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Home My WebLink AboutTR-10911A Glenn Goldsmith,President ogOfFO[,�CD Town Hall Annex A.Nicholas Krupski,Vice President �� y�n, 54375 Route 25 Eric Sepenoski y i P.O. Box 1179 Liz Gillooly • ry Southold,NY 11971 Joseph Finora 'y,� p�. Telephone(631)765-1892 1 at1r Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection Glenn Goldsmith,President w`�OF S0lir Town Hall Annex V' 54375 Route 25 Nicholas Krupski,Vice President /�® l® P.O. Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Joseph Finora • yQ Fax(631) 765-6641 ®I�COWN BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10911A Date of Receipt of Application: January 27, 2026 Applicant: CAROL ANN SICCARDI, CHRISTOPHER FOTI, FORTUNATO FOTI, IGNATIA E. FOTI LIVING TRUST, PASCAL FOTI, RUSSEL LIVING TRUST, VALENTINE FOTI SCTM#: 1000-53-1-19 Project Location: 1925 Pipes Neck Road, Greenport Date of Resolution/Issuance: February 11, 2026 Date of Expiration: Febuary 11, 2029 Reviewed by: Board of Trustees Project Description: Abandon existing cesspool; change existing waste line to 4" cast iron; install I/A OWTS system with eight (8) 2' precast leaching galleys with control panel, mac blower assembly, and vent; add ±80 cubic yards of clean fill from an upland source for grading and use beneath leaching galleys. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Homeport Engineering P.C., received on February 3, 2026, and stamped approved on February 11, 2026. Special Conditions: No construction of retaining walls without receiving a Trustee permit. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. 11 1AL Glenn Goldsmith, President Board of Trustees AS-BUILT SITE INFORMATION: -SUFFOLK COUNTY TAX MAP ID: 1000-53-01-19 -EXISTING 1-STORY DWELLING. NO PROPOSED CONSTRUCTION. EXISTING 5 BEDROOMS FOTI DESIGN-AREA: 0.0570 AC,R UP T024,899 DSQ FT. RESIDENCE -PROPERTY LOCATED AT 1925 PIPES NECK, GREENPORT, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK. -SURVEY PROVIDED BY: GARY BENZ LS: 07-21-2025 -VERTICAL DATUM - NAVD 1988 DATUM hh r .' •Y- . _ , -- -SURFACE WATER & WELTANDS SHOWN. 1925 PIPES NECK ROAD d`F.{•,:�`< Iwt -� _A� -PUBLIC WATER, ALL HOMES WITHIN 150LF CONNECTED TO PUBLIC WATER. GREENPORT, NY 11944 GENERAL NOTES: n(D FZD CAF ' '`` 'v I L 1. DESIGN FOR UP TO 6-BEDROOM HOME. o� (� = S,�,,,II ._.,�,i� 2. I/A OWTS SANITARY REPLACEMENT DESIGN. ENVIRONMENTAL ISERVI SERVICES I Y/��( ' l r - F.�,� 3. SITE PLAN AND REFERENCE ELEVATIONS TO BE USED FOR I/A OWTS SANITARY DATE \� `� SYSTEM CONSTRUCTION ONLY. EXACT PROPERTY BOUNDARIES, UTILITY LOCATIONS 0"0 rVar 1 �� AND ELEVATIONS ARE NOT GUARANTEED. --F----- 4. ELEVATIONS BASED ON PROPERTY SURVEY PROVIDED BY GARY BENZ LS 07-21-2025. 5. ONSITE UTILITY MARK-OUTS TO BE PERFORMED BY CONTRACTOR PRIOR TO SOUTHOLD PERFORMING SITE WORK. SUFFOLK COUNTY - - -- -- - i 6. SOIL TEST HOLE DATA PROVIDED BY MCDONALD GEOSERVICES 07-08-2025 7. EXISTING SANITARY CESSPOOLS(S) TO BE PUMPED AND REMOVED AS NECESSARY PER SCDHS STANDARDS. PROPOSED I/A OWTS SEPTIC SYSTEM FOR UP TO 6 BEDROOM RESIDENCE' 1. ONE (1) FUJI CEN-7 I/A OWTS 2. ONE (1) FUJI MAC 10OR BLOWER, FUJI CONTROL ASSEMBLY, AND VENT 3. ONE (1) 20" POLYLOK DISTRIBUTION BOXFFB 2020 4. EIGHT (8) 8.5' X 4.75' X 2' EFFECTIVE DEPTH LEACHING GALLEYS. 5. FOUR (4) 8.5' X 4.75' FUTURE EXPANSION AREA. 6. APPROXIMATELY 80 CY OF CLEAN SAND FILL FOR GRADING & USE BENEATH SANITARY STRUCTURES. I/A OWTS V TS 253.5't GENERALSANITARY SYSTEM AND INSTALLATION NOTES: CANT �Y OF 1. I/A OWTS SEPTIC SYSTEM DESIGNED FOR UP TO 6 BEDROOM HOME PER SUFFOLK SANITARY COUNTY DEPARTMENT OF HEALTH STANDARDS (SCDHS). 2. INTERIOR PLUMBING AND INVERT TO BE RELOCATED BY LICENSED PLUMBING MER . , '' CONTRACTOR AS SHOWN ON PLANS. SYSTEM DESIGN FOR OAK � �. 0 N F �o� \ .. . . ... 3. SANITARY GRAVITY DRAIN PIPE TO BE 4-INCH CAST IRON AT FOUNDATION N� NOW,� 0 s �P ��• �1 PENETRATION AND 4-INCH PVC SDR35 DOWNSTREAM OF FOUNDATION. UN ��F �� 4. I/A OWTS SHALL BE TESTED FOR WATER TIGHTNESS PRIOR TO ARRIVING ONSITE CO //��p��I-\�� ©�� 4,�EXISTING°ESSPG°L(s)T°BEPNMPEDAND USING THE METHOD APPROVED BY MANUFACTURER. PROP NUJICEN-7 I/A OW0"ADA DMEN 1 `LJ G REMOVED OR ABANDONED PER SCDHS &.- 5. THE DESIGN ENGINEER SHALL OVERSEE THE OWTS DURING SYSTEM STARTUP. FOR ANT[-BUOYANCY&90 ^ / STANDARDS 1 `\J p FUJI CONTROL PANE ,MAC ,� 6. THE OWTS INSTALLER SHALL BE LICENSED, HOLD AN ENDORSEMENT FROM SCDHS 11 44. ,7l) ) BLOWER ASSEMBLY, ND VENT I II Ov 0 EXIS B RIEDN TU AL STANK �,, , •', AND BE A FUJI AUTHORIZED INSTALLER. p ^ O 20'POLYLOK \ ) I 7. THE OWTS INSTALLER SHALL REGISTER THE ONSITE TREATMENT SYSTEM WITH 219't \� 1 DISTRIBUTIONBO 8' j 00 I EXI .WASTE LINE TO BE CH GED / SCDHS. THE DESIGN ENGINEER SHALL PROVIDE CERTIFICATION DOCUMENTS AS HOMEPORT ENGINEERING SHALL NOT BE \ •��-�_�__ TO -WCH CAST IRON INS LLED, - BY LIICENSEO PLUMBING REQUIRED BY SCDHS. 99'± CO TRACTOR L I E `O I tSET 8. AN OPERATION AND MAINTENANCE CONTRACT BETWEEN THE MAINTENANCE RESPONSIBLE FOR THE CONSTRUCTION PROVIDER AND THE PROPERTY OWNER SHALL BE PROVIDED TO SCDHS FOR I/A MEANS & METHODS UTILIZED BY THE o < z ° i ;!i�JPIN N OWTS. CONTRACTOR, NOR FOR THE SAFETY o`.. M w OE 1 1_ w � l Lj 9. A GARBAGE GRINDER SHALL NOT BE INSTALLED UPSTREAM OF THE OWTS. ° C c9 1as'± yl do LJ_I / 10. WATER SOFTENER BACKWASH SHALL NOT BE FLUSHED TO PROPOSED SEPTIC OF THE PUBLIC OR CONTRACTOR'S PROP.EIGHT(8)2-FOOT `� 12.1' 16.0' � o fBI CK w Q . SYSTEM. EMPLOYEES. THE ENGINEER SHALL NOT PRECAST LEACHING GALLEYS/' d. #1925 o > Ld i j 11. CONTRACTOR IS RESPONSIBLE TO OBTAIN TOWN BUILDING PERMITS AS NECESSARY -/' .w co m 21/2STY. DWELLING N v it I PRIOR TO INSTALLATION OF THE PROPOSED SEPTIC SYSTEM. BE RESPONSIBLE FOR THE FAILURE OF 12.1' 16.0 FF 11.8 Das. o c� �I / 12. NOTE THERE IS AN EXISTING HOUSE TRAP. I/A OWTS TO BE VENTED THROUGH 2 THE CONTRACTOR TO CARRY OUT THE FUTURE EXPANSION �N 1 TYJ SHW. 32.7'IE:7.5't I . ;1 Qi / INCH CARBON VENT. WORK IN ACCORDANCE WITH THE = I ENCL. STONE) �I ?� �� 13. NO EXISTING DRYWELLS SUFFOLK COUNTY DEPARTMENT OF v PORCH wl LEGEND HEALTH'S STANDARDS AND a st /-WM IN 1, �� LF - LINEAR FOOT ��/ W �� CI -CAST IRON LG - LEACHING GALLEY REGULATIONS. CONTRACTOR SHALL G& EL v s/ Q D "G AS's � Z s/ CO - CLEANOUT LNRB - LINED NRB NOTIFY THE ENGINEER PRIOR TO p �p HIGHIWATER LINE O, CP - EXISTING SANITARY CESSPOOL LP - LEACHING POOL DRI EWAY I z� CTG - CUT TO GRADE MAX - MAXIMUM BACKFILLING OF ALL STRUCTURES AND DB - DISTRIBUTION BOX MIN - MINIMUM ASSOCIATED PIPING. O -' '1;' `� y 1l lJ I EL - ELEVATION OWTS - ONSITE WASTEWATER TREATMENT SYSTEM 0 I I I EX - FUTURE EXPANSION POOL PROP - PROPOSED v O/ _CIAW EXIS - EXISTING PT - PERCOLATION TEST FFEL - FINISHED FLOOR ELEVATION SCDHS - SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 2 �M 3' & I GE - GRADE ELEVATION ST - SEPTIC TANK O` ' (_� Cif \ - -Rql F� �`S�•1 ____ \ 1 GPD - GALLONS PER DAY TH - TEST HOLE . `--"' \ • p � PIN �` I �� HEGE - HIGHEST EXPECTED GROUNDWATER TR - TREE � ^0 /�' Q ) I/A OWTS - INNOVATIVE / ALTERNATIVE OWTS V - VENT uz± ' °�C3- - )F-C• W ' �� ! i IE -INVERT ELEVATION TYP - TYPICAL O \ Q - NQ'i 0 O y WM - WATER METER (� 0 `c \ �t� / VV ----_ __5 S �( / PS - PUMP STATION S/ON i WOOD Z = l v� �� ` ��X 01N WALL q��M WALL , Z �S P r�Jl O, �1v ARP jp-1,- WOOD DESIGN NOTES: _ �pG 2 -FUJI CLEAN CEN-7 FOR RESIDENTIAL STRENGTH WASTEWATER UP TO'700 � Q �9 GPD. DESIGN FOR G-BEDROOM GGO GPD. v �Q• �/O 81NFECTION .•ACCEBS COVER -SECONDARY SAFETY COVERS TO BE INSTALLED UNDER ALL TREATMENT 18•ACCF55 COVE tr ACCESS COVE }<'ACCE55 COVE CYLINDER F`F) prP, R P, ronnoNAq UNIT COVERS. DWDPENING -TANK TO BE INSTALLED ON LEVEL COMPACTED SAND OR GRAVEL BASE Z- fO AND PROPERLY BACKFILLED PER MANUFACTURER RECOMMENDATIONS.16 ``' _.^,: t•-t.�' OARD TYPE OYVi 11 In _TMEDIA -USE WITH MAC I OOR BLOWER AND FUJI CLEAN CONTROL PANEL. INSTALLATION TO BE PERFORMED BY A FUJI CLEAN AUTHORIZED INSTALLER ONLY. ^ O -START-UP AND SERVICE TO BE PERFORMED BY A FUJI CLEAN AUTHORIZED R LIFT PUMP SERVICE PROVIDER ONLY. V-tt• 4'_tt• FUJI CLEAN CEN-7 ANTI-BUOYANCY CALCULATIONS W/CONCRETE DEADMAN © 9)• O°MEDIA MATERIAL PROPERTIES: v ANII�tIDYAIKIV 1TTRAP WATER: 7.482 GA1CF 5.34 LB/GAL G2.4 LB/CF FASTENED°M TAW n°ARSEMRLY CONCRETE:DRY: 1 50 LB/CF SUBMERGED/NET: 87.G LB/CF 501L: DRY: 100 LB/CF SATURATED: 1 17 LB/CF NET: 83 LB/CF I FUJI CEN-7 TANK EMPTY AT FULL SUBMERSION (G.0 FT): e-o• I Lv_e J SECTION B-B VIEW Lt•_•�I 1 TOTAL VOLUME: I OG9 GAL DRY WEIGHT: 705 LB "° •a` " SECTION A-A VIEW TOTAL BUOYANCY: I OG9 GAL X 8.34 LB/GAL = 8,9 15 LB N✓,TFRIALSSCNEDo11121 Pve tTYP)°,Re I� 8•-0• "`" 'I-EI— °"°` `" I PRECAST CONCRETE DEADMAN: M oR� r w.P�PrRo~.aae B DIMENSIONS: 8 FT LONG X 1.5 FT WIDE X .GG FT TALL = 7.92 CF Rs. E I - t'-a' TOTAL DRY WEIGHT: 7.e2 CF X 150 LB/CF = 1188 LB OTE'I a•�s^% 3, �'"9 `t' cunnweu Iv.lame al NET WEIGHT SUBMERGED IN WATER: 7.92 CF X 87.G LB/CF = G94 LB Sedimentation Chamber 397 SANITARY SITE PLAN _ ECIRCD AnDN jA-hI.F,I, 1U n Ch-le_ 396 SC,VM BAPR O , AIR LIFT PUMP Aerobic Confect 161mUmi Chamber Ixl w ,r E �--" \ / sNFEen°N Clenfcanon Chamber 90 Up SCALE= 1:30 eLE."eE ;,rPr TM..R , DYLINDEp p ( °NrP (op-) DIS,nfeellonChmnmr 6 SOIL WEIGHT ABOVE CONCRETE DEADMAN AT FULL SUBMERSION (G.O FT): "-tdD)- PINLETNP •WTLETPIPE o 1069 DEADMAN SURFACE AREA: 8 FT X 1.5 FT = 12 5F 0 30' 60, r-- - - t VOLUME OF SOIL: 12 FT X G.0 FT = 72 CF ,uT UL AT At AF;LE SPECIFICATIONS 1J ALI.