HomeMy WebLinkAboutHayes, John (2) O
ELIZABETH A.NEVILLE +'+_§. Town Hall, 53095 Main Road
TOWN CLERK o - % P.O. Box 1179
ti Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �i �*+� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER l �a�+++ Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,+�+ southoldtown.northfork.net
g.OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3216 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : FRANK W. UELLENDAHL
Address 1: PO BOX 316
City St Zip GREENPORT NY 11944
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 #R10-04-0049
Name Of Owner HAYES, JOHN & CLARE
Mailing Address 1 648 JOHN STREET
City St Zip NORTH BALDWIN NY 11510
Property Address 1 870 PARK VIEW DRIVE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 5 lot 24.020
Cross Street PLUM ISLAND LANE
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
4.
• i" -'
���,,oNoS�FFo��=OD; 3 a i
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ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O.t�ia Z Box 1179
REGISTRAR OF VITAL STATISTICS :� 1 Southold, New York 11971
O MR
MARRIAGE OFFICEIR y 0��.1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -=dot * `�►��.OI Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER „ ..""t� southoldtown.northfork.net
�� 3 0�� OFFICE OF TOWN OFI OUE OWN THOLD CLERK
RECEIVED
TO: Southold Town Building Department
- AUG 2 6 2004
FROM: Linda J. Cooper, Southold Town Clerk's Office
Southold Town Clerk
DATED: July 30, 2004
Transmitted herewith is a copy of application No. 3357 for a Cesspool/Septic Tank Construction
Permit submitted by:
Uellendahl for John Hayes
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: VI __ _
,.7 7,,,,.,4074.
Signature
/1V,4/-yet-'•01- 3 ...)-o ac,"
Dated
•
ELIZABETH A.NEVILLE ��i�`Z` G1, ; Town Hall, 53095 Main Road
TOWN CLERK - , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS j. ft
t$ Southold, New York 11971
G
MARRIAGE OFFICER % Fax f Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =r4/ aV oe Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER - * i .10. 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 I or Non-Residential @$25 Application No.3/ ��
Permit No.
Applicant Name_ 1/Xi k /U. a z.-L-Egli, ted
Applicant Mailing Address ' 2C 3/ '
&_,/ ./pete7-, Av //9
Septic Tank ✓ or Cesspool /
Brief Description of Proposed Construction or'Alteration A/EGV C-C74,977?.t,c?7Lam)
C 6 O..(fE -j/L (- e. .. ./.72&_____ ______JL3C
Location of Proposed Construction/Alteration:
Owner of Property: .07-2YLD `74c,,id/.-s /--71,z ‘-d----
Owner
, 'rOwner Mailing Address: -*fes ,7 rhsx.) S?2 7-
AJG.0?7-7-71 €5/94 U'ir 1/51 0
Owner Property Address: $1 0 13941 " v/&zz/ .<-,E-
. i&--crj-&cr •r/-/-&- ,.--,--- ----/-4, 4or /72
Name and phone number of contact person ,2A Jk /&-e-L6- 134/71-[_ 47? &Oct
Tax Map No:/000 Section /5 Block &5 Lot 24,2e
Cross Street_ /172G-bj /56.1%/X.)130 214L1
NOTE: LOCATION MAP MUST ,SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S ' 4 TH rALTH DEPARTMENT APPROVAL i $4
S ,
*31 f, , e of Applicant Date
Received by:
I am romnlar wan me . /. fvL1it UJ t-LIM HrtWLIV/4L
AND CONSTRUCT/ON OF SUBSURFACE SEWAGE N c P
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES SURVEYOF PROPERTY
and. will. abide by the conditions set forth therein and on the �' ��� '"F C'}
,\I ¢"`i'
permit to construct. �,. „_ ItYr.r1 n A .
VS AT ORIENT
The location of we/Is and cesspools shown hereon are ADW LLIN ) TOW DF S�UT �L
D
from field observations and or from data obtained from others. ALL +
ANY ALTERATION OR A001770N TO THIS SURVEY IS A V10LA71ON LP SUFFOLK OLK COU1r T l , N. Y.
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS 166 1000-15-05-24.20
HEREON
N ARE VALID OR COPIES RBTHIS
R THE IMPRESSED IES ES THL EREOF NLYIF SURVEYOR LOTwELLING) �' SCALE' 1' 40'
WHOSE SIGNATURE APPEARS HEREON. (DAELL n,+ 186.93 EL• 33'0' JUNE 29, 2004
Elevations referenced to an assumed datum. N7 ,10"E
155
LOT NUMBERS REFER TO "MAP OF OR/ENT BY THE SEA ,t ,
SECTION THREE" FILED IN THE SUFFOLK COUNTY CLERK'S -- El, 34.o' I
OFFICE ON OCTOBER 16, 1974 AS FILE NO. 6160. •i
AREA=40,937 SQ. FT. o ii g
z LOT 172 ' 6
g
"� LOT 173
NI
LOT 171
14
t1kd
\ ,O
L P. 33' <
/ D
CD /crap p 25.2 D
esaf s L /
AeL
N
Sy.st".1 i N 5r Z ,. .
CO
o Z 'al / \ ;:).. ,
120'
+- 0 a III
•"' 34.8 N
67' o H PROPOSED 8.3' %.. z �! \�� t .
�e e FF EL.£L 35' , $Q -hJ 1 �(P �'
E VII # � 1t1 ar_lik1� �l V 35 3' w d �O ` � , •�i" ' •,�
• *.. A,• r ::�.4 ter ill t "35.31"" 4 o �1 f- clit Pi
0.44) v)f)til OP- Pfep, 1,,f(/'2
TEST HOLE DA TA
INSPECTION k� �04 NJ
RQ�ff RAS -`p
J/1744 r/3o
1 DARK BROW SILTY LOAM OL o f esi of 5° J L S817.09'40".00 �N88�.0 0"W
160.00' 200.00'
BROWN SILT AIL
le fii
- 3'
5
BROW SILTY SAND NITH lox GRAVEL SM 57K. a. 32.8' a9 40"W
EL 29.7' C�
" 185.00
CONCRETE CURB
BROW FINE TO COARSE SAND WTH 20%GRAVEL SW
PARK VI I1 LANE
104EL. 29.2'
EL. 31.7' �(l�E'1
9'
BROW FINE TO COARSE SAND SW
i
E! 19.41 '
At Of NEW`
WATER IN PALE BROW FINE TO COARSE SAND SW E ALL �E 0
17' WELL -. - l 'p/ rl�`4#�'�
(DWELLING) (D WLUN ) ii / Pe"
PROPOSED SEP71C SYSTEM CP 150+ A I,; .S. LIC. NO. 49618,
CP 150'+ 4 g4, P.a
(4 BEDROOMS) ,�
[1] 1,000 GALLON SEPTIC TANK •
7
j2,] ' DEEP x 8' DIAMETER LEACHING POOLS ' _ ...o 5�Q2ate• i (631) 76 —179
E3 pro p0,504.- sl vcs -Ira,, SOUTHf '},o . Y. 11971T 0204