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Home My WebLink AboutTheodorou ELIZABETH A. NEVILLE,MMC ��r� � � ,'aw Town Hall, 53095 Main Road TOWN CLERK �� '�� P.O.Box 1179 N Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS �r+ °"a „f Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER , IIIAJ"IJ, 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: February 14, 2020 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4839 for a Cesspool/Septic Tank Construction Permit submitted by: Machael Theodorou 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,63096 Main Roa. TOWN CLERK @ � P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS PVT MARRIAGE OFFICER r, 41� Fax (631) 765-6146 RECORDS MANAGEMENT OFFICER Telephone(631)765-1800 FREEDOM OFINNORMA^LION OFFICER "" southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CO NSTRUCTIO IAF or ALTERATION PERMIIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. qOJ l Perinit No. _ ( j 0q,30 Applicant Name -IL/ Applicant Mailing Address LL_/> - Septic Tank, or Cesspool Brief Dscriptiora of Proposed Construction or. .lterat.ion Al�"e-1111 Location of Proposed Construction/Alteration: Owner ofProperty: rh , "� �. .. Owner Mailing Address: Owner Property Address: � Name and phone number of contact person Tax Map No: Section //0Block _ &I/ Lot Q a Cross Street NOTE: LOCATION MAP MUST'BE SUBMIIZ"TED WITH APPLICATION. NEW CONSTRUCTION SAPPROVAL _V" Signature of Applicant 4f� e Received by: m YOUNG &YOUNG Telephone (631) 727-2303 400 Ostrander Avenue Facsimile (631) 727-0144 Riverhead,New York 11901 admin@youngengi.neen.ng.com 11----....................................... ........................... .. ................................. .......... ...... ................ .. ...... ........... HOWARD W. YOUNG,Land Surveyor THOMAS C. WOLPERT, Professional Engineer DOUGLAS ADAM5,ProfiL5,5ionql EngineerlGeolnist ROBERT C. TAST,Architect ROBERT STROMSKI,Architect December 27, 2019 Mr. Michael Theodorou 4905 Pequash Avenue Cutchogue, New York 11935 RE: MICHAEL THECIDOROU at Cutchogue, T/O Southold, NY 4905 Pequash Avenue (19-0121) SCTM No.: 1000-110-04-1 HD Ref. No.: R-19-0030 Dear Mr. Theoclorou: Enclosed are two (2) prints of the Building Permit Survey (Sheets 1-2 of 2) last dated December 10, 2019 bearing the SCDHS stamp of approval to construct dated December 23, 2019, together with a copy of the Permit including Conditions for Obtaining Final Approval of Constructed Project, for your use. Very truly yours, Thomas C. Wollpert TCW/cw Encl. COUNTY OF SUFFOLK STEVEN BELLONE SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES JAMES L. TOMARKEN, MD, MSW, MPH, MBA, FRCPC, FACP Commissioner PERMIT CONDITIONS Project Name: MICHAEL THEODOROU Health Services Reference #: R-19-0030 SCTM #: 1000110000400001000 Revision#: 0 The attached plan,when duly signed by a representative of the department, in conjunction with these conditions, constitutes a permit to construct a water supply, sewage disposal, and/or collection system for the property as depicted. The applicant should take note of any conditions of approval, which may be indicated on the plan or enclosed herein. Construction must conform with approved plans as well as all applicable standards including Standards for Approval of Plans and Construction for Sewage Disposal Systems for Single Family Residences. Omissions, inconsistencies or lack of detail on the plan do not release the applicant from the responsibility of having the construction done in conformance with applicable standards. Issuance