ON �pwe I er\y o MFG. BY ELJEN CORPORATION MDL#B43 SCALE: t TS �+� ut` ����oW or{or Qe\en15r °� I SURVEYOR'S CERTIFICA O ,�•. fir ��- P R ��� n m Wa'I +5.93� * OR APPROVED EQUAL PEP ,,-` Q ver ; h s) Rcs 5.sa p RT9ht o{�� FrarcStreets&N 9 p SURVEY WAS PREPARED N ACCORDWE HEREBY CERTIFY TO ANCE WITH-W dDt�F PRA ITC_TFOR , ZoN cEF bl sa t (a0 00 0 LAND SURVEYS ADOPTED BY THE NEW YORK STATE ArS�OG�iATION"OF \o€ cNPN r ✓ Eli 3.74 rl 0 1�0• C w NE ,�'��/I O bA.4 rn PX PROFESSIONAL LAND SURVEYORS. �.;`', C + `\ (, I G �� \ O Cull OAO%O403 CSO c E�Ap1d5 6.05 -(� 0 �/. C r� a, P� oW oe s ?77'_, 1719�'' ��a�,, -�q 150p N-�4 w s WAJERW�Ac�bT, e�-- P� 7 t��ERGutiEN <� 17 WSs _ Gj m b556 NYSFRSsy SV O ozl�9iz m o; �/ ' // ;N / CMF \ r OQTT G'' i i `,.15b CS gO'IN 1"NiNG �ANps ✓ W G.i�.- 1 �Q SrSC 3 �OQ I k � n i P'ij S � / _d' A t72 .03 •\ KE VIE 3 0 \ i �'Q NOV 1 LQ25 e >g �_,- r' - -L HOWARD W.YOUNG,N. . .L.S.NO. 893 /gyp S UR _ I 0 93,7a „ _ (p 3.22 �23• 2.69+ t - - i ' 6.40 \ \ laat`n �5tip� �L100 TH ., - / S 4 Q y z.7s* �O. •.� O o p�j 'r �.a T;X: `k' �4 P P�NtiCARM\ O© 'i;. . W 3 % : , N._ + . N o /f SURVEY FOR O o �o Z qr��� o�SP 5y5CE \ 1: < ✓ ;�0 R�MA� ',: +4�4' , 4,liI e u N 2 I`= �,' . ^A AREA RAL 6 `'.y Z.; _ A G 22�c>! \�s ��� �Ej OB B O ��/ T'. /\ _ `, 14 NA Sn}Rg��5.36 rn i 449+, z. �535 �� JOSEPH P. VERMAELEN P o rs o �� cRti Q / ,� W 7.1 o P� 6 S - P1 �R / 80 �. 7.29 E �i�\\ Z�b4.6 - �-- == -s'; y w/W ` at Mattituck, Town of Southold i�9-~ W S CMF I c0 QED �ENSOy O W p b,.�" .� W N ORS 7.93 \ Suffolk County, New York N z 4.17 r ppOP oRy D a um aC ' _ w �QNEBLE 7.74 G6� I ✓i ��� "O� I z 2�oJ�PR�' � _ W pRoposED 5 ORI.VE`NxN 6ERa)o T, o / rmery MNAko � �� ^° w EARTti TiM �z N //- r°`�or{ So�'t�°`d ' J ��FFti°�� r�6 w�W 3��g� �, ; p,�;1��C �� °P� BUILDING PERMIT SURVEY o /' '€'C0`Nr°{ / 0 tiECK /w OF CLEARuo'D ire t it. T LEGENDy/ pRopO EA RS W N 0 � \ `� County Tax Map District lOOO Section 144 Block 03 40.1 40.1 _ UZMI &GR ANo s F GRApi p,ANC� \ / o / " 1--. ,-^ N ' W �04() "`N �pGE NG pZS�R FIELD SURVEY COMPLETED SEPT.12,2022 TL MAP PREPARED SEPT.13,2022 CLF =CHAIN LINK FENCE -« v1D o �' 57 E5 CMF =CONCRETE MONUMENT FOUND f� N W00psr LN6\-ZMI ` p ` -o p CMS =CONCRETE MONUMENT SET - - _ r CO- er\`1 'CMF 0 ,�; Record of Revisions CSW =CONCRETE SIDEWALK {°rm Y\S a EOP =EDGE OF PAVEMENT a a $ss gVI1biN6 roNl or A gaaaka / ' \ o REVISION DATE OL =ON PROPERTY LINE p o� p(zSNCTpA� EN�Et°p6 A(ER N;Ch\Ows s) _ �� P ADDED TEST HOLE MAR.09,2023 RO = ROOF OVER e of o- `� QROP05EpBP DATA MAP.22,2024 5 RVICE �pWewng --/ \ \ 5 GENERA AMENDMENTS MAY 01 2024 RCS =REBAR&CAP SET _ er) WETLANDS OCT.04,2024 o W WETLANDS OCT,15,2024 WIF =WIRE FENCE gA 3 \ - / WithpUb\tc 0t WETLANDS&BP DATA MAR.17 2025 WDF =WOOD FENCE r� G�N�� \ _ , / �pwe\\�ngMAY 15,2025 WSF =WOOD STAKE FOUND � 'o o� -� \ SCDHS NOIA#3 AUG.22 2025 WSS = WOOD STAKE SET �� t° ` / SP DATA OCT.27,2025 UTILITY POLE • =END OF DIRECTION/DISTANCE \/ Water) \ 40 0 20 40 80 120 =WETLAND FLAG&NUMBER -'/' With?ub\�� Scale: 1" = 40' ® =WELL \ JOB NO.2022-0155 DWG.2022_0155_bpr3 1 OF 2 I I (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO E%ISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES (3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)&CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. 2 STORY 400 Ostrander Avenue, Riverhead, New York I1a01 FRAME HOUSE tel. 651.727.2505 fax. 651.727.0144 (4 BEDROOMS) odmin®youngengineering.com FFEL=12.0 5WEET AIR VENT GAP MFG BY TUF-TITE FIBERGLASS LOCKING 4 � ��4� �� (5' MIN FROM ANY DOOR OR WINDOW) COVER 5005-RO 8 RISER MFG BY POLYLOK RIM_&.0 Howard W. Young, Land Surveyor 5' Thomas G. Wolpert, Professional Engineer 4 PVC 5' 10, 32'LONG TRENCH 3.0' Douglas E. Adams, Professional Engineer PIPE ® RISERS 8 GONERS 4" PVC, 4" PVG PIPE Daniel A. Weaver, Land Surveyor r 0090 MIN. WITH SAFETY LIDS PIPE @ ® 1.0095 MIN. MFG BY TUF-TITE (TYP) 1.009b MIN. GEOTEXTILE RIM=5.0 BARRIER _ ION 5 HEALTH DEPARTMENT USE CONNECT 5" PVC VENT LINE EL=6.6 SLOPE 0K".^ TO VENT HOLE IN OW5T �° 6 f(s AIR QLINE SAND ( 16te" IE=6.12 _ -TOP OF PIPE 3„ VENT NOV 1 0 2025 t--/ HOLE IE=5.85 IE=5.80 IE=5.7 5 0 , ' EL=5.6 PROVIDE GLEAN IE=6.02 OUT AT FACE 5)F BOT EL=4.5 BUILDING SEE DETAIL FOR 4"DIA. PERFORATED PIPE GE05YNTHETIGJ o z OWTS COMPONENTS AGGREGATE N 2 HI6HE5T EXPECTED &V4 EL=2.5 HIGHEST EXPECTED GW EL=2.5 BOT=1.62 2' DIA. POLYPROPYLENE GRAVELE55 ABSORPTION 12"XI2"Xa' LONG DISTRIBUTION BOX TRENCH5 (6 5F) CONCRETE BEAM 500 GAL. I/A OWT5 MF6.BY POLYLOK TOTAL OF (2) = 64 LF MDL. GEN-5 MFG. BY FUJIGLEAN USA MDL#50f7-G24 OR APPROVED EQUAL MF=6.BY ELJEN CORPORATION (TYP. OF 2) PROVIDE END GAP LEVELING DEVICE MDL#B45 OR APPROVED EQUAL MDL#SL-4 MFG BY TUF-TITE OR APPROVEBUOYANCY CALCULATIONS HYDRAULIC PRO=1LE DISTRIBUTION OU�EFT�PIPESL SCALE: NTS IA OWT5 ONE (1) OWTS MDL# GEN-5 MFG. BY FUJI GLEAN USA WEI6H5 517 LBS., REPRESENTING THE FIN. GRADE DOWNWARD FORGE FOR THE STRUCTURE. THE PROPOSED STRUCTURE WILL BE PARTIALLY 5UBMER5ED TO A DEPTH OF 0.55, (2.50 MINUS 1.62). THE VOLUME OF GROUNDWATER DISPLACED BY THE STRUCTURE V = AREA x SUBMERGED CORROSIVE RESISTANT CEN-5 STRAFING (TYP. OF 2) DEPTH (I AO)(4.02)(0.55) = 27A OF. EPDXY COATED OWT5 THE WEIGHT OF THE WATER DISPLACED BY THE PARTIALLY SUBMERGED STRUCTURE W = ANCHOR EYE BOLT 2-7A OF x 62.4 L55. PE OF = 1,7 PEG4I LBS. (TYP. OF 4) =_X R T PETED APPLYING A SAFETY FACTOR OF 1.5, THE UPWARD FORGE (BUOYANCY) EXERTED ON THE GW EL=2.5 PARTIALLY SUBMERGED STRUCTURE 15 1,741 x 1.5 = 2,612 LB5. NOTE: ALL CONDUITS BETWEEN PANEL AND TREATMENT TANK MUST BE SEALED TO PREVENT THE DOWNWARD FORGE OF 5a7 LBS. 15 LESS THAN THE UPWARD FORGE (INCLUDING 57A5 LEAKAGE INTO PANEL. SAFETY FACTOR OF 1.5) OF 2,612 LBS. AND, THEREFORE, AN ADDITIONAL 2,215 L55. OF 12"XI2"X0I' LONG DOWNWARD FORGE 15 NEEDED. CONCRETE BEAMS USE FOR WIFI COMMUNICATION DEVICE; CONTROLLER "0" MFG BYNEL 5JERHOMBUS H MBU 040 ENGINEER'S CERTIFICATION USE (2) 12 xl2 xa LONG CONCRETE BEAMS = 15.0 OF END VIEW DETAIL °^ ''�°" THE ADDITIONAL DOWNWARD FORGE PROVIDED = 15.0 OF x 150 LB5./GF = 2,700 L55. `2SCALE: TUTS ALARM/CONTROL I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL PANEL MDL#1041g72 SYSTEM(5)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY 01 CONTROLLER "A' DIRECTION.BASED UPON A CAREFUL AND THOROUGH STUDY _ OIL, N MFG BY SJE RHOMBUS SITE AND GROUNDWATER CONDITIONS,ALL FACILITI A5 606SED, a -1/2' VENTILATION PIPE CIIAMBER Volume(gal) N scuM BAFFLE B CONTROL PANEL MOUNTED CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF EAL'�H SERVICES ;\ Ql Sedimentation Chamber 277 O -10 N 4"x4" PRE55URE CONSTRUCTION STANDARDS IN EFFECT AS OF THI DAT8' "--, " 2 Anaerobic Filtration Chamber 278 11 TREATED WOOD POSTS E o -10 -7 4-Oa -I Q Aerobic Contact Filtration Chamber 127 ECIRCULATION Q Storage Chamber 63 AIR LIFT PUMP © 1 , C4 = Disinlcction Chamber 4 ( ISINFECTIDN Total Volume 749 INSULATED o % © CYLINDER (OPTIONAL) AIR WEATHER r> BLOWER RESISTANT HOWA MWOL G,N.Y.S.L.S. 45893n 4' INLET PIP ' OUTLET PIPE SPECIFICATIONS r�D BLOWER 1� J7 THOMAS RT,N.Y.S.P.E.N0.61483a A 4 A Anaerobic Media PP/PE Filling Rate 32% ENCLOSURE� DOUGLAS5,N.Y.S.P.E.NO.80897 \ r1,j © Board Type Aerobic Media PVC/PP/PE Filling Rate 16% E Aerobic Media PP/PE Filling Rate _`7% ; FIN. GRADE ----- Blower 2.8 efm ELECTRIC SUPPLY O2 AIR L LIFT PUMP Tank FRP TO BLOWER INLET HAFF Q3 Piping PVC/PP/PE SURVEY FOR T Access Covers Plastic/Cast Iron O FUJIGLEAN OWTS SPLICE BOX Disinfectant(Optional) Chlorine Tablets AIR LINE TO RECIRCULATION PIPE BAFFLE 1/2' AIR INTAKE LEGRIGAL SUPPLY FUJIGLEAN OWTS LOW JQSEPH P. VERMAELEN FLOW OPENING (TYP, (CLEANING OPENING) B CONTROL PANEL 4 BLOWER PLAN