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,rc-r Z SUFFOI G Town of Southold 4/10/2023 y� P.O.Box 1179 o - o .� 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39462 Date: 1/22/2018 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 975 Westview Dr.,Mattituck SCTM#: 473889 Sec/Block/Lot: 139.-1-4.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/18/2017 pursuant to which Building Permit No. 42085 dated 10/24/2017 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ACCESSORY IN-GROUND SWIMMING POOL,FENCED TO CODE The certificate is issued to GCG Bayberry LLC r of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42085 01-17-2018 PLUMBERS CERTIFICATION DATED Au o 'ze Si ature t� TOWN OF SOUTHOLD !; BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY dol ,� Baa BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 42085 Date: 10/24/2017 Permission is hereby granted to: GCG,Bayberry LLC 81 Harvard Ave Rockville Centre, NY 11570 To: construct an in round swimming g pool as applied for per DEC and Trustee approvals. At premises located at: 975 Westview Dr., Mattituck 7 SCTM # 473889 Sec/Block/Lot# 139.-1-4.2 Pursuant to application dated 10/18/2017 and approved by the Building Inspector. ji To expire on 4/25/2019. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 $300.00 Building Ins r__ t Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 !� APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must'be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I Wlead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6: Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)'non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly coinpleted application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Bailding Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy- New dwelling$50.00, Additions to dwelling$50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessorybuilding$50.00, Additions to accessory building$50.00, Businesses $50.00 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00 Date. New Construction: Old or Pre-existing Building: r/_ g g (check one) Location of Property: ,i / Ws4ye•r tT House No. Street Hamlet Owner or Owners of Property: C Suffolk County Tax Map No 1000, Section Block 1 Lot , o Subdivision Filed Map. Lot: Permit No. S Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ X Applicant Signature ii Certificate of Compliance i= CERTIFIED ELECTRICAL':INSPECTIO'NS; o, C F:;188PARK" AVE NUE AMITYVIL' L-E- 1701 - P: (631)598-5610 i ;l JAN1' 9 2018' f . ... ..... .__... + ' ,CERTIFIES.THAT'; _ „i _pon-the application of UP' n remises owne' - 1i -,GC Electrical Inc., ' GC,G.Baybe`rry:-_= ; :tlIWhTOF,_SOYJT�® T- '-102;Keyland,Court975 Westview:Drive° - �� `Bohemia, NY 11716 +. _ Mattituck NY,11 952 - (° Located at: 975 Westvi w ' •` l c;_ - s a Drive '-' Mattituck, NY-11952` a x-,+l �T l'p _F,, , — == ; t --1s+ - i!-- #' -48478`h_Cetficate#_ 1848478'_- _'j 11 Application- m8 _2909ME' ;�,!ElectricalLicense - 1r _ l -Section: -_Block: Lot:' Building Permit-#. 42085 i l Described as a Residential,occupancy';,'wherein the-premises-electrical system consisting of j( electrical devices and wiring, described below, located ih[6n the,premises'at:_ =,_', Inground Swimming`Pool ' A visual inspection of the premises electricah system;limited to'electrical;devices an wiring to„ the extent detailed herein; was conducted in accordance with the requirements of the applicable ' code'/or standard promulgated by the State of New York,: Department of.S_tate`Code' nfbrcem6nt and-Administration, or other authority having jurisdiction,,and found,to be in compliancether'ewith. r " on the, 17th day of January 2018:'' I Name +, f` GFI-Receptacle.-'-15Amp; 120V - ;=_i "r' �- `''_' ;',' ___ ' -= it = Pool Key Switch.,-;20;Amp; 120V, ', = Pool:Panel =80 Amp-=240V- it Pool Light Fixture . 15 Amp, 120Vz� ;1a 7 f Pool,Receptacle -_-20'Amp, 220V 1 _4 F j ' it - Swimming,Pool bonding', Electrical Inspector:Anthony Gi'oManol ;`'`` i-,' _,r ( i + 117-:ZVdCAJ.iiii t -, -,tt - -,. �.`���� r,..--•`' iii �l j Ai1 d r i T ai APPROVED=�= _ o_r aJ ,,��-� ': This certificate is not vali&unless raised, s6 _- OF SO�lyo� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ /FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ) FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: 1 S -� DATE INSPECTOR rf SO o�� UTyo ifS_ Ag TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING / STRAPPING [ FINAL t"JIlt' [ ] FIREPLACE & CHIMNEY [ ] -FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE 1I 1A 1191 INSPECTOR FIELD INSPECTION REPORT DATE CO l I is 4, � FOUNDATION1ST ( ) CIQ y ------------------------------------ C FOUNDATION (2ND) E4 z 0 ROUGH FRAMING.& PLUMBING y �7 INSULATION PER N.Y. STATE ENERGY CODE ft lt� FINAL V2 ADDITIONAL COMMENTS P'/m, ClAhRgiz t Its rn 1 N o z x d 4 I ' TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARtMENY " rr` T`' • Do you'have or need the following,,before applying? TOWN HALL . Board of Health x:;SOUTHOLD,NY 11971 3 sets of Building Plans I�zTEL: 7654802 Survey PERMIT NO. Check Septic Form N.Y.S.D.E.C. V Trustees- Examined— rusteesExamined t' � •� 2011 t � � \% �r' Contact: Approvedj • ,20��. D I 0 Disapproved a/c $� OCT ,1 8 2017 et fits 14 S5jef Phone: &3I'_t(14 - ?VS- -Cxk. L BUILDING DIJPT. 