HomeMy WebLinkAboutMusich, Richard
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ELIZABETH A. NEVILLE, MMC hy. Gy Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
H Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O Fax (631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1500
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department D
DEC 2013
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: December 3' 2013 Bloc OFP].
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RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4179 for a Cesspool/Septic Tank Construction
Permit submitted by:
Paul Davey for Richard Musich
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.
• • s s ~ s s
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
r
Signature
Dated
I',
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ELIZABETH A. NEVILLE Iy` GS. Town Hall, 53096 Main Roa-
TOWN CLERK X P.O. Box 1179
01 x Southold, New York 11971
REGISTRAR OF VITAL STATISTICS W
MARRIAGE OFFICER Fax (631) 766-6146
RECORDS MANAGEMENT OFFICER Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.nei
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TOXIN OF SOUTHOLD
BUILDING DEPARTMENMITHOLD WASTEWATER DISTRICT
P.O. ,Box 1179
SoLovi 1, KY. 11971 APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK 7/?
Residential @ $10 or Non-Residential @ $25 Application No. L ( D Permit No.
Applicant Name q~> v
Applicant Mailing Address
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Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration /j CSC
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906 Mod"
Location of Proposed Construction/Alteration:
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Owner of Property:
p
Owner Mailing Address: 9 69 1 qo S (>..J
Owner Property Address: S~1a
Name and phone number of contact person b"(- L" 63 -2
Tax Map No: Section Block Qo U Lot _
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY J3- DEPARTMENT APPROVAL
6
Si ture of Applicant Date
Received by:
• SURVEY OF PROPERT&
AT GREENPORT
READ TOWN OF SOUTHOLD
pOND a SUFFOLK COUNTY, N .Y.
T 1000-33-02-42
INLE°SCALE.' 1'= 30'
-13 OCTOBER 9, 2013
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L01,
O- , 0 E~30a RAIN RUNOFF CONTAINMENT
SHED \ S~~KP HOUSE = 1920 sq. ft.
O „t0 ^1r 29~ 1920 x tx 0.17= 326 cu. ft.
'0 2 N. N 326/42.2= 7.7 vf.
Ngg FED, / / PROVIDE 2 - 8'¢ x 4' deep DWs.
DW.
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L.30.6' ? o S
'Ic 70'~ 10' $ \
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TEST HOLE DATA 10~ a
013IENCE %J0 P JB~\C WPZER
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PALE BROWN SILT ML D By Suffolk County Department of Health Services
c ,•':M1 O y Q 4! SEPAC SYSIEL
" 2 8 FT. D/A.x T, FT. HIGH PRECAST CONCRETE LEACHING RING
PALE BROWN AND BROWN SILTY SAND SM i~ z r* 0 I e IL BACKRLL MATERIAL COURSE SAND AND GRA In ¢K~
t aj m 6O [11 1,000 GALLON PRECAST SEPTIC TANK.
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cl LOT ® REFER TO "MAP OF EASTERN SHORES AT GREENPORT,
To SECTION 5" FILED IN THE SUFFOLK COUNTY CLERKS
BROWN FINE TO COARSE SAND SW )i q y, 4 OFFICE ON 12/31/68, AS FILE NO. 5234.
WITH 10% GRAVEL I 4 &Y O 0
l W LOT ®s REFER TO "MAP OF EASTERN SHORES AT GREENPORT,
17' ! 6 44 t~ a SECTION 3" FILED IN THE SUFFOLK COUNTY CLERKS
u U :S - M y- Q OFFICE ON 09/27/65, AS FILE NO. 4475
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PIPE
I =MONUMENT
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m familiar with the STANDARDS FOR APPROVA4_-..,„
D CONSTRUCTION OF SUBSURFACE SEWAGE"
.OF NEW
POSAL SYSTEMS f OR SINGLE FA MIL Y RESIDENCES }O
J will chide by the conditions set forth therein and on the ~~T'MEt2
c~
-mit to construct. A
location of wells and cesspools shown hereon ore
m f,,,eld observations and or from data obtained from others. _
0. 49618
ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION YORS, .C.
EC71ON 7209OF THE NEW YORK STATE EDUCATION LAW. ~a 20 FAX 6
PT AS PER SEC7I0N 7209-SUBDIVISION 2. ALL CERTIRCA710NS - 31) 765-1797
'ON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P. 0. BOX 909
MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ELEVATIONS ARE REFERENCED TO 1230 TRAVELER STREET
,E SIGNATURE APPEARS HEREON. AN ASSUMED DATAM. SOUTNOLO, N. Y. 11971 13-262
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