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Home My WebLink About52258-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY 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#: 52258 Date: 09/11/2025 Permission is hereby granted to: Boost Construction Corp 25 Goldin Ln Southold, NY 11971 To: Construct a new two-story single-family dwelling with finished basement as applied for per SCHD approval. Premises Located at: 25 Goldin Ln,Southold, NY 11971 SCTM# 135.-2-17 Pursuant to application dated 07/08/2025 and approved by the Building Inspector. To expire on 09/11/2027. Contractors: Required Inspections: Fees: Single Family Dwelling-NEW $1,766.00 CO Single Family Dwelling-New $100.00 Total $1,866.00 Building Inspector � t c N TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax (631)765-9502 lltt :f'www.sttat)toldtrwrla . Date Received APPLICATION FOR BUILD"'. E C E a E For Ot �DD PERMIT NO. � Budding Inspector!, JUL Applications and forms must be filled out in their entirety.Incomplete Building Department applications will not be accepted. Where the Applicant is not the owner,an Town of Southold Owner's Authorization form(Page 2)shall be completed. Date: 00 25 OWNERS)OF PROPERTY: Name: _?OOS I C,01V5/ CV C%/Q/N COef SCTM#1000- 135- 2— 1-7 Project Address: Z D/N L N r - 0 V FHaG D / A/Y Phone#: '?/7 7 1 LY 6 4,31 Email: ,�c JEL/�v�SL��r'ZYNSK/. Mailing Address: 72 Ob 1/Ni / V r Py /`7/ClW 11i� 6 �, �yI/"37 CONTACT PERSON:; Name: r(O N I kA MA I ri,J5IC I Mailing Address: J2O Siff LL�� J7R ;/9 942. Phone#: q/-7 g92-37-5& Email: MO/V B67NI7-60MS/v, CO" DESIGN PROFESSIONAL INFORMATION: Name: 'TFHAI V r-Y1rV CZOUP LLG Mailing Address: 12 7S V flAGL 2fJ /�YSNo,2 NY /1706 Phone#: v/9/ 899- 73/g Email: Yel;1944OAf el;1944O CONTRACTOR INFORMATION: Name: KC ZJ119L11-15 2CA10Yj9T/01V, ?dlc. Mailing Address: ZO,6 57OU7N' 4 y45;1-Y. L//V.Dp/V/f� /tJ Y // ,f 7 Phone#: 1—7 7 Af S/ Email DESCRIPTION OF PROPOSED CONSTRUCTION —kAew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other 300,060 Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes Qlo 1 PROPERTY INFORMATION Existing use of property: �!'( Qt / Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑ L�JYes No IF YES, PROVIDE A COPY. Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by. Chapter,236 of the Town Code, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone ordinance of the Town of Southold,Suffolk,County,New York and other applicable taws,Ordinances or Regulations,for the construction of buildings,„ additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors co premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): SLES2 YNS,�/ []Authorized Agent ❑Owner Signature of Applicant: �74""1'0'� S',Y-IX4 Date: 7 7/2 d— STATE OF NEW YORK) SS: COUNTY OF = N ,k/ being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the "'0'r Icir (Cont(actor,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/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this 7 day of /rteV 2025--- Notary Public Monika Majewski PROPERTY OWNER AUTHORIZATION NOTARY P(,TLIC,STATE OF NEW YORX (Where the applicant is not the owner) Regist:duo❑No OI M.A6392440 Q:,ah. •d in Suffolk County COMMISS100 Exyues 051 ii1 210A j residing at 7206 x ",,• 4 do hereby authorize apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date