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HomeMy WebLinkAbout5614-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.~16 Date ... ~ Street Braiding Inspectm THIS CERTIFIES that the building located at · Bow Road Map No.~{ur, ekoma '~$tlB~ock No ..... Lot No.. 13 Southo!d conforms substantially to the Application for Building Permit heretofore filed in this office dated . Dal; 18 .. , 1971. pursuant to which Building Permit No. ~611+Z. dated ..... NO¥. ~ .. , 19 75 ', was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P..riy. a.t. 9.9.n.e,. fa.n.$.~7..a.w. 9.1.Z.i.ng ............................. The certificate is issued to J'egr,~ Da~o~ .... 0wnez' ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . UNDERWR. ITERS CERTIFICATE No ~[~ 31916. Juls' 17~ .t972 ...... tlOUSENUMBER ¢~ Street . Bt~d' TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 'BUILDING PERMIT \ (THIS PERMIT MUST BE KEPT ON THE PRF. MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5614 Z Permission is hereby granted to: at premises located at ........... Z~t~...~.~....jJ132~jJjJJll~..~t~J._~ll ....................... .~ ............................... ................................................. j~....~l ............ ~.t~ .......................................................... pursuant to application dated ........................... ~...Ol~.....~J ............. , 19..~[., and approved by the Building Inspector. Fee $...~[~.~ ......... ' Building I nspe/~ ' SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 H.D.Ref. No. $o 9&8 APPLICATION FOR APPROVAL OF INST,!-v.~-n PRIVATE SE~A~E DISPOSAL AND WATER sUPpLY SYSTEH$ InsPection for approval is requeSted, pertinent installation data herewith. 4-Section No. ' §-Lot Nmnber tJ 6-BldS .Permit No.~'& ;& Z Phone 7~-~$$ lO-Cesspools-(a)No.pools ~- (b)Blocke belo~ inlet-l) 2) 3) ,~ ,,. (c)Block size-L, in.~ in.H in. (d)Precaat pool ~ (e)l__2 3__ (f)H__~__ft. · in; Diam ~ fi. o in.(s)Finished srade to cover /-o ft. (h)Backfill Material ll-Water Supply: Public System ; Private Well If Private, the follo~in~ questions are to be anewered: 12-Private Water Supply System installed by *'~J~ ~e,~ ~f&,~,, Phone 13(a)-To~al D~h of Well ~ (b)Dep~h ~o S~a~ic Wa~er L~el l~-Di~e~er of cell pipe ~ . 15-N~e of ~borato~ ~,e,~ 16-Meth~ of Disinfection 17-Date ready for inspection The underaisned CERTIFIES: Above 8yste~ have been constructed and are in compliance with the Suffolk County Health Department's current Standards, Bulletins and Auenduente thereto. ~-~ 18-Date $/~"/~' Sisned / (~ner - Builder 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. STREET Based upon the info~t~n st~te~ above, satisfactor'~ffufl~tioning of the above systems can b~h ~oper maintenance and care. ' .... Chief of Oeneral~ngineering Services S-Se Instructions forSubmixsion of Installed Private Se~aKe Disposal and Water System Application Applications are to be submitted in duplicate. Required information should be typed or legibly printed in ink. Inspectors are not permitted to make inspections of installations until applications have been submitted to and accepted by this de- partment. The ite~ ntmber on the application form ahd item n~nnber listed below are the 1. Owner's name and address - if owner and builder are sane; so indicate. 2. Builder's name and address - approvals viii be mailed to this address. 3. Give name of filed realty subdivision map. Section number of realty subdivision map. 5. Lot number of plot on which disposal unit is constructed. 6. Building permit number assigned by the Building Department. 7. Name of person or firnvho actually constructed the sewage disposal facilities. 8. (a) For example: s/s Jones St., 100' e/o Smith St. (b) Hamlet, (unincorporated area in township), for example: East Moriches. Village (incorporated area), for example: Northport. (c) Township; for example: Brookhaven, etc. O. Give inside length and width in feet. Liquid depth is measured in feet from bottom of outlet pipe to bottom of tank. 10. (a) State number of pools. (b) State number of blocks below inlet pipe for each pool. (c) State length, width, and height of cesspool blocks in inches. (d) Indicate by check if pretest sections are used. (e) Give number of leach- ing sections per pool. (f) Give height end diameter of each leaching section. (g) Give depth in feet from finished grade to cesspool cover., (h) Describe backfill material used. ~1. Indicate by check if water supply is public or private. 12. Name of person or firs who actually installed the water supply facilities. 