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HomeMy WebLinkAboutTR-10963A Glenn Goldsmith,President �OStfF01 -ro Town Hall Annex A.Nicholas Krupski,Vice President �Z� G't.A 54375 Route 25 Eric Sepenoski y z P.O.Box 1179 Liz Gillooly 0 Southold,NY 11971 Joseph Finora 'y p! Telephone(631)765-1892 �Oly 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 1st day of construction % constructed Project complete, compliance inspection Glenn Goldsmith, President QF SO(/�� Town Hall Annex Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Joseph Finora • �® Fax(631) 765-6641 olyC®U ,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10963A Date of Receipt of Application: April 27, 2026 Applicant: Debra Coady & Patricia Reilly SCTM#: 1000-77-1-1 Project Location: 560 Oak Avenue, Southold Date of Resolution/Issuance: May 13, 2026 Date of Expiration: May 13, 2029 Reviewed by: Board of Trustees Project Description: Install an I/A OWTS system. 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 April 27, 2026, and stamped approved on May 13, 2026. Special Conditions: 1 to 1 tree replacement with native hardwoods with a minimum 2" caliper if any trees are removed. 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. � o Glenn Goldsmith, President Board of Trustees AS-BUILT SITE INFORMATION: SUFFOLK COUNTY TAX MAP ID: 1000-077-01-01 OF I�'z8>Ta TEST HOLE INFORMATION -EXISTING 3 BEDROOM HOME NO PROP05ED CONSTRUCTION. `��' �® GRADE EL.G.5'± r�N �Q' e1 00 PROVsDED BY-HOB r -LOT AREA:ACRE 0.33. 1 4,001 SF. os a�6 dp� NTS- ENGINEERING s" -PROPERTY LOCATED AT 5G0 OAK AVENUE. A,A LOAM EL PROPERTY LOCATED AT o SOUTHOLD,TOWN OF SOUTHOLD,SUFFOLK COUNTY, NEW YORK b_ (OL) 5.5'± 5GO OAK AVE -SURVEY PROVIDED BY:PECONIC SURVEYORS PC 1 2-1 G-1 005 r SILTY SAND EL SOUTIOLD, NY 1 1971. ,, f b (SIN) 5'+_ DATED 04-14-202G � VERTICAL DATUM-NAVD'1 058 DATUM -PUBLIC WATER SERVICE EL -ALL HOMES WITHIN 15OLF OF PROPEP.TYCONNECTEDTO PUBLIC WATERSERVICE. DEPTI-OF TEST HOLE G'± } e v b SAND(SP) 1.0' - - -SURFACE WATER SHOWN ON SITE PLAN. 0249 HI OUND A ER - GENERAL NOTES: �Q3 �Js0,®��`° .. +n WATER IN GROUIdDWATER ^� SAND EL STnrEIneNT: 1. DESIGN FOR 4-15EDROOM HOME. b SF 0.5'± -5T 701.E 5H0W5 GROUNDWATER „ / e�Sm zC 2. VA OWTS SANITARY REPLACEMENT DESIGN, WATER ENCOUNTERED EWCOLNTEPED AT EL I.O± 3.SITE PLAN AND REFERENCE ELEVATIONS TO BE USED FOR VAOWTS SANITARY SYSTEM AT EL I.O'± HEGW:I s± •-_... Kmy� 5P�� CONSTRUCTION ONLY.EXACT PROPERTY BOUNDARIES, UTILITY LOCH IONS AND ELEVATIONS p2.6 Eie. p ARE NOT GUARANTEED. TEST HOLE INFORMATION ,�,r _ ._ _.� E"s•: 4.ELEVATIONS BASED ON COUNTY GIS$ENGINEERS MEASUREMENTS. �d1 =Lr 5. 0N51TE UTILITY MARK-OUTS TO BE'ERFORMED BY CONTRACTOR PPIDRTO PERFORMING SITE SCALE: NT5 WORK. G. SOIL TEST HOLE DATA PROVIDED BY HOMEPORT ENGINEERING PC 04-14-202G 7.EXISTING SANITARY CE55P00L5(51)TO BE PUMPED AND REMOVED AS NECESSARY PER5CDH5 STANDARDS. r tc1 - PROPOSED VA OWTS SEPTIC SYSTEM FOR UP TO 4 BEDROOM RESIDENCE: I. ONE(I) FUJI CEN-5 I/A 0WT5 "E�HaAWA� .f 2. 0NE(1) FUJI MAC80K BLOWER,VENT AND FUJI CONTROL ASSEMBLY. NOTE'.LIMITS OF: '' �- I'T 3.ONE(I) POLYLOK DISTRIBUTION BOX AND GRouND�Dirlc A Ia 4.F0UR4)8,5'X 4.75'X 3 EFFECTIVE DEPTH LEACHING GALLEYS. LLI DISTURBANCE(LCOD) "gyp 1 •; - 5. THREE(3)8.5'X 4.75'FUTURE EXPANSION AREA. w ''SILT FENCING AND I I, r - - s GENERAL SANITARYSYSTEM AND INSTALLATION NOTES: V EROSION CONTROL TO Cu > Z BE INSTALLED ALONG I ' I. VA O'J✓F5 SEPTIC SYSTEM DESIGNED FOR UP TO 4 BEDROOM HOME PER SUFFOLK COUNTY w Z LCGD DEPARTN•1EN1T OF HEALTH STANDARDS!SCDHS). Lu } ECSr � 5dL75 2. INTERIOR PLUMBING INVERT TO BE R!