HomeMy WebLinkAboutPolites, Lia (2) 0004
&ELIZABETH A.NEVILLE �� � �J.�: Town Hall, 53095 Main Road
TOWN CLERK ; Z P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS
�. i Southold, New York 11971
MARRIAGE OFFICER �y ��I Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_ Q( �a,10° 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. 3162 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DONALD CONNOLLY
Address 1: 375 WATER TERRACE
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 #R10-03-0149
Name of Owner POLITES, LIA
Mailing Address 1 990 5TH AVENUE
City St Zip NEW YORK NY 10021
Property Address 1 1000 RAMBLER ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 5 lot 18.000
Cross Street MAIN BAYVIEW ROAD
Building Permit Number cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•0,40ySUFFO�,t°O% 31(1)--
ELIZABETH A. NEVILLE �1,
=� 4
Town Hall, 53095 Main Road
TOWN CLERK k CO - % P.O. Box 1179
t H 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; tt Pit+fit
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `=y_�Ql .0•0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ������ southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 31, 2004
Transmitted herewith is a copy of application No. 3299 for a Cesspool/Septic Tank Construction
Permit submitted by:
Donald Connolly for Polites
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:
7Y(.44,..e.i/e4
Signature
Dated
_ /iiiiii
,.� gUFFO�,�co \
ELIZABETH A.NEVILLE ,o ti� 4\ Town Hall, 53095 Main Road
TOWN CLERK p • ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER
O � Fax(631) 765-6145
� �
RECORDS MANAGEMENT OFFICER =y 04 Telephone (631) 765-1800
FREEDOM OF INFOR0'
MATION OFFICER 1 '� ,•" 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 t, or Non-Residential @ $25 Application No. 3c 9. 9
Permit No.
Applicant Name 7)014/ 62 (0,,I,,/oLL 1 Vte )
Applicant Mailing Address 3 7 S— vc]sQ r "(L T 44 Ci
Sou ld t/q 7 I
Septic Tank )C or Cesspool i
Brief Description of Proposed Construction or Alteration A/C6V (' A./S1
S , N 1�,� �u (/y ��Ell-r ,✓c
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Location of Proposed Construction/Alteration:
L
Owner of Property: , e 90 //l I11
'e s
Owner Mailing Address: 9 9 O c 4 A v E
A Y, / A),Y, 1062_1
Owner Property Address: taey %Z a of g L,E /2
c'5oc4.+1ald , //,V, ) 157/
Name and phone number of contact person 7)0,0 4- L i) 2. Co is'Jo U.Y ( ci ) .co-`a Z i
Tax Map No:ODD Section Block Lot / c( _
Cross Street /26t 2 ct. / 1'1'1. 1 U £ay v(£ c�J '
NOTE: LOCATION MAP MUST BE SUBMITTED WITH/ APPLICATION. NEW
CONSTRUCTION REQUIRES SU' I Y WITH HEALTHDEP MENT APPROVAL
z4/y/. r (E11.0 3-31-0V
ignature of Applicant Date
Received by:
ii-F ' �o�' SURVEY OF LOT 35
hicant2ibtlltYt0qMAP OF TERRY WATERS
istance c
maintain ad .: :, �;ni�ary d O� SITUATED AT
between a! SA!sitar s supply and sewage O BAYVIEW, TOWN OF SOUTHOLD
`I�pi facilites. O DWELLING
►, r,,, VACANT 0 WELL WATEREAR SUFFOLK COUNTY, NEW YORK
DWELLING 1C F: 12/29/1958 MAP NO. 2901
WELL WATER . PTS
SEPTIC IN REAR S.C.T.M N0. 1000-88-5-18
CI)
ER
FORE WELL FOOTD LESS THAN oo' O EXI51
,�G AREA = 14,835 SQ. FT. •
3' X 6' = 18 ADDITIONAL DEPTH ELEVATIONS U.S.G.S. DATUM
FE. COR. 0.1'E EL. 13.3 S 29'04'42"E 143.44' 4+' , ,E , y r):--?,ANT: _ `r c'� i' .f`.� i �+' .,.
g Ol e'i'o LKCOUNTY 1 Td E ClryicEs
FD. PIN N "CROSS WALK" ',
0.23'E
.23 "j
I` q�: ! :r O ,e.. r^17 r.= D�L ii--OR
d�
6 .'i Es�..•f7 a •,.�'.D_' iii ...'it`" Y 1�'b .:'zJ'.,s!6a,1i0 7'6d®3�G
NE - . 4 WELL I E 'ce.,'i NL r S Q�'�3 F'rE rhi-c_.".O'S`L
110• + TO PROPERTY �. ' O - �,,Vra ��3 d 1., ',�.F•.etO,2r2&_:::14,42_,/.42
/(12.9) 4 . .t Nt 11,
A tr, P P PC, ,E� 0 / :1 �w •
,.....