L5G.)r1,I NlA S LF5SZS ^401 ' Print Owner's Name 2 ORESche�ck* Web TA4 Compliance Certificate Project Information Project Title: NEW DWELLING o E IL.1 9 20,25 Energy Code: 2018 IECC Location: Suffolk,New York Construction Type: Single Family Project Type: New Construction Project Sub Type: None Conditioned Floor Area: 1940 ft2 Glazing Area: 13% Climate Zone: 4a (5999 HDD) Project No: 1749722 All Electric: false Is Renewable: false Has Battery: false Has Charger: false Has Heat Pump false Construction Site: Owner/Agent: Designer/Contractor: 0 GOLDIN LANE Emmanuel T.Addy R.A. SOUTHOLD,NY 11971 1257 Udall Road TOG Architects Bay Shore,NY 11706 6318887318 tehnaddy@gmail.com Project Notes: Report Title: NEW DWELLING Report Date: 9/7/25, 2:40 PM 1 of 11 w Envelope Assemblies Prop. Req. Assembly Gross Area or Cavity Cont. U- U- Prop. Req. Perimeter R-Value R Value Factor/ Factor/ UA UA F-Factor F-Factor Ceiling:Flat Ceiling or 1150 49.0 0.0 0.026 0.026 30 30 Scissor Truss Wall 1:Wood Frame,16" 532 13.0 5.0 0.057 0.060 24 25 O.C. Window 1:Wood Frame 31 0.300 0.320 9 10 SHGC:0.4 Door 1:Glass Door(over 80 0.300 0.320 24 26 50%glazing) SHGC: 0.4 Wall 2:Wood Frame,16" 886 13.0 5.0 0.057 0.060 45 47 O.C. Window 2:Wood Frame 62 0.300 0.320 19 20 SHGC: 0.4 Door 2: Solid Door(under 40 0.280 0.320 11 13 50%glazing) Wall 3:Wood Frame,16" 532 13.0 5.0 0.057 0.060 25 27 O.C. Window 3:Wood Frame 90 0.300 0.320 27 29 SHGC: 0.4 Wall 4:Wood Frame,16" 886 13.0 5.0 0.057 0.060 44 46 o.c. Window 4:Wood Frame 86 0.300 0.320 26 28 SHGC: 0.4 Door 4:Glass Door(over 30 0.300 0.320 9 10 50%glazing) SHGC: 0.4 Basement Wall:Solid 940 13.0 0.0 0.059 0.059 55 55 Concrete or Masonry Wall height:8.00 Insulation depth:8.00' Insulation position: Integral Insulation Compliance: Passes using UA trade-off �Compliance:4.9%Better Than Code Max UA,, Your UA: Max SHGC: ur SHGC: �' .40 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off E NOT provide an estimate of energy use or cost relative to a minimum-code home. Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck assembly in the specified climate zone must meet the minimum energy code insulation R-value and dep a m1t5 Compliance Statement LULA Pe The proposed building design described here is consistent with the building plans,specifications,and Oat c c�kion submitted with the permit application.The proposed building has been designed to meet the 2018 IECC r ire nts In 0 2% REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name -Title Signature °i Date Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 2 of 11 Inspection Checklist Energy Code:2018 IECC Requirements:38%were addressed directly in the RESCheCk software Text in the"Comments/Assumptions"column is provided by the user in the REScheck Requirements screen.For each requirement,the user certifies that a code requirement will be met and how that is documented,or that an exception is being claimed.Where compliance is itemized in a separate table,a reference to that table is provided. Pre-Inspection/Plan Review u ...... .............. ._ _.......... Section ... .. ... _..._ _. m ......, .. .