HomeMy WebLinkAbout30444-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31309 Date: 11/30/05
THIS CERTIFIES that the building ALTERATIONS
Location of Property: THE GLOAMING FISHERS ISLAND
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 10 Block 9 Lot 9
Subdivision Filed Map No. Lot NO_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 14, 2004 pursuant to which
Building Permit No. 30444-Z dated JUNE 25, 2004
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JOSEPH & LAURA KADDIS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1199951 11/28/05
PLUMBERS CERTIFICATION DATED 11/22/05 RICHARD G. AHMAN
s
)utj oriz d Signature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses:
1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic
features.
2. A properly completed application and a consent to inspect signed by the applicant.If a Certificate of Occupancy
is denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.06.Alterations to dwelling$25.00
Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$ messes 00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$25.00
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00,Commercial $15.00
Date.
New Construction: Old or Pre-existing Building: ,/6r ec ne)
Location of Property: -A I. V —
House No. &-0/Z?
Streett S Hamlet
Owner or Owners of Property: ( L /`t �Q6av
Suffolk County Tax Map No 1000, Section_ Block Lot
Subdivision Filed Map. -� Lot: �l
Permit No. O �Date of Permit Z.j Applicant:
,,tt �'
Health Dept.Approval: [ Underwriters Approval:
Planning Board Approval:.,,.__
Request for: Temporary Certificate_ Final Certificate: (check one)
Fee Submitted: $
Appli t Signature
3sy
Cc 3[307
O ffl3rL3rd32PLrL3WLPCJrrJ�J�rJ@PcP rJ r�rncP�rJ�r1rJ�rJ�r��Pr1rJ�rJ�cnrlrJ�rlcPrJ�rJ�rJrJ�rJrJ�rJ�rJrJ�rJ�rJrJ�rJcPrJ�r�rJ�rJ�rJ�r I�rJ�c P co
[5, BY THIS CE=RTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038 5
5 CERTIFIES THAT c5
5 Upon the application of upon premises owned by
5 WALSH SERVICE JOE KADDIS 5
5 P.O. BOX 325 GLOAMING ROAD �5
5 FISHERS ISLAND, NY 06390, FISHERS ISLAND, NY 06390 5
5 5
Located at GLOAMING ROAD FISHERS ISLAND, NY 06390
Application Number: 1199951 Certificate Number: 1199951 ��5
5 Section: Block: Lot: Building Permit: BDC: ns11 rrrr+++1
C1 Described as a Residential occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: 5
cCC.—I Basement,First Floor, Second Floor,total re-model,Outside, e�
�j A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
5 herein, was conducted in accordance with the requirements of the applicable code and/or standard
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5
5 authority having jurisdiction, and found to be in compliance therewith on the 28th Day of November,2005. 5
5 Name QTY Rate Rating Circuit Tyne C5
Alarm and Emergency Equipment C�
5 Sensor 4 0 Smoke S
Appliances and Accessories [�
5 Exhaust Fan 2 0 F.H.P.
Furnace 1 0 Oil 5
5 Wiring and Devices 5
Cj Receptacle 22 0 General Purpose
C Switch 26 0 General Purpose 5
5 rj Fixture 29 0 Incandescent
Paddle Fan 4 0 5
5 Receptacle 8 0 GFCI
5 Receptacle 1 0 30 amp Dryer 5
5 Receptacle 1 0 50 amp Range I
5 Service 5I Phase 3W Service Rating 100 AmperesService Disconnect: 1 100 cbMeters: 1 seal
Continued on Next Page 1 of 2This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.O cP rPrJ�rJr��PcPPr� J�J@P P lJJf�
O s r1� tldJ cPrJ�rJ�rJrJ�r1rJ�rJ�rJr03o
5 BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038 CC5
5 CERTIFIES THAT
5 Upon the application of upon premises owned by .1C
5 WALSH SERVICE JOE KADDIS 5
5 P.O. BOX 325 GLOAMING ROAD S
FISHERS ISLAND, NY 06390, FISHERS ISLAND, NY 06390 5
5 Located at GLOAMING ROAD FISHERS ISLAND, NY 06390 5
c� Application Number: 1199951 Certificate Number: 1199951
Section: Block: Lot: Building Permit: BDC: ns11C1
5 5 Described as a Residential occupancy, wherein the premises electrical system consisting of 5
electrical devices and wiring, described below, located in/on the premises at: 5
5 Basement,First Floor, Second Floor,total re-model,Outside,
C55 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
, herein, was conducted in accordance with the requirements of the applicable code and/or standard 5
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5
5 5 authority having jurisdiction, and found to be in compliance therewith on the Day of 5
28th November,2005. CD
5 Name OTTY Rate Ratine Circuit Type 5
5 5
5 5
5 5
5 5
5 5
5 5
5 seal 5
5 2 of 2 5
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5 5
�� v
Taves Haul 53095 Usk Road M� Fax(631)766.18]3
P.O.Box Tekppas(631)7661861
SatsLold,Nsw Yorkk t 11 1971•(Ndyi
Bt1ILDWO]WARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: 124- I o!5
119 / L11
Building Permit No. v
Owner: JA5fA� X AArj_
r—I (please print)
Plumber: ,CYyc, G. ayvta111
(please print)
I certify that the solder used in the water supply system contains less than 2/10 of I%lead.
