HomeMy WebLinkAbout52436-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 52436 Date: 11/05/2025
Permission is hereby granted to:
Joseph P Vermaelen
PO BOX 84
Bayport, NY 11705
To:
Construct a new Modular single-family dwelling with HVAC system as applied for per Trustees non-
jurisdiction letter, DEC and SCHD approvals. Flood development permit is required.
Premises Located at:
2020 Bay Ave, Mattituck, NY 11952
SCTM# 144.-3-40.1
Pursuant to application dated 09/15/2025 and approved by the Building Inspector.
To expire on 11/05/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling-NEW MODULAR $2,053.00
CO Single Family Dwelling-New $100.00
Flood Permit $150.00
Total $2,303.00
__dc'L
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
4 R Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 httr :Hwv w,southo1dtownny
Date Received
APPLICATION FOR BUILDING
For Office Use Only «S" ' CE
PERMIT NO. Building Inspector: ( kB
SEP 1 5 202 w
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owners Authorization form(Page 2)shall be completed. ^�vm,of v
Date: AoSr It ,
OWNER(S)OF PROPERTY:
Name: 505EPk. 40b VAMLtet3 vEQMASMO SCTM# 1000- 144 ,W0_0003 040,061
Project Address: U-W As , MArriNGL- , 14N! i 1q 62
Phone#: Email:
Mailing Address: °jSq �kcovjo Ave , 2AUPmr ,, 41 11-105
CONTACT PERSON:
.Name: -so ) QjQ-kt%)
Mailing Address: �0 aox Q'% %Q►rA\EL %.APCUN , %14 111?,
Phone#: 011 - fa'Nb- 7 qWS Email: -SS���rl� @ q41,ApiD0 nl00"(2.Lbw
DESIGN PROFESSIONAL INFORMATION:
Name: pAUL C)AO-( Lf-:WIS
Mailing Address: 1004 �pQi�C�; �,8Op1� AU�� �ppg,C , A Issol
Phone#: 67o--1'7c4 1000 Email: lt1Tb@SASQ0b.(bLk
CONTRACTOR INFORMATION:
Name: UESsO DESI(W ANfl �EUEtGJ�tEnr Il.� �o� Sce�►N
Mailing Address: r-b %cr),. W. �Q�palA�l�tUe.1 , �� I Igb'L
Phone#: Oj 1�_ MS- 79 4S Email: SQtQ-v-t%j @ iAq�OtprJAAo�UTAIL.D�
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ 160,000
Will the lot be re-graded? Yes ONO Will excess fill be removed from premises? 2'yes El No
1
w ,
PROPERTY INFORMATION
Existing use of property: (2L4 0 Intended use of property: S I,3 GUE FLU WLy 1Ak)1AE
Zone or use district in which premises is situated Are there any covenants and restrictions with respect to
this property? Eyes LANo IF YES, PROVIDE A COPY.
E(C.heck Box After i 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 Laws,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 authortzed inspectors on premises and in buildings)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 2WA5 of the New York State Penal Law.
Application Submitted By(pr" t name). WgtT L9Authorized Agent ❑Owner
Signature of Applicant: Date: ��is I-n-
STATE OF NEW YORK)
Q SS:
COUNTY OF JUi'FOi-�C )
I being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the eqy
(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/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
day of a 20 L3�-
Notary Public
JONATHAN P SIRKIN
Notary Public,State of New York
93382
Qualified in New1 fYo k County l ....0 rE,F' . ..OWNER
Commission Expires Sept. 15,20 hex;, (Where the applicant is not the owner)
I, residing at 44 001;
do hereby authorize lasra Nsms R-.Y) LLC- to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
? C5
Own 's Signature Date
"LLum Pgwers- e r-vKq eA-2 f q
Print Owner's Name
2
aTM Town Hall Annex
Glenn Goldsmith,President 54375 Route 25
A.Nicholas Krupski,Vice President ° P.O.Box 1179
Eric Sepenoski Southold,New York 11971
Liz Gillooly Telephone(631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 19, 2024
Eileen A. Powers, Esq. PLLC
456 Griffing Avenue
Riverhead, NY 11901
RE: JOSEPH & KATHLEEN VERMAELLEN
2020 BAY AVENUE, MATTITUCK
SCTM#1000-144-3-40.1
Dear Ms. Powers:
The Southold Town Board of Trustees reviewed the survey prepared by Young&Young, last
dated May 1, 2024 and determined that the proposed installation of a septic system is out of the
100 foot Wetland jurisdictional area under Chapter 275 of the Town Wetland Code and Chapter
111 of the Town Code.
