HomeMy WebLinkAboutBernstein, NinaELIZABETH 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, New York 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
Linda J. Cooper, Southold Town Clerk's Office
October 3,2011
OCT - 4 2011
BfOG DEPT.
TOWN OF SOUTHOLD
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4051
Permit submitted by:
for a Cesspool/Septic Tank Construction
John Berg, Architect for Warren & Nina Bernstein
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: k//.~
APPROVE
DISAPPROVE
Comments:
Signature
Datectr
ELIZABETH A, NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
REODRDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
.~Town Hall, 63095 Main R°a,
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.ne(
Residential ~ $10 v/ or
Non-Residential ~ $25 __
Application No.
Permit No.
Applicant N~ne .~k~ -]v-5~/r/ tdcg'F~6~ UW:L~(
Applicant Mailing Ad&ess ~ ~ ~ H44~ WA~, ~
Septic T~ or Cesspool~
Brief Description o f Proposed Cons~ction or Alteration
Location of Proposed Construction/Alteration:
Owncr of Property: !A2~)0
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Cross Street A '~/JA~
IIf_3~ o
not ~
Signature ofApplie~ ~/
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION, NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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c0mpic~e~ form
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6.7' X
FLOOR
ADOfTION$
4.1' X 5.7'
TEST HOLE ¢¢]ev~ion ITl
0' tO 10.8'
10.8' to 17'
Pa{e brown fmc sm~d
Watcr in pale brown fmc sand
(~-oundwafer elevation 2.2)
SUFFOLK COONTY DEPARTMENT OF HEALTH SERVICES
SUFFOLK COUNTY DEPART,',iF. HT OF HF,ALTH ~ERVICF,S
PERMIT FO.~ APP~C~!AL OF CONGT~UCTiO.L',f FOR A
EXPIRES THREE YE~.RS FROM DATE OF APPROVAL
ENGINEER'S CERT}FICATION REQUIRED.
SU-'3M{T P.E. Oa R.A. CERTIFICA]3ON
FOR INSTAU. A flON,~D CONSTRUCTION
OF %.-Vo~;,,~ ~,.~
FOR F{NAL APPR~L. USE FO~4 WWM-073.
ST ' PRr:CAST C~ SEPTE TAM(, 8 FOOT ~ 4 FOOT WATER DEPTH
2'-9' S0LJD WN..L IX~ME, CHM, EY NO 00VI~ ~
TOW ' TOP CF C(~ RETNNING WN.L ELEVATION,
ROOF A,~..A TOWARD~ GREAT POND 'I4ISSQFT
ROOF ,I,R~A AWAY FR(Nd POND 203SOFT
TOT{M. RO(~c ~ 1616 SQ FI'
QUANTIFY OF STORM WATB~ STORAGE
1618 X0.167FEET= 273 CU. F'I'.
8'~ Sl~J ~ C~ACFff 422 CU/R~'T
F~ ~q~4t. FOOT
2731422 $.$ VER'IlC.~ FEET
LISE TWO - 8' 01~ X 3.5' DEB~ STOI~ Ra,dG$