(Plumbers Signature)
Sworn to before me this
day of N2U/`u , 20 D—C—
r jr 4�11
NotaryPublic, County
ROXAN No. SPAULDIN,G
NOTARY 11, 1 NEW
YORK
01P11394S6
UIIAI If II IriN SUI 101 K COUNIV
N1'CUAIMI:<SION 1 XI'INI.S AUG.4,LU*
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 30444 Z Date JUNE 25, 2004
Permission is hereby granted to :
N OLIVIERI (KADDIS)
FISHERS ISLAND,NY 06390
for
ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at THE GLOAMING FISHERS ISLAND
County Tax Map No. 473889 Section 010 Block 0009 Lot No. 009
pursuant to application dated JUNE 14 , 2004 and approved by the
Building Inspector to expire on DECEMBER 25, 2005 .
Fee $ 360 . 30
Authorized Signature
ORIGINAL
Rev. 5/8/02
11/30/2005 09:28 FAX 631 788 7798
FITELEPRONE 2002
FIELD INSMCTromDAn COTDVUNTB
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INSULATIONPERN-Y.
STAIR LNER4Y CODE
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V6/25/2004 10:17 2034264920
Jsm ASSOCIATES PAGE 01
Permit Number
RESckeek Compliance Certificate CheckedBy/Date
New York State Energy Conservation Construction Code
BFScheckSoftware Version 3.6 Release 1
Data Mmame:Untitledsck
PROrCT MIM Kaddis Residence
COUNTY:Suffolk
STATE:New York
HDD:5750
CONSTRUCTION TYPE:Detached 1 or 2 Family
WINDOW/WALL RATIO:0.09
DATE.06/25/04
DATE OF PLANS:June 9,2004
PROJECT DESCRIPTION;
Joseph Kaddis Residence
Fisher's Island.New Yak
DMIGNER/CONfRACTM
Jobm S.Madmila, Architect
20 The Boulevard
Newtown,CT 06470
CONOVANCE.Passes
Maximum VA.=240
Yew Hoare UA r 204
15.01/4 24tex'Than Code((JA)
Gross Glazing
Area or Cavity Coat or Door
Periffiew R-Vahje R Vahia IJa 1TA
Ceiling 1:Flat Ceiling or Scissor Thus 513 30.0 0.0 18
Wa111:Wood Frame, 16"o c. 1450 15.0 0.0 102
Window 1:Wood Frame:Double Pane whit Low•E 41 0.490 20
Door 1:Glass 88 0.330 29
Floor 1:All-Wood JoisNlhns:Over UncmdJamed Space 486 11.0 0.0 35
Boller 1:Other(ExmprGas,Flred Steam),95 AFM
CONOVANCM STATEMMS P: The proposed building repzawAd in this dommie m is cansiami with the building
phone,Specifications,and other calwlatiaos submitted with this permit application. The propored syneams here bees
405101rd m mea the NeW Yak SM Eaagy Conservation Construction Cade requirements. Wben a Registered Design
Professional has stamped and sigaW this page,they ere ax.,-ting that to the best of bislherlmovi all beHd ad
"06/25/2004 10:17 2034264920 JSM ASSOCIATES PAGE 02
professional judgncnt,sswh4�pLo Is1 or speaficadws are in compliance wlth this Co¢e.
