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ELIZABETH A. NEVILLE le y�`, Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER
".?4°,4_ �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_ w,4 .0v Fax
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3143 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : DAN & DIANE MCGUNNIGLE
Address 1: 2355 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0081
Name Of Owner MCGUNNIGLE, DAN & DIANE
Mailing Address 1 2355 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 5 lot 15.000
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 2/13/04 Elizabeth A. Neville
Southold Town Clerk
(TO'W'S SEAL)
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ELIZABETH A.NEVILLE ��_ '% : Town Hall, 53095 Main Road
TOWN CLERK , o • % P.O. Box 1179
rr Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS r+'
MARRIAGE OFFICER `�,fi ����� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�Q! �a��,� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER - �,,��� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
Ftb i - 004 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 10, 2004
Transmitted herewith is a copy of application No. 3280 for a Cesspool/Septic Tank
Construction Permit submitted by:
Dan & Diane McGunnigle
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the
following recommendations:
APPROVE
DISAPPROVE
Comments: —F cnocQ Sukkr,( �n w..-k �Q�u -- __e_ --, C .
c-c-x--.,„) -7-._osx--)
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(\43____, [L_______
Signature Thgiip") /2 --L/S
Dated//3A
r w ''./•`OttfF04
ELIZABETH A.NEVILLE ���`Z`OV v�4\ Town Hall, 53095 Main Road
�
TOWN CLERK �j A 1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % may. Southold, New York 11971
• MARRIAGE OFFICER O I
,• Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y 0 �/ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O.' 41( ',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 K or Non-Residential @ $25 Application No...3:02 D(-)
Permit No.
Applicant Name ?an 4 P4ite
Applicant Mailing Address 23.S-S 30;s/fay '
//cl1/
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration Afe,... sivie
Location of Proposed Construction/Alteration:
Owner of Property: ., {R4SC ,�`(svna0 1
Owner Mailing Address: a3 41,e
564/l, .4/Y 1/97/
Owner Property Address: 23 5 ,oi jJeQ,, 44 ;.1 ,k Q s/e4ss. ,�✓e c%�
5.40/i , Ai% //S7l c xc,/ 411,,y ss.)
Name and phone number of contact person sor gore �-y� 765-Y9 rl
Tax Map No: 1000 Section 0 SS Block o S Lot o/ 5--
Cross
Cross Street / wn 41 A S.,tL Ltd / ,14-h
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
19/4(
Signature of Appli ant Date
Received by:
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TEST HOLE,. BY
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SURVEY MCDONALD GEOSCIENCE
N I GUARANTEES INDICATED HERE ON SHALL RUN OF 15 JAN 02
ONLY TO THE PERSON FOR WHOM THE SURVEY
' a IS PREPARED, AND ON HIS BEHALF TO THE DESCRIBED PROPERTY
": E •
.' TITLE COMPANY, GOVERNMENTAL AGENCY, ORIG. CND.
rL LENDING INSUTUTIDN, IF LISTED HEREON, AND '' LK TO THE ASSIGNEES OF THE LENDING INSTITUTION. SITUATE ::zc::
USOUTHOLD TOWN OF SOUTHOLDf
`F o SUFFOLK COUNTY N.Y. 3.O'
r.) { ' 0 UNAUTHORIZED ALTERATION OR ADDITION TO THIS
— ±. �`' �� SURVEY IS A NOVA TION OF SECTION 7209 OF
L... �: THE NEW YORK STATE EDUCATION LAW
t" s SURVEYED FOR: DANIEL McGUNNIGLE
C COPIES OF THIS SURVEY MAP NOT BEARING
{
i7,-, THE LAND SURVEYORS EMBOSSED SEAL SHALL • DIANE MCGUNNIGLE PALE BROWN FfNE
'"V• ' NOT BE CONSIDERED TO BE A VALID TRUE .
TO COARSE SAND,SW
COPY.
. t i PART OF TAX MAP NUMBER 1000-055-05-015 •
_Ar I GENERAL NOTE:
Cj i / _ 17'
I THERE ARE NO WELLS OR CESSPOOLS N F BORN
- "' ? HEREON TO THE NORTH, SOUTH. OR WEST RESIDENCE
1 O P .- �p
0r\rr WITHIN 150' OF THE PROPOER7Y SHOWN SERVICED BY MUNICIPAL WATER Ike _ __ -,
Ffr) FSI - `•4. i+. ,
AS `O��C h
Cil ','J •. OPEN FIELD
- --- k44,"C.) N S 02' 38' 20" W
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N 81'16'50"E ��o 492.97' 20.39' y i,?i
' b•-io' N. ___77.........
PROP. DRIVEWAY
FOR SCDHS USE ONLY 11.11S 81' 16' 50" W204.65' •
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GARAGE) E�ONCEM SEP�C ,93,
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TANK
YONWPROP, N/F MARTIN
P/O TM# 1000-055-05-115 TEST. CESSPOOL
SURVEYED: 10 DECEMBER 2001
OPEN FIELD ' UPDATED: 22 APRIL 2003
RESIDENCE SERVICED BY SCWA
• SCALE 1'= 50'
r.O
N AREA = 6.3,828 S.F.
N AVERAGE ELEVATION 35.0 . OR
� 1.47 ACRES
o , LOT GENERALLY tE- �
N SURVEYED BY
O STANLEY J. ISAKSEN, JR.
P.O. BOX 294
.. i 1 NEW SUFFOLK. N.Y. . 1 1 ' ',6 . -
S 81' 16' 50" W 2x68' 631 —,/34-5835
N/F QUAD ENTERPRISES, k CO. I .
RA
GUANTEED TO: • 41
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DANIEL McGUNNIGLE OPEN FIELD - � --
DIANE McGUNNIGLE LICENSED AN ' . U'�EYOR
FIDELITY NATIONAL TITLE INS. CO. NYS Lic. o. 492.73 03C1228
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