HomeMy WebLinkAboutMatejla, Jerry & Linda
ELIZABETH A. NEVILLE
TOWN CLERK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1ROO
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REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECO~EN'I' OEEICER".
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OfFICE OF THE TOWN CLERK
i TOWN OF SOUTH OLD
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TO:
Southold Town Building Department
FROM:
Lynda M Bohn, Southold Town Clerk's Office
DA TED:
November 15, 2006
Transmitted herewith is a copy of application No. 3646 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jerrv & Linda Mateila
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Lynda M Bohn
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
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DISAPPROVE
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Signature
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Dated I ,
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main ROE
P.O. Box 1179
Bouthold, New York 11971
Fax (631) 765.6145
Telephone (631) 765.1800
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@$10_ or Non-Residential@$25_
Applica<ion ~ctC
Pennit No.
Applicant Name .::J"'&(2;2:/ q} LliVl>rf
Applicant Mailing Address 7'V H....t-Tz?'"
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Septic Tank_or Cesspool "'-
BriefDescrip(ion of Proposed Construction or Alteration E:.E=tvO/J ~ (j 0 r
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L<Jcation of Proposed Construction! Alteration:
Owner of Property: J d> L ;t1 ~~
Owner Mailing Address: 9'1 R 1.- ^" 6'- v )
Owner Property Address: /2, 117) S"J14J/75zJ/\/ fL?)
CI..{~'6 05 .v y //9.l, \
Name and phone number of contact person ':::T" ~~.A'r .4~~
Tax Map No: Section / ~~ Block /0 L<Jt ~ 7
Cross Street blf7.-o tv IN "J;;ii-
NOTE: LOCATION MAP MUST BE SUBJ\fiTTED WITH APPLICATION.
CONSTRUCTION REQ URVEY H HEALTH DEPARTMENT APP
Received by:
,
TEST HOLE DATA
(TEST HOLE DUG BY McDONALD GEOSCIENCE
ON OCTOBER 27, 2005)
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.~ PAlE BROWN fltt:: TO IoIEDUIoI SNID Sf'
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WATER IN PAlE BROWN FlNE TO
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BALDWIN
PLACE
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N/O/F
A. MADELENE HAUSER
DWELLING
(USES PUBLIC WATER)
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Abandonment of eXlstmg san." ' S bmit
comfonnance with department requ remtt u
completed fmm WWM._~___al1 J:(~~~_ ,_'
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SUi-FOUC COU~~TV DEPA'iT:,1ENT OF HEtHH SaWlCES'
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PERMiT Fo;-;,: /'-\~.T,:~,OVP;~~ OF G':E'~ST~-:~:dCTiOl'J FOR A
("?\' ,..... ..To i":".~__~ "y r-,l'-r' '-\-'_,,-'~: :.;~'"D
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CERTIFIED TO,'
FIRST AMERICAN TITLE INSURANCE CO, OF N
PECONIC ABSTRACT
JERRY MATEJKA
LINDA MATEJKA
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SURVEY OF PROPERTY
SITUATE
NEAR PECONIC
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-103-10-27
SCALE 1 "=30'
JANUARY 3, 2000
NOVEMBER 22, 2005 ADDED TOPOGRAPHICAL SURVEY
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AREA = 15,587.24 sq. 11.
(TO BULKHEAD) 0.358 ae.
NOTES:
1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUt.4
EXISTING ELEVATIONS ARE SHOWN THUS; ~
2. MINIMUM SEPTIC TANK CAPAClTIES FOR 4 8EOROOM HOUSE IS 1,000 GALLONS.
1 TANK; B' LONG, 4'-3" WIDE, 6'-7" DEEP
3. MINIMUM LEACHING SYSTEM FOR 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA.
2 POOLS; 6' DEEP, e' dic.
@ PROPOSED EXPANSION POOL
@ PROPOSED LEACHING POOL
~ PROPOSED SEPTIC TANK
4. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM nELD
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
5. FLOOD ZONE INFORMATION TAKEN mOM:
FLOOD INSURANCE RATE MAP No. 36103C0164 G
ZONE AE: 8ASE FLOOD ELE\lATlONS DETERMINED
ZONE X.: AREAS OF 500-YEAR FLooO; AREAS OF lOO-YEAR FLOOD WITH AVERAGE
DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN
1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM lOO-YEAR FLOOD.
ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN
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N.Y.S. Lie. No
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UNAUTHORIZED ALTERAT)dN-~'OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEI.! YORK STATE
EDUCATION LAW.
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COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COpy
Josep A. Ingegn<
Land Surveyor
YORK
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF" TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON. AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
Title Surveys - Subdivisions - Site Plans - Construction
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