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HomeMy WebLinkAboutTR-8625John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen h�o�OgOFFOCA- `OG�� o - W ® rh BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE -CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, silt fence 1 st day of construction '/ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8625 DATE: JUNE 17, 2015 ISSUED;TO: GLENN-HEIDTMANN, JR. PROPERTY ADDRESS: 600 ALBACORE DRIVE, SOUTHOLD SCTM# 57-1-21 'AUTHORIZATION F' Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 17, 2015, and in consideration of application fee in'the sum of $250.00 paid by Glenn Heidtmann, Jr. and subject to the Terms and Conditions as stated in the'Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit for a proposed'161'02' swimming pool with 4' high pool enclosure fencing and'' pool utility area; and" nstall approximately 300sq.ft. of walkway and bluestone patio with a 16" higli seat wall; with the condition of the installation of a drywell for the pool"to contain backwash; and, as depicted on the survey prepared by Peconic Surveyors, P.C., last dated June 15, 2015, and stamped approved on July 17, 2015. IN WITNESS WHEREOF, the said Board of Trustees hereby pauses its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. �g�jFFQ��:l' ` CO2 I I I-' �. '-' �� Z V -e%- , ' � ' ' ' TERMS AND CONDITIONS The Permittee Glenn Heidtmann Jr residing at 600 Albacore Drive Southold, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. 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. John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee June 17, 2015 Glenn Heidtmann, Jr. 600 Albacore Drive Southold, NY 11971 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD RE: 600 ALBACORE DRIVE, SOUTHOLD SCTM# 57-1-21 Dear Mr. Heidtmann: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 The Board of Town Trustees took the following action during its regular meeting held on Wednesday, June 17, 2015 regarding the above matter: WHEREAS, GLENN HEIDTMANN, JR. applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated May 21, 2015, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 17, 2015, 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, PA 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 275 of the Southold 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 have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of GLENN HEIDTMANN, JR. for a proposed 16'x32' swimming pool with 4' high pool enclosure fencing and pool utility area; and install approximately 300sq.ft. of walkway and bluestone patio with a 16" high seat wall; with the condition of the installation of a drywell for the pool to contain backwash; and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated June 15, 2015, and stamped approved on July 17, 2015. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, �jA- John M. Bredemeyer III President, Board of Trustees JMB/eac A _0I4Vli OIIA.iWe] =IL*AolIIa_to *III N_ISIXI ■-Of-M■L• JL L]r John Bredemeyer, President gUFFD(,, Michael J. Domino, Vice -President James F. King y x Charles J. Sanders • Dave Bergen y�O1 Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: ) ° GLENN HEIDTMANN, JR. requests a Wetland Permit for a proposed 16'x32' swimming pool with 4' high pool enclosure fencing and pool utility area; and install approximately 300sq.ft. of walkway and bluestone patio with a 16" high seat wall. Located: 600 Albacore Drive, Southold. SCTM# 57-1-21 Type of area to be impacted: // Saltwater Wetland Freshwater Wetland Sound v ay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 . Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property Storm Water Management Review: Info needed: Modifications: other Yes No Not Applicable Yes No Not Applicable Present Were: ✓J. Bredemeyer-0. DominoKiny C. Sanders a� D. Bergen Bay Constable Form filled out in the field by Mailed/Faxed to: Date: Other Glenn Glenn Heidtmann, 7Jr. 600 Albacore Drive, Southold SCTM# 57-1-21 6110/2015 6 /;10/,2.015 11 -. 30 U- \�Y (ht\h,��F1 k ,�` '►A�i`,'�q '�'I'-`" �`.i/gip, �'i,.. _ 1 _ L[_L% .:- -Iwo--r � � I , } L' i t v -J -- - �a�e�eR-? •.... •.• • .a... ... a ................ .. •••...•■■•............. u. ...■... u.... u....0 ■........ •������ •...................• ...... a ... u u ■■.■..i ..............0 ..........• •................. u........ a. •t.. • •. ■... ..• •...................• •.....� ........ u u .. a u.0 ...... .... u....... .•..... ..... •................... ■... a............. u . u .. a ..� ............................� ..• .... a. •....... �tu.a �.■ .■. u u . u u ..........■ •..........................� •..........................• ■......���...•u.���...•...... .