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HomeMy WebLinkAbout27597-Z of souryo� TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: AulLl d I i DATE I �' 7� d g INSPECTOR FIELD INSPECTION REPORT DATE P_ 1J CO)MENTS J , H FOUNDATION ( IST)' c b d FOUNDATION (2ND)—_-- _= N S, ROUGH FRAME 6 L' _ pA PLUMBING INSULATION PER N. Y. t STATE ENERGY P- CODE S FINAL bd T ADDITIONAL COMMS: LAIC 5 p� M 1 � 0 vi Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/30/01 Receipt#. 0 Transaction(s): Subtotal 1 Septic Permit-Construct-Resid. $10.00 Total Paid: $10.00 Name: Becker,Susan 350 Kenny's Rd. Southold, NY 11971 Clerk ID: LES Intemal ID:37753 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATIONC6HECMM. BUILDING DEPARTMENT Do you have or need the following,bafm applying TOWN HALL Board of Health_ SOUTHOLD,NY 11971 3 sets of ... ..erg Plans TEL: 7654802 Survey MOM NO. Z 2,,0 7 2�- Check Saptie Fdan NY.SMac. Trustees Wined 20_L Contact: Approved -2061 Mail to: Disapproved a/c Phone:? �--T (-• 11 !I Bunning ector All 4'trZ 1 APPLICATION FOR BUn DING PERAW, Date. � �� 20 �/ 1NSTRIICTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans,accurate plot plan to scale.Fee according to schedule. r b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or arras,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of flus application,the Building Inspector will issue a Building Permit to the applicant Such a permit shall be kept on the promises available for inspection throughout the work. a.No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certi:Bcatc of Occupant is issued by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary'inspections. (Siguatmv of applicant or name,if a corporation) 350 J 04aRms address of applicant) //9-7/ State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber or builder 0yia'C� Name of owner of premises SLS Sam ,C3E t' �_y (as on the tax roll or latest deal) If applicant is a corporation,signature of duly authorized officer (Name and title of corporate officer) Builders License No. N l A Plumbers License No. 'U/f� Electricians License No. IV Other Trade's License No. A///+ 1. Location of land on whichproposed wo*will be done: eAnn_ e'f o House Number Stroet Hamlet County Tax MAR No. 1000 Section Block Subdivision K/ r Filed Map No. ,L j a-Z .Lot (Name) an o ' es and intended use and o=p—-3. cans on. Mate existing use and occap eY f pis . a Existing use and occupancY v b. .h#jaded use ead oecWancy Additiion Alteration . Nature of work(check which applicable).New Building— Other Work Repair Rio Demolition (Description) X Estimated� ' �� O©G ©� Fee (to be paid on filing this lication) . veg,number of dwelling units Number of dwelling units on eachif d — floor If garage, number of cars . If business, commercial.or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any:Front Rear Depth Height Number of Stories I . Rear Dimensions of same structure with alterations or addiflons: Front �� Height Number of Stories"--------- Depth tories•D 1 Dimensions of en ve new construction:Front s u Rear Height 5 Z 8 � Number of Stories Z ►. Size of lot:Front 3 3 2 " 5 Rear 3 ZZ 3�'. Depth 0.Date of Purchase__ALf Name of Former Owner in which es are situated ��t � "� ''( T ty � L' .1.Zone or use distri P� . 2.Does proposed constriction violate any zoning law,ordinance or regulation: .3.Will lot be re-graded e Will excess fill be removed from NO . onrn 2A.,Scx.�.�BD�neNo. .4.Names of Owner of premises Si���n r ►' AddressdresA���/ l a,,, hone No Name of Architect n i c ho/A sVP rte_ —Address Phone No. Name of Contractor l5. Is this property within 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED A Provide survey,to scale,with accurate foundation plan and distances to property lines. l7. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey )TATE OF NEW YORK) ��s, 3ovrTTY o being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, .S)He is the (Contractor,Agent,Corporate Officer,etc.) >f said owner or owners,and is duly authorized to perform or have perfmm d the sa work n beliet and thatthe and file this will be application; hat all statements contained in this application are true to the best of his Im edg ierfor ned in the manner set forth in the application'filed therewith- 3wom to before me this ffY Of Zp �prNi. HN , $ignatlitC Of liCBnt qRVYP2BLIC,State of New York No.01 806020932 Qualified in Suffolk County Term Expires March 8,2Q ~ APPLICATION PAGE 1 of 4 ` TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISTONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE. (APPLICANTS SIGNATURE) DATE SECTION 2: PROPOSED DEVELOPMENT(To be completed by APPLICANTI NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER / Ve C&Ias U see p/a n-,.d) Z81`3 PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark A sketch attached to this application showing the project location would be helpful. �3 #P, US RGA n� FDP(93) APPLICATION PAGE 2 OF d DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE New Structure Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofmg? O Yes) O Relocation O Combined Use (Residential & Commercial) ❑ Demolition F ❑ Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S -5 ZO 000100 B. OTHER DEVELOPMENT ACTIVITIES: Fill ❑ Mining ❑ Drilling ❑ Grading Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) ❑ Road, Street or lage Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or'Seyi�r System a O Other (Please Spect7y)� After completing SECTION 2,APPLICANT. should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. Dated The Proposed Development: ❑ Is h=located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). O Is located in a Special Flood Hazard Area. FIRM zone designation is .4�„_-e - 100-Year flood elevation at the site is; Ft. NGVD (MSL) ❑ Unavailable O The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. ,e^ SIGNED APPLICATION el PAGE 3 OF 4 SECTION 4• ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑ Development plans,drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the first floor, details of floodproofmg of utilities located below the first floor and details of enclosures below the first floor. Also ❑ Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofutg protection level (non-residential only) Ft.•NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A.❑ Is • B.❑ Is not in conformance with provisions of Local Law , 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION +� PAGE a OF a APPS-AI S: Appealed to Board of Appcals? ❑ Ycs ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION G• AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application)_ Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement Cin Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FI. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofing protection is FF. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complc a this section as applicable based oninspection of the project to ensure compliance with the communiWs local law for flood damage prevention. INSPP-MONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? OYES ONO SECTION 8• CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY_ CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19-, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) Albert J. Krupski,President �OSVFF���C Town Hall Jami s King,Vice-President ��� OGy 53095 Route 25 -4.Henry Smith Z P.O.Box 1179 Artie Foster y Z Southold,New York 11971-0959 Ken Poliwoda s �'� Telephone(631) 765-1892 Ol �a0 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 26, 2001 Mr. James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue,NY 11935 RE: SUSAN L. BECKER 4483 Wells Rd., Southold SCTM#86-1-9.6 Dear Mr. Fitzgerald: The following action was taken by the Board of Town Trustees during its regular meeting held on Wednesday, February 21, 2001 regarding the above matter: WHEREAS, James E. Fitzgerald, Jr. of Proper-T Permit Services on behalf of SUSAN L. BECKER applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated February 2, 2001, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on February 21, 2001 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold 2 Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of SUSAN L. BECKER to construct a single-family dwelling with on-site sewage disposal and private well, in-ground swimming pool and surrounding patio, and wood deck or grade-level patio behind a retaining wall,wit ndition of drywells to contain the roof run-off and the pool backwash, non- sturbanc buffer acid a row of hay bales to be placed down at the 75' buffer during BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms cc: DEC Health Dept. Building Dept. Board Of Southold Town Trustees SOUTHOLD, NEW YORK 1 Feb 26, 2001 PERMIT NO. _.. DATE: ............ .... .............. SUSAN L. BECKER ISSUEDTO ........................................................................... ... ................................................... Pursuant to the provisions of Chapter 615 of the Laws of t �° the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- 'tied ."REGULATING AND THE PLACING OF OBSTRUCTIONS n IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;'..': and in accordance with the Resolution of The Board adopted at a meeting held on ..Feb. 21, . 2001 and m consideration of the sum of x...200.,-00....... paid by *� Proper-T Permit Services for „Susan...L.