-- _.............. �...._e... tion Plans Field # Verified Verified &Req.ID Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions 03.1_ ......Construction ocumen a drawings on demonstrate .w.a _.....o ..., _ns : and (�Complies Location on plans/spec: Does Not See sht.1&section [PR111 energy code compliance for the building envelope.Thermal omply envelope represented on (]Not construction documents. Observable 0 Not Applicable 103.1,..... Constructionon drawings and _. . r �.-- ..... — �... Complies demonstrate Does Not energy code Compliance for [PR3]1 lighting and mechanical ply systems,Systems serving Not multiple dwelling units must Observable demonstrate compliance with Not the IECC Commercial Provisions. pplicable 302.1,WWWm HeMin and coolinp equipment Heating. mm Heating Complies C:7 [PR21 based on is size per loads c anus S Btu/ 6...._ m^— Does Not approved Manual codet �r m official. l@Cool BCoo/ling: Amply ACCA Manu�i J or other mekkrotls hn�1.. by nNot Btu/err Btu/17r 1 servable �..0 .,...... .. �...� _�.�.....� Ap plicable of Additional Comments/Assumptions: 1 High Im pact 1) 2mmmm Medium Impact(Tier 2) mm3 Lwow Impact(Tier 3) M 9 Pw _. Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 3 of 11 Foundation Inspection Section Plans Field # Verified Verified & Req.ID Foundation Inspection Value Value Complies? Comments/Assumptions 303.2.1 Aprotective covering is 0Complies Exception:Requirement [F011]2 installed to protect exposed is not applicable. exterior insulation and extends Does Not a minimum of 6 in. below grade. omply Not servable n Not pplicable _...._ .. ...:_...,..., -------- _... w 403.9 Snow-and ice-melting system C]Complies [FO12]2 controls installed. Does Not Comply Not [�] Observable Not qq pplicable insulation R-value.Where Does lies S . �.. -,.. 402.1.1 Conditioned basement wall R � R (] P See the Envelope [F04] e Assemblies table for interior insulation is used, values verification may need to occur R omply during Insulation Inspection.Not — n Not required In warm-humid servable locations in Climate Zone 3, Not pplicable ...... .. _,, .._.._...,�w ..._....� ...P 303....2w.. D p Conditioned basement wall Complies Location on plans/spec: ec: [FO5)1 insulation installed per Does NotI As per manufacturer manufacturer's instructions. Does Py Not servable PNot Applicable � ...... _. .......��_............... 402.2.9 Conditioned basement wall I'^ vft �ft O Complies See the Envelope [FO6]1 insulation depth of burial or d _ Assemblies table for distance from top of wall. o Does Not values Comply Not servable PNot plicable Additional Comments/Assumptions: �.., .._ w p Tier 3) 1 High Impact(Tier 1) 2 Medium Impact -._ ......g �... _ . ct(Tier 2) 3 Lo...,.lm act(.m„ .,. Report Title: NEW DWELLING Report Date: 9/7/25, 2:40 PM 4 of 11 0 Framing / Rough-in inspection 6 Re ID ,.. ........_--- Inspection .......... ... _._ Value .....w-....._---_ w_.....m, _... ..�..... ....._ Section Plans Field # Framing/Rough-in Verified Verified q p Value Complies? Comments/Assumptions 402.1.1, . Door U-factor. ..... Complies _.... See the Envelope W IT V .____ Assem r. tl m U �ry P P for 402.3.4 �."- 4....,---,-„I Does Not [FR111 Comply Not servable n Not pplicable U 402.3.1 average). --......_. .�-_ , Glazing_U factor(area-wei hted O Complies See the Envelope 402.1.1 ........ g .Does Not Assemblies table for 402. . , ___...... 