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Home My WebLink AboutJacques, Peter JELIZABETH 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.north fork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: July 13,2011 Transmitted herewith is a copy of application No. 4023 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Marina Recinos for Peter J Jacquest Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it ~ me. T!aaok/you j _// Carol Hytll~}/ (/ I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE ~ DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. Dated Page 1 of 1 Robert Barratt F~OB: To: Sent: Subject: "Rudder, Lynda" <lynda.rudder@town.southold.ny.us> <robefftbarratt@optonline.net> Wednesday, July 06, 2011 12:20 PM Construction Permit application.doc SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK [] Residential ~ $10 or ~(N~n-Residential ~ $2~5 Application No. ~1~ T'~ .... Septic Tank ~ or Cesspool [] Permit No. Applicant Mailing Address: ~,1e- ~:~:~T <t-/- , q~.~.~ ~oo~.T: t0¥ 11~44- Brief description of Proposed Construction or Alteration: Location of Proposed Construction/Alteration: OwnerofProperty: P~T~- ~'. Owner Mailing Address: Il 1'~5 ~ u'r't-,~:~ c.~ ~ Property Address: I~ooo tY~,~M Name and Telephone No. of Contact Person: g T~MapNo.: I~o Section: tt% Block: tl Lot: Ne~estCrossS~eet: ~%V~ ~ , NOTE: LOCATION ~ ~ST BE S~TED ~I'I'H ~PLICATION. ~W CONS~UCTION ~Q~S S~Y ~ ~ALTH DEP~ ~PROV~. Signature of Applicant Received by: ~ I Date %t 7/7/2011 COUNTY OF SUFFOLK STEVE LEVY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES JAMES L. TOMARKEN, MD MSW, MPH, MBA, FRCPC, FACP COMMISSIONER PERMIT CONDITIONS Health Services Reference # C t'<>- /[ ~ c.X/o ~ Project Name ~-t ~ '-~" 6/,rl[q ~-'~..~/, The attached plan, when duly signed by a representative of the department, in conjunction with these conditions, constitutes a permit to construct a water supply and/or a sewage disposal or collection system for the property as depicted. The applicant should take note of any conditions of approval, which may be indicated on the plan or enclosed herein. Construction must conform with applicable standards including "Standards for Approval of Plans and Construction for Sewage Disposal Systems for Other than Single Family Residences." Omissions, inconsistencies or lack of detail on the plan do not release the applicant from the responsibility of having the construction done in conformance with applicable standards. Issuance of this permit shall in no way relieve the design professional of responsibility for the adequacy of the complete design. The permit (plan) expires three (3) years after the approval date. Any modification which may affect the proposed sewage disposal or water supply systems requires submission of a revised plan and additional fees (if applicable) for reapproval prior to construction. No inspections will be performed by the department on expired permits. Permits may be renewed, extended, transferred, or revised in accordance with the procedures described in Instructions to Renew, Extend, or Transfer an Existing Permit for Other than Single Family Residences (Form WW'M-081). It is the applicant's responsibility to call the department in advance to arrange inspections of the sewage disposal and/or water supply facilities prior to backfilling. These include inspections of the sewage collection and disposal systems, water supply system components and piping, and final grading as shown on the approved plans. In certain cases, inspections of the soil excavation may be required to determine the acceptability of the soils for sewage disposal systems. The department must be notified at least 48 hours in advance to schedule an inspection by calling 852-5754; and excavation inspections must also be confirmed by calling 852-5700 prior to 9:30 a.m., the morning of the inspection. Article VII of the Suffolk County Code, "Septic Industry Businesses," requires that all installers of septic systems within Suffolk County shall possess a valid license from the Suffolk County Office of Consumer Affairs. This office can refuse to perform inspections or grant final approval for the construction of projects that are installed by an unlicensed individual. It is, therefore, in your best interest to utilize a cesspool contractor with a valid license to avoid substantial delays in your project. Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to existing buildings, or for the use of sewage disposal or water supply systems. SEE PAGE 2 WWM-016 (Rev. 10/02/06) Page 1 of 2 CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT As a condition of this permit to construct, the following items must be completed as a minimum, prior to building occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Other Than Single Family Residences (Form WWM-19). [] Excavation Inspection by the Office of Wastewater Management prior to installation of any leaching pools to determine acceptability of soils. (Call 852-5754 to schedule an inspection and confirm by calling 852-5700prior to 9:30 a.m., the morning of the inspection.) fl~atisfactory inspection by Office of Wastewater Management of the sewage disposal system / sewage eatment system. (Call 852-5754 to schedule an inspection.) [] Satisfactory inspection of the water supply system by: [] Office of Wastewater Management (Call 852-5754 to schedule an inspection.) [] Office of Water Resources, Water Quality Unit (Call 852-5810 for inspection.) [] Satisfactory inspection by the Office of Pollution Control (Call 854-2502 for inspection.) [] Storage tanks [] Other: ~Application for a Food Permit to the Food Control Unit (Call 852-5873 instructions.) for ~Four (4) prints of an As-Built plan [] "Tap letter" fi.om water district C~..Certiflcation from the licensed sewage disposal system installer [] "S-9 form" from Suffolk County Department of Public Works (SCDPW) [] Sewer district approval of sewer line installation (for other than SCDPW districts) [] Well drillers certificate [] Water analysis [] Certification of Sewage Disposal System Abandonment (form WWM-080) [] Design Professionals Certification of Constructed Works (form WWM-073, enclosed) for: [] Sewer lines and sewage collection system [] Retaining walls (approved as part of the sewage disposal system) [] Sewage pump station/valve chamber [] Sub-surface sewage disposal system [] Sewage treatment plant [] Water supply system [] Abandonment of Preexisting sewage disposal system and/or water supply [] Other: [] Other: WWM-016 (Rev. 10/02/06) Page 2 of 2 / / I I I I I I I