of this permit shall in no way relieve the design professional of responsibility for the adequacy of the complete design. The permit (plan)expires three (3)years after the approval date. Any modification to the approved design requires the submission of a revised plan and additional fees (if applicable)for approval prior to construction. No inspections will be performed by the department if a copy of the approved site plan/survey is not on site during construction or if the permit has expired. Permits may be renewed, transferred, or revised in accordance with the procedures described in Instructions to Renew, Extend, or Transfer an Existing Permit for Single Family Residences (Form WWM-104). It is the applicant's responsibility to schedule an inspection of the sewage disposal and/or water supply facilities prior to backfilling. This includes inspections of the sewage collection and disposal systems, water supply system components and piping, and final grading as shown on the approved plans. This can be done by calling the department at(631) 852- 5754. In certain cases, inspections of the soil excavation may be required to determine the acceptability of the soils for sewage disposal systems. Excavation inspections must be confirmed by calling (631) 852-5700 between 8:30a.m. and 9:30 a.m.,the morning of the inspection.Article VII of the Code, "Septic Industry Businesses," requires that all installers of septic systems within shall possess a valid license from the Office of Consumer Affairs. This office will not perform inspections for or grant final approval for construction of projects that are installed by an unlicensed individual. It is, therefore, in your best interest to utilize a cesspool contractor with a valid license to avoid substantial delays in your project. Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to existing buildings, or for the use of sewage disposal or water supply systems. WWM-016 Page 1 of 2 Project Name: MICHAEL THEODOROU Health Services Reference#: R-19-0030 SCTM #: 1000110000400001000 Revision#: 0 CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT As a condition of this permit to construct, the following items must be completed as a minimum, prior to building occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Single Family Residences (Form WWM-041). SCTM# 1000-110-4-1 R-19-0030 INSPECTIONS REQUIRED — For all inspections call 631-852-5754 to request an inspection by 4:00 pm, one business day prior to the requested inspection day. Satisfactory inspection by Office of Wastewater Management of the sewage disposal system / sewage treatment system. Satisfactory inspection by Office of Wastewater Management of the water supply system DOCUMENTS REQUIRED: Four (4) prints of an As-Built plan (See instructions Form WWM-041) Certification from the licensed sewage disposal system installer (Form WWM-078) Certification of Sewage Disposal System Abandonment (Form WWM-080) WWM-016 Page 2 of 2 )T BEARING THE LAND SURVEYOR'S INKED SEAL OR EL49OSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(i)CERTIFICATION ! OF WELLS(W),SEPTIC TANKS(ST)&CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND DR DATA OBTAINED FROM OTHERS. _ 400 Ostrander Avenue, Riverhead, New York IIcci01 tel. 631,727.2303 fax. 631.727.0144 -, admin®youngenglneering., REALTY K OF SUFFOLK HloNord N. Young, 1-and urry yor = N.A.V. DATUM(1988) Thomas 0. Aol art, Frofesslonal Engineer TRANCE RATE Douglas E. Adams, rofesslonal Engineer 2009. - Robert 0. Tast, Architect Robert 5tromskl, Archltect HEALTH DEPARTMENT USE ling with Public Water) i k I I SUFFOLK COUNTY OizARTM NT OF HEALTH SERVICES i F . I -PERMIT �� VL OF CONSTRUCTION FOR 1 I _N C L 1 -EMILY R E SID E NCE 0 N L I I DEC 2 3 2019 i DATE H-S, REF, No cMl' `\ APPROVED \ FOR M AXI MUM OF =GROOMS _ f \ EXPIRES THREE YEARS FROM OATS OF APPROVAL 0. \ ENGINEER'S CERTIFICATION , ' s [ € LL k HOWARD W.YOUNG,N.Y,S.L.S.NO.45893n \\ THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483 \ E ,- DOUGLAS E.ADAMS,N.Y.S.P.E.NO.80897 W ,y .