HomeMy WebLinkAboutMealy, Pricilla •,���StFFO��-C
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ELIZABETH A. NEVILLE �� *d` Town Hall, 53095 Main Road
TOWN CLERK
co,
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER
��f Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER : Ol *9010. 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. 3254 R Residential X Non-Residential
Fee $ 100.00 Septic X Cesspool
'ERMIT ISSUED TO:
Name : LONG ISLAND PERMIT SERVICE
Address 1: 1814 MIDDLE COUNTRY ROAD
City St Zip RIDGE NY 11961
Descripton of Proposed Construction or Alteration
SINGLE FAMILY DWELLING WTIH SEPTIC SYSTEM
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner MEALY, PRICILLA & AUBREY
Mailing Address 1 460 NAKOMIS ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 SAME
city St zip 0000
Tax Map No. section 870.00 block 2 lot 1
Cross Street NOKOMIS ROAD
Building Permit Number Cross Reference:
Issue Date: 1/27/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
?►254
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ELIZABETH A. NEVILLE ,`� y�` Town Hall, 53095 Main Road
TOWN CLERK % ria Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v O Southold, New York 11971
MARRIAGE OFFICER y, 0��,,�� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER :71! * `�►a8,l1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .M,0" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
‘\\U1g TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 8, 2004
Transmitted herewith is a copy of application No. 3396 for a Cesspool/Septic Tank Construction
Permit submitted by:
LI Permit Service for Aubrey & Pricilla Mealy
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
1
Comments: OF .Air /Loa.-..
..24fio#141, ‘Z*
Signature
/0 0/
Dated
ELIZABETH A.NEVILLE /�0`L` C Town Hall, 53095 Main Road
. TOWN CLERK 2 ' P.O. Box 1179
Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % v. A! t
MARRIAGE OFFICER ` G t Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `=y 1�0'• I Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER el * i .1' 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 or Non-Residential @$25 Application No. 3 %•
Permit No.
Applicant Name AA,baki p,,,,..{ 11, I LIP tp_. c/o t , /.e rii4_44 S&1 V
Applicant Mailing Address 1S)LI al,'liJ Li Rica 'thl —ed f 1 td-5
I Lei L I i' . `acs 1(Lvc c v ct-5-e---
Septic Tank i/or Cesspool
Brief Description of Proposed Construction or Alteration �7inCi) p fid 1 CI LUdI 0't;
Location of Proposed Construction/Alteration: p ,1
Owner of Property: )�-i-e 1 fr i CtIJ 4 -1 t ,h(JZ/p �y� �Owner Mailing Address: 4(P 0 L 1(.16)01_13 1 I
• D1i- C1 Cl -71 11Th
Owner Property Address: ✓ ,i'1,- t'
Name and phone number of contact person OWIL�4Zl -54-0,5_e_. (oN- S- 64S/ 2-
Tax Map No: Section .---1 Block Lot /
Cross Street IUdgOrlti S Pd
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HE. TH DEP TMENT APPROVAL
I:1 4 x)11
Si ature of • . i licant Date
Received by: -�1 -)M/W--
Ii`
-M -
SCDHS Re%# RIO-02-02:1
CERTFIED To: SURVEY OF PROPERTY
AUBREY MEALY, JR,
AT LAUGHING WATER
: r10Y4i0s R�
TOWN OF SOUTHOLD
. SUFFOLK COUNTY, NEW YORK
1000-87-02-01
SCALE: 1"="40'
JAN. 11. 2001
OCT. 3,2102 I Ase )
OCT. P 2002 1°� 1
'�\ Nov. 2002 r ha e.t.sl
DEC. 9, 2002 1 editing CF. )
DEC70/F DRUM & BALANI DiC. rr EOM r./ r
OFC. 2'�, !**No cross seeNon 1
•
Lex..-121, 20671nefdrabs 1
i CpNP�' 6 2003
SEPT. ZZ, 2003 ;r prop. Ass. revision 1
•
1L IL
V SALT MARSH ':V
u Y y :'��pp' S �6`!5 Q - • .• SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
EDGE OF •••N.•
SS e�y} F •••'\•'
WETLANDS 9 .G�1' - — •,••••. EL �I.
