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ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
MI
REGISTRAR OF VITAL STATISTICS �k R Fax(631)765-6145
MARRIAGE OFFICER °� o Telephone(631)765-1800
RECORDS MANAGEMENT OFFICERu" 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: May 16, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4756 for a Cesspool/Septic Tank Construction
Permit submitted by:
Laurie Scis erste
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.NEVILLE `" Town Hall, 53095 Main Road
TOWN CLERK G P.O. Box 1179
W Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
southoldtown.northfork.net
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
I
Residential @ $10'-� or Non-Residential @ $25 Application No.
Permit No.
Applicant Name
Applicant Mailing Address 'l�l
p
Se tic Tankjor Cessl ooI
Brief Description of Proposed Construction or Alterationy �:,, .....
Location of Proposed Construction/Alteration:
Owner of Property: .._ f®�. �° t c� _ n` l C...C 4m
Owner Mailing Address:
p � .._.� �...
Owner Property A�ld��ss.�..� � ... .�
Name and phone number of contact person ��� -
Tax Map No: Section Block Lot
Cross Street�._ _ w... ._ ...
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
(J.S' ia.turco lic I ant Date
Received by: .._ ............
........ .... .
SURVEY OF
P/O LOT 24 & LOTS 25 & 26
IS" BLOCK D
MAP OF
SU...OLFCCOLN' REYDON SHORES
FILE N,.631 FILED IULI 1,1931
SITUATE
PERMIT FOR APPROVAL.OF CONSTRUCTION FOR A RAYVIEW
S)NrLE FAI,LY RESIDENCE ONLY TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
APR 0 3 2019 C S.C. TAX No. 1000-80-02-11
SCALE I"=30'
OCTOBER 16,2018
ti
FOR OF
BEDROOMSAREA= 12,398 sq.ft.
I-4C
EXPIRES I HREC YEARS FROM LTATE OF APPROVAL, 0.285SO J
NOTES:
1.ELEVATIONS ARE REFERENCED TO Wkl.D,1988 DATUM
EXISTING ELEVATIONS ARE SHOWN THUS:)ILZ
nRST ODMR
S 69. 11- --G
48,40" ------ X.MINIMUM SEPTIC TANK CAPACITIES FORA 3 BEDROOM HOUSE IS 1.000 GALLONS.
TANK;
8 -3'WIDE,6*-7"DEEP
EYE= LONG,4'
T17 i"D
P 0h EAS 4.MINIMUM LEACHING SYSTEM FORA 3 BEDROOM HOUSE IS 300 q ft SIDEWALL AREA.
"nenk Submit
cf'm No m"m IFG,A'qe�(�e plMtfl!e.W I POOL:12'DEEP,S'di..
lbm� rph __GGIvrof.
' 4, PROPOSED B..FUTURE EXPANSION POOL
0
PROPOSED.'MA..1Y*DEEP LEACHINGN.10.
16S PRII—E.I...CALL-CH—11C TANK
5.THELOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
4 4
ft OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
0 THE REX ITING CESSPOOL IS TO BE PUMPED CLEAN AN
FILLED WITH CLEAN SAME AS PER S�C.D.H.S.STANDAR IVED
TEST HOLE E
NI,�DATA
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MAR z 12019
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F& HEALTH SrnvICp
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65.30,
R c g,. Nathan-Taft Corwin III
Land Surveyor
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PHONE O631)721-2090 Fax(631)727-1727
T"IUWAI
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T S_ I.—F N.Yoek 11947
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