'TOWN OF SOUTHOLD Building Inspector APPLICATION.FOR,BUIL••DING.PERMIT, Date , 20__L7 INSTRUCTIONS 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 accordiiig to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or-public streets or areas,and waterways. c.The work covered by this application may not becommenced before issuance of Building Permit. d.Upon-approval of this-application;the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No.-building-shall-be occupied or used in whole or in part for any purpose what-so-ever until'*a Certificate of Occupancy is issued by the Building Inspector. it • APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone`Ordinance 'of the.Town ofSouthold; Suffolk!County;l 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- gulations, aft&to admit authorized"inspecfois on p emises,and,in building for necessary inspections. „(Signature.of cant or e;if a corporation) a2t Wkj— Pcaca /17W ,(Mailing.address of applicant), State whether applicant is owner, lessee, agent,architect, engineer, generaIxontractor, electrician,plumber.or builder Name of owner of premises eaq6e4ci (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. - 44T_ Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: # 9.15" House Number Street Y,-?1/110 iH a&fet3 A AD F1 N1 County Tax Map No. 1000 Sectionnn �� i ► '-t'a t:i !�� , f Block :Lot �. Subdivision_ Filed Map.No:,,.+,i . i. , , Lot (Name) h 21. State existing use and occupancy of premises and intendedMW-we-0 d occupancy of proposed construction: � � 7�. f3 a. Existing use and occuptancy�.. 6-kyv b. Intended-use and occupancy 6i e,,+A-L- 9 PmQ 3'.. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work=_I nS no,)n-,o Vi All( C '1 `. 7 t C 4' (Description) . Estimated Cost „ V (to be paid'on filing this application) 5. If dwelling,number of dwelling units N Lr of dwellinguniis on each floor If garage; number of cars 6. If business, commercial or mixed occupancy, specify natarje'and xt4Lntjgf,-hitype of use. 7. Dimensions of existing structures, if any: Front J��. :Rear Depth 3o Height Number of Stories a Dimensions of same structure with",alterations•or,additions:,Front t Rear Depth Height Number of Stories 28 ' 8. Dimensions of entire new construction: Front � �XJZ PJOLRear Depth 3k Height Number of Stories 9. Size of lot: Front( 23) Rear 'Depth -260 10. Date of Purchase Name of`Former'Owner , 11. Zone or use district in which premises,are situated" ' 12. Does proposed construction violate any zoning law, ordinance or regulation: NQ 13. Will lot be re-graded c ,Will.excess%,fill,be removed,.from,premise YE NO 2 n 14. Names of Owner of.premises .. � Ad'dress.-7 Womhv l( Ka Phone:No.631-25T- 3798 Name of Architect AAddtess -Phone'No Name of Contractor vc YJmSAddress�i �x,2�+ Phone No. a_S1-7-K4-71 R Hi 0eA_ RaCQ 15. Is this property within 100!feet of a tidal wetland? *YES NO • IF YES, SOUTHOL•D TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey,to scale,-with accurate foundation plan and distances to property lines. 17. If elevation at any point'on property is at 1 U''feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF l �, moi,, �1 h�►� V�W�f-S being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) abov e named, (S)He is the (Contractor, Agent,Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief, and that the workVill be performed in the manner set forth in the application filed therewith. Sworn to before me this i �- day of bA,(- 201 kj (� otary Public Signature o plicant MARGARET A. KIDNEY o Notary Public-State of New York No. 01 K160211 1 1' Qualified in Suffolk County My Commission Expires March 8,20id E NEW YORK STATE l"1EPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-473'•-03947 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: CHARLES M TH( MAS THOMAS PROPERTY 206 LINCOLN ST 975 WESTVIEW DRISCTM#1000-139-1-4.2 RIVERHEAD,NY11901-0877 MATTITU CK,NY 11952 (631) 727-7993 Facility Applicah,4,n Contact: 7MO ENVIRONM -NTAL CONSULTING PO BOX 447 QUOGUE,NY 11 59-0447 (631) 653-0607 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: MATTITUCK Facility Principal 2efererice Point: NYTM-E: 706.7 NYTNI-N: 4541.4 Latitude: 40°59'51.4" Longitude: 72°32'32.8" Authorized Activi y: Construct a new single family dwelling with decking,pool,pervious driveway, dry�vells and septj .system in the Tidal Wetland Adjacent Area all as shown on the attached survey prepared byNathai Taft Corwinn III,dated 6/15/16, stamped "NYSDEC Approved" on 10/4/16. SAP 1- 09-014 Permit Authorizations Tidal Wetlands - Jnder Article 25 Permit ID 1=4738='3947/00003 New Permit Effective Date: 10/4/2016 Expiration Date: 10/3/2021 G 4 NYSDEC.Approval By acceptance of his permit, the permittee agrees that the permit is contingent upon strict compliance with he ECL,all applicable regulations, and all conditions included as part of this permit. Permit Administr,-;or:GEORGE W HAMMARTH,Deputy Regional Permit Administrator Address: �;� NYSDEC Region I Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY 11790 -3409 / ire: Date Authorized Signa- Page 1 of 7 r Scutt A. Russell .