HomeMy WebLinkAboutScourakis, JohnFJJT~,BETH 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:
OFFICE OF THE TOWN CLERK/~
TOWN OF SOUTHOLD /~ ~~
Southold To~ Building Dep~ent [
.......
~ot ~yaell, ~ou~old To~ Clerk's Office
M~ch 20, 2009
Transmitted herewith is a copy of application No. 3863 for a Cesspool/Septic Tank Construction Permit
submitted by:
John Scourakis
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.
I have reviewed the application an~[,tocation map of the project cited above and make the following
recommendations: /
APPROVE ~.: ~,z~/~_ ~~
DISAPPROVE
Comments:
Signature
Dated/"~///~~z
ELiZaBETH A. NEV~J~
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
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
__ or Non-Residential ~ $25 __
Applicant Name
Applicant Mailing Address
Septic Tank for Cesspool
Brief Description of Proposed Construction or Alteration
Application No. ~5c~
Permit No.
~¥ //~71
Location of Proposed Construction/Alteration:
Owner of Prope~:y:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person SA t~E
Tax Map No: Section ~C Bl~ock
CrossS eet
NOTE: LOCATIO/MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEP~NT APPROVAL
Jgn~tur~o f Applic~~ / Date
Received by:
~ :Y.- ~ 77-~/5'0 ·
7-- rot I/. /
'sbO.,y.o
N
COASTAL EROS/ON HAZARD LINE FROM
COASTAL EROSION HAZARD MAP
PHOTO # 56-570-B3
NOV 1 8 20O8
SUFF. CO. HEALTH SERVICES
..,,,, ~ ~ MGT.
ROOF RUNOFF ·
HOUSE & GARAGE 2280 sq. ft.
2280 x 0.17 x I = 388 cu. fl.
355/42.2 - 9.~ VF.
PROVIDE ~ LPs 8'~ x 5~ Deep O~
EQUAL
~ = DRY WELL
~-ST HOLE DA TA
McDONAL~ GEOSCIENCE
62'
SURVEY OF PROPERTY
A T SOUTHOLD
OF SOUT OLD
SUFFOLK COUNTY, L[.
1000--50--0~--10 & 11
SCALE,: 1'--$0'
DECEMBER I0, 2007
JAN. 8, ~008 toddilion~)
Merch. 4~ ~OOB (additions)
APRIL. 28, 200,9 (revisions)
dULY 16~ 2008 Uevlslo~s)
.JUL Y 30~ ~OOB trevlsionl
Sept. 22~ ~008 (revisionsl
Oct. '31~ 2008 (ADDITIONS)
NOV. I0, 2005 (REVISIONSI
· =MONUMENT
· =PIPE
EX/STING CESSPOOL TO BE REMOVED OR
FILLED IN
~xISTING WELL TO 8E ABANDONED
EXISTING SHED NOT SHOWN HEREON TO
BE REMOVED
I om fornilior with the STANDARDS FOR APPROVAL ,.
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions se( forth therein and on the
permit to construct. ~
Devotions referenced to N.G. V.D. '29.
The location of wells and cesspools shown hereon ore
from field observations and or from data obtained from others.
ANYcAL~'RATION OR ADDITION FO ~115 ~UR~f~Y IS A ~OLA770N
OF SEC~70N 7209 OF fH£ NEW YORK, STATE EDUCAt?ON LAW.
£XCEPT AS PER SECtioN 7209-~l, IBDI~f~I~ 2. ALL CERTIFICA770NS
HEREON ARE VAED FOR THIS MAP AND COPIE~ THEREOF ONLY tF
SAID MAP OR 61~PIE$ BEAR THE IMPRESSED SEAL OF THE SURI~EYOR
Fd-IOSE ~¢~NA TURE APPEARS HEREON.
PROP. NEW SEPTIC SYSTEM (5 BEDRO0~
I- lei20 641- PRECAST
I* 8'~ 16~
DO~ Wl~ 3" ~ ~LAR gW- 6' ~OW
LOT COVERAGE
~OfJSE- IU: 2
GARAG~ 5~' ~.ll.
DECKS, CONC. & C.E.
788 sq. ft.
SHED 83 sq.D.
~XISTING ~55~
PROPOSED ~75 ~q. fl.
AREA TO TOP OF BANK 13,~69 sq. fL
~ISTING ~55~// 3369 = 19 .I ~
PROPOSED 2~75/133E9~
......... tED
SANiTAry
SOUTHOLD. N. K
· N. K S. LIC. NO.
P.C.
FAX (6Sl) 765-
,,,, .Ly.(_TM