HomeMy WebLinkAboutReinertsen, John
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ELIZABETH A. NEVILLE, MMC Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
to Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p Fax (631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownnygov
FREEDOM OF INFORMATION OFFICER r~
E Q E
OFFICE OF THE TOWN CLERK r
TOWN OF SOUTHOLD D
1 7 2013
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office BLDG. DEPT.
HOLD
N OF SOOT
DATED: July 16, 2013
Transmitted herewith is a copy of application No. 4143 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
John Reinertsen
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 to me. Thank you
I have reviewed the application and loc lion 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.
Signature
v C3
Dated
.
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
p~ Residential @ $10 or ? Non-Residential @ $25 Septic Tank ? or Cesspool ?
Application No. Permit No. -
Applicant Name: ` -
Address: : ' t~ dr~m
Applicant Mailing ~
Brief description of Propsed Construction or Alteration: d k~ fryt ' n
O
Il'e
Location o Proposed Construction/Alteration:
Owner of Property: alq~-n- , :a lc,-~
Owner Mailing Address: t `~z
Property Address:
-U nic ?w
Name and Telephone No. of Contact Person: /S3 2~ ~1 Fi
p :
A
. • r n Lot ~n
Tax Map No.. Section Block:
Nearest Cross Street: YXA~rwl
AEI P G ~C Imo TION. NEW
NOTE: LOCATION MAP MUST BE SUBMITTED WITH PARATMENT APPROV
CONSTRUCTION REQUIRES SUR WITH
Si of Appli n ate
Received by: / '
LOT NUMBERS REFER TO 'MAP ?F ARROWHEAD COVE' SURVEY OF PROPERTY
FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON N
JUNE 20, 1963 AS MAP NO, 38t0. ,
AT PECONIC
RECEE p TOWN OF SOUTHOLD
JUL 10 2013 SUFFOLK COUNTY, NEW Y01
SUFF. CO. HEALTH SERVICES 1000-98-02-03 &
SCALE: 1 50~
OFFICE OF WgEM(ATER MGT.
MARCH 1, 2000
JUNE 28, 2006
~T p ~ t? Sept L~, Zooc C/aj ~.wcro.cj e)
N~~P POKY Feb 27i 2007 ~W4f•r- /'7 C)
IND~ o
W ~
W~
(31o
o-
VACANT o r
LOT 39 Q L _
I n
° o I
124,14' (chap) SUFFOLK COUNTY DEPARTMENT TMENT OF HEALTH
N 88'42'20' E 124.09' (actual) a PERMIT FOR APPROVAL OF COTrSTRUCT'O CT,^ SERVICES
2s.= G 2¢., N FORA
m° etE~ tt ~ N
10.3E !e7( .
LOT 38 bo "9 Ln
~n m DATE !6 H.S. F No.
IE CZ APPROVED
ri 9 m Tor 'MUM BEDROOMS
Z EXPIRES TNREF YEA R- FROM! I)f; I € G= APPROVAL
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v I pr°P o[nva o W v vlwl0 ~t~C-2~VQ~~~ WGf~~
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\ £ I I eut~ P P Water Line(s) s
~pt Be Inspected B
ry,t~~Q P Suffolk County Dept.
° Of Health ServiceThe
s.
v gar ip• I Call 852-5700
a o pfo? 35 1 48 Hours In Advance,
o I _ _ _ _sr _ - H To Schedule Inspection(s),
z 37, s^^ o
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CERTIFIED TO,
P JOHN REINERTSEN
~s s<. e7 ANGELA REINERTSEN
2¢.0
FE 88'42'20' W 135.00'' (chap) a0"
0.5 E I i1
LET 36
(dwelling) Lo-/ CoVera 3e
hseoo~f
ELEVATIONS ARE REFERENCED WATER METER oo/ Bap 9, f,
TO AN ASSUMED DATUM. P
cc.DCW)n, 30o s.f.
640,Ve, 15 so s C, /
AREA= 41,815 S.F. dwell Coi8Z> ./S1Ss.f.'/4
C,Rs /50~
TEST HOLE DATA
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE Dark brown silty loan DL
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 1.51
and will abide by the conditions set forth therein and Brown loamy sand SM
on the permit to construct. hsa , 3•
43:5 of NER,Y
The location of wells and cesspools shown hereon are 0 ~Nt. MEr2 0
from field observations and or data obtained from others. Pale Brown fine to coarse a_pd
/ s. N * c
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ECONIC SU , "
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. (631) 765 - ppX; ) 71
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS 'L .4 Ei1'3 1
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF R O. BOX 909 S'FQ `
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER fU
WHOSE SIGNATURE APPEARS HEREON. 17' SOUTHOLD, N.Y. 11971 Po,
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