HomeMy WebLinkAboutKempton, Gail ,%WFO14-c
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Town Hall,53095 Main Road
ELIZABETH A. NEVILLE,MMC ,4�'4% Gy
TOWN CLERK o : P.O.Box 1179
H Z Southold,New York 11971
PR
REGISTRAR OF VITAL STATISTICS ■P Fax(631)765-6145
MARRIAGE OFFICER ,'*AL 40* 0.1 Telephone(631)765-1800
4.RECORDS MANAGEMENT OFFICER : �l `�►„.0 www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER .��,,,,,,•�
OFFICE OF THE TOWN CLER —
TOWN OF SOUTHOLD
TO: Southold Town Building Department \1\I\ SAY - 5 2014
FROM: Carol Hydell, Southold Town Clerk's Office BLDO,.DEPT.
T0,4n!N OF SOFT?SOLD
DATED: May 5, 2014
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4236 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mark Schwartz for Gail Kempton
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: ' „dot., 0 .e„ :`a��■A
re
� C "
Signature
C/ /2 /'
Dated
:J �401itx UFF01ot
ELIZABETH A. NEVILLE ���� ``1` Gy`� Town Hall, 53095 Main Road
TOWN CLERK % p P.O. Box 1179 ft
REGISTRAR OF VITAL STATISTICS � i; Southold, New York 11971
MARRIAGE OFFICER : O �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = ?fp a0� #6 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '� .„0� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $ioX or Non-Residential @ $25 Application No. `I 23,(0
/.4 cc- Permit No.
Applicant Name d e r ln.J#1-- r Z
Applicant Mailing Address to 45 0,,k/ j 3 3
Cyrr_ & c,4 1i 93 r
Septic Tank /or Cesspool
Brief Description of Proposed Construction or Alteration Niz-Li fe.fa 77C £ y ././j .(1
,02 /vt2 w tfti v fe
Location of Proposed Construction/Alteration:
Owner of Property: 641C— t� e Ai f N
Owner Mailing Address: 2 c A(/0 Ai 00.a )Q_0 4,p
C (J7z t* 6c E—
Owner Property Address: S-4 41�_
Name and phone number of contact person 42) SClite/11-r Z- 7344/ P
Tax Map No: / 000 Section /1 0 Block 0.3 Lot 3 Z
Cross Street Pe Qv/U'i-}-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURV Y WITH HEifr T>■: PARTMENT APPROVAL
/
, o2// ¢
Signature e of Ap t te
Received by: 1-42---------
J 4 IL(
r
• .
p -
(DWELLING WITH PUBLIC WATER)
(DWEW WITH PUBLIC WATER) SURVEY OF PROPERTY 44 NG V
OAD W F A T FLEETS NECK o
�I[IDLAND Abandonment of existing sanita>i�► m„�S� D TOWN OF SOUTHOLD
/'
(PUBLIC WATER IN STREET) conformance with department z ._ SUFFOLK COUNTY, N. Y.
°" 13.0 completed form rtent Submit ..