(%V WAtER I:r ,r oi•rRsi P' ', TEST HOLE INFORMATION RUN6rr ��°' � \ Ana<IobuM<dla PP/PF NET WEIGHT OF SOIL SUBMERGED IN WATER: 72 CF X 83 LB/CF = 5,97G SCALE: 1:30 GRADE EL.9.5'± ,rvP, ••�• \ Board T Aerobic Med1n PVC i I'1'/PF. FACE OF WILDIIMi PROVIDED BY MCDONALD VENT BrACK C0IPCX1r 4'OFFNT NT5- L_~ / O \ Np LIF PUAW A-h.Media PP/PC LB wN,rxTrxr DEEP GEOSERV CES PROPERTY uJl aenn UE14a INLET Is+F CoNTR LYANEL „,w� BDw<r 3.xfm DESIGNER: TAO BTOPPER OR END PLUG LOCATED AT O Tank FRP ANTI-BUOYANCY CALCULATIONS: san SAND EL FLDON 9LASOR STRUCTURE 9 ME OPO NER p W/GRAVEL(5M) 4.5'± 1925 PIPES NECK ROAD sc.Ar4o ro reoL PVC/PP/Ph DATE: 01-22-2026 -ABLE- GREENPORT,NY 1 1944. T°D`°`"ER °„„ ......_ ....,_- ...,._._.,,,.,.. none.:e„Y<r Nam,.;Casumn NET BUOYANCY OF TANK: 8,915 LB- 705 LB = 8,2 10 LB N YELLOWISH r tnvENnun PIPE Disin(ectam O Tonal ChlnrmeTahlets NET ANTI-BUOYANCY OF DEADMAN (2): G94 LB X 2 = 1388 LB y BROWN FINE TO DATED 07-08-2025 ......,- ��.•a .I OMR:1t WIRlr;GTL� n•AIR IN KE &'v ,-,� tr_6• RE IRCIIUfroN PIP. - •g COARSE SAND EL DEPTH OF TEST HOLE 17.0'± -. .°. - -. FLOW OPENING P oW.BAFFL -- 1"•' INTE,iIOR FxT F I RE55UETREATEU ,,,,,_,..,, ,IDLEANINGOPENING NET ANTI-BUOYANCY OF SOIL(2): 5,97G X 2 = I I,952 LB p W/GRAVEL(SWl O.5'+ FIIGHEST EXPECTED 4xa Post LI'l ♦y "o m WATER IN GROUNDWATER °"ReE""",,, - ' Af >onux snap TOTAL NET ANTI-BUOYANCY: 13,340 LB Y -4TITER RF.`+ISTAM -_ - ., '`r" •` ""` YELLOW5t1 TATE - cNaosur�s.tRr•uro FASTENM OVER WiR = -_- WATER UNIE BROWN FINET -TEST HoLE511ows b M..,tA,.TI,RTR /7 13,340 LB/8,2I0 LB I GO% > 150%SCDHS REQUIREMENT ° a""•', �.�_ COARSE SANG EL GROUNDWATER / "","°°..""'"'°'"'""""•""°`"'°'°°""°`^'""'"""""""• W/GRAVEL(5W)_I.5-± ENCOUNTEREDATEL: „_,__•_, y_ "-_.-,,,�_.-• FUJI CEN-7 I/A OWT•5 w/ANTI-BUOYANCY FUJI CEN-7 ANTI-BUOYANCY 0 <'+r .�I I tAIMMUM I-°:CART IRDN E%TEN510N FlWM _ WATER N 0.5'+-,MIGHEST UOYAN CY CALCULATION �`` ..•,'';T «' I r9wNDpnaN pEEORE mANpmoR To r° BROWN CLAYEY EL EXPECTED .PE,° �.J - °. F..w SCALE: NT5 SCALE: NT5 ATSM Pa COMPLIANT 8DR Sa 8EWER PIPE a SAND SC -7,5'+ GROUNDWATER I.0- Fi.n •�• ♦♦ m. _ nT.. w• r.F, CLEANOUT AT FACEOF BUILDING r GROUND WATER aR� ER ""•^-r a' H 'eNMEP R T ENCOUNTERED EL 0.5'± ttc surrLr ..........„....-....,. �.,,.........,..- ......,..- FINISHED GRADE -,, ' FRLrMC LUNG TO OWT.. IaoaLUAS NPsvwuar ENGINEERING PC. FLO1W EQUALIZEK TYPICAL CLEANOUT DETAIL FUJI CONTROL PANEL DETAIL ------ ----- ------- ---- -- --------- ---- POLYLOK D15TRIBUTION BOX TEST HOLE INFORMATION 11=UJ1 90° INLET ADAPTER SCALE::NT5 NT5 SCALE=SCALE= NT5 COVER MIN. 1' MAX. 2' SCALE:NT5 SCALE:NT5 CALF=NT5 CTRCEJETERRAKE""°TES° HOMEPORT ENGINEERING P.C. MATNRR F.LRCTRICALPANF.1. FUIICONTROI.PANFI. THOMAS A O'DWYER HOl13E PANEL P E CB LI-20 AMPS-120VAC Bt f LI C. NO. 094873 `° 7,E71'Rm�®�® FUJI CEN-7 SINGLE LINE WIREING DIAGRAIVI PO BOX 1111 15' SETAUKET, NY 11733 ®®®®®®® SCALE= NT5 631-223-8752 EXIS FFE 11.8'± f_6 OEAP info@homeportengineering.com 1 0 1 CLEAN OUT 20-INCH P L L K DISTRIE UITION AT GRADE 6-INCH RISERS TO GRADE BOX W/SAFETY GRATING AND MINIMUM 12-INCHES TO GRADE EXIS GRADE 8'± _EXISTWG_GRADE El..1$.5'#__- W/SAFETY GRATI 4GS - 6-INCH±RISER TO GRADE MAXIMUM 24-INCHES TO GRADE N _EXISTING GRADE EL.8'± _ _ EXISTING GRADE_EL.-8'± -___ -__-- OF NStV 1.0 GROUNDWATER MIN. 2' A.o' EXIS IE 7.5'± IE:7.0't IE:s.a'± AP° o�` 4-INCH PVC SDR35 4-INCH PVC SDR35 IE: a'± E 6.3' IE:6.2'± ® ® ® ® ® ® ®®® 51 MINSLOPE.02'/LF MINSLOPE.017LF PRon �v® ®�®� e�® ® ® vs ® ® ®�® LEACHING GALLERY DETAIL NOTES SCALE:NT5 4-INCH P C SDR35 ± MIN SLOF E.017LF LEACHING GALLEY NOTES (8X)2'LEACHING GALL YS SPACED 2-FOOT APART IN LINE W/ -INCH SDR35 CROSSOVER PIPES 3 61 EIGHT(8)5.5'X 4.75'X 2'EFFECTIVE DEPTH PRECAST CONCRETE LEACHING GALLEYS ®A� oe4873 MINIMUM 2-FOOT SETBACK FROM BOTTOM OF SYSTEM TO GRC UNDWATER,3.6'SETBACK SHOWN MINIMUM 4-FOOT EFFECTIVE LEACHING DEPTH OF GALLEY ®FESS100 MINIMUM BURY DEPTH OF COVER 1 2-INCH TO GRADE,MAXIMUM 24-INCH HEGW 1.0'± d TOTAL OF 400 5F EFFECTIVE LEACHING AREA FOR UP TO G-BEDROOM HOME O' GROUNDWATER 1.0't GROUNDWATER 1.0't GROUNDWATER 1.0't - MINIMUM SETBACK FROM BASE OF CHAMBER TO GROUNDWATER 2-FOOT. 0' 1011 20' 30' 50' 60' 70' 80' 901 100, 1101 EXISTING 501L CONDITION STATEMENT LEACHING GALLEYS TO BE PLACED IN CLEAN SAND AND GRAVEL ONLY(5P,5W) SHEET: 501L CONDITIONS MAY VARY AND NEED TO BE CONFIRMED INFIELD AT TIME OF INSTALLATION. REMOVE AND REPLACE UNSUITABLE SOILS IF NECESSARY WITH CLEAN SAND AND GRAVEL FOR A 3-FOOT COLLAR AROUND GALLEY,EXTENDING DOWN INTO THE EXISTING ACCEPTABLE MATERIAL(5P SAND). PROPOSED SANITARY PROI-ILE SCALE:NT5 c I I iI i t SOUTHOLD TRUSTEES f Noe i I i i ' 4 I t 1 I Car�,l n S;Cc ref; Issued To A Date 1`��'S Q� �IQ-CIK �oaeGAddressreefs CO I I THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION , TOWN TRUSTEES OFFICE.TOWN OF SOUTHOLD , SOUTHOLD, N.Y. 11971 TEL.: 765-1892 - �� gUFO r Glenn Goldsmith,P ant �� CO __ Town Hall Annex A.Nicholas Krupski,Vice President 4.—,'` y< :: 54375 Route 25 Eric Sepenoski y ? P.O.Box 1179 Liz Gillooly �y • !` Southold,NY 11971 Joseph Finoraz Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:2 ZG Completed infield by: L • ti�� -{ . Cole Environmental Services on behalf of CAROL ANN SICCARDI, CHRISTOPHER FOTI, FORTUNATO FOTI, IGNATIA E. FOTI LIVING TRUST, PASCAL FOTI, RUSSEL LIVING TRUST, VALENTINE FOTI requests an Administrative Permit to abandon existing cesspool; change existing waste line to 4" cast iron; install I/A OWTS system with eight (2) 2' precast leaching galleys with control panel, mac blower assembly, and vent; add ±120 cubic yards of clean fill from an upland source for grading and use beneath leaching galleys. Located: 1925 Pipes Neck Road, Greenport. SCTM# 1000-53-1-19 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: �Chapt. 275 Chapt. 111 other Type/of Application: Wetland Coastal Erosion Amendment ✓Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No v/ Not Applicable Info needed/Modifications/Conditions/Etc.: M0 ✓'ems M LxA( )S Present Were: G. G,dldsmith N. Krupski E. Sepenoski V L. Gillooly J. Finora AS-BUILT SITE INFORMATION: UNTY TAX AP ID: 1000-53-01-19 -EXISTING 1 OSTORY DWELILING. NO PROPOSED CONSTRUCTION. EXISTING 5 BEDROOMS FOTI DESIGN-AREA: 0.0570 AC,R UP T024,899 DSQ FT. RESIDENCE -PROPERTY LOCATED AT 1925 PIPES NECK, GREENPORT, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK. -SURVEY PROVIDED BY: GARY BENZ LS: 07-21-2025 -VERTICAL DATUM - NAVD 1988 DATUM -SURFACE WATER & WELTANDS SHOWN. 1925 PIPES NECK ROAD -PUBLIC WATER, ALL HOMES WITHIN 150LF CONNECTED TO PUBLIC WATER. GREENPORT, NY 11944 GENERAL NOTES: 1. DESIGN FOR UP TO 6-BEDROOM HOME. WETLAND FLAGGING BY COLE 2. I/A OWTS SANITARY REPLACEMENT DESIGN. ENVIRONMENTAL SERVICES 1.7-26 3. SITE PLAN AND REFERENCE ELEVATIONS TO BE USED FOR I/A OWTS SANITARY SYSTEM CONSTRUCTION ONLY. EXACT PROPERTY BOUNDARIES, UTILITY LOCATIONS AND ELEVATIONS ARE NOT GUARANTEED. 4. ELEVATIONS BASED ON PROPERTY SURVEY PROVIDED BY GARY BENZ LS 07-21-2025. 5. ONSITE UTILITY MARK-OUTS TO BE PERFORMED BY CONTRACTOR PRIOR TO SOUTHOLD PERFORMING SITE WORK. SUFFOLK COUNTY 6. SOIL TEST HOLE DATA PROVIDED BY MCDONALD GEOSERVICES 07-08-2025 7. EXISTING SANITARY CESSPOOLS(S) TO BE PUMPED AND REMOVED AS NECESSARY PER SCDHS STANDARDS. PROPOSED I/A OWTS SEPTIC SYSTEM FOR UP TO 6 BEDROOM RESIDENCE: 1. ONE (1) FUJI CEN-7 I/A OWTS 2. ONE (1) FUJI MAC 10OR BLOWER, FUJI CONTROL ASSEMBLY, AND VENT 3. ONE (1) 20" POLYLOK DISTRIBUTION BOX 4. EIGHT (8) 8.5' X 4.75' X 2' EFFECTIVE DEPTH LEACHING GALLEYS. 5. FOUR (4) 8.5' X 4.75' FUTURE EXPANSION AREA. 6. APPROXIMATELY 120 CY OF CLEAN SAND FILL FOR GRADING & USE BENEATH SANITARY STRUCTURES. I/A OWTS 253.5'± GENERAL SANITARY SYSTEM AND INSTALLATION NOTES: 1. I/A OWTS SEPTIC SYSTEM DESIGNED FOR UP TO 6 BEDROOM HOME PER SUFFOLK SANITARY MERE' CANT Y �� ` COUNTY DEPARTMENT OF HEALTH STANDARDS (SCDHS). 2. INTERIOR PLUMBING AND INVERT TO BE RELOCATED BY LICENSED PLUMBING SYSTEM DESIGN OR E FOLK \ "`' CONTRACTOR AS SHOWN ON PLANS. 3. SANITARY GRAVITY DRAIN PIPE TO BE 4-INCH CAST IRON AT FOUNDATION NOW ,� 0 5U \ GPO 4� PENETRATION AND 4 G -INCH PVC SDR35 DOWNSTREAM OF FOUNDATION. G 4. I/A OWTS SHALL BE TESTED FOR WATER TIGHTNESS PRIOR TO ARRIVING ONSITE LAN QUNT \� _�`\ ;,�� _\ ! USING THE METHOD APPROVED BY MANUFACTURER. PROP FUJI CEN-71/A OWES W/D OMEN ,\\/c(n `'�-� �\ ��`T-EXISTING CESSPOOL(S)TO BE PUMPED AND '- �Z FOR ANTI-BUOYANCY 890°ADAPT � REMOVED OR ABANDONED PER SCDHS 5. THE DESIGN ENGINEER SHALL OVERSEE THE OWTS DURING SYSTEM STARTUP. ^ STANDARDS MAC / 6. THE OWTS INSTALLER SHALL BE LICENSED HOLD AN ENDORSEMENT FROM SCDHS ' G 1 FUJI CONTROL BLYJ,ND ,1 � 4-4 1 � BLOWER ASSEMBLY,'ND VENT I I r EXIS B RIEDN TU AL C{AS TANK AND BE A FUJI AUTHORIZED INSTALLER. 