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HomeMy WebLinkAboutMealy, Pricilla •,���StFFO��-C • 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 I••,,�oS�fFO�,�c OG 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