HomeMy WebLinkAboutMacIntyre, Patrica o��gllffOL,�-�O
ELIZABETH A.NEVILLE,MMC �� r/y Town Hall,53095 Main Road
TOWN CLERKo= P.O. Box 1179
COD = Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p .1C Fax(631)765-6145
MARRIAGE OFFICEROl � Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER J www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD �; ( t~_ ;I ! # 1
TO: Southold Town Building Department f ' MAY 2 9 2014 t
1
FROM: Carol Hydell, Southold Town Clerk's Office
8Icc. DrPT.
DATED: May 28, 2014
o SOUTHOILD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4242 for a Cesspool/Septic Tank Construction
Permit submitted by:
Patricia MacIntyre
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 to on map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
0616 11;K—
Dated
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
[ Residential @ $10 or ❑ Non-Residential @ $25 Septic Tank K or Cesspool ❑
Application No. Permit No. H�. 4
Applicant Name- -� 16 i'd y
Applicant Mailing Address: Q2 2 m t l� V tJr -6r �
:t ? 1d , 11 q 71
Brief description of Propsed Construction or Alteration:AL Q r-0 (2, C-iu rreo
-T 4.
Location of Proposed nstruction/Alteration:
Owner of Property: 11�4(`
Owner Mailing Address: W-75 f jj Q�
Property Address:
Name and Telephone No. of Contact Person: _ "/{-tfI
Tax Map No.: Section: Block: / Lot: r f
Nearest Cross Street: '_` ii.L- t
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL.
Za��� a 5a Ll
zj Siganture of Applican Date
Received by:
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FLOOD ZONE FROM FLOOD INSURANCE RATE MAP
MAP NUMBER 36103CO166H SEPTEMBER 25, 2009
ELEVATIONS REFERENCED TO N.A.V.D. 1988
LOT NUMBERS REFER TO "MINOR SUBDIVISION DEERFIELD
FARM" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE
ON MARCH 27, 2001 AS FILE NO. 10596.
I am familiar with the STANDARDS FOR APPROVAL
AND CONS7RUC770N OF SUBSURFACE SEWAGE
DISPOSAL SYS7FMS FOR SINGLE FAMILY RESIDENCES AREA=%
and will abide by the conditions set forth therein and on the
permit to construct. ANY AUERATII
OF SECTION Z
The location of public water, wells and cesspools shown hereon are EXCEPT AS PE
.from field observations and or from c�to obtained from others. HEREON ARE I
SAID MAP OR
WHOSE SIGNAT
/lk.
LEST HOLE DATA
McDONALD GEOSaENCE
12/20/2013
EL. 6.3'
0.5' DARK BROWN LOAM OL
BROWN SANDY CLAY CL
3'
PALE BROWN nNE SAND SP
EL. 1.3' S'
WATER IN PALE BROWN F7NE SAND SP
f3,
NOtE. WATER ENCOUNTERED 5.0' BELOW SURFACE'
�a1.MEp�,
Q FT.
8 .Y.S LIC. N0. 496 f8
NTO THIS SURVEY /S A HALATION EC � RS, P.C.
PW YORK STA 1F EDUflON LAW. (631) 76 - 20 FAX (631) 765-1797
.09-SUBDIVISION 2. AL ALL CERTIFICATIONS
S MAP AND COP/ES THEREOF ONLY IF P.O. BOX 909
THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRA VELER STREET
HEREON. SOWHOLD, N.Y. 11971 113-307
EL. 1.J' SURVEY OF PROPERTY
AT BA YVIEW
TOWN OF SO UTHOLD
SUFFOLK COUNTY, MY
1000-X88--01-2.1
SCALE: 1'--30'
DECEMBER 1$ 2013
DECEMBER 23. 2013 TEST HOLE)
FEBRUARY 28, 2014 PROPOSED BLDG. do SEPTIC SYSTEM)
MARCH 7, 2014 (REVISED SEPTIC)
IONS.
Q m
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ke,aw
0
Fors,a� ��g�cti
r�an►tara, ° �e`gruir
ss tem v
rA
� ti
TEST HOLE
..... .... ....
GRADING PLAN
FF EL 1Q 1' 4' APPROM
GRADE RPE
EL Q5"
7C7 GRACE EL
E f.Wo GAL ~
7.5' I E
e.�s' AW a.zs' e.0'
rs LZACHM N
Aon 1
r armor sew
1 PROPOSED SEPTIC SYSTEM
N.T.&
(FOUR BEDROOMS)
[8] 10' DIAMETER x 2' DEEP
LEACHING POOLS
[1] 1,500 GALLON CYLINDRICAL SEPTIC TANK
TO BE BUILT TO SUFFOLK COUNTY DEPARTMENT
HEALTH SERVICES SPECIFICATIONS,
EXISTING SEPTIC SYSTEM TO REMOVED IN ACCOR
WITH SUFFOLK COUNTY DEPARTMENT OF HEALTH
Abandonment of existin
conformance with de g sanitary system must be in
com 1 partment requirement Submit
as proof.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FO'q APPROVALOF d.';,0NSTRUCTION FOR A
p,L7S!DEqCE AND,
(''
MAY $ 2014
DATE G p- P.s
6`I.t� itil". Gni�.
APPROVED
TOTAL MAXIM :OROONJiS ��1
EXPIRES THREE EARS FROM DATE Of APPROVAL j �P
Water Line(s) MUST Be Inspected By The
�G
Suffolk County Dept. Of Health Services.
Call 852-5700, 48 Hours In Advance
To Schedule Inspection ,s
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