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JUDITH T.TERRY q eY *IN Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
V36°
471 Southold, New York 11971
MARRIAGE OFFICER �0
REGISTRAR OF VITAL STATISTICS Fax 1 Fax(516) 765-1823
:y�fo #1. Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER ( `� ��1
FREEDOM OF INFORMATION OFFICER Fr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1733 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JANE NORDSTROM
Address 1 : 595 GREENFIELDS LANE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-97-107
Name Of Owner NORDSTROM, JANE
Mailing Address 1 595 GREENFIELDS LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 RAMBLER ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 5 lot 37.000
Cross Street MAIN BAYV I EW
Building Permit Number Cross Reference:
Issue Date: 9/24/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
j / 733
JUDITH T.TERRY ale_ yid �� Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
ivy t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O •
MARRIAGE OFFICER `. �f� �%� Fax(516) 765-1823
i1� Telephone RECORDS MANAGEMENT OFFICER O•l aro '`1►Il11 p (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 19, 1997
Transmitted herewith is a copy of application No. 1806 for a Cesspool/
Septic Tank Construction Permit submitted by:
Jane Nordstrom •
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
4-,?C‘te,
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE /
DISAPPROVE
Comments:
ignatur
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o}�|�|[E U/' THE CLERK
TOWN
Town or sout| (Jd w Application Hv /
J"di!|/ T . Terry, Town Clerk
`wn Hall, 53095 Main Road Construction ~~
P. O. |Oox 178
Alteration .
Southold, New York 11971 • ---- - '
Telephone ~� � � Residential
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TOWN OF sUtn.||0LD
soul-HOLD WASTEWATER D|s|q3Sm'
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8PPL|CAT ION
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK o, C[S0`no|.
Permit No.
Fee $
DATE CII
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APPLICANT NAN�E:-_�_-----~~.~_--_ »\�0�_�*S ^��rr1
APPLICANT AD0RESS:( ' � °" � \� � ,� & 69r
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SEPTIC CESSPOOL
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|)ESCWIPTION OF PROPOSED CONSTRUCT ION OR 8|-TB�ATION
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LOCATION MAP: Must be attached hereto before |/eno|i may be Issued.
• LOCATION OF PROPOSED CONST RUCT ION OR ALTERATION :
OWNER OF PROPER TY �
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BU|iUiNC PERMIT NUKADBR CROSS REFERENCE :
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,�aoo ue, ::��i quare MAILING ADDRESS9 New York 11931 P.O. Box 1931.
Rive►fieod, New York 11901
PROPOSED SANITARY LEACHING POOL: 'i
PROPOSEO 50% EXPANSION POOL: 444'
4. S.C.D.H.S. REFERENCE No. R10-97-107
��4'd Approved in$cdlydancard Review TEST HOLE DATA
4b 'nation � 3/5 f e.- (TEST HOLE DUG BY McDONALD GEOSCIENCE ON JUNE 3, 1997)
J - - EL 6.3 a
iDARK BROWN LOAM PROPOSED CONC. RETAINING WALL DETAIL
. BROWN LOW (NOT 10 SC&E)
SUFFOLK •`•'.1v DEPARTMENT OF HEALTH SERVICES SANDY 0117
4 3. nms o GRNX f
NiI01YN FINE To ca,RSE sAHD ��%�'� I •� : '
PaMTT •R APPROVAL OP CONSTRUCTION FOR A q 2.4 '1 le j�lle jlll�•1
�Y RIi SIDLNC'E ONLY / / OI •..
N
DAM all HS,4:' E // / EXCAVATION tNBPEC N'ION R Q
/ SQUIRED No. 4 r:Fave
APPR, 7.'►:MUL
• 4,f'•�BEDROOMS // // DEPARTMENT
T WATeRPRooFrNc jl`.Il jl�.�l�l
/ / / SEPTIC s,sm+ WOE . .. .. �•Ie OI �'
SXFfRES TREE YEARS FROM DATE OF APPROVAL / ,
/ / / ,
/ , 14
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SUBJECT TO COVENANTS E 11ESTRICTIONB UBEM.,,� .,.=? -At%). No 3 REHAR • t 2
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'2 tee// S',:=1,>4 11/�%,::P ,� ... r.�4 N: 9 — .. -,—
PROPOSED SEPTIC SYSTEM DETAIL at 2 N '�-
HOUSE (NOT TO SCALE) .
ELEV. t0.0•
FINISHED GRADE
ELEV. 8 6' ELEV.FINISH 8.0'
GRADE I -Flo. 3 REa4R • 1!f 0.C.
3'-0.
TOP EL 7.6'�,� 1 —1' MTN. r
-+.T f� MIN. 4' Du TOP EL 6.9' -� .---1' MIN.
SEPTIC t-----67
INV. a. APPROVED PIPE TANK ---• .. - - LEACHING r `1 - /-3' CLEAN
6.8' min. PITCH 1/4/1' min. PITCH 1/8' 1' POOL LEACHING N ` SAND
-INV. a. 6.6 INV. a. / INV. a. 6.0' POOL " COLLAR
6.1' D
DISTRIBUTION POOL OF 801. EL 4.4' GROUND WATER
TOUNATHORIZED
TO THIS SURVE
SECTION 7209
EDUCATION LA'
COPIES OF TH
SEPTIC TANK (1) THE LAND SU+:
EMBOSSED SE
1. AININUM SEPTIC TANK CAPACITIES FOR A 1 TO 3 BEDROOM HOUSE IS 1.000 GA -ONS. LEACHING POOLS (51 TO BE A VALK
t TANK; 8• LONG. 4.—.5. WIDE a-Y DEEP 1. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 nq ft SIDEWALL AREA. CEFMF1CATION5
2. CONCRETE SHALL FIVE A MINIMUM COMPRESSNE STRENGTH OF 3,000 psi AT 28 DAYS 5 POOL 2' DEEP. 8• dia. ONLY TO THE
.3. WALL THICKNESS SHALL BE A MINIMUM OF 3', A TOP THICKNESS OF 6' AND A BOTTOM THICKNESS OF 2. LEACHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REINFORCm CONCRETE (OR EQUAL) IS PREPARED.
ALL MALLS. BOTTOM AND TOP SHAG CONTAHN REINFORCING TO RESIST AN APPLIED FORCE OF 300 pa. 2.
STRUcTuRes. o cows mo/o• sues. TITLE COMPAt4
4. ALL JOINTS SHALL BE SEALED SO THAT THE TANK IS WATERTIGHT. 3. ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE (OR EQUAL). INSTT
5. THE SEPTIC TANK SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS (WITH A MAX. TOLERANCE OF ±1/4') TO ASSIG'
ON A MINIMUM S THICK BED OF COMPACIID SAND OR PEA GRAVEL 4. A 10' min. DISTANCE BETWEEN LEACHING POOLS AND WATER UNE SHALL BE AWNLUNED.
6. A 1O• min. DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAiNTA1t€. 5. AN 8 min. DISTANCE BETWEEN ALL LEACHING POOLS AND SEPTIC TANK SHALL BE MAINTAINED. TUTiON. CERTi
THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD THE EXISTAN
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. AND/OR EAE
ANY, NOT 5'
The water supply & sewage disposal sys-
tems for this residence will conform to the PREPARED IN ACCORDANCE WITH THE MINIMUM
standards of the S t County Department BY THE LI. FOR TTTT.END PRVEYSOVE DADOPTED Joseph A.BY THE LJJ\L.S. AND APPROVED AND ADOPTED
of Health Servi 4�RED ARC FOR S THE NEW YORK STATE LAND 1Land Su