�......� ��� •.....................■ ...... a .......... u . u u■...� �............................. •... u... u...............•u. .... �...���.��. ����. •'.'.. � .- ..........................• .a...........................■ ............•• a .•............ ....■ ....... a ................. a .. i......a.•■ \ •.....• _.... .. .. ...._. :. .� __ .. _ ...u....0 uu....u..u.. u. n........... ....... ISLAND SOUND w CE COU TY OF SUFFOLK ReaGProperty Tax Samoa Agemy v w M .. •a ". . .... ___ w..,�— �.ww.w. wr.ou, w,m[wr["rwuwww m e m m A aee to M dnw,e.w tM0 o' H. ROY JAFFE E. 82 EAGLE CHASE, WOODBURY, N.Y. 11797 516-364-0148 FAX 516-364-0158 April 16, 2015 Town of Southold Dear Sir: _G% vt r t Oji ! JUN 12 2015 This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of: Heidtmann 600 Albacore Southold, NY will not require draining because the -pool is of gunite construction. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash is nominal and will not interfere with the public water supply, the existing sanitary facilities or,public highways. Very truly yours, H. Roy Jaffe, P.E. �M v4747� 1W�`�®F� SSI OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM JUN 1 2 2015 To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 12, 2015 Re: Local Waterfront Coastal Consistency Review for GLENN HEIDTMANN, JR. SCTM# 1000-57-1-21 GLENN HEIDTMANN, JR. requests a Wetland Permit for a proposed 16'x32' swimming pool with 4' high pool enclosure fencing and pool utility area; and install approximately 300sq.ft. of walkway and Bluestone patio with a 16" high seat wall. Located: 600 Albacore Drive, Southold. SCTM# 57-1-21 The proposed actions have 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 proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Please have the applicant clarify the setbacks to the wetlands from the pool. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney Peter Young, Chairman Lauren Standish, Secretary Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O Box 1179 Southold, NY 11971 Telephone (631) 765-1889 Fax (63 1) 765-1823 At the meeting of the Southold Town Conservation Advisory Council held Wed., June 10, 2015 the following recommendation was made: Moved by Peter Young, seconded by Keith McCamy, it was RESOLVED to SUPPORT the application of GLENN HEIDTMANN, JR. to install a 16'X 32' pool to be located in the rear yard, surrounding pool fence 4' high, and bluestone patio and walkway against the garage and pool equipment behind the garage. Located: 600 Albacore Dr., Southold. SCTM#57-1-21 Inspected by: Peter Young, Doug Hardy, Peter Meeker, Keith McCamy, John Stein The CAC Supports the application with the assurance there will be adequate drainage for the pool. ote of Council: Ayes: All Motion Carried JUN 1 1 2015 � John M. Bredemeyer III, President �*®v S®UTyo l® Town Hall Annex Michael J. Domino, Vice -President �� 54 Main Road P..O.O. Box 1179 James F. King, Trustee Southold, New York 11971-0959 Dave Bergen, Trustee G�, ® O Charles J. Sanders, Trustee tea, � U0 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES D E" E V E TOWN OF SOUTHOLD To: Southold Town Building Department MAY 2 2 2015 Re: Verification of Building Department Permit Requirements BLDG. DEPT. r TOWN OF SOUTHOLD SCTM#: S 6 Property Owner Name: ' [ r- (i Hel.'Jimafln Date Sent to Bldg. Dept.: So� The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO the proposed project require a Building Permit? Will the proposed project require a variance determination from th oning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: Signature of Wewer Date John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application _Wetland Permit Application Administrative Permit / _Amendment/Transfe /Ex nsion V Received Application: 11.5 Fee:$ s b ��Coeceived mpleted Application _Incomplete _SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) LWRP Consistency AssessqientiForin —CAC Referral Sent: E;/-2K/IS pate of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Yechnical Review: Public Hearing Held: Resolution: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 MAY 2 1 2015 Name of Applicant Mailing Address Phone Number:6 +79— 51k B Suffolk County Tax Map Number: 1000 - S-7- VI - z' Property Location: 600 V �� , 'St CA (provide FANNON (If applicable) Address: Pole #, distance to cross streets, and location) Phone: ird of Trustees Applicati GENERAL DATA 5 $' Land Area (in square feet): Area Zoning: r Previous use of property:, Intended use of property: '� ►,��a 1J Covenants and Restrictions on property? Yes No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes N o If "Yes", please provide copy of decision. Will this project reqi;jr 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? —X --Yes No Prior permits/approvals for site improvements: Agency l a 1LO Date u No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No If yes, provide explanation: Project Description (use attachments if necessary): !