Builder/DWO ) ► EN fes( Bate Z�
a a
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F 0 NEVJ
06/25/2004 09:15 2034264920 JSM ASSOCIATES PAGE 06
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET ( VILLAGE DISTRICT SUB. LOT
IV
c 7l ei L G w. , V, / s A e Y ,L/)e S�
FORMER OWNER N E /' ACREAGE
G�,e /CjZ d �e c�h't�f ¢ -4444 0`"7
S W TYPE OF BUILDING
RES. SEAS. .? VL. •.1�� FARM CO". IND. CB. I MISC.
LAND IMP. TOTAL DATE REMARKS
SOU 4-0 0 a z/ ---
500 /loo ,Z//00 3 4
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
Farm Acre Value Per Acre Value
Tillable 1
Tillable 2
Tillable, 3
Woodland
Swampland
Brushlandv
House Plot
Total
fir, •�,�' .� �• ■■�■�I■■■■ I ■■
■■ N■■■■ ■
■ nn ■■■■ ■
FoundationBoth
FloorsExtension Basement ="LL-
• • . r
Extension Fire Place Heat
C)
_ Porch'
Porch Rooms 1st Floor
Breezeway Patio Rooms 2nd Floor
Garage
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a
BUILDINGPEPARTMENT Do you have or need the following, before applvini
TOWN HALL Board of Health
SOUTH ,V 11971 3 sets of Building Plans
TEL: 765-1$u3 Survey_
PERMIT NO. Check
Septic Form
N.Y.S.D
Trustees_ _
Examined, 20 (/1' Contact:
Approved �, 20(2Y Mail to:----
Disapproved
o:_ _Disapproved a/c
_-y Q Phone---
Building
honey -Building Inspector
A APPLICATION FOR BUILDING PERMIT
`l
Date ZTvNE 8 ')0
INSTRUCTIONS
— ------------
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and waterways.
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 a permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupar
is issued 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, and to admit
authorized inspectors on premises and in building for necessary inspections.
C4 M 13Cb -i
(Signature of applicant or name, if a corporation)
}moo t3ok '7o8 F19M- S-15" NY
(Mailing address of applicant) 00,370
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises SCsk PI KRDDt S
(as on the tax roll or latest deed)
If applicant is a corporation, sign of duly authorized officer
Ow0,;;. 2 C'A ren au .4--
(Name
(Name and title of corporate officer)
Builders License No.—9 5', 5-1
—r
Plumbers License No.
Electricians License No. AIS O S- E
tither Trade's License No.
1. Location of land on which proposed work will be done:
6LOA1 IQ&— F+CPis -rS(NJ D Sc> 0r"C)
House Number Street - -ry-' Hamlet
County Tax Map No. 1000 Section - - Block --7— Lot
Subdivision_ Filed Map No. Lot
(Name) 110 9
eAI, L,iis use atiu occupancy or premises and intended use and occupancy of proposed construction:
a. Existing uge and occupancy 1'
[ b. )Intended use and occupancy AL :y )
i. Nature`61.4rk (check which applicable): New Building Addition Alteratio
Repair Removal Demolition Other Work
(Description)
1. Estimated Cost Fee
(to be paid on filing this application)
I£dwelling, number of dwelling units_ Number of dwelling units on each floor
If garage, number of cars
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front a S Rear oZ8 Depth
Height �P�y i Number of Stories ,Q
Dimensions of same structure with alterations or additions; Front <A ,4 Rear
Depth Height Number of Stories
Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
Size of lot: Front Rear Depth
0. Date of Purchase Name of Former Owner
1. Zone or use district in which premises are situated FF51 DFnI TA L
2. Does proposed construction violate any zoning law, ordinance or regulation: ►J O
3. Will lot be re-graded W> s _Will excess fill be removed from premises: YES NO
� w i L"&) c.T 0/0m?