�°Sum SUPERVISOR 1\M1A\N A\ G 1E1\M[1EN`]F SOUTHOLD TOWN HALL-P.O.Box 1179 0 53095 Main Road-SOUrHOLD,NEW YORK 11971 ' O r�r Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET FJ AN 4 2017, ( TO BE COMPLETED BY THE APPLICANT) -- •----DOES`-TITIS-I'MJEC'r—INVOL OF—TI3E—FOLLOWING: Yes O (CHECK ALL THAT APPLY) 9E] A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ! ❑ B. Excavation or filling involving more than 200 cubic yards of material ❑ldwithin any parcel or any contiguous area. c. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑dD. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. El❑ E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. qE] F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind 'replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Cbapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building DepartmcnLviihyouur Building Permit Application. APPLICANT. (Property Owne D sign Profc—mional, gent,Contractor,Other) S.C.T M. = 1000 Datr. �— District NAME C&I aL 4.2— Section .2 -Section Block Lot FOR BUILDING DEPAPTMEiNT t'IS1: Oil- l' Contact Information --�— .76•�w�urnen Reviewed By- - — — — — — — — — — — — — — — — — — Date: Property Address / Location of Construction Work. — — — — — — — — — — — — — — — — Wei;1,�1/4W'1'j ❑ Approved for processing Building Permit tor iat Swer Management Control Plan Not Required. Slormwater Management Control Pia„ s Required. (Forward to Engineering Department for Review.) FORM ' SMCP- TOS MAY 201 a I APPLICANT I � )Property Owner Design Protession�l,,Agent,Contractor,Other) S•C•T•M. ': 1000 aos .� CHAPTER 236 s NAME. Stormwater Management lControl Plan CHECK LIST �kAYI"L tt(ilWU4� Section Block Lot y z S M C P -Plan Requirements: Provide ONE copy of the Building Permit Application, �Z� Q3 Date: o * The applicant must provide a Complete Explanatlon and/or Reason for not providing TtkplgnsMun,hen1 �. all Information that has been Required by the following Checklist! r I A Site Plan drawn to scale Not Less that 60' to the inch MUST If You answered No or NA to any Itm, Please Provide Justification Here! show all of the following items: Y NO NA If you need additional room for explanations, Please Provide additional Paper. a Location.& Description of Property Boundaries b. Total Site Acreage, c. Existing - Natural & Man Made Features within 500 L.F. of the Site Boundary as.required by §236-1702). d Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. EROSION&SEDIMENT CONTROLS `e. Limits of Clearing & Area of Proposed Land Disturbance. ShalLunclude but not be lima ed to: f. Existing & Proposed Contours of the.Site (Mlnimumzincervals) maintained s .0 ion Entrance g. Location of all existing & proposed structures, roads, Silt biliion & driveways, sidewalks, drainage improvements & utilitles. h. Spot Grades & Finish Floor Elevations for all existing & proposed structures. I Location of proposed Swimming Pool and discharge ring, J. Location of proposed Soil Stockpile Areas. k. Location of proposed Construction Entrance/Staging Area(s). DRAINAGE REQUIRED I. Location of proposed concrete washout area(s). C1N5PFC11Q1YS AR ontact TO Engenatzr, m. Location of all proposed erosion&sediment control measures. Backfill- - IJU before �. Stormwater Management Control Plan must include Calculatlons�showingth e i Ieation that the slormwater improvements are sized to capture,store,and infiltrate a e t0 on-site the run-off from all impervious surfaces generated by a two(2"1 inch Code. rainfall /storm event I 3. Details 8 Sectional Drawings for Stormwater practices are required for approval. Items requi-ing details shall include but not be limited to: l a Erosion & Sediment Controls. V ?5:Z,r;p 0"rij3I b Construction Entrance & Site Access. 0 c. Inlet Drainage Structures (e.g.catch basins,trench drains,etc.) 0 d.. Leaching Structures (e. . infiltration basins,swales,etc.) l tett. L.NGINL::L.I-1lNG PAIZ"I'MENT USE ONLY Additional Information is Required. Reviewed d eBy.& I Stormwater Manageme t ConSbT 9 complete. Approved r ® i - - - - - - - - - - - r -TeVVNQF-SOUTH= - - - Stormwater Management Control Plan is Complete. Date: -( -/� SMCP has been approv Id by the Engineering Department. FORM " SWCP Check List - TOS MAY 2014 o�pf S0�1�0 op Town Hall Annex WTelephone(631)765-1802 54375 Main Road `" { 659502 P.O.Box 1179 G y roger.richertt�fov n southold.nv.us Southold,NY 11971-W59 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: -(age .A- Date: 1H 7 Company Name: C,1�C Name: License No.: Address: a 2 ww,b Com. I Phone No.: JOBSITE INFORMATION: ((*Indicates. required information) *Name:. &Qqheaq *Address: qW OAyi& f- *Cross-Street: Ern P, 2 9,0 *Phone No.: i -2'S-?. 