HomeMy WebLinkAboutPoulos, ArgeryE_~,, A~:~E,~-I A. NEVH J.F.~ RMC, CMC
'TOWN CLERK
RE~S~.~R OF VITAL STATISTICS
i~RR IAGE OFFICER
REC~)Ri~ MANAGEMENT OFFICER
FREE~OIV~ ~)F 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:
DPCTEI~:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
December 7, 2009
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3917 for a Cesspool/Septic Tank Construction
permit submitted by:
East End Construction Sves for Argery, Poulos
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:
APPROVE ~
DISAPPROVE
comments: Final approval required from the Suffolk County Health Department,
TOWN C~ .~.Rg
REGISTRAR OF ~ITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMElqT OFFICER
FREEDOM OF INFORMATION OFFICER
Town H~II~, 53095 Main hi
P.O. Bo~ 1179
Southold, New York 11971
Fax (63D 765-6145
Telephone (631) 765-1800
southoldtown.nor~hfork-net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
.APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $104~ or Non-Residential ~ $25
Application
Permit No.
Applicant Name /~,~-t,J~ Co~77eo~c~0 ,Poc.r
Applicant Mailing Address /~-0 a)a';-o~,~ ~-- ,~,~,~r~o,~,
Septic Tank / or Cesspool
Brief Description of Proposed Construction ot Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Proper~y Address:
/I//A ,-'n rtdc ~'
Name and phone number of contact person
a'ax~_epNo:/b0D S~ction /0(,, Sloc~ ~ Lot ~7
Cross Street f~..q r..o ,a'~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH ltF~ALTH DEPARTMENT APPROVAL
Received by: Si~ ~a/~eant
Test Boring
Sand
LOT 150
DW£LLIN~
(PUBLIC WA TER)
EXISTING WELL & CESSPOOL
TO BE REMOVED OR FILLED
IN
RAIN RUNOFF C;4LCULA TION. S;
2' RAINFALL
HSE & GAR. = 2417 sq, fl.
2417x I x 0.17 = 411cu. ff.
411/4E.~ = I0 VF
PROVIDE E DWs 8'~ x 5' deep
3795.7'
· ' SCDHS ReL# R10-09-0045
SURVEY OF PROPERTY
LOT I~
A T MA TTt CK
TOWN OF SOU HOLD
.' ~B~ 1~07
K II A~.
~ ~ ~I~S ~E ~A~ ~ DA~ OF ~V~
LOT ~ i
(PUBLIC WATER] HOUSE Z GA~. ~(7 ~o.h. ,,,
2~17/1~000
EXISTING HOUSE TO 8E REMOVED
I am familiar wilh Ibp STANDARDS FOR APPROVAL
~ ~* D/SP~AL.SYSTEMS F~. SINGLK F~IL Y ~ESIDENCES
~ TES~ ofld will ab~de by the conditions set forlh lherem end on the
BORING
permit to construct.
~z The locations of wells and cesspools
--------- shown hereon ore from fieJd observations
PROPOSED SEPTIC SYSTEM -- -- 100.00' ------------ and ~r from dolo ob/o/ned from o/hers.
f 4 ~OROOM~) -- ~
1- I000 GAL PRECAST SEPTIC TANK ~ ~ -- ~u(~ ~
I' LEACHING POOL 8'~ ' IZ' DEEP ~ITH ~ ~ P~T ' ~ ~ ~
3' SAND COLLAR (SW] BOTTOM OF ~ ~
LEA~ P~L TO BE 3 ABOVE ~ ~o ~
. o~ ~ w~ m =MONUMENT ~'/If~ ~~.
~n~A=~9000 ' ~.r AL~RA~ ~ AODI~ ~' ~lS SURLY IS A W~
~a ~ ~ ~' ~ ~ · ~ ~C~ 72~ ~ NEW ~ STA~ EDUCA~ LA~ /~f ) 7~_, ~~ )~-1797
. . ' . EX, PT AS P~ ~' ~ '72~- . ~R~ ·
PLED IN ~E SU~OL~ COUNTY CLERK'S OFFICE ON ~lo MAP ~ COPIES SEAR ~E IMPRE~ ~ ~ ~E ~R~Y~ 12J0 ~A ~LER
JANUARY 19, 1949 AS FILE NO. 1672. ~o~ ~A~RE APPKARS H~. SOU~OLO, N K 11971