HomeMy WebLinkAboutWaggoner, StephanieELIZABETH 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: September 1, 2010
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Stephanie Waggoner
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
3976 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
.¸5
ELIZABETIi A, NEVILLE ': ~-
tOWN CL RK
REGISTFAR OF VITAL STATISTICS
MAERIAGE OFFICER
REOORDS MANAGEMEN[~ OFFICER
FREEDOM OF INFORMATIO!~ OFFICER
..Town Hall, 63095 Main
P,O. Box 1179
Sou~hold, NewYork 119~
Fax (831) ~85-614~
Telephone (681) 765-180
sou t holdtown.no~hfoi,k.l~
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 ~ $25 __
Application No. ~ Cfi 7~
Permit No.
Applicam Mailing'Addr)ss t lo q ~ [~[.~O-_.x'~f~/'lJ'hk_
Septic Tank ~' or Cesspool
Brief Description of Proposed Consh'ucfion or Alteration
Location of Proposed Construction/Alteration: Owner of Property: ~ .-~, i/~,¢~f')i IL
Name and phone number o.f contact person ~o ~ I
Tax Map No: Section [ q C,~ Block
O/
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH i~.ALTH DEPARTMENT APPROVAL
, Signature f Applicant
TEST HOLE DATA
(TEST HOLE DUG BY ~ ON APRIL I. 2008)
PREPARED IN ACCORO~NCE WI~ ~IE MINIMUM
STANDARDS FOR TITLE SURVEYS AS EST~BUSHED
BY THE LI~.LS. AND ~PPROVED AND ~OP~
FOR SUCH USE BY ~HE NEW YORK STA~E LAND
N.Y.S. Uc. No. 50467
ithan Taft Corwin III
Land Surveyor
le Surveys -- Subdivisions -- Site Plons -- Construction Loyout
qE (651)727-2090 Fax (631)727-1727
~ICES LOCATED AT MAILING ADDRESS
COPIES OF THIS SURVEY ~ NOT BEARING
THE L~ND SURVE~'S INKED SEN_ OR
EMBOSSED SF~L SHALL NOT BE CONSIDERED
TO BE A VAUD RUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
fS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL ~ENCY AND
LENDING INSTI~N USTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INS~-
TU~GN. CER~FICATIONS ARE NOT TRANSFERABLE.
/
~/ / / / ~ --
,/
SEPTIC SYSTEM TIE DISTANCES
(MEASUREMENTS PROVIDED BY OTHERS)
SEPTIC TANK 24.8' 14.7'
LEACHING POOL [~ 17' 24'
LEACHING POOL [] 25.5' 29°4'
LEACHING POOL [] 40.$' 50'
NOTES:
1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM
EXISTING ELEVATIONS ARE SHOWN THUS:~
EXISTING CONTOUR LINES ARE SHOWN THUS:
F. FL. - FIRST FLOOR
G. FL~ - GARAGE FLOOR
T.B, - TOP OF BULKHEAD
B.B. - BOTFOM OF BULKHEAD
T.W. - TOP OF WALL
B.W. - BOTTOM OF WALL
2. FLOOD ZONE INFORMATION TAKEN FROM:
FLOOD INSURANCE RATE MAP No. 36105C0481 G
ZONE AR: BASE FLOOD ELEVATIONS DETERMINED
zONE X*:
AREAS OF 500-YEAR FLOOD; AREAS OF I O0-YEAR FLOOD WITH AVERAGE
DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN
h
SURVEY OF PROPERTY
MATTITUCK
:-....FF,C~A~'~O~STR~'CT,O'~',.^RO'~ .. ~ ~ . TOWN OF SOUTHOLD
~ US~U~UOW~ ' ~ ~':- ~' SUFFOLK COUNTY, NEW YORK
~ l~[ ~¢~. ~ 4~:'~':'". ~ S.C. TAX No. 1000-140-01-01
~i ~ X ~ .... . . ,
' ~g~ ~~' k ~'~ , ~ SCALE 1 =20
m~l~4. ~ ~ ~t~, ' ~::~X ¥' ~., X I~ I JULY 23, 2002
~ I - ~ ~ I~ ' , x ~::~' -.- ~ ~ AREA = 28,276.81 sq.
~ I ~ll ~ , Xt ~~~ :. "- ., ~ ~(~e ANTHONY WAGGONER .
4 ~ ' J ~ ~ ~ '~~~-,~ //~ ~ ~ STEPHANIE WAGGONER
(~ / /~t / / ~ ~ "Z....,. ~ ' ~ aSd oo the iafo~ation submkted, it has be~n de,c=, that
~ ~ / / i /J / / / //~' .I / / · ~ ~ ~:'~ N '" 'i~'' ~. '(/~ ixp facifities. ~ t & ~ Y
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