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HomeMy WebLinkAboutL 12994 P 260 1111111111111111111111111111111111111111111111111111111 1111111 lllli full 1111 1111 SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: AGREEMENT Recorded: 12/26/2018 Number of Pages : 15 At: 12 :27 :21 PM Receipt Number : 18-0239921 LIBER: D00012994 PAGE : 260 District: Section: Block: Lot: 1000 034 . 00 03 . 00 012 . 000 r EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $0 . 00 YES Handling $0 . 00 YES COE $0 . 00 YES NYS SRCHG $0 .00 YES .Affidavit $0 . 00 YES TP-584 $0 . 00 YES Notation $0 . 00 YES Cert.Copies $0 . 00 YES RPT ' $0 . 00 YES Fees Paid $0 .00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County Number of pages � , � `,' RECORDED 2018 Dec 26 12:27:21 PM JUDITH A. PASCALE This document will be public CLERK OFSUFFOLK COUNTY record. Please remove all L D00012994 Social Security Numbers P 260 prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 1 FEES — Mortgage Amt. Page/Filing Fee I 7 1.Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-52 17(County) Sub Total Spec./Add. EA-5217(State) TOT.MTG.TAX R.P.T.S.A. Ij©Q Dual Town Dual County Held forAppointment Comm,of Ed. 5. 00 Transfer Tax fig� eertifiedCopy avit • + Mansion Tax {; �j"�rf?��� The property covered by this mortgage is ' ` t .� or will be improved by a one or two NYS Surcharge 15. 00 `? �' family dwelling only. Sub Total YES orNO Other Grand Total `� -Gv � If NO, see appropriate tax clause on page# of this instrument. 4 1 Dist.1000 3734085 1000 03400 0300 012000 5 Community Preservation Fund Tax ReaIServi ServiceProperty P T S Agency R POL IIIIIBIIIIII�llllllll�llllllllllllllllllll CPF Tax Due Amount$ A Verification 09-OCT-1 _ --� Improved Satisfactions/Discharges/Releases List Property Owners Mailing Address 6 RECORD&RETURN TO: Vacant Land Jennifer Freese Public Health Sanitarian TD Office of Ecology 360 Yaphank Avenue TD Suite 213 Yaphank, NY 11980 TD Mail to:Judith A. Pascale,Suffolk County Clerk 7 Title Company information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffolkcountyny.gov/clerk Title# 8 Suffolk County Recording & Endorsement Page This page forms part of the attached Septic Improvement Program Grant Agreement made by: (SPECIFY TYPE OF INSTRUMENT) Clifford J. Harris and Kelly A. Harris The premises herein is situated in 207 Knapp Place,Greenport,NY 11944 SUFFOLK COUNTY,NEW YORK. TO In the TOWN of Suffolk County Septic Improvement Program; In the VILLAGE Office of Ecology; Septic Improvement Program or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over RESIDENTUL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT Si'STENI GRANT Rev. 7117117; 17-MLWA-0199;Law No. I8-HS- Contract No.406-6422-4770-00-00103 Page I of 12 RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT SYSTEM GRANT This RESIDENTIAL INNOVATIVE AND ALTETIVE NSITE WASTEWATER TREATMENT SYSTEM GRANT (the "Grant") is made t, day of 2017 between the County of Suffolk (the "County"), a municipal corpor�ltto of the State of New York, acting by and through its Department of Health Services (the "Department"), having its offices at 3500 Sunrise Highway, Suite 124, Great River, New York 11739-9006 and Clifford J. Harris and Kelly A. Harris (collectively referred to as "Grant Awardee"), who hereby represents and warrants that he/she is the owner of certain property by deed dated April 3, 2016 and recorded in the Office of the Suffolk County Clerk on April 29, 2016 in liber 12862 and page 642, known as 207 Knapp Place, Greenport, New York 11944, in the Town of Southold designated on the Suffolk County Tax Map as District 1000, Section 03400, Block 0300, Lot 012000, and as more particularly described in Addendum A attached hereto (the"Residential Parcel"). WHEREAS, the voluntary installation by homeowners of Suffolk County Department of Health Services (the "Department") approved Innovative and Alternative Onsite Wastewater Treatment Systems ("IIA OWTS," pronounced "OUTS") technologies is one of the first steps to reversing water quality decline in Suffolk County; and WHEREAS, in order to encourage homeowners to install Department approved UA OWTS the County of Suffolk has adopted Local Law No. 15-2017, which established the Residential Innovative and Alternative Onsite Wastewater Treatment System Grant Assistance Program (the "Program"); and WHEREAS, pursuant to the Program requirements, Grant Awardee has applied for and been awarded Grant funding for the design and installation of a Department approved IIA OWTS on the Residential Parcel; and In Witness Whereof, in consideration of the mutual covenants, conditions, and benefits contained in this Grant, the County and Grant Awardee hereby agree as follows: 1. Award Based on Grant Awardee's application, attached hereto as Exhibit 1 (the "Application"), the County hereby awards Grant funds in an amount of up to ten-thousand dollars ($10,000), with a potential for an additional one-thousand dollars ($1,000) to be used towards the design and installation of a Pressurized Shallow Drainfield (`'PSD"), provided that such PSD is deemed necessary by the Department at its sole discretion (the "Grant Award"). The Grant Award shall be paid to the Grant Awardee subject to actual incurred costs. The Grant Award shall be used .toward the cost of the design and installation of the IIA OWTS and three (3) years of inspection and maintenance by the Manufacturer/installer on the IIA OWTS after installation. For the purpose of this Grant, IIA OWTS means the onsite decentralized wastewater treatment system which meets the requirements and standards for nitrogen removal as set forth in the Suffolk County Sanitary Code and has been approved by the Department for use in the Program. , t RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT SYSTEM GRAN'r Rev. 7117117; 17-MLWA-0199; Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 2of12 2. Term Installation must occur within one hundred eighty (180) days of the date of this Grant (the "Term"), but Grant Awardee may request an extension, in writing, to the Department Commissioner. The Department Commissioner may, in his sole discretion, extend the Term. 3. Choosin Desian Professional and Manufacturer[Installer/Assi nment of Grant Award a. Design Professional i. Within two (2) weeks of the execution of this Grant, Grant Awardee will choose a "Design Professional" from the list published by the Department (www.reclaimourwater.info), who will design the UA OWTS. The Department Commissioner may, in his sole discretion, allow the Grant Awardee additional time to choose the Design Professional. NOTE: The Grant Award may only be used toward payment for a Design Professional on the list published by the Department. ii. Grant Awardee will complete and return to the Department the form attached as Exhibit 2, entitled "Design Professional Selection and Assignment," within seven (7) business days of signing a contract with the Design Professional for the design of the UA OWTS. iii. As part of the "Design Professional Selection and Assignment" form attached as Exhibit 2, Grant Awardee will assign twenty-five percent(25%) of his/her Grant Award to the Design Professional named by Grant Awardee on the form. b. Manufacturer/Installer i. Within one (1) week of the Department approval of the Design Professionals plans for the IIA OWTS, Grant Awardee will choose a "ManufacturerMstaller" from the list published by the Department (www.reclaimourwateninfo), who will provide and install the IIA OWTS. The Department Commissioner may, in his sole discretion, allow Grant Awardee additional time to choose the Manufacturer/Installer. NOTE: Grant funds may only be used toward payment for a Manufacturer/Installer on the list published by the Department. ii. Grant Awardee will complete and return to the Department the form attached as Exhibit 3, entitled "Manufacturer/Installer Selection and Assignment of Payment," within seven (7) business days of signing a contract with the Manufacturer/Instal ler. r RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT SYSTEM GRANT' Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 3of12 iii. As part of the "Manufacturer/Installer Selection and Assignment of Payment" form attached as Exhibit 3, Grant Awardee will assign seventy-five percent (75%) of his/her Grant Award to the Manufacturer/Installer named by Grant Awardee on the form. 4. Scope of Grant Funds a. Grant Awardee understands and agrees that the Grant Award is to cover the partial costs of the design, purchase and installation costs of an I/A OWTS for and on the Residential Parcel and three (3) years of inspection and maintenance by the Manufacturer/Installer of the IIA OWTS after installation. If the amount billed by the Design Professional and/or Manufacturer/Installer is greater than the amount of the portion of the Grant Award allocated to them, Grant Awardee is responsible for paying amounts in excess of the Award allocation directly to the Design Professional and/or the Manufacturer/Installer. b. The Grant Award will only be paid by the County after the IIA OWTS is installed and the Department has inspected and issued a "final approval" of the IIA OWTS installation. Grant Awardee is responsible for all costs if the UA OWTS is not installed for any reason, including, but not limited to, Grant Awardee determining to withdraw from the Program prior to installation or installation not occurring within the Term. However, the Department Commissioner may make a determination, in his sole discretion, to release funds in accordance with adopted Program rules and regulations if