WWM= — . .. I,t 1000-110-03-32
EDGE OF PAVEMENT 176.57' . SCALE: 1'=30'
1,D V�RE _4, -- ' r EL 7. NOVEMBER 20, 2013
ow(EL. 12.8' N50'03 20 E 'KII g
OVERHE • M. r S'j'ILLWAT SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
3 t 1. l 4br 4' o AVENUE
I � " 'C' NEST HOE r; SINGLE FAMILY RESIDENCE ONLY
v EL. 9.1
2 ? / -t- F ► ---_----}uTUTY FEB Z 0 2014
.�/ UTILITY
POLE
P t O r ,�7' fr •f^��/// DATE /REFNO. x) - 1 --CA; I
k ?� E 37. .E , ' . , _ •- : �. * I o44 c APPROVED i�
, ] 1 . .. DRIVEWAY CO
W � FOR MAX U OF •
I ASPHALT DRIVEWAY n , -D / BEDROOMS
sir- u /("f��, , ,4" ��� ��� y ago ► EXPIRES TH E YEARS FROM DATE Or/PPROVAL
I 1 9/ — / ir 1
V
OR' rW <lr �� '�.��� I (E isnNC) v Z D c e
-VI 1./ 4 4 0 4 ; :4 -21
`� a ii, .ti. ' Li1
171
PROPOSED LOT COV RAE.CaV 'i / Y17. .I HOUSE - 2354 sq. t. � atiorl el
EL s.T Mme+/s' q _.°- SW 2354/16320 = 14.4'K For San tpeCtion Req Uired
MON. X54 550 W ROW OF 3 2.2 7 y��y �r�I V R
N 1/5.2� ROn, OF 9 . O �rY System
_ __ E> EL es' c v ROOF RUNOFF CAL ATION�y Health pepartme�I(To )(DWELLING WITH PUBLIC WATER)
T 2354 xql x 0.17 V , •0 cu.tt. t
Fi z 400/42.2 = 9.5 VF
a• N/o/r PROVIDE (2) DWs. 8'o x 5' depth
'*I o T i MARIE & KEVEiN gVER1N, CAN�CE & SEAN YORK
� c c'3 A ;
�> ", rn ARAD/NG PLAN EXISTING HOUSE do DRIVEWAY TO BE REMOVED
ra�
'".= r 3 ,P rm 4' PRO FLOOD ZONE FROM FLOOD INSURANCE RATE MAP
.f ( 3 C F.F. EL 16• prE TEST HOLE DATA MAP NUMBER 36103C0163H SEPTEMBER 25, 2009
E BY McDONALD GEOSCIENCE .OF NEW y AA
Q •• ...�"" ". EL. 14' ELEVATIONS REFERENCED TO N.A.V.D. 1988. NOVEMBER 25, 2013 �P� •(. Er 0`7,
I •■ • ••,.• 144 �,N
I 12" I.E. �°"'I- LE. YT — I am familiar with 'the STANDARDS FOR APPROVAL °- 9•1' ____ 1,DARK BROWN LOAM CL �& ,`i
_____� _ 11." �c rr.o' tar AND CONSTRUCTION OF SUBSURFACE SEWAGE BROWN SILTY SAND sM * ^,.":^ ';':'.!1
r rr DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 3.
PROPOSED SEPTIC SYSTEM POOL 1 - BROWN FINE SAND Ski
e Una I a c� and will abide by the conditions set forth therein and on the ____ 9,
OR.[1]LEACHING POOL 6' DEEP WITH 3' CLEAN-6_-- ——--3 Ez. _1. permit to construct. .__-_9.MATER IN BROWN FINE SAND SP �"
SAND COLLAR, REMOVE MATER/AL DOWN =a•a ll The location of wells and cesspools shown hereon are ~` No.40
TO SAND SP AND BACKFILL WITH CLEAN SAND.I- P WATER IN BROWN CLAYEY SAND SC v p,
I &_ 1 from field observations and or from data obtained from others. 2, - •LAND....„11.16 ...„„„,.1„04111:....
[1] 1,500 GALLON SEPTIC TANK. I -11.9'.� lC. NO. 49618
TO BE BUILT TO SUFFOLK COUNTY DEPARTMENT OF
Ja -12' ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION WATER ��D FINE TO C�IC YORS, P.C.
HEALTH SERVICES SPEC/RCA 110NS OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW. 28' (631) 765-5020 FAX (631) 765-1797
EXCEPT AS PER SECTION 7209-SUBD/VISI 2. ALL CERTIFICAT70NS P.O. BOX 909
EXISTING SEPTIC SYSTEM TO BE REMOVED IN ACCORDANCE HEREON ARE VALID FOR THIS MAP AND C PIES THEREOF ONLY IF 1230 TRAVELER STREET
WITH S.C.D.H.S. SPECIFICATIONS. SAID MAP OR COPIES BEAR THE IMPRESS4) SEAL OF THE SURVEYOR AREA-16,320 SQ. FT. 13-281
WHOSE SIGNATURE APPEARS HEREON SOUTHOLD, N.Y. 11971