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ELIZABETH A.NEVILLE,MMC 4V� ea Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
K cm K Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICERTelephone(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: July 16,2019
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4768 for a Cesspool/Septic Tank Construction
Permit submitted by:
Anne Surchin for John&Gloria Skoblicki.
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 auaroval ieuired from theSuffolk Count-,Health Denartment
Signature
Dated
ELIZABETH A.NEVILLE Town Hall,53095 Main Road
P.O.Box 1179
TOWN CLERK
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS w Rt
MARRIAGE OFFICER Fax(631)765-6145
RECORDS MANAGEMENT OFFICER Telephone(631)765-1800
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 ,/or Non-Residential @$25 Application NO. U 7
pp.-ail No.R if}_
Applicant Name h
Applicant Mailing Address t"-
Septic-Tank-�'/.Cesspool
-
Brief Description of Proposed Construction or
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
IJK_A,
Owner PropertyAddress:
ea
Name and phone number of contact person
Tax Map No: 10 0 6 1 Section Block Lot
Cross Street '-t,kJ
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
7 1
Signature of Applicant Date
Received by:
SANITARY NOTES: csj
EXISTING CESSPOOL TO BE 1 SURVEY BYPECONIC SURVEYORS DATED
O PUMPED DRY AND ABANDONED FEBRUARY 21.2018.
R OR REMOVED IN ACCORDANCE , 4 BEDROOM ,g910
- f °JVY3TH THE SGDHS STANDARDS - RESIDENCES ARE PROPOSED FOR THE
PROPOSED WASTE UNE f
/ 3, TOTAL LOT AREA AREA=10,003 Sf 4F. 'L
joA PROPOSED 1,200 GALLON OIL PROJECT
PROJECT
SF RESIDENCE t4 SEPTIC TANK i �'dr ;q� SF RESIDENCE 4. EXISTING TOPOGRAPHY REFERENCES THE NAVE y. _
O CONNECTED TO PUBLIC
CONNECTEDCONNECTED TO PUBLIC '88 DATUM AND SCDPW TOPO MAPS SHEEP . LOCATION
tlrs WATER 5 MIN. QO•QQ jjj O WATER EE-38. c
PROPOSED DECK T MIN. j h
W ADDITION aLOC FE C, 0..1 r— 1 1 N 5. THERE ARE NO WELLS WITHIN 156'OF THE TOWN CREEK
{�
PROPOSED .24'OO�E OZ PROPOSED SEWAGE DISPOSAL SYSTEM.
7l� PORCH �'��—� - -` `$mss.. f BEACHING PoOL
TYP.OF 2 (h O� 6. THERE ARE NO WETLANDS WITHIN 300'OF THE �+
V1 ADDITION ,A _ f y � z PROPERTY. LOBATION MAP
20.0 .-3 �2- y
s ir, gr —f crca 4� PROTECT& O
N1 0'20'20W DW, 1 STY l 9 1 1 eceD MAINTAIN EX.TREE O
n
12.70' Ex. ,,T H,"Ya ST H
ie s.d SE _ 15.4
til w FOF. _92.0 fra o �—= -F, `+,RA � r, -a:t _.EL.200±0
TE LE
.,, I ,(IQ QQ EDGE OF SLOPE DARK BROWN
SF ORES{DEME 1
N10 42'2Q YV � c-sr�-0 LOAM OL t� do ttt of existing sanitary sysT-must be Des
CONNECTED TO I'� 2 7 -' �' av u cUr —'s 8'0 X 6'DEEP EXPANSKNd 0.5
PUBLIC WATER 37- _�. — — 1 \ — conformance'cV`SL43 C t�TF[IisUilt.requh .Tent St[I3%[3%t
u - ,,4A;ORAS OAY J_1=T�. f \\ LEACHING POOL BROWN SILT for,
£ I
ML OOTi1P(e.E`=�>_O._ SSS pr g.
4$QQa: TESTHOLE SEX.WATER AND ELEC.SERVICE
8 rF S79 PROPOSED2-STORY ! 2
—EX.GAS SERVICE ADDITION (�fQA f PALE BROWN
"v Ur EX.WATER SERVICE SF RESIDENCE MZUh� FINE TO MEDIUM
T`-rSa PI-YE WWF CONNECTED TO PUBLIC i gApgi
WATER SP
1?UfWAT ER TABLE EL.2.5;
V7 �
WATER IN PALE
``J BROWN FINE TO
MEDIUM SAND
SITE PLAN
TEST HOLE PERFORMED MAY 16,2019
SF RESIDENCE SCALE:1°=30 BY MCDONALD GEOSCIENCE
CONNECTED TO PUBLIC GROUNDWATER ENCOUNTERED 17.9
WATER BELOW GRADE SUF FP'O R COUNTY DEPARTMENT OF HEALTH SERVICES
WATERTIGHT FRAME&COVER W/
F.F EL.22.0 MORTAR FROST APPROVED LOCKING DEVICE CONCRETE COVER RE V.. PERI.IT FOR APPROVAL OF CON3TRUCTION FOR A
CONCRETE COVER PROOFING 24.0 PRECAST CONE.RISER BELOW GRADE SINGLE FAMILY RESIDENCE ONLY
BELOW GRADE'--, C E EL 2000+, RINGS(12'MAX.HEIGHT) GRADE EL.20.00±
1 mN uk , g 2019 s
TRAFFIC BEARING SLAB 24" 1'min. DATE _? _,1;EP.No
20' PVC WASTE LINE 2'Mau (Ufv'M qp=Rov-� °
PITCHY INCH PER FOOT TRAFFIC BEARING SLAT.T.
OF APPROVAL
DAT
4'SANITARY WASTE PIPE 8"
1 PITCH1t41NCHPERF00T } INVEL. 17.3 i N1DXz,x 0, RE[aRTSCtF t
INV EL.18.0 INV EL.17.8 INV.EL.17.1 INSTALL DUMMY RINGS AS NECESSARY TO EXPiR S THREE YEARS FROhl E
10'MIN, 0 20'MAX.(e MIN:)
BRING PROPOSED STRUCTURE TO GRADE "s
c+ ALL LEACHING POOLS SHALL BE PLACED IN IN
4'_ I ACCEPTABLE LEACHING SOILS AS APPROVE /
BY THE SCDHS. IN THE EVENT POOR Health Department Approval Stamp
LEACHING MATERIAL IS ENCOUNTERED,
-4. 8'DIAMETER B'DIAMETER - j .,,.saa2aaroan.co°d°:5ar�,°p-- cei:ay .rNewr«:.r
EXCAVATION IS TO BE CONTINUED TO
SUITABLE MATERIAL AND BACKFILLED AS
PRECAST SEPTIC TANK DETAIL EL.11.1
- z ----- ---- DETAILED. CUTTING RINGS MAYBE Ewan«.r'c.�.mn<n<mn «•®sl„u",<. ^'r�<aay'ret+'
LEACHING POOL DETAIL REQUIRED.
z SC
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