0 7. THE OWTS INSTALLER SHALL REGISTER THE ONSITE TREATMENT SYSTEM WITH 20'POLYLOK \ E �i I SCDHS. THE DESIGN ENGINEER SHALL PROVIDE CERTIFICATION DOCUMENTS AS 219'± / 1 DISTRIBUTION BO 0 O II EXI WASTE LINE TO BE CH GED l� 1 TO INCH CAST IRON INSTXLLED, �\ O �•�� 't'L BYCENSED PLUMBING/ , REQUIRED BY SCDHS. HOMEPORT ENGINEERING SHALL NOT BE 95'± I COIIi TRACTOR. L SET , / 8. AN OPERATION AND MAINTENANCE CONTRACT BETWEEN THE MAINTENANCE RESPONSIBLE FOR THE CONSTRUCTION �R�E UNE OO' r P\N O ^1 w I f MPIN w p // PROVIDERO(� AND THE PROPERTY OWNER SHALL BE PROVIDED TO SCDHS FOR I/A MEANS & METHODS UTILIZED BY THE CE.1 1 _ ^ w >_ I J I J- / L d 9. A GARBAGE GRINDER SHALL NOT BE INSTALLED UPSTREAM OF THE OWTS. CONTRACTOR, NOR FOR THE SAFETY �' c9 135± " ` '�I Ll_I 10. WATER SOFTENER BACKWASH SHALL NOT BE FLUSHED TO PROPOSED SEPTIC OF THE PUBLIC OR CONTRACTOR'S SYSTEM. EMPLOYEES. THE ENGINEER SHALL NOT PROP STLEAC)2-FOOT 4 , 12.1' 6'0 �$$1925r -� o B ICK w Q �' 11. CONTRACTOR IS RESPONSIBLE TO OBTAIN TOWN BUILDING PERMITS AS NECESSARY PRECAST LEACHING GAL S/' I �_ 21/ STY. DWELLING Q `: I /� BE RESPONSIBLE FOR THE FAILURE OF PRIOR TO INSTALLATION OF THE PROPOSED SEPTIC SYSTEM. 12.1' 16.0' 2 FF 11.8' EXIS N o ` I Ili �1 12. NOTE THERE IS AN EXISTING HOUSE TRAP. I/A OWTS TO BE VENTED THROUGH 2 THE CONTRACTOR TO CARRY OUT THE J 32.7'IE7.5'± �� I INCH CARBON VENT. WORK IN ACCORDANCE WITH THE FUTURE EXPANSION 1 TY. SHW. Q w �Z _ x /ENCL. STONE)/� _�; 13. NO EXISTING DRYWELLS SUFFOLK COUNTY DEPARTMENT OF U I PORCH / �WM �b �'� wI \ U �� LEGEND HEALTH'S STANDARDS AND 1TM / rn LF - LINEAR FOOT ✓ L / �/ N W �� CI -CAST IRON LG - LEACHING GALLEY REGULATIONS. CONTRACTOR SHALL �G VE G V) CO - CLEANOUT LNRB - LINED NRB NOTIFY THE ENGINEER PRIOR TO E % I HfGHWATERLINE�o, CP - EXISTING SANITARY CESSPOOL LP - LEACHING POOL DRIVEWAY CTG - CUT TO GRADE BACKFILLING OF ALL STRUCTURES AND � Q �/ / qTh I / DB - DISTRIBUTION BOX MIN - MINIMUM ASSOCIATED PIPING. '1; � ' �/ ) EL - ELEVATION OWTS - ONSITE WASTEWATER TREATMENT SYSTEM EX - FUTURE EXPANSION POOL PROP - PROPOSED EXIS - EXISTING PT - PERCOLATION TEST v FFEL - FINISHED FLOOR ELEVATION SCDHS - SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES _ ,Z�! ___ �M /,'J 3 POST &N S l GE - GRADE ELEVATION ST _ SEPTIC TANK O Cp ` RAIL FC• <�` I GPD - GALLONS PER DAY TH TEST HOLE 0 -� PIN �\ Ln HEGE - HIGHEST EXPECTED GROUNDWATER TR - TREE 1a2'± \ / ' g 0------ FC. W ! ' / IE -INVERT NVERT ELEVATIONOWTS - / ALTERNATIVE OWTS TYP TYPICAL O � -� \ / O Q �F �GI O.5,S O y� WM - WATER METER \� --"-` SIGN -- Wp PS - PUMP STATION a 0 O O o -_7 = l v� �� PJF� /011 WALL M WALL P � R c::N (3 Cl_ z Z �c� ; O 10 Iy0O0 \ DE51GN NOTES: - �pG Z -FUJI CLEAN CEN-7 FOR RE5IDENTIAL 5TRENGTH WASTEWATER UP TO 700 _j GPD. DE51GN FOR G-BEDROOM GGO GPD. BINFEL DN -5ECONDARY SAFETY COVERS TO BE INSTALLED UNDER ALL TREATMENT ""- P) J•ACCESS COVER _`"-' �_-�-4`- /� � IB'ACCESS COVE 19'ACCESS LOVE 2I'ACCESS WV£ CY UNIT COVERS. (FY (TYP7 ITYPI LINDER(OPTIONAL) DVDPENING Z- -TANK TO BE INSTALLED ON LEVEL COMPACTED SAND OR GRAVEL BASE Q' \h / �• AND PROPERLY BACKFILLED PER MANUFACTURER RECOMMENDATI(ON5. O ACT/'// 16 0`% �'-��• °"P°TY PE -USE WITH MAC I OOR BLOWER AND FUJI CLEAN CONTROL PANEL. INSTALLATION TO BE PERFORMED BY A FUJI CLEAN AUTHORIZED INSTALLER ONLY. / JJ O -START-UP AND SERVICE TO BE PERFORMED BY A FUJI CLEAN AUTHORIZED 1 LIRLIRDaPUMP GN SERVICE PROVIDER ONLY. �L J, R I ^� \ / Q ��P\`�O s-�• a_�r a.-»• ) FUJI CLEAN CEN-7 ANTI-BUOYANCY CALCULATIONS W/CONCRETE DEADMAN O EP I:MFDIA MATERIAL PROPERTIES: ANn- NCY WATER: 7.482 GAL/CF 5.34 LB/GAL G2.4 LB/CF FnsrFRm pVER RATIO ASSEMBLY CONCRETE:DRY: 150 LB/CF SUBMERGED/NET: 87.G LB/CF SOIL: DRY: 100 LB/CF 5ATURATED: 1 17 LB/CF NET: 83 LB/CF J I u ff I FUJI CEN-7 TANK EMPTY AT FULL SUBMERSION (G.0 FT): e-0• I L�-e•� SECTION B-B VIEW h TOTAL VOLUME: I OG9 GAL DRY WEIGHT: 705 LB SECTION A-A VIEW -B M TOTAL BUOYANCY: I OG9 GAL X 8.34 LB/GAL = 8,9 15 LB I� Aw°rER gMMTERRIIALS*SCNEWLE 40 PVC INPI°TwE a•-0• PRECAST CONCRETE DEADMAN: B DIMENSIONS: 8 FT LONG X 1.5 FT WIDE X .GG FT TALL = 7.92 CF NrT ME -i'� 1'-e• TOTAL DRY WEIGHT: 7.92 CF X 150 LB/CF = 1 188 LB r Ns„ J' 11, -1'° CHAMBER ;:ane(eal NET WEIGHT SUBMERGED IN WATER: 7.92 CF X 87.G LB/CF = G94 LB ewlTvv' SedlmeotMlon Chalnbel 397 SANITARY SITE P LA N ° _ LIRLD A ON Anaerobic Filtration Chamber 39,11,, /\,--,II\(j //��--�/\ AIR LIFT PUMP �- SCUM BAFFL O t ^emhlc Col Filtration Chamber IS I \ SINFECTpN ('IariOCallnn Chamber 9D a° F.F°,uY�" LE oT°vnnlEs i /• CYLINDER SCALE= 1:30 °'°°°""' LIII (OPTONAL) DisinfectionChanlher A SOIL WEIGHT ABOVE CONCRETE DEADMAN AT FULL SUBMERSION (G.0 FT): INLET PP WTLETPIPE T.,AVRlmn< 1069 DEADMAN SURFACE AREA: 8 FT X 1.5 FT = 12 5F ^! J^ VOLUME OF SOIL: 12 FT X G.0 FT = 72 CF 0 30' 60' `"P° ATA"A"°" s _r a-8� AnaerohlcMedia S11"PP PEIIN NET WEIGHT OF SOIL SUBMERGED IN WATER: 72 CF X SCALE: 1:30 r..I __ --- __ a i' TEST HOLE INFOPMATION TviiF oi'rww"1ft 1p y.N�p' - 1 FACEOFBWLDING GRADE EL.0.5'± PROVIDED BY MCDONALD '.._ aMF"'`s, ''�• ' wN.Ts•x+mxrDEEP -NT5- ❑� J-U�J•� Bl,ara rY<nemr,le Meala rve/Pr/re 83 LB/CF = 5,97G I <✓' VENT BLACK COMPACTEDENBEDMENT , GEOSERVICES PROPERTY JnCLEAIJNE 4n FF°nuuIET I_�r INLETBAFR / FFLUENT LB Q \ AIR UFTPUMP Ae 1-Medta PP/PF, CGNTROL 11:11 NE ,.�, LIIII\vCl 35L81 DESIGNER: TAO STOPPERORENDPLUO 51fTY5AND FL LOCATED AT Tani. FRI, n 5x FCODA SLAB ORSTRUCTURE SLATE OROTNER W/GRAVEL($M) 4,rj'+ Ie25 PIPES NECK ROAD LC::AIDC:II.'1R0L L °vA ® Piping PVC'/PP/PF. ANTI-BUOYANCY CALCULATIONS: - R MrrABLECOVER o - O OBL:)T.f YiN.Lt• _- vw-„ -+ - 8,9I 5 LB- 705 LB = 8,2 10 LB DATE: 01-20-2026 GPEErJPORT,NY 11944. «p w„p"�« m . •.�_._,�.Mu ^eee.,tiln" Plastic I,1.61Dn NET BUOYANCY OF TANK: _ YEI.LOWISrI (iv' 2-+T VENTIUTI N91PE DI,Inleclalll l()`II"nal (hlOrine labler, BROWN FINE To DATED 07-08-2025 n1.TPnLwiraNCTn 1,-a. •` `AffLr B FlMRIN ' NET ANTI-BUOYANCY OF DEADMAN (2): G94 LB X 2 = 1385 LB �lJI'- RE IRCULA1pN PIP. IK:• „ ' x:• f• COARSE SAND EL DEPTH OF TEST HOLE 17.0'± _ -....w .,.. .. ""« OY,'. �� FLOW OPENING 11Yo^ •,CLEANING OPENINDI n NET ANTI-BUOYANCY OF SOIL(2): 5,97G X 2 = 1 1,952 LB RfTER10P ExIERpR i$ W/GRAVEL(5W) - 4`f 1,UF iREAI ED L .." - w.°.".a.....u. O O. HIGHEST EXPECTED ROST ...,.,««.«..,,. 4 `K' m WATER IN GROUNDWATER AT„ERPESIB,PrT "„<FF"°., - TOTAL NET ANTI-BUOYANCY: 13,340 LB . Rn-•eurn�,wcy sorer YELLOWISHIATrJ�A NT encLosur(s',I'PLIED FASTENED OVER TAIIL - s E 13,340 LB/8,2 I 0 LB - I GO%D > 150%D SCDHS REQUIREMENT WATER LME BROWN FINE T -TE51 HOLE SF10W5 COARSE SAND EL GROUNDWATER '"""-" "_""•""°"-"`,,.b.°"°"."""_'-"" 5vN o ( W1 1 5'� ENC HI H T -7 OV�fS w ANTI-BUOYANCY ANTI-BUOYAN Y A ^ sEmcTANx-- WGRAVEL 5 _ ENCOUNTERED AT EL FUJI CEN I/A / FUJI CEN-7 C C LCULATION G E5 �I MINIMUMS-N BCAST IRONExTENSION FROM WATER N _ SCALE: NT5 FOUNDATION BEFORE TRANSITION TOA"B _ �L EXPECTED SCALE: NTS --- ATM R3 COMPLIANT BDR 35 SEWER PIPE BROANDG COY-7.51± GROUNDWATER 1.O± �♦ PGB' M Eta RT CLEANOUT AT FACE OF BUILDING n GROUND WATER ae eiow r -""^' % `�... r ENCOUNTERED EL 0.5'± r, MI_Ll „. . -,a ._ - GA ROMowELLn:, TO °A°LEAN°EN°ERIa �- FINISHED GRADE "" ENGINEERING PC. FLOW EQUALIZER TYPICAL CLEANOUT DETAIL FUJI CONTROL PANEL DETAIL °"�F°r�,�Ea.FL TEST HOLE INFORMATION FUJI 90° INLET ADAPTER - ------ ---------------------------- -------- ------------------ ----- - - -- - - 5C/ALE:NT5 POLYLOK D15TRIBUTION BOX SCALE= NT5 SCALE:NT5 SCAIE=NITS :ALE=NT$NITS COVER MIN. 1' MAX. 2' C1RCUITBREANFRN°TES° HOMEPORT ENGINEERING P.C. yI SCALE:NT5 MAINRRf AKTk ELECTRICAL PANEL FUJICONTR(1L P'ANFI.HOUSi:PANEL THOMAS A O'DWYER P CB LI-20 AMPS-120VACLO BI 1 LI C. NO. 094873 15' ® ® ® FUJI CEN-7 SINGLE LINE WIREING DIAGRAM PO BOX 1111 cv ®ICI®ILA®�® SCALE= NT5 SETAUKET, NY 11733 ®®®®®®® 631-223-8752 EXIS FFE 11.8'± '-6.0"' info@hhomeportengineering.com 1 01 CLEAN OUT 20-INCH POLYLOK DISTRIE UTION AT GRADE 6-INCH RISERS TO GRADE BOX W/SAFETY GRATING AND MINIMUM 12-INCHES TO GRADE W/SAFETY GRATI GS 6-INCH±RISER TO GR DE N EXIS GRADE 8'± EXISTING GRADE EL._8..5'+ MAXIMUM 24-INCHES TO GRADE OF EXIS IE 7.5'± 1T0' GROUNDWATER MIN. '' �bo�� P A.0° 11 :7.0'± I E:6.8'± 4-INCH PVID SDR35 4-INCH PVC SDR35 IE:6.4'± rq Pill ~ 5, MINSLOPE.02'/LF MINSLOPE.01'/LF ®�®� q® ®�®2 �® ®�® � 3® P-9 2m m LEACt11NGGALLERY DETAIL NOTES u& e SCALE:NT5 a P C SDR35 ± MIN SL LEACHING GALLEY NOTES MIN SLO E.01'/LF O X A � MINIMUM 2F00 SETBA K FROM BOTTOMCHING GALL YS SPACED OFSYSTEM TO GRT APART IN LINE / UNDWATDER 5 3.6'SETBACK SHOWN 3 6SSOVER PIPES ' M NEIGI U 5 IMM 4FOOT EFFECTIVE LEACHING DEPTH 09a673 O GALLEYCAST CRETE LEACHING GALLEYS A�o�ESS10�� MINIMUM BURY DEPTH OF COVER 1 2-INCH TO GRADE,MAXIMUM 24-INCH JAN 2 7 HEGW 1.0'± TOTAL OF 400 5F EFFECTIVE LEACHING AREA FOR UP TO 4-BEDROOM HOME i 0' GROUNDWATER 1.0'± GROUNDWATER 1.0'± GROUNDWATER 1.0'± MINIMUM SETBACK FROM BASE OF CHAMBER TO GROUNDWATER 2-FOOT. i 0' 1 (0' 20' 30' S0' 60' 70' 80' 100' 110' EXISTING SOIL CONDITION STATEMENT LEACHING GALLEYS TO BE PLACED IN CLEAN SAND AND GRAVEL ONLY(5P,5W) "' ""' - "' SHEET: SOIL CONDITIONS MAY VARY AND NEED TO BE CONFIRMED IN FIELD AT TIME OF INSTALLATION. REMOVE AND REPLACE UNSUITABLE SOILS IF NECESSARY WITH CLEAN SAND AND GRAVEL FOR A 3-FOOT COLLAR AROUND GALLEY,EXTENDING DOWN INTO THE EXISTING ACCEPTABLE MATERIAL(5P 5AND). Ord PROPOSED SANITARY PROFILE SCALE:NT5 THE AREA OF THIS PROPERTY IS 24,899 S.F. OR 0.571 ACRES S.C.T.,M. NO. ALL ELEVATIONS SHOWN REFER TO NA VD '88 DATUM 1000 — 53 — 1 — 19 n SURVEY OF: lJ�J DESCRIBED PROPERTY CLEARING CALCULATIONS L,QND EXISTING CLEARING IS 20,670 S.F. (83.07) COVERAGE CALCULATIONS SITUATED 1N:GREENPORT Y 0/4- R�e, L Y ALLOWABLE COVERAGE IS 5,720 S.F. (207) TOWN OF:SO.UTHOLD LI V�Lr 13 I�CZI mEF LN f /V 4s. FF°4/>' OX. EXISTING COVERAGE IS 1,657 S.F. (5.8%) SUFFOLK COUNTY, NEW YORK o S 2 p01'00"-E DATE: 7/21/2025 p.,17& o I GARDEN JOB NO. G25-11341 .