HomeMy WebLinkAboutReynolds, Gaitri I
1,$:.
I�,o���1FF0(�►�o
ELIZABETH A. NEVILLE,MMC y. 4\ Town Hall, 53095 Main Road
TOWN CLERK o d PO. Box 1179
H �Z ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p �� Fax(631)765-6145
MARRIAGE OFFICER '"* V'.�' 0 Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER : el 41i *too' www.southoldtownny goy
FREEDOM OF INFORMATION OFFICER --..,,..,,,.•0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ___________
TO: Southold Town Building Department j _____L_,
1:
_�_ JUL 2 7 2015 L''
FROM: Sabrina Born, Southold Town Clerk's Office
L _
-,Pr. ;;-r --
DATED: July 24, 2015 ' ' .
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4332 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gaitri Reynolds .
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 required from the Suffolk County Health Department
Air/A1111 ....ir/3 Zit
Signature ror-
e77 / ' i
Dated
-
• ,,,,,,,,__-
'SII�� CiV
Town Hall,53095 Main Road
ELIZABETH A.NEVILLE �'�'1`
TOWN CLERK % p ; P.O. Box 1179
V3 = Southold New York 11971
REGISTRAR OF VITAL STATISTICS k t•
MARRIAGE OFFICER `F �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER s. a0...1 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
• 1.
Residential @$10 ✓or Non-Residential @$25 Application No. 13 3 a
Permit No.
Applicant Name % 1.\-9.4 io O (t>
Applicant Mailing Address Q O 0 X I S3
Septic Tankor Cesspool %
Brief Description of Pfoposed Construction or Alteration i, a '.° A 'G/ °_1 1
Location of Proposed Construction/Alteration:
Owner of Property: GAA I &A 0 L) .5L) .5 •
Owner Mailing Address: _ P S . CA-BOV
Owner Property Address: V7fi JScu& L wkly.I k v t
S +3t1I , 1 ' i t q '71
Name and phone number of contact person X14 — ( I.0
Tax Map No: Section \O Orp Block Lot 0 6
9
Cross Street V t etA) Iri �t . • S ■i t
- NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION,REQUIRES/ii RVEY WITH #• TH DEP• 'TMENT APPROVAL
Oiba; kA : — 0_, AA I OA) 1 -C'1/4A Lc
Signature of Applicant Date
fa,
Received by:
liG CN-p,� raJ ci. \s�o `\\ ,o�r�\ <:Y :;';_ �,11% 'i4)fit` x.'t it _T`'i�J HEALTH SERVICES
`�� 9 EXCAVATION tAfS 'EC`f!• i
��'� o <O FOR SANITARY RF�QtiIR�D �� ti'' L.GT l 1 0� \ \ P' t'SVIT 'AI:, `' iiiA1,OF^ONSTRTJ TF*N FOR A.
'�, `' BY HEALTH DEPAR {�{' Oc., k _ -- X90N '1'.:-,_ :;;': ._ REF MENU,ONLY
`�j`1 .L�.�1:,}.-,-:,,,...... �� �t2 '4-.„ i .4 � \`
DATE 17-li i + r.,F / 10-12.--&-Z
/ - € t /� '4 r 1' /".6'
o \. 4 / 3 -�
3 i
6 ,i„,
�\ 1,�` >; `4 : •DROOMS
• • per` L / c.p ii ii i iZ�it iv�OF
• I/ 03-."--
6�A�' �`r ,``� d • �Z�S�Gv ll�t EXPIRES THREE YEARS FROM DATE OF APPROVAL
ms's 4, oh it, / •" . �q =�h �S?o ‘a-ec�� 2 J 'f
4. (°6 -- (0r c 0 c �y {�s X60 &a r EXCAVAT10N N$¢'EC`1'lON REQfJ1RElJ
l hiPkOu� / 1,,q OE
\ %CWG OQ`, 9�rN v o �e 1SI A*.sq ,,:- '1,.
�'1� `'�
FOR SANfTARY
'Sr N..,,
t I taE� 1 10.7 o 6.- C.