402.3 , values omply [FR2]1 Not servable Not pplicable 402.4.1 1.... .Airins barrier and onsr manufacturer's barrier E]Does pNot Location n o plans/spec: c — map barr p nefspec: P instructs Not servable PNot plicable 402.4.3 Fenestration that is not site built O Complies [FR20]1 is listed and labeled as meeting Does Not AAMA/WDMA/CSA 101/l.S.2/A440 or has infiltration omply rates per NFRC 400 that do not Not exceed code limits, servable Not pplicable 402.4.5 housing%ed e e ssefinighting and s � - �mo mpNot See detail lies Location o.-� - . ..__._.��....._�..__ n plans/spec: ior [FR16]2 fixtures sealed at sh labeled to indicate 52.0 cfm leakage at 75 Pa. Not servable PNot plicable 403.3.1 Suinspply d r R 8 where -in.a mm.�.._.._. ... ._. . �.,..._ 403.3. Su ly and return ducts in attics CJ Complies ere duct is Does Not >=3 inches in diameter and >=R-6 where<3 inches. omply Supply and return ducts in other Not pportions of the buildlrtig servable insulated>—R-6 for diameter Not >=3 inches and R-4.2 for<3 inches in diameter. pplicable a.. - ----- . ..... _ ...__._ m __.__. 403.3.2 Ducts,air handlers and filter �® C es [FR13]1 boxes are sealed with joints/seams compliant with [�Does Not International Mechanical Code Comply or International Residential Not n Code,as applicable. servable Not pplicable _.-....-,3. ---__---_---v-"ties _-___-- ..... .,....,..� --- -. ,. .:----... 403.3.5 Building cavities are not used as (�Complies [FR15]3 ducts or plenums. Does Not omply Not servable Not pplicable Report Title: NEW DWELLING Report Date: 9/7/25, 2:40 PM 5 of 11 Section ..._.......-- Plans Field # Framing/Rough-In Verified Verified & Re ID Inspection Value Value Complies? Comments/Assumptions 403.4 HVAC pipin conveying fluids Complies [FR17]2 above 105�F or chilled fluids R� R below 55 9F are insulated to_>R- Does Not 3a - Pmply Not servable PNot plicable _.... . - ----------.-.-. -. ............., 403.4.1 Protection of insulation on HVAC Complies [FR24]1 piping. ( J Does Not Comply Not servable PNot plicable .�.....-_. � .:.._.- ..--.._--..... 403.5.3 Hot water pipes are insulated to R(--1 R 0 Complies [FR18]2 _>R-3. —J R J �]Does Not Comply nn Not �56servable (�Not pplicable ... • 403.6 Automatic or dampers 0Co p Lo cation.a�o.n plans/ sp ec:[FR19] on all outdoor air Does Asper hvcsub-gc intakes and exhausts. Urr Not servable Not pplicable 303.1.3., accordance a are determined r frneR heest.....-- C Does p YpNot As pe rNFRC plans/spec:._..... [FR4] products procedure ortaken default table. Not servable PNot plicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 6 of 11 Insulation Inspection ectiorw plans Field # Verified V reified Req.11) Insulation Inspection Value Value Complies? CommentslAssumptions -i-H."T-All nStalted insulation is labeled 0 Complies [IN13P7 oprtrovi he Installed R-values Does Not ded. Umply 9 Not servable )Not Applicable ................................ 402-111 Wall insulation 11-value.If this i's R= OCOMPOes See the Envelope a mass wall with at least Y2 of Assemblies table for 402.2.5� ��Does Not values 402.2,6 the wall insulation on the wall [IN311 exterior,the exterior insulation Wood Wood damply requirement reqWrement applies(FR10), wl mass C-)mass Not jStee I qo Steel 06servable 2Not plicable, .2, Wall Insulation is installed per Complies Location on plansispe!c: [INO manufacturer's Instructions. Does Not As per manufacturer Comply [' Not OZervable [)Not Applicable Additional Comments/Assumptions: ......................................................... ............. .................. ................- ..................... ----------- Hig 3 It I aR�StLTierj) 2 Medium Impact(Tier 2) (Tier 3) ELI............ Report Title: NEW DWELUNG Report Date: 917/25, 2.,40 PM 7 of 11 Final Inspection Provisions _..........._...... .. _. �...a ._ � _..... __..� .........._.e w w_. Section Plans Field # Verified Verified & Req.ID Final Inspection Provisions Value pp Value Complies? Comments/Assumptions 402 2,6, IT Ceiling insulation R-value. O m k O C0 Complies See Does Not valuesbiEr�vebrapme ICJ he rev Envelope for ly 402 2.2, Wood Wood 402. ]Fill' O Steel CJ Steel ��]]Not 66serva ble PNot pplicable .. ._ _.. ........_. _.._. .. ,. _- 303_.1._1.1, Ceiling insulation installed per 0 Complies Location on plans/spec: 303.2 manufacturer's instructions. Does Not As per manufacturer [FI2]' Blown insulation marked every 300 ft'. amply [ ]Not Observable Not pplicable 403.1.2 Heat on at.. . .thermostat installed � �Do Complies �... . ....... Heat pump thermostat �� plies pumps. s Not ompl []Not Observable Not pplicable �.. .............. .... �.-- _. :...--.---...---.--- 403.5.1 Circulating service hot water 0 Complies [FI111z systems have automatic or accessible manual controls. Does Not Comply Wot N servable 0 Not Applicable ...........-....... _ .... 403.6.1 All mechanical ventilation Complies [FI25]2 system fans not part of tested and listed HVAC equipment Does Not meet efficacy and air flow limits omply per Table R403.6.1. ]Not Observable ONot plicable _„_..402 Hot water boilers supplying eat pt[F[26]z th M eating systems loweriut� No setback control to b ler �Complies ...�.__ water temperature based on Not outdoor temperature. @servable Not pplicable - [F _-.... .. 0 .1.1 sy ated water circulation Complies rculation n ..... ....... x tems have a circulation 128] pump.The.system return pipe is Does Not a dedicated return pipe or a amply cold water supply pipe Gravity Not �l and thermos syphon circulation servable systems are not present. Not Controls for circulating hot water system pumps start the �Ipplicable pump with signal for hot water demand within the occupancy. Controls automatically turn off the pump when water is in circulation loop i5 at set-point temperature and no demand for hot water exists. .- „.. ,..... , - ., ...mr .....� -.._. ...._... 403.5.1.2 Elec tric heat trace systems Complies [FI29]2 comply with IEEE 515.1 or UL 515.Controls automatically Does Not adjust the energy input to the amply heat tracing to maintain the ��Not desired water temperature in b servable the piping. OpNot pplicable Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 8 of 11 M Sec_. ......_......, ....- _._.__ ......... .w. ,.-,w...m ....u„ tion Plans Field # Verified Verified & Req.ID Final Inspection Provisions Value Value Complies? Comments/Assumptions �403.5.2Y Demand recirculation water Complies [F130]2 systems have controls that manage operation of the pump ��Does Not and limit the temperature of the omply water entering the cold water Not n piping to<=104°F. servable PNot licable ....... _........__.. - 403.5.4 Drain water heat recovery units Complies [F131]2 tested In accordance with CSA B55.1.Potable water-side Does Not gressure doss of drain water omply heat recover units<3 psi for n Not individual vnits connected to servable one or two showers.Potable water-side press-ogre Toss of drain Not water heat recovery units<2 pplicable psi for individual units connected to three or more showers. 