HomeMy WebLinkAboutGillooly, WilliamELIZABETH 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
May 2, 2012
MAY - 7 2012
BLDG DEPT.
TOWN OF SOUTHOLD
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
William L. Gillooly
4081 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
Signature
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
REC-~ORDS MANAOEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
.~Town Hall, 53095 Main Roa.
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (681) 765-1800
so u [holdtown.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 __
Applicant Name h~t ~/~4~ ~ ~ ~9c'~
Applicant Mailing ,~dress ~XS>.X' -~'-
Septic Tank ,/~or Cesspool /
Brief Description of Proposed Construction or Alteration Q ~ ~
Application No. _t~C~ {
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property: (2)/L/~//t~.
Owner Mailing Ad&ess:
Owner Properly Ad&ess:
Name m~d phone number of contact person
Tax Map No, frS~- Section
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
Signature of A~plic~// Da~
Received by:
~ · SURVEY OF PROPERTY
· ~ ~ ¢~j/ A T ORIENT
~ ~ TO ~N OF SO UTHOLD
~ ~ ~~ ~ SUFFOLK COUNT~
~ ~ SC~' I =50
11/21/57(D~iN~)nLE NO. 2777 ~ ~ ~ ~ ~ ~ ~T~ER 14, 2010
~ ---' t'~ ,. ZONE X
RAIN ROOF RUNOFF
HOUSE WITH ~ARAGE - ~048 sq. ft.
ZOd8 ~ t . 0.17 - 348 cu. fl.
GRADING ~ -- Ir ~ --
PLAN ~ ~ 1 T
i j
PROPOSED SEPTI~ SYSTEM
~1~ - 1500 ~eL PRECAST SEPTIC TANK
(~) - ~' ~ ~ 6.5 deep LEACHING POOLS WITH
3' SAND COLLAR ~SW} 3' ABOVE GROUNO WATER
TO BE B~LT TO S~FOLK COUNTY DEPARTMENT OF
HEAL TH SERVICES SPECIFICATIONS
TEST HOLE DA TA
~cDONALD GEOSClENCE
PROVIDE - 4 PWs. 6'e. 4' deep ~:~ '~
' ~( ..... ~ ' ' ~~:e~r~''
B =MONUMENT (VACANU i N/O/F NORMAN D. ELSKY ~kXPY~S~[~YSA~OMDA~OF
, - ~ I I wA~ ~ ~ fiNE
FLOOD ZONE FROM FIRM RATE MAP NUMBER J610JCOO88H (D~LLING) __
ELEVA~ONS REFERENCED TO ~ A ~D '88 ~ REVIEW DEiERMIN~ DATbD / -~.::
~e /ocoUon of we/Is and cesspools shown hereon ore ~._~ ~ ..... ~ ~¢ea~.,M
from field observations and or from data obtained from others ~--~ ~. ~ I . ~ ~ ~ ,~ ~.~.
N.~S. LIC. NO. 4961,~
ANY AL~RAEON OR ADDISON TO ~IS SURLY IS A ~OLAE~ I am fomil;~ ~;+~ +~ er~*,n~onc C~D ~on~,.*,
~ SEC~ON 72090F ~E NEW Y~K STA~ EDUCA~ LA~ AND CONSTRUCTION OF SUBSURFACE SEWAGE
~.~¢ ~ ~E5-5020 FAX (6~1) 765-1797
EXCEPT AS PER SEC~ 7209-SUBDI~SI~ 2. ALL CER~CA~S DISPOSAL SYS~MS FOR SINGLE FAMILY RESIDENCES ~0. BOX 909
SAIDHERE~MApAREoR VALIDcoPiEsF~BEAR~IS~EMAPiMPRESsEDAND COPIESsEAL~ERE~oF ~EONLYsuR~YORIF and will abide by the conditions set forth therein and on the 1230 TRA~LER S~EET
~ ~,~ ~ ~. ~ ~ ~,r~, ~o construct. ~ 0--220
SOUTHOLD, N.~ 11971