VIEW 0 4' MANHOLE SCALE: NT5 at Mattituck, Town of Southold n 18' MANHOLE <TYP 18' MANHOLE (TYP 24' MANHOLE <TYP ISINFECTIDN Suffolk County, New York m CYLINDER (OPTIONAL) I � LOW ❑PENING N 11 METER BUILDING PERMIT SURVEY N 1-0& 1'-2' ❑ARD TYPE INCOMING SERVICE o CONTACT MEDIA o _ �: _ _ = DEDICATED County Tax Map District 1000 Section 144 Block 03 4o.1 40.1 15 AMP BREAKER o © FIELD SURVEY COMPLETED SEPT.12,2022 D MAP PREPARED SEPT.13,2022 120V AC, 10, 60HZ, 15 AMP POWER SUPPLY ® #12-2 AWG WITH GND IN I" PVC CONDUIT Record of Revisions 5'-5' 0) ® 5'-5' ECIRCULATION MAIN ASSEMBLY SERVICE REVISION DATE 4'-4 4'-3 © 4'-2 PANEL ELEC. CONDUIT ADDED TEST HOLE MAR.09,2023 OWT5 WIRING PER MFG. BP DATA MAR.22,2024 GENERAL AMENDMENTS MAY 01,2024 HARDWIRE WETLANDS OCT.04,2024 EROBIC MEDIA WETLANDS OCT.15,2024 WETLANDS&BP DATA MAR.17,2025 ADJACENT AREA MAY 15,2025 ERATION ASSEMBLY SCDHS NOIA#3 AUG.22,2025 BP DATA OCT.27,2025 W = SECTION A-A VIEW SECTION B-B VIEW GROUND 5JE RHOMBUS MAGIOOR FUJIGLEAN 40 0 20 40 80 120 CONTROL AIR BLOWER AERATOR PANEL Scale: 1" = 40' o. I/A OATS MDL. GEN-5 MFG. BY FUJICLEAN USA ELECTRICAL ONE-LINE DIAGRAM JOB NO. 2022-0155 DWG. 2022_0155_bpr3 2 OF 2 I ��� Town Hall Annex t �© �� 54375 Route'25 President ® 7g Glenn Goldsmith, Pr � � P.O. Box 11 Southold, New York 11971 Vice President °�® A. Nicholas F{rupski, Eric Sepenoski Telephone (631) 765.1892 Liz Gd10o1y Fax (631) 765 6641 Elizabeth Peeples CCUNTi,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUST OFFEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CH BELOW INSPECTION SCHEDULE _ Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction _ 17 constructed When project complete, call for compliance inspection; .s 'UTHO'L'D TR- U S I TEES o No. Issued. To SaseP� �e��+a�1en Date 9 Address d 0� d �a�._ AVe Av►e� IMgT1 �Tu C,1� .THIS. NOTICE-MUST BE DISPLAYED._ DURING CONSTRUCTION .TOWN TRUSTEES OFFICE JOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL: 765-1892 NOTICE COVENANT TO THE.1,. D. ################################################################################################################## DECLARATION THIS DECLARATION,dated this -V day of , 2025, is made by Joseph P. Vermaelen and Kathleen Powers-Vermaelen,(hereinafter the"D •larants"),whose address is 389 Second Avenue, Bayport,NY 11705. WITNESSETH WHEREAS,the Declarants are the owners of certain real property located at 2020 Bay Avenue, Mattituck, in the Town of Southold,County of Suffolk, State of New York,Tax Map District 1000,Section 144, Block 3,Lot 40.1 which real property is more particularly described in Schedule A annexed hereto(hereinafter referred to as the"Property");and WHEREAS,the Property is situated in or adjacent to regulated freshwater wetland as determined by the New York State Department of Environmental Conservation(hereinafter"Department"),pursuant to Environmental Conservation Law(hereinafter"ECL")Article 24(also known as the"Freshwater Wetlands Act") and Part 664 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 freshwater wetlands are regulated by the Department pursuant to ECL Article 24 and Part 663 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,of 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 24 and Part 663 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; and erection of any structures. Joseph^ermaelen Kathleen Po ers-Vermaelen STATE OF ss: COUNTY OF On the day of 0 in the year 2025,before me the undersigned,personally appeared Jose 11 P. Vermaelen>.& Kathleen Powe Vermaelen, personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their capacity, and that by their signatures on the instrument, the individuals or the persons on behalf of which the individuals acted,executed the instrument. ELIZABETH MARIE BONANNO NOTARY PUBLIC,STATE OF NEW YORK No. 01 B06429796 Public Qualified in Suffolk County Commission Expires 02/22/2026 r SCHEDULE A ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,situate, lying and being at Mattituck,Town of Southold,County of Suffolk and State of New York,bounded and described as follows: BEGINNING at a point on the westerly side of Bay Avenue,said point being situate South 00 degrees 46 minutes 00 seconds East as measured along the westerly side of Bay Avenue 424.00 feet from a monument found at the southeasterly corner of land now or formerly George E. Snider,Jr.; RUNNING thence from said point of beginning along the westerly side of Bay Avenue the following two(2) courses and distances: 1. South 00 degrees 46 minutes 00 seconds East 33.91 feet to a monument found; 2. South 22 degrees 00 minutes 00 seconds East 83.62 feet to a monument found and land now or formerly William H. Hillman&another; RUNNING thence South 74 degrees 40 minutes 00 seconds West along land now or formerly William H. Hillman &another 307.91 feet to a monument found and land now or formerly William J.Clark&Esther Clark; RUNNING thence North 21 degree 30 minutes 00 seconds West along land now or formerly William J.Clark& Esther Clark,along land now or formerly Town of Southold,and along land now or formerly Louise S. Sawicki 141.69 feet to other land now or formerly Francis P.Vermaelen,Jr.; RUNNING thence along other land now or formerly Francis P.Vermaelen,Jr.the following three(3)courses and distances: 1. North 74 degrees 40 minutes 00 seconds East 171.96 feet, 2. South 15 degrees 20 minutes 00 seconds East 25.00 feet, 3. North 74 degrees 40 minutes 00 seconds East 150.00 feet to the westerly side of Bay Avenue and the point or place of BEGINNING. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05045 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: KATHLEEN POWERS VERMAELEN VERMAELEN PROPERTY 389 2ND AVE 2020 Bay Ave BAYPORT,NY 11705 MATTITUCK,NY 11952 JOSEPH VERMAELEN 389 2ND AVE PO BOX 84 BAYPORT,NY 11705 Facility Application Contact: EN-CONSULTANTS 1319 N SEA RD SOUTHAMPTON,NY 11968 (631)283-6360 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 707.4323121255811 NYTM-N: 4539.63683123465 Latitude: 40°58'53.6" Longitude: 72°32'03.6" Authorized Activity: Construct a single family dwelling with accessory structures. All work must be done according to the plans prepared by Young and Young, last revised 5/15/2025 and stamped NYSDEC approved 7/14/2025. Note: The portion of the property landward of the 100'wetland setback as shown on the approved plans is beyond Article 24 jurisdiction. The subject property, which is landward of Bay Avenue that has been paved prior to August 20, 1977 as shown on tidal wetlands aerial photo 706-538 is beyond Article 25 jurisdiction. Permit Authorizations Freshwater Wetlands -Under Article 24 Permit ID 1-4738-05045/00002 New Permit Effective Date: 7/14/2025 Expiration Date: 7/13/2030 Page 1 of 6 MEW NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05045 NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations,and all conditions included as part of this permit. Permit Administrator:ELYSSA E SCOTT,Deputy Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY 11790 -3409 Authorized Signature: Date / /25 Distribution List EN-CONSULTANTS Habitat Wildlife Elyssa E Scott Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: FRESHWATER WETLANDS 1. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work. 2. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 3. 