3-7 q _ P,,tij Permit No.: If2 0 9 Tax Map District: 1000 Section: j 3 Q Block: I Lot: *BRIEF DESCRIPTION OF-,WORK(Please Print Clearly) (Please Circle.All-That Apply) *Isjob ready for inspection: YES NO Rough In Final *Do you need a Temp Certificate: YES / O Temp information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 3001 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH-APPLICATION 1 82-Request for Inspection Form SO!/r�,Ql Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Q �y�DUNTY,�� January 18, 2018 BUILDING DEPARTMENT TOWN OF SOUTHOLD GCB Bayberry LLC 81 Harvard Ave Rockville Centre, NY 11570 Re: 975 Westview Dr, Mattituck TO WHOM IT MAY CONCERN: The Foil 'ng Items(if Checked)Are Needed To Complete Your Certificate of Occupancy: ectri I U rwri s Certifica — all 765-1802 to s ction A fee of$50.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 411/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. (Planning#765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept. Final Storm Water Runoff Approval from Town Engineer BUILDING PERMIT — 42085 — Swimming Pool i ';,SUFFOLK COUNT.YrDEPT/OFAABOR }L, LICENSING b CONSUMER�AFFAIRS.,i k '�-QME IMP_R VgM T e �a'•y 'r CONTRACTOR �• ' LICENS I D.W'/ARD GATT0'�- Thggles that theyWARk.orrgs::, T�• i ,� bearg�ls IN duly -R` ,Y;`' ` esvno� • Gcqnsed,tij!the C only of,Suffolk "" ""~ ? �. �r 1• �� r 34486-H 4 tw`t SIO i7 = al WFArw an 03/01/2018 ;t m P � i a New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEWYORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^ 113528926 EDWARD GATTO INC 275 BAYER ROAD MATTITUCK NY 11952 ❑ ■ Scan to Validate POLICYHOLDER CERTIFICATE HOLDER 645 SOUTHERN CROSS EDWARD GATTO INC TOWN OF SOUTHOLD 275 BAYER ROAD 54375 ROUTE 25 P O. BOX 1179 MATTITUCK NY 11952 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11088153-0 871185 08/06/2017 TO 08/06/2018 10/5/2017 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 1088153-0, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS./MNVW.NYSIF.COM/CERT/CERTVAL.ASP THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. EDWARD GATTO PRESIDENT OF EDWARD GATTO INC (A ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY i i I NEW YORK STATE INSURANCE FUNC DIRECTOR,INSURANCE FUND UNDERWRITING i 0 ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/05/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ios) must be endorsed. If SUBROGATION IS WAIVED, subject to the to6s and conditions of the policy,certain policies may require an endorsement A statement on this cortificato does not confer rights to the certificate holder in liou of such ondorsoment s. PRODUCER CONTACT NAME: Timet I y S Purdy PHONE F . (631)821-2200 AA/C No):(631)821-2296 45 Route 25A suite D2 E AO Shoreham, NY 11786 INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A. Farm Family Casualty Insurance Company INSURED `�VW~ INSURER 0: Edward Gatto Inc INSURER C: 275 Bayer Road INSURER D: INSURER E: Mattituck NY 11952 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBRi`TR TYPE OF INSURANCE POLICY NUMBER MW CYE PO LIMITS A X COMMERCIAL GENERAL LIABILITY 31520374 02/07/17 02/0718 EACHOCCURRBNCE $ 1,000,000 CLAIMS-MACE LX OCCUR I F — 3 100:000 X Contractual Liability MED EXP one son) 3 5,000 _ PERSONAL&ADV INJURY 3 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000.000 X POLICY E LOC PRODUCTS-COMP/OPAGG S 1,M0,000 OTHER: S AUTOMOBILE LIABILITY (COED�NGLIE E I d nt I WT S ANY AUTO BODILY tNJURY(Por pormn) S ALL OMED SCHEDULED BODILY INJURY(Por ocadonl) f AUTOS AUTOS FAIRED AUTOS NON-OVWED 0 S AUTOS (Por now'74) S UMBRELLA'LUAB OCCUR EACH OCCURRENCE S I'— EXCESS LIAB CLAIMS-MADE AGGREGATE S I DED , I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS'LIABIL1Tr T R STA YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED'? - "•- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S It req doxfibo undo( DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LWUT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddlUonal Romano Schoduia,may be attached It moro apace Is roqulred) Residential Carpentry CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 50983 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold, New York 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �� ^ ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD 25(2013104) The ACORD name and logo are registered(narks of ACORD ORRK Workers' CERTIFICATE OF ATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board a Legal Name&Address of Insured(use street address only) Business Telephone Number of Insured Arthur J Edwards Mason Contracting Co., Inc 631)744-7185 29 Route 25A Miller Place,NY 11764 I c.NYS Unemployment Insurance Employer Registration Number of Insured 1 d.