�1 SCALE. 1 = 40 PIN / 71.45, 1 � WIRl FC. ' \ CONCRETE Q / j S� , COVER Pik NEW Z N11 ; 66' ? cF o c°yc� \ OOP ��P�Pp�Y J. BO,�%` �'1 �Q� I / L � � s c�R�<' O• (u Cl A°Rod /s 2� �• /S /, \ ` / 1 0 � �• � I ! I / srOy a�ry�1�?s,� ��8 � / r' - O O c� p g �4 I F� fir. o`er a / •�p�/ / 2s s082II yea o° �� / ,/' / // =1'• ��LAND Sv4 MCC ZD GUARANTEES INDICATED SHALL RUN ONLY f TO THE PERSON FOR WHOM THE SURVEY WATERS unuTY i' _-s' / 1..: ::/:.:•/;.` ' HEDGES POLE IS PREPARED AND/OR AGENCY, AND ARE NOT TRANSFERABLE. P!P :.: __E$_N 20" W _ � '' ::::= ::: `�� //'' CERTIFIED TO: _ K� — '::: ..: ° r = t, _ Carolann Siccardi Christopher Foci —a ' \ +-. �'p�';`:':-;''•'''-:'.` / Fort'unato Foti GRAVEL 9"i✓: ! �`''1N; ='. / I3Q s, � ..:.. c+ QV �� GARY BENZ, L.S. JAN 27 2. I Surveying and Land Planning 527—B Hawkins Avenue Ronkonkoma, N.Y. 11779 GaryBenzLS@Yahoo.com SHW. = SHOWER (631) 648-9348 RD. = ROOF OVER CE. = CELLAR ENTRANCE • THE EXISTENCE OF RIGHT OF WAYS, WETLANDS, UNDER GROUND UTILITIES UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR•'S INKED SEAL AND/OR EASEMENTS OF RECORD IF ANY, NOT SHOWN ARE NOT GUARANTEED. VIOLATION OF SECTION 7209 OF THE NEW PORK STATE EDUCATION LAW. OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management PHOTO SHEET VALENTINE FOTI 1925 PIPES NECK ROAD GREENPORT, NY 11944 SCTM No.: 1000-053.00-01.00-019.000 PHOTO 1—AERIAL FROM ABOVE 74 4 , PHOTO 2-AERIAL(FACING NORTHWEST) Jl PHOTO 3-AERIAL(FACING SOUTHWEST-) v H � a PHOTO 4-GROUND LEVEL(FACING NORTHWEST) PHOTO 5-GROUND LEVEL(FACING NORTHEAST) r 1 Y Coe FaviropmCataSe 'ce + 1 l r r _ f E tiT.S� �� ^��•�\ ' • • ' • • ' C QU PHOTO ' • NORTHWEST) �ti f x ae \ 1 C ;MATCH SEE 6EL. . . 1 NO.1NO - �% r az xIS ��Ieervwas ._�..�o sEC I o �Q p aas os n W.p•... a N °a-z s as •ao' Y :;r ro , sE.sE E ua o ze.. R n u miwess r/ e'^ Jf TQ w OE SC mN i ; o- av' or" 3 a ' .y oPeax, ttt, * 7 x z to y/ �♦�i ?4r�ienenwIXrtN0.G l:/ 1r: ♦ . .. P D P' pWEB *Iw s �z a i\ ••mow t; �,� Sc`.. '_a 5•�e @ �,+'y it ' ' � �v, e* . ✓ c "O ♦ Ix '� 4 .',b,• tom.�sss�}'♦�� .x� ` V\sY «w. l♦ � °►i4.t s+r �i Lt�.�y+p.�69y ,5 N 7 ��'-' y i.` 4 �- � �a♦i.;e- ��. w Fai `'a � � ar ,pu. .� qj i.!( d, �s�i�k♦i'a 4 r�s �, x, z -� i�^t` `4,� ti4 x a♦ > � �� ti..,.a'• 'A e Iz. U •.a ., c� �yYF,r �,�' •' ••' '" t a r .w • 4, 7; ko � Y ` ) yq ♦ `4 � y4 � ar Ai P'y < mot •`�.�,� , a a,> s a•.•r .��:'�` • ' ,i� "� j - _ �-,,g.aa�. `.0 �;"4 _ ems^-��.f.•r,.4 �, 9 �• f i � h•• ' rortx�Ho SEC 3 S41.J1+3b,3 c ,, ry11 i Lt.. wire" 0R SEE SEC NO OSI - _. feE aEa rq.aer �' aeEas.ra.av� �ay ' 'r� j�4 .. ., COUNTY OF SUFFOLK I —ate ... .IW� O s —�— , Wal Property lax Service Agency Y 053 w v ' _.. ti i 425 Montauk Highway::,�, S g Y ' East Quogue, NY 11942 Environmental Consulting (631)369-9445 Wetland Project Management Town of Southold Board of Trustees 54375 Main Road P.O. Box 1179 Southold, NY 11971 Re:Application Fee and Updated Plans Carol Ann Siccardi,Christopher FotiJortunato Foti, Ignatia E. Foti Living Trust, Pascal Foti, Russel Living Trust,Valentine Foti 1925 Pipes Neck Road Greenport, NY 11944 SCTM No.: 1000-053.00-01.00-019.000 Dear Tom, In response to your email dated 1/28/26, noting that the project at the property referenced above will be reviewed administratively, please find attached the$250.00 application fee. In addition, after conversations with the Engineer,we will be proposing less fill than originally submitted, decreasing the amount from 120 cubic yards to 80 cubic yards. Please find enclosed the following items: 1. 1x Administrative Application Fee (Check#2973) 2. 2x Updated application with attached project description noting 80 CY of fill 3. 2x Stamped site plan by Homeport Engineering Should you need anything further, please do not hesitate to contact us. Sincerely, Summer Looney Info@ColeEnvironmentalServices,cony �= Cole Environmental Services, Inc. F E B 3 2026 0U1,hold 7ovEn C�oarc�of Tri�ctnes f www.ColeEnvironmentalServices.com ; � ��.. J Glenn Goldsmith,President r: S Town Hall Annex !v `� 54375 Route 25 A.Nicholas Krupski,Vice President at`' t P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ''`�� ► *� t�' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit --Amendment/Transfer/Extension Received Application: Received Fee: $ _ Completed Application: Incomplete: SEQRA Classification: Type I__ Type lI Unlisted Negative Dec. .' 'Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: F E B 3 2026 Date of Inspection: Receipt of CAC Report: Scu[r,Uld Town Technical Review: Public Hearing Held: Resolution: Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Ignatia E. Owner(s)Legal Name of Property (as shown on Deed): Foti Living Trust,Pascal Foti, Russel Living Trust,Valentine Foti Mailing Address: 31 Rocky Woods Road, Hopkinton, MA 01748 Phone Number: (781)578-4646 Suffolk County Tax Map Number: 1000 - 053.00-01.00-019.000 Property Location: 1925 Pipes Neck Road, Greenport, NY 11944 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable):Cole Environmental Services Mailing Address:425 Montauk Highway, East Quogue, NY 11942 Phone Number: (631)369-9445 Email: Info@ColeEnvironmentalServices.com __ 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631)369-9445 Wetland Project Management Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Ignatia E. Foti Living Trust, Pascal Foti, Russel Living Trust,Valentine Foti 1925 Pipes Neck Road Greenport, NY 11944 SCTM No.: 1000-053.00-01.00-019.000 Proiect Description Existing cesspool(s)to be pumped and removed or abandoned per SCDHS standards. Existing waste line to be changed to 4-inch cast iron installed by licensed plumbing contractor. Proposed FUJI CEN-7 I/A OWTS w/deadman for anti-buoyancy and 900 adapter. Proposed 20' polylok distribution box. Proposed eight(8) 2-foot precast leaching galleys. Proposed FUJI control panel, mac blower assembly,and vent. Addition of approx.80 CY of clean fill from an upland source for grading and use beneath leaching galleys. www.ColeEnvironmentalServices.com Lrd of Trustees Applicatic GENERAL DATA Land Area(in square feet): 24,899 sq. ft. (0_571 acres) Area Zoning:R-80 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions on property? Yes _✓ _No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? flYes _ZLNo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes _1�]_No If"Yes", please provide copy of decision. is project any demolition as per Town Code or as determined by the Building Dept.? re Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: Agency Date ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes,provide explanation: Project Description(use attachments if necessary): Please see attached project description. j 4 --"rd of Trustees Applicatio__ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To install new septic system to meet today's standards and improve water quality. Area of wetlands on lot: Approx. 2,450 square feet Percent coverage of lot: 5.8 % Closest distance between nearest existing structure and upland edge of wetlands: 54.2 _feet Closest distance between nearest proposed structure and upland edge of wetlands: +95 feet Does the project involve excavation or filling? ❑ No RI( If yes, how much material will be excavated? Approx. 50 cubic yards How much material will be filled? 80 cubic yards Depth of which material will be removed or deposited: 6 feet and 1 inch Proposed slope throughout the area of operations: 0.05 feet Manner in which material will be removed or deposited: Typical construction equipment to be used. Excavated material to be used for backfilling. Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): There should be no effect on wetlands. The limit of construction to be contained by silt fencing. OFFICE LOCATION: ��0�soUIjyD MAILING ADDRESS: Town Hall Annex ,`� l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold, NY 11971 Telephone: 631 765-1938 • i LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees Cc: Honorable Lori Hulse, Attorney From: Heather Lanza, AICP, Planning Director LWRP Coordinator Date: February 5, 2026 Re: LWRP Coastal Consistency Review CAROL ANN SICCARDI, CHRISTOPHER FOTI, FORTUNATO FOTI, IGNATIA E. FOTI LIVING TRUST, PASCAL FOTI, RUSSEL LIVING TRUST, VALENTINE FOTI, SCTM# 1000-53.-1-19 This application is to abandon existing cesspool; change existing waste line to 4" cast iron; install I/A OWTS system with eight (2) 2' precast leaching galleys with control panel, mac blower assembly, and vent; add ±120 cubic yards of clean fill from an upland source for grading and use beneath leaching galleys. The proposed action has been reviewed to Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the policies of the LWRP as follows: Policy 6. Protect and restore the quality and function of the Town of Southold's ecosystem. 6.3. Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The proposed plan includes actions which are consistent with the "Administrative Permit" requirements of Chapter §275-2 A of the Wetlands Law of the Town of Southold which qualify under §275-5 (8)(2)(d) Remodeling or renovation of a wetlands-permitted structure, provided that such activity will not have an undue adverse impact on the , wetlands and tidal waters of the Town. All activities, except for placement of temporary silt fencing, will take place greater than 100' from landward of the wetland. The proposed work nearly complies with Chapter §275-4 Exceptions A.1.