HomeMy WebLinkAboutSmith, AndrewELIZABETH A. NEVILLE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS OF MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, NewYork 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
August 4, 2011
AUG - 4 2011
8IDG DEPT.
TOW~ OF SOllTHOID
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4031
Permit submitted by:
Meryl Kramer for Andrew Smith
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.
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
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTItA~ OF VITAL STATISTICS
MARP~IAOE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INF0~TION OFFICER
.~Town Hall, 63095 Main P~oa
P.O. Box 1179
8outhold, New York 119 71
Fax (631) 765-6145
Telephone (631) 765-1800
sou thold~own,northfork,ne!
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. t40~}
Permit No.
Applicant Name
Applicant Mailing Adch-es:~
Septic TaMpon"or Cesspool
Brief D~scfiption ofmloposed Cons~kc~on or Alteration~~
~cation of ProposM Constmctio~teration:
Owner of Propeay:~
O~er Prope~ Ad.ess:
Name and phone number of cor~ Tax Map No: , S. ection ~ Block ~ Lot
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUHtES SUR~ARTMENT APPROVAL
~Signature of ~nplicant
Received 6~
N
Water Line(s) MUST Be inspected By The
Suffolk County Dept. Of Health Services.
Call 852-5700, 48 Hours in Advance,
To Schedule Inspection(s).
E/EVA TIONS ARE REFERENCED TO
AN A*,~MED DA TUM
TEST BORfNG --
~/~9///
BROWN SILT
P~LE BROWN
: BROWN
~X. TY ~4NO SM
IROWN
~NE SAND SP
WA TER IN PALE
BR. FINE SAND
~P
8MOWN ~L TY
~WN F~
vAcANT
PROP. NEW SEPTIC SYSTEM
5 BEDROOMS
I :1500 BAL. Pi~ECAST
SEPTIC TANK
3 ' $'~ "6.5' OEP Tit
IVI~'H $' S~ND COLLAR (SW)
3' ABOVE. CROWD WA T~
EL ~.1
R~OVE EXIST~G ~P~C SYSTEM &
REPLACE MTH 1500 g~ SEPTIC TANK
SURVEY OF PROPERTY
A T ORIENT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-18-06-22.1
, SCALE: 1'=30'
SEPTEMBER 21, 2010
OCT. 20t ~010 ~40N. FNDJ
JUNE 21~ SOIl (ADDITIONS)
The local/ohs of wells and cesspool~.,
shown hereon ore /rom fieid obsetvnlions
and or from dnla ob/o/ned from o/hers.
Therefore lheir locations nnd or exislence
is nol guaranteed.
SUFFOLK COUNTY
PERi',liT FOR APPROVAL
SINGLE FA[',~[ L
JUN 2 9 ~.011
H, EEF.
DATE ~ _
FOR
'iRES TH
ALTH SERVICES
~,,~,CTION FOP. A ~
:'~IDENC~-' O~ .
I ~ lam#Jar ~lfh Ibc STANDARDS FOR
AND CONSTRUCTION OF SUBSURFACE SEPIAGE
DISPOSAL SYSTEI~S FOR SINGLE FAk#L Y
~d ~ll o6i8e bi' ~ conSilions se/forlh /herein o~d on
pet~il Io co~lrucl.
FROM DATE OF
c°a£onnanCe
o%
CERTIFIED TO:
ANDREW SMITH
JENNIFER SM/TH
FIRST AMERICAN TITLE INSURANCE COMPANY
C/T/MORTGAGE, /NC., /TS SUCCESSORS OR ASSIGNS
AREA=39,773 SO. FT.
· =MONUMENT
· =PIPE
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A ~40LATION
OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CER77FICATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED'SEAL OF THE SURVEYOR
WHOSE SIGNATURE APPEARS HEREON.
~tCON/C ~YORS,'
(651) 765-5020 FAX (651.) 765-1797
P.O. BOX 909
1250 TRAVELER STREET
SOOTHOLD, N.~ 11971