_LOCATED BY LICENSED PLUMBING CONTRACTOR A5 z y w SHOWN, Q ur µ t'R 3, SANITARY GRAVITY DRAIN PIPE TO BE 4-INCH CAST IRON AT FOUNDATION PENETRATION AND uj -- -�' EXIS.SANITARY BLOCK =�,qX. 0'p�T - - CESSPOOLS TO BE PUMPED AND ��y 4-INCH FVC SDR35 DOWNSTREAM OF FOUNDATION. Y J A ' ' ABANDONED OR REMOVED PER Isl 4. VA O'Wi-5 SHALL BE TESTED FOR WATERTIGHTNESS PRIOR TO AR;IV,NG ONSITE U51NG THE Q a SCDHS STANDARDS. Q 44S` , METHOD APPROVED BY MANUFACTURER. } _ 5 PROP mat i3 5. THE DESIGN ENGINEER SHALL OVERSEE THE OWTS DURING SYSTEM STARTUP, 0 BOARD T]{ �� i� �L`(�rtiy �L { ;, I ca f G. THE OWTS INSTALLERSHALL BE LICENSED, HOLD AN ENDORSEMENT FROM SCDHS AND BE A O O ~ DVl-+1`V ` CD PROP.WASTE LINE RELOCATION t YT:F2/ 4 L, FUJI.AUT'10RIZEDINSTALLER 0 j �(� 4-INCH CAST IRON INSTALLED BY CP ' E `Z',` 4 N BA4161f Y�i�-®� SOUTHO D LICENSED PLUMBING ' I ' 4!, m, 7. THE OWiS INSTALLER SHALL REGISTER THE ONSITETREATMENTSYSTEM WITH SCDHS. THE (� TV I CONTRACTOR. • T D i /gam f DE51GN ENGINEER SHALL PROVIDE CERTIFICATION DOCUMENTS A5 REQUIRED BY SCDHS. q. C 8. AN OPERATION AND MAINTENANCE CONTRACT BETWEEN THE MAINTENANCE PROVIDER AND THE FUJI CONTROL PANEL,MAC BLOWER !" , • - PROPERTY OWNER SHALL BE PROVI DEC)TO SCDHS FOR 1/A 0WT5. ASSEMBLY,AND VENT I, �, \ 9. A GARBAGE GRINDER SHALL NOT BE INSTALLED UPSTREAM OF THE 0WT5. ®ATE b� PROP.FUJI CEN-SI/A `E" ' , I [ ` �o. 10. WATER SOFTENER BACKWASH SHALL NOT BE FLUSHED TO PROPOSED SEPTIC SYSTEM, �� ezr� s sx.acE exze I I OWiS W/BO°ADAPTER "-'--'� - ' Y a 2� EXIS.OVERHEAD 1 1. CONTRACTOR 15 RESPONSIBLE TO OB AIN TOWN BUILDING PERMITS AS NECESSARY PRIOR TO PROP.POLYLOK + ELECTRIC SERVICE INSTALLATION OF THE PROPOSED SEPTIC SYSTEM. DISTRIBUTION eOX�_ i a Q 12. NOTE THERE 15 AN EXISTING HOUSE TRAP. VA0WT5 TO BE VENTED THROUGH 2 INCH CARBON DIS ONNECTE ) - VENT, w - - PROP.FOUR(4)3-F00T PRECAST k8t- 1 a -" 13. NO EXISTING OR PROPOSED DRYWELLS•. LEACHING GALLEYS kit, Q O X t° \\ "p TT(F�� .,I `.' } L i:,;l LEGEND IE-INVERT ELEVATION r sV t., 11.9 GTCM BASIN !P-UNCAR FOOT FUTURE EXPANSION G i \' m' C[CC-Cr_LAR ENTRAN LP-LLkCHING POOL N) CI-CAST IROI M-PSD MANIFOLD .. O . GO-CL[ANOU" MAX-MAXIMUM 00 EXIS.TREES TO BE REMOVED AS- b - - EXIS.PUBLIC CP-COSTING 5ANMARY OESSP00L IN NECESSARY FOR INSTALLATION WATER SERVICE CTG-OLT TO GRAD[ 0Wf5-0N51TE WA5T5VATER TREATMENT SYSTEM Z OF SANITARY SYSTEM ,Q OB-DISTRIBUTION BOX PT-P.:RGOIATION TEST O JS ".L-CLNATION SCOM5-SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Q -- tX-EXPANSION POOL 5T-S EPTIC TANK r' "'-' 'e'�<EL:t3•: D(15-DAISTINC' TH-T:ST HOLE O�"' FFE-FINISHED FLOOR ELEVATION V-VENT ��� GE-GRADE ELEVATION TB-THRUST BLOCK W Z>" �• \ C+PD-GALLON,PER DAY TYP-TYPICAL 0 z i�"I". 5�'�I /•~ VA0Wf5iC NOVAATIVE/ALTERNATI EOWfS -WATER METER r^ d ��` S I� A ;/�('f�C HOMEPORT ENGINEERING SHALL NOT BE RESPONSIBLE FOR THE CONSTRUCTION MEANS do METHODS UTILIZED W VJLd W S' BY THE CONTRACTOR, NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES. THE ENGINEER I- cU j O � "" "'` -- SHALL NOT BE RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN (n 0 ¢ ACCORDANCE PATH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH'S STANDARDS AND REWLATIONS. ~ CONTRACTOR SHALL NOTIFY THE ENGINEER PRIM TO BACKFlWNG OF ALL STRUCTURES AND ASSOCIATED Q V) PIPING. < O o a i A PR 2 7 2026 r I 15' 2 M'M AR 2414C EESSPoTO SHOWN DATE:04-21-2026 SouthoidTot�, QEAWUT 20 NOXWrL OTYGRAT6VTON MAXIALM24gO-ES TO GRADE _ p,,� s nr�,.,� FEEL 11'3 TO GPACE EXIS GWLE SINCHt PoSERSTO GR BO%W15AFElY GR1TIN0 -qeQe�'"-�- EXIS GD EL 10't Ez15 GRADE EL.1 n• SCALE: 1:30 -. PROP INV 8't „N0T WCSDR35 IE:8 DESIGNER J .7Y IE:B,q. IE:84'_ E8.2't IE 81- : B 5AN ITARY 51TE PLAN TAN SLOPE.077UF 41NCH PVC SDR35 SCALE:= 1 :30 5' 'AN SU�.Gt� SHEET: FUJI CLEAN CEN-5IIA0 (4)53'LEA_HING GALLEYS SPA ED2-FOOT APART IN LINE y W41NCH SErBA35CR SSOVER PIPES _ MINIMUMS-eiXJT SEf&1O(FR MBOTTOM OF SYSTEMTO 30' 60, ' HEGW 1.54 HIGHEST EXPE(:1E0 GRf}1NDWATER 1.3• 0' 10, 20' 30' 40' 50' 60' S T TRU. STEES OU . D . No, ' 1090 A Issued To Address Oak A-\ren%Ael SoLM016 THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION .TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 Glenn Goldsmith,Oxus dent �0�0 4119 Town Hall Annex A.Nicholas Krupski,Vice President —,'` < 54375 Route 25 Eric Sepenoski ? P.O.Box 1179 Liz Gillooly �y�• a0�� Southold,NY 11971 Joseph Finora ¢ Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report 3° Date/Time: �& Completed in field by: ffiJ6QA Twin Forks Permits on behalf of DEBRA COADY & PATRICIA REILLY requests an Administrative Permit to install an I/A OWTS system. Located: 560 Oak Avenue, Southold. SCTM# 1000-77-1-1 Type - area to be impacted: V Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: \/Chapt. 