the installation does not occur. c. Grant Award is to be paid only to the extent that costs are actually incurred. d. The Grant Award may only be used toward the following items: i. the total cost of the purchase of 1/A OWTS materials and necessary components; ii. the purchase of electrical components; iii. labor costs incurred in connection with installation of the UA OWTS and any necessary leaching fields and structures; iv. a three-year warranty for the UA OWTS; V. three-years of operation and maintenance of the I/A OWTS purchased through the Manufacturer/Installer; vi. excavation and backfilling; vii. design services including the preparation of a site plan, installation; inspection, as-built surveys, and applicable permitting; and viii. pumping and decommissioning of an existing on-site system. e. The Grant Award may not be used for irrigation repairs, electrical improvements unrelated to 1/A OWTS installation, and post installation design and landscaping. RF,SIDENTIAL INNOVATIVE ANI)A1:FERNATIVF ONSITE WASTEWATER TREATMENT SYSTEM GRANT Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 4 of 12 f. Grant Awardee understands and agrees that any costs for necessary maintenance, repairs or replacements to the IIA OWTS occurring after installation are the responsibility of Grant Awardee unless covered by a warranty or service contract provided by the Manufacturer/Installer or purchased by Grant Awardee. The County is not responsible for such costs. 5. Perm it[License/Approval Permits, licenses or applications necessary for or associated with the design and installation of the I/A OWTS are the responsibility of Grant Awardee. 6. Remedies/Right to Terminate If Grant Awardee 1) has made a material misrepresentation on the Application and/or 2) fails to comply with the terms and conditions of this Grant and/or 3) fails to comply with a covenant, agreement or representation in this Grant, the County shall have the right to: a. withhold or receive the return of the Grant Award; and/or b. terminate this Grant, in which case the County shall have no further obligation pursuant to this Grant or otherwise, including, among other things, any obligation to pay the Grant Award; and/or c. take any other reasonable action to enforce this Grant. 7, Grant Awardee's Covenants, Agreements, Representations a. As of the date Grant Awardee signs this Grant, Grant Awardee represents that he/she has good and valid title to the Residential Parcel, that he/she may enter into this Grant, and that all representations made in the Application are true and accurate. Grant Awardee shall notify the Department in writing if during the Term of the Grant, any of the representations made in the previous sentence change, in which case this Grant may be terminated, at the discretion of the Commissioner and the County shall have no obligation to issue any fiords under this Grant. b. Grant Awardee agrees that he/she shall permit the designated representatives of the County to have access at reasonable times to the necessary parts of the Residential Parcel for the purpose of inspection, obtaining data and making various tests (including, but not limited to, water quality testing and effluent sampling) concerning the Program and/or ensure that the design and/or installation and/or maintenance of the I/A OWTS is being carried out consistent with this Grant and the law. c. Maintenance i. Grant Awardee agrees to ensure the proper operation and maintenance of the I/A OWTS_ RESIDENTIAL INNOVA'rIVE AND ALTERNATIVE O\SITE WASTEWATER TREATMENT SYSTEINI GRA1'T Rev. 7117117; 17-NILWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 5 of 12 ii. Grant Awardee agrees to maintain a service contract for the IIA OWTS with a certified service provider. iii. Grant Awardee understands and shall ensure that the installed IIA OWTS is inspected and has necessary operation and maintenance performed by a certified service provider at a minimum of once per year. iv. Grant Awardee shall initial below to show that he/she understands the continuing proper operation and maintenance obligations, which survive the Term. Grant Awardee Initial �� d. Grant Awardee acknowledges that the only responsibility of the County under this Grant is to distribute the Grant Award pursuant to the terms of the Grant and that the County bears no liability for any damage to persons or property caused directly or indirectly from the design, installation, inspections, testing or sampling of the l/A OWTS by the Design Professional or Manufacturer/]n stal ler or arising from any disputes between Grant Awardee and Designer Professional and/or Manufacture rhnstaHer, or if the I/A OWTS fails or overflows. The County does not warrant or guarantee the design, construction, operation or installation of the 1/A OWTS and does not warrant or