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Home My WebLink About53063-Z TOWN OF SOUTHOLD `°' BUILDING DEPARTMENT ILA, � SOUTHOLD, NY �o fauwn. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 53063 Date: 06/12/2026 Permission is hereby granted to: Jane Bieneman 250 W 94th St 13C New York, NY 10025 To: demolish (as per Town Code definition) and reconstruct asingle-family dwelling as applied for per SCHD&ZBA approvals. Premises Located at: 10100 New Suffolk Ave, Cutchogue, NY 11935 SCTM# 116.-6-1.2 Pursuant to application dated 05/08/2026 and approved by the Building Inspector. To expire on 06/11/2028. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition &Alteration $10854.00 CO-RESIDENTIAL $100.Q0 Total $L954.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Amex 54375 Mai n Road P. ( .Box 1179 ,outhold,NY 11971-0959 fib" Telephone(631)765-1802 Fax(631) 765-9502 ht �.� w fl o o � . , uR: Date Received APPLICATION FOR PERMIT h a. 4, a r For Office Use Only PERMIT NO. Building Ins ec;o' rt Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date OWNER(S)OF PROPERTY: Name. scrnn#1000- 6 - . 1. 2. Project Address: (9r00 Ago Phone#: 11 C ww."I I Email: Al ;LAP ............ ,, $e Mailing Address. 1 j, W), // t�,Rtf ?0Y CONTACT PERSON: Name: 11�41 rIC16 010-409 00� Mailing Address. mop* loom 06 /Vy 1fC14f 47 .w.r. Email: MIN. Phone#. e19127sa? Pf O )... DESIGN PROF , IONAL INFORWTION: Name: V .f- , Aol.Y Zling Address: ° Phone#: 7,4341, Email: cow CO R IN , RMATIONO Name: A) Mailing Address: ri �t Al Y Phone#: Email,. '!00"10? 441 11 1DESCRIPTI O N OF P111,6POSED,CONSTRUCTION ition Alteration ❑Re air ❑Demolition Estimated Cost of Project: El New structure C�Add p Ot'he Will the lot be re-graded. ❑Yes 01NO Will excess fill be removed from premises? CJYes ❑No i 1 ............... PROPERTY INFORMATION intended use of property: tyj7v e 4;a Existing use of property., ,fit e4 Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? E]Yes o IF YES,PROVIDE A COPY-- --------------- .......... 0 Check Box After Reading: The,owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code.APPUCATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordimmee of the Town of Southold,Suffalk,County,New York and other applicable Laws,Ordinances or RegWatlons,for the construction of bundings, additions,alterations or for removal or demolition as,herein desctibed.The applicant agrees to comply with all applicable laws,ordinances,buNng code, housing code anfd regulations and to admit authorized Inspectors on premises and In bulidingis)for necessary Inspections.False statements made herein are punishable as a Cass A ndsdemeanor pursuarg to Section 210.45 of the New York State Penal Law. I Application Submitted By(print,narn,e,),,. hJ? 1cra. ElAuthorized Agent 0 Owner f2l"A�W UN Signature of Applicant: *Z0040 Date: jP 2 STATE OF NEW YORK) SS: CO U NTY 0 F 9'k-- M.0w Ovate W�N l'oe—, being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the .. ........ (Contractor..Agent,,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of 20 & Wwgffiwll W Notary Public MOAS Majew4d, PROPERTY OWNER,AUTHORIZATION 'W yon M (Where the applicant is not the owner) Rq*mda Na OIMA6392440 QWifiW'i6&ft*CMq' 9*0 residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 TM RESc,h,, ,e,c COMPI"ialncie Certil'ficate Project Information Project Title: 10►3LOO New Suffolk Ave Energy Code: 2018 IECC Location: Cutchogue, New York Construction Type: Single Family Project Type: New Construction Project Sub Type: None Conditioned Floor Area: 2817 ft2 Glazing Area: 18% Climate Zone: 4a(5572 HDD) Project No: 1886785 All Electric: true Is Renewable: false Has Battery: false Has Charger: false Has Heat Pump true Construction Site: Owner/Agent: Designer/Contractor: Project Notes: E nvelope Asse m blies 41 Prop. Req. Assembly Gross Area or Cavity Cont. U_ U_ Prop. Req., Perimeter R-Value R-Value Factor/ Factor/ UA UA F-Factor F-Factor Ceiling: Flat Ceiling or 1645 30.0 32.0 0.017 0.026 28 42 Scissor Truss Skylight:Metal Frame 14 0.250 0.550 4 8 SHGC:0.31 Floor:All-Wood 1597 30.0 32.0 0.016 0.047 26 75 joist/Truss Wall:Wood Frame, 16" 3156 21.0 22.0 0.024 0.060 62 156 O.C. Window:Wood Frame 336 0.250 0.320 84 107 SHGC:0.31 Door:Glass Door(over 228 0.250 0.320 57 73 50%glazing) SHGC:0.31 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements. Compliance Statement The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2018 IECC requirements in REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name -Title Zsig-natut/e Date CQ"A is un, 0,41 4 InspecUion Check,llst rf Energy Code: 2018 IECC Requirements: 0%were addressed directly in the RESCheck software Text in the"Comments/Assumptions"column is provided by the user in the REScheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented,or that an exception is being claimed.Where compliance is itemized in a separate table,a reference to that table is provided. Preminspection/Plare Review Section Plans Field Verified Verified Re .ID Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions 1103.1, Construction drawings and 0 Complies 1103.2 documentation demonstrate Does Not [PR1]i energy code compblancefor the build ing envelope.Thermal Pomply envelope,represented on Not construction documents. Observable Not pplicable 103.1, Construction drawings and Complies 103.2, documentation demonstrate Does Not 403.7 energy code compliance for[PR3], in ec,! Pomply sy em Y'S� n t 9 end m s serving Not I Multi I' dw'e'�'jig units must ❑93servable i demonstrate com Hance with the IECC Commercial Provisions. Not Applicable ............. 