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 Young&Young, last revised 5/15/2025. Page 2 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05045 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. Work Area Limits Any work, disturbance, and or storage of construction materials shall be confined to within the limit of clearing and ground disturbance shown on the approved plan. 6. Materials Disposed at Upland Site Any demolition debris, excess construction materials, and/or excess excavated materials shall be immediately and completely disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland. These materials shall be suitably stabilized so as not to re-enter any water body, wetland, or wetland adjacent area. 7. Clean Fill Only All fill shall consist of clean soil, sand and/or gravel that is free of the following substances: asphalt, slag, flyash, broken concrete, demolition debris, garbage,household refuse,tires, woody materials including tree or landscape debris, and metal objects. The introduction of materials toxic to aquatic life is expressly prohibited. 8. Equipment Storage 100' from Wetland,Water Body All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or water body at the end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. 9. Silt Screen Prior to commencement of any construction activities, a continuous line of silt screen (maximum opening size of U.S. Sieve#20)shall be staked along the LCGD as shown on the approved plans. 10. Silt Screen to Be Recessed Silt screen shall be recessed six inches into the ground. 11. Maintain Silt Screen The screen'shall be maintained, repaired and replaced as often as necessary to ensure proper function, until all disturbed areas are permanently vegetated. Sediments trapped by the screen shall be removed to an approved upland location before the screen is removed. 12. Driveway of Permeable Material The driveway must be surfaced with a permeable material. 13. Demarcate Buffer A permanent 4'high post-and-rail fence or other similar barrier must be installed along the Limits of Clearing and Ground Disturbance(LCGD)as shown on the approved plans to distinguish the developed area from the buffer to remain natural and undisturbed. 14. Runoff and Discharges Directed to Drywells All roof runoff and/or pool discharges shall be directed to drywells located greater than 100'from the freshwater wetland boundary. 15. Seed,Mulch Disturbed Areas All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass, and mulched with straw immediately upon completion of the project,within two days of final grading, or by the expiration of the permit,whichever is first. 16. Temporary Mulch,Final Seeding If seeding is impracticable due to the time of year, a temporary mulch shall be applied and final seeding shall be performed at the earliest opportunity when weather conditions favor germination and growth but not more than six months after project completion. Page 3 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05045 17. Minimum % Vegetative Cover Suitable vegetative cover is defined as a minimum of 85 %area vegetative cover with contiguous unvegetated areas no larger than 1 square foot in size. 18. Notice 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 Regional Habitat Manager NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY11790 -3409 19. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings,paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 20. 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. 21. 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. 22. 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. Page 4 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION +' Facility DEC ID 1-4738-05045 GENERAL CONDITIONS - Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility, including relevant records,is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions,must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained 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,NY11790-3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Freshwater Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions,relevant technology or applicable law or regulations since the issuance of the existing permit; ' Page 5 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-05045 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 PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies,.expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC")for all claims, suits, actions, and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of,the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions,or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The pemuttee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands,easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Page 6 of 6 YOR Department of STATE Environmental w Conservation NOTICE 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 refer to the permit number shown when contacting the DEC. Regional Permit Administrator SHERRI AICHER ` Permit Number: 1-4738-05045/00002 NYSDEC Region 1 Environmental Permits 50 Circle Road Stony Brook, NY 11790-3409 Expiration Date: 7/13/2030 Email: dep.rl@dec.ny.gov Note: This notice is NOT a permit g�fFO[k Glenn Goldsmith,President �0�0 COGS Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski W nx, P.O.Box 1179 Liz Gillooly �y • �!� Southold,NY 11971 Elizabeth PeeplesCl �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 9 i Completed infield by: �� s,.,o 1-► JOSEPH PATRICK VERMAELEN & KATHLEEN POWERS-VERMAELEN request an Administrative Permit to clear a 28' wide area; to expand existing pathway and install a 240' x 10' stone blend driveway; to conduct construction activity consisting of installation of an I/A OWTS septic system, a 994 sq.ft. two-story dwelling with a 288 sq.ft covered porch, and a 64 sq.ft. deck with stairs. Located: 2020 Bay Avenue, Mattituck. SCTM# 1000-144-3-40.1 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 of 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.: Cdn�.:��do nda, - d`��-e,c��.a,e�.. �u•'�'Ecs-, Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples (I)UNAUTHORIZED ALTERATION Oft ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 72D9 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPEaFI;PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF TIE LENDING INSTITUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W),SEPTIC TANKS CST)k CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. DRAINAGE CALCULATIONS HEALTH DEPARTMENT USE NOTES VOLUME REQUIRED(ROOF AREA 1) 400 Ostrander Avenue, Riverhead, New York 11401 1.THE OWTS SHALL BE MODEL CEN-5 MANUFACTURED BY 635 SF x 2/12 x 1.0 = 106 CF .727.0144 FUJICLEAN USA. VOLUME PROVIDED te1. 631admin@youngengine.727.2505 fox. le ng.com USE NEW DW#1: 2.THE DESIGN ENGINEER,FUJICLEAN USA rc\er�11 I 8' DIA.x3' DEEP DRYWELL = 127 CF REPRESENTATIVE,AND SCDHS REPRESENTATIVES SHALL ,Ow or{or er,3r. OBSERVE THE INSTALLATION OF THE OWTS AND e E•Sn\d - CMF VOLUME REQUIRED(ROOF AREA 2) LEACHING SYSTEM. APPROVAL FROM ALL THREE PRIOR TO Georg - - 635 SF x 2/12 x 1.0 = 106 CF Howard W. Young, Land Surveyor BACKFILL. - / ' I VOLUME PROVIDED Thomas C. Wolpert, Professional Engineer USE NEW DW#2 Douglas E. Adams, Professional Engineer 3.THE SYSTEM START UP WILL BE COMPLETED UNDER THE I 8' DIA.x3' DEEP DRYWELL = 127 CF DIRECT SUPERVISION OF A FUJICLEAN USA I Robert G. Tast, Architect REPRESENTATIVE. LOT COVERAGE Robert Stromski, Architect 4.AN EXECUTED OPERATION AND MAINTENANCE BUILDABLE LAND AREA = 35,606 SF CONTRACT BETWEEN THE MAINTENANCE PROVIDER AND PROPOSED PROPERTY OWNER MUST BE SUBMITTED TO THE SUFFOLK SITE DATA COUNTY DEPARTMENT OF HEALTH SERVICES(SCDHS)PRIOR FRAME HOUSE = 288 SF TO APPROVAL OF THE I/A OWTS REGISTRATION BY THE erly I COVERED PORCH5 = 288 SF SCDHS IN ACCORDANCE WITH ARTICLE 19 OF THE SUFFOLK or 1°rm even I DECK&STAIRS =64 5F AREA = 40,086 SQ. FT. n0 vermaLn . FVERTIC� L DATUM =NAVD(1988) COUNTY SANITARY CODE. Anse M. �e'Crast I g TOTAL=1,346 SF=3.8/o * 5.ARCHITECT TO VERIFY FINISHED FLOOR ELEVATION(5). Re�Ocpb it GROSS FLOOR AREA (GFA) SEE FLOOD INSURANCE RATE MAP PANEL N0.36103C0481 H LAST DATED I SEPT.25,2009. g MAXIMUM GFA(LOTS UP TO 40,000 SF) * ZONING USE DISTRICT =R 40 I m 4,350 SF+(5,606 SF x 0.075)=4,770 SF PROPOSED GFA=1,988 SF * WETLANDS AREA =4,480 SF 4"DIA. PERFORATED PIPE TEST HOLE I * BUILDABLE LAND AREA=40,086 SF-4,480 5F = 35,606 SF PERMEABLE BACKFILL BYMcDONALDGEOSERVICEs NYSDEC ADJACENT AREA PROPOSED FILL = 200CY DATE:02/24/2023 CMF (lot area within 100' of wetlands) C�EOTEXTILE * DEPTH TO GROUNDWATER = 2 FT GEOSYNTHETIC BARRIER EL=3.1 0.0' ' ' ADJACENT AREA(AA)= 21,678 SF AGGREGATE PALE GRAY& _ NUMBER OF BEDROOMS(DESIGN EQUIVALENT) =4 BROWN SILTY NATURAL VEGETATION WITHIN AA= 18,345 SF USABLE 501E SAND 14A * MINIMUM REQUIRED I/A OWTS CAPACITY =440 GAL (SM) I � NATURAL VEGETATION TO 1.5' b PROVIDED I/A OWTS CAPACITY =500 GAL (I-60 MIN/INCH o REMAIN WITHIN AA=13,799 SF ��PERCOLATION RATE) BROWN FINE ti *GRAVELLESS ABSORBTION TRENCH REQUIRED USING SAND 0 PERCENT OF NATURAL VEGETATION TO TABLE 11 OF THE SCDHS STANDARDS FOR A 3 BEDROOM =46 LF (SP) er�y o REMAIN WITHIN AA =75.2% DESIGN dl 1-5 min/in PERCOLATION RATE) GWEL1.2 1.9' Or 6" 6"` . r°w °r e�{en& *GRAVELLESS ABSORBTION TRENCH PROVIDED =48 LF 77 7 - -rF: T Aric 5� Baruch WATER 5he\1y B E S CERTIFICATION : W N ENGINEER' TIFICATION -' ..!- !...I.-r...i Iv !�_.:I`� € BROWN z [ _ 4'TO ADJACENT _ (SP) CMF "I HEREBY CERTIFY THAT THE WATER SUPPLY(5)AND/OR SEWAGE DISPOSAL j 1 __-I 1 I _ TRENCH , -� SYSTEM(5)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY DIRECTION.BASED UPON A CAREFUL AND THOROUGH t')Y'OFjTHE-SOIL, B.o SITE AND GROUNDWATER CONDITIONS,ALL FACILITIES;5' PR0PO5ED GW EL 2 g PELTED fi *� CONFORM TO THE SUFFOLK COUNTY DEPARTMENT,61'HEALS'H SERVICES''; HIGHEST EX - EL 2HIGH5 BASED OEST NEOFFICOE RECORDS d VA�ON5 ? "- _ ,•�` CONSTRUCTION STANDARDS IN EFFECT AS OF 5 DATE., USGS MONITORING WELL DATA FLO c� y LitlE SNP p UNSUITABLE SAND SHALL 8 OAR fU � j t j BE REPLACED WITH SAND g0�CAU�p fRO I e rr I RATED AT SP OR SW A5 5 ANCE RA I v `� '„ ` 15UR - `c tt c., r 4 1 •` .A� �y �, ` � , {ors` & �'' �11 LEACHING TRENCH SHALL n Or erm Leh T41b2 ", o I ( HOWARD W.YO N.Y.S.L.S.N0.45893n SAND MEETING ASTM OW ae N 9$ / r n a , BE EXGAVTED DOWN TO SPECIFICATION C33 f�I ter E v ermpe�e _,/ SEMEN _",1 p I THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483 I'` ILISAND RATED AT SP OR 5W �r ��tL Pepa MO,�ie P b1`C�fpter) / AINAGEEA H I DOUGLAS E.ADAMS,N.Y.S.P.E.N0.80897 �P 1 e with ~;', ` ' DR "'' w I z I S 01 GRAYELE55 fi\B50RPTION TRENGI-f SECTION U' (°we o -. ' " / _ MFG. BY ELJEN CORPORATION MDL#B43 SCALE: NTS 'f ' " -''" 14A09 w or{°rm e�er\f 3r" I I SURVEYOR'S CERTIFICATION-= - OR APPROVED EQUAL uA- AREA -.. ''"' h° Q \JermahwpYsl RCS 5.88+5.93 * N RD Woy 6%s • N 9 WE HEREBY CERTIFY TO J B S E P H P. V E R N# ONEXlF�00D r o ai\ ; Gtlght°{ FOpdS streets�' Uo1 r - R 0 O / SURVEY WAS PREPARED IN ACCORDANCE WITH THE Cf1�RAC CE tNANc "" El�bl 3.74 N \ o 150� ° LAND SURVEYS ADOPTED BY THE NEW YORK STA AS (4CI 13"Ilbt�l fQF O o \ ''Z NE '' p ; S4 A4 rn °� PROFESSIONAL LAND SURVEYORS. j � }j? ° C i a� 4.03 CS A °AN 0q,G ANDy 6.05 i. F i G) 6� P� \ RO OREENS 1�2 9b �{ �� m \5 74 WSS WA WEE 8�25 w 1T �1• 18 p o� N cER QED P� I y. L� \ a EVER WSS �."' Cj 6556 NysFRESR ASDELON0211g12 °X .;b-�OQ"E ,""".:�5bp6 ' CS.a. g0U NIENNING ANpS �Pi't.e'�- P✓S cM , �- 4 r72' 03 gEvs WEB- 3 r i° ' \'1\9tj HOWARD W.YOUNG,N. . .L.S.NO. 5893 ��Np J�FL�' 3T8. .ram . 2 "� ;+* .�:- k ` . �- < o E° 9 i b 2.89 \ -.\ �/ a 6.40 N l ' . 1 ) �-T p•L ' x' \"Y } '� LP I \ 1',�",.�.�I.: � i� WS °• � `I' -',e* 74 O0� . .. 'TH'�� '>\ �5`,` � ✓ "�-+f>� '\y�n ',.�. .t j�:y--?4 � i�6. ��� � � \ s i 5.42 Q�\\ erY\' Ry 2.76+ /'✓ �ti fig.`` ' �t1 O p• k.% �. _ -- f'ti: O .. v�•� \J° �(1 \ SURVEY FOR p/ �o sue,\\ ,�5p�1y5 �r Ate,,. . �Q RrMAZ�1`% ,x :.'' 44 `` `48t� N �o !j\ SEP 3 2025/ _ o �o o �° 2 qt� �� ,,_;F o _ ,}� '` ,AR�AARA� 2 ` ooG� (- \s �' \RENCN ` +< i N �5 NRB5.36 ,`• >' CC O `�\� ENCN ° N / v'' 4.49+ 5 35:, vND i / OJ H V R A SnJti ,I(;ro n s 01-1 00 \\ > a ,o °P J E E M ELEN BnRr?0f TfUS`��g i Ga n� 7 3�'� '� / +7.29 \ �O '�,; l �,\ GONIEL 2�ENs �� C�-F� 7�` = - ` / Yi" ` Y at Mattituck, Town of Southold 0 p \ PA ° mho O-1 �.. .•.�.»� >. �'��.`' � ,: vJ VewAV S n 1 ��CMF I \ PgOP05 y w o N .-'''.�� ` ;';. :��.' / W�DDRI 7.93 Suffolk Count New York It �I °Pti d / 4.17 � 2o�ux,AR °o DN#1 �,^^^�� v✓�SONEBL WAy Rg� \ 7.74 \ 6� �� N ✓ er�y 15 3u M NOMEOMI r"� / w�ROp05 f RT lLMgERCU \ \ ' Or °� V�h°\d 568 °"' cAF� Olz° w 3019� EA a� \ °, / row r°�( :° q23 �� �,/ RING \ BUILDING PERMIT SURVEY VJ 0 \ County Tax Map District 1000 Section 144 Block 03 40.1 40.1 a LEGEND OF GRADI RgANC� �� \� \ / °40'QO EpGE NG DIS� `. p FIELD SURVEY COMPLETED SEPT,12,2022 a CLF =CHAIN LINK FENCE �. DNA E f �o� 1 �j74 IS� \ MAP PREPARED SEPT.13,2022 CMF =CONCRETE MONUMENT FOUND / \o n WOOD NGLLM \ \ CMS =CONCRETE MONUMENT SET - - - ! C1,EARI er1y /CMF O \ 6�P Record of Revisions CSW =CONCRETE SIDEWALK °r{orr', 1 ms / a EOP =EDGE OF PAVEMENT r moo- a s �1zLDs,� now gpca , , \ \ o REVISION DATE OL =ON PROPERTY LINE ?!gp oZ PRI pAL ENVELOPE SER \Gh01aS A , / \ \ \ P :. ADDED TEST HOLE MAR.09,2023 BP DATA MAR.22,2024 RO = ROOF OVER P Gl o- Op05ED .,NICE N CDWeUm9 / \ \ ` GENERAL AMENDMENTS MAY 01 2024 RCS =REBAR CAP SET q ` \ �^ \ PR 5 - / pter) \ WETLANDS OCT.04,2024 WIF =WIRE FENCE s �i o'' \ _,/ pubs W \ WETLANDS OCT.15 2024 o n�3� \ �i e„�rg with \ WETLANDS 6L BP DATA MAR.17,2025 WDF =WOOD FENCE c WSF =WOOD STAKE FOUND 0 1 �DW \ ADJACENT AREA MAY 15,2025 a WSS =WOOD STAKE SET o o1>io 0 UTILITY POLE P \ • =END OF DIRECTION/DISTANCE ' " \ C11 / \ 40 0 20 40 80 120 P =WETLAND FLAG&NUMBER ` - / - With pub\1,*oter) FF - ' �DWe��;n9 Scale: 1 - 40 ® =CL WELL \ JOB NO.2022-0155 DWG. 2022_0155_bpr2 1 OF 2 (I)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY UNES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (S)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)k CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS, 2 STORY 400 Ostrander Avenue, Riverhead, New York 11901 FRAME HOUSE (4 BEDROOMS) tee. 631.727.2503 fax. 651.727.0144 admen®youngenglneering.00m FFEL=12.0 5WEET AIR VENT GAP MFG BY TUF-TITS FIBERGLASS LOCKING (5' MIN FROM ANY DOOR OR WINDOW) COVER 5005-RC B R15ER rMFG BY POLYLOK How Nl ard . Young, Land Surveyor 5, I RIM=8.0 Thomas G. Wolpert, Professional Engineer 4 PVG 5' 10'- 32'LONG TRENCH 3.0' Douglas E. Adams, Professional Engineer PIPE ® RISERS 8 COVERS 4" PVC 4" PVG PIPE y Danlel A. Weaver, Land Surveyor OOY MIN. WITH SAFETY LIDS PIPE @ ® 1.0090 MIN. MFG BY TUF-TITE (TYP) 1.00% MIN. GEOTEXTILE RIM=8.0 BARRIER 1 { CONNECT 5" PVC VENT LINE EL=6.6 AIR LINE---� I ON 5 HEALTH DEPARTMENT USE 1 TO VENT HOLE IN OAST �o SLOPE Ewa -' 5AND _ -TOP OF PIPE 1 9 IE=6.12 HOL VENT IE=5.85 IE=5.80 IE=5.70 �' SEP 3 2025 ` pI r EL=5.6� I PROVIDE GLEAN IE=5.60J ::K=^T'r: :•. t.: ,;;: ;r•. OUT AT FACE OF IE=6::;/ .02 BOT EL=4.5 Sosif?--�IdTavan BUILDING SEE DETAIL FOR 4"DIA. PERFORATED PIPE GEO5YNTHETIC b z [?