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ELIZABETH A. NEVILLE, MMC hZ~ ~Gy Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
C Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (631) 765-6145
O
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER www.southoldtownnygov
OFFICE OF THE TOWN CLERK n r
TOWN OF SOUTHOLD Iin
TO: Southold Town Building Department U U FEB 10 2014
~D
FROM: Carol Hydell, Southold Town Clerk's Office
i_
DATED: February 7, 2014
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4420 for a Cesspool/Septic Tank Construction
Permit submitted by:
Pat Moore for Uvanik
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
DISAPPROVE
Comments:
C
Signature
03 d 4/*-
Dated
o~~?FF01/rea
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK C2 P.O. Box 1179
I Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ld hf
MARRIAGE OFFICER Oy Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
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~ or Non-Residential @ $25 _ Application No. 4q
"
Permit No.
Applicant Name G ae-~
Applicant Mailing Address cJ
Septic Tank or Cesspool V~~
Brief Description of Proposed Constructipn or Alteration
<i Gren 51 C1Gls/Griu ~i~
Location of Proposed Construction/Alteration: /
Owner of Property: hl rn . `4 ~n l~ yccn r -
Owner Mailing Address:
IZ A-Y -7 71
Owner Property Address:
Name and phone number of contact person 7ctt 7~j L133 C
Tax Map No: Section YLI Block / Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY II RFf TH DEPARTMENT APPROVAL
1 Signature of Applicant Date
Received by
I am /=Wv With the STANDARDS FVR A AL
NO AND CONSTRUCTION OF SU8'SURFACE SEWAGE
t DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
50 v o \ S 6,1-0, and WE abide by the conditions set forth therein and on
O J P 63~p0, the permit to construe/.
COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FO:t APPROVAL OF CONSTRUCTIOIJ FOR A
Avow
1)v ~OJ•"Qh
SINGLE FAMILY RWStDcaICE OF41-Y
LO t/~ ~OtJ K.B' OCT 2 8 2013;
oQ K0.)10 DATE f I?EF:
•\\ea~ M;.. fZMitY`,L = K~ :1+6 rea:,Ci ..D
Eps Q~ r
96t yJi FG^ h9n A. a .U OF FRO?vl DATE OF APPROVAL
as
a ZtNe P,i' Et• > rn°"'
EXPIRES ti i ATE Or APPROVAL
00 eel iii df\~1 ~ T,.. U:
NOTES r+5{ . " N ,yjk O
SETBACKS TO BULKHEAD v CV \
EXIST. HOUSE 37' e~ t• J~ w
PROP. HSE. ADDIT. 50' TEST BORING
SETBACKS TO TOP OF BANK d• / m BY McDONA D OSCIENCE
EXIST„ HOUSE 20' ,A. 6181113
PROP HSE..ADDIT, 42'. V/ /Z
TRELLIS-PATIO ON GRADE E5 2 D rk Br. Loam O,
X 10 s A L
CPA D 1
(f~~
AREA TO CEHL= Fg ,I c? z Sfr" e Or. S11 ML ~ ~&r o 3•
48,244 sq.ft. ' Std is ? ho s i Q BrSM y Sand
COP~P 5~_ ~y 1 Q T 14.3 Water In Br.
LOT COVERAGE Fy t9" a O S& Smd
EXISTING - +
16'
HOUSE- 1347 sA.ft. ~1e 'M
GARAGE- 596 sq.ft 'E`` f4 s ` ~j q~, Brown F6 ~fo
Total 1943,sq.H. o A sand
1943/48,244 - 4.0% A
iao•
O` I a 28'
AT COMPIr6TiON OF CONSTRUCTION
HOUSE -4127_ sq:ft. ~;9 N 1 A Z
GARAGE 596 sq.tt. O R• r~ o O
Total 4723 sq.It. ° J Q
~e 9242 i
4,72:5148,244 - 9.8% Q ' all[
PROPOSED NEW SEPTIC SYSTEM,/(obG Sa D
(4 BEDROOMS) l ~
` k J i~s frySW8 ~dl f0
I - 1000 GAL. PRECAST' SEPTIC TANK ry
2.- B' 0 x 6' DEEP LEACHING POOLS ot~tl• ghO14?A®, exactly as
WITH 3' SANG (StM). COLLAR 3' approved SuL
/ a
ABOVE WATER ~ hoGe ~.m ~ o
O
9. Tp a R ~
LLI S4KND (SW) a w 7~
1!E 4 MLiN Et9STiNG CESSI-OOL TO % r
3 S. 66
TISRA TION OR ADDITION TO THES SUR Y IS A VIOLATION U1 C%
AF 9ECMN 78" OF'TNE NEW YpyW-( STATE EDUCATION LAW, 01,1. 16
£XCEPTAS PE41 SECTION 7209 S.U1I 1WSM Z. ALL CERTIFICATIONS ~`a Po/& ~t
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAD MAP OR COPIES BEAR THE SEAL OF THE SURV R Q \ \ O
WHOSE SIGNATURE APPEARS HEREON.
d t
Excavation tnspecti n Req a e j 27 3's
For Sanitary S tern
nt
CERTIFIED TO, By Health Depa g6, 6
126.
TRW TITLE INSURANCE CO. a11116
THE PRUDENTIAL HOME MORTGAG CO. INC. 7
/
SE~ UUYANIK YANIK , 85' - j~
FO 4005,S, '78
d e _ ~ "DAB (fit - P~UNGATER)
LIG
e os PeI hle ~DVL
FLOOD ZONE LINE FROM FIRM Road Lin Abandonment of existing sanitary system must in
be
3
COASTAL EROSION LINE 61'03CO158H conformance with department re. ysteelJY Submit
from COASTAL EROSIONA AZARD AREA MAP VACANT completed form WWM_ 0 as proof.
Photo # 55-581-83
AREA = 1:4266 ACRES to SURVEY OF
tie tine LOTS 12 13 8f: 14
)NAP OF PROPERTY OF W, 4 YOUNG & R.J. GOODALE
CONTOURS AND ELEVATIONS ARE FILED SEPT. 11, 1929 MAPNCy14685
REFERENCED TO NA VD. A T ARSHAMQMQQ7E
OF NEtr TOWN OF SO THOLD
~X=T SUFFOLK COUNTY, N. Y,
1000-44-01-04
'd ! -n
o o SCALE 1 = 50
.,,o ~ M OCT. 29, -1991
~
'~o.tgfii x n APRIL 14, 2009 (COASTAL EROSION HAZARD LINE)
NO. 49618 DEC. 12 2012 (ADDITIONS)
m FEB. 5, Y63 (additions)
E'CONIC S , C. FEB. 11, 2013 (additions)
(631) 765 - 5020 FAX 1631) 765 - 1797 >rn o < JULY 23, 2013 B.O.H.)
ern w m AUG. 2, 2013 (REVISIONS)
1230 0 BOX TRAVEL909 ER STREET A~ XT 9,20t96Rev15IoNS
SOU < OUTHOLD, N. Y, 11971
OM 91 -2 73