HomeMy WebLinkAboutSchultz, David
o~ssaFFOL,r~o
ELIZABETH A. NEVILLE, MMC Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
Na Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p Fax (631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER 01 www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK D ~I
TOWN OF SOUTHOLD D
APR 2 3 2013
TO: Southold Town Building Department
FROM: Carol H dell, Southold Town Clerk's Office BLDG. DEPT.
y TOWN OF SOUTHOLD
DATED: April 22, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4213 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mark Schwartz for David & Patricia Schultz
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.
: * t * ~ * s r * r •
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
Signature
O~
Dated
o~SUFFOIt
ELIZABETH A NEVILLE h`Z` Gy Town Hall, 53095 Main Road
O
TOWN CLERK p P.O. Box 1179
to 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS WO
T
MARRIAGE OFFICER Fax (631) 765-6145
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 @ $10 *e"'~or Non-Residential @ $25 _ Application No. 4 °Z 13
Permit No.
Applicant Name X(4 - C~~ Z
Applicant Mailing Address PO l505Q K 93 3
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration NE uJ 2 73w-~-Al
Location of Proposed Construction/Alteration:
Owner of Property-.PAW Q -YL ~i g 1 }2 / C(A L C 6t U(, E Z
Owner Mailing Address: J~D 0 d X 6 Z Q
/41;f TT c., c A.
Owner Property Address: 2 z4 f- W(G (L ~7Q et-~
77G~
Name and phone number of contact person 7 77 ¢ IX E
Tax Map No: (W d Section Block D Z Lot 0,?
Cross Street
NOTE: LOCATION MAP MUST BE SUB TED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY SPAR NT APPROVAL
Signature of Applic Date
Received by:
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NOTES:
1. ELEVATIONS ARE REFERENCED TO 1988 N.A.V.D. DATUM
EXISTING ELEVATIONS ARE SHOWN THUS: "
2. FLOOD ZONE INFORMATION TAKEN FROM:
FLOOD INSURANCE RATE MAP No. 36103C0481H
ZONE AE: BASE FLOOD ELEVATIONS DETERMINED
ZONE X: AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN
3. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND
REMOVED IN ACCORDANCE WITH S.C.D.H.S. STANDARDS.
4. MINIMUM SEPTIC TANK CAPACITIES FOR 3 BEDROOM HOUSE IS 1,000 GALLONS.
1 TANK; 8' LONG, 4'-3" WIDE, 6'-7" DEEP
5. MINIMUM LEACHING SYSTEM FOR 3 BEDROOM HOUSE IS 250 sq ft SIDEWALL Al
5 POOLS; 2' DEEP, 8' dia.
PROPOSED FUTURE 50% EXPANSION POOL
PROPOSED 8' DIA. X 2' DEEP LEACHING POOL
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