Please be advised, however, that no construction, sedimentation, or disturbance of any kind
may tape place seaward of the tidal and/or freshwater wetlands jurisdictional boundary, or within
100' landward from the edge of vegetated wetlands, without further authorization from the
Southold Town Board of Trustees pursuant to Chapter 275 anddor Chapter 111 of the Town
Code.
It is your responsibility to ensure that all necessary precautions are taken to prevent any
sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal
Wetlands jurisdiction and Coastal Erosion Hazard Area,which may result from your project.
Such precautions may Include maintaining adequate work area between the tidal wetland
jurisdictional boundary and the coastal erosion hazard area and your project or erecting a.
temporary fence, banter, or hay bale berm.
This determination is not a determination from any other agency.
Sincerel M
4!
Glenn Goldsmith, President
GG:ec
fl KATHY HOCHllL
LqN( � Governor
Ivrr ►awltI l
AMA LEPTON
Conservation Commissioner
July 14, 2025
Joseph Vermaeien
Kathleen Powers-Vermaelen
PO Box 84
Bayport, NY 11705
Re: Application #1-4738-05045/00002
Vermaelen Property: 2020 Bay Avenue
SCTM# 1000-144-3-40.1
Dear Permittee:
In conformance with the requirements of the State Uniform Procedures Act (Article 70,
ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your
permit. Please carefully read all permit conditions and special permit conditions
contained in the permit to ensure compliance during the term of the permit. If you are
unable to comply with any conditions please contact us at the above address.
Also enclosed is a permit sign which is to be conspicuously posted at the project site
and protected from the weather.
Sincerely,
Ely sa Scott
Deputy Permit Administrator ,
cc: En-Consultants
BEH
Wildlife
File
Division of Environmental Permits, Region 1
50 Circle Road, Stony Brook, NY 11790 1 dec.ny.gov I dep.r1@dec.ny.gov 1 (631)444-0365
femme
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05045
PERMIT
Under the Environmental Conservation Law ECL
Permittee and Facility Information
Permit Issued To: Facility:
KATHLEEN POWERS VERMAELEN VERMAELEN PROPERTY
389 2ND AVE 2020 Bay Ave
BAYPORT,NY 11705 MATTITUCK,NY 11952
JOSEPH VERMAELEN
389 2ND AVE
PO BOX 84
BAYPORT,NY 11705
Facility Application Contact:
EN-CONSULTANTS
1319N SEARD
SOUTHAMPTON,NY 11968
(631)283-6360
Facility Location: in SOUTHOLD in SUFFOLK COUNTY
Facility Principal Reference Point: NYTM-E: 707.4323121255811 NYTM-N:
4539.63683123465
Latitude: 40°58'53.6" Longitude: 72°32'03.6"
Authorized Activity: Construct a single family dwelling with accessory structures.All work must be
done according to the plans prepared by Young and Young, last revised 5/15/2025 and stamped
NYSDEC approved 7/14/2025.
Note: The portion of the property landward of the 100'wetland setback as shown on the approved plans
is beyond Article 24 jurisdiction.
The subject property, which is landward of Bay Avenue that has been paved prior to August 20, 1977 as
shown on tidal wetlands aerial photo 706-538 is beyond Article 25 jurisdiction.
