HomeMy WebLinkAboutHallock, Jeff (2) ELIZABETH A.NEVILLE � ��et/ ofF04
: Town Hall, 53095 Main Road
TOWN CLERK ; Z P.O. Box 1179
v. i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS .F 1�
MARRIAGE OFFICER \ # �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -_�O,( �► ,,�� 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. 3163 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 #R10-03-0148
Name of Owner HALLOCK, JEFF
Mailing Address 1 101A SECOND STREET
City St Zip SOUTH JAMESPORT NY 11970
Property Address 1 870 RAMBLER ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 5 lot 19.000
Cross Street MAIN BAYVIEW
Building Permit Number Cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
r.
,,,�o�oSUFFoc,,OD 3 1
ELIZABETH A.NEVILLE ; Gy� Town Hall, 53095 Main Road
TOWN CLERK o • P.O. Box 1179
H Z Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS � � �
MARRIAGE OFFICER `� �. 0-0'
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `;�� �a�iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,s" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 4 '4
III
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 31, 2004
Transmitted herewith is a copy of application No. 3300 for a Cesspool/Septic Tank Construction
Permit submitted by:
Donald Connolly for Hallock
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: / ,i �.•,.. �.��_
7/74"4P, ,d04-e
Signature
41f.g.t://
Dated
,Io,•O��S�FFO�,�t0
ELIZABETH A. NEVILLE �$h`t 4 Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
t VI Z Southold New York 11971
REGISTRAR OF VITAL STATISTICS ;v. � '
MARRIAGE OFFICER . O Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y Dii 1, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O' * 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 or Non-Residential @$25 Application No. 3300
Permit No.
Applicant Name 'TIDO!Ji L 1) /?, COPPo 7 (��L
Applicant Mailing Address 37 r (,iIT LIL T,C,L/L-4CL
Septic Tank K dr Cesspool
Brief Description of Proposed Construction or Alteration A/,e C6 T.
5( Ny f L FA.,,i /,1 DLO c--,
Location of Proposed Construction/Alteration:: 'M
Owner of Property: 7 FT Fig 1/0
Owner Mailing Address: /0 / ,Se p/,/ S t
S 6,04 * ) �/ 1177O
Owner Property' Address: 81O 72 u,"R L?rL l�
Stc4 LoJCl ty. 11
Name and phone number of contact person
Tax Map No: /tom Section Ce Block ' Lot / /
Cross Street 2 ct v-t a l e_z_ 2 S / m'L v4 / .1 eA y tl l E t,J
NOTE: LOCATION MAP MUST BE SUBMITTED WITH /APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
7 (Lid g. 614,kieft..$) 3-31 -0L(
Ignature of Applicant Date
Received by:
PLEASE NOTE
SURVEY OF LOT 34 `;L
' I e applicant's responsibility to MAP OF TERRY WATERS
ma n adequate sanitary distance DWELLING SITUATED AT
between ; . ater supply and sewage ELL I FRONT N REAR BAYVIEW, TOWN OF SOUTHOLD
disposal fa •- . SUFFOLK COUNTY, NEW YORK
SEPTIC IN THIS AREA
O f
33 F: 12/29/1958 MAP NO. 2901
S.C.T.M. NO. 1000-88-5-19
DWELLING AREA = 16,172 SQ. FT. •
WELL IN FRONT to FR. EXIST ELEVATIONS U.S.G.S. DATUM
SEPTIC IN REAR • SHED S 2845'41"E 153.15' O WELL S.C.H.D. NO. R10-03-0149
FD. MON.
FD. MONm ° ;° St 'i-OLK C3UNTI 5 Ai. e�40,4T(J-HEALTH SERVICES
EL. 11.7 5• MIN. PROP.SEPTIC SYSTEM EL. 9.2— , ,
PROVIDE 1000 GAL. SEPTIC TANK JV1
5-B DIA. 2' DEEP LEACHING POOLS 4i G ey „ Apr:I� e tr ?Y 8' a ;
wiblibie ROOM FOR 50X EXPANSION WELL DWG. °•y L �L` FOR A
O TO EXISTING WELL WATER C + ` I a
211'+/— .e.a. a..t: �a saw<�a . _ s�szi'
O "
Ow. Ea E�/ �T HS RarE.�aO. C/'/ -'/
(12.5) (12.5) !fj O `
O 24.0' PaS APPROVED f Gam- � I s __A_____-_ ,
"+ 0.2'E COR. moo. PROP. DWY.
