HomeMy WebLinkAboutRichards ELIZABETH A.NEVILLE, MMC �,, �� °1 Town Hall,53095 Main Road
TOWN CLERK w P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ;� Fax(631)765-6145
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MARRIAGE OFFICER �w Telephone 631 765-1800
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RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER � �°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: March 12, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4705 for a Cesspool/Septic Tank Construction
Permit submitted by:
Tara Richards
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
................... - ....._
Signature
Dated
ELIZABETH A. NE LE Town Hall,53096 Main Roa
TOWN CLERK � �� " P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ,,�.� �"�� r Southold,New York 11971
w �" .q Fax (631) 765-6146 '
MARRIAGE OFFICER °
RECORDS MANAGEMENT OFFICER Telephone(631)765-1800
FREEDOM OF INF033.IvIATIOATOFFICER '" ` ", " "' southoldtown.northfork.nel
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
EWE R D ISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERA41T
CESSPOOL or SEPTIC TANK
Residential 1 or Nan- esi ential 25 A licaf ion No. o l
� pp
/ I erni.t No. ... ..
lic t e rl G�ICLr s
licant Mailing Addres
... �
Septic,"I or Cesspool�
defDescription of Proposed Construction or to tion
tion of Proposed Construction/Alteration:
Owner of Property:_
Owner,Failing Address:__
Owner
. Property
Name and phone number ofcoo_..
ntact person
i � /0 7 m Lock �....
T ti
Map o: � Section / t /0. _.
Cross Street_... _. .. -.. ��...__..r..._�. ... �... . �m,
NOTE: LOCATION MAP MUST-BE SUBMITTEDWITH APPLICATION. NEW
CI Y WITH E[EALTH DEPARTMENT APPROVAL
S iri:s.t .e of
Applicant Date
Received 6y
Q
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 03/12/19 Receipt#: 252104
Quantity Transactions Reference Subtotal
1 �m Septic Permit Construct- Resid _ 4705 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CASH $10.00 Richards, Heath &Tara
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Richards, Heath &Tara
3060 N Wading River Road
Wading River, NY 11792
Clerk ID: JENNIFER Internal ID:4705
SUFFOLK COUNTY HEALTH DEPARTMENT ENDOR EMENTS NOTES:
SURVEY OF LOT#3
SITUATE BUILDER TO PROVIDE:
F HEALTH SEPN'"S
--NTyDEPART1.jE4TO
MATTITUCK r--S--UF-F-O-LK s- I-1500 GALLON SEPTIC TANK
WT
TOWN OF SOUTHOLD PFRFOR AFPR0VK!-0-1 C ,R UCTION-OR A
I 1 1-s'DIAMETER X 16' DEEP
SUFFOLK COUNTY, NEW YORK
LEACH POOL
'o
ELEVATIONS IN ASSUMED DATUM
MAP OF MINOR SUBDIVISION
40 1 2, VIS, N
DATE
CONSISTING OF 4 LOTS a g 0 100
PREPARED BY OTTOVAN TUYL
to, TEST BORING AS PER Mc DONALD
'W"A OF
D,
--------
LAND SURVEYORS,GREENPORTN.Y. APPROVIZI-1 games an. GEOSCIENCE DUG 11 04/10 -11
4
APPROVED:FEBRUARY 14,1986 '? o,
I �
FOR MkUm"M OF--(P— ar�'
TOWN OF SOUTHOLD F
BYTHE .OF APPROVAL
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PLANNING BOARD EST PEE YEARS FROM DAT
EXPIRESTHREEYE
SCTM# 1000-107-1 10.2
AREA= 106,102 sq It
2.45 acre
H
, 9
25 0GIA
A-53 Tj
V�bter Line(s)MIUS T Be Inspeected%Tl* 3
Suffoik Couniy Dept.Of Hen Swvic6tN72-21'50"E I, . 1 0
223 00-� N6"
Call'852-5700,48 Hours In Advanoe -il---5 4 9'
g 11 RI.-I-1 Y 3
To Schedule Inspection(s)
joj#4 E
an
pmp,.,..d -d-
y.m.
LL AND LATERAL WLTST BE
SHOWN ON FINAL SURVEY vacant
127"
128-
test boring d&.
.1, 48.6- oa 8
Dark brown loam OL 4
prop.-ol pool-f-
Brown Silty sand sm 20* 50' 0.
--------- a I test
bori.,i'g
'n eiv 48.6
V. p —
alo brown SP
51.0
vacant 3
17' lot#2
No-t.r ggg-..of
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REVISED:MAY 15,2018(HEALTH DEPARTMENT INFO) LAND SURVEYOR
59FLOPENCEDKIVE
REVISED:NOVEMBER 8,2010(HEALTH DEPARTMENT INFO) M"ORVILLE,N.Y.1,949
REDATED:OCTOBER 8,2010 (631)874-0400
SURVEYED:SEPTEMBER 1 2009