275 Chapt. 111 other Typ ADf-Application: Wetland Coastal Erosion Amendment V Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No \/Not Applicable Info needed/Modifications/Conditions/Etc.: (0Ad7,9 2 Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly ✓J. Finora fop G 1 0,0 of Slog/ 50.0 r� N g.30,500 E. cam'w p ot N•6 ow m p f agti m � Tr- Ao f 12' h m� to , U. Z/ 10, 7. 2 fie '0000 27 STo G sr g / w►w� m 0. Ole 9` \ r !o AV 0o Ooue yo• SURVEY OF PROPER Y �C AT SOUTHOLD TOWN OF SOUTHOLD opk SUFFOLK COUNTY, N. Y. y+ 1000 - 77 - 01 - 01 �;" 16 �."I SCALE 1" = 20-' DEC. 16, 1998 AUG. 21, 2000 (loc. dock! OcL 3, 2000 fre vlsionl '` L, �NOTE, LOT NUMBERS REFER TO "MAP OF GOOSE APR 2 7 2026 BA Y ES TA TES' FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON NOV.13, 1934 Southo►dTown AS MAP NO. 1176 -- Board of Trustees AREA = 14 001 sq. ft iT ANY AL TERATION OR ADDITION TO THIS SURVEY fS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERT/F/CATION►S H RE0 ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF l �� L " . .,,fOO. 49618 SAID MAP OR COPIES BEAR THE&PRESSED SEAL OF THE SURVEYOR WHOSE SIGNA TUBE APPEARS HEREON. PECONIC S YORS, P.C. ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTERED BY' (63P 765 - 5020 FAX 1631) 765 - I797 MUST BE USED BY ANY AND ALL SURVEYORS UT49WG A COPY P. 0. BOX 909 OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS 'WSPECTED'AND 1230 TRAVELER STREET 'BROUGHT-TO DATE' ARE NOT W COMPLIANCE W/TH THE LAW. SOUTHOLD, N.Y. 11971 AO 704 IV k. rNF+ a I 44V _ R'yR• ' - •y.-'r:'Q-� ?Y s�•pr '�' � --- _ - 44 �a bi. '" �."* Qc f�.�"yJ, „da .�y., .�'.s„ ... $ z',�_', - r -:. �` -r 1�iSs �,��lE,�'s* ^:^+ - e mot,, - _ ^'`C�:�•.. T-- t rt �6�p ��`t4t�'� � -r - C; �t � . ♦ < � �,# �, ^���� ;r �9* t. } �,.; _ 2t' lw` 'ty K'ti'i fi• ,yf�/' +� � AZ i. wl IF .� w ---- - ___.dam°' `. - ,�• : — .. - � ��_max �-�,.. _- �`� x .:a ... R ,�•a e ate;''• ;� � r�..��.. ; —. yin _ 6j .Y=:.: .- .aft , ••." , �a / a f )a , t •yaw, A, ot T• ,' � � rr- ram' .?�L�'/ .-V � � �6 J. �- i .+ x may.a �c'!K"'^ �"•,.f �•�' "�:, �`" '-�,-... -'✓'}¢�; O "=,v -• .y. ' F` y Lam. ` Alp Nrl.�♦' � ` 1 _ w or tS t C r ' � f JT '�F ♦ � 'y.. Ut 21-04 .' 03, • � C�� �.� ��� f1 PS � !_ mom� � `86E'j \� \ r t c � 1 x � 5 n V n.��su �,y tir .� � � ; ��ir �, \�, .. \� \ A �, �,,,as ���N*��� � a •.,,ate\�� � __.-._. COUNTY OF SUFFOLK N NOTICE K — �»��..> ,000 secT NO R Pr p—y'T Srnce Agency *eunw eus ae v >A W sKnrmry ru wv6F%Yp1E0 M�±p5 -- �Np 0(, p ..w.___. "'.' __..__ w r,r.. (27) ^ S xLet wrrfxy�newx gnvlcE,m..+ F d a OFFICE LOCATION: ��OF SO(/ry� MAILING ADDRESS: Town Hall Annex h0 l� P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G • Q Telephone: 631 765-1938 COU 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: May 12th 2026 Re: LWRP Coastal Consistency Review DEBRA COADY & PATRICIA REILLY, SCTM# 1000-77.-1-1 This application is to install an Innovative/Alternative Onsite Wastewater Treatment System (I/A OWTS) system. 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 5: Protect and improve water quality and supply in the Town of Southold. 5.1 Prohibit direct or indirect discharges that would cause or contribute to contravention of water quality standards. C. Ensure effective treatment of sanitary sewage and industrial discharges by: 3. modifying existing sewage treatment facilities to provide improved nitrogen removal capacity The I/A OWTS will treat wastewater to a better degree than the system it is replacing. 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 Glenn Goldsmith.President �Z ��/ p Town Hall Anne: ` . 54375 Route 25 A.Nicholas Krupski,Vice President "� P.O.Box 1li'9 Eric Sepenoski Southold,New York 11971 Liz Gillooly a Elizabeth Peeples Telephone(631)7135-1892 ` Fax(631) 765-0641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Oftice Use Only ® E rN Coastal Erosion Permit Application l� 1 L Wetland Permit Application A P R 2 7 2026 Administrative Permit Amendment/Transfer/Extension Received,Application: southoia town Received Fee:'$. -_ Board of Tnlsfone Completed Application: Incomplete: _ SEQItA Classification: Type I_Type II L)nlisted . Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: _Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): Debra Coady Mailing Address: „ 38 Frazer Dr., Greenlawn, NY 11740 - Phone Number: 631-742-4396 Suffolk Count}+Tax Map Number: 1000- • 1000.77-1-1 Property Location: 560 Oak Ave., Southold NY 11971 If necessa ry,ary,provide LILCO Pole #, distance to cross streets, and location) AGENT(If applicable): Lisa Poyer, Twin Forks Permits Mailing Address: 288 E. Montauk Highway, Hampton Bays, NY 11946. 631-644-5998 IisaCtwinforkspermits.com Phone Number: ___ Email;;, -- to^'rd of Trustees Rpplicatign GENERAL DATA Land Area(in square feet): 4,001 sq.ft. (0.33 A) Area Zoning R-40 Previous use of property:, Residential Intended use of property: Residential Covenants and Restrictions on property? —ayes r_ No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes ._�No 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? _O_Yes _E]_No If"Yes",please provide copy of decision. is project re . any demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure(s) on,property have a valid Certificate of Occupancy? Yes I^I No Prior permits/approvals for site improvements: Agency Date Trustee.No. 5627.,Sept..25 2002 Trustee N o. 0776C Certi ficate,of Compliance, July,23, 2012 Trustee No. 8471, July 23, 2014 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental.agency?_n NoEL Yes If yes,provide explanation: Project Description(use attachments if necessary): The project includes the proposed septic upgrade to the existing residence. ' -_,rd of Trustees Appli.cati WETLAND/TRuSTEE LANDS APPLICATION DATA Purpose of the proposed operations: �® The project includes the septic upgrade to the existin residence. proposed p p9 9 . e. Area of'wetlands on lot: N/A square feet Percent coverage of lot:. N/A1/0 Closest distance between nearest existing structure and upland edge of wetlands: . 50 feet 77' to the tank Closest distance between nearest proposed structure and upland edge:of wetlands:_g 1' t0 the LG Does the project involve excavation or filling? No 0 Yes If yes,how much material will be excavated. _-260 cubic yai-ds How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: N6 feet Proposed slope throughout the area of operations: <2% Manner in which material will be removed or deposited: PLqposed excavation in the area of the.existing septic system in order to abandon and remove the existing septic system. The new proposed I/A se:ptic system will be located landward of the ­ existing septic system which will be abandoned as.per the SCDHS standards. Statement of the effect, if arty,on the wetlands and tidal waters of the;town that may result by reason,of such proposed operations (use attachments if appropriate): No physical impact.to any potential on site wetlands. No detriiment.to any.potential.on site wetlands. 'Proposed positive'impact to any'poteriital on site wetlands due to the I/A septic upgrade and moving the system to a more landward location. f 61 Z20 Appendix 1I Short Environmental Assessment Form Instructions fer 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 additions information which you believe will be needed lby or useful to the lead agency;attach additional ipages as necessary to supplement any item. `,.Part 1 'f roject and Sponsor Information ' w Name of Action or Project: Debra Coady _. — Project Location(describe,and attach alocation map): 560 Oak Ave., Southold NY 11971 Brief Descri Lion of Pro osed f Acti P P m: _The project includes the proposed septic upgrade to the existing residence and abandonment of the existing septic system. Name of Applicant or Sponsor: Telephone: 631-742-4396 Debra Coady E-Mail: — Debracoady@aol.com ..Address. 38 Frazer Dr., Greenlawn, NY 11740 City/PO: State: 2ipGode: ].'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 i�� i may be&,Tected in the municipality and proceed to Part 2. If no,continue to question 2:. - i 2. Does the proposed action sequin.