404.1 q0"r t-...-� .� _.................. .�. r more of permanent 0 Complies [1`I6]1 fixtures have high efficacy lamps. Does Not omply UNot Observable Not yy pplicable --------------- 404.1.1 ..mFueconsilighting outs g s light. have. (�Complies [F123] p g Does Not Umply Not servable PNot plicable . 401.3 Compliance certificate" . . .a.. ®.. �_._ -.. .. .., ..., posted. Complies [F17]2 Does Not Comply Not servable f-I Not Applicable 303.3 M anufacturer manuals for -_ (�Complies [FI18]3 mechanical and water heating systems have been provided. Does Not omply Not servable PNot plicable 402.2.3 Vented attics with air permeable 0 Complies Location on plans/spec: [F122]2 insulation include baffle See details adjacent to soffit and eave Does Not vents that extends over omply insulation. n Not Observable (,Not Applicable [F1311 4 adjacent assembly of door P4. v fl ......mm_........ C Does Not Location on plans/ Attic access hatch an spec: [FI3] > f the See details ly Not servable PNot plicable 402.4.1.2 Blower door test @ 50 Pa. < 5 ACH 50 ACH 50 (�Complies Location on plans/spec: [FI17]1 ach in Climate Zones 1-2,and (�Does Not As per certified tester <=3 ach in Climate Zones 3-8. .. .., Pomply Not servable PNot plicable Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 9 of 11 ............��_...._..n, .�_._.—_--..... �� ...... ...— .._. Section Plans Field # Verified Verified & Req.ID Final Inspection Provisions Value Value Complies? Comments/Assumptions ...... 403.3.3 Ducts are pressure tested to Ir ""I f Complies [FI2711 determine air leakage with k .....�{ Z z [�]Does Not either:Rough-in test:Total cfm/100 ft cfm/100 ft Comply leakage measured with a pressure differential of 0.1 inch (�I Not w.g„across the system including Observable the manufacturers air handler Not enclosure if installed at time of test.Postconstruction test:Total pplicable leakage measured with a pressure differential of 0.1 inch mg,across the entire system including the manufacturer's air handler enclosure. 403.3.4 system or< 3 cfm/esu ft2 .. Does — --..... Duct tightness test result of pp�� Complies [Fl4] <=4 c /100 ft2 across the mn... N ........_.� cfm/100 ftz cfm/100 ft2 (] Not without air handler @ 25 Pa.For Comply rough-in tests,verification may Not need to occur during Framing servable Inspection. Not Applicable 403.3.2.1 dAir esign handler leakage designatedn� � �A ,��mo mp.�.. —�. ..... _ .......... Complies [F124] Y es Not (�Not servable Not pplicable _--......._. --...... ... --�.............. ...._� ��...� � _... .. 403.1.1 Programmable thermostats Complies [FI9]2 installed for control of primary heating and cooling systems Does Not and initially set by manufacturer omply to code specifications. [�Not Observable PNot plicable Additional Comments/Assumptions: p . w pi l _.....High Impact Tier 1.) Medium Impact(Tier 2) Low Impact(Ter 3) ......... 