302.1, Heath and cool"Ing equipment i Heating: Heating: Complies is sized zecfperA( Manual'S Btu/hr Btu/hr Does Not [PR2]2 based on loads calculated per ACCA Manual I or other methods I Pomply approved by the code official. Coolfng: 'Coofing,,., Not Btu/hr' Btu/,hr Qservable L Not .............. .............. ....................................... Ppplicable Additional Comments/Assumptions: 1 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) J11 "orsToundat"on Inspect' Section &Req.ID Foundation Inspection Complies? Comments/Assumptions 303.2.1 A protective covering is installed to, Complies W01112 protect,exposed exterior insulation and extends a mlini rnumi of 6 in.,below Does Not grade. Pomply PNot servable PNot pplicable 403.9 Snow-and ice-melting system controls Complies [FO12]2 instafled,. Does Not Z:,Omply Not Observable Not Applicable ....................... Additional Comments/Assumptions: 7.................. L 3i' Low Impact 1 High Impact(Tier 1) 2 -t(Tier 2) Crier 3) M 00 rr ming oughmin Inspection i Section Plans Field # Framing/R(?ugh-In Verified Verified & Req.110 Inspection Value Value Complies? Comments/Assumptions 402.1.1, Glazing U-factor(area-weighted 0 Complies I See the frivelope Uf- 402-3.1, average). Does Not Assemblies table for 402.3.31 values 402.5 Pomply I[FR2]1 Not Observable 0 Not Applicable 1402.4.1.1 Air barrier and thermal barrier C]Complies [FR23]1 installed per manufacturer's instructions. Does NotPomply PNat servable PNot p licable 402.4.3 Fenestration that is not site built Complies [FR20]I is listed and labeled as meeting AAMA/WDMA/CSA Does Not 101/l.S.2/A440 or has infiltration Pomply rates per NFRC 400 that do not Not exceed code limits. Observable PNot plivable 402.4.5 IC-rated recessed lighting CJ Complies [FR16]2 fixtures sealed at housing/interior finish and Does Not labeled to indicate-<2.0 cfm Corry ply leakage at 75 Pa. Not Poserva bie PNot livable I Supply and return ducts in attics Complies 4, = [FR12111 nsu I"ate > R-8 where duct is Does Not >=3 inches in diameter and >= R-6 where<3 inches. amply Supply and return ducts in other 9 Not I portions of the building 3servable insulated>= R-6 for diameter >=3 inches and R-4.2 for<3 0 Not inches in diameter. Applicable .......... 403.3.2 Ducts,air handlers and filter 0 Complies [FR1311 boxes are sealed with joints/seams compliant with Does Not International Mechanical Code ,Omply or International Residential ❑Not Code,as applicable. 93servable n Not pp licable 403.3.5 Building cavities are not used as 0 Complies (FR15]3 ducts or Plenums. Does Not Po mply Not Observable E)Not Applicable 403.3.6(lo Ducts partially or completely EDComplies 2)[FR26]3 buried in ceiling insulation have an insulation R-vafue not less P Does Not than R-8,,the sum of the ceiling mply instilation R-value against and Not above the top of the duct,and Uservable against and below the bottom of Not the duct,is>=than R-19, P i excluding the R-value of the pplicable duct insulation. .................................. .. ................................. ............... .................. ................ Section Plans Field Framing/Rough-in Verified Verified Req.11D Inspection Value Value Complies? Comments/Assu'mptions 11-1-1....................... 403.3.7 Ducts declared to be within the Complies (FR28]3 conditioned space are either 1) completely within the Does Not continuous air barrier and within 0 Mply the building thermal envelope, QNot 2)buried within ceiling servable insulation in accordance with Section R403.3.6 and the air Not handier is located completely Opplicable within the continuous air barrier and within the building thermal envelope and the duct leakage is<=1.5 cfm/100 square fleet of conditioned floor area served by the duct system,or 3)the ceilin'?ins ol'atfonRvalue instate a,atl ainstandabove the insulated 'uct>=to the T, proposed ceiling insulation R- value, less the R-value of the insulation on the duct. 403.4 HVAC piping conveying fluids R R Complies [FR17]2 above 105 4 IF or chilled fluids below 55 OF are insulated to>--R- Does Not 3. Pornply Not Observable Not I Applicable ..... ...... 