13. (a) Give depth in feet from top of veil pipe or casing to yell point. (b) Depth in feet from top of veil pipe or CaSing to water level in vel1. Ii. Inside diameter Of well casing. 15. Name of laboratory performing the examinations. 16. Describe method of disinfection, for example: quart of laundry bleach in ten gallons of water poured into veil and alloyed to stand six hours. 17. State date on which installation will be ready for inspection. 18. Application must be signed by builder or owner. Signatures of subcontractor, superintendent, etc., w~ll not be accepted. 19. Indicate location of Water & Sewerage Facilities with accurate dimensions on sketch. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROTAL TO CONSTRUCT PRIVATE S .E~/AGE DISPOSAL SYSTEMS Approval to construct said systems is reqU~sted,pertinent data herewith: Date i-Applicant ~f,,~ ..... ~, ~... Phone ~ ~-v,~, 6-Sub div A~ ..... -~ Address ~ ~' '~ ..... J '? ~' ~ ?-Section 2-Detailedp~ro~rtylocation *~'¢~' * ~ .... ; ~' ~ ~''~ 8-Lot No. Hamlet £~ '~ Town ~ '~ ....... 9-Private well? 3-Pmblic ~ter supply name --' Distance to nearest main S-Lot Size: Width ~ ft. Length ~ ft. (also enter on center plot plan below:) ~-Dwelling: Single Family ~ ~ Two Family? ~ ~ Cellar? ~. ~ Slab? ~ I Crawl Space? 10-Proposed system: Septic ~ank ~Precast~'~_~Cesspools ~Shallow pools ~_~Other il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth__ft. 12-Precast sections: ~Number~Square Ft. Cesspools: Block sizeL incs.D ins. H~ins. Total blocks below inlet: ~1 ~2 PLOT PLAN Capacity ~Gals. G.P.M. ~ ~ W.L. O The Undersigned CERTIFIES: I e NoPth ~ 2 = 6 ~' 8 10 12 18 "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Syst?s". Date '~/'~'/" Signed ~/~ j~'~ ' ........... '~ ~wner or Builder FOR HEALTH DEPART~NT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. 8-15 APPLICATION FOR APPROVAL TO CONST~JCT PRIVATE SEWAGE DISPOSAL. SYSTEM~ INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-Enter name of Publid Water Supply District, together with the distance to their main. 4-Enter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the face of this application. ~-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number ~-.Lot N,,mber 9-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, 11, & 12 please consult the Suffolk County Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " " " " " " Septic Tanks Part IV " " " " " " Unusual soil conditions Part V " " " " " " Shallow Leaching Pools PIOT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be indicated at the Lot line~ of the heavy lined square in the center of Plot Plan shown on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located ~ithin a distance of ~0 feet of Applicant's Lot lines, must be sho.~n on the plot plan also. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance to the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots, state '~acant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LGCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-lO0 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-10 feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-40 feet minimum into ground water for well point Well-4 feet 6 ins. minimum below grade to well head and lateral water pipe CESSPOOLS DOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-10 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet minimum distance from nearest water line Cesspool "Center" must be t5 feet from house foundation Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams, Lakes & Bays, etc. Cesspools must be 20 feet minimum distance from large trees Cesspool center to Cesspool center must be at least 16 feet Cesspool cover top to grade must be held to minimum of 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot CASOLA WELL DRILLERS 1408 MONTAUK HIGHWAY · MASTIC, L I, N.Y., 11950 Telephone' 281-5454 (Area Code 516) February 22, 1973 To~n of Southold Building Inspector Main Street Southold, N.Y. 11971 Sie~ond Homes Job: Dawson Located: n/s Bow Rd. Opp. Tee Pee Trail Nummokumo Waters~ Southold, N.Y. Dear Sir: This is to certify that the "Captive Air" well X-trol (Tank), install ed at the above job, is a typical and acceptable installation for domestic water supply. It is a vast improvement over the conventio~l tank a~ it el~uates ~waterlogging', the major cause of pump failure. The only reason it is not used on all installations is its higher cost. Sincerely, CASOLA I~ELL D~'I'T,T~ Robert F. Casola RF¢/dcn Z-fO, O TOWN OF SOUTHOLD ~/"//~ 2-- {~'a~ BUILDING DEPARTMENT ~r>n I c~ ~/~--' * Approved ~ 19 ........ Pemit No ........... ~..7. .................... ~,, .... , 9,j/g- ~V//% '~., APPLICATION FOR BUILDING PEBMIT 150'/- ~/ V /4 2.