0 o b
ti -0,:.
'. 'r I ' `"" �isAiX a NI O3 BEDROOMS .
14 N N
[ LA44EX flFZ THREE YEARS/"ROM C E OF APPROVAL
h �J- 5.67' �t — �
•Al
WELLDWELLING IN FRONT o ° �' NOTE:
SEPTIC IN REAR �h / 6. ,�_ N _ L44 On° UNSUITABLE SOILS MUST' BE REMOVED AND REPLACED
W2 PROP. a P•.P. DWG. N p ti i kq • SEPTIC IN FRONT WITH A THREE FOOT CLEAN SAND AND GRAVEL COLLAR
0GEDECK FF. 13.3 . OAROUND THE LEACHING POOLS TO A DEPTH OF AT LEAST
.EL. 12.7 SIX FEET INTO A STRATA OF TYPICAL LONG
7.67' a a 35.0' ISLAND SAND AND GRAVEL.
29.88' 6.0 0' MIN44 GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE. UNDERGROUND UTILITIES
(12.5) - (12.5) !0 EASEMENTS NOT SHOWN AND UTILITY POLE LOCATIONS ARE NOT GUARANTEED.
O WELL WATER THE OFFSET DIMENSION SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES
wO ca W s P. ARE FOR SPECIFIC PURPOSE AND USE, THEREFORE ARE NOT INTENDED TO GUIDE THE
FE. COR. 0.1'E EL. 13.3
". WELL 'I? 'I c
O1 rn m ERECTION OF FENCES, RETAINING WALLS, POOLS, PATIOS, PLANTING AREAS.
EL. 9.9
ADDITION TO BUILDINGS AND OTHER CONSTRUCTION. THE EXISTENCE OF RIGHT
FD PIN 0.65W N 29'04'421Y 143.44' I w '-ti ft
..i WAYS, WETLANDS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN
0.23'E Ch
ARE NOT GUARANTEED
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF
-co SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP
� � '`� INSPECTION ~ NOT BEARING THE LANO SURVEYORS SIGNATURE AND RED INK OR EMBOSSED SEAL SHALL
NOT BE CONSIDERED A TRUE VALID COPY. '.
�;" ' ` ' GROUND ELEVATION EL. 9.8 <
O WELL '-r'
DWELLING SILTY BROWNDARK OAMOL
WELL IN FRONT VACANT l'
SEPTIC IN REAR /�.4
BROWN SILTY SAND PAT T. SECCAFICV
L \ 'e00 WITH 10% GRAVEL SM PROFESSIONAL LAND SURVEYOR, P C
00.°0','‘V- 3'
' - SUCCESSOR TO -
YELLOWISH BROWN FINE DONALD TASE, L.S. _
TO COARSE SAND SW RICHARD WILHELM AND ASSOCIATES E '
WITH 5-10X GRAVEL NORTHSTAR SURVEYING, P.C. t'"°
7.6' PAUL T. CANALIZO, LS., ROBERT A. KART, L.S.
WATERW GOOD GROUND SURVEYORS, P.C. 1 Cg
IN YELLOWISH
FLA' AND PALE BROWN FINE 328A Main Street 107-4 W. Montauk Highway
TO COARSE SAND Center Moriches, NY 1 1934 Hampton Bas NY 11946
WITH 5-10X GRAVEL SW Phone: (631) 878-0120 Phone: 631 728-5330
1(7Z-/(7........---- 14' Fox: (631) 878-7190 Fox: (631) 728-6707
pLvAsoir
TEST HOLE N.Y.S. LIC. NO. 049287
REVISED: 2/13/2004 3/2004 AS PER HEALTH) BY: MCDONALD GEOSCIENCE COPYRIGHT - 2003 PAT T. SECCAFICO P.L.S., P.C.
DATE: 8/25/03
FILE NO. T7515 SCALE: 1"
= 30'
DATE: 9/5003