& lx 321 P0, 0 L, 12 Yes E -d of Trustees Applicatioi WETLAND/TRUSTEE LANDS APPLICATION DATA 0 Purpose of the proposed operations:%0[ tr �i�/t Area of wetlands on lot: rN U, square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: t 6D feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? 6 D cubic yards How much material will be filled? G'0 cubic yards Ar u Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: MM Imcq0— Manner in which material will be removed or deposited: wM 169- � rn ��►m-''' ► _'lt' _= - i t�Oi s l i' _ , _ iia �' 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completinp_ Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part l 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 l - Project and Sponsor Information Name of Action or Project: a&vta'Jd3 t Project Location (describe, and attach a location map): ,. e "a o �V Brief Description of Proposed Action: pvoc Name of Applicant or Sponsor: 61 ��6�a�J �� ?/t�Aye"D �� Telephone: E -Mail: Address: 630 City/PO: State: PV Zip Code: A 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that NO YES may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? If Yes, list agency(s) name and permit or approval: NO YES ❑ 3.a. Total acreage of the site of the proposed action? s acres b. Total acreage to be physically disturbed? ®®2 [ acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? d acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban ❑ Rural (non -agriculture) ❑ Industrial ❑ Commercial 1WResidential (suburban) ❑Forest ❑Agriculture El Aquatic ❑ Other (specify). ❑Parkland Page 1 of 4 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ W 0 ❑ ❑ ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ LEI 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO YES ® ❑ 8. a. Will the proposed action result in a substantial increase in traffic above present levels? 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? NO YES 1®�I ❑ ❑ 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: NO YES ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES 9 ❑ 1 l . Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES � [—] 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES ❑ 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain 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: NO YES ❑ � ❑ 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ❑ Shoreline El Forest ❑Agricultural/grasslands El Early mid -successional ❑ Wetland ❑ Urban ❑ Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO YES ® F] 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? If Yes, Will storm water discharges flow to adjacent properties? NO YES b. Will storm water discharges be directed to established conveyance systems (ruDoff and storm drains)? If Yes, briefly describe: ONO [—]YES NO YES 10 Ela. Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size. NO YES I All ❑ to large 9 e impact impact may 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: NO YES occur ❑ 1:1regulations? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES ZI ❑ F1 El 3. Will the proposed action impair the character or quality of the existing community? 0 ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: 1tr°" ge4d, All aniiI L2 Date:UP Signature: IN - Part 2 - Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part l and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action?" Page 3 of 4 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 1:1regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? F1 El 3. Will the proposed action impair the character or quality of the existing community? 0 ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the �jj ❑ establishment of a Critical Environmental Area (CEA)? LLJ 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 (�I ❑ reasonably available energy conservation or renewable energy opportunities? I I 7. Will the proposed action impact existing: a. public / private water supplies? a El b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, 1:1architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, �J( I-1 Elwaterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 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. F] Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an nvironmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmen al impacts. Town of Southold - Board of Trustees �j ` Name of Lead A ncy Date e President Print or Ty Name opf R risible fficer in Lad Agency Title of Responsible Officer S' ture of Res nsi le Officer in Lfl�g_en y Signature of Preparer (if different from Responsible Officer) PRINT Page 4 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 1:1problems? l l . Will the proposed action create a hazard to environmental resources or human health? ❑ Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. F] Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an nvironmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmen al impacts. Town of Southold - Board of Trustees �j ` Name of Lead A ncy Date e President Print or Ty Name opf R risible fficer in Lad Agency Title of Responsible Officer S' ture of Res nsi le Officer in Lfl�g_en y Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 Town of Southold Erosion, Sedimentation 8t: Storm -Water Run-off ASSESSMENT FORM PROPERTY L ATION: s.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A I 0 '2Q STORM -WATER, GRADING, DRAINAGE AND EROSION CONTROL PLA -6Tsvic� Sect on hoc cl— Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YOI SCOPE OF WORK - PROPOSED CONSTRUCTION I ITEM # / WORK ASSESSMENT I Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within t the Scope of Work for Proposed Construction) Eland b. What is the Total Area of Land Clearing (S.F !Acres) and/or Ground Disturbance for the proposed t. 0 21- construction activity? ❑ Item shall include all Proposed Grade Changes and (S.F. /Acres) PROVIDE BRIEF PROJECI' DESCRIPTION (Provide Additional Pages as Needed) Submission of a SWPPP is required for all Construction activities involving soil disturbances of one (1) or more acres; including disturbances of less than one acre that are part of a larger common plan that will ultimately disturb one or more acres of land; Including Construction activities involving sol disturbances of less than one (1) acre where the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit For Storm Water Discharges from Construction activity - Permit No. GP -0-10-001.) 1. The SWPPP shall be prepared prior to the submittal of the Not. The NOI shall be submitted to the Department prior to the commencement of construction activity. 2. The SWPPP shall describe the erosion and sediment control practices and where required, post -construction storm water management practices that will be used and/or constructed to reduce the pollutants in storm water discharges and to assure compliance with the terms and conditions of this permit. In addition, the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. 3. All SW PPPs that require the post -construction storm water management practice component shall be prepared by a qualified Design Professional Licensed in New York that is knowledgeable in the principles and practices of Storm Water Management. 1 Will this Project Retain All Storm -Water Run -Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all run-off created by site sediment control practices that will be used to clearing and/or construction activities as well as all Eland Site Improvements and the permanent creation of impervious surfaces.) item must be maintained throughout the Entire 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This ❑ Item shall include all Proposed Grade Changes and 4 Will this Project Require any Land Filling, Grading or Slopes Controlling Surface Water Flow. Excavation where there is a change to the Natural 3 Does the Site Plan and/or Survey describe the erosion sediment control practices that will be used to Eland control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand FI (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction El or within One Hundred (100') feet of a Wetland or Beach? 7 Will there be Site preparation on Existing Grade Slopes Exceed Fifteen (15) feet of Vertical Rise to Elwhich One Hundred (100') of Horizontal Distance? 8 Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm -Water Run -Off ��IL into and/or in the direction of a Town right-of-way? 9 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any ❑ Item Within the Town Right -of -Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) NOTE: If Any Answer to questions One through Nine is Answered with a Check Mark in a Box and the construction site disturbance is between 5,000 S.F. & 1 Acre in area, a Stonn-Water, Grading, Drainage & Erosion Control Plan is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check Mark (.I) and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, COUNTY OF ........&.. .1 ........... SS That I, ......'�,/.l. 1��!....�djl"".Mij��............... being duly sworn, deposes and says that he/she is the applicant for Permit, (Name of individual signing Docum Andthat he/she is the............................................®f.