HomeMy WebLinkAboutEpperson, Brooke ,i"rj FFoc,�;
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ELIZABETH A.NEVILLE Gy Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold,New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ' Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,S' 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. 3229 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : BROOKE EPPERSON
Address 1: PO BOX 93
City St Zip MATTITUCK NY 11952
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 #R10-04-0079
Name of Owner EPPERSON, BROOKE
Mailing Address 1 PO BXO 93
City St Zip MATTITUCK NY 11952
Property Address 1 250 NAUGLES DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 5 lot 2 .000
Cross Street LUTHERS ROAD
Euilding Permit Number Cross Reference:
Issue Date: 10/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
. ELIZABETH A. NEVILLE I���_� °7a: Town Hall, 53095 Main Road
TOWN CLERK t y Z 1 P.O. Box 1179
%REGISTRAR,OF VITAL STATISTICS
‘134 °
�► �� Southold, New York 11971
MARRIAGE OFFICER .Gy l��I�, Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER O,,j jig �a�''i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - S ,its southoldtown.northfork.net
SEP ` OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 31, 2004
Transmitted herewith is a copy of application No. 3371 for a Cesspool/Septic Tank Construction
Permit submitted by:
Brooke Epperson
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' - �"�, ,,.�(
I/lj/70J s � /•- r/ -
2CC'e. 4e'otee' .,e4t.
Signature,4isfr ®® ` lii,
Dated '� �I
ELIZABETH A.NEVILLE il�`1` Town Hall,53095 Main Road
TOWN CLERK Z •; P.O. Box 11.79
Z Southold New York 11971
REGISTRAR OF VITAL STATISTICS : v. ISFax
I '
MARRIAGE OFFICER O (631) 765-6145
RECORDS MANAGEMENT OFFICER , 0 0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER , 0'` �a�'0southoldtown.northfork.net
OFFICE`OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 X or Non-Residential @ $25 Application No. 3 3 7/
Permit No.
Applicant Name ' c3-01CQ, P()QXscsi-Th
Applicant Mailing Address `7€ 0- `+-jC ( q 3
Kites (k IV.q. l i( S2
Septic Tank X or Cesspool
Brief Description of Proposed Construction or Alteration 2 S r-L A S cw31 Q
c� ,
;, -, 1, res( nn \ICC C_OLAr4 c 4-
Location of Proposed Construction/Alteration:
Owner of Property: C-)abr., e l T) +,-
Owner Mailing Address: ?, 0. �- vel Co3 3
LA c & ; \--1....)(_k_, t... •`I• \062-
Owner Property Address:arj) k)& -(o_ 12c•\ ,
LAC)Al2, -1-vc ) 1J•q, 1 ‘ot 52
Name and phone number of contact person (___V ,#--.-e.on cj\c &.Q.o 69 3` ) 2qe)-% 1 z-9
Tax Map No: Section 99 Block QS Lot 02
Cross Street �V 2,t•S �-'d o
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CQNSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
6..0-r:Ruz. ?,f-ip-eA_/3 on P., 1 .&-I
Signature of Applicant Date
Received by: • }-)4-e--14-4-------,
N
(ECEIVED
SUFFOLK
UFFO SERVN« SURVEY OF PROPERTY
loos NAY i 'P 2 AT MATTITUCK
.... + TOWN OF SOUTHOLD
(VACANT) SUFFOLK COUNTY, NY.
1000--
XALE': '�tf0'
,n4 NAAPRIL 19, 2004
TEST HOLE DATA Pi ELMO'
J�/� 1228.
'Hal' 91
EL one• R..422,172'L, - 727794.27' R•965.36' L=142.37• °" rao __ —
r�rEo LOAN 20f 27' rf a. »., raT
1.5' 'AL BROW OE S se SAND a1'w •
a. zrZr SM.MR R4 PALE MOWNCRAWV 20aa+RSE �1FPOt.R OF REAL7Ti SERVICES
. e.
or MIEN w Mawr SILTY SAND SW b _
r _ �'r-"- OF CONgTRL'CTION FOR A
OMR w Maw SANDY aur _ b 021_ — — — -1 RLSIDF.TICE ONLY
7' 11
Are OA)EY saw sc e a _
ippr
iamr W Maw TO COARSE SW g I Q 16' o OVER /
GRADING PLAN
Z0 \ m FOR MAXIMUM OF B''"l`+MS
�. ,, � I = THREE YEARS FROM DATE OF APPROVAL
F.F.EL 24' Pf°E r :321. _colAir„DpREP,,,,AR„,...Thswry.
- mimeo * 80 PROPOSED I z EXCAVATION INSPECTION REQUIRED
_ _ GRADE EL x' 1 HOUSE - .'�fe FOR SANITARY SYSTEM
�T
/.E :. I FA EL 24' .Sar I r BY HEALTH IJF'ART EN
79.3' I.E. !EPIC �� LE
; scr
Tar W my p85' Is M
r re� ? D
I C)
PROPOSED SEPTIC SYSTEM
EL 0' W ell
�� N
(1.1 LEACHING POOL If DEEP INN 3' CLEAN a'pyg•1prn
SAND COLLAR. REMOVE MATERIAL DOW SAND - v rn
TO SAND SP AND BACKFILL *171 CLEAN SAND. t QAR EL •
WA
031,000 GALLON SEPTIC TANK. EL. -J6 W I I
Z).g
l' �� I J D.'"""
1 am familiar with the STANDARDS FOR APPROVAL ..C
AND CONSTRUCTION OF SUBSURFACE SEWAGE I
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 0 _ -- - ,
and will abide by the conditions set forth therein and on the . c.Pk L-
permit to construct. vow '
The location of wells and cesspools shown hereon are yrL° N
from field observations and or from data obtained from others. 5.0 ' tl ACTUAL s�
Elevations referenced to on assumed datum.
234'9°235•6°1
DEED) I D JNG)
ANY AL JERA 11GW OR A0011T0N 70 THIS SURI.E Y IS A NQLA IICJW "7- it. j&$ Sr" 1.1 ":
qqFF SSCiaN 7209 OF ME PEW YORK STATE ED(ICA17Q 1 LAW ,pp tQ�� t.METw J�D�
A EJtCEPT AS PER SECJ/OW 72 9-St!l�YNSIAN 2 ALL C(RTPKA11GW5 9 asw N .E i.
+ NEXON ARE VAD FD? n is MAP ANO COPIES 1NEREQF ONLY/F a4 L C? T MUSAK et,...t.„: 0 4
SW MAP OR CODS BEAR IME IMPRESSED SEAL OF THE SURVEYt7YP ` ROBS l • 0. 0. 49618
WHOSE SIGNATURE APPEARS HEREON. oeal ""E CONI ' r ?PAC. i`
' M ailonument c". FRANK ) (631) 7• '2P
1(631 •5-1797
N/O� (D P.O. BO 1 V
WV-
• AREAa72,340 SU. FT. 1230 TRA :� a,�7��WI
crown-my., . `+' :IL .. d_1CPY