'QST l 10; 1 T 15 he�r�' O i e� N` Uj(D -� I Lo ;\ _�? r�c�"5{,
&or.a-no/4 Up-T-o!v-�S ( AC]p�Crv ., 'b 9. y / / , P ' ` a�5 Ar,41- ,R
o
�V�E� �`) jiWEbL4- 0,,K O `4.�� o� / 4 Iw gcat.E: a \ \\\
flC�,crtvE�/� 26 , i GOLDSMITH'S `\
M f �_ .OfikCt� INLET •P.A.ii'K
o so roc t c L�xr p6_ c1 2 •/ pRa4E� `��lq M4 O .�� icf,,•,h4 iCDt1N.IYt: /o% 44' 1 Ss.ES. SITE
I \ E,� / A� SC k � th ? „w=;'' 'F sou '
13.
Isosc` govNOA,rcy r'' ,n'Ro°9� `f'oq` y-cb- ll•9 �'� ca • ti,e,V _•-� 4 �
-Q0 M LOT ` \ / � ‘,.
Q ( I, FA t.
'_ / SKi MMSM' !,i w1 a • d ..,.)4.
'f I N.R
Noz'E. TI+Ee€ 1s oNE R c-T ''E wEI_.L -�. - wets 9, , Se:it-‘_,' „-
I
..Y �4(\
I INSIDE THE 150=T Qcv t,.A.: ( .-:-...-c L�i ;1 (Ac1- i.-) _ / V `µ� el
gv-r IT is Mo¢6 TN�.1 t s0{-,.- Flaor`•t -\`y i /,� L1n
SCALE sot¢ / . cD \
T44E PQOaOS�o LECC�-�. fN4 Po�� .
9
% oU• II9 rl , -,/
F'REpARE.r) its ACC OK.DANCE. 1nl ►-rM 5tC t1 TEST HOLE DATA
S E V.1 A c E tis P:a s AL •S'1 S T E ms t=e.n_ S t wC,L e. 5 A it I t_y lZ E S t D:v N t;E S f,c s, HOLE DUC BY M_0ONAL0 CEOSCIENCE ON MARON 4 2008) (A-- NEW Y
---• EL-8•b' co C�O�/Bq ,Q��'Q'i-
r L-7•�t _./;;;/�� 6W ERD1YN lAN1 9� V Nil0 . �i ?
FtR1T Fl.Oo R. G e I ertmm m,MI. �- '�I;'i. - *
. FIw1;5!AEI> (K ACE -EL 12 t� 1 w*
.fight111117 6
�' . 1.�/ S� —� EL )�i �j =; ereowr FlrL, eon sus sr
UTEV
.3. t Il '^I • OB1$6$ �2IP
E�7.0` 5 r.1,
-� 9_611
E_ 7 1 : .g t-P ; Et Z- AR `" .'
T x / I / v 1 OF-Es- •• r�/C7 (ti i
d._8 Si V �d LP i•S ,
1-2-OCC y.'.1k &L z.qt
GCOvnibkfAT._� -j RSV ,i� Flipp 11/14412. tF6A`TH PEP'r LoMMttti1'Is
—' "Al`s"B"O"'" FlTE ID`°"'S7 RAW
SW Drawing #080112 Rev 0 Date 09/03/12
Nor To S co,LE. , 1 SCTM # 1000-59-06-11
E` -4. I I-- Owner: Daisy Folk
Title Health Dept Permit Application FZ10- 11----c""‘
Site Plan
These plans are an instrument of the service and are the property of the design professional whoseRobert Barratt PE,
I seal is affixed hereto. infringements will be prosecuted to the fullest extent of the law. Contractor l
shall verify all field conditions and dimensions and be solely responsible for field fit. The design 4295 Vanston Road,
professional assumes no liability for omissions due to unknown or unforeseen field conditions and Cutchogue, NY 11935, Tel 631 734 2730
or additions based upon comments not formally acknowledged as revisions to these plans. 1
1 i