HomeMy WebLinkAboutDoka ELIZABETH A.NEVILLE MMC 61 ",0 's Town Hall, 53095 Main Road
TOWN CLERK ty P.O. Box 1179
ze
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS i�, � ;r Fax(631)765-6145
MARRIAGE OFFICER �u� - � Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER
INFORMATION OFFICER £���� www•southoldtownny.gov
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: September 8, 2020
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4868 for a Cesspool/Septic Tank
Construction Permit submitted by:
Frank J. Doka
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
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or ❑ Non-Residential @ $25 Septic Tank ❑or Cesspool ❑
Application No. ...... Permit No. UQyb
Applicant Name: ?_l�+•)
Applicant Mailing Address: 5 L I 'S PT-
TV
T-V uv- �j
Brief description of Propsed Construction or Alteration: „mwµµv, 1cL _wwnJ HT1✓�
Location of
te-
Owner of Property:rpsed Car ltera tion
Owner Mailing Address: _
Property Address; SAS l
Name and Telephone No.
p of Contact Person: � .. �..� .....� .... � :..�
Tax Map No.: Section (� Block: „ `� Lot:
Nearest Cross Street: , V—'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY' E TH DEPARTMENT APPROVAL.
Siganture of Applicant Date
Received by. q (q(Y
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 09/08/20 Receipt#: 274612
Quantity Transactions Reference Subtotal
1 Septic Permit-Construct- Resid. 4868 $10.00
_,.._ �
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CK#700 $10.00 Doka, Frank & Paula
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Doka, Frank& Paula
755 Lupton Pt Rd
Mattituck, NY 11952
Clerk ID: BONNIED Internal ID:4868
I,
TIE DISTANCES:. TEST HO�LE DATA
No. A B
1. 22.0' 20.0' BROWN SILTY LOAM(OL)
I1.
2-
�A ops I .o' 3s.o,
BROWN LOAMY SILT(SM)
1 ,
LjPFkXK �P TM T SERVIGE6 3. 49.0' 59.0 8 5'
APPROVAL OF T UCT D WORKS FM 4. 43.5' 53.0'
A SWGLE FAMILY R.FR1bSNCt AND DWEWNG CONNECTED PALE BROWN FINE TO COARSE SAND(SP)
l' TO PRIVATE WELL 5. 47.(Y 51.5'
�—4 � 6. 37.0' 22.0'
a jut 3 f d ® too Fw.No. S H STAAR.7J
TERTREA �
� 7. 43.0' 26.5'
_ u
be gWkftckxV FOR 791�AL�
F . —
110'TMOg� ,
_ _ iwta g
7
td TESTHOLE FROM APPROVED
OF AY I V er PLAN SCDHS
15' fi P REF NO.:R70-99-0221
Craig Knepper, P.E., Chief P 9 NO GROUNDWATER ENCOUNTERED
_
OfficTEST HOLE PROVIDED BY SCDHS.
e of +a to rater 0 .rw .
VALVE BOX I LOCATION OF TEST HOLE NOT PROVIDED.
TT�E°rTITTH � �" �
2.34 LF.INFILTRATOR WATER � y, A, `"` SIAM OLPANEL'
TECHNOLOGIES QU O U PLUSST .� 0 ,r �O rdml
INFILTRATOR SEPTIC TANK
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6 10
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131RECEIVED
OF MAY 2,2 2020
EP
Fx WATT
SERVICE SUFr-,CO. F
2ND FLOOR POOL iIDS- lyLOT
1 1
EXISTING WATER
SCDHS REFERENCERID-19-0060
o " 4N4� __ — �
~-_
' SI0 S.C.T. .: DIST. 1000 SEC. 115 BLK.11 LOT. 4.1
771
Plans are prepared by Condon Engineering,P.C. It is a violation of the New York State Ed-IrtTorr,,, Scale:1•=�(1'-0.
DO RESIDENCE
Law,Article 145 n 7209 for an n unless PA
, y perso ess acting under the direction of a licensed �#4"� ��' Engineering,Condon
Professional Engineer,Architect,or Land Surveyor,to after any item in any way.If an item `T — _ A 755 LUPTONS POINT ROAD
the Y Y Y " � WAY Drawn by.JJC 1755 Sigst>ee Road
p� p R' Matfituck,New York 11952 ATTITUCK, NY
LandServe or shah affix t mtheem his/her and notation by'followed b hhislher BOE y (631)298-1986(631)298-2651 fax
Engineer, Y ngEngineer,
s nature and the date of such alterations,and a specific description of the alteration. Date:5/20/2020
'0 www.condonengineering.com SANITARY AS-BUILT