3W .... ...,,, --- ( Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 10 of 11 2018 IIECC Energy Efficiency Certificate ,Insulation Rating R-Value Above-Grade Wall 18.00 Below-Grade Wall 13.00 Floor 0.00 Ceiling/Roof 49.00 Ductwork(unconditioned spaces): Door Ratingi, Window 0.30 0.40 Door 0.30 0.40 Skylight 0.00 Cooling Heating System: Cooling System: Water Heater: Name: Date: Comments: Report Title: NEW DWEWNG Report Date: 9/7/25, 2:40 PM 11 of 11 A5-BUILT SITE INFORMATION: yf -SUFFOLK COUNTY TAX MAP ID: 1000-135.00-02,00-017,000 -PROPOSED 2 STORY DWELLING ON EXISTING VACANT LOT. TOTAL OF 4 BEDROOMS -LOT AREA:0.203ac, -PROPERTY LOCATED AT 25 GOLDIN LANE,SOUTHOLD TOWN OF SOUTHOLD,SUFFOLK COUNTY,NEW YORK -SURVEY PROVIDED BY:CITY BOROUGH LAND SURVEYING PLLC. S IMPROVED - PUBLIC WATER DATED:FEBRUARY 02.2025 IV N/F OF IMPROVED - PUBUC WATER -VERTICAL DATUM-NAVD'1 988 DATUM s EVELINA MEFA&FRANK META ' -ALL HOMES WITHIN 1 50LF OF PROPERTY CONNECTED TO PUBLIC WATER HE JANA FFERNAN ` N -NO SURFACE WATER OR WETLANDS WITHIN 300'FROM PROPERTY LINE N88'02'50"E 79.72' GENERAL NOTES: H _ " I. DESIGN FOR 4-BEDROOM HOME, - E OF C'�tf#L, 2.I/A OWTS SANITARY DESIGN_ r X s 39.72' -� -! 39.72' s X 3.SITE PLAN AND REFERENCE ELEVATIONS TO BE USED FOR I/A OWTS SANITARY SYSTEM Y 16.0f 15.Of CONSTRUCTION ONLY,EXACT PROPERTY BOUNDARIES,UTILITY LOCATIONS AND ELEVATIONS o ED ARE NOT GUARANTEED- 0) 4.ELEVATIONS BASED ON SUFFOLrr,COUNTY G15 t ENGINEERS SITE MEASUREMENTS. o LL{ PROP.OVERHEAD ELECTRIC 5,ON51TE UTILITY MARK OUTS TO BE PERFORMED BY CONTRACTOR.PRIOR TO PERFORMING SITE I SERVICE WORK. '0 { a 6.501L TEST HOLE DATA PROVIDED BY SUFFOLK COUNTY 501L EVALUATIONS O 1-29-2025 7.501L PERC TEST PROVIDED BY SUFFOLK COUNTY SOIL EVALUATIONS 01-29-2025 0W "I�~ PROPOSED I/A OWFS SEPTIC SYSTEM FOR UP TO 4 BEDROOM RESIDENCE: ' !^i 1, ONE(I)FUJI CEN 5 I/A OWFS DRYWELLS BY 51'h(ERS F, �{I 2.ONE(I)FUJI MAC50P BLOWER,VENT AND FUJI CONTROL A55EM13LY.. `y 3.ONE(1)NUGENT t POTTER SIMPLEX PUMP STATION PF 3005 PUMP AND MVP CONTROL PANEL 4.TWO(2)26'ROWS OF 34'INFILTRATOR CHAMBERS USED FOR P5D APPLICATION- 0) i o 5<ONE(1)2G'ROWS EXPANSION OF INFILTRATOR FOR FUTURE EXPANSION,TO BE INSTALLED- 4 G,IMPORT 60 CY OF FILL FOR USE BENEATH LEACHING STRUCTURES, M . e _ GENERAL SANITARY SYSTEM AND INSTALLATION NOTES: e .. I. I/A OWTS SEPTIC SYSTEM DESIGNED FOR UP TO 4 BEDROOM HOME PER SUFFOLK COUNTY PROPOSED 2 STORY . DEPARTMENT OF HEALTH STANDARDS(5CDH5). FRAME RESIDENCE 2. SANITARY GRAVITY DRAIN PIPE TO BE 4-INCH CAST IRON AT FOUNDATION PENETRATION AND PROPOSED FFE= 19.5' 4-INCH PVC 5DR35 DOWNSTREAM OF FOUNDATION, PROPOSED 1E= 16.0'3 !!! ^ 3, I/A OWTS SHALL BE TESTED FOR WATER TIGHTNE55 PRIOR TO ARRIVING ON51TE U51NG THE I� METHOD APPROVED BY MANUFACTURER. = N 4. THE DESIGN ENGINEER SHALL OVERSEE THE OWTS DURING SYSTEM STARTUP, 'I O 5, THE OWTS INSTALLER SHALL BE LICENSED.HOLD AN ENDORSEMENT FROM 5CDH5 AND BE A FUJI AUTHORIZED INSTALLER. ' G; THE OWFS INSTALLER SHALL REGISTER THE ON51TE TREATMENT SYSTEM WITH 5CDH5. THE IN IN yy yy.� '-- DESIGN ENGINEER SHALL PROVIDE CERTIFICATION DOCUMENTS AS REQUIRED BY SCDHS. 