403.4.1 Protection of insulation on HVAC Complies [FR24]1 piping. Does Not 1 Pomply PDNot servable PNat licable 403-5.3 Hot water pipes are insulated to Complies 11 R� [FR18]2 R-3. PDoes Not omply RNot servable Not Applicable 403.6 Automatic or g Comp ravity dampers lies [FR19]2 are installed on all outdoor air Does Not intakes and exhausts., [] omply Not Observable PNot plicable 303.1.3 U-factors of fenestration 0 Complies [FR4]1 products are determined in accordance with the NFRC test Does Not procedure or taken from the amply default table. Not 9:)servable PNot licable 1 402.1.1, 1 Skylight U-factor. U= Uj Complies See the Envelope 402.3.3, Assembles table'for 402.3.6, P Does Not values 402.5 ornply [FR5]1 Not Observable PNot plicable Additional Comments/Assumptions: I I 1 High Impact Tier 1 2 Medium Irrr act{Tier 2) � Low Im act C prier 3) I ' n, insulation Inspection i Section j Plans Field # Verified Verified & Req.113 insulation Inspection Value Value Complies? Comments/Assumptions f 303.1 All installed insulation is labeled Complies [IN13]2 or the installed R-values provided. Does Not Po Not Observable Not Applicable 402.1.1, Floor insulation R-value. '0 Complies See the Envelope 402,2,ER,' R Does Not Assemblies table for i[IN111 Wood"''' Wood values �'Omply E]Steel )Steel Not servable Not pplicable 1303.2, Floor insulation installed per Complies 402.2.8 manufacturer's instructions and Does Not [IN2]1 in substantial contact with the underside of the subfloor,or Pomply floor framing cavity insulation is Not in contact with the top side of Observable sheathing, or continuous Not insulation is installed on the underside of floor framing and Ppplicable extends from the bottom to the top of all perimeter floor framing members. 1402.1.1 Wall insulation R-value.If t his is Complies See the Envelope ' 402.2.5, a mass wall with at least 1/2of R Assemblies table for De 1402.2.6 the wall insulation on the wall Wood Wood Covalues Mass Mass [IN3]1 exterior,the exterior insulation 0 mpo ly s Not requirement applies(FR10). QNot 0 Steel 0 Steel servable Not Applicable 303.2 'Wall insulation is installed per Complies [IN411 manufacturer's instructions. PDoes Not omply PNot servable PNot licable Additional Comments/Assumptions: -1 1 H igh I,m act(Tier 1) 2 Medium ediu Impact(Tier 2) 3Law Impact(Tier 3) r rinal InspectionProvisions mr -- -------------------- Section Plans Meld # Verified Verified & Req.ID Final inspection Provisions Value Value Complies? Comments/Assumptions ....� 402.1.11 Ceiling insulation R value. CD Complies .See the Envelope 402.2.11 �"�� I ,, Assemblies toe for PrriDoe 402.2.2, 0 Wood 0 Wood s Not ;values [F11 2.6 0 Steel 0 Steel Not P servable 0 Not Applicable 303.1.1.1, Ceilinginsulation installed per ❑Complies 303.2 manuacturer's instructions. [F12]1 Blown insulation marked every Pomply Goes Not 3O0 ft , Not c3bservable ❑Not A licable 1 PP � M 403.1.2 Heat pump thermostat installed O Complies [FIJO]2 on heat pumps. t PDoes Not omply QNot servable PNot pplicable ..,.. .., 1NiWA91UNriNNiNDAMdDJDYDY➢YW1NiNWYY11N/YY,. ..Urli �!H((HNJl4.. :. 403.5.1 Circulating service hot water Complies [F111]2 systems have automatic or accessible manual controls. Pomply Does Not QNot servable PNot pplicable , aMr mm mmrvu mmmm mwmmmfreGfi uuw0P0 uuuuuuuuu �www¢wwwwwwwwwwwwwwww,.,mwwwmwm.wwwvwwwwwww.wwwswwuwwwuww,a. .;- 403.6.1 All mechanical ventilation Complies [F125]2 system fans not part of tested Does Not � and listed HVAC equipment meet effik'a yy and air flow limits Pomply pier Tab] 63.6.1. Not 12servable 1 Not Applicable 403.2 ;Hot water boilers supplying heat Complies [F126]2 through one-or two-pipe Does Not heating systems have outdoor setback control to lower bailer amply water temperature based on Not outdoor temperature. Qservable PNot pplicable {:auw.m..r,ww.,w.rv»ry umww«n,a'«wnwmM+wwww .woaaayN.:aphyau ffil3ffYTINNIYl;NN1NYlNYNYYi11iN;YNNYl;NN1NNYJriffNlfAdfdHIf1NNNNNNNNNNlfiAWfiNWW!(WNNr✓rtVIJWfi44Wfi4Him'rmmvrmmmnrmrwmwwmmnnmmnummummimimmarreumw,w,mmmw.w,w,mmmw.w..w.mw.um , 403.5.1.1 Heated water circulation Complies [F12812 systems have a circulation purnp.'The,system return pipe is Does Not Pomplyadedwated r'�,un pipe or a , cold water supply pipe.,Gravity Not and thermos-syphon circulationP servable systems are not present. x Controls for circ ll'at"ing hot Not waters stem pumps start the licable pump with signal for hot water pp demand within the occupancy. Controls automatically turn off the pump when water is in circulation loop is at set-point temperature and no demand for hot water exists, : '"''''' »»mWmmrvwiwwwwwwvwmwxurrwvmmmimmmnvininirrmrnrnrmnnnnnininirrmrnrnrmimmnuuuunmrwvwrwnwwuwrac n 403.5.1.2 Electric heat trace systems Complies [F129]2 comply with IEEE 515.1 or UL 515.Controls automatically Does Not adjust the energy input to the omply heat`ra�lg to maintain the Not desired water temperature in Pbservable the piping. Not Applicable .nw.w,wraumrer rtr rrtwrrtwuu'rueiuwur<.ws mrtrrrrr�epux dwdwruvrc....nnW'✓+wWneNm{iry rrr.rr P..vvvi�wrnmmmmmdrwu it Section Plans Field Verified Verified Req.10 Final Inspection Provisions Value Value Complies? Comments/Assumptions 403-5.2 Demand recirculation water Complies [F130]2 systems have controls that manage,o, erat Does Not ofthe,purnp PO M p ly and l'i temperatUrf't e of water,entering the cold water piping to<=1040F. QNot servable Not p plicable ............. ........ .......... 