(Tar( of To- D� OWT5 COMPONENTS AGGREGATE N I- -- _ - - HI6HE5T EXPECTED GW EL=2.5 HI6HE5T EXPECTED GW EL=2.5 BOT=1.62 2' DIA. POLYPROPYLENE 6RAVELE55 ABSORPTION 12"XI2"X1' LONG f DISTRIBUTION BOX TRENGHS (6 5F) CONCRETE BEAM 500 GAL. I/A OWTS MPG.BY POLYLOK TOTAL OF (2) = 62 LF (TYP. OF 2) MDL. GEN-5 MFG. BY FUJIGLEAN USA MDL#3017-024 OR APPROVED EOVAL MF6.BY EL-EN CORPORATION PROVIDE =ND GAP LEVELING DEVICE MDL*e45 OR APPROVED C-MAL MDL#5L-4 MFG BY TUF-TITE OR ALL BUOYANCY CALCULATIONS HYDRAULIC PROFILE PROVED PP15TRIBUTIION�UL TUALOPIPES IA OWT5 SCALE: NTS ONE (1) OWTS MDL# GEN-5 MFG. BY FUJI GLEAN USA WEIGHS 597 LBS., REPRESENTING THE FIN GRADE DOWNWARD FORGE FOR THE 5TRUGTURE. THE PROPOSED STRUCTURE WILL BE PARTIALLY %13MER6ED TO A DEPTH OF 0.88' (2.50 MINUS 1.62). THE VOLUME OF GROUNDWATER DISPLACED BY THE STRUCTURE V = AREA x SUBMERGED CORROSIVE RESISTANT GEN-5 STRAFING (TYP. OF 2) DEPTH (7°IO)(4.02)(0.88) = 27.1 OF. EPDXY COATED OWTS THE WEIGHT OF THE WATER DISPLACED BY THE PARTIALLY SUBMERGED STRUCTURE W = ANCHOR EYE BOLT 27.9 OF x 62.4 LBS. PER OF = 1,741 LBS. (TYP. OF 4) HIGHEST EXPECTED APPLYING A SAFETY FACTOR OF 1.5, THE UPWARD FORGE (BUOYANCY) EXERTED ON THE GW EL=2.5 PARTIALLY 5UBMER6ED STRUCTURE 15 1,741 x 1.5 = 2,612 LB5. NOTE: ALL CONDUITS BETWEEN PANEL AND TREATMENT TANK MUST BE SEALED TO PREVENT THE DOWNWARD FORGE OF 5a7 LB5. 15 LESS THAN THE UPWARD FORGE (INCLUDING GAS LEAKAGE INTO PANEL. SAFETY FACTOR OF 1.5) OF 2,612 LB5. AND, THEREFORE, AN ADDITIONAL 2,215 LB5. OF 12"XI2"X0I' LONG FOR WIFI COMMUNICATION DEVICE; DOWNWARD FORGE 15 NEEDED. CONCRETE BEAMS U5E ALARM/CONTROL PANEL MDL#1045040 USE (2) 12"x12"xcl' LONG CONCRETE SEAMS = I8.0 GP CONTROLLER "G" MFG BY SJE RHOMBUS ENGINEER'S CERTIFICATION THE ADDITIONAL DOWNWARD FORGE PROVIDED = 18.0 OF x 150 LB5./CF = 2,700 LB5. END NVIEW DETAIL � N N SCALE: NTS ALARM/CONTROL I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL MD PANEL MDL "A"i72 CONTROLLER A" SYSTEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY 01 DIRECTION.BASED UPON A CAREFUL AND THOROUGH STUDY OIL, o -1/2' VENTILATION PIPE MFG BY SJE RHOMBUS CHAMBER Volume(gal) SITE AND GROUNDWATER CONDITIONS,ALL FACILITI AS PROPOSED,, SCUM BAFFLE B CONTROL PANEL MOUNTED CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF EALHSERVICES /Sedimentation Chamber 277 O CONSTRUCTION STANDARDS IN EFFECT AS OF THI DATE. S ' ` ;i, ;�` 0 -10 N 4"x4" PRESSURE i Q2 Anaerobic Filtration Chamber 278 -10 -7 0 TREATED WOOD P05T5 Q3 Aerobic Contact Filtration Chamber 127 I, ECIRCULATION ® Storage Chamber 63 Q Disinfection Chamber 4 AIR LIFT PUMP f i� 1; ; I <N ISINFECTION t c % © Total Volume 749 � AIR WEATHERD t. ,��. - `~ ' o N CYLINDER (OPTIONAL) ? ( 4' INLET PIP OUTLET PIPE o BLOWER E515TANT HOWARD W.YOVI G,N.Y.S.L.S.NO.45893n SPECIFICATIONS r> BLOWER A 4 •. A Anaerobic Media PP/PE Filling Rate 32% 1 ENCLOSURE THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483 4'-0 ' = Board Type Aerobic Media PVC/PP/PE Filling Rate 16°/D I DOUGLAS E.ADAMS,N.Y.S.P.E.NO,80897 ® Aerobic Media PP/PE Filling Rate 57% FIN. GRADE Blower 2.8 efm FFLUENT ELECTRIC SUPPLY _ INLET BAFF ® 3 AIR LIFT PUMP Tank FRP TO BLOWER Piping PVC/PP/PE SURVEY FOR Access Covers Plastic/Cast Iron To F SPLEANICE BOX Disinfectant(Optional) Chlorine Tablets AIR LINE TO RECIRCULATION PIPE LOW BAFFLE 1/2' AIR INTAKE LEGTRIGAL SUPPLY FUJIGLEAN OWTS JQSEPH P. VERMAELEN FLOW OPENING (TYP, (CLEANING OFENING) B CONTROL PANEL 4 BLOWER PLAN VIEW SCALE: NTS n 4' MANHOLE at Mattituck, Town of Southold 18' MANHOLE (TYP 18' MANHOLE (TYP 24' MANHOLE (TYP ISINFECTION CYLINDER (OPTIONAL) Suffolk County, New York I N LOW OPENING 1'-02• BOARD TYPE METER INCOMING SERVICE BUILDING PERMIT SURVEY T CONTACT MEDIA t� County Tax Ma District 1000 Section 144 Block 03 40.1 40.1 � rT :��= - - DEDICATED tY P o © 15 AMP BREAKER FIELD SURVEY COMPLETED SEPT.12,2022 o_ MAP PREPARED SEPT.13,2022 120V AC, 10, 60HZ, 15 AMP POWER SUPPLY #12-2 AN6 WITH GND IN I" PVC CONDUIT Record of Revisions 5'-5' ® 5'-5' ECIRCULATION MAIN ASSEMBLY SERVICE REVISION DATE 4'-4 Y 4'-3 4'-26' PANEL ELEC. CONDUIT ADDED TEST HOLE MAR.09 2023 OYiT5 WIRING PER MFG. BP DATA MAR.22,2024 GENERAL AMENDMENTS MAY 01,2024 © ® WETLANDS OCT.04,2024 EROBIC MEDIA H�'�WI� WETLANDS OCT.15,2024 WETLANDS&BP DATA MAR.17,2025 ADJACENT AREA MAY 15 2025 ERATION ASSEMBLY a w SECTION A-A VIEW SECTION B-B VIEW GROUND 5JE RHOMBUS MACIOOR FUJIGLEAN CONTROL AIR BLOWER AERATOR 40 0 20 40 80 120 PANEL Scale: 1" = 40' VAS OWTS MDL. GEN-5 MFG. 5Y FUJIGLEAN USAF ELECTRICAL ONE-LINE DIAGRAM JOB NO. 2022-0155 DWG. 2022_0155_bpr2 2 OF 2 I I (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 72D9 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC RIRPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIONEES OF THE LEKIING INSTITUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)&CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS, DRAINAGE CALCULATIONS HEALTH DEPARTMENT USE NOTES VOLUME REQUIRED(ROOF AREA 1) 1.THE OWTS SHALL BE MODEL CEN-5 MANUFACTURED BY 635 SF x 2/12 x 1.0 =106 CF 400 Ostrander Avenue, Riverhead, New York I MCI FUJICLEAN USA. VOLUME PROVIDED tel. 651.727.2505 fax. 651.727.0144 USE NEW DW#1: admin@youngengineering.com 2.THE DESIGN ENGINEER,FUJICLEAN USA erly I 8' DIA.x3' DEEP DRYWELL = 127 CF REPRESENTATIVE,AND SCDHS REPRESENTATIVES SHALL noW Or{°r der,Jr- OBSERVE THE INSTALLATION OF THE OWT5 AND George E'Sn _ - '•CMF VOLUME REQUIRED(ROOF AREA 2) LEACHING SYSTEM. APPROVAL FROM ALL THREE PRIOR TO 635 5F x 2/12 x 1.0 = 106 CF Howard W. Young, Land Surveyor BACKFILL. - �� '' I VOLUME PROVIDED Thomas G. Wolpert, Professional Engineer USE NEW DW#2 Douglas E. Adams, Professional Engineer " 3.THE SYSTEM START UP WILL BE COMPLETED UNDER THE I DIRECT SUPERVISION OF A FUJICLEAN USA I 8' DIA.4' DEEP DRYWELL =127 CF Robert G. Tost Architect ;. REPRESENTATIVE. LOT COVERAGE Robert 5tromski, Architect I. ¢ BUILDABLE LAND AREA =35,606 SF S E P 3 20?j � , 4.AN EXECUTED OPERATION AND MAINTENANCE CONTRACT BETWEEN THE MAINTENANCE PROVIDER AND PROPOSED PROPERTY OWNER MUST BE SUBMITTED TO THE SUFFOLK FRAME HOUSE =994 5F SITE DATA COUNTY DEPARTMENT OF HEALTH SERVICES(SCDHS)PRIOR TO APPROVAL OF THE I/A OWTS REGISTRATION BY THE erly I COVERED PORCHS = 288 SF SCDHS IN ACCORDANCE WITH ARTICLE 19 OF THE SUFFOLK W or form ae\en I DECK&STAIRS =64 5F AREA = 40,086 SQ. FT. COUNTY SANITARY CODE. Arne M.V;em�raSi I o TOTAL=1,346 SF=3.8% * VERTICAL DATUM =NAVD(1988) 5.ARCHITECT TO VERIFY FINISHED FLOOR ELEVATION(S). Re�ocab o GROSS FLOOR AREA (GFA) SEE FLOOD INSURANCE RATE MAP PANEL NO.36103C0481 H LAST DATED I SEPT.25,2009. g MAXIMUM GFA(LOTS UP TO 40,000 SF) * ZONING USE DISTRICT =R-40 m 4,350 SF+ 5,606 SF x 0.075)=4,770 SF - ( PROPOSED GFA=1,988 SF * WETLANDS AREA =4,480 SF 4"DIA. PERFORATED PIPE TEST HOLE I * BUILDABLE LAND AREA=40,086 5F-4,480 SF - 35,606 SF PERMEABLE BACKFILL BY MCDONALD GEOSERVICES NYSDEC ADJACENT AREA * PROPOSED FILL = 200 CY lot area within 100' of wetlands GEOTEXTILE DATE:02/24/2023 . - CMF ) * DEPTH TO GROUNDWATER = 2 FT GEOSYNTHETIG BARRIER EL=3.1 0.0' '� ADJACENT AREA(AA)= 21,678 SF AGGREGATE PALE GRAY A / ` NUMBER OF BEDROOMS(DESIGN EQUIVALENT) =4 BROWN SILTY - I NATURAL VEGETATION WITHIN AA=18,345 SF SAND �+ MINIMUM REQUIRED I/A OWTS CAPACITY =440 GAL USABLE 501L (SM) I a NATURAL VEGETATION TO (1-60 MINANGH * PROVIDED I/A OWTS CAPACITY =500 GAL 1.5' o REMAIN WITHIN AA=13,799 SF GRAVELLE55 ABSORBTION TRENCH REQUIRED USING PERGOLATI ON RATE) BROWN FINE 1y Z i i SAND o PERCENT OF NATURAL VEGETATION TO TABLE 11 OF THE SCDHS STANDARDS FOR A 3 BEDROOM =46 LF / REMAIN WITHIN AA =75.2% 22 (sP) meM o DESIGN&1-5 min/in PERCOLATION RATE) GW EL 1.2 1.9' {or M 6"•, t` now , tef{en& *GRAVELLES5 ABSORBTION TRENCH PROVIDED =48 LF �_ _77-= p,r1c 5 Baruch i �T 'r .\' 'y'.p;:s`d',° .`v3• :2;..(D,,,a,,"•' ';5 WATER IN Shelly 1V BROWN FINE ENGINEER'S CERTIFICATION \. -IiI (� I� I ,1I1 i�f SAND n � I I j Ii I I f4'TO ADJACENT _ �sP) CMF I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL !. TRENCH SYSTEM(5)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY �- ' ' r DIRECTION.BASED UPON A CAREFUL AND THOROUGH STUDY YFTHE SOIL, a.0' _ SITE AND GROUNDWATER CONDITIONS,ALL FACILITI -A5 PROPOSED;-\ HIGHEST EXPECTED CONFORM TO THE SUFFOLK COUNTY DEPARTMENT&,HtALTH SERVICES .: 1--I I GW EL=2 1j HIGHEST EXPECTED GROUND WATER `IONS rn i I EL=2.5 BASED ON OFFICE RECORDS d E1-EVA CONSTRUCTION STANDARDS IN EFFECT AS OF THis DATE:°, ._TILT,: USGS MONITORING WELL DATA FLOOD 5�j00 - � / UNSUITABLE SAND SHALL Vq 0 BpU bA LI OMFL OD f.> BE REPLACED WITH SAND rpLLED fR RATED AT 5P OR SW A5 5 ANcE RA ; 1 T.NS'JR ,,F� v _..r:�•.. 1• �. i} C`;.` <, 4' ormer y �°`� ° 00WE LEACHING TRENCH SHALL SAND MEETING A5TM nOW or{ rlmoelen& to 6 98 , / n > I HOWARD W.YO G,N.Y.S.L.S.N0.45893n ` /> �' n'7 BE EXGA\,/TED DOWN TO SPEGIFIGATION G33 E•�e aelen i` ENS I p Ir m M THOMAS C.WOLPERT N.Y.S.P.E.P 1483 r SAND RATED AT SP OR SW Qete ar%eVer W"tern - ASE "-� �I N .b Sean(�\ hpub�ic� / `URP`INAGE "" I I S DOUGLAS E. ADAMS,N.Y.S.P.E.NO.80897 ;�- _ = ,fait - - W z 01 GR?�VELE55 A55ORPTI ON TRENCH SECTION �°"je11�ne, 81 o MPG. BY ELJEN CORPORATION MDL#B43 SCALE: NT5 �, '14409 {OrYn 1 3r• LPL PREP �'' uT n°W Q \Jern�ah aysl RCS I 5•gg 5.93 I * SURVEYOR'S CERTIFICATIQN- _- OR APPROVED EQUAL " IV P W�l 65 6 N g + WE HEREBY CERTIFY TO J O S E P H P. V E R M LE1Cii t EXlO?°*OID o o , R;ght°{ Fr ds Streets p r' ,. °N EFL r t Roa O / q� SURVEY WAS PREPARED IN ACCORDANCE WITH TH CObE`.Q1 P(2 C1C of 2 P c E\bl ° 0. o / LAND SURVEYS ADOPTED BY THE NEW YORK STATEASSOG A,T>ON.OF'0 N Vo - 0 \ GN EPEl ��� '3.74 N 1 O 15 4qA' P f N.r %T. ,i N � Z°N ,-"' 4.03 cs p > LSE $ �N PROFESSIONAL LAND SURVEYORS. ir �• n 6 96T _ 0 4 00 WSS Wry/ ey ' j K,< a G � � w` °�0 ND � 6.05 -� ..-.c- N C, P� R OF EN d �7 ``"' 1' `�$� y'T\ (C1 15 00 ,v� NW PAR Vt-1,- 20-5 I �O l C1 =r,; ow s 2. 11 EVERGRE a WSS ygj 6556 NySFoEA y PSDESON0211g1 9" S CM O''-�� 1�0 �� i"`�lyb06 x7�'-•i"`_- -03 s ',� KE�N3EN 'W5�,A�``D`� m .� \ WL oe-- �� �`S�93 3 0 Q 4� �0 HOWARD W.YOUNG,N.Y. .L.S.N0.45893 93�a,�v� � 6.40 r�D Sv rj a�\\ e0Ns� �M \ �ti Q�9 Y. va 0_ ✓.,, AIN F '_ �f�,y; ' 0 6 �- ra. SURVEY FOR Q� N O Z r+ \ k 5 yy - P �EI� �'4.74 \ 4.$7� O APLEA O O� 22 \� ��� CN o -�' i. ¢r' NAN ` A-/ �� L"' �� SRE NC 0 4,49 W 15� ws W O� JUSEPH P V RMA -a N / ^, + 5.35 UND i, IX E ELEN 00 •6 \\ THE jy = '". A w 7.10 °� P. �i l0 1 Z \\ N\p0 21b $ \ +4.670 �6' -� \ co PPNEL �ENjo o :': = ~= A', Way :� at Mattituck, Town of Southold CMF \ pPOSED , m o ,�, r ;'..'\, SP �O 4.17 I ) F�-tUyy ° m of ^" '�` ;��: �'� /W EBLENDOR f 7.91.74 G6 , New York zs U1,PR•o mo Dw � -,°, � �-. _' - w SSON J � Suffolk County N ✓ e ��30 MHOMEOM) \ i w�ROPOsEO SNDRI�wP�SMBER�R$r1y 15 " or or 1a 56g Dw A gFELRO ° i ` W W O� EPR \ �z l 17- 9� \ °-� BUILDING PERMIT SURVEY / no van 0150 /, - bit. e �� �� w/ 3 RI � � \ S 0 % N 1 .»•^ w � � EA \ Tt / } / \ �p ^ "PR D IRSCK w , AIM DING b�ROVND ` O `\ County Tax Map District 1000 Section 144 Block 03 40.1 40.1 LEGEND - PN oLTW 6Eof aRAWR'SANCE 1 / 0 ED DL5 \ \/ FIELD SURVEY COMPLETED SEPT.12,2022 a CLF =CHAIN LINK FENCE / mo..wDfl o \-1 51�0� 5�N6 \ C ' ' MAP PREPARED SEPT.13,2022 CMF =CONCRETE MONUMENT FOUND \oE �� a` W00DS�EN6UzMYc CMS =CONCRETE MONUMENT SET - - - CLEARI erly 'CMF po ` 6,P Record of Revisions CSW CONCRETE SIDEWALK or form kalis / - a EOP =EDGE OF PAVEMENT moo- CMF ViL011� now gaga _ \ �� REVISION DATE OL =ON PROPERTY LINE �� o °g PRItePL BP DATA MAR.22,2024 ENVELOPE -�R \Gh°laS A sl ,,/" \ \ °P ADDED TEST HOLE MAR.09,2023 PO =ROOF OVER N Ql O- °,S QROp05ED5 RVICE N �DWe1�t°5 _ / \ \ ? GENERAL AMENDMENTS MAY 01 2024 RCS =REBAR&CAP SET y CA % `\ / Water) \ WETLANDS OCT.04,2024 WIF =WIRE FENCE S '' ,_/ pub�`c \ WETLANDS OCT.15,2024 0 2! cT With \ WETLANDS&BP DATA MAR.17,2025 WDF =WOOD FENCE 6 C, G� \ ,_ `pwe�lTr9 \ ADJACENT AREA MAY 15,2025 WSF =WOOD STAKE FOUND o °� c , WSS =WOOD STAKE SET =UTILITY POLE • =END OF DIRECTION/DISTANCE �' \ _ ' 40 0 20 40 80 120 =WETLAND FLAG&NUMBER `/ _ - / e„Tng WithPub1;c W \ w Scale: P = 40' ® WELL \ �D JOB NO.2022-0155 DWG. 2022_0155_bpr2 1 OF 2 I 8/30/25,3:09 PM 2020 Bay Ave-Google Maps O le Maps 2020 Bay Ave ,t- "r 5 - y d ♦, • • • Imagery(02025 Airbus,Maxar Technologies,Map data 02025 Google 50 ft 2020 Bay Ave OQ Co% 9 < Directions Save Nearby Send to Share phone Q 2020 Bay Ave, Mattituck, NY 11952 • XFJ8+J7 Mattituck, New York Photos https://www.google.com/maps/place/2020+Bay+Ave,+Mattituck,+NY+11952/@40.9816187,-72.5345725,135m/data=!3ml!1 e3!4m6!3m5!1 sOx89eB8eO... 1/2 is .� ,his �' r ` ti y � I �,�,�_y ���• . 4 'b n' � ✓ T:" �t� is J.3 Y v- � � +• �� ,... - *��" sir c. h� �i:. y�.,�, �. 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COUNTY OF SUFFOLK g) N k' _ ,00a _ sscrwm no oar b_ v .I[toper,,lax 5 ,r:ig—y w 144 a 4� _ ��� so��ao 120 Sod;-r• o �v4 .ts S / OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex '-' d!' ,,' P.O.Box 1179 54375 State Route 25 1 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) G Telephone: 631 765-1938 Southold,NY 11971 ' + •' O 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 Interim LWRP Coordinator Date: October 6, 2025 Re: LWRP Coastal Consistency Review JOSEPH PATRICK VERMAELEN SCTM# 1000-144-3-40.1 The application referenced above is to clear trees within 100' of a wetland (closest distance is 50'), to install a 240' x 10' stone blend driveway; to conduct construction activity consisting of installation of an I/A OWTS septic system, a 994 sq. ft. two-story dwelling with a 288 sq. ft covered porch, and a 64 sq. ft. deck with stairs. Located: 2020 Bay Avenue, Mattituck. SCTM# 1000-144-3-40.1 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 with the following considerations. 1. The boundary of the area to remain natural and undisturbed should be staked and inspected for accuracy prior to clearing. 2. Require a silt fence be installed along that boundary. Page 11 I t 1 3. Also consider requiring a split-rail fence be installed along the boundary of the area to remain natural and undisturbed to clearly mark the location during construction, and prevent vehicles and materials from encroaching. These considerations will help ensure that the action will be consistent with Policy 6.1 A & B of the LWRP by protecting the buffer to the wetlands and thus avoiding the physical loss or degradation of the wetland, and helping to retain indigenous plants to maintain the ecological value of the wetland. Note the Town has an easement for drainage over this property, including in a portion of the area to be cleared. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Page 2 Glenn Goldsmith,President 4a Town Hall Annex A.Nicholas Krupski,Vice President '` at°Q's � 54375 Route 25 B 1179 Eric Sepenoski '1 Southold,New York11971 Liz Gillooly C/>- Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application _Administrative Permit _Amendment/Transfer/Exten ion _Received Application: 01 13f Received Fee: $ S o-oo Completed Application: Incomplete:_ SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: [ r (i= rCoordination:(date sent : D E C t' LWRP Consistency Assessment Form Sent: ��' D'S CAC Referral Sent: s Date of Inspection: 01 f l 5 Receipt of CAC Report: _Technical Review:_ -suuur _Public Hearing Held: Board of Trustees, Resolution: . Owner(s)Legal Name of Property (as shown on Deed):Jasep l?a%ao cj�LASs lei „—u�=��«. s- a r, a►e� Mailing Address: 389 Second Ave, Bayport, NY 11705 Phone Number: 631-472-2839 Suffolk County Tax Map Number: 1000- 144.