HomeMy WebLinkAboutMeriam, Tom �//
,IO s', SUFFO(,�C
ELIZABETH A. NEVILLE �`i y� Town Hall, 53095 Main Road
TOWN CLERK h Z P.O. Box 1179
Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS Oy� �����',, Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER 0.� `1►�,��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,.is" 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. 3241 R Residential X Non-Residential
",Fee $ 100.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SAMUELS, THOMAS C.
Address 1: 25235 MAIN ROAD
City St Zip CUTHCOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SMALL SANITARY SYSTEM FOR NON-HABITABLE POOL HOUSE
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner MERIAM, TOM & SUSAN
Mailing Address 1 15 DOCHESTER ROAD
City St Zip ROCKVILLE CENTER NY 11510
Property Address 1 1335 MARATOOKA ROAD
City St Zip MATTITUCK NY 11952
":ax Map No. section 115.00 block 11 lot 26
Cross Street BUNGALOW LANE
Building Permit Number Cross Reference:
:ssue Date: 1/26/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,/o,,O��SUEFO�,�6-
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ELIZABETH A.NEVILLE IA•
Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O �1t Southold, New York 11971
MARRIAGE OFFICER \. y ��/ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =��1 �a•��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ., ,••�� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
8 2004
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 8, 2004
Transmitted herewith is a copy of application No. 3383 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuels & Steelman for Tom & Susan Meriam
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: ����t_�.�� ,. ;�,��AIV-
Signature
�
BJ iso
Dated
OFFICE OF THE TOWN CLERK " ''
TOWN OFSOUTHOLD • c ' L ' Application No.lii4
FT.I7ABETH A.NEVILLE,TOWN CLERK e%41)
. G� ���
P.O.BOX 1179 `
Construction
SOUTHOLD,NEW YORK 11971 : Z
• C Alteration
Telephone4 # 0' $10.00 - Residential i
(631) 765-1800 _ - 1.
/ $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
•
DATE am - / 77"
APPLICANT NAME: r fff.�,�1�S' dAtm '
APPLICANT ADDRESS: 025235 /f f,}//V ,e44-47,
"C1f Cc )I
SEPTIC V CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4' O 04,1a 61 '7 s ysp 7- 4/ --(mg(77 f CE-
PevchvUsc
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Z2// & StV 7CCP/MI
OWNER MAILING ADDRESS: /5. Jo'4. zi `2 e/7
//Cei (/r'a6:7 e ,- 7t y
OWNER PROPERTY ADDRESS: /335 ,, r90K/4 c
TELEPHONE NUMBER OF CONTACT PERSON: /75-4-07 as 734( - 6
TAX MAP NO. : Section /45- Block // Lot
CROSS STREET: &A/ 6,4-L O
BUILDING PERMIT NUMBER CROSS REFERENCE:
Orb / dr
ignature of Applicant
RECEIVED BY:
ow Clerk's •Office
DATE: l6 K (l
REVISED 7/6/01
SITE DATA
{ J4 O� J� SCTM# 1000-11511-26 A t
Water lines PROPERTY. 1135 MARRATOOKA ROAD
Crust be inspected by the l ADRESS MATT!UCK NEW YORK 71952 1
Suffolk CountyDept.of e, ti
p Health Services. \ OWNER OM 85USAN MERIAM —F
.,; Call 852-2100,24 hours in advance,
15 DORCHESTER ROAD
\ ROC K VILLE CENTER.NV 11570
TEL k(5161-766-5016
to schedule inspection(st) r�5 .� •� ',N
O`�J lYi \ �},, \� SITE. 91.617.6950.FT.=2.103 AC. WI
416\0‘'+
11 1� ,Ik ilk 4 ' \ �s �`(I , CSI AREA Ila
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5 \ `G. ' IF..wSU•�J ZONING: R-40
ilk ..,-.6
116 !yf=� < FLOOD'. %
•- ''"• 114\ '�O >CJE _ ZONE
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SURVEYOR. JOSEPH A INGEGNO
\ \
� �` '� ()_Ir I 1360 ROANOKE AVENUE
%y ilk �j. VJO� GL RIVERHEAD NEW YORK 11901
u.._+ d LICENSE# 49888
• M \ S \ �� .y0 \'''° 1111141/4 .1"1:,\
O�.p �liQ i` GATED' OCTOBER 3,2000
V.- `35./0.. '- \� �6 \llk �` ` �M �w p NOTES' ELEVATIONS SHONM ARE REf ERENCED
f ♦� =\ Wyk N TO N G V.D.1EVATIONS
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EXISTING ELEVATIONS ARE SHOWN THUS:5.0
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•CT9-. .� e \ \\ �1 !I, 7HE LOCATIONS OF WELLS AND CESSPOOLS
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1k \ SHOWN HEREON ARE FROM FIELD
�. t \ �° OBSERVATIONS AND OR DATA OBTAINED
• �' \ 1S. FROM OTHERS
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OlA _„'^^19 LI )Z�E O Aj a �a�/ _ - \ \I- `� \ T:ST HOLE DATA!5111(2001) 11AM E SCIENCE .
P 1C'Fa // "^i) '�^ , w5iM0 2 a F-
{J • "1 w� eOAi I i O o Ei GRADE ELEVATION 1.0 FT n y,
M �I.�-.lk 1' /1 [wL a d W 1'l DARK BROWN LOAM OL
° ®�° 1� 1Z9' q r^,4 a(n Q Fl "OWN LOAMY SANG SM
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O 17n FINE TO MEDIUM SAND SP
'7 .. �� COMMENTS.NO WATER ENCOUNTERED
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, J ,_,-yr 5,o , NO SCALE �ROJECT NO 2004
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RJB
` CHECKED BY:TCS
111. 9\ -. .I F_
_° �. DATE. 3104104
/ 6,RADE
E .r21'.O FT SCALE
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SITE PLAN _ IE.16I-10-1/2' [`r^_7
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Scale 1••=50' — BUNGALOW SEPTIC PROFILE i;K is35°e
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