-' ~0 ....... ~ ~.~ October 18 . 19 71 a. This application mths~ I~Lc4~c~etely filled in by typewriter or in ink and submitted in duplicate to ti~e Building b. Plot plan showing ocation of at and of bud ngs on premises, re ahonsn p to aalo n ng prem ses or puallc streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ .e~l~x~l,..~t~t~t~t .......................................................................................................................... ; .... Name of owner of premisis .;.{...m~.e.J~.~ll.~Al',.:l~"J~J~t1~l~e~lgR-~J".,..]~JiNll~r.~l~e~'.'~'t'~ ................................................. ~ If applicant is a corporate, signature of duly authorized officer. ~,X~, .................. ......... · 1. Location of land on which proposed work will be done· Map No.: ...5..~..Z..6. ........ ..~ ............... ,.. Lot No. ,Z..3. .................... Street and Number JJ~.~..~.J~..~,ll~J.....~-~-~.?..a.~.-~..e..~.~,.~T~;'3' ........... ~i'~1~'1;]~'1'R1' ....................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed Canstructian: a. Exisiting use and occupancy ................................................................................................ ':' ............................... b. Intended use and occupancy ........... ..O~...~....~..n..~..~..1.~.....j~-.--.1..~...:~.~ ............................................................................... 3. Nature of work (check which applicable): New Building ..... ~ .......... Addition .................. Alteration .................. Repair .................. Rem~v~ ........ :...~p~,~ ~emolitior' .................. Other Work (Describe) ........................................ 4. Estimated Cost ................. ~..'. .................. ~L~ .................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ..0~...e. ............... Number of dwelling units on each floor ..... .0~...e. ................. If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front'. ........................... Rear ................................ Depth .................... Height ........................ Number of Stories ......................................................................................... i ....................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories 8. Dimensions of entire new construction: Front ....~J~). ........................Rear .....~..~..I} ................ Depth ....3....(~... ............. Height ....... ~...0..-~. ..... Numbe, r of Stories ........ ..~..~...~ ................... 9. Size of lot: Front . . ..[. .2. ,8.: 5. ~ ............. Rear ....2.../1~..:..0.~ ..................... Depth ...9...9.~.9..[. .................. 10. Date of Purchase .............[..9..7..0. .................................... Name of Former Owner ........................................................ 11 :. Zone or use district in which premises are situated .......... ~11..,~. .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.q ...................... 13. Name of Owner of premises ...~.navsoa ............ Address zg..~ezb,'oo~.Ra~..l~cmie~Phone No. 9~.4.-.,~5~.-..?.793 Name of Architect ...................................................... Address ............................................ Phone No ..................... ~lame of Contractor ........ &ahaL.~...S:Le~mmcl ............ Address ..~:m~'a~.Z~.~l:~..,~a~lphone No. 7~...*~,c)~, .... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner at STATE OF N~ Y~R~ I- - ~ COUN~ OF ....,~,..~.~,.,.,..~ .......... ~ . ~ .. ......... -- ' ................................................................ ~ng au~y ~orn, d~o~s and says t~¢ he is the applicant (Nome of individual signing opplicat on),~ above named. He is the C~t~aet~ ..........................................................................................~ ................ ................................. (~ntmctor, ag~t, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke ond file this application; that all statements contoin~ in this application am t~ to the best of his knowledge and belief; ond tha~ the ~rk will be performed in the manner ~t fo~h in the ~plicatim fil~ therewith. Sworn to ~fore me this 18c~ 0 be~ 71 ........................ doy of ..... ~[e .............................. ]9 ........ ~ /~/ c F - ' ........ ..................... N~o~ Pu~~.~=5~~ ...... ~. Coun~ / /(S o~oture n~ nnn ~.*~ ................... // WALTER E, ZALESKI ..... ~ ....... ~ ~ NOTARY PUBLIC, STAT~ C? ~!~W YORK Residing in SuffoJk Country No. ~2-4378200 Co~[ssion ~pire~ ~rc~ 30, 19~ L $~CT~,ON r*a~ ££$,£06MZ SECT/e^/