-3-40.1 Property Location: 2020 Bay Ave, Mattituck NY 11952 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: B._ Yd of Trustees Application, GENERAL DATA ' Land Area(in square feet) 40,086 sq ft Area Zoning: Residential Previous use of property:Vacant Intended use of property: Single family house Covenants and Restrictions on.property? zYes _g._No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? gYes allo 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 _Z_No If"Yes.", please provide copy of decision. WrTis project re 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? Yes_No Prior permits/approvals for site improvements: Agency Date NYS DEC Permit 07/14/2025„ Southold Trustee Permit 06/14/2023 Permit#_.10391) ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_a Nog Yes If yes,provide explanation:. Project Description(use attachments if necessary): To clear the vegetation/trees to improve accessibility by expanding the-pathway and creating a proposed driveway and construction related area within 100ft of the wetlands. ((lam � ►�-.�d �� ���. �., � �. d of Trustees Application', WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To prepare the property for a proposed single family house and to comply with the NYS DEC permit.# 1-4738-05045/00002 on clearance.of vegetation/trees. . Area of wetlands on lot: 4,480 square feet Percent coverage of lot: 11 Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge.of wetlands: 103.9 'feet Does the project involve excavation or filling?. 0 No Yes. If yes,how much material will be excavated? n/a cubic yards How much material will be filled? n/a cubic yards Depth of which material will be removed.or deposited: n/a. feet Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: Wood will be carted away. 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): None to minimal effect. The NYS DEC has approved the proposed operation within the 100ft of the wetlands. (See.attached Permit) 61 Z20 Appendix.S Short Environmental Assessment Form. Instructions for Comnletina Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part I. Responses become part of the application for approval.or funding,are subject to public review,and may subject to further verification. Complete Part I 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 I-Project and Sponsor.Information Owner-J Vermaelen & K Powers-Vermaelen Name of Action or Project: Clearing of vegetation for a,propose driveway & construction area Project Location(describe,and attach a location map): 2020 Bay Ave, Mattituck NY/Vacant Residential Lot Brief Description of Proposed Action: To clear the vegetation/trees to improve accessibility by expanding the pathway and creating a proposed driveway and construction related area within 100ft of the wetlands. Name of Applicant or Sponsor: Telephone: 631-472-2839 Joseph Vermaelen. ''E-Mai,l,:jpvermaolen@aoi.com Address:' .389 Second Ave City/PO: State: Zip Code: Bayport I I 'NY 111705 , 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. boes 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: "Approved -NYS DEC Permit# 1-4738-05045/00002. 3.a.Total acreage of the site of the proposed action? 0.92 acres b.Total acreage to be physically disturbed?. n 096 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0•92 acres 4. 'Che I land us at occur on;adjoining anPliar the propqw4 action: Urban Rural(non-agriculture) Industrial Commercial ©Residential(suburban) Forest ❑Agriculture HAquatic QOther(specify) , Parkland Page I 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. ffNOYES 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:. 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO_ YES 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 meetor exceed the state.energy code requirements? NO_. YES If the proposed action will exceed requirements,describe design features and technologies: Z 10. Will:the proposed action connect to an existing public/private water supply? NO ':;YES If No,describe method for providing potable water: n/a 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:.n/a Z ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic TNO. , .YES Places? ✓ b. Is the proposed action located in an archeological sensitive area? ✓ la.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO. YES 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: ✓ ` Wetlands_';buffer zone would be.enmached on�bv 0_096Acres f 14.ruf ntify the typic bitat types that oc n,or are likely to be found on tl�project site. Check'all that apply: Shoreline ✓ 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? EU ✓ 16.Is.the project site located in the 100 year flood plain?. NO YES ' 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes; a. Will storm water discharges flow to adjacent properties? ZNO YES ❑✓ ❑ b.Will storm water discharges be directed to established conveyance systems ff an m drains)? �NO If Yes,briefly describe: ES Page 2 of 4 18.Does the proposed action includeconstruction or other activities thatresult in the impoundment of. NO YES. water or other liquids(e.g.retention pond,waste lagoon, dam)? If Yes,explain purpose and size ZT 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: RID A.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'.JO h,.V@I"tllaeleCl,.,,_ Date:09/01/2025 r Signature:.•' Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the;4f6llow.ing questions in Part 2 using the information contained in Part l and other materials submitted by the project sponsoror. 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? D, 2. Will the.proposed action result in a change in the use or intensity of use of land? a o 3. Will the proposed action impair the character or quality of the existing community?` a 4. Will the proposed action have an impact on the environmental.characteristics that caused the' establishment of a Critical Environmental Area(CEA)? a 5. Will the proposed action result in an adverse change in the existing level of traffic or 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? . a 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? El, 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: Q; problems? 11. Will the.proposed action-create a hazard t6..environmental resources or human health? a o 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 ifyou.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. DCheck 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 8; -d of Tkustees ,Appl -catio, AFFIDAVIT; Joseph,Patrick Verrnaelen BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE-IS THE APPLICANT:FOR THE ABOVE DESCRIBED PERMITS)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 TOW7. N,OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS ANDFREE FROM ANY AND ALL DAMAGES AND CLAIMS'ARISING UNDER OR BY VIRTUE OF SAID PERMIT'S), IF GRANTED. IN COMPLETING THIS APPLICATION 'IHEREBY`AHORIZE THE ..TRUSTEES,.THEIR.AGENT(S) OR REPRESENTATIVES;INCLUDING THE CONSERVATION ADVISORY:COUNCIL: TO'ENTER ONTO MY:PROPERTY TO INSPECT THKPREMISES 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 PERMITISSUED`BY THE`BOARD.OF TRUSTEES DURING THE TERM . OFTHE.PERMIT. / N/A Si ature of Prop , y weer Sgnature.of Property Owner .loseph.Patrick.Uermaeleri SWORN TO BEFORE ME.THIS ..50 DAY OF 5�5 f ,.24 L� Notary Public ANTWONY.VITo SERRA Notary public,State of New York No.O1 SE6365412 'Qualified in Nassau County Commisslon:Explres October 2,20 . APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics'prohibits-cOi fli6ts.ofirit6ri!"ton the part of idwn bfficees'and,emtovees:The nuroosd of. thrs:forrn is to provide'informafion`which catf 6rt thezfown of p'ossibie confltcts•of mterest=and allow a toStake whatever act on`s. riecessary to avoid same. YOUR NAME: Vermaelen,Joseph Patrick (Last name;first name,jp ddle initial;unless you are applying iri4he name of someone else or other entity,such:as a,company:If so,indicate the,other person's or company's name.) NAME OF APPLICATIONS_.