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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 �x"� �� Fax(631)765-6145
MARRIAGE OFFICER
Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER „
FREEDOM OF INFORMATION OFFICER ' www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: October 1, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4793 for a Cesspool/Septic Tank Construction
Permit submitted by:
Tom Samuels Samuels and Steelman Architects
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
1
ELIZABETH A.NEVILLETown Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICERS Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � � �� Telephone n.no hfork.00
FREEDOM OF INFORMATION OFFICER i southoldtown.northfork.net
2
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
1
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL r SEPTIC TANK
Residential 10 or Non-Residential 25 Application No.
Permit o.
------------
i
Applicant Nae Tom Samuels, Samuels and Steelman Architects
Applicant Mailing Address 25235 Main Road, Cutcogue, NY 11935
Septic Tank
Cesspool_
new septic�, s stem with neww....
piping Description of Proposed Construction or Alteration
I
Location of Proposed Construction/Alteration:
Owner of Property:..._..._K"1.LeeD B,_Kfl dde_.__w_ .......
Owner Mailing Address:�P'O„Box 192, Cutchogue, NY 11935
Owner Property Address: 904,5 Nassau Point Road, Cutchogunennnw
..,.,.,. ..—_ www...___ ..........._... .,..ea.. ...._..m .....,.m..._....__.. ..e. .m.
Samuels 631 734-6405
Name hone number of contact person Tom n
i
Tax Mapo: Section ...........11 .a�....._.....Block _ 04........... Lot. �...._�4..1 _.
Cross Street
LOCATION
APPROVALCONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT
Signature of Applicant Osie
Received y:
i
W
F2x
Rgz
D CUR)
LOAMY SAND w aU!
M W _
FINE TO COARSE SAND 5 "
Q H �
WATER IN
FINE TO COARSE SAND kkiN N '
NTS: WATER ENCOUNTERED
LOW SURFACE, ELEV 2.3'
NAGE CALCULATIONS OF Nh,9�
C. , 0
)F GARAGE POOL HOUSE (DW-A .
O
-L AREA x RAINFALL x RUNOFF FACTOR
0125 5F x (2/12 FT.) x 1.0 = 154 CU. FT.
U5E: (1) 8' DIAMETER x 4' HIGH POOL
(1) VX 4' STORM DRAIN RING = 166.9 CU. FT. 50APROVIDED REQUIRED
168.41 CU. FT. > 154 CU. FT.
PROJECT NO:
0710
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES DRAWN BY.
UT
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
CHECKED BY:
W , � TCS
,
DATE:
8/29/19
DATE*24
H.S. R>=r.. � ��. �d' 1
SCALE:
APPROVED 1" = 20'-0"
TOTAL MAXIMUM ROOMS
SHEET TITLE:
EXPIRES THREE YEAR FROM DATE OF A.PPROVA!.
WATER LINE 5) UST BEINSPECT
MUST ED BY THE
SUFFOLK COUNTY DEPT. OF HEALTH SERVICES. i SITE PLAN
CALL 852- 48 HoUP.S IN ADVANCE,
TO s( ; E LE INSPECTION($).
Cleanout must be installed on the
septic tank inlet waste line.All utilities SHEET NO.:
require a 5ft minimum separation to
the septic system. r;zs{ 'rC4 C ?Ntf
/ N/OAF
CASTALDI DIANNE \
j PO Box 960
CUTCHOGUE, NY 11935
8525 NASSAU POINT RD
1000-118.-4-12
f/ DWELLING
PUBLIC WATER
f
I J
/ G
yN
/ �O
F
NEA SEPTIC SYSTEM FOR A 6 N FN NEI&HBORIN6
-NEA 1000 CAL SEPTIC TANK(5T) 6AR46E NEE PROPOSED
/ -CLEANOUT TANK UNDERSROUND
f -(?)8 FT x 6 FT LEAGHIN POOL(LP)
-(1)8 FT x 6 FT FUTURE ENTANSION NEA PROPOSM
(EXP)LEAGHIN&POOL UWEL5rT ND AAS
AND LECTRIC LINA
NASSAU GLEAN OUT FROM RESIDENCE
0 NOTEGE(S) AGGE550RY EJIL
NEW ACCESSORY
BUILDINc5 Rys olk County Depmtmnt of Health Se
-NO BEDROOMS F-X15TIN6 SERI
�b
N82°00'00"E RATER LINE TO AD
3
mIn min 0
TO�' c LP 11q.5 EXP Q
m €' -
L=--_j—�
PROPOSED
'(OR LF
° CGESOFty
&x4 IL
ViATER LINE
B 3Fa5f • er:
•� ,' F �=yah s� +Iq.3 ,,,� �..,..
PAR IN&AREA
HURLEY RICHARD VRgN ? r
8880 NASSAU POINT RD
CUTCHOGUE, NY 11935y�
8880 NASSAU POINT RD � >_
1000-118.-6-2 I5TIN5 NEA
DWELLING eu ,' tF24J TRELLISED