403-5.4 Drain water heat recovery units Complies [F131]2 tested in accordance with CSA Does Not B55.1. Potable water-side pressure loss of drain water Pomply eat recovery units<3 psi for 'P Not individual units connected to servable one or two showers.Potable water-side pressure loss of drain Not water heat recovery units<2 Applicable psi for individual units connected to three or more showers. 404.1 90%or more of permanent Complies [F1611- fixtures have high efficacy Does Not lamps. Pomply Not Observable ONot plicable 404.1.1 Fuel gas lighting systems have Complies [F12313 no continuous pilot light. Does Not Pomply QNot servable Not Ppp licable 401.3 Compliance certificate posted. Complies JF17]2 Does Not Pomply PNot oservable Not Applicable 303.3 Manufacturer manuals for Complies [F118]3 mechanical and water heating P Does Not systems have been provided. mply QNot servable Not A-pplicable 2 40 .2.3 Vented attics with air permeable Complies [F122]2 insulation include baffle Does Not adjacent tosoffit and eave vents that extends,over Does insulation. Not Qservable (]Not Applicable 402.2.4 Attic access hatch and door Complies [F13]1 insulation>R-value of the adjacent assembly. Does Not COmply �servable Not PNot livable 402.4.1.2 Blower door test @ 50 Pa. <=5 AC H 50 ACH 50 0 Complies [FI171:1 ach in Climate Zones 1-2, and Does Not I <=3 ach in Climate Zones 3-8. Pomply [--Not Ogervable O'Not pplicable ........... .............. ...... ........................................................... ..... ...... Section Plans Field # Verified Verified & Req.ID Final Inspection Provisions Value Value Complies' Comments/Assumptions 403.3 3 Ducts are pr ss,ure tested to Complies i[F[27]1 determine air leakage with .... either. Rough-in test.Total cfm/100 ft2 cfm/100 ft2 Pomply Does Nat leafage maured with a pressure differential of 0.1 inch Not w, .across t yst Tin including Paservable the manufacturer's air,handler enclosure if installed at time of Ppplicable Nat test.Postconstruction test:Total leakage measured with!a, pressure,differential of 0.1 inch w.g.across the entire s,yste ; � in Eluding the manufacturers air handler enclosure. 403.3 4 Duct tightness test result of t E]Compiies 1 <=4 ci m/100 ft2 across the[F14.j � system or<-3 cfm/100 ft2 cfm/100 ft2 cfm/10 ft2 Does Not without air handlerPomply25 Pa,For rough-in tests,verification may Not need to occur during Framing Rservable Inspection. PNot pplicable 1403,3,2.1 Air laar�dier�1elage designated ,»»��µ µ�� ,�»�� Complies [F124]1 bymanufacturer at<=2 Ya of design air flaw. a P Does Not mP l y RNot servable Ppp Not licable m 403 l,l Programmable thermostats E)Complies i[FIg]2 iastafedfor control of p imau Does Not heating and tooling systems Pomply and'Initiail manufacturer��tmanufacturer to cede spelcification5j. Not Rservable 0Not PP licable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Im act(Tier 2) 3 Low Impact(Tier 3) 201�8, IECC Energ�y Efficiency� g Certa'ficate ..................I............ ................................................... Nome----------------.... Above-Grade Wall 43.00 Below-Grade Wall 0.00 Floor 62.00 Ceiling/Roof 62.00 Ductwork(unconditioned spaces): Dols Window 0.25 0.31 Door 0.25 0.31 Skylight 0.25 0.31 I SIMON Heating System: Cooling System: Water Heater: IV .................... Name: Date: Comments: BOARD : BLS rjf SO Southold Town Hall Leslie anes Weisman, Chairperson 53095 Main Road a P.O. Box -1 1 79 . PatriciaAca ara Southold,NY 11971-0959 P Office Location: Robert Lehnert, Jr. S001 Town Annex/First Floor Nicholas Planamenta 543 75 Main Road(at Youngs Avenue) Margaret Steinbugler �100UNV SouIVED l 1; T6 VA/ http://southoldtownny.gov F' A PP`EAL S D EC 2 3 2025 ZO fNG BOARD O TOWN OF SOUTHOLD ° Tel. 631) 765-1809 Southold 'Town Clerk LJ FINDINGS9 DELIBERATIONS AND DETERMINATION �n MEETING OF DECEMBER 189 2025 Zf3A FILE.: No. 8064 NAME OF APPLICANT: Jane Beier an and Gianfranco Mitrione PROPERTY LOCATION: 10100 New Suffolk Avenue, Cutchogue,NY SCE` .No. 1000-116-6-1.2 S'E ' A. DE1"ER IN '1"1 , ,: The Zoning Board of Appeals has visited the property under consideration in this app fication and determines that this review falls under the Type 11 category of the State' List of Actions, without further steps under SE R.A. , FF0 K C 'N 1 Y A `1 lS kA rIVF C E: This application was not required to be referred to the Suffolk. County Department artment of Planning Linder the Suffolk.County Administrative Made Sections A 14-14 to 23. L,� E"rER 1NA " : The relief, permit, or interpretation requested in this application is listed under the Minor Actions exempt list and is not subject to review under Chapter 268. PI OPI��r1 T 1 ,C '5" C`l liP LIB The subject property is a noncar�f r i 37,561 (the survey measures the lot area as 37,38535 s , .) ,sq a a a°-e foot parcel located in the R.