HomeMy WebLinkAboutFNV LLCELIZABETH A. NEVILLE, RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
TO:
FROM:
DATED:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
OFFICE OF THE TOWN CLERK
Tow or so T.o ..
April 7, 2009
~=q - 8 2009
BLDG. DEPI.
TOWN O[ SOUTI'IOLD
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3865 for a Cesspool/Septic Tank Construction
Permit submitted by:
FNV~ LLC (bv Gerard Stankewicz)
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
Comments:
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTBJdt OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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
Applicant Name
or
Non-Residential ~ $25 ~
Application No. 3 ~- ~''
Permit No.
Applicant Mailing Address
Septic Tank or Cesspool
Brief Descup~on of Proposed
,
~cation of Proposed Constmctio~teration:
Owner of Property:
Owner Mailing Address:
[z-NY )LLC
Owner Property Address:
Block / Lot
Name and phone number of contact person
Tax Map No: Section ~ /
Cross Street t~f~ ZCZ/eL,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION.
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Appl[can't I d d D~tet
Received by: K ~ _~
(~ TEST HOLE
~OT TO SCALE
APPROVAL STAMPS
10
--mc-c-c--
OCT 2
· CO. HEALTH SERVtCEI
i~.iFc~F~ OF WASTEWATER MG~
Plans am prepared by Condo. Enginee~g, p.c' It is a v[d,a~ of the New yod[
dale d such ~a~'ms, and a sped~ descfip~ of the al~a~*
Engineering, P.C.
1755 ~ R~ed
~a~a~ kb~.Ynf~ 1,1952
FEATHER HILL COMMONS
53345 MAIN ROAD
,~SOUTHOLD, NEW YORK 11971
COUNTY OF SUFFOLK
STEVE LEVY
SUFFOLK COUNTY EXECUTIVE
DEPARTMENT OF HEALTH SERVICES
HUMAYUN J. CHAUDHRY, D.O., M.S.
COMMISSIONER
PERMIT CONDITIONS
H th S ces ef rence # - O ? - 0 0
~e a~h~ pl~ when duly si~ by a ~en~ve of ~e d~t, ~ conj~c~on ~ ~e
~ndigom, ~nsfimtes a p~it ~ ~m~ct a wa~ s~ply ~or a ~age ~o~ or ~ll~on s~t~ for
&e p~pe~ ~ d~ict~. ~e ~plic~t ~ould ~e note of ~y ~n~gom of ~pmv~, w~ch ~y ~'
~cat~ on ~e pl~ or ~clos~ h~. Co~on mint confo~ ~ ~ph~le s~ inclu~g
"Standa~s for Approval of Plans and Cons~c~an for S~age Dispos~ Syste~ for ~er ~an
S~gle Family R~idenc~.' ~ssiom, in~mist~cies or l~k of d~l on ~e pl~ do not ~1~ &e
~lic~t ~m ~e ~spomibility of ~ng ~e ~m~odon done ~ ~nfo~ce ~& ~plic~le s~s.
Issu~ce of ~s p~aiiit ~1 ~ no way relieve ~e desi~ pmf~sion~ of ~omibi~ for ~e M~,ocy of
· e ~mplete desi~.
The permit (plan) expires three (3) years after the approval date. Any modification which may affect the
proposed sewage disposal or water supply systems requires submission of a revised plan and additional fees
(if applicable) for reapproval prior to conslxuction. No inspections will b~ perfo.ma_~ ~!.ky the dopa!Llment on
expired p~mits.
Permits may be renewed, extended, transferred, or revised in accordance with the procedures described in
Instructions to Renew, Extend, or Transfer an Existing Permit for Other than Single Family
Residences (Form WWM-081).
It is the applicant's responsibility to call thc deparmaent bt advance to arrange inspections of the sewage
disposal and/or water supply facilities prior to backfilling. These include inspections of the sewage
collection and disposal systems, water supply system components and piping, and final grading as shown on
the approved plans. In certain cases, inspections of the soil excavation may be requil~ to determine the
acceptability of the soils for sewage disposal systems. The department mnst be notified at least 48 hoars
in advance to schedule an inspection by calling 852-S7S4; and excavation inspections 'must also be
confirmed by calling 852-$700 prior to 9:30 a.m., the morning of the inspection- Article FI/of the
'Suffolk County Code, "Septie Industry Businesses," requires that all installers of septic systems within
Suffolk County shall possess a valid license from the Suffolk County O~ce of Consumer Affairs, This O.O~ce
can refuse to perform inspections or grant final approval for the 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.
SEE PAGE 2
WWM-016 (Rev. 10/02/06) Page 1 of 2
CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT
As a condition of this pcxmlt 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 Other Than Single Family Residences (Form WWM-19).
[] Excavation Inspection by the Office of Wastewater Management prior to installation of any leaching
pools to dete. ffine acceptability of soils. {Call 852-5754 to schedule an inspection and confirm by calling
8$2-$700 prior to 9:30 a.m., the morning of the inspection.)
~atisfactory inspection by Office of Wastewator Management of the sewage disposal system / sewage
treatment system. (Call 852-5754 to schedule an inspection.) ~"~0'4-.-~s 4, ~, 1, ~ ¢ ? )
[] Satisfactory inspection of the water supply system by: [] Offico of Wastewater Management (Call 852-5754 to schedule an inspection.)
[] Office of Water Resources, Water Quality Unit (Call 852-5810 for inspection.)
[] Satisfactory inspection bythe Office of Pollution Control (Call 854-2502 for inspection.) [] Storage tanks [] Other:
[] Application for a Food Permit to the Food Control Unit (Call 852-5873 for instructions.)
[~our (4) prints of an As-Built plan
[] "Tap letter" from water district
[~Certificafion from the licensed sewage disposal system installer (to
[] "S-9 form" from Suffolk County Department of Public Works (SCDPW)
[] Sewer dis~et approval of sewer line installation (for other than SCDPW districts)
cWell drillers certificate [] Water analysis
ertificafion of Sewage Disposal System Abandonment (form WWM-080) ( o ~ f,~ ,~,~
[~Design Professionals Certification of Constructed Works (form WWM-073, enclosed) for: [] Sewer lines and sewage collection system
[] Retaining walls (approved as part of the sewage disposal system)
[] Sewage pump station/valve chamber
[] Sub-~u, face sewage disi~osal system
[] Sewage treatment plant
[] Water supply system
~Abandonment of Preexisting sewage disposal system a,'~.dzr
WWM-016 (Rev. 10/02/06) r Page 2 of 2
N 29'38'30" W
65.08' , N
CHAIN
110.2'
S 28'28'40" E
N/O/F LAND OF SO~HC
BECKWITH AVENUE