(k) The relocation of an existing septic system from within Trustee jurisdiction to outside of Trustee jurisdiction, except that part of the installation is within 95 feet of the wetland boundary and does comply with Chapter §275-3 Findings; purpose; jurisdiction; setbacks. Exceptions D.(1).(a) [31 sanitary leaching pool: 100 feet. The proposed action has been reviewed to Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. 2 I Glenn Goldsmith,President t;r"i, � �' �k� ..".:. Town Hall Annex •j. .f�.; �� A.Nicholas Krupski,Vice President 54375 Route 25 �,j }�s P.O.Box 1179 Eric Sepenoski ii i Southold,New York 11971 Liz Gillooly Telephone(631) 765-1392 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only IF '7� n c7 `E Coastal Erosion Permit Application 1; (`" � =' Rau , ' I Wetland Permit Application U)" Administrative Permit s � Amendment/Transfer/Extei }��sion � I J A N 2 7 2O26 'K Received Application: Received Fee: $ 4.1"n -- Completed Application: �;,ae Cfi- 'S'IP's_.__ Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec.V_ Lead Agency Determination Date: Coordination:(date sent): �LWRP Consistency Assessment Form Sent: 1 r 3'0 Sri, CAC Referral Sent: Date of Inspection: a r y IX Receipt of CAC Report:_ _Technical Review: X Public Hearing Held: Resolution: Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Ignatia E. Owner(s) Legal Name of Property (as shown on Deed): Foti Living Trust,Pascal Foti, Russel Living Trust,Valentine Foti Mailing Address: 31 Rocky Woods Road, Hopkinton, MA 01748 Phone Number: (781)578-4646 Suffolk County Tax Map Number: 1000 - 053.00-01.00-019.000 _ Property Location: 1925 Pipes Neck Road, Greenport, NY 11944 (If necessary, provide LILCO Pole 4, distance to cross streets, and location) AGENT (If applicable): Cole Environmental Services Mailing Address:425 Montauk Highway, East Quogue, NY 11942 Phone Number: (631)369-9445 Email: Info@ColeEnvironmentalServices.com { 425 Montauk Highway ---- East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Ignatia E. Foti Living Trust, Pascal Foti, Russel Living Trust,Valentine Foti 1925 Pipes Neck Road Greenport, NY 11944 SCTM No.: 1000-053.00-01.00-019.000 Project Description Existing cesspool(s)to be pumped and removed or abandoned per SCDHS standards. Existing waste line to be changed to 4-inch cast iron installed by licensed plumbing contractor. Proposed FUJI CEN-7 I/A OWTS w/deadman for anti-buoyancy and 90°adapter. Proposed 20' polylok distribution box. Proposed eight(8) 2-foot precast leaching galleys. Proposed FUJI control panel, mac blower assembly,and vent. Addition of approx 120 CY of clean fill from an upland source for grading and use beneath leaching galleys. c� www.ColeEnvironmentalServices.com and of Trustees Applicati GENERAL DATA Land Area(in square feet): 24,899 sq`ft. (0.571 acres) _ Area Zoning: R-80 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions on property? =Yes W1 No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? RYes _WLNo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes _✓ _No If"Yes", please provide copy of decision. T is project re any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: Agency Date ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_a No Yes If yes, provide explanation: Project Description (use attachments if necessary): Please see attached project description. and of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations. To install new septic system to meet today's standards and improve water quality. Area of wetlands on lot: Approx. 2,450 square feet Percent coverage of lot: 5•8 1 % Closest distance between nearest existing structure and upland edge of wetlands: 54_2 feet Closest distance between nearest proposed structure and upland edge of wetlands: +95 feet Does the project involve excavation or filling? ❑ No z Yes If yes, how much material will be excavated? Approx. 50 cubic yards How much material will be filled? 120 cubic yards Depth of which material will be removed or deposited: 6 feet and 1 inch Proposed slope throughout the area of operations: 0.05 feet Manner in which material will be removed or deposited: Typical construction equipment to be used. Excavated material to be used for backfilling. Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason,of such proposed operations (use attachments if appropriate): There should be no effect on wetlands. The limit of construction to be contained by silt fencing. 61 Z20 Appendix E .Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: 1925 Pipes Neck- I/A Sanitary System Project Location(describe,and attach a location map): 1925 Pipes Neck Road, Greenp_ort, NY 11944 Brief Description of Proposed Action: Please see attached project description. Name of Applicant or Sponsor: Telephone: 631 369-9445 Cole Environmental Services E-Mail: Info@ColeEnvironmentalServices.com Address:. 425 Montauk Highway City/PO: State: Zip Code: East Quogue NY 11942 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that R1 ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: ❑ NYSDEC, SCDHS r 3.a.Total acreage of the site of the proposed action? 0.57J acres b.Total acreage to be physically disturbed? 0.1 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.571 acres 4. Che 1 land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) Industrial Commercial IZIResidential(suburban) Forest ❑Agriculture Aquatic ❑Other(specify): _ Parkland Page 1 of 4 5. Is the proposed action, NO I YES N/A a. A permitted use under the zoning regulations? ✓ b.Consistent with the adopted comprehensive plan? ✓ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ✓ 7. is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: eco�ic_Bay��Et��riorns Regulatory TicLeLWe#lands area, ❑ P�sC9-e—Creek 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ✓ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ✓ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: P'l ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: New I/A OWTS t0 be installed Z 0 per SCDHS standards. 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ✓ b.Is the proposed action located in an archeological sensitive area? Property is located in Archaeological Buffer Area ✓ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ✓ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ✓ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14, ntify the typic bitat types that oc n,or are likely to be found on tl�groject site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional ✓ Wetland Urban ✓Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? Dragonflies and damselflies,bats ✓ 16.Is the project site located in the 100 year flood plain? NO YES JIK17.Will the proposed action create storm water discharge,either from point or non-point sources? 11NO If Yes, � Ela. Will storm water discharges flow to adjacent properties? O DYES ✓ b. Will storm water discharges be directed to established conveyance systems f an drains)? If Yes,briefly describe: C50 YES Page 2 of 4 I8.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond, waste lagoon, dam)? If Yes,explain purpose and size: ❑ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: _, _ _ ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Chris Cole,Cole Environmental Services 1/21/26 Applicant/spo�,pino��r--nappme: _� �____ _��_ Date: _ Signature: 1.��7"�`"�'___ .__._.__.�_..�._._ _._..._._.._.__. Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 0 El 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ EJ 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ El of a Critical Environmental Area(CEA)? I 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? , 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ El 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? El EL 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. W ill the proposed action result in an increase in the potential for erosion,flooding or drainage problems? El 1:1 11. Will the proposed action create a hazard to environmental resources or human health? ❑ El t Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based'on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type'Name of Responsible Officer in Lead-Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency- _ Signature of Preparer(if different from Responsible Officer) PRINT-, Page 4 of'4 s 1 425 Montauk Highway - East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Ignatia E. Foti Living Trust, Pascal Foti, Russel Living Trust,Valentine Foti 1925 Pipes Neck Road Greenport, NY 11944 SCTM No.: 1000-053.00-01.00-019.000 Project Description Existing cesspool(s)to be pumped and removed or abandoned per SCDHS standards. Existing waste line to be changed to 4-inch cast iron installed by licensed plumbing contractor. Proposed FUJI CEN-7 I/A OWTS w/deadman for anti-buoyancy and 90'adapter. Proposed 20' polylok distribution box. Proposed eight(8) 2-foot precast leaching galleys. Proposed FUJI control panel, mac blower assembly,and vent. Addition of approx 120 CY of clean fill from an upland source for grading and use beneath leaching galleys. www.ColeEnvironmentalServices.com l rd of Trustees Applicati4 AFFIDAVIT CAROL ANN SICCARDI BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ure'o. Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS. l ,( ,DAY OF NQyttAAk(- -�20 5 -30`teh TiDuo '40 JOSEPH S Y00 Notary Public,state of New Jersey Iic My Commission Expires Nov 12, 2028 rd of Trustees Applicatii AUTHORIZATION (Where the applicant is not the owner) I/We, CAROL ANN SICCARDI owners of the property identified as SCTM# 1000- 053.00-01.00-019.000 in the town of Southold .New York,hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. rty Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF I I�VP.VOLV r ENotary SEPH S Y00 c,State of New Jersey Ot PU �C n Expires Nov 12, 2028 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of intereston'the part of town bfflcers and employees The ournose of this foram is to provide information which can alert the town of o Bible'confl�ct5 of interest and.al low it to take whatever action is necessary to avoid same. YOURNAME: CAROL ANN SICCARDI (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you personally(or through your company;spouse,sibling,parent or child)have a relationship.with any ofticer;or employee of the'own orSouthold? "Relationship"includes by blood,marriage;orbu,sincss rnteresL"Business interest"•means_a business, 1 including a partnership,in which the town officer or employee has even a partial ownership of(or employment by a corporatiot' in which the town officer or employee owns'morethan 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold, Title or position of that person Describe(he.relationship between yourself(the applicantlagent/representative)and the town officer or employee.Either check the appropriate,line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): the owner of greater than 5%of tine shares.6f the corporate stock of the applicant (when'tile applicant is a corporation); I3)the legal or beneficial Owner of any interest in'a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or cmptoyee_ofilieapplicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP i Submitte is f. a of �JC,/O 20 °t 5 S ignatur Print Name ('r rJ1 f S tr ce& Form TS I Lrd ,of Trustees Applicati- .AFFIDAVIT CHRISTOPHER FOTI BEING DULY SWORN DEPOSES AND AFFIRMS'THAT HE%SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND_THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS,APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHO)LD AND THE. BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR.BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE. TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE 'COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY T14E BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT: i Signs fir of Property Owriter Signature of Property Owner SWORN TO BEFORE ME THIS a� DAY OF., ��M Notary Public Darlene M.DeGonza Notary Public, 01 DE6te of New Yo* 1 63 Qualified in Schenectady County Commission Expires: - rd of Trustees Applicati, AUTHORIZATION (Where the applicant is not the owner) I%We, CHRISTOPHER FOTI , owners of the property identified as SCTM# 1`000-053.00-01.00-019.000 in the town of Southold. ,New York,hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work involved with the application process for permits) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS�� DAY OF Notary Public Dadene M.DaGonza Notary puboo,state of New Yak No.01DE602WO auellfied in scheneotady 0=* Commission F.xplrew. 095 +I a-1 APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM The'Town-of S6uthold's Cride of Ethics prohibits`conflicts,of interest on'the out oftowni f8ccrs and employees.The ouurliose of this form is to provide inforimation which can alertth'e town of possible conflicts of interest and allow it to take-whatever action is necessary to avoid same. YOURNAME: CHRISTOPHER FOTI (Last name,first name,Middle initial,unless you are applying in the name of someone else or other entity,such as a.company.If so;indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee x Change of Zone Coastal Erosion Approval of.plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you personally(or through your'company;spouse,sibling,parent,,or child)have a relationship with any officer or employee of the'town of Southold? "Relationship"includes by blood,marriage,-or business interest."Business interest"mems a business, including a partnership,in which the town officer or employee bias even a partial o,ainership of(or employment by)a corporation in which the town officer or employw'owns more than 5%of the shares. YES .._.. _ NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by die Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check 'the appropriatc:line A)through D)'andlor describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is acorporation) 13)the legal or beneficial owner of'imy interest'in a,non-corporate entity(when the applicant is not a corporation); C)an officer,director,.partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of " r 20 0 Signature- y Print Name f Form TS l Lrd. of ;Trustees Applicati AFFIDAVIT FORTUNATO FOTI BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED`PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN~THIE MANNER SETFORTH IN THIS APPLICATION AND AS MAY BE APPROVED.BY THE SOUTHOLD TOWN BOARD OF TRUSTEES, THE APPLICANT AGREES TO HOLD THE'TOWN OF SOUTHOLD AND THE. BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE.THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION.. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT`ISSUED BYTHE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF .O INI� 20 5 Notary Public EVAN D.VAN LEER GREENBERG Notary Public, State of New York No. 02VA6181873 Qualified in New York countvJ Commission Expires Feb. 11 2� rd of Trustees Applicat� AUTHORIZATION (Where the applicant is not the owner) I/We, FORTUNATO FOTI owners of the property identified as SCTM# 1000- 053.00-01.00-019.000 in the town of Southold New York, hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work.involved with the application process for perrnit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN.TO BEFORE ME THIS �'4 DAY OF 20 2� Notary Public EVAN D. VAN LEER GREEN;BERG Notary Public, State of New York No. 02VA6181873 Ouaiified in New York County Commission Expires Feb. 112� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town'd. Southold's Code'of Ethics prohibits conFlicts'of interest on'the part of toww6fticers and employees The Durpose of this form is"to provide information which can alert thetown,of possible conflictsf m w ot-pt—A-flo tt to take whatever actan is necessary to avoid same. YOURNAME: FORTUNATO FOTI (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally:(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the`l'own.of Southold? "Relationship"includes by blood,njarriage,or'business interest."Business interest",means a business, including a partnership,in which the town officer or:vniployee fiats even a�pattial owncrship of(or employment by)a corporation in which the town officer or employee owns-more.than 5%of the shares. YES NO t/ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe'the relationship between yourself(the applicant/agcnt/representative)and the town officer or employee.Either check the appropriate:line A)through D)and/or describe-in the space provided. The town officer or employee or his or her spouse,sibling,patent,or child is(check all that apply): A)the owner of greater than 5%.of the-shares of the corporate stock of the applicant (wl.cn the applicant is a corporation);. 13)the legal or-be neficial.owner of Bury interest-in a non-corporate entity(when the applicant is not a corporation); C),an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2v day of et/P ek, 20 Z°� Signature Print Name Snc t r Form TS 1 yoard of Trustees Application .AFFIDAVIT 1 � BEING DULY SWORN � DEPO AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN 3 ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION,';:' :' . AND AS MAYBE APPROVED BY THE SOUTHOLD TOWN'BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE ';= TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL { EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM. OF THE PERMIT. Signatioe of Property Owner Signature of Property-Owner 1 2 5 SWORN TO BEFORE ME THIS. DAY OF VV U Notary Public DIANA M PEREZ U Notary Pubk,State of New Jersey Canm.#2430704 My Cm rdsslon E)*w 3NI2028 'j —card of Trustees Application AUTHORIZATION (Where the applicant is not the owner) S 1 ' 4 owners of the property identified as 053.00-01.00-019.000 SCTM# 1000- ,in the town of r Southold ,,New York,hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all s necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. i Pro erty Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS. DAY OF IV 0()CM�Cr ,.20 a S Notary Public a NA M PEREZ NttiNc,state of New Jersey Wmm.