-40 Zoning District. The northerly property line measures 175.00 feet and is adjacent to New Suffolk Avenue, the easterly property line measures 215.12 feet, the southerly property line measures 139.54 feet and the westerly property lime measures 320.72 feet and is adjacent to a 15 foot Right of Way. The property is improved with a one-story frame dwelling with an attached t o ca-1 ga,rage on the south side of the dwelling with an outdoor shower at the rear of the dwelling along with an attached wood porch at the rear of the residence. The easterly rear yard is well screened and a hedge screen along the southerly property line providing privacy as shown oil the survey map prepared by Kenneth M. Woychuk, LS, and dated May 2 0, � �024. �`l�e S rte Info p rep ared by the A.t chrtect, Sleet T- sllouId be corrected to reflect the correct size of 1 Oil��, the parcel. F AI'PLr,ICA1'l0N: Request for Variance from Article XXIII, Sections 280-124 and the Building (tispector'sJuly 11, , 25 otice°of is ppr val basedon ail application for a.pe wnit to detnolish (as,per"Town Cede definition) a single-fain i�ly dwel ling and reconstruct a si ig'le-i"al Ali ly dwelling, at: l lens than the code�,required r`r jiltn a��n rear yard setback, of 50� i' et locatedi� at 10100 �,env Suff lk A ei ��:e°°, ��"" itel�o�g wee, f�'. SCTM Na. �l 0� 116-6-1.2. RELIEF REQUESTED: The applicant requests a variance to demolish(as per Town Mode definition)and reconstruct a single-family dwelling. The proposed construction has a rear yard setback. of 41.6 feet instead of the required minimum rear yard setback of 50 feet. ADD1TIGNAL IN FORMA �� .The applicants wish to add a second story and add a new one-car garage on the other side of where the existing garage is now. The demolition by Town Cade definition calls for a complete remodel Page 2, December 18,2025 #8064, Beineman/Mitrione SCTM No. 1000-116-6-1.2 and up date of the existing dwelling while staying withing the existing footprint as shown on the prepared Site Plan drawings prepared by Katherine Jean Samuels, Architect and dated June 18, 2025. The subject parcel is the most northernmost parcel of 3 lots created by Martha Leibell and Herbert Henry in 1973 pursuant to variance relief obtained in ZBA decision No. 1784. The two parcels to the south are also improved with single-family residences. The applicants intend to upgrade the sanitary system to a new modem Innovative Advanced (I/A) low nitrogen system. A letter from a neighbor was received in support of the variance request. ON' I I REASONS FOR BOARD AQ.TI , FNDNG'S OF FAC17 The Zoning Board of Appeals held a public hearing on this application on December 4, 2025 at which time written and oral evidence were presented. Based upon all testimolly, documentation, personal inspection of the property and surrounding neig hborhood, and other evidence, the Zoning Boardfinds the following tiacts to be true and relevant and makes the following findings: 1. Town Law,§2 �2-'bJ3),0b)(JJ.. Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. Other than the existing dwelling not meeting the code required minimum 50-foot rear yard setback,the dwelling conforms to the bulk schedule for setbacks. The easterly property line is well screened,as is the southerly property line.The proposed improvements and remodel will complement the neighborhood. 2. Town, La,w 267-bQ)(b)(2). The benefit sought by the applicant cannot be achieved by some method, -feasible for the app licant to pursue, other than an area variance. Due to the pre-e xi'stang non conforilii ng rear yard, setback, the applicant cannot accomplish the proposed renovation within the existing footprint without variance relief 3. Town,Law f I I ,§267-b(J)Lh Lf-, The variance granted herein 's mathematically substantial,representing 6.8%relief relief. The -story or variance re h i firom the code. However,there is no other option to the applicant but to apply for ject dwelling has a 142.2-foot front yard setback and,, is extension will not exceed the existing f ootprint and the sub hardly visible from the road 4. Town, Law §�67-,W A'b)(4 No evidence has been submitted to suggest that a variance in this residential I I community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. 5. Town Law §267-bJ.3J(bJJ5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect, and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 1 ry 6. 'Town Law V67b. Grant of the requested, relief is, the mi m nimu act,"ton neeessa and adequate to enable the ap,l),11cant to,enjoy the benefit of a t-econstructed,sin gle-fern fly d wemll lig'wh'Il le presery ing and protecti ng the character of the neighborhood,and the health, safety,and,welfare oftbe corar ,tin i'lly., RESOLU'rtoNc OF THE BOARD,': In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Acampora, seconded by Member Weisman (Chairperson), and duly carried, to GRANT the variance as applied for, and shown on the Site Plan (S-100.01) dated September 7, 2025, and Architectural Drawings (DM-100, A-100, A-101, A-102, A-275, A-300, A-301, and A-350), dated June 18, 2025, prepared by Katherine Jean Samuels, Architect. Page 3, December 18,2025 48064, Beineman/Mitrione SCTM No. 1000-116-6-1.2 SUBJECT TO THE FOLLOWIN"G CONDITIONS: 1. The septic system on the subject property must be approved by the Suffolk County Department of Health Services. 