-a permit,approval or fiinding'from any other governmental Agency ; IVo� YES, i if Yes,list agency(s)name and permit or approval: Town of Southhold Wetland Permit-to be issued Town of Southold Building Permit, SCDHS permit El Z 3.a.Total acreage of the site of the proposed action? 039 1 acres b.Total ameage to be physically disturbed? Q,1 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0 _321 <<cres I land Lt1iiat occ oil adjoining an ar the 4. Cho Urban us Rural non-agriculture) ndustrialp Commercial q=4 action. LA esid entis (suburban) Forest ❑Agricultun- Aquatic ❑Other(specify):._ R, Parkland Page: 1 of 4 5. s the proposed action, — NO '- 'YES NIA a. A permitted use under the zoning regulations? X , b.Consistent with the adopted rA)mprehensive plan? X ,El 6. Is the proposed action consistent with the predominant character of the existing built or natural NO. YES landscape? X _ . 7. Tithe site of the uroaose'd action located in,or does it adioin,a state listed Critical Environmental Area? NQ YES If Yes,identify:,;Name:Goose Creek,Name:Peconic Bay and Environs,Reason:Significant coastal fish&wildlife ' habitat,Reason:Protect public health,water,vegetation,&scenic beauty,Agenc!l:Southold,Town of, Agency:Suffolk County,Date:3-9-90,Date:7-12-88 8. a.Will the proposea action result in a suostannai increase in warnc aoove present levels-r NO i ,YES, X b.Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 9.Does the proposed action meet or exceed the state energy code requirements? NO ;YES proposed ��quirements,describe desiign features and technologies:If the ro iosed action , .�__. will exceed n.:._ 10. Will the proposed action connect to an existing publidp6vate water supply? NO' .YES If' No,describe method for providing potable water: F t I. Will fhe proposed action nconnefit to'existing wastewater utilities? ::NO YES If No,describe method for providing wastewater treatment:._. . � rr Lx . 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? X b. is the proposed action located in an archeological sensitive area? X 13,a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain Pd0_..! .YES wetlands or other waterbodies regulated by a federal,state or local agency? X b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X 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 t1mroject site. Check all that apply: X Shoreline Forest Agricultural/grasslands Early mid-successional ElWetland Urban Suburban 15.Does:the site of the proposed action contain any species of animal,or associated habitats, listed r10 YES by the State or Federal government as threatened or endangered? Piping Plover, X 16.Is the project site located in the 100 year'flood"plain? rJ0 '. YES X l7.Will the proposed action create storm water discharge,either from point or non=point sources? P10 If Yes, L-J ❑a. Will storm water discharges flow to adjacent properties? ON DES b.Will storm water discharges be:directed to established conveyance systemsfi'anf-tm drains)? If Yes,briefly describe: D LffES Page 2 of 4 18.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,ex plain purpose and size 19.Has the site of the proposed action or an adjoining property been __.. the location of an active or closed NOS 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: X I AFFIRFA THAT THE INFORMIA ' TION PROVIDED AI30'VE IS TRUE AND A+CCURATE TOO' THE BEST OF MY-` KNOWLEDGE Applicantrspan' rname:. _Lisa Poyer Agent Date: 04/23/2026 Sjgnature:� Part 2-impact Assessment. The Lead Agency is responsible for the completion ofr 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 actionT' No,or I Moderate', small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? E E 2. Will the proposed action result in a change in the use or intensity of use of land? 