Permit Authorizations
Freshwater Wetlands-Under Article 24
Permit ID 1-4738-05045/00002
New Permit Effective Date: 7/14/2025 Expiration Date: 7/13/2030
Page 1 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05045
NYSDEC Approval
By acceptance of; this permit, the permittee agrees that the permit is contingent upon strict
compliance with the ECL,all applicable regulations,and all conditions included as part of this
permit.
Permit Administrator:ELYSSA E SCOTT,Deputy Regional Permit Administrator
Address: NYSDEC Region 1 Headquarters
SUNY @ Stony BrookJ50 Circle Rd
Stony Brook,NY 11790-3409
Authorized Signature: &.Wi ivl- -.
Date
Distribution List
EN-CONSULTANTS
Habitat
Wildlife
Elyssa E Scott
Permit Components
NATURAL RESOURCE PERMIT CONDITIONS
GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following
Permits: FRFS'II`'4ATER WETLANDS
1. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee
and contractor shall sign and return the top portion of the enclosed notification form certifying that they
are frilly aware of and understand all terms and conditions of this permit. Within 30 days of completion
of project,the bottom portion of the form must also be signed and returned, along with photographs of
the completed work.
2. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous
location on the worksite and adequately protected from the weather.
3. Conformance With Plans All activities authorized by this permit must be in strict conformance
with the approved plans submitted by the applicant or applicant's agent as part of the permit application.
Such approved plans were prepared by Young& Young, last revised 5/15/2025.
Page 2 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 14738-05045
4. Tree Clearing Prohibition for Long-eared Bats Due to the proximity of a known northern long-
eared bat summer occurrence, tree clearing is prohibited between March 1 and November 30, inclusive, of
any calendar year.
5. Work Area Limits Any work, disturbance,and or storage of construction materials shall be
confined to within the limit of clearing and ground disturbance shown on the approved plan.
6. Materials Disposed at Upland Site Any demolition debris, excess construction materials, and/or
excess excavated materials shall be immediately and completely disposed of on an approved upland site
more than 100 feet from any regulated freshwater wetland. These materials shall be suitably stabilized
so as not to re-enter any water body,wetland,or wetland adjacent area.
7. Clean Fill Only All fill shall consist of clean soil, sand and/or gravel that is free of the following
substances: asphalt, slag, flyash,broken concrete,demolition debris, garbage,household refuse,tires,
woody materials including tree or landscape debris,and metal objects. The introduction of materials
toxic to aquatic life is expressly prohibited.
8. Equipment Storage 100' from Wetland,Water Body All equipment and machinery shall be
stored and safely contained greater than 100 feet landward of the regulated wetland or water body at the
end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the
regulated area.
9. Silt Screen Prior to commencement of any construction activities, a continuous line of silt screen
(maximum opening size of U.S. Sieve#20)shall be staked along the LCGD as shown on the approved
plans.
lo. Silt Screen to Be Recessed Silt screen shall be recessed six inches into the ground.
11. Maintain Silt Screen The screen shall be maintained,repaired and replaced as often as necessary
to ensure proper function, until all disturbed areas are permanently vegetated. Sediments trapped by the
screen shall be removed to an approved upland location before the screen is removed.
12. Driveway of Permeable Material The driveway must be surfaced with a permeable material.
13. Demarcate Buffer A permanent 4'high post-and-rail fence or other similar barrier must be
installed along the Limits of Clearing and Ground Disturbance(LCGD)as shown on the approved plans
to distinguish the developed area from the buffer to remain natural and undisturbed.
14. Runoff and Discharges Directed to Dr wells All roof runoff and/or pool discharges shall be
directed to drywells located greater than 100' from the freshwater wetland boundary.
15. Seed,Mulch Disturbed Areas All areas of soil disturbance resulting from this project shall be
seeded with an appropriate perennial grass,and mulched with straw immediately upon completion of the
project,within two days of final grading, or by the expiration of the permit,whichever is first.
