HomeMy WebLinkAboutFisher, DavidELIZABETH 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
October 9, 2012
OCT ] 0 £L%
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
David L. Fisher
4117 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 retum 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
RECORDS MA~AOEMENT 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, 58095 Main Ro
P.O, Box 1179
Southold, New York 1197
Fax (681) 765-0145
Telephone (681) 705-1806
southoldtown.northfork.n~
Residential ~ $10 ¢ or Non-Residential ~ $25 __
Application No. ql[~
Permit No.
Applioant Mailing Address
Septic Tank ~ or Cesspool
Brief Description of Proposed Cons.traction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Malting Address:
Owner Property Address:
ho.e. ber o£co . t
Tax Map No; Section ~ Block ';[~-~-~ Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, NEW
CONSTRUCTION REQUllLES SURVEY WITH HRALTH DEPARTME1WF APPROVAL
/'"7'N/~ /.---~ignatur~t of ~/oplicant Date
ReceivedgT. / /~J~ YL~ lc) / fi( ~
'.I.gN a3.1.¥~3.1.S¥~ :10 3,3,1:1.-10
S:IglA~qS H£-I'q3H '09 j-Ins
(3-~^I~'.)'::IU
SURVEY OF PROPERTY
A T ORIENT
TO~N:' OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000--18--08-25
SCALE' 1'--40'
JULY 1,7, 1985
DECEMBER 18, 2009 (UPDATE & BOH)
FEB. 1, 2010 (ADDITIONS)
SEPT. 15~ 2010 (prop. h.~e.)
DEC. 30, 2010 (CERTIFICATIONS)
N48'29'OO'E
N/O/F DEBORAH :q_ YNN & COLLEEN
(D',NELL ING)
75' ·
Fi 265'
D. P. & ,1. H. ~
MOORE R
S48~9'00"W
GRACE & SAMUEL PILCER
· =MONUMENT
ELEVATIONS ARE REFERENCED TO AN ASSUMED DA TUM.
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions set forth therein and on the
permit to construct.
The location of wells and cesspools shown hereon are
from field observations and or from data obtained from others.
AN)' ALTERA~70N OR ADDITlON TO THIS SURVEY IS A ~IOLA~70N
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SEC170N ?209-SUBDIt4SION 2. ALL CERTIFICATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
~OSE ~GNA rURE APPEARS HEREON.
BUILDING ENVELOPE
N/O/F' ROBERT GUERRA
(VACA~T)
F~V. ~t%4DE Et Z9
15'
TEST HOLE
b)' McDon=ld
9/08110
S~
~ora'~e S~
AREA=2.4279 ACRES
4J6.58'
cOtL,~
PROPOSED SEPTIC SYSTEM
(4 ~
I PREC,4$T I000 ~ ,SEPTIC TANK
W'ITW 3' ~ C'OL. LAR. DI~ DO~"I TO
CER T/FlED TO'
DA VID L. FISHER
FIDELITY NATIONAL TITLE INSURANCE
COMPANY
Title # 10-7404-80589-SUFF.
RAIN RUNOFF
HS~ 30'~50' ' 1500
1500 ~ I ,~ O J7 "255 cuJlo
255/~E.3 ' 11.4 VF
PROVIDE .=.7 DRY WET-LS 6'~ ~ 4' DEEP
(651) 765-5020 FAX
P.O. BOX 909
1230 TRAVELER STREET
SOUTHOLD, N. K 11971
4961~
765- 179 7
85-24 ?'