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 establishment of a Critical Environmental Area(CEA)? a 5. Will the proposed action result in an adverse change in the existing level of traffic or a" Cl affect existing infrastructure fair mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El reasonably available energy conservation or renewable enegy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b,public/private wastewater treatment utilities? a 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 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 i 6 No,or .' Moderate,' small to large impact impact 1j may may ;1 cur occur is 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage i problems? ' proposed 11. Will the ro osed action create a�hazard to environmental resources or human health? � LJ 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 ori'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. i Town of Southold-Board of Trustees f Name of Lead Agency Date President Print or Type Name of Responsible Officer in lead Agency Title of Responsible Officer Signature of Res onsible Officer in Lead A enc 5i nature of Pre parer if different from p g y g p (' om Responsible Offcer) PFtIIVT Page 4 of 4 zd >of zustees':�1 pla.Imi Debra-Coady,_... . .. . ........ __._..... BEING-DUI.Y SWORN` _ DEPOSES AND AFFIRMS THAT HE/SAE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT.ALL STATEMENTS CONTAINED HEREIN ARETRUE'TO_THE..BEST.OF.HIS R &OW- 9ftF,�ANI-D-BELIEF ANDi:THAT'..--t=� ALL WORK WELL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE.APPLICANT AGREE STOMOL&THF�1'OWN-OF.SOUTHOLD BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF.SAID P (S ,IT GRANTED.=IN COMPLETING THIS APPLICATIONR,I. Y AUTHORIZE THE`` TRUSTEES,THEIR AGENT(S)OR NTATIVESt INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THEAPREMISES IN't-ONJUNC�"iONWITI =TIM 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 WETLA—NDD�OR COASTAI" z f< A EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM. OF THE PE tM1T. Debra Coady Signature of Property Owner Si ofPr4jrty f SWORN TO BEFORE ME THIS a© DAY OF 20 a & Notary Public DAWN MARIE GUARNERA Notary Qublic State of New York NO.01.GU6412483 Qualified in Suffolk County My Commission Expires Dec 28,2028 -_,�ard•..Qf•:;Tsast�ees: Apg11�a ►a _: AUT$ORZATION ' (Where the applcant,s`not the owner) "^ owners ofthe Y in dwtown.of d Ss SCr000- 771 11 - a ..-. } ft ed 'A - N �Yorlr S Lisa.Poyec,,�wnn Forks erm s: x Y ID act5a aW..a and hasdte all IteellIGSW &� W ad w�t}�e:�pphc�co�gr�e�fin, s fiom the SO uthold Toam, Sj ;,.<. ._ x Board of Tn es,for, is F . . Debra Coady k Promty Ownees.S*nabm Property OWIIer'S S' SWORN TO BEFORE ME THIS- c2 D DAY OF 20 a CP Notary Public DAWN MARIE GUARNERA Notary Public-State of New York NO.01G06412483 Qualified in Suffolk County My Commission Expires Dec 28,2028 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Soutbaid's Code of Ethics Prohibits conflicts of interest on the parttif townofflcers and emtrlMs.The qrr se of this fora is to.provide inforination which can alert the town of Passibleconflicts.of interest and allow it to take whatever action is r to avoid same. YOURNAw- Debra Coady (lust name,first name,*1ddle initial,unless you are applying in the name of someone else or other ea ty,such as a company.V so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check an that apply.) Tax grievance Braiding Variance Thine Change of Zone Cal Erosion Appmvalofphd Mooring Exemption fiom phlorofficial map U Flaming other (lf"Other';natpe the activity.) - — -- Do you personally.(orthrough your Company,spouse,sibling,pane or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,.manii g%.or busiaess.:interest:"Business intaesr means.a business, including a partnership,.inwhich the townofftoeror emploYee.has.even.a partialownerslnp of(or em oymen b.y)acmporatio n in which tear tawn offioerof e.mpioym.owns morethan.S%of the stares. YES NO n 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 applirant4gent representative)and them town officer or employee.Either check the appropriate line A)through D)andlor describe in the space provided. The town officer or employee or his or her spacsq sibling,parent;oirchild is(dim*all Mat ap*)y f1A)the owner of gmmr than s%of the shahs ofthe eorpornita sto&orthe applic w t : � (when the applicant is a owporation); B)the legal or baneficial owner of any interest in a non-corporate entdy(whenthe Rapplicant is not a corpomationk C)an officer,din ew.partner,or employee of the applicant or D)theWbWappHc1ML DESCRIPTION OF RELATIONSHIP Subtttitted this :2 D day of /l 20 Signature r Print Name U Form TS I APPLIiCANUAGENUREPRESEN'TATWE TRANSACTIONAL DISCLOSURE FORM t has To�+m at'Soathold's Cade oftlttcs olttb is co a "o a tare o t e a afro aer nrw a nl ees The: o e th�5 farm a5 to rn ovtde mfarmation rvhicliean alert tine towwn ofnoSsibie crn[licts ofnterest and atlrnvit to take'whztever aciigti:i_s ',necessarv.to avotd�.. . YOUR NAME: . Lisa Poyer, Twin Fortes Permits. . (Last name;first name,JAiddle mltial,'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{ar through,your company,spouse;sibling,parept,or cliiid)have a re1attariship with arty officer or emptayce of the'Cown of;uauthold? "12elaUonship"include by,.bloodt stlamagc„or,Uusines�auterest "f3usmess tnterest�'means ii busyness, including a partaershapin Which the;to'ivn af6cei or em}iQyeehas even a:partri±l orvnershlp t(ar.empioyznent by)aegrporaUori in which the''t0tvil,affcer6>;empioyee;a►vn�wore than 5°l0 ofthe 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 appiicant/agenttrepresentative)and the town off cer 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 ali that apply): A)the owner 0&6ater than 5%of the shams of the enrpoYdte:stock ofthe appy* (when the appbcant is a corporataan}, B)the lagmt of beneficial owner of any interest in'a non-corporaRe:etitiry(�Ylien ilia applieant_ s not a cinponttion); C)an officer,director,partner or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted day of 20Ag S9gnattar, Print N e,: mitS — Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FDRM A. INSTRUCTIONS 1. A.11 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 130ding 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 jaropo§ed action.:will be.:evaluated as .t��its significant beneficial;and,adverse.effects upon the coa;ttal area(which':includes all.of Southold Tom 3: 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. eadh:answer musf.bii I detatl� lasting both sUgW!jtnn�ohi. �oulvporhn facts: If an action cannot be certified as consistent with the LWRP policy standards and c:onditions,.rt shall t be.undertaken: A copy of the.LWRP is available in the following places: online at the Town of Southold's wehsite (southoldtown.northfork.net),the Board of Trustees Office,the Planning Departnient, all Local libraries and the;Town Clerk's offrc.-. B. DESCRIPTION OF srm AND PROPOSED.ACTION SCTM# 77 1 1 PROJECT NIUM Debra Coady„ The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ,0 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 regndation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,liG;nse,certification: ❑ Nature and exGtnt of action: The project includes.the pro�)osed septic upgrade to the existing residence and abandonment of the existing septic system Location of action: 560 oak Ave., Southold NY 11971 Site acreage: 14,001 sq.ft. (0.33 A) Present land use: . Residence Present zoning classification:_ 11-40 2. If an application for the proposed.action has been filed with the Town of Southold agency, the following infornuden shall be provided: (a) Name ofappuc0t: Lisa Poyer, Twin Forks Permits (b) Mailing address 288 E. Montauk Highway, Hampton Bays, NY 11946 631-644-5998 lisa@twinforkspermits.com (c) Telephone number: Will the action be directly uridertaken,require fuming,or approval by a state or federal age acy? Yes C] No E If yes, which state or federal agency? C. Evaluate the project to the f Howing policies by analyzing how the project will further support,or not support the policies. Provide all proposed Best Management Practice s that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED,COAST POLICY Policy 1. Poster a pattern of development in the 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 LWR;P Section III—Policies;Page 2 for evaluation criteria. Yes ❑ No F Not Applicable ,Private residential lot, I/Aseptic.upc r_ade only. . 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 El Yes El No 0 Not Applicable Private residential lot, I/A sc Upgrade only. Attach ad�onal sheets if necessary Policy 3. ,Enhance visual quality and protect scenic resources throughout the Town of Southold. See LNM Section III-Policies Pages 6 through 7 for evaluation criteria ,❑ Yes ❑ :Ko E] Not Appliacable — I/Aseptic grade only.Private residential lot, _ Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. 