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Orly regrrired ircmvirrge is specUcally lfmiled to 11-2377925 2.Name and Address of Entity Requesting Proof of Coverage(Entity 38. Name of Insurance Carrier Bing Listed as the Certificate Holder) AmTrust Ins Co of Kansas; Inc: Town of Southold b. Policy Number of Entity Listed in Box.,I a' WC-RWC3405186 Town Hall c. Policy effective period to Po box 728 63/0V2017—03/0V2018 /2018 Southold,NY 11971 a. The Proprietor,Partners or Executive Officers are Included. (Only check box if all partners/officers inclu all excluded or certain partnerstofftcers excluded. This certifies that the insurance carrier indicated above in box 7'insures the business referenced above In box'I a'for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation Insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder In box°7'. This certificate Is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or after the coverage afforded by the policy listed,nor does It confer any rights or responsibilities beyond those contained In the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy Is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business Is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the Insurance carrier referenced above and that the named insured has the coverage as depleted on this form. Approved by: Keeviiy Spero Whitelaw Inc (Print name or authorized representative or licensed agent of insurance carrier) Approved by: February 28 2017 (Date) Title:President Telephone Number of authorized representative or licensed agent of insurance carrier:(914)381-5511 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are N01 authorized to issue it. Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the Insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? YES NO Workers' Compensation Law Section 67.Restriction on issue of permits and the entering Into contracts unless compensation Is secured. 1. The head of a state-or municipal department, board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter.Nothing herein, however,shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 1. The head of a state or municipal department, board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. ARTHU-1 OP IDO VM DATE(MMIDDIYYYY) ��- CERTIFICATE OF LIABILITY INSURANCE 01/09/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 631-864-1111 cT Bagatta Associates, Inc. Bagatta Associates,Inc. PHONE 631-864-1111 FAX 631-864-8274 823 W Jericho Turnpike Ste 1A WC,No Ems: (AIC,No): Smithtown, NY 11787 ESS: Bagatta Associates,Inc. INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A:Cna Insurance Company 20435 INSURED Arthur Edwards Mason INSURER B.Rochdale Insurance Company 12491 Contracting Company Inc. DBA wsuRERc. Arthur Edwards Pool&Spa Centre INSURER 0: Arthur J. Edwards 929 Route 25A INSURER E. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR 6043396248 01/01/2017 01/01/2018 DAMAGETORPREMISES(EaENTED rencel S 100,000 MED EXP(Any one oerson) 5,000 X BLANKET ADDITIONA PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0 jea- EILOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: $ AUTOMOBILE LIABILITY C e eBINEDtSINGLE LIMIT $ ANY AUTO BODILY INJURY Per oerson OWNED SCHEDULED AUTOS ONLY AUTOS yy Ep BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONNLY P08ERr nt AMAGE $ as $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEC) I I RETENTION S S B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN R ANY PROPRIETOR/PARTNER/EXECUTIVE WC3405186 03/01/2016 03/01/2017 ATUTE ER 11000,000 FILE�MEMg��EXCLUDED/ � NIA E.L.EACH ACCIDENT $ andatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It Yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall P.O. BOX 728 AUTHORIZED REPRESENTATIVE Southold, NY 11971 ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workerg' CERTIFICATE OF INSURANCE COVERAGE A1nE Compensation UNDER THE NYS DISABILITY BENEFITS LAW 8oam PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a. Legal Name and Address of Insured (use street address 1 b. Business Telephone Number of Insured only) Arthur J Edwards Mason Contracting Company (631) 744-4455 Inc 1c. NYS Unemployment Insurance Employer Registration 929 Route 25A Number of Insured Miller Place, NY 11764-2700 24-10871 1d. Federal Employer Identification Number of Insured or Work Location of Insured(Only required if coverage is specifically Social Security Number limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 11-2377925 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Lasted as the certificate Hoiden The Guardian Life Insurance Company of America Town of Southold P.O. Box 728 3b. Policy Number of entity listed in box 1a": Southold, NY 11971 00984424-0000' 3c. Policy effective period: 07/01/2017 to 07/01/2018 4. Policy Covers: a. ® All of the employer's employees eligible under the New York Disability Benefits Law b. ❑ Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. s bit -:5- S haw Date Signed: 07/07/2017 By: Stuart J. Shaw, FSA, MAAA (Signature of insurance carriers authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number: 1-888-278-4542 Title: Vice President,Group Insurance IMPORTANT: If Box"4a"is checked,and this form is signed by the Insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail It directly to the certificate holder. If Box"4b"Is checked,this certificate Is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law.It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,328 State Street,Schenectady,NY 12305 PART 2. To be completed by NYS Workers' Compensation Board(Only if box'Ab"of Part 1 has been checked) State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed: By: (Signature of NYS Workers'compensation Board Employee) Telephone Number: Title: Please Note:Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (09/15) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box "3" on this form is certifying that it is insuring the business referenced in box "1 a"for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box "2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? ❑ YES ® NO This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220.Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all employees has been secured as provided by this article. 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'e. >i_ _ ;. -_� le `''��s =y4• L v�t�bg a n 'K.R. �r �r•i w"4 l 7��^ i } ��.rrj• • • t _O _ • • � '•• •_ fey:l �+ • •• • L•i l.ltili�� . �t t C4 .� -• -Y �•�a'�oau�wx�rmm��r s w..}.K rn�oenwF-.�.�»,wps7w�as .,lyy3y��cgr>�.••-:sa�cQ•x»;xrcnronmur.�psrtmasm+rcmsa�-asmr o.m.M-a�..�srvn..m,.�m•::�vars._w��m• gg� � .. f tfx '�/ ��• i s ,t \ � �Ff' t/. 3 f/�� �r ec=rR •!�, i:+ar,r _ n _ c -�. - r�Cs GB;ta• -+� "sC / \:� r "� tt+- u .,�` _ l' sujf•` :zi fru' ri�F;y•;,. ,!�;: �1�. 'x ">;: r .�rxaca�'+ .^. ...., xxie .t•G<,re ,rte-. ",�,,"... r -amu .. �r4!* - .x .2r :vi#t ti' 4'-�Gs r� z. # }��k1 Y Sr��r�}...-rr "•lf `� 7 SUFPOLK =�y+`TY EPT OF FQ7 ORV F tilt t �G CONSUMER FAIRS ( STAR R - _ • - _, ELECTRICIAN i f TH R_ � . . I iC ELECTRIC INC - y Date. Issued ME 1 0/04/1982 EmXPRATI,DN DATE 10/01/2019 r AP R VEDAS NOTED D CO"��+, 1• ,:;�!7'F1 ALL CODES OF DATE:( Z� B.P.# a NE—VV `r'C r, C STATE: & TOWN CODES FEE: iBU BY a 'AS REG'j;RED AND CONDITIONS OF N0TIF ILDING DE PF F ER THE 765-1802 8 AM TO 4, M. — SOUT+ OLD TOWty ZBA FOLLOWING INSPECTIONS: _ _SO�'THOL^TOV;!N PLANING BOARD CONCRETE 1. FOUNDATION -CTWOQUIRED FOR POURED SO THOLO TO"ANTRUSTEES 2. ROUGH - FRAMING & PLUMBING N.'Y•S DEC 3. INSULATION 4. FINAL - CONSTRUCTION .MUST BE COMPLETE FOR CO. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW OCCUPANCY OR YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ��E �S U N LAII VW F� ° WITHOUT CERTIFICATE OF OCCUPANCY CAL AIRED RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. "1MIUIEMAT .. ELY a ENCS_-Sr- POOL TO'CODE„ l.-TION E?tFOFsE ";IVA ori" A �1 SNwr ere Rohn= B ® B ,�u E F ' ro nu, Fran FOfar R Prer�p To Irasb/ — �To � � oll �7 Red Mlos Foci Plan " Piping Arrangement wa wyl H R"42" Section B—B H 1 0" Section A—A Typical Wall Section SIZE A B C D E F G H AREA CAP. FEET FT. FT. FP. FT. FT. FT. FT. FT. SQ.FT. GAL. PraaLe.e 16X32' 16' 32' 8' 14' 6' 4' 4' 8' 512 19,000 _ q7,5 r r r 16 X36 16 36' 12' 14' 6' 4' 4' 8' 576 21,600 POOL�k SPA CE[v M 18'X36' 16' 36' 12' 14' 6' 4' 5' 8' 648 24,300PERMACRETE WALL SYSTEMI-'�` l/G�C � 929 Route 25A Miller Place NY 11764 cKy 20'140' 20' 40' 16' 14' 6' 4' 6' 8' 800 30,000 (631) 744-7185 FAX (631) 744-0174 J 8� 379 �qb� 24'X44' 24' 44' 18' 14' 8' 4' 6' 10' 798 30,000 Suffolk License #4436—HI 24'X48' 24' 48' 20' 16' 8' 4' 6' 10' 900 30 000 Nassau License #HI7445OOOO 50•p0� S SURVEY OF PROPERTY SITUATE RO N TYPICAL STORMWATER UNIT (TOPS TO BE TRAFFIC BEARING) MATTITU C K N OE (NOT TO SCALE) -g R, CAST IRON INLET FRAME a COVER (FLOCKHART fe351e TYPE eB4D) OR e'THICK REINFORCED CONC. TOWN OF S 0 U T H 0 L D FINISHED GRADE BEARING SLAB SUFFOLK COUNTY, NEW YORK 1. 1000 S.C. TAX No. - = PIPE FROM ROOF GUTTERS 3 9-01 4.2 SCALE 1 "=20' Au SAN/4• _ 1_1,2• STONE JUNE 1 5, 2016 ~ LEACHING RINGS U NOVEMBER 30, 2016 REVISE PER SCDHS NOTICE No. 1 REINFORCED PRECAST CONC. 3.�. 4000 PSI O 2e DAYS 3'-0' min.) o�� 41 (mM') TOTAL AREA = 21,321 sq. ft. (TO TIE LINE) 0.490 ac. 1 E UPLAND AREA = 20,097 sq. ft. ' GROUND WATER Im DRALEACE SYSTEM CALCULATIONS. LOT COVERAGE DATA 'OVER UPLAND AREA C 1 ROOF AREA: 1,740 sq. ft . 1 {, 1,740 sq. ft. X 0.17 = 295.8 cu. It. DESCRIPTION AREA X LOT COVERAGE i LA N 1 = n 295.8 cu. ft. / 42.2 = 7 vertical ft. of 8' dia. leaching pool required PROVIDE (2) 8' dia. X 4' high STORM DRAIN POOLS HOUSE W/ PORCH 1,737 sq. ft. 8.7X 14.6 DECK Irp2 v DRIVEWAY AREA: 860 sq. ft. 285 sq. it. 1.4X 1 � � \ g 860 sq. ft. X 0.17 = 146.2 cu. ft. 146.2 cu. ft. / 42.2 = 3.5 vertical ft. of 8' dia. leaching pool required INGROUND POOL 648 s ft. 3.2X PROVIDE (1) 8' dia. X 4' high STORM DRAIN POOL WITH OPEN GRATE q• - 1 � TOTAL 0/1 ETO / ` \ PROPOSED 8' DIA. X 4' DEEP DRYWELLS FOR ROOF RUN-OFF ARE SHOWN THUS: --- 2,670 sq. ft. 13.3X 1 x \/ TEST _ ,� PROPOSED 8 DIA. X 4 DEEP DRYWELL WITH OPEN GRATE FOR DRIVEWAY ARE SHOWN THUS: \ �•:.a..•y ^ x Zn o PROPOSED SEPTIC SYSTEM DETAIL s+: ::. ••:•...:: : \ HOUSE (NOT TO SCALE) 9 ELEV. ]A,`�' FINISHED GRADE . x FINISH GRADE FLAG - �� \ �\\. Q.. \ - •.. ELEV. 13.5' ELEV. 12.0' TEST HOLE DATA M6 ` ` ` •• :' 1, CAST IRON COVER TO GRADE PRECAST;REINFORCED CONCRETE COVER �• +A 24'dia. LOCKING, WATERTIGHT k INSECT PROOF \ BURIED DEEP min. 2' DEEP max. (TEST HOLE DUG BY MCDONALD GEOS 1 NG ON NOVEMBER 25, 2014) v \ \ ` :.. - ..: "� I y'f.z �. O TOP EL. 12.4' 18'.MIN. TOP EL 10.5' .. V MIN. o' ::.... MIN. 4 DIA. 6' BROWN SANDY Law OL X22 \ ` I :{: ; .'