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ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS -1 ; Fax(631)765-6145
MARRIAGE OFFICER % Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER x www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born,Southold Town Clerk's Office
DATED: March 26,2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4739 for a Cesspool/Septic Tank
Construction Permit submitted by:
Charles Brudi for Jack and Barbara Stavridis
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
SO MI
ELIZABETH A.NEVILLE Town Hall,53095 Main Road
TOWN CLERK fi f' P.O.Box 2173
9 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ,.a- ''V a
MARRIAGE OFFICER 't rr Fax(631)765-6195
RECORDS MANAGEMENT OFFICER ��' Tetephono(631}766-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 V/ or Non-Residential @$25_ Application No.
Permit No.
Applicant NameI � �_ i�
Applicant Mailing Addre v_ t
septic Tar kor C�scc1
Brief riin of cue to^. :rtl r etir,
-� �T e
Location of Proposed Con to c;ori Al , ww
Owner of Pirie.-.-
17
Owner Mailing Address:
Owner Property 1ddr All
_ 1 ---
4, .
Name and phone number of contact person ` 1
Tax Map No Section ( ' Block -----
Cross
_Cross Street 'FZC
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION NEW
CONSTRUCTION REQUIRES SURVEY 11 L tFNT.APPRO -xL
'? Signature of, p 1iean Date
Received by: � _
S.C.T.M. NO. DISTRICT: 1000 SECTION: 106 BLOCK: 5 LOT(S):35
I+NT Cb S'E�EAt.,t"1�''E1&ty._......a,_..,
a � CC'S:Ca
TYPICAL CLEAN OUT 1��LRU01'r F'o R APPI-z0VAL OF CONSTRUCTION F'OR A
SLATE OR -- `tNGLE'i7, ! GI
EMD � E P L1
OR
SUITABLE COVE STOPPER END
STST PLUG
NA3 1 2018
11 00-1 ao75
t�30` ELBOWId,Y! tO BEDROOM.,,,
60' WYE EXPIP .'d"THR' YEARS FROM DATE OF",APIPROVAL
FLOW
!,"IuY Y I"C I,a.,1114,✓.lTI r M.)
MAP OF CAPTAIN KIDD ESTATES #7672
DWELLINGS `T'
W/PUBLIC WATERp
150' CV/,'
4' CHAINLINK FENCE 0.2'N�
8 87011'00°E to (JO° FOR I�:,Ai al�. I�eftit,t Its. � C)R l W14TA-073.
IAL 4' PICKET FENCE 0.5'W
EL 61.0 n EL 60 9
" 5.1
EXISTING SANITARY TO 6'
BE ABANDONED AND BACKFILLED $ V n
N WITH CLEAN COURSE SAND, O
w 0
} 20.5' O
O
v ROOF OVER
LANF N/F 2 a BRICKPATIO v
OF a EL 60.3 w LANF N/F
ANTONOPOULOS BRICK WALK EL 60.2 OF
23.6' 56.4" Y KRESHON
_U
DWELLINGS 1 STORY a
W/PUBLIC WATER n, FRAME DWELLING
-x-150' N' 4"BEDROOMSDWELLING
#170' W/PUBLIC WATER
FfL 625 150'--►-
'P, 120.x: 49.T
1.7'E 44.4'''
LFhNOUT EL 60.4
W EL 60.3BRVCK O'�
JO�' ,
ELEV. 57.8 °� ^ X o
DR BROWN O -0 OL NDY LOAM 7.2' Z4 BEDROOMSM LOAMYWSAND 1.5' xSANITARY SYSTEM1250 GAL. S.T. R
(1)8'DIAx12'DEEP L. mBROWN
M D UM POST EL 56. W.M. ry .$.SC LAYEY SAN 3.3' a EL 57.8 EL 57.1
MON. — N 87011'00"W 100.00' MO .
}
PALE
BROWN
MEDIUM
SP SANG 11.0' �. ..�.�. .:....
& WATER MAIN ---
GRAVEL RUTH ROAD
NO WATER
— 17'
APRIL 20, 2018
K. WOYCHUK LS VACANT DWELLING VACANT THE WATER SUPPLY, WELLS DRYWELLS,ANq CES»�¢,?OOL
W/PUBLIC WATER
100' -.,-100' U.P. 150'+x- LOCATIONS OR
SHOWN ARE FROM OTH'RBSERVATI'OAVwe"
AND OR DATA OBTAINED FROM OTHERS.
AREA: 12,500 SQ.FT. or 0.29 ACRES ELEVA77ON DATUM: NAVD88 _ _ ----
UNAUTHORIZED ALTERATION OR ADD177ON TO THIS SURVEY IS A OOLA770VV OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE,
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDIT70NAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: JACK STAVRIDIS;
MAP OF: BARBARA STAVRIDIS;
FILED:
SITUATED AT:MATTITUCK �
TOWN OR SOUTHOLD KENNETH M °WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
yI P.O. Bog 153 Aquebogue, New York 11931
FILE # 1 47 SCALE: 1"=20' DATE:APRIL 20, 2018 r' -- PHONE (831)298-1588 FAX(631) 298-1588
N.Y.S. Ll NO. 050882 mdntelntna the--rde of Robert J.H.—M k X= 1.Royehuk