2. The Design Professional shall submit a Site Info Sheet indicating the correct size of the subject lot. This approval shall not he deemed effective until the required conditions have been met.At the discretion of the Board of Appeals,failure to comply with the above conditions may render this decision null and void That the above conditions be written into the Building, Inspector's Certificate of Occupancy, when issued The Board reserves the h t to substitute a siinfldrge�vi n,that is ale minimis i4inature Lor an,aftera&n that doe,, in one ear�o 'the date,,oJ* not incretne the,d, nonco 'y provided de, mint"US is re ueste( with .y I .gree oL n&,rinit m th,ts', dere Anv time,after one Egar the Board al7reauire a newg",Vica,10 IN EM-PORTAN"Ir LIMITS ON THE AP PR0VA,L($J GRANTED HERE Please Read Carefully- Any deviation from the survey,site plan and/or architectural drawings cited in this decision, or work exceeding the scope of the relief granted herein, will result in delays andlor a possible denial by the Building Department of a building permit and/or the issuance of'a Stop Work Order, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variance(s)granted herein as shown on the architectural drawings,site plan and/or survey cited above,such as alterations, extensions, demolitions, or demolitions exceeding the scope of the relief granted herein, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses,setbacks and other features as are expressly addressed in this action. TIME LIMITS ON'THIS APPROVAL., Pursuant to Chapter 280-146(B) of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured,and/or a subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from the date such variance was granted. The Board of Appeals may, upon written request prior to the date of expiration,grant an extension not to exceed three(3)consecutive one (1) year terms. IT IS THE'PROPERTY OWNER'S RE SPONSIRILITY TO ENSURE COMP".'L'I'AIIIN'C",E 'W"'.,I"T,H,, TR. E COD,E REQUIRED T1,NlE FRAME DESCRIBED HERE' Failure to complyin a titnely manner me * y approved may result in the den ia,1 by-the Build ing Departnt of a Certificatek of Occupancy,nuillf the , vadiance retief,and require a new,vart,ance application with,public hea,ri',,tig before the Board, of Appeals,,, Vote of the Board: Ayes: Members Weisman (Chairperson), Acampora, Lehnert,and Steinbugler. (4-0)(Member P I al a I to Rec used) .A ................... Leslie .Banes Weisman, Chairperson Approved for filinq 2 2 1,2!_3025 wr 00 10 40, AGRI' -uT g GG E v i1L INSPECTION T1EI R OU ��vau.� .; FoR SANITARY Sle. _ g >_ a L g 6c*uts P s ti < �.. \ \ TESL \ _ s� \ \ \ \ \10 HOLE �. � ``"�-�� TEST HALE \� L \\ v s a E _�.j A% TL_DATA Sul-€V '_a A�'_ TT PROPOSED SANITARY SYSTEM SUITABLE FOR 4 BEDROOMSvt Fn�z- l FUJI CENS IA TREATMENT TANK(600 GPO) - E - 1 - - SGTMNI00t1_116.6-1<2139 154SF 7 9 ACRES %NU PLASTIC DISTRIBUTION BOX(POLYLOK 017-206-6 CAR EQUIVALENT) ( ELEVATIONS NAVO 1988 DATUM a CONTROL PANEL WITH GFI SERVICE OUTLET, VENT WITH CARBON FILTER AND FUJI MAC80R BLOWER Li � TO BE INSTALLED WITHIN VIEW OF TANK PROPOSED IN rILTRATt?R ATL(ADVANCED TREATMENT LEACHFIEL) __ _R :.- i y ray: SUITABLE FOR 4 BEDROOMS S _. t-Y L� - F r N - s z ,.° - 4-11d 3-1V LUNG MODULES IN 2 ROWS Wl ROOM FOR 50%EXPANSION _� - c 4 A, 2-12'f4 ATL CONDUIT PER TRENCH ' _ g =� g` REMOVE 4'LAYER OF UNSUITABLE SOIL MATERIAL TO CLEAN SP1 SIN SANE?LAYER _?0 R-25 121T] _ g 40 ;� T�?� GRADING ABOVE TRENCH SHOULD NOT EXCEED 24"MAXIMUM 1 o � - c c YEARS FROM DA-E F D A! vi C T 3 .`A. LL) C! N -:SiIN = w� IL Y EXISTING SEPTIC SYSTEM TO BE REMOVED A5 PER SCDFIS REGULATIONS (A a C 'ENGINEERS CERTIFICATION IS REQUIRED FOR ALL IAOWTS INSTALLA-nONS,THE r E � Tz � � �'' ��¢� __-`-� t DESIGN ENGINEER MUST BE CONTACTED WHEN THE BOARD OF HEALTHI WASTE EXISTING 3 BEDROOM.RESIDENCE TO BE RENOVATED � WATER MANAGEMENT INSPECTOR IS CONTACTED FOR INSPECTION,ALL SEPTIC Of -- wl A NEW SECOND FLUOR ADDITION wl I BEDROOM � �3 `4 � � AND LEACHING FIELD COMPONENTS MUST BE VISIBLE_CALL 631.728-9480 WITH AN EXISTING FULL BASEMENT mi,2 FFE:10.691 FIRST FLOOR FOOTPRINT:1661.18 FT' - WITH PRC]RUSEC?4413 FF't",ARAGE SET ON A SLAB ON GRADE •� `i _ INCITE.,A MAINTENANCE CONTRACT&CONTINUOUS MAINTENANCE IS REQUIRED FOR THE PROPER FUNCTIONING OF ALL IIA TREATMENT TANKS OEM - 1 r �T04 T A ;'� 1 THE INSTALLER MUST HOLD A CURRENT LIQUID WASTE LICENSE PURSUANT TO CHAPTER$65 ARTICLE V1I(SEPTIC t _ - INDUSTRY BUSINESSES)AND ENDORSEMENT.!(INNOVATIVE AND ALTERNATIVE TREATMENT SYSTEM INSTALLER)THROUGH --_-_��Y PA THE SUFFOLK COUNTY DEPARTMENT OF Lt18DR LICENSING AND CONSUMER AFFAIRS PURSUANT TO SUFFOLK COUNTY CODE - 1I 563-791TII;JI THE DEPARTMENT OF LABOR LICENSING AND CONSUMER AFFAIRS M+UNTAINS A LIST 0--LICENSED ILA OYr'TS MAINTENANCE PROVIDERS. 2.ALL VA O.VTS MUST BE REGISTERED L'a'1TH THE DEPARTMENT IN�tCC{]RDJ1.N.