. }�y,(i7E `�., \ . 1 PERMIT FOR APPROVAL OF CONSTRUCT/ON FOR A
MOI'1 Pr°�s 1$ .; SINGLE FAHUS RESIDENCE ONLY 1
tY t1: Z. El- A.5• b .s 1 :s+.:
DATE ` •! �q Hs REF. 6 ' " �► a I
DROWN LOAMY SAND SM L� � '► °�T L ST7NE D-VAY LL w- l-L`�/
-- -w r �j . ,.. Ice's--• APPROVED
�y} gyp. e ! "tc` ► v FOR IvIAXIl�1U.�i!OF BED .e ti
PALE BROWN �_ $E7¢- N <,p o{ ��y\ 17 EXPIRES THREE YEARS FROM DATE OP APPROVAL
FINE SAND SP '71 FL F r Z.
f5 4' X62 c '/ea tn y
pK a
Z D ! � o
tz
Z., G e! ,o� t G,
Xr
�y a s 6
9 Z !TV/00 \ • !�/ ,�' N.--'- -
1
NO ADDITIONAL FILL REQUIRED
PM O d - rql:�/,PALE BROWN SILTY SAND SM "A -' , . 4 �� -$� FZ. 16
, V-�'s•'"t4, Q FIWS!£D GRADE
11' ..A an. --
PALE BROWN FINE SAND SP {I. SERIPN `\A '� �6 t r�.. E3- q',T."b Not f'Al'. +ae•
•I,.6 $ 'W, R •
D �" / �... V'4, II.7 ® LE ILE I.E II 1 LNrAYr
0 SHED �. k� .. ,. a T1 I Fbr( ..
WATER IN PALE BROWN EL 16•B• 3.7'E ,� `* p� '.- • N D
rl
FINE SAND SP - �q tow,' 4. y....473
-1
Al 86-• ' -s. V - - d s..•.7 °!i. r,'"y, SEASONAL HIGH 6ROLEWA TF11
20' . or 'D '70
ELEVATION EL LS 3•.-
Z
T HOLE ", v ��., PROPOSED SEWAciE DISPOSAL SYSTEM
YL 2 POOLS 6'Dep WITH 3'COLLAR
1000 GAL. SEPTIC TANK BOTTOM OF
N/O/F MEALY
P.S TO BE 3'ABOVE GROUND WATER II
-S (V4NT) { SEPTIC SYSTEM CROSS SECTION
familiar with the STANDARDS FOR APPROVAL
CONSTRUCTION OF SUBSURFACE SEWAGE
]SAL SYSTEMS FOR SINGLE FAMILY RESIDENCES Prop. et��
I. will abide by the conditions set forth therein and G'• sFl�,,c sr•w' ,'To BE of NEW
• he permit to construct, gevaev cv,- .rt sou. t���i.ruin r.0
' ` location pf wells and cesspools shown hereon are IZ OD ZP > I`7 141LM ,,
field observations and or data obtained from others /d3Cord.6 4. ,,'/ { /�(r� � r:4 �[ IC. ND. 49618
ANY ALTERATION CIR.t ION TO THIS SURVEY IS A VIOLATION *Elf C SJ•tib IR' "C
).tions are referenced to an assumed datum. OF SECTION 7209 O NEW YORK STATE EDUCATION LAW. (63 5 •-'''_".2.0 AX:(631) 765-1797
AREA=34 2`93 S,F, EXCEPT AS PER SECT° 79119-SUM VISION 2. ALL CERTIFICATIONS P r_. '�9f1��s�� ,
/ HEREON ,ARE VALID f NAP ANO COPIES THEREOF ONLY IF 1nno v� r�t� [MiSul� �.�O�J A1.1�ES S tMI OWN SOUTHOL •
•, + 1971 00- 3116