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SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3306 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERTS CUSTOM HSS
Address 1: 50 DIANA COURT
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-05-0015
Name Of Owner ROBERT'S CUSTOM HOMES
Mailing Address 1 50 DIANA COURT
City St Zip WADING RIVER NY 11792
Property Address 1 345 CEMETARY ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31.00 block 10 lot 7.000
Cross Street
Building Permit Ntamber Cross Reference:
Issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
/'SIF/fro
I0III �pF SOU, , 330
ELIZABETH A.NEVILLE �� lQ Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS cn Southold, New York 11971
MARRIAGE OFFICER �QQ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `;meq . ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER . COUNV\ Ia1 southoldtown.northfork.net
I►
U' n. OFFICE OF THE TOWN CLERK
' TOWN OF SOUTHOLD
; APR _ I+ 205
�►�
T Souxlzald T wn Building Department
FROM Linda J. Cooper, Southold Town Clerk's Office
DATED: April 1, 2005
Transmitted herewith is a copy of application No. 3450 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert's Custom Homes
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: /04
cli"#'64"
Signature
/2'00
Date
ELIZABETH A.NEVILLE
111111111r
Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER : O Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `_� 0.eel Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER _4'1 * 4.„'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. 34 VD
Permit No.
Applicant Name-.o b,-w +', d m t4 rn c S
Applicant Mailing Address Cb 1' r a n c, e--i-
1,00_8,
f
IIIDa (Ivie NSP c(79 ?--
Septic Tank ko r Cesspool •
Brief Description of Proposed Construction or Alteration k P, (.1-)Y1 S1'Yu--C- -u/YL,__
Location of Proposed Construction/Alteration:
Owner of Property: 2p VJ- -v1 (5 C tis ti,-„„_ 1444
Owner Mailing Address: c0 Z N'eft-VI o,, CA--
Owner Property Address: .3 tic ce.,,,,..A_0"1 R.,1
6PIS �Ma A-i Oen
Name and phone number of contact person U t c_t 714-k tg 3 4 D-I-/
Tax Map No: IOD 0 Section 3 I Block I G Lot `1
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITEALTH DEPARTMENT APPROVAL
jVi.
it (of
Signature of Applicant Date
. 4
Received by: 1 /U/ -
AT SAW MARION
rOWN OF sourHow
-11-- SUFFOLK COUNTY N Y.
1oco-31-10-07
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SCALg 1'=.10'
DECEA4EER 14, 2004
0...
suFFOLK CDC:711';
0414 itV\3'1*' ,.1 e.1.1 A 1
`::,::,Fo:1:.?cc-70N FORA g 121'CV* iti \ .... A i
14 1 lc 31:0?Viev t 1
rArii 4,i/ 2 :1,,,,,
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APPIWYS, ,-‘1Y. ILIZ--_--------
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vAA;..mt_h,.1 OF _LTDROOMS ..* 1
3.--.......
EXPIIIILS AIREF,YEARS FROM DATE OF APPROVAL 411 ° Itli° 15,
i
$
$
- - I
Cel.
49
to
TEST HOLE DATA ,
141.10.4
12/30/04
6 ',V
I
Oil' 4O 0' : )
S
DARK BROWN SANDY LOAM OL let• 1‘ ...n --se
+A --
BROWN SILTY SAND SM ..') 1-..., ,-' '.-- TIN% .,(k,
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;I _V-45 - 't,,,,
4, \V&
15,Vt "16:-P
PALE MOWN FINE TO MEDIUM SAND SW
CD (10A
71, t` alL
13A.
..A li.
Cati 9c. 41). 1
Ak,
.414'
17'
A-1,*
v..6
'44
'0° ,..1 r•
k SGt\w
I am familiar with the STANDARDS FOR APPROVAL
*a
AND CONSTRUCTION OF SUBSURFACE SEWAGE S
a etf% INA 0)0
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES v3 \I-C4' if-
.0 '
and will abide by the conditions set forth therein and on the \
1111k0, - .1 010if (P
permit to construct. `P ..scIF New ..1
ok. ,cY 1.MEr.. -cf.
The location of wells and cesspools shown hereon are O.,1/44 ,0
,
from field observations and or from data obtained from others.
0 * w
41 15 ...
-,-, ...,,.
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION !;1'.71 1)
OF SECTION 7209 OF THE NEW YORK STATE EDUCA 770N LAW.
1,1
EXCEPT AS PER SEC 710N 7209-SU8DIWSION 2. ALL CERTIF7CATIONS
HEREON ARE VALID FOR NIS MAP AND COPIES THEREOF ONLY IF V A illgili .‘it4.1,-. I ... '
b - YOFir. ..'"
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1,10) CONIC S
.... -- --.-
KIOSE SIONATuftE APPEARS HEREON. _.„0-0.. CY (631) 765-5020 PAX • • -179;
Elevations referenced to an assumed datum. Cuvr‘S ."4*
140P-IsP P.O. BOX 909
AREA=20,000 SO. FT. si=MONUMENT
.40, PIPE ; 1230 TRAVELER STREET THO04 314
SOULD, N. Y. 9 7.971 -.In"-