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HomeMy WebLinkAboutGillooly, William role pa SOiJ ELIZABETH A. NEVILLE • Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS d� ac Southold, New York 11971 MARRIAGE OFFICER . a ��� ��` Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER \-440 ro1.1' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUI'HOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3337 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : WILLIAM GILLOOLY Address 1: PO BOX 38 City St Zip ORIENT NY 11957 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 #R10-05-0047 Name Of Owner GILLOOLY, WILLIAM Mailing Address 1 PO BOX 38 City St Zip ORIENT NY 11957 Property Address 1 ORCHARD STREET City St Zip ORIENT NY 11957 'ax Map No. section 27.00 block 1 lot 4.000 Cross Street OLD FARM ROAD Building Permit Number Cross Reference: ::ssue Date: 7/08/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) . 111F , l pf SOU/ - 3337 ELIZABETH A. NEVILLE ��• i0� 0<6 ; Town Hall, 53095 Main Road TOWN CLERK ; * * , P.O. Box 1179 REGISTRAR OF VITAL STATISTICS % N Southold, New York 11971 MARRIAGE OFFICER % Fax�1�, Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER :Oly I Telephone (631) 765-1800 FREEDOM OF INFORMATIONNOFFICER COU ,0 ��� southoldtown.northfork.net .1..#, S eel. ~' i 5 n r " OFFICE OF THE TOWN CLERK �.0 JUN 2 2 20 ! TOWN OF SOUTHOLD Lia. outlold-Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 20, 2005 Transmitted herewith is a copy of application No. 3480 for a Cesspool/Septic Tank Construction Permit submitted by: William L Gillooly 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: .�Z`L=„ • 7/,,ce....4rite Signatur 2 2. 2-00,r- ted ,iso°11°10F01 ELIZABETH A.NEVILLE $.a . 4; Town Hall, 53095 Main Road TOWN CLERK p� .0 A I P.O. Box 1179 REGISTRAR OF VITAL STATISTICS y. Southold, New York 11971 MARRIAGE OFFICER G :471$ Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER -.0 Telephone (631) 765-1800 0 FREEDOM OF INFORMATION OFFICER '� * 1,.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. Permit No. Applicant Name lf)/L L/n .N L CLoot1/4/ Applicant Mailing Address 12O)( 3 8- (5),/5>yr H(/ )/9.S7 Septic Tank x or Cesspool Brief Description of Proposed Construction or Alteration cO'✓S?29.4x7- Th 4 P 1 3 Cx — Location of Proposed Construction/Alteration: Owner of Property: (4)/dLi Aw, Ci LL bo Owner Mailing Address: LOX 3r- (-:*/)4.-- IIf y ti 9/ Owner Property Address: ti2G/Msd S% ©!2/mr T Al Name and phone number of contact person 11L✓/1 1 7 6.11-44'54-3,s1 575— Tax Map No:/L. Section -17 Block 0/ Lot 0 9 Cross Street OI2 f'm re0,5/ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVE WITH HE: TH DEPARTMENT APPROVAL �i \T- fir- '�d 7d ignatur; of A,'leant Date Received by: aiiiimaimmoi `..rte. ; _ war► Allammixilimaxlissammilleawillimii N SCDHS Ref. # P10-05-0047 SURVEY OFPR. OF ERTY ''ill '' AT ORIENT TOWN OF SOUTHOLD CERTIFIED TO' SUFFOLK COUNTY, N. Y. WILLIAM GILLOOL Y CHICAGO TITLE INSURANCE COMPANY 1000-27-01-04 42. 33?. SCALE. 11=30' p., FEBRUARY 10, 2005 5�� SS2,, �VjO� �L-7C4NJ PAi�IR20, 20, 2005 ,o R May 14, 2005 (Revisions) Nt1• ,/ Mir 22; Zc ' e_Gar Sed+` j SE Or EL. 36 QG� '� 4i1N11111°P.. Finished Grade EL 33 \l' m1n-f- f-1i' min E 3?J E N.7 /500 a/ —__•-1 . T-6ST 9 lE'atm E 4'' sE 3 L.P.s - 6'-6' s Lf 8'� �.r� CLQ\.: ` �c� EL 21.2 Ground Waler 3' min. �� Q�a �G�J P SEPTIC SYSTEM` CROSS SECTION i\\ c� ,� , — ♦\ �' a �p �'0 RK BROW LOAM OL �O / Ns �.' /5oa�c�,'/���© ,�� 4� \\,\,c,_ /7 BROW SANDY 9LT ML P//d NCJ Fc. s s t y 'S- ik ,�. Q C?' *�- Q" • • BROMN FINE TO COARSE SAND N47N f0 GRAVEL x .‘-'-.40' \ o- , A/ �� C7 Q� # 44)4 s 11.8' '�, �'`' yS3 0>0 ��` � .3/ ' V 4.•Q MAZER NV BROW FINE TO COARSE SAND 0* \ *ST47 !� WITH 10X GRAVEL\ 4. Q 4Q� 4 f7' Acp ip, 1, p.- - `t•-> 5rrd K Qh A. MaDAAIALD GEOSCIENCE 12131!04 �' \ -•1�'„?,�j�, ft /0N '�.� 44 , im familiar with the STANDARDS FOR APPROVAL 4411, V CONSTRUCTION OF SUBSURFACE SEWAGE . ryA . 'RF VI- <ADIS 414.2114,4.144. it• �, V. iPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES �o ``� ,,A, 4 d will abide by the conditions set forth therein and on the m he<' ,s�CJ 0 '� , RNs 'mit to construct. ��,. c \00 T �iY �4%-,I ., location of wells and cesspools shown hereon are 11\113.0- Llir \ ' � Gl1L�L.00ILY 70140. ,i m field observations and or from data obtained from others. PisS f «.IC CO 711ZE „`,It v COMPANY ' ALTERATTON OR ADDITION TO THIS SURVEY IS A VIOLATION f- �. SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. :1U Co +4 `. re �r AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFlCATIONS fON ARE VALII FOR THIS MAP AND COPIES THEREOF ONLY IF t,? ' h ' S l 1 a " , f i U 1` �vp r'f L .i. C?. 4515I 7 tf MAP OV? COPIES BEAR PIE IMPRESSED SEAL OF THE SURVEYOR �, { �4 � �� �ti �. ECONlC `�'�`k�` `.fr , /" C ?SE SIGNATURE APPEARS HEREON. i t in . ?" s: I