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ELIZABETH A.NEVILLE,NIlVIC Town Hall,53095 Main Road
TOWN CLERKfJ P.O.Box 1179
r � J Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ���� �( s"� Fax(631)765-6145
MARRIAGE OFFICER S Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �"' �` ' www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER .;, „ •
X
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: August 30, 2021
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 5061 for a Cesspool/Septic Tank Construction
Permit submitted by:
Bryan Nicholson for John & Linda Sh.ivickas.
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
uirc
c rtment
Comments: Final approval rmme q � � from the Suffolk C„ounty Health Depa_ �m_ITITIT
Signature
Dated
F0a
ELIZABETH A.NEVILLE w, �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
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
,� 1
Residential @$10 or Non-Residential @$25 Application No. b
Permit No.
Applicant Narnc t
5( �
..
Applicant Mailing Address
Septic Tad<:
or Cesspool
Brief Description,of Proposed Construction or Altration..— � �
� " ..,.� a i
Location of Proposed Construction/Alteration:
Owner of Pr:�oper~ty+:.. � l 1,
Owner Mailing Address:-----L7. .
Owner Property Address,___
Name and phone number of contact person
l a
Tax Map o: 1000 Section .... lock ............. ...... Lot _.. ._.
Cross Street
N LOCATION MAP MUST BE SUBMITTEDIAPPLICATION. NEW
CONSTRUCTION SVE 1111 HEALTH T APPROVAL
Signature of A pfican.t Date
Received by: �... ...
sl . II" 100� Ng LOTS): 3
Cleanout must be installed on the
septic tank inlet waste line. All utilities
IRWr.7 �� � NT -, I -A require a 5ft minimum separation to
MGM Y RES39N=ONLYthe septic system.
31A nt NOTE CHANGE(S�
AP -s by Dept. of Health Services
I .
FR T_f�� �A D L r: 11)� � ;t:'v, L PROPOSED
LAND N/F OF 4 BEDROOM SYSTEM
1250 GAL. S.T.
- I" W/PUBLIC WATER PANAGIO7IS RODAIS (2)8x6'DEEP L.P.
150' 1
®SO'SUI 100.00 gELG. BLi . CuR i
g.
N 84SHEI i � � ' UINYI ALON , LNE 5 EL 11.9 1
MIN I
PI
I 0.4,x`, .���--��SILT FENCE CELLAR o (12.5) 1 �
0.3E l EL 12,3 ENT_ c
I l !it t � 0 DWELLINGS
DWELLINGS z _ '0 MIN 7 ��pp5` BLIC WATER
35.0' /12.5) 30, ' �.rYt iN 4 i W/PU
/PUBLIC WATER 12 COVERED z : ' 1 150'
150' o = PRC
44 -� X6� ro 1
1 , ' i 0SE0 i 0
1 1 PROPOSED SOIL �Y•j//{' z }}
STOCK PILE AREA 1 STY RAh�E V Z m` 1
LANA N/F OF '® ? DSV 'LIQ GP
1 ? DEDOOF� 1 tz`M!N r n i
E
CANDACE KUR7Z 1 FF L;, } = z
SILT FENCE ALONG 35.E 1
PROPOSED LIMIT
i- 1 (1 C 5 EXP t l
OF DISTURBANCE ,4 t I 1I
EL 11.7 / 6600 S.F.t I z I[ 1
(12.5) 11 3 11 �=
Y C OSED EL 1i ® i 1 PROPOSED r
E TVEWAY 44tL1 STAGING APEA
AND CONSTRUCTION
'Iv t 1 I ENTRANCE VACANT
LDRY 165'
WELL/ � � 1
6,y no r `o
„ ',-• 1 1
DWELLINGS "'
W/PUBLIC WATER QT\ SERtC t
150 LAND N/F OF - — — 4
l MARK LUPARDI
�-FLi 14.0; 1 f EL 1 1.4
12.5) GRADE i 2.51 CONCRETE WASH OUT AREA 111 ' '
IN BED OF PROPOSED DRIVEWAY. �9i t
(10.51) (10.31, 1250 (11.0) Plr
S.T. ('9'81)(9.67DWELLING
t 8'0x6' " i W'PUI LIC WATER
L.P. , X00,
(5.0) U.P. f
HIGHEST WATER 2.0 / j
SCR EN SE{�Tlvi •
TYPICAL CLEAN OUT
ELEV. 11.3
%PPca�:' � SLATE OR - STOPPER END
f Baa o� �` SUITABLE C0V_ER OR PLUG OL f BROWN
SANDY LOAM 0.5'
DRAINAGE CALCULATIONS s
BROWN
SM OAMY SAND,
1.7
L< g ,
30' ELBOW A} DWELLING F00"PR 4 E�,,
SQ.Fi.
960 x O 16L COct' REQ. —
�ti
I� = BROWN
' WYE
L e) ORI aY=34o sQ.Fr. SP MEDIUM 3 3.3'
60
340 x 0.166= 57cf REQ. D
FLOW
217 OF TOTAL REQ.
# =Ls '7`0 PRJ .OED l
PALE g
TYPICAL DRYWELL CROSS SE 'ON,, V MEDIUM
(CONC. PRECAST COMMON TS) 'RyfamD 4.9'
S'SUW IN•® - a
,'�uw WATER
/SLAB FM TMFFIC SEARM EL 0.9
VPEP .4• ft f M, APPRMM)"17 PFE — MASE To 4 HIGHEST EXP. EL 2.0
EQT SEDIMENT UN sl MCHM s . � m a/8-/V SW IN
6.0'
I tL FENCING L D/oR ® � ❑ ❑ MEDIUM —
ILT [ SAND
' ❑ ❑ ❑ DIf [ 16.4
s f
I JUNE 17, 2021
K. WOYCHUK LS
NON-CONFORMING LOT
FRONT YARD: 35 MIN
EMMICE- FOUNDATION OF COMPACTED REAR YARD: 35'MIN
STONE
BLEND OR N.Y. STATE D.O.T. APPROVED R.cn SIDE YARD: 10'M I N 25'TOTAL
'.
Flu To 18'(Mm.)ABOVE EXISTING GRADE FOR DRAINAGE.
I
3' MIN. ___� 8' -•--�...-
DOLIAR BACK FILL MATERIAL TO BE THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL
�
CLEAN SAND AND GRAVEL f LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
AND OR DATA OBTAINED FROM OTHERS.
AREA: 6,659.96 S .FT. or 0.15 ACRES ELEVATION DATUM. NAVD88
- - - - -
UNAUTHORIZED ALTERA77ON OR ADDITION TO THIS SURVEY IS A WOLA77ON OF SECT70N 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INST77UT70N, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THEI PROPERTY LINES OR TO GUIDE THE ERE077ON OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRU URE.S CORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
FSURVEY OF: DESCRIBED PROPE'PTY CERTIFIED TO: BRYAN NICHOLSON;
MAP OF:
FILED: ]
SITUATED AT: GREENPORT
TOWN OF: SOUTHOLD ' -
KENNETH M WOYCHLTK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK_ Professional Land Surveying and Design
= - P.O. Box 153 Aquebogue, New York 11931
FILE #221 -100 SCALE: 1 "=20' ®ATE: JUNE 8, 2021 PHONE (831)298-1588 FAX (631) 298-1588
N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk