HomeMy WebLinkAboutArena, DavidELIZABETH A. NEVIIJ,E~ RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 MoAn 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:
RE:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Of~
September 21, 2010
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3982 for a Cesspool/Septic Tank Construction
Permit submitted by:
Thomas Samuels for David & Sandra Arena
Please review the application and locatio.n 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 fi.om the Suffolk County Health Department
ELIZABETH A. NEVILLE
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 ~ $25
Applicant Name~
Application No. 3 ?~P ~
Permit No.
Applicant Mailing Address
Septic Tank V or Cesspool
Brief Description of Proposed ,C, onstruction or Alteration ~
aoa,~s~w7. fo,.;og;~; p(.r ~coW~- '
Location of Proposed Construction/Alteration:
Owner of Property: DzgF'z.f~
Owner Mailing Address: ~(.~
8wner Prope,y Address:
Name and phone munber of contact person
Tax Map No: Sechon
Cross Street
·
Block ~ Lot ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
sign~ T/D~aa:/f o
Received by:
SEPTIC PROFILE RESIDENCE
(N.T.S.)
Water Line(s) ~ Be Inspected Ely The
Suffolk County Dept. Of Health Services.
Call 852-5700, 48 Hours In Advance,
To Schedule Inspec~on(s).
SUFFOLK COUNTY DEPARTI~ENT OF HEALTH SEf~VIC[:$ ~
YEARS FROM DATE OF APPROVAL
Z
Z
SITE DATA
scm. 1ooo-117-o~o.
PROPERTY: 160t5 N~ SUFFO~ A~UE
ADDRE~ N~ SUFFO~, ~ 119~
G~CH, ~ ~1
16,0~ sf = 0.370 ac
~IC, PIATER
ZONING: R-40
SURVEYOR: STANLEY J ISAKSEN, JR
PO BOX 294
NEIN SUFFOLK, NY 11956
License # 49273
Dated~/30/0g
LOCATION MAP
41301'
812011
AVENUE
15OO ~ ~ --
(2)~,' OIA ~
t%r/1JRE I_~
LI~NC. HIN~
~ .~ ~ ~ .=u~ TEST HOLE
lC. TAGqI~ (ET) NO SCALE
I~,H ~11~9 ~ (LP) . BY MARK McDONALD GEOSCIENCE
TEST HOLE DATA 219110 ELL=V. + 28.0
T / IPALE BROWN FINE TO
2 FT. BROWN SILTY SAND SM
17 FT. IMEDIUM SAND SP
NO WATER ENCOUNTERED
SITE PI.~