HomeMy WebLinkAboutBaisch, Mark
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iii i F AMC Town Hall, 53095 Main Road
ELIZABETH A NTF{ > P.O. Box 1179
TOWN CLERK H = Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS Fax (631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER Ol www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK pp ~n
TOWN OF SOUTHOLD D E u v
D
TO: Southold Town Building Department MAR 12 2013
FROM: Carol Hydell, Southold Town Clerk's Office BLDG. DEPT.
TON,N 0, SOCTNOLD
DATED: March 11, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4203 for a Cesspool/Septic Tank Construction
permit submitted by:
Mark Baisch
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 Det)artment
Signature
D3 5
Dated
O~gUFFO(,~co
ELIZABETH A. NEVILLE fi`t` G.y Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
q Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER • Fax (631) 765-6145
MANAGEMENT RECORDS FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
'A/ CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No.
Permit No.
Applicant Name
Applicant Mailing Address 7 f
Septic Tank or Cesspool
Brief Descripti n of Proposed Construction M Altera
i U
Location of Proposed Construction/ Alteration:
/
Owner of Property. -M (,1[ 7~ ( 1 I I Rw6f , 5
Owner Mailing Address: Vp--F'- A
Owner Property Address: 070 09
Name and phone number of contact person ^
Tax Map (No: Section Block a 3 Lot
Cross Street Vii{ { ~7 V IPG(_~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURD Y WITH HE TH DEPARTME NT PR1 ~VAL
171 ignature of Applicant ' Date
Received by:
GJInVLC W1 NJ JnVYYIV I
ON MAP OF INLET EAST ° 40,092 1 DOG FENCE
ESTATES w I
FND.
MON. 2 J
LOT 1
CERTIFIED T0. (DWELL.)5 w
1
LANDMARK PROPERTIES OF'30 OLK, LTD. r' If L',"$A-WITAIRY .;TGN1 1
CHICAGO TITLt'INSURXNC£ 6 NY -HEW Irr.-NT
FNC.
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w 0.3Ny
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FNC. w ~ U LL) Z
4' CHAIN UN ~EI~CE N
EL.106.911 0 0
THE EXISTE -A L2Nx
r WAY 0.3E v w = N 15'23'30" W 156.00' ci zz zo j~
AND/OR EAS CORD IF c l o o LOT No. 5 o^ 0o w
ANY, NOT SHOWN ARE NOT ?x pyELLGUARANTEED.
( ) of LOT No. 7
\ xI (DWELL.)
UNAUTHORIZED ALTERATION OR ADDITION Z./ \'os~
TO THIS SURVEY IS A WOLA77ON OF NOTES
SECTION 7209 OF THE NEW YORK STATE ELEVATIONS SHOWN ARE
EDUCATION LAW. IN ASSUMED DATUM
COPIES OF THIS SURVEY MAP NOT BEARING ALL SURROUNDING PROPERTIES WITHIN 150' OF PROPOSED SANITARY
THE LAND SURVEYORS INKED SEAL OR SYSTEM ARE CONNECTED TO PUBLIC WATER SUPPLY EXCEPT AS SHOWN
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY. DRAINAGE CALCULATIONS,
GUARANTEES INDICATED HEREON SHALL RUN SYSTEM No. 1
ONLY TO THE PERSON FOR WHOM THE SURVEY ROOF AREA - 2591 S.F. x 2/12 x 1007 = 432 CU. FT.
S PREPARED, AND ON HIS BEHALF TO THE GRASS AREA = 20,000 S.F. x 2/12 x 157 = 500 CU. FT.
TOTAL REQ. TITLE COMPANY, GOVERNMENTAL AGENCY AND CAP. = 932 CU. FT.
LENDING INS77771770N LISTED HEREON, AND USE 1-1100' ' DIA. 14 V.FT. = 958 CU. FT. ACT. CAP.
TO THE ASSIGNEES OF THE LENDING INSTI- SYSTEM No. 1
TUT/ON, GUARANTEES ARE NOT TRANSFERABLE. DRIVEWAY AREA = 1200 S.F. x 2/12 x 1007 = 200 CU. FT.
USE 1-8" DIA. 5 V.FT. = 211 CU. FT. ACT. CAP.
SURVEY OF: LOT No. 4
MAP OF INLET EAST ESTATE Fes" KENNETH H. BECKMAN L S
FILED MAY 1, 1975 FILE No. 6249
SITUATED IN: MATTITUCK Surveying and Land Planning
s 1814 Middle Country Road
TOWN OF: SOUTHOLD Suite D
771
R1lICBS Ridge, N.Y. 11961
SUFFOLK COUNTY, NEW YORK r. (s31) 345-9427
FAX (631) 345-9429
DATE: 81112012 JOB NO. 812-14418 SCALE: 1" = 30'
DIST. SEC. BLK. LOT
• S.C.T.M. NO. 1000 100 03 010.4
REV. DWELLING 12/17/2012 B12-14711
REV. 9/10/2012
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