-...Becke-r......................... , ............ >: y. of ..............Cutchogue........................................... N. Y. and. subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: " Wetland Permit to construct a single-family dwelling with on-site ,:= 1 sewage disposal and private well, in-ground swimming pool and surrounding patio, wood deck or grade level patio behind a retai wall, with the condition of drywells. to contain the roof run-off a all in accordance with the detailed specifications as presented in the originating application. the pool backwash, a 75' non-distur buffer and a row of haybales to be placed down at the 75' buffer during conM WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these resents to be subscribed by a majority of the said Board as of tis date. Albert J. Krupski, Jr. - Absent Artie Foster - Absent l [ - Trustees •iY '�.._;. :'a:--r.. :r.•sf .,r y�+'.�� 4 -n ._-�- .-'�-s•+. ;r:'.;k"t STATE OF NEW YORK ) ) ss: COUNTY OF SUFFOLK ) being duly sworn, deposes and says: That deponent is over the age of 18 years and resides at m L44 RZAc 14, A/C C✓ YO K4::-- That on the!rday of Jv L r , 2001 deponent arch itect/engineer, licensed by the State of New York, hereby states that fhe accepts full responsibility for the accompanying plans compliance with the New York State Fire.Prevention and Building Code (9 NYCRR); said plans pertain to property located at SCTM# 1000- 91n "O I. street address NWA S rQ1 Peco n Lc, Architect/Engineer Sworn to befo e e this a of 'A. 001. LINDA I.STAMN Notary Public,State of New York No.b2.4602164 Qualified in Suffolk cc: Applicant Commission EExxppires Z New York State Department of lEnvironmental Conservation Division of Environmental Permits, Region One AM Building 45-SUNY,Stony Brook, New York 11790-2356 Phonq,: (631)444-0365 • FAX: (631)444-0360 _ Website:www.dec.state.ny.us Erin M.Crotty Commissioner June 20, 2001 Ms. Susan Becker 298 Bridgeport Avenue Medford, NY 11763 RE: 1-4738-02545/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable-to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Susan V. Ackerman Environmental Analyst SVA/Is Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-02545/00001 June 20, 2001 FACILITY/PROGRAM NUMBER(S) P E RM I T EXPIRATION DATE(S) Under the Environmental Conservation Law I June 30, 2006 I1 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate i ■ Article 15, Title 5: Protection ■ 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management ❑ Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Lanai Reclamation ❑ Article 36: Floodplain Island Wells Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Susan Becker ADDRESS OF PERMITTEE 298 Bridgeport Avenue Medford, NY 11763 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Pro r-T Services, P.O. Box 617, Cutchogue, NY 11935 (631) 734-5800 NAME AND ADDRESS OF PROJECT/FACILITY Becker property, Wells Road Peconic LOCATION OF PROJECT/FACILITY SCTM #1000-86-01-9.6 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Richmond Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construction of a single family dwelling with garage,decks,porch,pool,septic system and asphalt driveway. The project also includes construction of a 4"x 60'dock with a 4'wide access pathway and 4'x 9'stairs at the seaward end. All work is to be done in accordance with the attached plans stamped NYSDEC approved on June 20, 2001. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Roger Evans (SVA) Bldg. #40 SUNY Stony Brook NY 11790-2356 AUTHORIZED SIGNATURE DATE June 20, 2001 Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives,employees,agents,and assigns for all claims,suits,actions,damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the 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. GENERAL CONDITIONS General Condition 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 SAIDA 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. General Condition 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. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for 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. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities(HWMF), major Air Pollution Control(APC)and Solid Waste Management Facilities(SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02545/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5), 24, 25,34 AND 6NYCRR PART 608 (TIDAL WETLANDS) 1: 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 alterthe 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. 2. 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. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S.Army Corps of Engineers,U.S.Coast Guard,New York State Office of General Services or local government which may be required. 