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Home My WebLink AboutKelleher ELIZABETH A. NEVILLE,MMC ` fin ' d Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 uz 1 Y Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 05f t' Fax(631)765-6145 MARRIAGE OFFICER �o Telephone(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: September 23, 2021 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 5068 for a Cesspool/Septic Tank Construction Permit submitted by: Robert Brown for Terence Kelleher. 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 ppro q .m County Health l l� Comments: Final a royal re u�red from thee,llolk Signature ...._..... ...�.,. Date... �,_ _ ...,, Dated NJ ELIZABETH A. NEVILLE Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 W ' Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (631) 765-6145 MARRIAGE OFFICER 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 508 Residential @ $10 or Non-Residential @$25 Application No. Permit No. Applicant Name .. _ . f dress- A licant Mallin Ad .° �� _ .. .. tioh of Proposed posed C.. � n or Alto-at Septic Tk or Cess ool Brief D scri p � p Construction oll Location of Proposed Consti1iction/Alt atiola: Owner of Property: „ � Owner Mailing Address: � . ._,�' '�„ ..... .._.� Owner Property Address, 1,49 7 , Name and phone number of contact person '"` m� . ' Tax Map No: Section BlockLot �,S .... r Cross Street �� •� ''°` �� . a, `� NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY NII' 11 EA1-J'JJ DEPARTMENT APPROVAL . .... . . i aatuaY `of l a� t Date Received by: COUNTY OF SUFFOLK a, STEVEN BELLONE SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES GREGSON H. PIGOTT, MD, MPH Commissioner PERMIT CONDITIONS Project Name: 1075 Clipper Dr. Health Services Reference#: R-21-2326 SCTM #: 1000079000400017005 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, or through the ACA Portal at hftp ://aa-pr cP[a. can/SUFFQL CO. 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 Vl/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: 1075 Clipper Dr. Health Services Reference #: R-21-2326 SCTM #: 1000079000400017005 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). 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. 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) -Water analysis by a NYS certified laboratory (performed within one year) {After 6/21/20221 WWM-016 Page 2 of 2 COUNTY OF SUFFOLK STEVEN BELLONE SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES GREGSON H. PIGOTT, MD, MPH Commissioner r RMIT CONDITIONS Project Name: 1075 Clipper Dr. Health Services Reference #: R-21-2326 SCTM #: 1000079000400017005 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, or through the ACA Portal at httpa.:,�a; -p o�cce1a.con7iSUFl-OLI CO. 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 V11 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: 1075 Clipper Dr. Health Services Reference #: R-21-2326 SCTM #: 1000079000400017005 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). 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. 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) -Water analysis by a NYS certified laboratory (performed within one year) {After 6/21/20221 WWM-016 Page 2 of 2 �r I, 114 is II` k 2�s { \` V [_ 24,92 2x.62 _..�...,,.. �., � . „_..._ � ....�-._.,. _„ti _..� ,�S T,3.�'s p• _ E 102.72� �. 5 o �_._ y� .�.^v ""' 21 �'. N _ 26.e _. �. ......._ "' is AI'111 , ,P��i �' r,,;i.;r d q� f Ar ami p x 2.2.2 "^...,,,. 4�.T��" r',b'i.A'w'e(�i Ilal: LO 23.k ..� ..a2 k P ......�. 2C7 Yd"6 P 3 n .�. _ �� ° 2&0 2�4 r, __&'_,f �,.,.,.-' - ,,,:- s6.r^ ,.. 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