�m'�/.................................................................................................. (Owner, Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before m//eeq this; / r/ j,� ............................1.:1.......... da of ...... .... f! ......................... , 20./ Notary Public: ............ .... .............. ���"..-"""...... .... ............................. I I AIP18 e n A 01 en U (Signature of Applicant) FORM - 06/10 Notary Public, State of New York No. 01 CA6137178 Qualified in Suffolk County Commission Expires Nov. 14, 20 /I PROOF OF MAILING OF NOTICE ATTACK CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,residing at e-0 ✓ '��%' , being duly sworn, deposes and says that on the L�J day of '�v�.t , 20 / ! ;-deponent mailed a. true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town f Southold; that said Notices were mailed at the United States Post Office at S0,�.,rko; , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this °7 Day of 1v PJ, 20�_ Notary Public LINDA S, CARLSON n1®tart' Public,01State of New York CA6137178 No. Qualified in Sus Nov. 14, County olk COMIWIssion Exp CO .--U Ln rq r - a 0 Ln 0 O C3 0 zr •0 0 Ln 0 r - m Ln ri r- O LO O O O -r _El 0 Ln ra 0 r- 0 Er r'1 r- ri O Ln O m O 0 0 Ln O r -- 0.. 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ZtPE®� ry N ------------------------------- 7-7/ John Bredemeyer, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of GLENN HEIDTMANN, JR. COUNTY OF SUFFOLK) STATE OF NEW YORK) Town Hall Annex 54375 Route 25 P.O Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DA YS I, 6&&7 r��ding at /dba being duly sworn, depose and say: -ek r� That on the 1-7dayof \j %J cam- , 201 , I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, June 17, 2015. Dated: p �Q Sworn to before me this 151'day oGuty 2015 � 1AW-W d-. Rd R/L — Notary blit TRACEY L. DWYER NOTARY PUBLIC, STATE OF NEW YORK NO. 01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30, 2j/_.0 r*.ItlTlt &. rye LJ&.P rd of Trustees Applicatio County of Suffolk State of New York 6e0Q4��`�iJI� DEPOSES AND AFFIRMS THAT BEING DULY SWORN IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF i ,20 Notary Publio.c, S aS. nte of New York Qualified in Suffolk uffolk1County Commission Expires Nov. 14, 20 //J APPLICANT/AGEN'T/REPRESENTA TIW TRANSAC'T'IONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town bfficers and em llooyees The purpose of this form is to provide information which can alert the town of possibly conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: &0' nal I (1 6 --fin TC( , f� (Last name, first name,.qiddle initial,essun yl oa ate applying tri the name of someone else or other entity, such as a company. If so, indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee - Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"OtheC', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in which the town officer or em yee ven a partial ownership of (or employment by) a corporation in which the town officer or empl=NO�< owI har YES If you answered y `YES", complete the-balaftee-of4'ts form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant(agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space proJided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non -corporate entity_ (when the applicant is not a corporation); C) an officer, director, partner; -or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ( day of 20 S ignature— Print Name -",k et-, Form TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated. as to its si 'rug ficant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non - supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ��� - -�_ MAY 2 1 2015 p PROJECT NAME —4-�:awww n Poo i The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: PODL Gu® fo? ,S' Ap �V-Ac ode , r{ �3� ��- C�� Location of action: UbO W "''k- �A� Site acreage: " � 5 Present land use:.�►i%L� Present zoning classification: e 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: 2-9-n6li (b) Mailing address: �, , QST. (c) Telephone number: Area Code ( ) °'I[ -zL K (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency?, C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LV RP Section III — Policies; Page 2 for evaluation criteria. ❑ Yes ❑ No A] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III — Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 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 LN 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 n No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of ,Southold. See LWRP Section III — Policies Pages 16 through 21 for evaluation criteria El Yes ❑ No NNotApplicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III — Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Appucable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. 