=F \\ SURVEYOR'S CERTIFICATION WE HEREBY CERTIFY TO MICHAEL T H E O D t. \ SURVEY WAS PREPARED IN ACCORDANCE WITH THS I�'0£ C , LAND SURVEYS ADOPTED BY THE NEW YORK STAT Ni PROFESSIONAL LAND SURVEYORS. � 41 HOWARD W.YOUNG, Y S.L.S.NQ6693 F SURVEY FOR MICIPHAEL THEOOOROU PART OF LOT 44 & LOT 45 "MAP OF PROPERTY OF RAVATORE REALTY CORPORATION" \, at Cutchogue, Town of Southold Suffolk County, New York BUILDING PEP-MIT SURVEY / / / / County Tax Map District 1000 Section 110 Block 04 Lot 1 / FIELD SURVEY COMPLETED AUG,23,2019 / MAP PREPARED NOV.05,2019 Record of Revisions REVISION DATE ADDRESSED SCDHS NOCA#1 C,10 2019 30 0 15 30 60 90 - Scale: V = 30' JOB NO. 2019-0121 DWG. 2019_0121_bp 1 OF 2 STATE EDUCATION LAW.(2)DISTANCES SHORN HEREON FROM PROPERTY LINES i0 EIUSTINO STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO DE USED- �`E'AH1 -t FRCP RTY LINES OR F{ -TGR OF r--s y (D). IEz OF THIS SUR'V'EY VA: .O Na TITLE P." =GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THEA EES OF THE LENDINO INSTTUT7ON.CERTIFICATIONS ARE NOT"OWN AELE TO ADDITIONAL.INaT]TUnONS OR SUBSEGL-x7 T-ragyERS. (5)THE LL SITE DATA AREA = 18,894 SQ. *SUBDIVISION-"MAP OF PROPERTY OF RAVAT% CORPORATION' FILED IN THE OFFICE OF THE C s COUNTY ON DEC. 22,1930 AS FILE NO.0539. * VERTICAL DATUM *SUBJECT PARCEL I5 IN ZONE X-SEE FLOOD IN! MAP PANEL NO.36103CO164 H LAST DATED SEPT.2 i I 1 ! (DW (Dwelling with Public Water) 1 (Dwelling with Public Water) (Dwelling) car xx-k,) -fe_ - a �e l Z Com tty De%. Oc u I a� _ _ 852-5700, 48 HoUr- _n Andvaml lo SchedWe Inspectiom's) � WATER MAIN w W ,v —W -k v D+ ROAD APPROXIMATE LOCATION OF +10.11 XI5'YIN&SANT'='ARV SY Tl;M TO F�_ E TW _ 8E ABANDONED IN ACCOMANCE )P I ti18 04010011 E, _34 14.70 199.90' { WIT'=i SCDHS STANDARDS PRF CMF 1376 1 1 I ' F PRF MR \ 59 UT L 15.2 _ 13,72 10.08 fit . ' ' + �9 s &ARAGE 1-0 T -7 \ € E MOVED / +17.35 ON 1818.E +13.51 ffl 10.06 9, i ggti +17.81 20 RaI77+-- IL 't 0.27 e - 84,P t - B O 12.28 r rs �\ �o, -� r'22.1 l366 O, SOF GA LOC. i +15.33 22.26 0- / §� 14.21j / / 13 O t / G ,'x1 / TH 16.28+ // VGCP. / \ a / qkN\ \ 101 \ / SOF 17.9 r // �' l1 � 0 lip CMF N / P +19.62 a d etn€ in OX i > N� i - t* J �i�s s ( OTE: FINISHED FLOOR ELEVATIONS TO BE VERIFIED BY ARCHITECT (1)UNAUTHORIZED ALTERATION-OR ADDITION TO THIS SURVEY IS A VIOLATION OF CnIj"72 Or THE NEW YO f BEARING THE LAND SURVEYOR'S INKED SE) INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IStf T'ARED I;!ON HIS BEHAI F YELLS(W),SEPTIC TANKS(ST)k CESSPOC l REALTY (OF SUFFOLK i = N.A.V. DATUM(1S ` RANCE RATE11 { l 2009. 1 S I ling with Public Water) i N \ (Dwelling with ` \ Public Water) z - m WELL E\ 7r Of CMF \ \ +17.88 I 16.96 173, `O �G6/ CMS m k i Ox _ 17.56 '{ate �L,\ \ F\ os Y � r a . N 18\26" NA 01 `' \ +19.39 b i01 . t 0 N✓ ->. ry � m E a m N ' U 0 /d / a / o / o / a LEGEND BBC = BELGIAN BLOCK CURB CP =CONCRETE PAVEMENT EOP = EDGE OF PAVEMENT PVCF o 0 0 =PVC FENCE ® PRF -c =POST&RAIL FENCE CM5 =CONCRETE MONUMENT SET ° CMF =CONCRETE MONUMENT FOUND s W55 = WOOD STAKE SET ® WSF =WOOD STAKE FOUND WMR = WATER METER = UTILITY POLE