HomeMy WebLinkAboutAdipietro, RobertELIZABETH A. NEVILLE, RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLER~
TOWN OF SOUTHOLD
TO:
FROM:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
DATED: March 28, 2011
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Robert Adipietro
4002 for a Cesspool/Septic Tank Construction
Please review the application and location map and advise if this office may issue thc permit.
Please complete the form below and retum it to me. Thank you.
Carol Hydell
I have reviewed the application and loffation map of the project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department.
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGIST~ OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 53095 Main Road
P.O. Box 1179
Southaid, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoIdtown.nor thfork.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 ~ $25 __
Application No.
Pemfit No.
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address: '~ C~, /:~ ×
Owner Property Address:
Nameandphonenumberofcontactperson,~oft'~'~' :O')~f,~o ~,~1
· mp o: S tion mo k O:
Cross S~eet ~ c ~ ~ :f }:c' ~ >e ~ ~
CONSTRUCTION ~QUI~S SURLY ~TH HE~TH OEP~~ ~PROV~
Silage of Applic~t / Date
Received by:
SCDHS Ref. # S10-07-0011
SUFFOLK COUNTY D?PARTEENT OF HEALTH SERVICES
PEEr'4IT FO~ ~.~':RO'F/'_L O~' CONSTRUCTION FOR A
LOT NUMBERS ARE REFERENCED TO 'STANDARD
SUEOIV;;~ON FOR THE PROPERTY OF ROBERT &
PA TRICK AD~ETRO~FILED /N THE OFF/CE OF
THE SUFFOLK COUNTY CLERK ON 8//3//0 AS
MAP NO. !1785
TOTAL AREA = 39,~t82 sq.H includes
R/gM Ot Woy
· Righl of Woy 8,52? sq. fl.
I = MONUMENT
ELEVATIONS A~ REF~ENCED TO T~ FI~ EAETERN TOWNS
I am familiar wilb lhe STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEIFAGE
DISPOSAL SYSTEMS FOR SINGLE FAMg. Y RESIDENCES
and w.,~/ abide b)~ the conditions sol forlB Iherein and on lhe
permi/. 1o conslrucl.
The local/oas of wells and cesspools
shown hereon ore from field observations
and or from data obtoiped from others.
SEWAGE DISPOSAL SYSTEM
4 BEDROOMS
I I000 ~. PR~C~$T ..ff~PTIC TANK
~3'~~
~ ~ NO ~L ~ ~'
SURVEY OF PROPERTY
A T PECONIC
TOWN OF SOUTHOLD
ANY AL TERAT/ON OR ADDITION TO THIS SURVEY I~ A ViOLAT/ON
OF SECT/ON ?.209 OF TIE NE~' YORK STATE F__~JCATION LAF,
T .48 PER ~.cTION 7g09 - $~ 2. ALL CEET/FTCA TIONS
ARE VALID FOR THIS ~AP AND COP~$ THEREOF O/fL Y IF
~/HOSE S/6N~ TUE£ APPEARS t'ERE~
SUFFOLK COUNTY,
ScOa: 1"' = 40"
PECONIC S~EYO~~~' ' '~' '. '
P. O. BO~-~09
1~30 T~A VELEE
SpUTHOLD, N.Y. 11~71