#2430704 'My Commission Expires 3/112028 r APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM , The'T own o Sau `Id's C"de' f tines ib's conflicts°af i to n t a` a 9&towirofficers a de�nnla e u se of #his:a s't' rovide inforinakia ic" ca ateit,the"townaf o" " e' " sets i terestand'allo ''tto ke a :actian�s. naq—g Iry to+ayoid same:: YOUR NAME. T G Ay (Last name,first name,piddle initial,unless you are apQlymg.in;the name of. l someone else or other entity,such as a company.If so,indicate the other person's or company's name.) 9 NAME OF APPLICATION: (Check all that apply.) Building Tax grievance E Variance Trustee X t Change of Zone Coastal Erosion Approval of plat Mooring s Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you persnaally(or through:your;campany,:spcSuse,,sibling,parent,or chi)d)hivo:si relationship Wiih,my dfliccrfar einplgyO p of the Toyvn;of;Soythpld? "Relationship"includes byVood,'marrrage,ar tiusrr�csstiiterest "B.:ystnessinterest"mesnts a bUstness; including a partnership,snawhich the totivn officctor'cmtil.4yee husevan i'partiaorvncrship of;(orcmploymenl lwy�&,,corporatioV in which the tbwn officer,oraemployee�owris'+norn.than,S%o of the shares. YES NO t If you answered"YES",complete the balance of this form and date and sign where indicated. 3 Name of person employed by Town of Southold Title or position of that person, pcseribe thoxciationsh�p tict cen yaurscif(the applicantlaggriVrepresentative)and the town officer or employee.Either check the'appebodtitc'`.line A)thrbogh D)nndlor descripp'in the,spacp provided. The town officer.or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the dwrier%of greaterG,iltan S%a ofithe sha'ms�ofthe�corporate stock of the applicant (vrhenti�eupphcan(,isa corporation ),. I3j"ttic legal.or'honet toial awnar�tif tuty littcrest in u}lion-corporate entity(when the appltemir is not a ct)rporatton, C)akt;ofticcr,director,partnei;oar cmjpbyeo.of fhb applicant;.or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thf day of 9'�JA— 20�� Signature Print Name Form TS I s �-.-•;&rd of Trustees 'Applicat: AFFIDAVIT PASCAL FOTI BEING DULY SWORN DEPOSES AND AFFIRMS'THAT HE%SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE,BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT-. . ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES, THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE. TRUSTEES,THEIR AGENT(S):OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS.REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature o Property O ner Signature of Property Owner SWORN TO BEFORE ME THIS / S+ DAY OF �"{�6 ; 20 � Notary Public EVAN D.VAN LEER GREENDERG Notary Public, state of New York No. 02VA6181873 oualified in New Yorl< County commission Expires Feb. 11 1 Z' and of Trustees Appliaat: AUTHORIZATION (Where the applicant is not the owner) I We, PASCAL FOTI owners of the property identified as SCTM# 1000 053.00-01.00-019.000 in the town of Southold New York, hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work'involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. I ' Property Owner's Sign re Property Owner's Signature SWORN TO BEFORE ME THIS. DAY OF,. �a�� ,.20 2 1 - Notary Public EVAN D. VAN LEER GREEWaFRG Notary Public, Stare of New York No. 02VA6181873 Qualified in New York County Commission Expires Feb. 11 2�g APPLIC. 'Y'/ACENT/REPRESENTATYVE TRANSACTIONAL DYu�,LOSL►RE FORM The Town of Southold's Code ofEthics 12rohibits conflicts-of connicts-of interest on.the part of town o sets and em to ecs.The L)urppse of this form is to nrovide information which can alert the towrrof possible conflicts of interest and allow it to,take whatever action is necessary to avoid same. YOUR NAME: PASCAL FOTI (Last name,first name,spiddle initial,unless you are applying hT the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check aii that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat ___ Mooring Exemption from plat or official map _ Planning Other (If"Other',name the activity.) — Do you lcrsonally(or through your company,spot.se,.sibling,parent,or child)have a relationship with any officer or crnployeta of the'1'ov n oil Southold? "Relationship"includes by blood,tgarr r igc,or busit:css interest.:"Business.ir6Crest7 means a business, including a partnership,in which the town officer or employee has&en.a partial gwnership or,(or:cmployment by)a corpc,ation in which thr town officer ar employee owns mpre.thal 5%of the shares. -NO w if you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the appliparlt/agettt/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):, p,l t`, r,!Vngr Of :Miter'-.han.5%of tl=.e shares of flu.corporate stock of the applicant (when the applicant is a corporation); R)the legal or�benefrcial owner of any interest in a non-corporate entity(when the applicant is not a corporation),. C)an ofcer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Su[�niitted thi~" day.of h 20 (z �, Signature t�. `� - ''L :Print Narne.XaSe Form TS 1 EVAN D.VAN LEER GREENBERG Notary Public, State of New York No, 02VA6181873 Qualified in New York Count Commission Expires Feb. 11 g Board of Trustees Application AFFIDAVIT BEING DULY SWORN DEP SES AND AFFIRMS THAT'HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT.' t s ALL WORK WILL BE DONE IN THE MANNER SET,FORTH:IN THIS.APPLICATION AND AS MAY BE"APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. 'THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE s BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)'OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE'BOARD OF TRUSTEES,TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. A F 3 Signature of Property Owner't Signature of Property Owner ' k i SWORN TO BEFORE ME THIS., a I DAY OF 0J f_�A� 20.2 S r No Public DIANA M PEREZ Ngtary Public,State of New Jersey: Comm.#24307,04 my:cmVnIssfon EOW 3"ine i board of Trustees Appli.catioL AUTHORIZATION (Where the applicant is not the owner) I/We, t� J q f1. n � SSA i owners of the property identified as SCTM# 1 Ot?0- 053.00-01.00-019.000 _ in the town'of t Southold New York,hereby authorizes ' COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town i { Board of Trustees for this property. F Property Owner's Signature Property Owner's Signature a SWORN TO BEFORE ME THIS...- PA DAY OF V W en''bec- 2Q Z S No ary Public DIANA M PEREZ Notary-Public,State d New Jermy Comm#2430704 My Cam ssion Ex 3"am 6 APPLICANT/AGENT/REPRESENTATM TRANSACTIONAL DISCLOSURE FORM � x I T e To Stint old, aa"bf , 'o" tiils`cantiict& into n ho ftb offl 1- s nd gnp li' orm is t ravine intarma` whie n a IcttIthe,own cif U o° ➢b titeres>and ally ttto hatevoractlon is YOURNAME: Last name, rst name,fuddle initial, .less you are a plying:in;the name of i someone else or other entity,such as a company.If so,indicate the other person's or company's name.) x NAME OF APPLICATION: (Check all that apply.) s Tax grievance Building Variance a Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning ° Other i (If"Other'',name the activity.) c Do you personally:(or through yoar eompany,spo use,.sibling,parents or child)barn a roiationship with any cifficcr or atnployec ' of thetiiwri;af Southold? "Re,(ationship"includes by blood,,rnarriage,,orbusiness'i4torest, .Baou mess inteie,sC';means a business; ; including a;partnership,°in.which the trivia officeror t mnli yee has evcn'o;partial pwncrslup,of(oromploymen('by)a°carporadoii in which the town officer'4,iemployce'a<wns;tnore.thim5° of the shares. s 5 YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold. Title or position of that person,,. E Describe thc,cclationship between yotirself(the ttppheatittagcnt?representative)and the town officer or employee.Either check fhe-appropriatcline A)thraugh;D)andtor describe in the.space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A);ttie owner:of greater""than S%q'of the"stures:of thco corporate stock of the applicant (when the apphcant,is.acorpt�ratton);. 13}aha;legal or,'benoficial.awnef';ofany#merest tn_a'ion-corporate entity(whets the appheaat;is not a carporation�, C}aa,officer,.,directar;partner,iarempioyee:of tlteapplicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day J210 S ignature wt Print Name Form TS I y k ,i ,rd of Trustees Applicati7 AFFIDAVIT VALENTINE FOTI BEING DULY SWORN- DEPOSES AND AFFIRMS THAT'HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER`SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO,HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES .AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN-COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENTS);OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER"ONTO MY PROPERTY TO INSPECT THE PREMISESIN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I_FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS ls" N�ve mb�✓ .. .,DAY OF ; 20 t S_ otary Public � Conmm ven: j ::.sachusetts �,y CainYnwsiaz��z,��i'}ay.27,.