16. Temporary Mulch, Final Seeding If seeding is impracticable due to the time of year, a temporary
mulch shall be applied and final seeding shall be performed at the earliest opportunity when weather
conditions favor germination and growth but not more than six months after project completion.
Page 3 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05045
17. Minimum % Vegetative Cover Suitable vegetative cover is defined as a minimum of 85 %area
vegetative cover with contiguous unvegetated areas no larger than I square foot in size.
18. Notice Covenant The permittee shall incorporate the attached Covenant(or similar Department-
approved language)to the deed for the property where the project will be conducted and file it with the
Clerk of SUFFOLK County within 30 days of the effective date of this permit. This deed covenant shall
run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record,
along with the number assigned to this permit, shall be submitted within 90 days of the effective date of
this permit to
Regional Habitat Manager
NYSDEC Region 1 Headquarters
SUNY @ Stony BrookJ50 Circle Rd
Stony Brook,NY11790-3409
19. Precautions Against Contamination of Waters All necessary precautions shall be taken to
preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents,
lubricants,epoxy coatings,paints, concrete, leachate or any other environmentally deleterious materials
associated with the project.
20. State Not Liable for Damage The State of New York shall in no case be liable for any damage or
injury to the structure or work herein authorized which may be caused by or result from future operations
undertaken by the State for the conservation or improvement of navigation, or for other purposes,and no
claim or right to compensation shall accrue from any such damage.
21. State May Order Removal or Alteration of Work If future operations by the State of New York
require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the
Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation
of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause
loss or destruction of the natural resources of the State,the owner may be ordered by the Department to
remove or alter the structural work,obstructions, or hazards caused thereby without expense to the State,
and if, upon the expiration or revocation of this permit,the structure, fill, excavation,or other
modification of the watercourse hereby authorized shall not be completed,the owners, shall, without
expense to the State,and to such extent and in such time and manner as the Department of
Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill
and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall
be made against the State of New York on account of any such removal or alteration.
22. State May Require Site Restoration If upon the expiration or revocation of this permit,the
project hereby authorized has not been completed,the applicant shall, without expense to the State, and
to such extent and in such time and manner as the Department of Environmental Conservation may
lawfully require,remove all or any,portion of the uncompleted structure or fill and restore the site to its
former condition. No claim shall be made against the State of New York on account of any such
removal or alteration.
Page 4 of 6
v
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05045
m ....__�.�.._._ENERAL___
G CONDITIONS - Apply to ALL Authorized Permits:
1. Facility Inspection by The Department The permitted site or facility, including relevant records, is
subject to inspection at reasonable hours and intervals by an authorized representative of the Department
of Environmental Conservation(the Department)to determine whether the permittee is complying with
this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301
and SAPA 401(3).
The permittee shall provide a person to accompany the Department's representative during an inspection
to the permit area when requested by the Department.
A copy of this permit,including all referenced maps, drawings and special conditions,must be available
for inspection by the Department at all times at the project site or facility. Failure to produce a copy of
the permit upon request by a Department representative is a violation of this permit.
2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly
provided for by the Department, issuance of this permit does not modify, supersede or rescind any order
or determination previously issued by the Department or any of the terms, conditions or requirements
contained in such order or determination.
3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a
separate written application to the Department for permit renewal,modification or transfer of this
permit. Such application must include any forms or supplemental information the Department requires.
Any renewal,modification or transfer granted by the Department must be in writing. Submission of
applications for permit renewal, modification or transfer are to be submitted to:
Regional Permit Administrator
NYSDEC Region 1 Headquarters
SUNY @ Stony BrookJ50 Circle Rd
Stony Brook,NY11790 -3409
4. Submission of Renewal Application The permittee must submit a renewal application at least 30
days before permit expiration for the following permit authorizations: Freshwater Wetlands.
