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ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK v9 P.O.Box 1179
ai Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS a Fax(631)765-6145
MARRIAGE OFFICER _ Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER 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 28,2019
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4740 for a Cesspool/Septic Tank Construction
Permit submitted by:
Tom Samuels of Samuels&Stcelman Architects for Timothy Casamento&Idea King.
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: Final ap>rroval required from the Suffolk County Health Department
Signature
Dated
ELIZABETH A.NEVILLE 4 '% Town Hall,53095 Main Road
*' P.O.Box 1179
TOWN CLERKF Southold,New York 11971 SRI
REGISTRAR OF VITAL STATISTICS • Fax(631)765-6145
MARRIAGE OFFICER _ Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER , eouthaldtown.northfork.net
FREEDOM OF INFORMATION OFFICER = '
= tea=
OFFICE OF THE TOWN N CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK f�
Residential @$10 f or Non-Residential @$25_ Application No.`I-71-10
Permit No.
Applicant Name Tom Samuels,Samuels and Steelman Architects
Applicant Mailing Address 255235 Main Road,Cutchogue,NY 11935
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration new septic system with new piping
Location of Proposed Construction/Alteration:
Owner of Property: Tim�f Gns rtio&L{-eo-Kin�a
Owner Mailing Address: 17 Woodbridge Ct.,West Babylon,NY 11704
Owner Property Address._` oao out.c ,
Name and phone number of contact person Tom Samuels 631 734-6405
Tax Map No: Section 52 ___Block 09.__ Lot 1.2
Cross Street Pari kye—'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATIOM NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signat c of Applicant Date
n
Received by: _
S.C.T.M. NO. DISTRICT: 1000 SECTION:52 BLOCK: 9 LOT(S):1.2 #PRE-17-1683
C.I. LOCKING (75)FINISH GRADE
COVER TO GRADE
1'WN-2'MAX z �i
j » 0.
"MI.
1,4-FT. 6' COVER 1 8 FT. a COVER
6 6"SLAB N: `
NVE) I (s0> LU
I" E{sn'RUN7 {e.25) INVERT NVERT 9 U)a,
(7.0)mance(35' UN) {6.757 t5:5�) e n
FOUNDATION B'0 3' COLLAR
WALL TANK MI '. POOL CLEAN Uj
COARSE x
S
3'MIN 1 -8» 2 GRAVEL qn
USE 4" DIA. APPROVED SEWER PIPE ale
1000 GAL. PRECAST S.T.
(on) LYJ
as
HIGHEST EXPECTED WATER EL I. DYO.DD' . ""^ K0- (J n y
150' N 75•Si°t
cl
i
p oV 1 s s 1.0 tO
La W
TYPICAL CLEAN OUT
,r ..4
SLATE ORSTOPPER END I a. iJJ
SUITABLE
COV }'s� OR PLUG
co
D
5 0
30' ELBOW } f »
60• WYE
6} I 1 t
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4
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�g,� 46
R
er e(s) turd Tim
LOT 1 1folklCount)1 H Ith 8 ' a�
VIACANT Call P52-5. 48 Hqu In Adv ce
(TS
ELEV.6.9
OL DR BROWN 0.9' p ) f✓ �, Ot LOT 2
NOY LONA1
BROWN
SM. .OAMY SAND 1.1'
PALE0.
BROWN
SW
FINE
4.9' ty n} �u8n I {r.sy tt lRO�N ti 7I11o ,
COARSE �, 5ED ry'N1? u�,T 0- I t
SAND J 32,2 6 pPbS (BS}i PPOEPRgOUS th �" 4
—WATER
C EEV 1.0 o .. rYPPfO,. ✓ �an+.:. d'
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WATER IN Dro
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08-02-17^ ,,� CL6.8
K.WOYCHUK LS __7 S15"e5 5S, Nn.po mNM.
�.. pXCAVKnONINSPkCltONRBgl7DiED
Vim FOR SANITARY SYSTEM
13Y I ALTH DEPARTMENT
i
UNDERGROUND UTILITY LOCATIONS RS PER MARK-OUT
PROVIDED BY OTHERS.
REVISED 11-03-17
THE WATER SUPPLY, WELLS DRYWELLS AND CESSPOOL
LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS
/ FIRM PANEL #36103CO158H AND OR DATA OBTAINED FROM OTHERS
AREA: 87,939 SQ.FT. or 2.02 ACRES ELEVA77ON DATUM: NAVD88
UNAUTHORIZED ALTERA77ON OR ADD177ON TO THIS SURVEY 1S A WOLA71ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS 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 INS777VI70N
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS777U770N, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 7HE PROPERTY LINES TO 7HE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRU&TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREM1SES AT 77-IE 77ME OF SURVEY
SURVEY OF:LOT 2 CERTIFIED T0: MCCARTHY MANAGEMENT INC.;
MAP OR MILL CREEK PRESERVE X51 P,I 1,
FILED: JANUARY 28, 2005 No.11216
l I KENNETH ai �OYCH(TK LAND SURVEYING,SITUATED AT:SOUTHOLD
TOWN OF:SOUTHOLD YING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
is P.O. Bos 153 Aquebogue, New York 11931
PHONE(891)298-1688 FAX(831)298-1688
FILE f 16-179 SCALE:1"=50' DATE:AUG. 02, 2017
N.Y.S. LISC. NO. 050882 matntdn[nj the--de of Robert J.Benne"6 K—th Y.Uy huh