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ELIZABETH A. NEVILLE, MMC ~~fy Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
CIO : Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p .iC 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
TO: Southold Town Building Department D
JUL 2 9 2013 ':!J
FROM: Carol Hydell, Southold Town Clerk's Office
A
DATED: July 29, 2013 Bloc- DEFT.
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4149 for a Cesspool/Septic Tank Construction
Permit submitted by:
Pat Moore for Jeffrey Andrade
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 V/
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
D~ 30
Dated
. O~gUFFO~,r~o
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Z
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER • Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 0 Telephone (631) 765-1500
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10Y or Non-Residential @ $25 Application No. Ll
Permit No.
Applicant Name &4 rq~ 4, l-cea CM~
Applicant Mailing Add~fr ss / o 604
Septic Tank or Cesspool X /
Brief Description of Proposed Construction or Ajtera ion fo ry L -ef(l /S
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Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address: 8
Name and phone number of contact person
Tax Map No: Section S Block Lot
Cross Street 4 l ,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES 5 UR DWI HEALTH DEPARTMENT APPROVAL
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Ignature of Applicant Date
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Received by:
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SURVEY OF PROPERTY
° oAV AT PECONIC
TOWN OF
o SUFFOLK COUNTY,ON. Y.
1000-75-06-04
•k9 c~. SCALE: V--30'
r15 ®Q o y OCTOBER 3, 2007
MAY 21, 2012
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1~ ~4'' f ( ~Z('~~IwUii~~cr~P(~cH;~ px~ad" 0111k'ECs.
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9 W \ ST M1~ cr0
u- TEST HOLE
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f~`'[ ~ J? ~~T ~ ,h~rlc9orittx,rt[ ~ f xislins ti'._~
~6 a mo 01llrlmll;jnce al,i<<1i'patx trlien rcxlni[arv uiPYstem must he,. lt,rnentSubr[1lin
S~~ a ~c~~nhleted town Wu ~ff
a5 proof.
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PROPOSED SEPTIC SYSTEM o c s \ \
(4 BEDROOMS MAX.]
1 - 1000 GAL. PRECAST SEPTIC TANK
2 - L.P.s 8'0 . 6' DEEP WITH 3' SAND (SW)
LA . q' _ 8 x k~ D~ ro
COLLAR 3' MIN. ABOVE GROUND WATER
t CIS
21~ 1, ~a het r r~r
TEST HOLE DATA I~` ,Q \ Z
BY McDONALD GEOSCIENCE 3 1 a'i'm'~~ O
3/1/12 be y
EL. 15.8'
MIXED SAND AND LOAM
' ~zl
-k l
BROWN SILTY SAND SM
3 NN ~ mC' 1
_ W
PALE BROWN FINE TO COARSE SAND SW 1j0 U, tRT.4C'vY Or' HEA.LIh: -cr'RV[CE
EY PER&1r~
rr ~
EL.3.9'
WATER 11.9' r L ` J'ti Ll n
SUP( <;
WATER IN PALE BROWN FINE TO - n~
COARSE SAND SW fC
~3s
RAIN RUNOFF CALCULATIONS p DEC' ms
HOUSE 2030 SOFT. EATE OF APPROVAZ
CONC. SLAB 800 SOFT.
,0830 • 1 r OJ7 - 481 CU. FT. _
481142.2 . 11 VF -PERVIOUS DRIVEWAY 1425 SO. FT. $ Z °y
1425 • 0.7 x OJ 7 - 169.6 CU. FT.
169.6142.2 e 4 VF
TOTAL 15 VF Tp N0
PROVIDE 21 DWs 80.6' DEEPEEP 0~ D -\Z
AREA = 36,536 sq.ft. WEnP-V-
AEVATIONS ARE REFERENCED TO NGVD. ~L
I am familiar with the STANDARDS FOR APPROVAL 97.28
AND CONSTRUC77ON OF SUBSURFACE SEWAGE
- SAL SY57EMS FOR SINGLE FAM/LY RESIDENCES
~ on will abide by the conditions set forth therein and on the 3,26 5z~
_ per it t0 construct. 57
ocation of wells, cesspools & public water shown hereon ore
rr fr field observations and or from data obtained from others.
Y.S. L/C. NO. 49618
ALTERA77ON OR ADD1770N TO THIS SURVEY IS A VIOLA77ON AE'CONIC SU RS, P. C.
SE0770N 72090E THE NEW YORK STATE EDUCA770N LAW.
4 EPT AS PER SEC77ON 7209-SUBDIWSION Z ALL CER77F7CA77ONS (631) 765-5020 FAX (631J 765-1797
EON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY /F P. 0. BOX 909
MAP OR COPIES BEAR THE IMPRESSED SEAL OF 7H£ SURVEYOR 1230 TRAVELER STREET
SE SIGNATURE APPEARS HEREON. SOUTHOLO, N. Y. 11977 07-208