4. 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. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. 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 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. 8. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303,306 and 307 of the Clean Water Act of 1977(PL 95-217)provided that all of the conditions listed herein are met. 9. 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 and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by: Howard Young, last revised March 1. 2001 with dock plans(sheets 1 &2)dated 6/15/01. DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-02545/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 100 linear feet from the tidal wetland boundary. 5. All fill shall consist of"clean"sand, gravel, or soil (not asphalt, flyash, broken concrete or demolition debris). 6. Dock or timber catwalk shall not exceed 4 feet in width and shall be a minimum of 3%feet above grade*over tidal wetland areas(*as measured from ground to bottom of dock sheathing). 7. The use of wood treated with pentachlorophenol in the construction of structures that will be in contact with tidal waters is strictly prohibited. 8. Dock reconstruction or replacement or seasonal installation shall not involve expansion or substantial modification of existing structures or facilities. 9. All repairs to existing structures shall be confined to replacement of existing elements with no change in design, dimension, or materials, unless specifically authorized herein. 10. No dredging,excavating or other alteration of shoreline or underwater areas is authorized by this permit,nor shall issuance of this permit be construed to suggest that the Department will issue a permit for such activities in the future. 11. A row of staked hay bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 65 linear feet from the tidal wetland boundary, or as per NYSDEC approved plan, at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 12. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for immediate on-site recharge. 13. Dry wells for pool filter backwash shall be located a minimum of 100 feet landward of the tidal wetland boundary. 14.There shall be no draining of swimming pool water directly or indirectly into tidal wetlands or protected buffer areas. 15. Driveways and parking areas shall be constructed of pervious material. 16. Sanitary system (bottom of tank and leaching pools) shall be located a minimum of 2' above seasonal high groundwater. 17. The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated tidal wetlands associated with Richmond Creek are located at Suffolk County Tax Map Number. District 1000,Section 86, Block 01, Lot 9.6,otherwise known as the properties of Susan L. Becker and her heirs,assigns,or successors. This property is subject to the provisions of New York State Environmental Conservation Law (ECL) Article 25 or its successor, and the conduct of regulated activities may occur only pursuant to ECL Article 25 if prior approval is given by the New York State Department of Environmental Conservation (NYSDEC) or its successor. Regulated activities include, but are not limited to the erection of any structure(s); excavation; dredging grading and filling; clearing of vegetation; and application of chemicals." D 1-4738-02545100001 EC PERMIT NUMBER PAGE 4 OF 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS This deed covenant shall be recorded with the Clerk of Suffolk County within 90 days of the issuance of this permit. A•copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sentwithin one calendar year of the issuance of this permit to:NYSDEC,Regional Manager, Bureau of Marine Habitat Protection, SUNY Building 40, Stony Brook, New York 11790-2356. `No ramp or float is authorized with the permitted dock nor should issuance of this permit be construed to suggest the Department will issue a permit for such structures in the future. DEC PERMIT NUMBER PAGE 5 OF 5 1-4738-02545/00001 NO TICE OF COMMENCEMENT OF CONSTRUCT/ON RETURN THIS FORM TO: Regional Manager Am Bureau of Marine Habitat Protection New York State Department of Environmental Conservation Bldg. 40-SUNY, Room 223 Stony Brook, NY 11790-2356 ERIN M.CROTTY Q' f� COMMISSIONER PERMIT NO.: 30 ' ��j ISSUED TO: S�(.SG� h 6 ccklle/Q CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to Supplementary Special Condition D of the referenced permit, you are hereby notified that the authorized activity shall commence on . We certify that we have read the referenced permit and approved plans, and fully understand the authorized project and