(Check all that apply.) Tax grievance Building Variance Trustee X 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(orthrough your..company,spouse;sibling,parent,-or child)have a relationship;with any officer&'employee; ofthe Town of Southold? "Relationship''includes by blood ma riage;:or hussness<interest;:"Business interest"means;a busErress, including.a partnership,in.which the-town officer or•employce,has even a partial ownership of(or employment by):a corporation in which the lown otlicer or employee.owns more thwY%oftl a shares. YES r..,.,.,,. NO �., . If you answered"YES",complete the balance of this form and date and sign where indicated.G Name of person employed by the Town of Southold �5, . I 1 e.en?ouSe_rS .: Title or position of that person of z7 n a;P Sa 45L .a 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): f1A)the owner of greater than 59/o,of the shares of the corpotatc stock of the'appffi*t, EL (when the applicant is a corporation); .. B)the legal or beneficial owner of any interest in a non-cgrporate;entity(rvhen;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 thi 30� d' of►"N 20 Signature Print Na se-h Patrick Vermael Form T'S 1 ^ ANTHONY VITO SERRA Notary Public,State of New York No.61 SE6365412 Qualified in Nassau County Commission Expires October 2,20_d 8 d. og Trustees Application APPIDA IT: Kathleen Powers-Vermaelen BEING.DULY SWORN. K. DEPOSES-AND.AFFIRMS THAT HE/SHE IS THE APPLICANT F,OR THE.ABOVE ' DESCRIBER PERMIT(S)ANDS THAT ALL..STATEMENTS CONTAINED HEREIN . ARE TRUE TO THE,BEST OF I-H 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 SO.UTHOLD TOWN BOARD OF TRUSTEES THE APPLICANT AGREES TO. HOLD THE TOWN OF SOUTHOLD AND THE BOARD`OF TRUSTEES HARMLESS ANDFREE'FROM ANY AND.ALL DAMAGES AND�CLAZMS:ARISING UNDER:OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED .IN COMPLETING.THIS APPLICATION;,I HEREBYAUTHORIZE THE TRUSTEES,T)IEIR 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 aF TRUSTEES DURING THETERIVI OF THE PF RMIT. oZd.P/t;A�W.Pui242 --� b. NLA Si ature o roperty Owner: Signature:of Property Owner Kathleen`Powers=Vermaelen S WORN TO:BEFORE;ME THIS 3 ;DAY:OF Aijoyl 77 0 2c: ANTHONY VITO SERRA Notary Public,State o1 New Yolk s ..,Ni:)* o.01SE6365412; Qualitied.in Nassau County Commission Expires.Octobe(2,20 y5 APPLICANTlAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM. TheTown of Southold's Code of Ethics prohibits conflicts of interest on he part'of town:of}icers and emples The puroose_of. this form is twOrovide information whieh•ean alert the#own of anssible conflicts'of interest and allow It to iake whateveraction is: necessary to avoid same; YOUR NAM& Vermaelen,Kathleen Powers (Last name;1 first name,iriddle initial,unless you are applying 4the 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 x Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"Other",name the activity.) Do you personally'(or throughyourcompany,spouse,sibling,parent�or.child)have.a relationship-,Withanyofficer or.employee of the Townzf5outhold? "Relationship''includes by:blood marriage,.br'busmessinterest,"Business interest"means a business;. including a partnership,in:which the town:oflicer or employce,has e,ven•a partial ownership of(or employment by.).a,corporation in which the town officer oremployee,owns more than5%of the shares. YES NO n. . . 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 I`�s,.'�tIeen ?pwtiS Title brposition of that Person `ncvn Describe the relationship between yourself(the applicantlagentlrepresentative)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):. gA)the owner of greater than 50/d of thc:shares.of the corporate stock of the.'a !icaitt; pp. , �n (when the applicant is a corporation); . B)the legal or beneficial owner of any interest a non-corporate.entity(when'the. ' applicant is not a corporatin); _1___l_C)an ofFcer,director,partner or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this_3°k� day of J 20 Z , Signature (�� owl Print.Name Kathleen PowersNerrr aelen Fonn TS 1 ANTHONY VITO SERRA Notary Public;State of New York ND.OISE6365412 Qualified in Nassau County Commission Expires October Z 20-M- 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 Buildingg-Permits and other ministerial permits not located within the Coastal Erosion.Haiard 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'contain d in the Town of Southold Local Waterfront Revitalization Program: A proposed action will be evaluated as,..to its.si f carit beneficial and,adverse effects::upon the coastal area,fwhicli includes all of Southold Town)., ; 3 If,any,question in.Section.0 onthis 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. ea'ch.'answer must be exblamed:iin`detail, listing both.supporhM and non-.. .. supporting facts.11: If an action cannot be certified as consistent with the LWRP policy,standards and conditions,jt'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#_1000 144 - 3 40.1 PROJECT NAME Clearing vegetation/trees within 100ft of wetland for a driveway 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 iransaction) (b) Financial assistance(e.g.grant,loan,subsidy) (c) Perot,approval,.license,certification. Nature and extent of action: To.clear:the.vegetation/trees.to.improve accessibility by expanding the pathway ark creating,a prop9sed,.drivewa .and..construction related area within 100ft of the wetlands� e, . Location of action: 2020 Bay Ave Mattituck NY;11952 . Site acreage: 0.92.Acres Present land use; Vacant Present zoning classification. Residential T.: 2. If an application for the proposed action has been filed with the Town of-Sou thold agency;the following 4 information shall be provided: (a) Name of applicant .Joseph Vermaelen (b) Mailing address; 389 Second.Ave Bayport, New York 11,705 (c) Telephone number: 631- 472. 2839 - Will the action be directly undertaken,require-funding,.or approval by a:state or federal agency? Yes R -No.0 Ifyes,which state or federal agency?NYS OEC -See Permit 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 F No ✓❑ Not Applicable a 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 0 Yes 0 No.R Not Applicable 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 8 through 16 for evaluation criteria Yes ❑ No Not Applicable ,. Attach additional sheets ifnecessary 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 MNot Applicable Attac 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. 7:Yes ❑No 7 Not Applicable A split:rail fence will be installed to protect_the wetlands as per NYSDEC permit... Attach additional sheets ifnecessary 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. 1 -❑ ❑. Z Yes No ' 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. nn 0 Yell No 0 Not Applicable Attach additional sheets ifnecessary WORKING COAST POLICIES Policy 10. Protect SoutholWt 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 ❑✓ Not-Applicable Attach,additional sheets if necessary Policy 11. Promote sustainable use of. living marine resources.in Long YIsland Sound, .the .Pe ' Estuary and Town waters. See LWRP Section III.-Policies; Pages 57 through.62 for evaluation criteria.' ❑Yes 7 No 0 Not Applicable Attach additional sheets if necessary ;.. Policy 12. Protect.agriculturallands m .the Town of Southold. See LWRP Section III,.Policies; Pages 62 through 65 for evaluation.criteria. 3 0 Yes ❑ No.O 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:; No❑✓ Not Applicable Q Yes ❑ PREPARED BY Joseph.Vermaelen TITLE C�v n er DATE 09/01/25