^,E 1+�ITH ARTICLE 19 OF THE S:IFFQiK COUNTY ` w CODE PRIOR TO THE DEPART IEyT G RAN TiNG CE 3TIFICAIION OF CCIhIPLETED OO!dSTRUCTION t3 d'AS BLtiLT'PLANSui 1 AN EXECUTED OPERATION AND LANNTENX14CE CONTRACT DEINVEEN THE MAINTENANCE PROVIDER AND PROPERTY OWNER _ PROF -T X 4 DEEP ORY WELLS l MUST BL SUBMITTED TO THE DEPARTMENT PRIOR TO THE APPROVAL OF THE PA DWrS REGISTRATION BY THE DEPARTMENT }� 1 - _ IN ACCORDANCE WITH ARTICLE 0 OF THE SUFFOLK COUNTY SANITARY CODE � V J \ A ALL INSTALLED IIA OWTS ARE REQUIRED TO HAVE AN INITIAL 3-YEAR WARRANTY AND OPERA71ON;MAINTENANCE SERVICE CONTRACT. ''1 W - 5 INSTALLATION AND USE OF THE VA OAITS MUST CONFORM TO THE DEPARTMENT'S APPROVED IIA OWLS GUIDANCE W �>_ ui DOCUMENT PREPARED IN ACCORDANCE WITH THE STANDARDS FOR'APPROVAL AND MANAGEMENT OF INNOVATIVE AND \ 4� E ALTERNATIVE ONSITE'WASTEVWATER TREATMENT SYSTEMS'THESE STANDARDS COVER VENTING AS FOLLOWS W Y 1 'WHEN AN IIA OVtTS REQUIRES A VENT,THE UNIT SHAH BE VENTED TO THE ROOF OF THE RESIDENCE BEING SERVED.VENT 0 1.� PIPES SHALL EXTEND A A9NIMJM OF 6'ABOVE THE ROOF LINE AND THE TOP OF THE VENT SHALL HAVE A M.lNIMUM LL� HORIZONTAL SEPARATION OF Ir TO THE SLOPED PORTION OF THE ROOF,IN CASES%NHERE IT IS NOT PRACTICAL TO VENT �Q 1 THE SYSTEM TO THE RESIDENCE ROOF,A VENT PIPE MAY BE PIPED TO THE EXTERIOR SIDE OF THE RESIDENCE AND I� � 1\ ISO, TERMINATES A MINIMUM OF r8'ABOVE GRACE THESE VENT PIPES Sw1LL BE LOCATED A MINIMUM OF Y FROM ANY VANDOW t' W� c OR DOORWAI'AND MUSTfiERM1NATE V,ryT}t A CARBON FILTER DEVICE ALL VENT PIPES MUST HAVE MMMUM 01-METER OF U A 6.GARBAGE GRINDERS SI(ALL NOT BE PERMITTED WHEN AN VA OWIS IS UTILIZED AS A MEANS OF SEWAGE DISPOSE l ADDOTION WATER SOFTENERS SHALL NOT DISCHARGE INTO AN VA O%VTS � �� ,,.�+ ll < i A CONTROL PANEL BOX MUST BE PLACED OUTSIDE NEAR AND t�tiTF{IN VIEW CF EACH STRUCTURE THAT IT SERVES.THIS m1m1 MUST PROVIDE A WARNING SYSTEM W CH V ILL ACTIVATE AUDIBLE AND VISIBLE ALARMS THAT CAN BE READILY SEEN AND ti 1 HEARD BY THE OCCUPANTS OF THE BUILDING SETiVED TH'c DEPARTMENT REGC!+1MEND5 A TELElIETTIY DEVICE BE INSTALLED 1 1 { TO TRANSMIT IMMEDIATE REtrOT'E ALARM NOTIFICAnON TO THE O&M PROVIDER NAMED IN THE 08M AGREEMENT.A CFI ui j11 1\l OUTLET MUST ALSO BE PROVIDED NEAR THE CONTROL PANEL TO PROVIDE POWER FOR MAINTENANCE AND TESTING EQUIPMENT USE A DEOIC.ATEO 120 VOLT AC,20 AMP,SINGLE-PHZE CIRCUIT BREAKER IN THE MAIN ELECTRICAL PANEL F(IR =' SERVICE TO THE FU31dLEAtd CONTROL CENTER. - � } � ui e3.THE FIAG BLOWER REGUTRED FOR THIS INSTALLATION MUST BE INSTALLED ON A CONCRETE BASE.ENSURE ADEQUATE � S �T F SITE VENTILATION AND PROTECT AGAINST SUNLIGHT.UNIT MUST BE HARD-AIRED TO A DEDI^ATED 15 AMP BREAKER IN THE T e. �,. __ C0NTRQL PANEL ALL UNDERGROUNDAlRING TO BE INSIDE CCNDUIT E _jv P INSTALL IfA OVkTS TANKS ACCORDING TO MANUFACTURERS RECOMMENDATIONS ALL APPLICABLE RECOMMENDATIONS E PROVIDED BY THE MANUFACTURER SHALL BE IMPLEMENTED THERMOPLASTIC RISER GONERS V+tEIGHiN6 LESS THAN 53 LBS E DATE, 06,12.25 E 3fl" D' 3fl' oU' i SHALL HAVE ASI~CONDARY COVER OR SUPPORT OEbTCE INSTALLED BENEATH THEM 11\ SCALE AS NOTvG- 10 THIS IIA OVVTS HEAVING BEEN APPROVED BY SUFFOLK COUNTY FOR PROVISIONAL USE IS REOLIRED TO BE SAMPLED EXISTING UTILITIES WITH THE FREQUENCY REQUIRED BY ARTICLE 19 FOR PROVISIONAL 1 OR 2 USE DURING THIS PENOD THE MEAN ROLLING SHEcT AVERAGE OF TOTAL NITROGEN IN THE EFFLUENT MUST 9E-ORt ig MG'L E `, PROPOSED UTILITIES -- EXISTING TO E I'ilel'1OVEI) F z T T TT A 1 „h —— ��. ntac _ w�T a 0 i (� \t T I OF 3 SHEETS 1 E r —I~UJI CLEAN DENS o M i R E S � ASSOCIATES r CONSULTING ENGINEER Flow 1K"4 Wa.h-t Bauaut sauGaa Av it Fra1�AYS_Fat`11w6 GALVANIZED L?RItdG C}R— � im SHACKLE(2 LOCATIONS) EYELETS(2 LOCATIONS) �,t Project:1Q1{TO New Suffolk Avenge,Cutchogue,N.Y. 5.000 LB ALLOWABLE TENSILE LOAD e- SCTM:1000-116-6-1.2 A IN 5T- Reference Number:R-251203 € -' SATURATED SOILS GALVANIZED TURN BUCKLE(2 LOCATIONS)— =e F DEA[TMAht BUOYANCY CALCttLATi{TNS 30DO LB SAFE WORKING LOAD ---I H x 1-S'W x 8'L CONCRETE DEADMAN-EITHER SIDE c Fuji Clean CEN5 CQIdCR TE C EA[�FAAN OF TANK(991,2 LBS PER DEADMAN) -. 4 t?epih: 5 48 FT \\ BtOTT OF TANK HE GROUNDWATER Length: 7 9 FT =- -y-=-r- - - _ ,- , N ELEVATION 2.5 ELEV.2.5 Width: 4 FT m�U Water[Tensity 62.4 LB/FT' GALVANIZED I•EYE BOLT wl- � � r ate-'ti� ALL SITE DATA . �*� ��N ftV Weightot Tank: 463 L8 FLAT WASHER TOP&BOTTOM �� _ €'a {6 LOCATIONS) SGTIPIIV100B-115-&1.2 t39,154SF t 9 ACRES Tank Positioning&Groundwater Elevations _ ELEVATIONS NAVD 1958 DATUM Top of Tank Elevation 9 FT ° W Bottom of Tank Elevation 25 FT Groundwater Elevation 25 FT Estimated Storm Surge Elevation 6 FT L) `' + SEE s 0 Bucryant Force U) fiTowmfwalw prMtralimm- W 11-r 3.5 FT { r° Length of Tank 7-9 FT W ro Width of Tank 4 FT CD t Vol of displaced(WxLxGWPen) 110,6 FT' = c Buoyant Force(Veal x DensityW) 6901.4 LBS 5 { 2 m Concrete Deadman Force per deadman) W 0 z Width of Deadman 1.5 FT ry Height of Deadman 1 FT Length or Deadman 8 FT f Concrete density 145 LB/FTI Submerged Concrete Density 82.6 LB/FTa Buoyant Deadman Weight(Vol x Density 5) 991.2 LBS Soil Farces Dry soils (per soils columns Width of snit column 1-S FT Dry Soil Density 110 LB/FT' Depth of dry soil 3 FT i.I.l Length or Deadman 8 FT Dry soil anti-buoyancy(Vol x Density) 3960 LBS W Saturated Solis (per soils column) z Width of Stall Column 15 FT Saturated Soil Density(11ti-F:2A) 47-6 LB/FT' Depth of