guarantee that future repair or replacement of the UA OWTS may not be necessary. S. Additional Covenants a. Grant Awardee, his/her successors and/or assigns shall set forth all covenants, agreements and declarations contained in this Grant in any and all leases to occupants, tenants and/or lessees of the above described Residential Parcel and shall, by their terms, subject same to the covenants and restrictions contained herein. Failure of Grant Awardee, his/her successors and/or assigns to so condition the leases shall not invalidate their automatic subjugation to the covenants and restrictions. b. These covenants and restrictions contained within this Grant shall run with the land and shall be binding upon Grant Awardee, his/her successors and assigns, and upon all persons or entities claiming under them, and may be terminated, revoked or amended only with the written consent of the Department. 9. Recordinlf This Grant shall be recorded in the Office of the Clerk of the County. 10. Homeowner's Insurance Grant Awardee has and agrees to maintain homeowner's insurance coverage in an amount that is generally acceptable for similarly situated properties. RESIDE\RAL INNOVATIVE AND ALTERNATIVE ONSITE WASTE►►'A"CER TREATMENT SYSTEM GRANT Rev.7/17/17; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 6of12 11. Miscellaneous a. This Grant contains the entire understanding between the parties and may not be amended or modified except in writing signed by both Grant Awardee and the County. b. No action or failure to act by the County shall be deemed an approval or consent of any breach of this Grant by Grant Awardee. c. If any term or provision of this Grant is determined by a court of law to be invalid or unenforceable, the remainder of this Grant will not be affected by such a decision, and every other term and provision of this Grant shall be valid and shall be enforced to the fullest extent permitted by law. d. Notice. The Department will give notices and all correspondence to Grant Awardee at Grant Awardee address on the Application, unless Grant Awardee requests use of a different address. Grant Awardee must give notice and correspondence to the Department at the following address: Suffolk County Department of Health Services Division of Environmental Quality 360 Yaphank Avenue Yaphank, New York 11980 e. Governing Law. The Grant shall be governed by and construed in accordance with the laws of the State of New York. Venue may be designated in the Supreme Court, Suffolk County or Suffolk County District Court. SIGNATURES ON FOLLOWING PAGE REsmrN'TIAL INNOVATIVEAND ALTER.NA'rivF,ONSITE WASTEWATER TREATMENT SYSTEM GRANT Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 7 of 12 IN WITNESS WHEREOF, the parties hereto have executed the Grant as of the latest date written below. Grant Awardee COUT Y OF SUFFOLK By: By: Name: Ch ord J. Harris Dennis M. Cohen Address: 207 Knapp Place Chief Deputy County Executive Greenport,NY 11944 Date: Date: lO /7 /? Approved: Department of Health Services By: Name: Kelly A. Harris Address: 207 Knapp Place By: Greenport, NY 11944 Dr. lames L. Tomarken, MD, MPH, MBA, MSW Commissioner Date: /U ,/ / ` Date: j? // Approved as o Form: Recommended: Dennis M. own, County Attorney Department of Health Services, Division of Environmental Quality By: JSVica H. Hogan Assistant County Attorney By• � �� Walter Dawydiak, P.E. Date: XI)A �� Director of Environmental Quality llll�llllll�llalllllll�llllllllllli Date: /OA�//7 0048227 RtsiDENTIAL INNOVATIVE ANI)ALTERNATIVE ONSrrE NVAS'rENVATER TREATMEN'r SYSTEM GRA.N-r Rev. 7117117; 17-MLWA-0199; Law No. 18-HS- r�2 Contract No.406-6422-4770-00-00103 Page 8 of 12 STATE OF NEW YORK } ) ss.. COUNTY OF SUFFOLK } rd- On d- On the day of in the year 2017 before me, the undersigned, personally appeared DENNIS M. COHEN, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. Q /�. 442�2 ignature and Office of IndiVidual Taking Acknowledgement STATE OF NEW YORK ) wan p'" Notary Public,State of New York, ss.: No.01 KE6168764 COUNTY OF SUFFOLK ) iss� ene1B, Commn>VIsJu2019 On theZ"day o in the year 2017 before me, the undersigned, personally appeared , `-` —, personally known to me or provided to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument, ignature and Office o dividuaI Taking Acknowledgment STATE OF NEW YORK } Dardelle E,Menchise Of Now Yogic COUNTY OF SUFFOLK } ss.: Nat�I1PubVA SUM ft.OI M�11576 QWmW in `CounV CMMWWW Egires tqptembw21'z0& On the& (day of kle-in the year 2017 before me, the undersigned, personally appeared , personally known to me or provided to me on the basis of satisfactory idence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. 4Signatured Office of 1 ivi ual Taking Acknowledgment Danielle E.MsndALse Notwry Public,State of New York No.01 1YIE6211576 0ualified in Suffolk Commission Expires September RESIDENTIAL INNOVATIVE AND ALTERNATIVE,ONSITE WASTEWAi,ER TREATMENT SVSTEm GRAN-t' Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 9 of 12 Exhibit 1 Grant Awardee's Application (See Attached) Administration - Septic Initiative Page I of 2 Septic Improvement Program Application Review Property Owner(s): Parcel I Tax Map Numbers: Name IRS Filing Status IRS Tax Form Amount District Section Block Lot Clifford J Harris Joint 1040 245733.00 1000 03400 0300 012000 Kelly A Harris Joint 1040 0.01 Address: City: Zip: Year House Built: Email: 207 Knapp Place(aka 220 Knapp Place) Greenport 11944 1930 kingdingaling50@aol.com Single Family Dwelling?Yes Number Of Bedrooms:2 Occupied Year Round?Yes Number Of Occupants:2 Current system type:Block Cesspool Sewage disposal system has to be pumped two(2)or more times a year?No Sewage disposal system has collapsed or is collapsing?No Sewage backing-up into the dwelling?No Wastewater rising to the surface of the ground over or near any part of the existing sewage disposal system?No Is this a primary residence that is owner occupied?Yes Is the primary residence considered new construction on a vacant lot?No Does the residence rely on an onsite system(septic system or a cesspool)?Yes Is the residence connected to a sewer system or located in a sewer district or a proposed sewer district?No Is the Property a rental property?No Is there a home based business on the property(outer than a personal home office that does not require additional kitchen use or customer access)?No Are there any real property tax liens on the property?No Is the property in foreclosure?No Is the property owner an elected official or an office holder of any political party(including official political party committee members)?No Is the property owner a current Suffolk County employee?No Are valid Certificates of Occupancy(CO),Certificates of Zoning,or an equivalent available for the residence?Yes Do you consent that the County may share each property owner(s)'name,property address,grant award(if any),and property deed with CDCL1-FC,a third-party lending agent that offers low interest loans for the installation of IIA OWTS?Yes Attached Documents: Doc, ID Doc.Type Doc.Name Doc.Date 664 Deed Harris%20Deed.pdf 7/17/2017 12:53:06 PM 665 Insurance Harris%201nsurance%20Renewal.pdf 7/17/2017 12:53:06 PM 666 CO @@xxxx%20_20170714094955.pdf 7/17/2017 12:53:06 PM 667 Tax Bill Harris%20Tax%20Bill.pdf 7/17/2017 12:53:06 PM 668 Tax Return Harris%20taxes%20FY%202016.pdf 7/17/2017 12:53:06 PM http://septicadmin/AppIicationReview.aspx 9/21/2017 Administration - Septic Initiative Page 2 of 2 1419 CO HARRIS CLIFFORD CO.pdf 911 21201 7 11:45:00 AM 1420 Tax Return HARRIS CLIFFORD SIGNED TAX RETURN-002.pdf 9/12/2017 11:45:00 AM Property Owner(s)certify that: 1. The information set forth in this electronic printout of the Property Owner(s)'Septic Improvement Program--Grant Application is the information that was submitted by Property Owner(s)as part of Property Owner(s)'Septic Improvement Program—Grant Application. 2. Property Owner(s)has good and valid title to property as of the date of the signature(s)below. 3. Property Owner(s)remain property owner(s)of the subject property and that all the representations and information furnished in Septic Improvement Program—Grant Application and the uploaded supporting documentation is true and complete to the best of Property Owner(s)'knowledge and belief. 4. Property Owners understands that the submission of the Septic Improvement Program—Grant Application does not guarantee an award of a grant and that the terms and conditions of the Septic Improvement Program may be changed at any time by Suffolk County. 5. Property Owner(s)understands that Suffolk County is not responsible to any party for the loss of funding or any other damages which may arise as a result of the provision of false or inaccurate information within the application or documentation or by any property owner's failure to adhere to the terms of the Septic Improvement Program or any agreement entered thereunder. 6. Property Owner(s)grants Suffolk County Septic Improvement Program representatives the right to enter onto the property to perform any site assessments related to the processing of Septic Improvement Program—Grant Applicati X Suffolk County Government,®2017. http://septicadmin/Appl icationReview.aspx 9/21/2017 RESIDENTIAL INNOVATIVE vN-D ALTERNATIVE ONsrrE WASTEWATER TREATNfENr SVSTEa1 GRAN Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00 t 03 Page 10 of 12 Exhibit 2 Design Professional Selection and Assignment of Payment DIRECTIONS Grant Awardee: Complete and submit the following within seven (7) business days of executing a contract with a Design Professional for the design of the IIA OWTS. Please attach a copy of the signed cost estimate for the IIA OWTS design. This form and the cost estimate should be submitted to: Justin Jobin. Environmental_Proiects Coordinator, SCDHS, Division of Environmental Quality, 360 Ya hank Avenue Ya hank New York 11980 I/We, , ("Grant Awardee"), have received a grant award of pursuant to the Suffolk County RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT SYSTEM GRANT(the "Grant Award") and has/have executed a Grant Award agreement with Suffolk County (the"Agreement"). 