? :: ' ' r i s oG •,�s SEPTIC LEACHING LEACHINGT 3' CLEAN Dom' A' APPROVED PIPE TANK APPROVED PIPE : : a'i INV. EL. GALLEY I :::::::::: ::::::: :. . \ o \• J,N N%_ 11.6' min. PITCH 1/4"/1' VINV. u� min. PITCH 1/8/1' o GALLEY ? SAND PALE BROWN SBT ML EL. 11.2' o COLLAR gg 1 , p INV. EL 9.7 �' :: y 8• INV. EL. 8' . BROWN SILTY SAND SM tt }�-- 7^? }f--'-8•• �--,8'a -++} •Z w HIGHEST EXPECTED GROUND WATER 4' . •:•::�:: :•::•:�:�::i:•:'•:•.�.;•::.:�:.�:::::.:: • :' PALE BROWN FINE SAND SP EL 3.0' HIGHEST EXPECTED GROUND WATER 11 A4 X ` / v SEPTIC TANK (1) BOT. EL. 5.0' BOT. EL. 6.0' - 1D.4' 1' ABOVE AVERAGE HIGH 1VATER MARK O :: ELEV 0.0 GROUND WATER EL 0.0. 13.4' HIGH WATER ELEVATION 2.0' 1. MINIMUM SEPTIC TANK CAPACITIES FOR A 5 BEDROOM HOUSE IS 1,500 GALLONS. x� \ a •�� ;.:.:,:� :::i�;:;:;•;:.�:•. �!. 1 TANK; 8' DIA., 6' HIGH (5' EFFECTIVE DEPTH) LEACHING GALLEYS (4) WATER IN � 1 � 2. CONCRETE SHALL HAVE A MINIMUM COMPRESSIVE STRENGTH OF 3 000 psi AT 28 PALE BROWN FINE SAND SP 6 -+ it}: F DAYS. 5'a 1024 .:;:; \A'::: ::.::`,�' / 1. MINIMUM LEACHING SYSTEM FOR 5 BEDROOM HOUSE IS 400 ft SIDEWALL AREA.I 3. WALL THICKNESS SHALL BE A MINIMUM OF 3', A TOP THICKNESS OF 6' AND A BOTTOM THICKNESS OF 4'. 4 GALLEYS; C DEEP, STEM 4.75') 17' f�� O' \ �II ::;,':.. �':;?:: p• / -,y ALL WALLS, BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 300 paf. 2, LEACHING GALLEYS ARE TO BE CONSTRUCTED OF PRECAST REINFORCED CONCRETE OR EQUAL 4. ALL JOINTS SHALL BE SEALED SO THAT THE TANK IS WATERTIGHT. LEACHING STRUCTURES, SOLID DOMES AND/OR SLABS. ( ) I , \ 5. THE SEPTIC TANK SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS (WITH A MAX. TOLERANCE OF t1/4') 3. ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE (OR EQUAL). co W ' � .' ON A MINIMUM 3' THICK BED OF COMPACTED SAND OR PEA GRAVEL • 6. A 10' min. DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED. 4. A 10' min. DISTANCE BETWEEN LEACHING GALLEYS AND WATER UNE SHALL BE MAINTAINED. 5. AN 8' min. DISTANCE BETWEEN ALL LEACHING GALLEYS AND SEPTIC TANK SHALL BE MAINTAINED. x s Z ' 1 x 1 \ z rn XAV _VI x7j ���} NOTES: rn �P �� / / �jo ` 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM EXISTING ELEVATIONS ARE SHOWN THUS: XLX O \ co EXISTING CONTOUR LINES ARE SHOWN THUS: - - -- - � _ - •_ y l 1 I 100 / / 70 / t�' Q S� PROPOSED FIRST FLOORR LINES ARE SHOWN THUS: F.�L E FLOOR '� x� I ' �' /9� LU W F� TB - TOCP OF BULKHEAD So � HAY BALES 2'x2' STAKES > N ,Z�� TW - TOP OF WALL OM OF BULKHEAD (TWO EACH BALE) 8W - BOTTOM OF WALL x-M TlIo1� QsFLOW - GRAD U 2. FLOOD ZONE INFORMATION TAKEN FROM: rn \ I ��� COMPACTED E FLOOD INSURANCE RATE MAP No. 36103CO481 H DRAINAGE ZONE AE: BASE FLOOD ELEVATIONS DETERMINED Qt \ ' I I ' 406. 1 �i��S BACKFILL INS p ZONE X: AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN. (� c \ dF S�� �y . ,{ 3. MINIMUM SEPTIC TANK CAPACITIES FOR 5 BEDROOM HOUSE IS 1,500 GALLONS. A2 �° py 1 TANK; 5 LIQUID DEPTH, 8' DIA. 1 x\ , . \ goo MINIMUM LEACHING SYSTEM FOR 5 BEDROOM HOUSE IS 400 sq ft SIDEWALL AREA. BALES TO R SET 4 LEACHING GALLEYS; 8.5' LONG, 4.75' WIDE, 4' DEEP \ \ \ IN 4' TRENCH \ ��' \ CIP 50' MIN. �N oR TO BE SUFFICIENT To FARRIER O INLETS r 1 \ 1 KEEP SEDIMENT ON SME sroRrl►drER �A►�cE aNr Noras: L__J PROPOSED FUTURE 50% EXPANSION GALLEY 1. ANY WORK OR DISTURBANCE, AND STORAGE OF CONSTRUCTION I \ \� SUFFOLK COUNTY DEPARThIENT OF HEALTH SERVICES I HAYS�'� MATERIALS SHALL BE CONFINED TO THE UNIT OF CLEARING , SILT FNc AND/OR GROUND DISTURBANCE SHOWN ON THE APPROVED PLANS. ® PROPOSED 8.5 LONG x 4.75' WIDE x 4' DEEP LEACHING GALLEY PERMIT FOR APPROVAL OF CONSTRUCTION FORA $ 2. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, • �J \ ' A CONTINUOUS UNE OF SILT SCREEN (MAXIMUM OPENING OF SINGLE: FAMILY RESIDENCE ONLYbi U.S. SIEVE *20) SHALL BE STAKED AT THE LIMIT OF CLEARING O EI STEEL OR wood AND GROUND DISTURBANCE SHOWN ON THE APPROVED PLANS. PROPOSED 1,500 GALLON SEPTIC TANK POST TYP. THE SCREEN SHALL BE MAINTAINED, REPAIRED AND REPLACED AS �� \ �� p �}• EXTRA STRENGTH FILTER FABRIC ( ) l I _____ REQ'D. WITHOUT WIRE MESH SUPPORT OFTEN AS NECESSARY TO ENSURE PROPER FUNCTION, UNTIL ALL 1 Oh 0 --------- DISTURBED AREAS ARE PERMANENTLY VEGETATED. SEDIMENTS ZO` �,�� DATE Elz` / .5, REF. N0. �Q V O I N 10' MAX. O.C. SPACING TRAPPED BY THE SCREEN SHALL BE REMOVED AWAY FROM THE 4. ALL HOUSES WITHIN 150 ARE CONNECTED TO PUBLIC WATER. r ' / O j w/ WIRE SUPPORT FENCE SCREEN TO AN APPROVED UPLAND LOCATION BEFORE THE �1 �V 6' MAX. O.C. SPACING SCREEN IS REMOVED. 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD APP ROVE n / �v /ti/ W/O WIRE SUPPORT FENCE ;„ 3. PRIOR 70 THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. :•.! A CONTINUOUS ROW OF STAKED STRAW OR MAY BALES SHALL FOP, 1�9/iXIh1U6t OF -,4: ,. .; •f BE STAKED END TO END AT THE BASE OF THE REQUIRED SILT 6. ANY WETLAND BOUNDARIES SHOWN ARE SUBJEC 130 IIEDROOms SCREEN AT THE BASE OF THE REQUIRED SILT SCREEN. THE BALES BY NEW YORK STATE AND/OR NAY BALES AND/OR •}••� ;.,? g(�01f SHALL BE MAINTAINED, REPAIRED AND REPLACED AS OFTEN AS IS / R OTHER RE ORY AGENCIES. EXPIRE. THREE YEARS: FROM DATE OF APPROVAL S`T FENCING •;: '� NECESSARY TO ENSURE PROPER FUNCTION, UNTIL ALL DISTURBED -r - _ , AREAS ARE PERMANENTLY VEGETATED. THE AVERAGE USEFUL UFE - •' `!• - " OF A BALE IS 3-4 MONTHS. SEDIMENTS TRAPPED BY THE BALES MWARMANA�€�R PjJ�N VIEW r SHALL BE REMOVED AWAY FROM THE BALES TO AN APPROVED ATTACH FILTER FABRIC SECURELY UPLAND LOCATION BEFORE THE BALES THEMSELVES ARE REMOV:D. TO UPSTREAM SIDE OF POST 4. STRAW BALES SHALL BE RECESSED TWO TO FOUR INCHES INTO THE GROUND. APPROVAL OF S OCCAyAT10sN JNS•Iz,. ••�, • S. SILT SCREEN SHALL BE RECESSED BY TRENCHING SIX INCHES INTO THE GROUND. cadre FOR SAN ACTIO,1d e. LEADERS AND GUTTERS THAT EMPTY INTO DRYWELLS SHALL BE INSTALLED COWROL PLAN TO I]•gRY SYSTEM �� ON THE PROPOSED RESIDENCE. BY HEALTH D SILT FENCE DETA/L4 7. ALL PROPOSED SWIMMING POOL DISCHARGES SHALL BE DIRECIED TO DRYWELLS. EROSION&SEDIMENT CONTROLS Date' 1-10 I EPARrMENT NOT TO SCALE e. PROPOSED DRIVEWAYS MUST BE CONSTRUCTED OF PERMEABLE MATERIALS ROAD OR IF PAVED. BE EQUIPPED WITH DRAINAGE SUFFICIENT TO PREVENT RUNOFF Shall Include but not be limited t0: Approved by FROM BEING DISCHARGED ONTO THE ROAD OR OFF-SITE. A Well maintained Construction Entrance, MAY BALE W,p/OR NOTES: SILT FENCE SHALL BE PLACED PARALLEL To SLOPE CONTOURS TO 9. ALL AREAS OF SOIL DISTURBANCE RESULTING FROM THIS PROJECT SHALL BE _ sLT coNsrRuc,aN . FRANCE BASE OF EACH MAXIMIZE STORMPONDING EVENTEFFICIENCY. AND REMOVE SEDIMENT WHEN NECESSARY. REMOVED IMMEDIATECT AND REPAIR SILT FENCE AFTER SEEDED ELY UPON COMPLETION OFPERENNIAL PROJECT, WTHINMULCHED (2) DAYSOFSTRAW Wire Backed Silt Fencing, stabilization & NOTESo COMPACTED 3/4 STONE BLEND SEDIMENT SHALL BE DEPOSITED TO AN AREA THAT WILL NOT ALLOW FINAL GRADING, OR BY THE EXPIRATION DATE OF THE BUILDING PERMIT, Seeding pose(.j I f,11if?$0115. 1. AREA CHOSEN FOR STOCKPILING OPERATIONS OR N.Y.S. D.O.T. APPROVED R.C.A. r)f pr�»tO,pd Pnrilnr'na ,+' TO BE USED WHERE TOPSOIL IS NECESSARY FOR OFF-SITE TRANSPORT. WHICHEVER IS FIRST. MULCH SHALL BE MAINTAINED UNTIL A SUITABLE FILL TO 16' MIN. ABOVE EXISTING REGRADING t VEGETATING DISTURBED AREAS. SHALL BE DRY AND STABLE. GRADE TO ALLOW FOR DPANAGE VEGETATIVE COVER IS ESTABLISHED. IF SEEDING IS IMPRACTICAL DUE TO PREPARED IN ACCORDANCE WITH THE MINIMUM TEMPORARY STOCKPRLE STABILIZATION MEASURES INCLUDE 2. MAXIMUM SLOPE OF STOCKPILE SHALL BE 2:1. TIME OF YEAR, TEMPORARY MULCH SHALL BE APPLIED AND FINAL SEEDING STANDARDS FOR TITLE SURVEYS AS ES'T'ABLISHED VEGETATIVE COVER, MULCH, NONVEGETATiVE COVER, AND 3. UPON COMPLETION OF SOIL STOCKPILING, EACH CROSS SECTION 36' HIGH POLE (MAX.) PERFORMED AS SOON AS WEATHER CONDITIONS FAVOR GERMINATION BY THE LI.A.L.S. AND APPROVED AND ADOPTED PERIPHERAL. SEDIMENT TRAPPING BARRIERS. THE PILE SHALL BE SURROUNDED WITH EITHER SILT STEEL OR WOOD POST AND GROWTH. FORESUASSOCIAE BY YORK STATE LAND STABILIZATION MEASURE(S) SELECTED SHOULD BE FENCING OR STRAW BALES, THEN STABILIZED WITH 10. SUITABLE VEGETATIVE COVER IS DEFINED AS A MINIMUM OF 85% AREA 'DRAINAGE INSPECTIONS ARE RE IRED W APPROPRIATE FOR THE ME OF YEAR, SITE CONDITIONS, VEGETATION OR COVERED. TEMPORARY CONSTRUCTION ENTRANCE FLOW VEGETATIVE COVER WITH CONTIGUOUS UNVEGETATED AREAS NO LARGER QU r ~- THAN 1 SQUARE FOOT IN SIZE. Contact TOS Engineering at 765-1560 A. � AND REQUIRED PERIOD OF USE. (NOT TO SCALE) 11. ALL CONSTRUCTION ACCESS WAYS SHALL BE RAISED SUFFICIENTLY AT THEIR before �-, SLOPE OR LESS SITE ACCESS LOCATIONS WITH THE EXISTING ROADS, TO PREVENT RUNOFF Backfill, OR Provide Engineer's Certification OF WATER, SILTS AND SEDIMENTS FROM BEING DIRECTED OR DISCHARGED ONTO ftt the drainage has been installed to Code. ~ STABILIZE ENTIRE PILE �, � �, N, 1 WITH VEGETATION OR COVER THE ROAD. ANON-LOAM BASE MATERIAL. SUCH AS CRUSHED STONE, GRAVEL. 1, v, y �, OR RECYCLED CONCRETE BASE, SHALL BE PLACED ACROSS THE DRIVEWAY OR � Z CONSTRUCTION ACCESS WAY AT THE ACCESS POINT ALONG THE ROAD.41 _ *t2 �, W �, y 41 J, �, �, �, a 4' X 6' TRENCH W/ COMPACTED °ACXFILL N.Y.S. Lic. No. 50467 UNAUTHORIZED /LL.TEA VIOL OR ADDITION Lathan Taft Corin III TO THIS SURVEY IS A VIOLATION OF y SECTION 7209 OF THE NEW YORK STATE EDUCATION OF` Land Surveyor COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR STRAW BALES OR SILT FE EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. SOIL STOCXPILE CERTIFICATIONS INDICATED HEREON SHAU. RUN Successor To: Stanley J. Isaksen, Jr. L.S. ONLY M THE PERSON FOR WHOM THE SURVEY Joseph A Ingegno L.S. NOT O SCALE IS PREPARED. AND ON HIS BEHALF TO THE TITLE LENDICOMPANY.INSTITGOVERNMENTAL ED AGENCY MID D Title Surveys - Subdivisions - Site Plans - Construction Layout TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 FOX (631 727-1727 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. ( ) • THE EXISTENCE OF RIGHT OF WAYS �� LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jalmesport, New York 11947 Jamesport. New York 11947