4. Names of0wnerofpremisesTOsF&Z A.ADDIS 4ddress_Y57k1w30)2L>V9y Phone No. Q03— ?03-3�l �
Name of Architect ff� `T-AT&ess 003-4'�6 79 Y3 Phone No
Name of Contractor L"t• Wl Address Po $ox 7� Phone No, N 61 —'?ql —00rr5HCps t L"d
5. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIItED
i. Provide survey, to scale, with accurate foundation plan and distances to property lines.
If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
-ATE OF NEW YORK)
)LINTY OFsO-Q�JA�,.
'i 4— (C( C�.r t—�`—� being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
yHe is the C4 M pu)
(Contractor, Agent, Corporate Officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
it all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
rformed in the manner set forth in the application filed therewith.
onto before me this
Notary Public Signature of Applicant
VERONICA HAMILMN
NOTARY PUSUO
STATE OF NEW VONT(
NO. OINA0007M
QUALIFIED IN su
TERM EXPIRE&.. 0
i
WAST E
HARBOR �
LOCKING CASTING r CO O)
TO GRADE PROPOSED GRACE U O
ENDCAP TYPE a a U
LEVELING DEVICES
t r-�
MIN. 4' 4
2" MIN. ABOVE INIEf 1.4 M
OUTIET INVERT2" MIN.
0 4 $ v
}a m
BANTLE REQUIRED •� L'
IF INLET PITCH EXCEEDSH' 0
1/2" PER FOOT 0
TYPICAL DISTRIBUTION BOX 6 •� y w°� Z m
NOT TO SCALE
W ��
EDU
I U � N
KNOCKOUT INLET AND
I OUTLET OPENINGS
�=2v4T I RIBS INSIDE
y
ENIF o LOCATION MAP SCALE 1 "=400'
SUZANNE & FREDERICK I + +
BANCROFT I
MUNICIPAL WATER I
s62oBo0k ON SITE SEPTIC SYSTEM I I cnsT
S I
IRON CONCRETE COVERS
PIPE tilt/ ry �y�� 201v I
s� y4 a 5 I PLAN
'37,6p)� 9N I I j ) COVER LOCKING CASTING `
/pF SECOND RIGHT 3 i J I TFO DROP
RRADE7 TO GRACE
N/F / OF WAY PER I
SUZANNE & FREDERICK /p0� REFERENCE DEED a I I IS USED FINISHED GRADE
fy I I E CHIMNEY
BANCROFT 4 POLE 4 x 4 12.6/12.6 A. WI E MESH
MUNICIPAL WATER p°• x42s I a x 2 n s x 6 6/6 G wIR MESH
A O q.� I I I min. 20 6" TEST HOLF„09A
ON SITE SEPTIC SYSTEM =���� BENCHMARK �C/t 16.5 i I I m BY R. STRIUSE P.E.,L.S,
TOP OF HUB/TACK I ( I INLET a' vENr�x 3^ vENr� OUTLET
0"-10" 'OPSOIL
ELEVATION = 18.68 LIQUID LEVEL 10"-22 518501E
I I o ET
CONTINUOUS HOT I OAFRIE 1_ 22"-11' VD. COMP. SANDY TILL
I I ASPHALT SEAL LINED WITH
4" SCHEDULE x4 1/E" mj N'TER ® 10,T
B
M.S. Al I 1 4 INLET BAFFLE 60' GAS
.1 DERECTOR Y
(BURIED) s l f 3 i g i I I ) MAP REFEIFNf`FR
PROPOSED � a I ' 1. SURVFI PAP PROPERTY TO BE CONVEYED TO JOSEPH KADDIS; THE '^
N N O,\ I 4 5 -6 )
0' D0. x 4' DEEP IST ow r^V I I I 3" GLOAMING; ISHERS ISLAND, NEW YORK; CME ASSOCIATES; NORWICH, CT,; DATE:
LEACHM POOLS ,'+% FlRST RICHT f "1 I i CROSS SECTION 0
11/OB/2f03; SCALE: 1"=2O"; SHEET 1 OF 1 �
//�/L�\' TEST OF WAY PER
\ / � HOLE REFERENCE DEED\ m ?' N/F I
PRaPosm �o' I ELSA H. RI`/ERS 1 I 1000 GALLON - o ZI
' 10M ; ta' -... I_... . ._i -' HMQffSI Z %e
'D'
Y Z
\
PROPOSED DBI5� I / ��/ —^SEP clTANK o I - 2 COMPARTMENT
/ SEPTIC TANK I I ; SEPTIC TANK 1.) THIS S':RVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED 0- p
,. ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED 70 S
pp / b mo 1 NOT TO SCALE LIJ
I BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE H Q
ENGAGEMENT. I,0j w t/1
EXPANSION "' W I TI _
IF NECESSARY 1 / \ I I 2.) IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS a w ~
\ n o I ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN w
BUILDING SETBACK LINE �. £ W i I ITEM IN MY WAY. O
\\m. 225 PROPOSED WATER I i 3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S L`
EXISTING n`� a SERVICE I I 24' SIGNATURI AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF
\ HOUSE AS `1,21] `"- PRDP0 0 _ 1 THE LANC SURVEYOR.