7. AN OPERATION AND MAINTENANCE CONTRACT BETWEEN THE MAINTENANCE PROVIDER AND THE 0 PROPERTY OWNER SHALL BE PROVIDED TO 5CDH5 FOR I/A OWTS AND P5D 5Y5TEM., GARAGE [ PROP.PUBLIC WATER SERVICE 8. A GARBAGE GRINDER SHALL NOT BE INSTALLED UPSTREAM OF THE OWTS. M = DRNEWAY I W 9- WATER SOFTENER BACKWASH SHALL NOT BE FLUSHED TO PROPOSED SEPTIC 5Y5TEM. irb• ; 10, CONTRACTOR 15 RESPONSIBLE TO OBTAIN TOWN BUILDING PERMITS AS NECESSARY PRIOR TO • ---PROP.NUGENT&POTTER INSTALLATION OF THE PROPOSED SEPTIC SYSTEM, N STATION WITH DEADMAN FOR I I THE CONTRACTOR 15 RESPONSIBLE FOR DE-WATERNG AND ACQUIRING ANY NECESSARY Z I� ANTI-BUOYANCY AND PF-3005 DE-WATERING PERMITS IF PUMPING GREATER THAN 45 GPM.GROUNDWATER 15 ANTICIPATED TO :n PUMP BE APPROXIMATELY 7.3'±BELOW NATIVE GRADE IN AREA OF I/A OWTS. FUJI CONTROL PANEL, •D`F);-- 5 I 12 NOTE THERE 15 AN EXISTING HOUSE TRAP,I/A OWTS TO BE VENTED THROUGH 2 INCH CARBON MAC BLOWER AND,ASSEMBLY VENT. (t'F 13. MAINTAIN I 0-FOOT SETBACK FROM TREES TO PSD.. PROP.FUJI CEN-5 _ ` PROP,INFILTRATOR 34" I/A OWTS W/90°ADAPTER I CHAMBER PSD LEACHING TRENCHES:(2X)26'X 2.83'ROWS. wlu n".ac.cEs,rorn FUTLTREEXPANSIONTOBE INSTALLED x ` $ C, TI IMPRO - PUBLIC WATER ids�. Y_ Y 0 LEVIN FAMILY LIMITED PARTNERSHIP - g) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES oi� ( ; PERMIT FORAPPROVAL OF CONSTRUCTION FOR A IMPROVED N/F OF SINGLE WATER SINGLE FAMILY RESIDENCE ONLY LEVIN FAMILY LIMBED PARTNERSHIP SEE ATTACHMENT(S) I Y SITE PLAN Design Professional's Certification APPROVED 4/2025 t . R-25-0521 20 gn Prof ssi €3T R.l's C erotic tion Required.For DATE H<S< 20' 40' FORMAXIMUMV4 BEDROOMS TRIO instal€0tion and Construction of the Sewag0 Disposal SystoFn Use Form WWM-073 EXPIRES THREE YEARS FROM DATE OF APPROVAL F UWI 211 Town Hall Annex � "t Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PREP OINEERED W0_,0Q CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: Owner: O'o 1A0 r 10 Location of Property: Please take notice that the (check applicable line): ✓ New commercial or residential structure Addition to existing commercial or residential structure Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): ✓ Truss type construction(TT) Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): ✓ Floor framing, including girders and beams (F) Roof framing (R) Floor and roof framing (FR) Signature: Name(person submitting this form): Capacity(check applicable line): ✓ Owner Owner representative TrussReg15.docx Effective 1/1/2015 SURFQ Scott A. Russell �: � NA\�G�]EI��I[]E1�'7C' SUPERVISOR AAA\ SOUTHOLD TOWN HALL-P.O.Sax 1179 Town o Southold l 53095 Main Road-SOUTHOLD,NEW YORK 11971 " TER 236 - STORMWATER MANAGEMENT .REFERRAL� FORM ( APPLICANT INFORMATION TO BE COMPLETED 1, OMPLETE® BY THE APPLICANT �fi ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) P APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) N NAME Date: S BGN YYoSU . Contact Information: q►`� _. (tSMesrl a B rl*hna*PJ<<iv,t;rP! J J Pro ) 'rt Address ! Location of Construction Site: 25 �OLDiN L A/ S-C.Te . 1000 � Dirti°ict 1367 2 I—? �secHon Block ..p.M-._ TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ® - Area of Disturbance is less than I Acre, No S,P, E,S�.. Permit as Re wrtd 's Project does Not Discharge to Waters of the State. IN S2 D F S. 6 er. �L__L. - Area of Disturbance is Greater than I Acre & Storm-water Runoff Discharges Directly H APPLICANT 013rfAIN a �11 D.E.S Pemit_. to ` f the� tf New �oi DIRICtI.YvionNY.S DE CPror to Issuance rB � e tr® Area of Disturbance is Greater than I. Acre & Storm-water Runoff Flows Through Southold NT MUST OBTAIN Permit through he State of Ne� ark T HC APPLICf',�� . a �l�D. 4 e�n�t � Wati a Sr a,ithol�I ..I...own 1 twineer�a� Deg ray' ment Pr,'oa d�o Issuance I a t��1din Permit. Da( P"ror MW ' hZMf P-TOO n- tnhar gn ltl