Saturated Soils 2.5 FT ( U) Length or Deadman 8 FT UJ ` UJ Saturated Soli Anti-Buoyancy(Vol x Density) 1428 LBS O w, 100 Force Summation r T U Buouyant Force 6901.4 w Reststinli Forces } Tank Weight 463 Both Sides 1921 Deadman Weight 991®2 19824 Dry Snails 3960 7920 Saturated Sails 1428 2856 LIJ z Total Resisting Forces 13221.,4 W Buoyant Foroce 6901.4 .' K Resisting Fortes 13221.4 factor of Safety 19 E DATE' 06,1275 SCALE: ASAKTED ET OF 3 SHEETS Z jo I abed 910-AMM -suuaisft Aiddns ja4em jo lesodsip o6emas jo asn aq; jol-io IsBuiplinq Bui;slxe of suoij!ppe IsBuipl!nq mou jo A:)uedn:)3o eqj o4.joiid Amssooeu si juampedea eL41 Aq panssi JeAoidde leui:j palaid.inoA uj sAelep leguelsqns p!oAe of asuao�ll pyeA e tipmioloeijum loodsseo e 0411!ln o4 4sejelt#geq jnoA ui "ajojajaq "sl 11 'lenp!A!pqi pesueo�ilun ue Aq pollelsui aie jeq sloafaid jo uQqonljsuooloj lemidde leqij 4 uejB jo ioj s uqp a dsui Lujopa d I o u 11!m ao!jjo si Li L -sqey Vjawnsuoo jo eogjo aqj wail asuaig p!IeA e ssassod Ile qs qitil!mswo4sAsi�ildesjos,lellelsuilleleqlse.jtnbej ,,Isassouisni3fulsnpujoildeS,, 'apo,o &q4jo1jA91o!pVwuoijoadsul at44;0 Bulujow GLp Iswoe OC WMBOE:g ueemlaq 00LS-ZS8(M) Builleo Aq pawjijuo:)aq Isnw suoiloodsui 0 :6 pue - 0 U01leABOX3 -swalsAs lesodsip a6emas jol spos aqj jo Al!l!qeldaooe aqlaupialap of paiinbei aq fxew UOIJeAeOXG lion aqIo suoiloodsui 'seseo uppoo ul ON I dVoVqqjq6nojqjjo 'tqLq -ZSq(�Cq) le juawliedap aqj builleo Aq auop aq ueo siqjL -sueld PGAojdde ;9qj uo umoqs se BuipejB leug pue 'Buidid pue sluauodwoo walsAs Aiddns joleAA swalsAs lesodsip pue uoijoalloo 96emas aLlI jo suoiloadsui sapnioui siqi -6uillploeq of joijd sail!l!oel Aiddns jolem jo/pue lesodsip ebemes;aql jo uoiloodsui ue appaps of Al!l!qisuodsoi speoildde aqj si 11 w(vo vwmm wjo-A) saouappaM Al!we_q 016u',S JOI I!wJGd BuRs.x3 ue J01suBJ.L JO 'PuOlx3 ImouaU of suoi;t)njlsul ui paqposap sainp000id eqj ql!m aouepi000e ui PGSIAOJ JO 1p;ajjajsuejl 'pgmau;aj aq Aew sl!wjed -pajidxa seal j!uLuad a4l jl jo uoi;onj;suoo Bupnp 9;ls uo jou si Aojuns/ueld GJ!S PGAoidde;ao44 jo Adoo e j!JuampedePa4l Aq pawjojiad eq ll!m suoiloodsui ON -uoilonilsuoo of joud 1BAoidde jol(opeoildde j!)seal leuoil!ppe pue ueld POSIAW e jo uoissiwqns aq sajin�aj ubisp p9Aoidde aqj of uo Oow AUV'91ep j8Aojddet4j je:4e sieeA(C) egjql s;aiidxe(ueld)jpjadaqj j i 1, ..J.1 eomp ;9 -u6is;ap;qj9jdwooaqj jo Aoenbape aqj jol Al!l!q!suodsoi jo leuoissajoid UbIS9P aqj GA;BllGJ AeM OU Ul lleqs I!wjed slqj logouenssl -spiepuels alqeoildde ql!m gouewjojuoo Ul auop uoilowlsuoo 9t4l 6UIAeq jo Al!l!q!suodsoi aryl wolf.jueoildde 9141 9se;alaj lou op ueld aqj uo pelop jo�oej Jo seloualsisuooui A suoissiwo -soouep!s9jj Ai!we:j elBuiS jol swelsAS lesodsia oftmeS jol uoilonilsuoc) Pue sueld 10 JBAojddVjoj spiepuelS buipnioui spiepuels elqeoildde lle se liam se sueld p9Aoidde ql!m wjojuoo Isnw uoilowlsuoo -ui;ajaq posoloue jo ueld aql uo palempui aq Aew 1401t4M 'JeAoidde jo suoil!puoo Aue jo alou 9�lej pinoqs jueolldde aqi paloidep se Apadoid aql jol walsAs uoijoalloo jo/pue 'lesodsip a6emas 'Alddns jalem e jonilsuoo of I!wjad e selnl!lsuoo Isuoil!puoo aseqj ql!m uoijounluoo ui 'juaupedap at4l 10 GAIjejuasaidej e Aq poubis Ainp ueqm 'ueld p;gqoelle ;gqi :#UOISIA9� zoo�000090009 000� :#INIOS COZV9Z-2j :#@3uGJ9MJ S90I.AJ;9S qlle9H anUGAV�IojjnS mGN 00 W :19weN 109.fWd IZIGN0311 Ad JquolSSl W Wo3 HdW"OVY'1109ld mH NOS93M!D 53:)lAU35 HIIV3H 30 IN3WIHVd30 3Aiin:)3X3 AiNno:)>noj�ns 3NIVWOII "douvma3 xiojjns 30 iNno:) Project Name: 10100 New Suffolk Avenue Health Services Reference#: R-25-1203 SCTM#: 1000116000600001002 Revision#: CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT As a condition of this permit to construct,the following items must be completed as a minimum, prior to building occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Single Family Residences(Form WWM-041). INSPECTIONS REQUIRED— For all inspections call 631-852-5754 to request an inspection by 4:00 pm, one business day prior to the requested inspection day. Excavation Inspection(s) by the Office of Wastewater Management prior to installation of any leaching structures to determine acceptability of soils. After requesting, confirm the inspection by calling 631-852-5700 between 8:30 am and 9:30 am on the morning of the requested inspection. Excavation Inspections are not performed on Fridays. Satisfactory inspection by Office of Wastewater Management of the sewage disposal system /sewage treatment system. Check with local Building Dept. to verify if a building permit is required for the installation of an [/A OWTS (e.g. electric permit). DOCUMENTS REQUIRED: Four(4) prints of an As-Built plan (See instructions Form WWM-041) Certification from the licensed sewage disposal system installer(Form WWM-078) Certification of Sewage Disposal System Abandonment(Form WWM-080) Signed copy of the Operations& Maintenance Contract for the I/A OWTS Completed Application to Register an I/A OWTS (Form WWM-304) Design Professionals Certification of Constructed Works (Form WWM-073)for: I/A OWTS and all related components arr WWM-016 Page 2 of 2