13.5) PROP. Dy _
29. r
F Cei O terJAXWiZ)ki C sEMONIS
0 ,`� 91 +
N C 5 M I snd,a 'THIiF Y AFyEj F ODATE
O Seep r'e`v,,
O 0' 1
DWELLING a, J� EXIST NOTE:
WELL WATER 44 6.O Sb WELL
SEPTIC IN REAR c goo -..s, p. UNSUITABLE SOILS MUST BE REMOVED AND REPLACED
VI 14.0' c °' WITH A THREE FOOT CLEAN SAND AND GRAVEL COLLAR
PROP. DWG. pROp. DWELLING
AROUND THE LEACHING POOLS TO A DEPTH OF AT LEAST
c GF.EL. 13.0 DECK 9' N WELL WATER SIX FEET INTO A STRATA OF TYPICAL LONG
0 PROP. • 'Prop. a 28 35.0 W SEPTIC IN REAR ISLAND SAND AND GRAVEL.
0. SEPTIC ►DECK IO
0.
SYSTEM (15'2) GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE. UNDERGROUND.UTILITIES
-
pj EASEMENTS NOT SHOWN AND UTILITY POLE LOCATIONS ARE NOT GUARANTEED.
0 • • g8' THE OFFSET DIMENSION SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES
COB 20' 14 0 ARE FOR SPECIFIC PURPOSE AND USE, THEREFORE ARE NOT INTENDED TO GUIDE THE
0 • 05.5) 0 El- •g m al co a'• ERECTION OF FENCES, RETAINING WALLS, POOLS, PATIOS, PLANTING AREAS,
Illi.
Co s, FD plpE. �:4g' m ADDITION TO BUILDINGS AND OTHER CONSTRUCTION. THE EXISTENCE OF RIGHT
6 w OE 0
OF WAYS, WETLANDS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN
ARE NOT
EED
® tO
0 '57"W 105,8 0 UNAUTHORIZEDITERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF
GROUND ELEVATION EL. 9.8 s1 6.14 0. SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SUIhjVEY MAP
DARK BROWN �. 15 2 N % NOT BEARING THE LAND SURVEYORS SIGNATURE AND RED INK OR EMBOSSED 'SAL TSHALL
SILTY LOAM OL CfN NOT BE CONSIDERED A TRUE VALID COPY. "1
I'
43 P1e� 0 3yEN 36
BROWN SILTY SAND OFD. PAT T. SECCAFICO
WITH 10x GRAVEL SM
3' '"DWELLING h'_� PROFESSIONAL LAND SURVEYOR, F .
r
YELLOWISH BROWN FINE A AF ! SPcCT. PTIC IN REAR L 43 e �, — SUCCESSOR TO — .
TO COARSE SAND S Q
WITH 5-10Z GRAVEL DWELLING �� DONALD TASE, L.S. :
7.6' WELL WATER
SEPTIC /N REAR RICHARD WILHELM AND ASSOCIATES 1\:
WATER IN YELLOWISHNORTHSTAR SURVEYING, P.C. r`
AND PALE BROWN FINE 151)P
TO COARSE SAND PAUL T. CANALIZO, L.S., ROBERT A. KART, L.S.
WITH 5-1OS GRAVEL swl GOOD GROUND SURVEYORS, P.C.
14' ,
328A Main Street 107-4 W. Montauk Highway i`
TEST HOLE Center Moriches, NY 11934 Hampton Bays, NY 11946
BY: MCDONALD GEOSCIENCE 'Q Phone: (631) 878-0120 Phone: 631 728-5330
DATE: 8/25/03 1 dir7,
Fax: (631) 878-7190 Fax: (631) 728-6707
7-FILE NO. T7518 SCALE: 1" = 30' DATES 9/5/200320 'C N.Y.S. LIC. NO. 049287
COPYRIGHT 2003 PAT T. SECCAFICO P.L.S., P.C.
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