5. Permit Modifications, Suspensions and Revocations by the Department The Department
reserves the right to exercise all available authority to modify, suspend or revoke this permit. The
grounds for modification, suspension or revocation include:
a. materially false or inaccurate statements in the permit application or supporting papers;
b. failure by the permittee to comply with any terms or conditions of the permit;
c. exceeding the scope of the project as described in the permit application;
d. newly discovered material information or a material change in environmental conditions,relevant
technology or applicable law or regulations since the issuance of the existing permit;
Page 5 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05045
e. noncompliance with previously issued permit conditions,orders of the commissioner, any
provisions of the Environmental Conservation Law or regulations of the Department related to
the permitted activity.
6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or
another permit condition. Applications for permit transfer should be submitted prior to actual transfer of
ownership.
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification
The permittee,excepting state or federal agencies, expressly agrees to indemnify and hold harmless the
Department of Environmental Conservation of the State of New York, its representatives,employees,
and agents("DEC")for all claims, suits, actions, and damages,to the extent attributable to the
permittee's acts or omissions in connection with the permittee's undertaking of activities in connection
with, or operation and maintenance of,the facility or facilities authorized by the permit whether in
compliance or not in compliance with the terms and conditions of the permit. This indemnification does
not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or
intentional acts or omissions, or to any claims, suits,or actions naming the DEC and arising under
Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision
under federal or state laws.
Item B: Permittee's Contractors to Comply with Permit
The permittee is responsible for informing its independent contractors, employees,agents and assigns of
their responsibility to comply with this pennit,including all special conditions while acting as the
permittee's agent with respect to the permitted activities,and such persons shall be subject to the same
sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee.
Item C: Permittee Responsible for Obtaining Other Required Permits
The permittee is responsible for obtaining any other permits,approvals,lands, easements and rights-of-
way that may be required to carry out the activities that are authorized by this permit.
Item D: No Right to Trespass or Interfere with Riparian Rights
This permit does not convey to the permittee any right to trespass upon the lands or interfere with the
riparian rights of others in order to perform the permitted work nor does it authorize the impairment of
any rights,title, or interest in real or personal property held or vested in a person not a party to the
permit.
Page 6 of 6
/0-4w Department of
YORK
STATE Environmental
Conservation
NOTICE
The Department of Environmental Conservation (DEC) has issued permit(s) pursuant
to the Environmental Conservation Law for work being conducted at this site. For further
information regarding the nature and extent of work approved and any Departmental
conditions on it, contact the Regional Permit Administrator listed below. Please
refer to the permit number shown when contacting the DEC.
Regional Permit Administrator
SHERRI AICHER
Permit Number: 1-4738-05045/00002
NYSDEC Region 1 Environmental Permits
50 Circle Road
Stony Brook, NY 11790-3409
Expiration Date: 7/13/2030 Email: dep.rl@dec.ny.gov
Note: This notice is NOT a permit
NOTICE COVENANT TO THE DEED
DECLARATION
THIS DECLARATION,dated day of ,20_ ,is made by
(hereinafter the "Declarant"),whose address is
WITNESSETH
WHEREAS, the Declarant is the owner of certain real property located in the Town of Southold, County
of Suffolk, State of New York,Tax Map#District 1000, Section 144, Block 3, Lot(s)40.1 which real
property is more particularly described in Exhibit A annexed hereto(hereinafter referred to as the "Property');
and
WHEREAS, the Property is situated in or adjacent to regulated freshwater wetland as determined by the
New York State Department of Environmental Conservation(hereinafter"Department"),pursuant to
Environmental Conservation Law(hereinafter"ECL")Article 24(also known as the"Freshwater Wetlands
Act")and Part 664 of Title 6 of the New York Code of Rules and Regulations(hereinafter"6 NYCRR );and
WHEREAS,various activities conducted both in and adjacent to freshwater wetlands are regulated by
the Department pursuant to ECL Article 24 and Part 663 of 6 NYCRR and require written authorization from
the Department prior to being conducted;
NOW,THEREFORE,in recognition of the Department's jurisdiction as set forth above,it is the
responsibility of a party having any right,title,or interest in the Property,to obtain from the Department or
any successor organization,a current description of all activities which are regulated pursuant to ECL Article 24
and Part 663 of 6 NYCRR,and to obtain written authorization from the Department prior to such regulated
activities being conducted on the Property. Regulated activities include,but are not limited to, clearing of
vegetation;application of chemicals;excavation;grading and filling; and erection of any structures.
