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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- •3A`--f 1 • � 0. 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 !i' 5 \ `G. ' IF..wSU•�J ZONING: R-40 ilk ..,-.6 116 !yf=� < FLOOD'. % •- ''"• 114\ '�O >CJE _ ZONE U W d�'A LLJU7 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 `� EXISTING ELEVATIONS ARE SHOWN THUS:5.0 y1 I#.F• '—/ \ EXISTING CONTOUR LINES ARE SHOWN THUS •CT9-. .� e \ \\ �1 !I, 7HE LOCATIONS OF WELLS AND CESSPOOLS ii 1k \ SHOWN HEREON ARE FROM FIELD �. t \ �° OBSERVATIONS AND OR DATA OBTAINED • �' \ 1S. FROM OTHERS �kz • - 1, _- offs ,�71.4.9S. >4 p f LOCATION MAP F TO'T'E C1IANC ° •). =� \f `�° >k a a De flf Health SetNiceB .m. 1 `� , w by /uHhi: 31:11►�, F w ..a NER AN RF MEN, j� vJ 1338 Mnna.looK ROAD S W l� +.j° �y Q ' o x Cj Mnnm,.:K...v.,nz b z 11.1 = /•� ta4 re aoo �V 'i da , j ,� �O r.= �r is. , W o E+ �_ �.. p a w EST HOLE BVMCDONALD R N GO s 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 •- �\ ./ `� ,` '1 PALE BROWN O 17n FINE TO MEDIUM SAND SP '7 .. �� COMMENTS.NO WATER ENCOUNTERED • �� Iiitiit,11 , J ,_,-yr 5,o , NO SCALE �ROJECT NO 2004 .° ,'--' '7' Y' ,1` DRAWN BY: RJB ` CHECKED BY:TCS 111. 9\ -. .I F_ _° �. DATE. 3104104 / 6,RADE E .r21'.O FT SCALE • i.. 50 S. W —_ 1 �G`SZERED C�' SHEET TITLE Si' c. sA Y L- I IE.,le IE*Il Amo �a, �'� SITE PLAN IE. IT-4"- 0/10341 FL Of u) SITE PLAN _ IE.16I-10-1/2' [`r^_7 � ' SHEET NO. — Scale 1••=50' — BUNGALOW SEPTIC PROFILE i;K is35°e SNE �✓0• AT %rA 1