1. Me have entered into a contract with the following Design Professional for the design of a Suffolk County Department of Health ("Department") approved UA OWTS: 2. The Design Professional is a professional engineer or registered architect licensed by the New York State Education Department and included on the list of the Suffolk County RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT SYSTEM GRANT participating Design Professionals provided by the Department to Grant Awardee. 3. Authorization of Payment to Design Professional Pursuant to Section 839-8 of Suffolk County Local Law No. 15-2017, UWe hereby assign payment of twenty-five percent (25%) of the Grant Award to the Design Professional listed above, such payment to be made subject to the terms of the Agreement and only to the extent that costs are actually incurred. I/We shall not pursue payment directly from the County for the Grant Award provided for the installation, design and maintenance of the UA OWTS. GRANT AWARDEE 6y: Name: Address: Date Amount of Grant Award Authorized by Department to Design Professional: By: Name: Title: Date: RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSrrE WASI'EWA'rFR TREAT¢mNT SYSTEM GRANT Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 1 I of 12 Exhibit 3 Man ufacturer/Installer Selection and Assignment of Payment DIRECTIONS Grant Awardee: Complete and submit the following within seven (7) business days of executing a contract with a Manufacturer/Installer for the design of the IIA OWTS. Please attach a copy of the signed cost estimate, which should include the name of the I/A OWTS being used. This form and cast estimate should be submitted to: Justin Jobin, Environmental Projects Coordinator, SCDHS. Division of Environmental Quality,-360 Yaphank Avenue, Ya hank New York 11980 I/We, ("Grant Awardee"), have received a grant award of pursuant to the Suffolk County RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREAT NIENT SYSTENi GRANT(the "Grant Award") and has/have executed a Grant Award agreement with Suffolk County (the"Agreement"). 1. I/We have entered into a contract with the following Manufacturer/Installer for the design of a Suffolk County Department of Health ("Department") approved IIA OWTS: 2. The Manufacturer/Installer is a the manufacturer, dealer or seller of UA OWTS that has been approved by Department and included on the list of the Suffolk County RESIDENTIAL INNOVATIVE AND ALTERNATIVE ONSITE WASTEWATER TREATMENT SVSTENi GRANT participating Manufacturer/Installers provided by the Department to Grant Awardee. 3. Authorization of Payment to Manufacturer/Installer Pursuant to Section 839-8 of Suffolk County Local Law No. 15-2017, I/We hereby assign payment of seventy-five percent (75%) of the Grant Award to the Manufacturer/Installer listed forth above, such payment to be made subject to the terms of the Agreement and only to the extent that costs are actually incurred. UWe shall not pursue payment directly from the County for the Grant Award provided for the installation, design and maintenance of the UA OWTS. GRANT AWARDEE By: Date Name: Address: Amount of Grant Award Authorized by Department to Manufactured]nstaller: By: Name: Title: Date. RESIDFINMAL INNOVATIVE AND AI;rERNATIVE ONSITE R'ASI'EWATER TREATM N'I'SYSTEM GRA\r Rev. 7117117; 17-MLWA-0199;Law No. 18-HS- Contract No.406-6422-4770-00-00103 Page 12 of 12 Addendum A Legal Description of the Subject Property 207 Knapp Place, Greenport,NY 11944 1000-03400-0300-012000 ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being near the Village of Greenport, Town of Southold, Suffolk County,New York, bounded and described as follows: BEGINNING at a point on the southerly line of Knapp Place distant 40 feet in an easterly direction from the northeasterly comer of land of Kenneth Dimon; RUNNING THENCE southerly and parallel to the easterly line of land of Kenneth Dimon, a distance of 138 feet more or less to the land now or formerly of Theresa Durst; RUNNING THENCE easterly along said last mentioned land a distance of 40 feet; RUNNING THENCE northerly and parallel to the first course to Knapp Place; RUNNING THENCE in a westerly direction along the southerly line of Knapp Place a distance of 40 fcct to the point or place of BEGINNING. End of Text for Addendum A