HomeMy WebLinkAboutPergament, AnneELIZABETH A. NEVILLE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS OF MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
T(iwn }lall, 53095 Main Road
]~O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
RE:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
November 14, 2012
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4123 for a Cesspool/Septic Tank Construction
Permit submitted by:
Christopher W. Drum for Anne Pergament
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.
1 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
Si[mature
/ /
Dated /
ELIZAB]~FH A. NEVILLE -
TOWN CLERK
REOISTRAH, OF VITAL 8TATISTIC~
MAKKIA/2E OFFICER
REOORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
.~Town Hall, 53095 Main
P.O, Box 1179
Southold, New York 1 197
Fax (631) 765-6145
Telephone (681) 765-1800
so utholdtown.northfork.net
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./'] / ~ 3
Permit No.
NOTE: LOCATION MAP MUST BE SUBM1TT~ WITH APPLICATION. NEW
CONSTRUCTION REQUIRES ~ARTMENT APPROVAL
~plic~t M~hng Ad.ess
Septic T~ ~ or Cesspool
Brief D~ption ofPropos~ Cons~ction or Alte~tion
~tion of Propos~ ConstmctioW~terafion:
Owner of Prope~:
O~er Prope~ Ad&ess:
N~e ~d phone n~ber of ~n~t p~on
T~ Map No: S~tion
N
TEST HOLE DATA
BY McDONALD GEOSCIENCE
5/,30/12
NO WA~R ENCOUNTERED
DARK BROWN LOAM O{
BROWN SILTY SAND SM
PALE BROWN FINE SAND SP
,
SUFFOLK COUNTY DEPARTMENT OF HEALTH SER~CES
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY ~,E$1DENCE
'"; TOTAL ~M U M DF. BROOMS
EXPIRES THREE YEARS FROM OAT~OF APPROVAL
AREA=21,125 SO. Fr.
TO TIE LINE
LOT NUMBERS REFER TO "MAP OF SECTION D, NASSAU
POINT CLUB PROPERTIES, INC." FILED IN THE SUFFOLK
COUNTY CLERK'S OFFICE ON MAY 7, 1926 AS MAP NO. 8.06.
ELEVATIONS REFER TO AN ASSUMED DATUM.
PROPOSED SEPTIC SYSTEM SURVEY OF PROPERTY
(rou~ .EDRO0~ MA×.) 8'6' ~ A T NASSAU POINT
[1] 1, 000 GALLON SEPTIC TANK
[1] 12' DEEP× 8' D,A.ETE~ LEACH,NO *00~ TOWN OF SOUTHOLD
SUFFOLK COUNT~ N.
RAIN RUNOFF CALCULATONS 1000-111-11-10
HOUSE ~ GARAGE= 2,688 sq. ft. SCALR' I~30'
5,261 x 1 x 0.17= 457 cu. ft. JUNE 26, 2012
457 / 42.2 = 11 VF AUGUST 10, 2012 (PROPOSED HOUSE ~ POOL)
PROVIDE 2 DRY WELLS DIAMETER x DEEP
OR EQUAL.
~o
LOT 415
(D~LLING)
-c44/~e , N85'21 '50"W ' ~
~?~ ?&~)LOT 419 Wi~ / -~8 EL 28,O'
~OO~b LOT 418 203.80'
~ =MONUMENT
~he
ANY AL~RAHON OR ADDITION TO ~IS SURLY iS A ~ATI~ PECON/C
OF SECTOR 72090F T~E NEW Y~K STA~ EDUCATION LA~ ~6~) 765--5020 FAX
765
1797
EXCEP[ AS PE~ ~CB~ 7209-SUBDIWStON 2. ALL CERTI~GA~ONS
~OSE SIONA~URE APPEARS HEREON. SOU~HOLD, N. ~ 11~71
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and wfll abide by the conditions set forth therein and on
permit to construct.
The location of public water, we/Is and cesspools shown hereon are
from field observations and or from data obtained from others.