HomeMy WebLinkAboutNicholson, BrianELIZABETH A. NEVILLE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: April 23, 2015
�!f
i, APR 242015
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4311 for a Cesspool/Septic Tank Construction
Permit submitted by:
Nancy Dwyer for Bryan Nicholson
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it tome. 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 required from the Suffolk County Health Department
Dated
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ELIZABETH A. NEVILLE
TOWN CLERK
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REGISTRAR OF VITAL STATISTICS
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MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
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FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown. northfork. net
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
/or _ o.Residential @ $10 Non -Residential @ $25 Application N
Permit No.
Applicant Name lKj6t. n
Applicant Mailing
969
Septic Tankor Cesspool
Brief Descri tion of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: �Y �J Ot, � a� J f A ti IS o
Owner Mailing Address:
1'-0U "'0—
Owner Property Address: GS5 Y" j
Name and phone number of contact person iia L✓1 D9Y4—c-
Tax Map No: i MTb Section 5 .Blocic Lot 1- ozo-
Cross Streeta�d�
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURV Y WIT HEALTH DEPARTMENT PPROVAL
Signature of Ikppl a t Date
Received by:
----- IMP R0OeU- -PUB LIC- WATERI IMPROVED - WELL EXCESS OF 150'
EXISTING 12'WATER MAIN IN STREE-f
KENIVEY S R OA D
AS SHOWN QNYHE S.O. WA WATER DISTRIBUTION MAPS 2007
' l �S 41057'50" E : 175.00'
EDGE�F RAVEMENT
DROP LE
UTILTTI'POLE ���. 283.76'
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1 8 _ 2
1 HANDS ON SURVEYING �.� a U)
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8/12/14 `'
0 L''
— CL
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N 41043'10" W 141 Ur LINE OF PLANTED PINE TREES (GEN.6.6'WJ
LAND NOW OR FORMERLY OF IMPROVED —
PEROTTI SERVICED BY WELL
IN EXCESS OF 150' S.C.D.H.S. ENDORSEMENTS
CERTIFIED TO: BRYAN NICHOLSON
OLD REPUBLIC NATIONAL TITLE INSURANCE CO.
JOB NO.: 2014-231
MAP N0.:8901
FILED:FEBRUARY 22, 1990
REVISIONS PREP. FOR HEALTH
2/05/2015
LICENSE NO.: 050363
HANDS ON SURVEYING
26 SILVER BROOK DRIVE N
FLANDERS, NEW YORK w e
11901
TEL: (631)-369-8312 - FAX.'(631)-369-8313
COPIES OF THIS SURVEY MAP, EITHER PAPER OR ELECTRONIC, NOT BEARING
THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE
CONSIDERED TO BE A VALID COPY AND SHALL NOT BE USED FOR ANY PURPOSE.
LOTAREA: 80,001 SQ.FT.=1.837ACRES
ELEVATIONS HEREON REFER TO APPROX. NA VD 1988 DATUM
AND ARE THE RESULT OFACTUAL FIELD MEASUREMENTS.
NO SURFACE WATER EVIDENT WITHIN 300'
3
FEB 18 2015
SUFF. CO. HEALTH SERVICES
OFFICE OF WASTEWATER MGT.
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OWNERS
SURVEY OF
LOT 2
MAP OF
HENRYARBEENY
SITUATE AT
SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEWYORK .
S. C. T.M. DIST.: 1000 SEC.: 59 BLK.: 07 LOT 31.002
5 -0 30 60 90 120 160 180 290 240
SCALE: V'= = 60' DATE: AUGUST 12, 2014