�G�6 Lrd of Trustees Applicati-- AUTHORIZATION (Where the applicant is not the owner) I/We, VALENTINE FOTI owners of the property identified as SCTM# 1000- 053.00-01.00-019.000 in the town of Southold New York, hereby authorizes COLE ENVIRONMENTAL SERVICES to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS I S DAY OF govem btr J 20 Not y Public f01RIAN RDC ":E':! Q,-U1,107_ACA ku4yCommission Expirss Pdov,27,2026. APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town'of Southold's Code of Ethics prohibits conflicts'of interest on the part oftown officers and employees.The purtiose of this form is tyirovide information which can alert'the townofpossible'conflicts of interest and allow it to take whatever action is necessarYto avold same. YOUR NAME: ' VALENTINE FOTI (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity;such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other'',name the activity.) Do you persorially.(or through you`r'company,,spouse,,sibling,parent,or child)have a relationship with any'officer or employcc of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means'a business; including a partnership,in which the town officer oeemployee hzm6en a partial ownership of(or employment by)a corporation in which the town ofiiGer_or employee owns.mote.than 56fa of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold_ Title or position of that person Describe the relationship between yourself(the ipplipandagen)Urepresentative)and the town officer or employee.Either check the appropriate.line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): Q)the Owner of greater than 5%.of the shares'of the corporate stock of the applicant (wile ri the applicant is a corporation); B)the legal orbeneficial owner.o.f any interest in a non-corporate entity(when the applicant is not a corporation); C),an officer,director,partner,oremployee.of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of A Ar--6� 20 Signature Print Name Form TS 1 APPLICANT/AGENUREPRESENY'ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Souihold's C de of Ethics.orohibits conflicts of.interest'on.the part of town officers'and emoloyees.:The nl se`of .ihis-forsri=is to�brbvide`ioformafion which can alert the-town of it to take whatever action is. `necessarvto` vo�dsame:. YOUR NAME:. Cole (Last name,first_name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as alcompany.If so,,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply:) A, Tax grievance Building• Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map: Planning Other (If"Other",name the activity.) Do you personally toi rthrough your company,spousemsibling,parent or child)have.a relahonship.with any officer,or-employee., of the Town of Southold? "Relationship"mclades by blood,marriage,orb'ussnes's interest "Business interest"means a busi6ess, including ay partnership;in,which the(own officer or employe%e tfias'even,a partial ownership,of(or employment 6y)a corporation in which the to_w_n.b, ricer or eniployee'ownt�more than.'. °%:of3he shares: YES n NO If you answered"YES",complete the balance of this form and date and sign where indicated, Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. "The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): jjA)-the owner of greater than.5%of thcfshares of the corporaie stock of theappli jt (when the applicant is a corporation); _B)the legal or beneficial owner of any,interest in a non=corporate entity,(when,ft applicant is not a corporation); C)an officer,director,partner;or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submittedythm day f_ anaar 2026 Signature . = Print Name_Cb;; .k ok�r C, a fe Form IS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS L All.applicants for permits* including Town of Southold agencies, shall complete this CCAF for Proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront, Revitalization Program. _-,A_proposed action.will be evaluated as to-,its siz0icant Beneficial and-adverse-''effects:upon the coastal area(which'includes all of Southold Town). 1' 'If any, question in Section C on this form is answered."yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions.contained in the consistency review law. Thus, each answer'must be explained in detail, listing both supporting and non- supuortine facts. If an action-cannot be certified.as consistent with the LWRP policy standards and conditionsAt shall not be undertaken.. A copy of-the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office,the Planning Department, all local libraries and,the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000 _53. _1 - 19 PROJECT NAME,1925 Pipes Neck- 1/A Sanitary System. The Application has been submitted to (check appropriate response): Town Board . ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑✓ 1.. Category of Town of Southold agency,action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: Please.see attached project description.= ..._ Location'of action: 1925 Pipes Neck Road, .Greenport; NY 11944 Site acreage; ;0.571. acres (24,899:sq. ft). Present land use:.Residential;: Present zoning classification: 2. If an application for„the,proposed`action has"been filed with the Town"of Southold agency, the following information shall be provided: (a) Name of applicant::Cole Environmental Services (b) Mailing address: 425 Montauk Highway, East Quogue, NY 11942 (c) Telephone number: (631)369-9445 , Will.the action be directly undertaken,require funding,or approval by a state or federal agency? Yes` ✓❑ No❑ If yes,which state or federal agency?NYSDEC, SCDHS C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all,proposed'Best Management Practices that will further each policy. Incomplete answers will require that the form be returned.for completion. DEVELOPED.COAST POLICY., Policy 1. Foster a pattern of development in he Town of Southold that enhances community character, preserves,open space, makes efficient use of infrastructure;makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III--Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ✓❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and"archaeological. resources of the Town of Southold. See LWRP Section III--Policies Pages 3 through 6 for evaluation criteria .0 Yes ❑ No❑ No,t Applicable Minimal excavation is proposec historic structures, materials, or-,.,..,ares are proposed to be altered or demolished. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ❑✓ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑✓ Yes ❑ No E]Not Applicable Existing sanitary system will be abandoned and the residence will connect to a new I/A sanitary system, which-will protect and improve water quality by reducing nitrogen. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No F Not Applicable Attach additional sheets ifnecessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑No ✓❑.Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Z Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No Z Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No Z Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No❑✓ Not Applicable PREPARED BY Chris Cole TITLE Agent DATE 1/21/26 .r 425 Montauk Highway _.. East Quogue, NY 11942 Environmental Consulting (631)369-9445 Wetland Project Management Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Ignatia E. Foti Living Trust, Pascal Foti, Russel Living Trust,Valentine Foti 1925 Pipes Neck Road Greenport, NY 11944 SCTM No.: 1000-053.00-01.00-019.000 Project Description Existing cesspool(s)to be pumped and removed or abandoned per SCDHS standards. Existing waste line to be changed to 4-inch cast iron installed by licensed plumbing contractor. Proposed FUJI CEN-7 I/A OWTS w/deadman for anti-buoyancy and 90°adapter. Proposed 20' polylok distribution box. Proposed eight(8) 2-foot precast leaching galleys. Proposed FUJI control panel, mac blower assembly,and vent. Addition of approx 120 CY of clean fill from an upland source for grading and use beneath leaching galleys. www.ColeEnvironmentalServices.com I 425 Montauk Highway ° East Quogue, NY 11942 Environmental Consulting (631) 369-9445 Wetland Project Management Town of Southold Board of Trustees E l5 C 2 j� NJ E 54375 Main Road D VU 11 V P.O. Box 1179 Southold, NY 11971 JAN 2 7 202$ Re: I/A Sanitary System °= Southold TOW11 Carol Ann Siccardi,Christopher Foti, Fortunato Foti, Board of tirla Ignatia E. Foti Living Trust, Pascal Foti, Russel Living Trust,Valentine Foti 1925 Pipes Neck Road Greenport, NY 11944 SUM No.: 1000-053.00-01.00-019.000 To Whom It May Concern, The clients seek to abandon existing septic system, approx. 91'away from the wetland boundary,and install new I/A OWTS per SCDHS standards 95' away from the wetland boundary. Based on conversations with the Trustees office, it needs to be determined if the application will be reviewed as an administrative wetlands permit or full wetlands permit. When a determination is made, please let us know and a check will be mailed to your attention. Please find the following items enclosed: 1. 4x Application 2. 4x SEAF 3. 4x Affidavit,Authorization,&Applicant Transactional Disclosure Forms for all owners(1 orginal,3 copies) 4. 4x Certificates of Trust for Ignatia E. Foti Living Trust and Russel Living Trust(1 orginal, 3 copies) 5. 4x Agent Transactional Disclosure Form (1 orginal, 3 copies) 6. 4x LWRP Consistency Assessment Form 7. 4x Survey by Gary Benz,Surveying and Land Planning,dated 7/21/25 8. 4x Site plan by Homeport Engineering dated 1/20/26 9. 4x Photo sheet Should you need anything further, please do not hesitate to contact us. Sincerely, Summer Looney Info@ColeEnvironmentalServices.com I Cole Environmental Services, Inc. www.ColeEnvironmentalServices.com