By:
STATE OF NEW YORK )
)ss.
COUNTY OF )
On the day of in the year 20 ,before me,the undersigned,a Notary
Public in and for said state,personally appeared ,personally known to me or proved
to me on the basis of satisfactory evidence to be the person 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 person or entity upon behalf of which the person acted,executed the instrument.
NOTARY PUBLIC
NO E,OF COMM9NCEMEN1 O,E CONSIRUMON AM
RETURN THIS FORM TO:COMPLIANCE
Bureau of Ecosystem Health E-Mail:dec.sm.1111 BEH@dec.ny.gov
NYSDEC
50 Circle Road SUNY@ Stony Brook
Stony Brook, NY 11790-3409
PERMIT NUMBER: EXPIRATION DATE:
PERMITTEE NAME&PROJECT ADDRESS:
CONTRACTOR NAME&ADDRESS:
TELEPHONE:
Dear Sir:
Pursuant to special conditions of the referenced permit,you are hereby notified that the authorized activity shall commence on
. We certify that we have read the referenced permit and approved plans and fully understand the authorized
project and all permit conditions.We have inspected the project site and can complete the project as described in the permit and as depicted
on the approved plans, We can do so in full compliance with all plan notes and permit conditions.The permit,permit sign,and approved
plans will be available at the site for inspection in accordance with general Condition No. 1.(Both signatures required)
PERMITEE: DATE
CONTRACTOR: DATE
THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT
AND/OR ANYASSOCIATED REGULATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE
THE PERMIT AND APPROVED PLANS AVAILABLE AT THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE
PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT
CONDITIONS.
Cut along al9ng this line X 21 x X X X
Am
NO ICE.OF COMPLETION OF CONSTRUCTION
RETURN THIS FORM TO:COMPLIANCE or by tmmw
Bureau of Ecosystem Health E-Mail:dec.sm.R1BEH@dec.ny.gov
NYSDEC
50 Circle Road SUNY@ Stony Brook
Stony Brook, NY 11790-3409
PERMIT NUMBER: EXPIRATION DATE:
PERMITTEE NAME&PROJECT ADDRESS:
CONTRACTOR NAME&ADDRESS:
TELEPHONE:
Pursuant to special conditions of the referenced permit,you are hereby notified that the authorized activity was completed
on .We have fully complied with the terms and conditions of the permit and approved plans.(Both signatures required)
PERMITEE: DATE:_
CONTRACTOR: DATE:
THIS NOTICE, WITH PHOTOGRAPHS OF THE COMPLETED WORK AND/OR A COMPLETED SURVEY,AS APPROPRIATE, MUST BE
SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT.
