HomeMy WebLinkAboutNadherny, Patricia & ThomasELIZABETH 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
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED: August 24, 2009
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Patrleia & Thomas Nadhern¥
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
3892
AUG 2 4
BLDG. D£PI.
TOW~ OF SOUTHOtD
for a Cesspool/Septic Tank Construction
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.
Carol Hydell
· , , · , , , , · , · ,
I have reviewed the application and location map of the project cited above and make the following
recommendations: j
APPROVE
DISAPPROVE
Comments:
Final approval required from the Suffolk County Health Department.
Signature
Dated
ELIZABETH A. NEVILLE '; .~
TOWN CLERK
REGIST1La~ OF VITAL STATISTICS
MAt~RIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOILMATION OFFICER
OFFICE OF THE TOWN CLERI~
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
.~Town Hall, 58095 Main
P.O. Box 1179
Scut, hold, NewYork 11971
Fax (631) 765-814~
Telephone (681) 765-1800
sou tholdtown.northfovk.ne,
Residential ~ $10__ or
Applicant Name '~943t/~('tr_~ .{--
Applicant MaiLing Address (Oo1 S'-
Septic Tm~k t,./or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ~rA_'[ f-~ O I ok
Owner Mailing Address:
Owner Property Address: (O~- ~'
Name ~d phone nmber of mnmct person
T~ Map No: S~tion ~ Block
NOTE; LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, NEW
CONSTRUCTION REQUIRES SURVEy WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:.
N
SURVEY OF PROPERTY
cee A T $OUTHOLD
TOWN OF SOUTHOLD
SUFFOLK GOUNTY, N. Y.
... 1000- 70 - 05 - 34
:
:
-- -- ,~uFFOLF, COU~,TY'~PARTMENT OF HEA~TH
p~R~I' ~ ~0~-' '~ ;~'T":~r3¥AL OF CONSTRUCTION ~OR ~
/
\
,. \
/
J
I ~ f~n~lar ~vllh lhe STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SElYA~E
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
Md will abide by lhe condilions sel [crib lheraln and on lhe
I)ermit lo construct.
N 0 TE:
DWELLING- PUOLIC WATER
EX/STING CESSPOOLS TO BE REMOVED OR
FILLED IN.
NEW SEPTIC SYSTEM ( 4 BEDROOMS ) I - I000 GAL. PRECAST SEPTIC TANK
2 - LEACHING PODLS 8'~ x 6.5'DEEP WITH
3' SAND COLLAR (SW) 3' ABOVE GROUND
WA TER
TEST HOLE DA TA
McDONALD GEOSCIENCE
N83;~.9'~,0'W p]~T~ J~ECK ~u~ PUBIIc WATER) (J=Ut3LIC WATER
RENCED TO N O V.D '29 ,DWELLINGS WITH
ELEVATIONS REFE, * · · · ·
The location of wells and cesspools shown hereon ore . "
from field observations and or from data obtained from others. "
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A ~10LA770N
OF SECTION 72090F THE NEW YORK STATE EDUCAIION LAW.
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VAUO FOR THIS MAP AND COPIES THEREOF ONLy IF FLOOD ZONE FROM F/RM.
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ~ J610JC0166 G 5/04/98
WHOSE SIGNA~'URE APPEARS HEREON.
765 ' 1797
07-228
95.00'
u11U6'