HomeMy WebLinkAboutReinertsen, John O�*Of SO(/jyo
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
CA ac
REGISTRAR OF VITAL STATISTICS G Q
MARRIAGE OFFICER �0 Fax (631) 765-6145
RECORDS MANAGEMENT OFFII Telephone (631) 765-1800
FREEDOM OF INFORMATION 01'FICER yC�Ury"�� southoldtown.northfork.net
1
MAR 16 'L_7 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Lynda M. Bohn, Southold Town Clerk's Office
DATED: March 15, 2007
Transmitted herewith is a copy of application No. 3672 for a Cesspool/Septic Tank Construction
Permit submitted by:
John Reinertsen
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
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
03 AG .
Dated
o�gUFF01,;�c
ELIZABETH A. NEVILLE h`t Town Hall,89096 Main Roa
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ft Southold, New York 11971
MARRIAGE OFFICER t` Fax(691) 766-6145
RECORDS MANAGEMENT OFFICERy�ol Telephone (691)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
Residential @$10 "/or Non-Residential @$25_ Application No.
yy��
LL- Permit No.
Applicant Name �h R e t fl .v`[,$ �
Applicant Mailing Address V�o �l g L S- S1Y'eet-
by-6o k kill N 1122 8
Septic Tank_or Cesspool QQ //
Brief Description of Proposed Construction or Alteration U UI I d I n C h eW n fj o f
Location of Proposed Construction/Alteration: 5 / 0 Arron p head L4ne-- I Peep n G
Owner of Property: &'Rej�4 196nia'+e4l
Owner Mailing Address: 14 L( 11' I �'-
mUh I tib( f 1 LZ-8
Owner Property Address: 6g 0 Ayyh I h a egg e-6. yl I G
1 L5 iR
Name and phone number of contact person �(n 4 PeW i-1118 238— 1767
Tax Map No: Section�8 Block pa, Lot
Cross Street I n d i,.,✓i Reck Roar
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HE4TH DEPARTMENT APPROVAL
3 /3 C7
ignature of Applicant Date
Received by:
LOT NUMBERS REFER 'MAP OF ARROWHEAD COVE' SURVEY OF PROPERTY
FILED IN THE SUFFOLKK COUNTY CLERK'S OFFICE DN
JUNE 20, 1963 AS MAP NO. 3810.
�� AT PECONIC
TOWN OF SO UTHOLD
T, SUFFOLK COUNTY, NEW YORK
1000-98-02-03 & 04
SCALE: 1"=50'
MARCH 1. 2000
m� JUNE 28, 2006
.5ept LG, to 06(/0-/uarcrog e)
IND NgCB ItOAD fea. 2z, Zoo 7
c
0
co
00N
01o -
IVACANT n r
LOT 39 Q �
124.14' (map) o I�
N 88.42'20' E 124.09' (actual) is 3 e� SUFV0L 'QU%7 _
el za H Q @E RM p�
t R 0.3E fllf fi
n
LOT 38 b!.'�9 C11 ? ar - 'QNB
• P06 L-tiDOSP_. -
4
J m
I` x a�a3 9� SID D-7 oc�(Z I
i NNr
Z c • G2 ,� �
. D — prep 35
N I7C r .w-.
P n �• y�.` ° mo=t czuoc1t m I
P''41 .ea
prop -SA
4o-6a/1 a+ V O
00
03
n A
CERTIFIED T0-
P, JOHN RE/NERTSEN
is ss " r� ANGELA RE/NERTSEN
2�0
88.42'20' W 134.93' Cactuaq 111
FF
e l 135.00' Crtap> 1+
LOT 36
(dwelling) LoL Coverage
ELEVATIONS ARE REFERENCED NATER AFTER Ase 3500 .5 {
TO AN ASSUMED DATUM per/ $00 5•f'
ce--bar;a- 3 oo S,f.
GYa''ve. /D so "r,
AREA= 41,815 S.F. owed �o/Sas-A4 8iSs.F. =/48 '�"
GPs /50•d
TEST HOLE DATA
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE Dark brown silty loan DL
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES —— u.
and will abide by the conditions set iforth therein and Brown toany sand SM
on the permit to construct. , __
hx 43.s — 3' pF NEwyO
The location of wells and cesspools shown hereon are 5 �t•METZ �F
from field observations and or data obtained from others. Pate Brown vine to coarse sand al � ck
- 9
N. S. 4 61
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION _ ECONIC SU VE ,g
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. (631) 765 — 502
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS P. O. BOX 909 -1797
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER SIRE
WHOSE SIGNATURE APPEARS HEREON. 17• SOUTHOLD, N.Y. 11971 .00 - 108,