HomeMy WebLinkAboutRerisi, Gail (2) /t %S�ffOC��;
OG•�
ELIZABETH A.NEVILLE ��4/4� y Town Hall,53095 Main Road
TOWN CLERK o - P.O. Box 1179
y Z Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS 1,10 rav
MARRIAGE OFFICER
%; �
. �i � �ft, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '; it
e,i" 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. 3212 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GAIL RERISI
Address 1: 5 BETHPAGE ROAD
City St Zip HICKSVILLE NY 11801
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 #R10-04-0016
Name Of Owner RERISI, GAIL
Mailing Address 1 5 BETHPAGE ROAD
City St Zip HICKSVILLE NY 11801
Property Address 1 497 PRIVATE ROAD #22
City St Zip SOUTHOLD NY 11971
Tax Map No. section 76.00 block 1 lot 15.003
Cross Street MAIN BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
TOW - -
,
ELIZABETH A. NEVILLE '�,=�0 V Town Hall, 53095 Main Road
TOWN CLERK % P.O.vda Z OBox 1179
REGISTRAR OF VITAL STATISTICS O 1�, Southold, New York 11971
#4
MARRIAGE OFFICER :----716:1
�l� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER :, II tl * +,/ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICERg. ,•.""� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
A- 2 3" TOWN OF SOUTHOLD
TO: Southold Town Building Department RECEIVED
FROM: Linda J. Cooper, Southold Town Clerk's Office AUG 2 G 1004
DATED: July 23, 2004
Southold Town Clerk
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 3353 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gail Rerisi
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: .A.''s"b--4' / . .4,
/ I 'IP 140.' i
91 .4- 101‘0
Signature
Dated
A .1
,/�".1(kSUFFO(,��o
ELIZABETH A. NEVILLE � `L` G � Town Hall, 53095 Main Road
y
TOWN CLERK p ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS y rrr
= Southold New York 11971
MARRIAGE OFFICER �.O .• ��� Fax(6365
1) 7 -6145
•
RECORDS MANAGEMENTOFFICER =y 0����� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'' * 4:0 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 XC or Non-Residential @ $25 Application No. -33--q.-3
Permit No.
Applicant Name 64 I L R6.e/S!
Applicant Mailing Address .rTf,'4Ce ov99
ilr eAS - //Vv/
Septic Tank k or Cesspool
Brief Description of Proposed Construction or Alteration_
NEL4- I rit,n<L y +�.-ue&/A (
Location of Proposed Construction/Alteration:
Owner of Property: 64e
Owner Mailing Address: 5 girAph6C1 £ti
/- ck' ',ttf N y. //go/
Owner Property Addre 11 Pro 14 -TE b . 22--
6-
ou1 otD
Name and phone number of contact person G.4/4. /Peek
Tax Map No: Iooe Section 490676 Block (7 j Lot % 5,.3
Cross Street mm1,/AJ gay vd&J AL,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEA DEPARTMENT APPROVAL
82 77--"/""
Si ature of Applicant Date
Received by: 9 �� �.
" . , GOOSE E
cCCREK
(WESTI ',..T.14 T i s PLOT PLAN OF
N 87'02'24" E 122.79' �,T ,* �-` 1..,,- '.„-c
t}'"`�
tTr 1, cvkJ,t- 1, `�� LOT 4
OF PROPOSED PRELIMINARY MIP OF
�tiq� '. LI
A , p, 10 2� BRANDER—McCAFFREY PLAN
,�4,• s 13111� SITUATED AT
'` SOUTHOLD
/ d' < TOWN OF SOUTHOLD
6q ,o� SUFFOLK COUNTY, NEW YORK
"' SAID MAP ALSO BEING
4 ivc
4 ii,4,- 2 ,. .. •,:.;- A REDIVISION OF LOTS FOUND
�.
N
APPARENT Low WATER MARK ON A MAP_ PREPARED FOR
� �� 4 v MICHAEL ZUKAS
GQ 6.,P 6 >t� ___2 j AND APPROVED BY THE
��,¢,�S 0��1 N , TOWN OF SOUTHOLD TOWN PLANNING BOARD
q,�,r Qg �=- ,>}� ,4 ZON FEBRUARY 7, 1972
Z Y-$ o g 1 ,-'' •• Q ).. LIBER 8355, PAGE 181
�, 1 , Q___ --_— , 6 z V. S.C. TAX No. 1000-76-01-15.3
--iruirgf
\\ \, —�� �' 6 W CSCALE 1"=50'
_ _— q R� SEPTEMBER 15, 2003
'7� Ci OCTOBER 2.1 2003 REWSED PROPOSED ROUSE
`70✓ JANIMMY 5, 2004 ADDED PROPOSED OECD
ii. Q �' FEBRUARY 27, 2004 RELOCATED HOUSE
al.le - _ OR d ? MAY3, 2004 REVISED PROPOSED WATER EASEMENT
--� \�_ _�- l' __— —'---12 .
