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HomeMy WebLinkAboutAcker, Anna A ,,,,,III,i ,O��S�f FO�,�-�0 • ELIZABETH A. NEVILLE Qa� Gy� Town Hall, 53095 Main Road TOWN CLERK CI3 Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971 MARRIAGE OFFICER 'f,'L ������ Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER -=7/1 * j►a;,.• Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ,•i" 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. 3276 R Residential x Non-Residential =ee $ 100.00 Septic x cesspool PERMIT ISSUED TO: Name : ACKER, ANNA Address 1: P o BOX 429 City St Zip SHOREHAM NY 11786 Descripton of Proposed Construction or Alteration NEW HOUSE CONSTRUCTION FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT Name of Owner ACKER, ANNA Mailing Address 1 P 0 BOX 429 City St Zip SHORHAM NY 11786 Property Address 1 855 PINE NECK ROAD City St Zip SOUTHOLD NY 11971 "'ax Map No. section 700.00 block 5 lot 33 cross Street Building Permit Number Cross Reference: issue Date: 2/01/06 Elizabeth A. Neville Southold Town clerk (TOWN SEAL) 3z: •• �,ii''SUFFO(,� , � G ELIZABETH A. NEVILLE �`� ��` Town Hall, 53095 Main Road TOWN CLERK t ti3 2 t P.O. Box 1179 tk v' ; Southold New York 11971 REGISTRAR OF VITAL STATISTICS : 4 ' MARRIAGE OFFICER ..,. Q�iFax (631) 765-6145 RECORDS MANAGEMENT OFFICER =��1 jili */*',0 0 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER „••.1 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD JAN - 7 '-- TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: January 5, 2005 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3420 for a Cesspool/Septic Tank Construction Permit submitted by: Anna Acker Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: sr- ,.�� 9-,....,,, ,a,g,* Signature 0//1 7oS-" Dated ,,,,ice.., ELIZABETH A.NEVILLE t"%z, Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Z Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS % ts. A� MARRIAGE OFFICER %%. t Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER -:#* ',tt Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER =_' * I' 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.3lid_.0 Permit No. Applicant Name �'' Ack Applicant Mailing Address P. 0 • 8 0 X `}a 9 3 Ho Pe.o--w+ ng 7/ 711.r' Septic Tank or Cesspool //� Brief Description of Proposed Construct ri or Alteration r i e w 4 o us-` C -7(s+vc ,urs Location of Proposed Construction/Alteration: Owner of Property: A '1 k•ok A�-k er2 Owner Mailing Address: P' ° x 4/x9 SA oK 1 , , n //7 8to Owner Property Address: 8"5 ' •n e Cie G k €o/ SoA0(d ; n ccta Name and phone number of contact person A h Ackerz, et 8/ 7103 Tax Map No: /000 Section -2 D Block SS Lot 33 3 - ���_� 7 Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALT DEPARTMENT APPROVAL Signature of Applicant Date Received by: 1 n V I`!,-r-av� -. . of / WATER '. _ FROM MOUSE , \ ---TO TIDAL WETLAND,\ �\\ �•\ TIDAL WETLAND i' BOUNDARY BOUNDARY T5' SECK FROM TIDAL ,' 4 \ \\, -- . - WETLANC BOUNDARY i \P , \.\ EXISTING SANITARY \ -� SYSTEM TO BE \ ~.4?„' ABANDONED PER SGDMS o4// I STANDARDS 0 / i 7 2' r 45' `\ , •� /' • EXISTING WELL TO BE ABANDONED �; �� PER 5GDt15 SPECIFICATIONS I6-'rk \`\�,' �,\ ' PROPOSED LINE OF TING Wt .L /1' 4HAYBALES ALONG , \ 10 10' CONTOUR PROPOSED SEPTIC SYSTEM: / I4 EXISTING ONE USE 1000 GAL. SEPTIC TANK, 4 2 STORY FRAME t'3).8' DlA.x4' DEEP LEACHING DWELLING TO RIN65 AND (I) DISTRIBUTION ir OBE DEMOLI;I ICD BOX 4 ` EXISTING WELL 7PROPOSED DRYWELL FOR s l D0F RUNOFFNg ; ;8. "'•"05ED TWO LAND OF SULTAN STORY , ME SINGLE FAMILY DWELLIN4 ryTEST DWELL (WELL WATER) gHOLE ` d) F.F.-18.2' *41TH EXISTING FRAME ( EXCAVATE \ LLIN6 BUILDING TO BE ir.`-1 APPYARDSOX.OF 2501E / ' ! DEMOLISHED �_`� �. --- __-- \ 4" SDR PITCH AT P1-EASE ©TF_ / / �,. I/4" PER FOOT MIN. Sanitary System, to be installed 1 7 l.�A► / j (,',4 u driveway.nder1 .•../ (I i \ ► 4" 5DR PITCH AT i e ( / ( tip\ I/8" PER FOOT MIN. l.," / ti p ea orrpeerc--- [--- 7 • / \ 1114541**P‘ 'SO., 1- 1 4 ! 4" SOR PtT HAT 10E. " f I/4:' PER FOO IN. ,` , o PROPOSED '_ - -- / GARAGE Zit GF=20.5 N 10'-0" ---__ 8....,____.-.—_-_ g O1, H,,,,,..., 1 i • x r \ 1 s \ oi t Icryo i w i — nrisi GRADE . N/F MARK O5MER 0 LE FAMILY DWELLING 2 I \(W 0 ELL WA►tk) I EXISTING WELL i--- I I �,"' I r . I t ' ili t ... . 04 kil co A i M 5' MIN.1 tft -4 X1 x T Vs) i I -n _rs. ui T b 73 t R. HATEI rn II A g x i mc- i ;r- -- _ -----4 , 0 is 0 5 b . gi ,,,, „ rn o r#8 8 0:11 rim .. ..., _ a, ....t.ut § 2 _, __. _ ! 6 5 i i vl 44; = trl -1:• A rn _ tp A 4 1 1 0 0 ,-- 0 1 I I I , r 0 1 ; 41 ill:: M 14 i 1 r 2 - 2 ffl-,:, 0 0 2 Pi 0 0 En- 1 ril i I to - 0 0 —Pb. 4 \ g 641VEI § -a T ° r ) 7 5 •-•.• , Ng . in i (4 IR -11 0 0 ' ---1 1he I ze V :rim -tt , --1 , . E-1-.....,,.. , • 1 _ . I 'SITE PLAN PEt/19018 - , PINE NEGK ROA° , . 5/10/04 PER cor.fmr 1 00011 4.,6,),..fri, ni SOUTHOLD, NY A 1;46 -its',17'7..•\::'4":13)(I‘C) i 1 JEFFREY T BuTLER P.E.pS.G.T.M.# 1000-10-05-33 1 4/1/04 RR COM/4M ...... 1. 111' 1111rfill411116',•■•••" P.O. f3OX 634 141VO4 PER cdowein COUNTY OF SUFFOLK TOWN OF SOUTHOLD si2 c 0- yie4.4i; ,-1 z1 . 0 0 ..,.:-----_—_ co rri SHOREHAM, NEVI YORK 11111111 /IAA& •A ....:%.r_21 ' .S. z. 10/14kg PM Ca.494 105 No 040011 DRAWN E3Y: DG 13 1.r. TEL.: 631.20E2.8550 FAX: 631.1215033 • — 4 ". st-' 6'ill'E12108/04 PER ccree )ATE: 4/23/04 APPROVED BY: JIB ER 'f ‘.°sZ• ., ........--______