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uN(aq._E f OaN E xICD�C E ONLY BACKFILL. w I VOLUME PROVIDED Dqg
•• USE NEW DW#2 qas E. ,PPaP'esebrwl NniPeT
3.THE SYSTEM START UP WILL BE COMPLETED UNDER THE + 8'DIAx3'DEEP DRYWELL =127 OF • Robert G.Task,Arohlte-t
DIRECT SUPERVISION OF A FUJICLEAN USA +
REPRESENTATIVE. LOT COVERAGE Robert Strom•kl,Architect
DATE WW um9/13/25 "'p S. R-24-0905 4.AN EXECUTED OPERATION AND MAINTENANCE BUILDABLE LAND AREA 35,606 SF
,.M
FRAME HOUSE =994 SF
APPROVE.D �� CONTRACT BETWEEN THE MAINTENANCE PROVIDER AND PROPOSED SITE M�ATA
PROPERTY OWNER MUST BE SUBMITTED TO THE SUFFOLK _
IB� 4 BEDROOMS ROf:�MS COUNTY DEPARTMENT OF HEALTH SERVICES(SCDHS)PRIOR COVERED PORCHS =296 SF tl6d0AyCIItNh49 �y q AREA=40,086 SQ.FT,
- " TO APPROVAL OF THE VA WITH
A REGISTRATION BY THE � N DECK S STAIRS TOTAL - SF
�°OU2E�9THIREEYE a9F�u�) Up(TE�YI�A.U3U�B'�S�VAi SCDHSIN ACCORDANCE WITHARTICLE190�THE SVFFOLK �" q 'VERTICAL DATUM =NAVD(1988)
COUNTY SANITARY CODE. •to `d =1,346 SF=3.BR
.----.... ��....,..,,, )4 `6 *SEE FLOOD INSURANCE RATE MAP PANEL NO.3610300481 H LAST DATED
5.ARCHITECT TO VERIFY FINISHED FLOOR ELEVATION(S). II+.,$ MA7£IMSAM 6FA(LOPS UP TO A(1, FA) SEPT.25.zoo9.
q _ AREA I *ZONING USE DISTRICT =R-0
FLOOR
WETLANDS AREA -4,480 SF
m 4'
-
� ,950 SF�(5,606 SF x 0
4"DIA.PERFORATED PIPE TEST HOLE NYSDEC ADJACENT AREA OSED GFA=11,9BB SF
+ *BUII.DAED LAND AREA=4oAe6 SF-4,480 SF =35,00SF
PEPJ-VABLE 5AGI ILL DY'N`Dot"GEo��' (lot area within 100'of wetlands) 'PROPOSED FILL 20 CY
61MOT1:M LE DATE.OV24/2023 CAW w =2 FT
6E05YNTHETIG ER EL.-31 PALE6RAYA OA' ' ADJACENT AREA(AA)=21,678 SF DEPTH TO GROUNDWATER
ATE' "NUMBER OF BEDROOMS(DESIGN EQUIVALENT) =4 .
BROWN S iy „,:w-' 1 A NATURAL VEGETATION WITHIN AA=18,345 SF *MINIMUM REQUIRED VA OWTS CAPACITY =440 GAL
USABLE 501L ( ++ NATURAL VEGETATION TO *PROVIDED VA OWTS CAPACITY =500 GAL
,rX,..,,r r r` r 0 0 MIN/INC.H �' $ REMAIN WITHIN AA-13.799 SF *6RAVELLESS ABSORSTION TRENCH REQUIRED USING
" ' r feROOLATION RATE) BROWNFwE -
+ r r r r x x y $ PERCENT OF NATURAL VEGETATION TO TABLE 11 OF THE SCDHS STANDARDS FORA 4 BEDROOM =61 LF
= rrrr r it '� xrr .� r ✓ "Ae
(s% REMAIN WITHIN AA=75.2% DESIGN 61-5 min/In PERCOLATION RATE
m ✓ r r 6w,ELL2 L9• r -
's" 8,, '• ; /" r' pr b;, "6RAVELLE55 ABSORBTION TRENCH PROVIDED =64 LF
WATMIN cJ 1Y " N ENGINEER'S CERTIFICATION
Y Mo INE
M I "'1 HEREBY CERTIFY THAT THE WATER SUPPLV(S)AND/OR SEWAGE D SPOSAL
_ 4'TO TRENCH (5M cMF
s "#EW+(S)FOR T'H1IS MwEcr WERE DESIGNED BY ME OR UNDER MY
DIREiG'1•ION,BASED UPON A CAREFUL AND TMOROU6H S IL,
SITE AND
T6HESTEXPEGTED FOMOUFFOLLKCODUNTYRTMENTNDWATER CONDITIONS. FA rall
Hl2 ST �OUND WAIER CONSTRUCTION T CT
S OF
EL 6A�oowox A_... _ US"M &'rOAn*WELL DATA g '" � •.