- C- w " _ �+ z 1 AREA = 33,537.18 sq. ft. 1
���'' r0`\ � ' /����� —14 004- 9A �' 0.770 ac.
it i
IV cr
Jsc-i'. '14-
,41*
al Z
____J ��` �p ,�' -46 COQ a• OI ,s"'' Maras:
p - .. '�► / 411P I 4`':.' 1 r I. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1126 DATUM
SUNj ��2 - 7, �l' 4i 0J�i 6Y EXISTING CONTOUR lLES ARE SHOWN THUS: 10
1J v r . •l' a
N 4J X r {�/`V % Q r T 2. MIIBPEIM SEPTIC TMtl(CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1.000 GALLONS.
I +1 NET . - ''r /1 `784 9 V 6�, U)f � I TANK: IANC. 4`-3' WIDE. 6'-Y DEEP
L .`+ 7,t 4 tl ',T..' 4; -. T * )�i L =,-."-----0.020 01 3-MMWIN LEACHING SYSTEM FOR A 1 TO.4 BEDROOM HOUSE IS 300 sq ft SIOEWALL AMA.-
,�h' ''q7- .,../' 7 ..t �' 2 POOLS: S. DEEP..D. db.
/• Q� r+�:
,'• 4,
k r 1. �" P'R'OPOSED EXPOS/CM root
14--- Ks ,..`/ w ,� .� YEi�Gi�o • ... ��''.&� 7. ' �6� 1., M ' % PROPOSED LF�1dIM0 POOL
O`?O 4/ Z". - _ �� �4 •1`► (" V �• 0 �S ® D SEPTIC TAM
�,o v �J , ,J - * s i
4. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE PROM FIELD
1- ` %,d - •_-% ,0 �� OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
p.c.• 15 ��' .'� �` �� 5. PROPOSED LOT COVERAGE = 2.321 sq. k. OR 13.16X OF LOT AREA
Q . \ M1� �\ A � LESS WETLANDS AREA(WETLANDS AREA = 15.807 sq. ft.)
itry. Y4. \ 6. DRIVEWAY AREA = 1.056 sq. H.
y
d. �4;5)# TES1 _ i 90 ' •—�,— —18 TEST HOLE DATA PREPARED IN rT61 THE
1.7.E � O� '�s \ . (TEST HOLE DUG BY McDONALD GEOSCIENCE ON MAY 4, 2001) STANEWIDS
FOR�1�a 14.,t7 r
l -� \ - 4,.. 17$ D. RICHTME it? 44-i',7-•v _ E
O 1 1V' ♦ \
30• eRole,+nwr.SOW
f. I �.
�0 4a p� t7,•, 6..ZI ,j+\\ / r x r /
`�Y�,�r �ci',�,44.4. 4 • '\ /' C-- �. �G`
�S,s, fit.,
9 �' � . PALE ORM slL1V SAND wil 0
iG /41.
". �'t W " N.Y.S. Lic. Ho. 49668
;Cf / • . • - ~WORM ALTERATION OR AOORION
M PALE MOM FINE 10 THIS SURVEY R A NOLATDN OF
4, k-
+ • �e // �� TO MEDIUM SALID SECTION 7206 OF ME NEW YORK STATE
XIN IAM. • seph A. efl
4- / •.A. 'DE ►O• COPIES°FSURYE1 ► 1EAL INS SURIEY Ivo,Nor AOR
41‘ , NTING
/ •
,d,` 1EMBOSSED SEAL SMALL NOT 0 %4 D TR Y. BE CONSIDERED
nd
Surveyor
4�� *. ,/,
- nil:NFnLEir Sew OW TO THE
F R NHOMHEREON !llll�E'I
6 PNLTARED. ON 213 WOLF TO THE i
VIE 48 IPANY OOVFUMW HE EON. AND nee Surveys - SuD DRe - Ste Plane - Construction *oat LgIg0101I LISIFD HEREON AND
401 f, 'r TO DIE AMINIMEM OM MR-
TBYROi.t o s ARE Fiat 1�I IE PI4ONE (631)727-2090 Fax (431)727-1727
' L' ' THE EXISTENCE GE 110314T OF MAYS OFFICES LOCATED AT ANU OWORESS
AND/dt EA3t1ENTS OF Efluil r IF
ANY. NOT SFIOWN ARE NOT IblE11A1/TEED 321 R'a4N01(E AV9tt1£ R.O. Box 1831
RNERHFAD, Now York 11901 RIvarbood..Now York 11401-0065
Z3-38b(...