1 Didmiae loss of life, structures, and natural resources fromi flooding and erosion.. See LWRJ? Section III—Policies Pages 8 through 16 for evaluation criteria 1:1 Yes c] N®a Not Applicable Private residential lot, I/A septic uKrade only. Attach additional sheets if necessary Policy 5. Protect and improve water.quality and supply in the Town of Bouthold. See LM7RP Section III —Policies Pages 16 through 21 for evaluation criteriat 0 YesEl No Dot Applicable Private residential lot,"I/A septic Upgrade' only. Attach aiiho nal 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 LW?.P Section III—Policies; Pages n through 32 for evaluation criteria. M Yes ,,El No Not Applicable Private residential lot. I/A se tic upgrade only. Attach additional sheets ifnecessar}i Policy 7. Protect and improve air equality in the Town of Southold. See LWRP Section In. Policies. Pages 32 through 34 for evaluation criteria. 'R Yes F-1 No a Not AppEicable Private'residential lot, ILA septic upgrade only.. Attach additional sheets-if necessary Policy 8. Miia hnize environmental degradation in Town of Southold: from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluatiop criteria. 0 Yes.® No 0 Not Applicable Private residential.lot, I/A septic upgrade only. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lamds, and public resources of the Town of Southold. See LWRP Secion III—Policies; Pages 38 through 46;for evalluaflim criteria. YeEl No 0 Not Applicable Private residential lot, I/A septic upgrade only. ... _ Attach additional sheets if necessary` WORMNG COAST POLICH 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 0 iKo ENO Applicable lYate residel�tzaJ_1ot� I/A seplic ,ngrWe only,- 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 L'WRP Section III—:Policies; Pages 57 through 62 for evaluation criteria. No❑ Not Applicatble ❑X Yes ❑ Private residential lot, 1/A septic upgrade.only. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L'W" Section III—Policies; Pages 62 through 65 for evaluation criteria. Yes El No❑X Not Applicable Private residential lot, I/A septic upgrade only. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resourms. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ :Ko Not Applicable Private..residential lot, I/A septic_upgrade only. PREPARED ]3Y- Lisa Poyer TIME Principal Planner DATE 4/23/26 k TWIN T FORKS PERMITS ® E C E VE April 27, 2026 APR 2 7 2026 -Via Hand Delivery- Southold Town Glenn Goldsmith,President Board of Trustees Southold Town Trustees 54375 Main Road PO Box 1179 Southold,NY 11971 RE: Administrative Wetland Application Owner:Debra Coady Situate: 560 Oak Ave., Southold SCTM No.: 1000-77-1-1 Dear Mr. Shea: Please find the enclosed Administrative Wetland Permit application for permission to remove an outdated cesspool and install an upgraded I/A septic system on the landward side of the residentially improved with a concrete wall for the property located at 560 Oak Ave., Southold,NY (SCTM No. 1000-77-1-1). The property is located along Goose Creek. In support of this request,please find the following materials: 1. Application fee in the amount of$250.00 issued by Madeline,Patricia,Debra Coady no 1414 dated 4/24/26; 2. One original(1)and one copy of the application forms including the General Data form,Wetland Application Data form, short EAF,LWRP form,Authorization,Affidavit,Transactional Disclosure Forms; 3. Two(2)copies of recent site photographs; 4. Three (3) copies of the property survey prepared by Peconic Surveyors, P.C. dated December 16, 1998 last revised on October 3,2000;and 5. Three(3)copies of the proposed septic plan as prepared by Homeport Engineering P.C. sheet S-1 dated April 21,2026. If you have additional questions regarding the enclosed documents or the project in general,do not hesitate to contact this office. Thank you. .Sincerely, 2At�— Lisa Poyer Principal Planner 631.644.5998 1 lisa@twinforkspermits.com 1 288 East Montauk Highway,Hampton Bays,NY 11946