UTIBURIED
o �1 4.) COOFDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC
4" DIA, KNOCKOUTS SURVEY RIANGULATION STATION "PROS"
2019A �a, / � I o a o v 5.) SITES IN THE TOWN OF SOUTHOLO, COUNTY OF SUFFOLK TAX MAP 1000,
N/F IRON i O� / 120.40 G/W POLE
< SECTIONDIO, BLOCK 9, LOT 9.
KEVIN WATERHOUSEPIN ; 26'00' W G/W x44,2'R 4
\ MUNICIPAL WATER (END.) a6 : � ��°�- " 8 0, o� 6.) TOTA AREA = 0.373 ACRES.
\ ON SITE SEPTIC SYSTEM a � °� POLE EDGE OF PAVEMENT �,,' I _z 7.) SITEIS LOCATED IN R-40 ZONE.
/ I x440 x' I6.I 3 I ;n 8.) APP.ICANT: JOSEPH KADDIS
I
O/A
O/W---STONE WALL 195 _� EC : • .. ��W< -� 9.) SI7f IS SERVICED BY MUNICIPAL WATER AND ON SITE SEWAGE DISPOSAL
J� 4' 3 HIGH THE GLOAMING EXPECTED HIGH GROUND WATER SYSTEM N Z
POLE _ �- LEACHING POOL 10.) BASTE FOR LEVELS; NGVD 1929. Z 0
1439 _ �� CROSS SECTION O m
_- NOT TO SCALE _ m
_-� GO
_ N 1212.28 w W
W 0.65
a
0
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eo ,.pD H,gTR 0
v� O 'er
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1
FrFNQ 1 Q vagi
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BUILDING SETBACK LINE PT`s m m
vi ui n
170 INVERT ELEVATION - C3 I c=' I
THY/ TEST HOLE O p o o
Y' F- Z W W ILL
Y V
0 O W Ll
O W m D
a m o 0 v v Ii
DATE: 04/05/2004
RETAIN STORE l Wq--�
PURSUANT TO FEc r 1, SCALE; 1 ° = 20'
QUALITY CONTROL CERTIFICATION OF THE TOWN
CROUP REVEWED I DATE
PROJECT MANAGER q.u,o
sul, 20 10 0 20 SHEET
ENVIRONMENTAL GRAPHIC SCALE IN FEET 1 OF 1
CIVIL ./
STRULIDRAL
ARCHITECTURAL
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Applicant/ Date.
Owners Nalne: J i , ✓r y i n • e Reviewed:
Architect/ Date
Engineer: Submitted
SCTM #:
District: 1.000 Section /^: 0 13Iock: Lot:
Project y�l(,�„t�,,�� Subdivision
Location __--- _ Name:
Sin & separate Required
certification: I Yes f No
AD—oReq. ( Req.
I_rniing District: (I of size: 0 CN?7 Aclual: I (Io(cuveraS a
Req.
rolxsed
(F=ront Yard Proposed: (SideYard 1'ro s Req.
Po J (Rear Yard Proposed 1
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Project Description:
AGENCIJV RMITS Permit
�ZUIRED FOR REVIEW N.A. NO ( Numb
Suffolk County Health Dept.
New York State D. E. C. .�
Town Trustees
Town Zoning Board approval:
Town Planning Board approval: ✓ /
Flood Plane Elevation???
Flood Zone: y+9
Notes: _.
•