UNSUITABLE SAND SHALLEM
=PLA B�
RATED AT SP YVI ORT SAND RL
` A
ism
N " t
SH
LEACHING TRENCH SHALL ,5,g1,(Cp MEETING ASTM ry1ytN dqr t ',0 y8 „:./ p, HOWARD W.YOUNG,N.Y.S.L.S.No.45B93n '014 83 e�
SAND RATED ATT SP OR Ski( `�IDIFIGATION G39 8 � 1� I Y F A '" ,� -1 DOUGLATHOMA C.WDAMS,,N.Y.S.P.E.O 8DB97
" gym ,,,. DOU61.15 E.ADAMS,N.Y.S.P.E.NO.BOB97
6RAVELESS ABSORPTION TRENCH 5EGTION �119 "-~ r 1 a q
MF6.BY EL.JEN CORPORATION MDLt+B49 SCALE, NTs .'" 'rk �. _„,.•�.-~"" aW or tDr'+' ,Sr• , I SURVEYOR'S C;RTIFICA
OR APPROVED EQUAL ». of Wa♦ "P„ sgs,&93 "WE HEREBY CERTIFY TO J 09 E PH P.VE
Z ��gfa /" s SURVEY WAS PREPARED IN ACCORDANCE WITH
,)p ' ' LAND SURVEYS ADOPTED BY THE NEW YORK STA 0
PROFESSIONAL LAND SURVEYORS. �1 cT
HOWARD W.YOUNG,fWS.L.S.N&45M � C3 L
.,• t- r....�' "L AND
SURVEY FOR
�^ r
JOSEPH P. VERMAELEN
-7.29 at Mattituck,Town of Southold
1. .74 Suffolk County,New York
Ilk
t d �'' BUnbU46 PERMIT SURVEY
1t T I °rod
Cotmty Tax Map District 1000 Sectim 144 mock 03 4o.i 40.1
3.. LEGEND �'t r` ""'" '' E OF \/ l FIELD SURVEY COMPLETED SEPT.12,2022
CLF =CK41N LINK FENCE � / \� v+d' , �" '� "� 6 t � ` MAP PREPARED SEPT.13,2022
CMF =C E'TE MONUMENT FOUND � "�41�' ''"�„ �'� ,',q � �(10D 1� 1 `"`
CMS =CONCRETE MONUMENT SET ', `-..-- or(' /- REVISION Record Of Revisions DATE
CSW
WALK
Rio CONCRETE ON PR PERTY A+LINE � 1 BP A sT oR
e
EOP EDGE OFPAVFAAENT �9 p+1q� ( �.
RCS =REBAR A CAP SET '"�" t` �'' R h.P •t'At'�
a1 e e
WIF =WIRE FENCEJu� Y re k l
= ^4r \ . .• fy _
WDF =WOOD PENCE
WSF -WOOD STAKE FOUND
WSS WOOD STAKE SET
B" t �/! i
'III =UTILITY POLE Water) t� pRsC EgaRiiraR a rnft RI.,or F A.xu9 Iffll�mtbion ffaafr the, V System�VeRn,
m • =END OF DIRECTION/DISTANCE / 0 2B 40 80 12p
=WETLAND FLAG&NUMBER .� .. tt .N tlarl Scale.V= 40'
L&AmNG
ATfACHEf_3 Sf�FcoAL(:ONOBYTON, ..... ..... ..® JCtB NO.2022
® _ DW6.2020155abpr2 1 OF 2
IPa/NANr�d�1aI_a1T' ILl4N