1-1 Yes [—] No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ 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. ❑ YeF-1 No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIEo Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No W Not Applicable I Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No F, Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III — Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable WETALNDS FLAGS BY: \\ CXBOWMAN - LAND USE ON 11-24-02 1 N86i5'30"W DWELLING (PUBLIC WATER) FLOOD ZONE X FIRM MAP NUMBER J610JC0159H ELEVA TIONS ARE REFERENCED TO N. V. G. D. Qe? \ VgLq,VT �cC} %e4/C vq TFR //V DWELLING (PUBLIC WATER) ANY ALTFRA770N OR ADD177ON TO THIS SURVEY IS A V70LA77ON OF SEC77ON 7209OF 7NE NEW YORK STA 7F EDUCA 77ON LAN! EXCEPT AS PER SEC77ON 7209 -SUBDIVISION 2. ALL CER77FICA77ONS HEREON ARE VALID FOR 7HIS MAP AND COPIES ]HEREOF ONLY lF SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF THE SURVEYOR AREA = 23,800 80. FT. WHOSE SIGNA7URE APPEARS HEREON. LOT COVERAGE 2J,800 SQ. FT.—1710SQ. FT. _ 22, 090 SQ. FT. UPLAND EXIS77NG HOUSE & DECKS —2900 SQ. FT. GARAGE — 868 SQ. FT. —3768 SQ.FT. W 774 POOL — 512 SQ. FT. —4280 SQ.FT. 4280/22090=19.49 D (p�'e941C He I AM FAMILIAR W17H 7HE STANDARDS FOR APPROVAL AND CONSTRUC770N OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND WILL ABIDE BY 7HE COND177ONS SET FOR7H 7NEREIN AND ON THE PERMIT TO CONSTRUCT. The location of public water, wells and cesspools shown hereon are from field observations and or from data obtained from others. SURVEY OF PROPERTY A T ARSHAMOMA0UE TO WN OF SO UT °HOLD SUFFOLK COUNTY, N. Y. 1000-67-01-21 SCALE.- 1'--30' JULY 6, 2001 SEPT. 18, 2006 (REVISED FINAL) SEPT. 24, 2014 (PROP. POOL) APRIL 29,2015 (PROP. POOL) MAY 20, 2015 (PROP POOL FENCE) JUNE 15, 2015 (REVISIONS) CERTIFIED TO. NOR774 FORK BANK GLENN HEIDTWANN FIDELITY NA77ONAL TITLE INSURANCE COMPANY OF NEW YORK 777LE No. 01-3704-39757-SUFF. N07F SUBSURFACE SEWAGE DISPOSAL SYSTEM & DRAIN DESIGN BY JOSEPH FISCHET77, P.E. HOBART ROAD SOU7HOLD, N.Y 11971 (631)765-2954 LOT NUMBERS REFER TO "MAP OF SOUTHOLD SHORES" FILED IN 7HE SUFFOLK COUNTY CLERK'S OFFICE ON AUG. 29, 1963 AS FILE Ala 3553. JUN 1 7 203 WT -S. LIC. NO. 49618 PECONIC SURVEYORS, P.C. (631) 765-5020 FAX (631) 765-1797 P.O. BOX 909 SOoNRi 91T ®1U7HD, 7 -171 WETALNDS FLAGS BY. \\ 0*11 C.W.BOWMAN - LAND USE ON 11-24-02 I I / 0 N A` / 533. CONC. INLET EL. 7.3 r� 0 CV 0"x2 WATER COLLECTOR LOT 2 LOT 2 t/gLgHT �cC} ,�F v TFR /N S F " of A�� F F'vT � o \M��RR OQ N ,` o ' `jr, ^2 c ��w FRN c P ROp 1 Ff�Of eR,c �,• 3.0 > 2 FR cTy qR, IDWI PROP. POOL cli &fir / N86'15'30"W DWELLING (PUBLIC WATER) FLOOD ZONE X FIRM MAP NUMBER J610JC0159H ELEVA 77ONS ARE REFERENCED TO N. V. G. D. ANY ALTERATION OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209OF 77 -IE NEW YORK STATE EDUCA77ON LAW EXCEPT AS PER SEC77ON 7209 -SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR 77 -IIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. I I N I I I 183-85' LOT 22 DWELLING (PUBLIC WATER) 0. 00' \ f � it -PONDS k LOT NUMBERS REFER TO "MAP OF SOUTHOLD SHORES" / �i POOL• / r FENCE q�® STEEL eo^ i GRATE O � JUS 1 7 201 4'x2'deepO BUBBLER ELSco T - JUN 16 4, 00 110 LOT COVERAGE 2J,800 SQ. FT.—1710SQ. FT. = 22,090 SQ.FT. UPLAND EXIS77NG HOUSE & DECKS —2900 SQ. FT. GARAGE — 868 SQ. FT. —3768 SQ.FT. KITH POOL — 512 SQ.FT. —4280 SQ.FT. 4280/22090=19.49 APPROVED . �. �, r i BOARD ARTRUSTEES O j l a 29S 89, SURVEY OF PROPERTY A T ARSHAMOMA 0 V TO WN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000-67-01-21 SCALE 1'=30' JULY 6, 2001 SEPT. 18, 2006 (REVISED FINAL) SEPT. 24, 2014 (PROP POOL) APRIL 29, 2015 (PROP. POOL) MAY 20, 2015 (PROP. POOL FENCE) JUNE 15, 2015 (REVISIONS) CERTIFIED TO. NORTH FORK BANK GLENN HEI07MANN FIDELITY NA77ONAL 777LE INSURANCE COMPANY OF NEW YORK TITLE No. 01-3704-39757-SUFF. NOTE• SUBSURFACE SEWAGE DISPOSAL SYSTEM & DRAIN DESIGN BY JOSEPH FISCHE777, P.E. HOBART ROAD SOUTHOLD, N. Y. 11971 (631)765-2954 AREA = 23,800) SO. FT. FILED IN THE SUFFOLK COUNTY CLERK'S OFf10E ON AUG. 29, 1963 AS FILE 3653. . \tl W7 I AM FAMILIAR 7H THE STANDARDS FOR APPROVAL AND CONSTRUC770N OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND WILL ABIDE BY THE CONDI77ONS SET FORTH THEREIN AND ON THE PERMIT TO CONSTRUCT. The location of public water, wells and cesspools shown hereon are from field observations and or from data obtained from others. 4` �t tib )27 "rS LIC. NO. 49 PECONIC SURVEYORS, P.C. (631) 765-5020 FAX (631) 765-1797 P.O. BOX 909 1230 TTNA VELER STREET SOUTHOLD, N. Y. 11971 101-171