HomeMy WebLinkAboutNickolaus, Jamie ELIZABETH A. NEVILLE,MMC y► l/y Town Hall,53095 Main Road
TOWN CLERKO P.O.Box 1179
H = Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p . Fax(631)765-6145
MARRIAGE OFFICER a�� Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER 0.( `�► www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CIARK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
U,� MAY 2 1
FROM: Carol Hydell, Southold Town Clerk's Office 2014
DATED: May 20, 2014
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4240 for a Cesspool/Septic Tank Construction
Permit submitted by:
LPA Architects,LLP for Jamie Nickolaus
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: Final approval reguired from the Suffolk County Health Department
2 r -
Signature
Dated
o�OSOFFO(,�C'
ELIZABETH A. NEVILLE _`� �Gyl Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
REGISTRAR OF VITAL STATISTICS yy, Southold, New York 11971
MARRIAGE OFFICER ♦ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �O'� �a 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.
Permit No.
Applicant Name VA / 'WC-T5 l,t.9
Applicant Mailing Address �� (Atf f-1
Septic Tank )( or Cesspool
Brief Description of Proposed Construction or Alteration ^� 113GlU
Location of Proposed Construction/Alteration:
Owner of Property: jkjfz* �,Cr�.i, �5 � p `Ckv S
Owner Mailing Address: 3O (3UMMA016W O"W,
0x OW5 Aw (111b
Owner Property Address: t3!5,55 5Wr- (1W AyV_
Sy�rtti' .
Name and phone number of contact person
Tax Map No: Section 051 Block Lot Z•
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signa of A UDPlicarnt Date
Received by:
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EXCAVATION INSPECTION RE IRED P e to
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SCALE: 1"=40' _ s� Vater
SITE INFORMATION AS TAKEN FROM A SURVEY BY NO WELLS WITHIN {{
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NATHAN TAFT cORWIN I11, LS., DATED DEC. 18, 2013in 100' OF PROPERTY Orli $52-5
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SEPTIC SYSTEM TO BE ABANDONED,
PUMPED, REMOVED, 4 FILLED IN W/ CL
GLEAN SAND d GRAVEL
SITE DATA:
CURRENT LOCATION OF EXISTING MAP: DESCRIBED PROPERTY
111 2 1/2 STORY BRICK RESIDENCE SE TINA WALOT-
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Q � #
..................................:......................... 1000-051-OI-2.1
m AREA OF 51TE:................................................ 115,206 5F
In AREA OF PROPOSED BLDG:••••........................2,02.1 5F
Q AREA OF PROPOSED COVERAGE:................... 2,721 SF
% LOT OGGUPANGY: ........................................2.4%
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ELEVATIONS AS PER NGWD 1929 DATUM
ACTIVE WELLS WITHIN 150'
PROPOSED SITE DRAINAGE POOL Z
$ (TYPICAL FOR 4 LOCATIONS) LEGEND:
FROP05ED RELOCATION OF EXI5TING ELEVATIONS FROM SURVEYZ u,
2 1/2 STORY BRICK RESIDENCE \
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ST SEPTIC TANK 4-jV w v
U' LP LEACHING POOL Q Z
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EXISTING GARAGE ;
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TEST HOLE INFORMATION TAKEN FROMU E w a
MGDONALD GEOSGIENGE Q 3 — m
1- DATED: NOVEMBER 08, 2013
W LLL AND LATER ,MUST BE TEST HOLE
SHOWN ON "IIdAL SURVEY
EL:56.7
ALL DRA"N65,5FECIFICATION5 AND COPIES THEREOF
F1A2 O%W BY THE ARrATECT ARE AND SHALL RB41M
DARK BROWN LOAM OL THE PR�n OF THE ARCHITECT. THEY ARE TO BE
IY.�ED ONLY Hn RESPECT TO THS PRO,ECT AND ARE
AOR OISMIXBE�noNN T r EOFFV&RESa TORRr N
17ZWRB-EM OR FOR OTHER PI RPOSE5 IN
CONNEi O BE
BROWN CLAY GH WST AS�ICATIONNTHE °a VERO&ATION OF THE
Be Inspected % The ARHTWTS LM OR OTS
Of Health Services. ' ---- 3' (EL:53.'U RE53tV�RIGHTS.
ours In Advance AR
Nedl Ins' SL--
BROWN CLAYEY SAND 50
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BROWN FINE TO LU C-J
p, COARSE SAND SW z
UNAUTHFIOLATION
ZED ALTERATION
I Ill 42' (EL.-14.1) W O OF ANY ION THI5 DOCUMENT
U 15 OF
U
NEW YORK 5TATE LAW.
u� a s 'st>r must be in `"
I m AbandD1L ic,"t 0f ex'sfing SAli:t«:7/ sue Date:
Subr:�:t
�' JAN "t 0 2014
Project Date:
JUL 2013
IScale:
SUFFOLK COUNTY DEPART MLNT OF HEALTH SERVICES AS NOTED
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A Project# Drawn:
SINGL FA's'tLY RESI0c,,4C ONUI 13023 EPH
Job: Check:
�: JAN 2 9 2Q14 NICKOLAUS KMP
A DATE 1-3.'_ �:v�". 1vC. R 10- 1 Lf cyc D�
-A
APPROVED �A � ' ' Sheet
�55 FOR MAX51W4 OF BEDROOMS
EXPIRES THREE YEARS FROM DATE OF APPROVAL C�2N
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