HomeMy WebLinkAboutGrocke, EdELIZABETH A. NEVIr.r.F~, RMC, CMC
TOWN CLERK
REGISTRAR OF ~V-ITAL 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 CIJ~,P.K
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
RE:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
December 29, 2009
Cesspool Construction Application
DEC 3 0 2009
BLDG. DEPT.
TOWN OF SOUTHOLO
Transmitted herewith is a copy of application No.
Permit submitted by:
Wayne Goidberg for Ed Grocke
3921 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: ~
APPROVE
DISAPPROVE
Comments:
Final approval required from the Suffolk County Health Department,
Signature/ .
Datef////t9 ~/0
ELIZABETH A. NEVILLE '~ ~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICEB
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION er ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
.,.,Town Hall, 63095 Main Pos
P.O. Box 1179
Southold, NewYork 11971
Fsx (631) 785-6146
Telephone (681) 786-1800
sou tholdtown.northfork.ne~
Residential ~ $10. V'~or Non-Residential ~ $25 __
Applicant Name ~/O.~t/~
Applicant Mailing Ad&ess /~'-
Septic Tank l/or Cesspool
Application No.
Pennit No,
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:..~<J CFO G l-~ ~.
Owner Mailing Ad&ess: Wlor;
OwnerPropertyAd&ess:/~/'6~ /~t. t r-/-Pl 5¢
Name mxd phone number of contact person ~/g~, t~g t/~'/F/,~ ~
Tax Map No: Section //7 Block t~ Lot
Cross Street ~,~Q ~4-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUI1LE8 SLrRV~y W1T~J~ ALTH~ DEPARTMENT APPROVAL
R~oivedby:.'-- '~ I/// ~
PERMIT Fb~ A;=~O~ A~ O? LON,~ ~,.L ......
FOB MA~mUJ,~ O~ "1 , B-~
EXPIRES THREE YEARS FROM DATE OF APPROVAL
MSE.
HEALTH DI~PARTM~NT ]
I~JBU¢ WA
N/O/F DA VID L. ~ SUSAN A. NOONA~V
/ I*~ STy £n, BLDg.
3. ~$.~4.Qo. ~. J
~~ 100. 73'
FR. SHED
· 83'59'40- W.
100.6~?,
,AI/O/F JOHN ~ MELODY JEFFREY
TEST BORING
b~/oMCDONALD GEOSCIENCE
8/09
EL ~4.5
)ARK BROWN LOAM
OL
BROWN $1L TY
BROWN $~ T ML
~ ~ EL ~.5
$A~ A~ CLAYEY $AN~
C~ Y~Y ~AND ~ ~ ~C
~REY ~A Y CH
FA TEE ~ ~OFN
AVERAGE SETBACK ~ 6.7'
HSE.
FIN. FLR.
EL. g6.5
.~t~,.~
PROPOSED
SEPTIC SYSTEM
4 BEDRO0¥$
I- I~0 ~L. PRESET SEPTIC
TANK
I- 8'~ ~ I~ DEEP PRE. ST LEA~Nd
POOL FITH D~E AND
~ COLOR
DIG ~N TO SAND ISP)
A~ BA~FILL WITH SAND
WO~ T£R
I I ~j / ~ SURVEY OF.PROPERTY
.~.II A T NEW SUFFOLK
I/. TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y.
"°' 1000 - 117 ~ '08 ~,03
~-~---__~_ / Scale:, =20
MAIN
'; JUL Y 20, 2009
JuL Y $¢~ ~ (REVISlOICS)