all permit conditions. We have inspected the project site and can complete the project as described in the permit and depicted on the approved plans in full compliance with all plan notes and permit conditions. Ther Permit sigh, permit, and approved plans will be available at the site for inspection in accordance with General Condition No. 1. PERMITTEE DATE CONTRACTOR DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS IN ADVANCE OF COMMENCEMENT OF THE PRO FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE PERMIT AND APPROVED PLANS AVAILABLE A WORK SITE MAY SUBJECT THE PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR N COMPLIANCE WITH PERMIT CONDITIONS. CutSiong this line ----------------------------------------------------------------------------------------------'---- ----- NOT/CE OF COMPLETION OF CONSTRUCT/ON RETURN THIS FORM TO: Regional Manager ERIN M.CROTTY Bureau of Marine Habitat Protection COMMISSIONER New York State Department of Environmental Conservation Bldg. 40-SUNY, Room 223 Stony Brook, NY 11790-2356 PERMIT NO.: �0 -Va� S OQ70 ISSUED TO: SkSo� h �P C1�ele CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to Supplementary Special Condition D of the referenced permit, you are hereby notified that the authorized activity was completed on We have fully complied with the terms and conditions of ther permit and approved plans. PERMITTEE DATE CONTRACTOR DATE THIS NOTICE, WITH PHOTOGRAPHS OF COMPLETED WORK AND/OR A COMPLETED SURVEY', AS APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. FAILURE TO DO SO WILL RESULT IN A COMPLIANCE INSPECTION BY N3 SDEC STAFF. Note: An as-built.survey is required for the following categories of new construction:single family dwellings and additions,septic systems,decks,pools,bulkheads and other shoreline stabilization structures. 9520.1(8/8"n-9d New York State Department of Environmental Conservation Am Am vNOTICE 111111111111V v 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 Permit Number .3 'd 5 1 J� iIN WT PAVAC;IC Expiration Date b O NOTE: This notice is NOT a permit PLAN VIEW Ap loo5 Susan L. Becker �roposed: Walk 8 Steps Situate: Peconic ToKn: Southold Suffolk Gounty, NY SGa l e: 1 = 60 Purpose: Private Mooring Datum: low water \oo°\1P�aba Tide DatengO6-�5-OI P,\0P p Q�00 CC, C90\) N s o.•'•. •. W �N Q� 7 chi Q" Q �� h 9 6• Q+ ��q O� S o F IS�' T 6 Q,., , - ---------,'r ---- :y �S K�' 1 4' ipQ wood Chip hath °',vo P� •�p *b.6 e W% e�gEq, ' $o \ 01 Q�O� All demenslonal lumber, `` BOJ\`(+ O+(, (fie timber and piles are t--` �. All arrdwore galva�ldzed �.+ `` \Lr�0,�L\00 2 Lhe Depth at end of dock was taken by NYSDEc on June '7, 2001 ® 9 AM A �licant: Susan L. Becker ropoed: Walk & Steps CROSS SECTION Situate: Peconic Through Genter I ine Dock Town: Southold J II l Suffolk Gounty, NY SGGt I e : I = I O Purpose: Privat=e, Mooring Datum: low water Tide Ranger 2' +/- Date: 06-15-01 All demenslonol lumber, ! umber and plles are GGA-treated wood. edge of Tidal Pro p05ed Fixed All hardware galvanlzed Wetlands os Walk (4' X 609 ! delineated by min.3.5'above grade 5-1' +/- to opposite R. Fox 3-25-00 shoreline K Upland or Adjacent Area mean high water I 1119 h .� Marsh Intertidal mean low water Z I Marsh�> 2.4 piles (4"x ib") Steps '. (4'xq') Depth of end of dock was taken by NYSDEG on June 7, 2001 (9 G AM ! t Aduoining Owners: North side: South side: Tax # 1000-66-i-q.3 Tax # 1000-86-I-q.5 Land of Peconic Land Trust Land of Peconic Land Trust PO Box 2088 PO Box 2088 Southampton, NY ilgbq Southampton, NY Ilgbq Sheet Depth at end of dock was taken by 2 Of 2 NY50EC on June 'i, 2001 ® q AM L r u V1 - X W ' NOTE ° AREA = 2.4087 ACRES • SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON MAY 18, 1999 AS MAP NO. 10282 • VERTICAL DATUM = N.G.V. DATUM (M.S.L. 1929) $ • FILL REQUIRED = 1,400 C.Y.t Zy,V • LOT COVERAGE = 13,434 S.F./2.4087 ACRES x 43,560.S.F.=12.89. Nm$ • SOURCE OF FILL SHALL BE FROM AN APPROVED UPLAND SITE. a Nig SURVEYOR'S CERTIFICATION • WE HEREBY CERTIFY TO SUSAN BECKER & CHICAGO TITLE INSURANCE COMPANY THAT THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE CODE--OF PRACTICE FOR LAND SURVEYS ADOPTED BY TH TATE ASSOCIATION OF PROFESSIONAL LAND SURVE W. HOWARD W. YOUNG, N.Y.S. L.S. NO. 45893 458 LAND 4 f�4't Cs EL=8.0 �4lble 10�gK -- --o SURVEY FOR WSW CP$ a<s>s -- - � � ' SUSAN B ECK ER - � ' LOT 3 "RICHMOND CREEK FARMS, SECTION 2" Or At Peconic, Town of Southold Suffolk County, New York $ g o° County Tax Map District 1000 Section 86 Bink 01 Lot 9.6 BUILDING PERMIT SURVEY 1N. GRADE EL=8.0 GENERAL AMENDMENTS MAR. 1, 2001 GENERAL AMENDMENTS JAN. 22, 2001 MAP PREPARED JAN. 8, 2001 1019 N 1. SCALE 1" = 60' b. JOB NO. 2000-0584 OF 1 UP DWG. 2000-0584—bps ilp