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ELIZABETH A. NEVILLE e '` O Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
41, N Southold,
REGISTRAR,OF VITAL STATISTICS
New York 11971
MARRIAGE OFFICER ����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �l�C I.�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER DU �� 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. 3406 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HOWARD & FRANCIS SKEGGS
Address 1: 30 ADAM ROAD WEST
City St Zip MASSAPEQUA NY 11758
Descripton of Proposed Construction or Alteration
-THREE BEDROOM HOME
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTENT
Name Of Owner ANNE RUBAT ESTATE
Mailing Address 1 58 PLEASANT STREET
City St Zip HUNTINGTON NY 11743
Property Address 1 12990 SOUNDVIEW AVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 3 lot 10.000
Cross Street HORTON LANE
Building Permit Number Cross Reference:
Issue Date: 2/01/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
x•0.1*0 soup,/
ELIZABETH A.NEVILLE . l0 : Town Hall, 53095 Main Road
TOWN CLERK i 4 4g , P.O. Box 1179
vs y• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G
MARRIAGE OFFICER 1p4,
. �� Fax(631) 765-6145
RECORDS MANAGEMEN FFICER i� Telephone (631) 765-1800
FREEDOM OF INFORM P�TTO OFFICER = CDUE,,�o�� southoldtown.northfork.net
' r SAN 2 5 , ; OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TQr _."" Southold Town Building Department
FROM: Lynda M Bohn, Southold Town Clerk's Office
DATED: January 25, 2006
Transmitted herewith is a copy of application No. 3559 for a Cesspool/Septic Tank Construction
Permit submitted by:
Howard & Frances Ske22s
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.
Lynda M Bohn
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
Dated
' i io$UFFOtt
ELIZABETH A.NEVILLE ��047 Co:-,,VA 1 Town Hall,53095 Main Road
TOWN CLERKP.O. Box 1179
REGISTRAR OF VITAL STATISTICS ;dyiy Southold, New York 11971
MARRIAGE OFFICER v '� 1� Fax(631) 765-6146
RECORDS MANAGEMENT OFFICER �-y�fo 0W-•
W'ilTelephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER = '� Jig .eI• southoldtown.northfork.net
e......t''1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT '
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 X or Non-Residential @$25 Application ► -�
1-10 Wand T- S k egg s Permit No. # _ .
r
Applicant Name rriir CeS C . �J c JJ
ke S
Applicant MailingAddress 30 Adam o a d V�eS
pp
M asscL13 et Neu, N Y // 75-T
Septic Tank or Ce&spooll f t_
Brief Description of Proposed Construction or Alteration 3 Jr edroom hovne'
Location of Proposed Construction/Alteration: C L
Owner of Property: Anne u ba-+- t—\5+A•Te
Owner Mailing Address: C/O 1/_Lt---e_i E- /14e NF,.L L
mfr AzE-,15,4,o7oS , 7IIu ,,, 7--6.) /f° //7'73
Owner Property Address: ha 9 90 SO wet d V i ew Ave
50 it-41 01 ri NY f1`l7/ -YZ713
Name and phone number of contact person Fret viers e ° -ke5j s (5/0 Pp -615 7
Tax Map No: Section 6-ht Block Lot 16
Cross Street Horton 1,-..a ti P.1
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
0 lj _ rte,• I-d3-4,6
Si afore of Applic. / Date
Received -41
w
if
rl
r SUFFOLK COUNTY DE?Au�TMI tl T C. ,-. 3AL,'"" 1,,2aVICEa
L• SURVEY OF PROPERTY
' PE�kT FOR A_.s 1asl w.,, .,;..=k ti.•C s s` _.'.. ._f.) . 2:,11€ TEST HOLEDATA SITUe4 'Ii'D AT
Y r LE Ft��rriLY u EON (TEST HOLE DUG BY McDONALD GEOSCIENCE ON NOVEMBER 3, 2005) SOUTHOLD
A / Q EL. 53.5 TOWN OF SOUTHOLD
DATE 1 O6. Y }? :�; _ r'O'Z.�7.1 . DARK BROWN LOAM OL
SUFFOLK COUNTY, NEW YORK
APPROVED '
- 1.
S.C. TAX No. 1000-54-03-10
° SCALE 1"=40'
FOR XIMii_, 1" . OMS • BROWN CLAYEY SAND WITH GRAVEL IN LAYERS SC NOVEMBER 3, 2005
a •
EXPIRES THREE YEARS FROM DATE OF APPROVAL ,
� EL 40.3 • I�' 7
,(
' '(1`\f) a . - '.- BROWN CLAYEY SAND SC AREA = 17,709.85 sq. ft.
Y `. , / _.
13.3' 0.407 ac. {
�� a 0,
4 0
. • O .j WATER IN BROWN CLAYEY SAND SC
yf4 • 6QF / r Q� o
O / QC, ��'� Tt�s t^!'� O�� 1
V
/�`P \ �• "b c �,,y 24
a
/Q-" -'yA-
/44
F _- WATER IN PALE BROWN FINE SAND SP
c)'\.%
\ • • e'•• fes' •.
ri �� NOTES:
•
e / no a• •�j, 1. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM
p •o,
J .
a'
• / EXISTING ELEVATIONS ARE SHOWN THUS:
j s �(. • 2. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1,000 GALLONS.
5� /O a •
.5.___9 0 bci 1 TANK; 8' LONG, 4'-3" WIDE, 6'-7" DEEP
/'\ •n aStio 3. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA.
'`' 4./.0 '''S� 2 POOLS; 6' DEEP, 8' dta.
01 Att G5t $ <4 ,1p' PROPOSED SOX FUTURE EXPANSION POOL
.0 ofte
by a / S 81 .%. ANO. % PROPOSED 8' dia. X 6' DEEP LEACHING POOL WITH SLAB COVER
V ,��yt 53.5 ® PROPOSED 1,000 GALLON SEPTIC TANK
0,, ?' S. n "'J4` 4 \ \ TEST HOLE ��� 4. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
�i OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
NxA \ rset
° , 6�OoN �q 14116 Gol4.
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t'A4 '.` \ ip... 1, 4 *14 Off+ ••,a• a, IN T►IF
G . 9,. ki O 04
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OO J FOR TITLE As ESWHED
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d• '9�.; T 5 co g\A , r.- =1 .. U �� L I
i 41, .114' B V 1........i
° \ /�� .4.,, ` ' N.Y.S. Inc. No."4Gi68
EXCAVATIONINSPECTION REQUIRED UNAUTHORIZED N.TERATxN OR AODTTKN ' ,v'�
{p.+ SANITARY @� TO THIS SURVEY s A VIOLATION OF +=ik
• FOR •R�1 SYSTEM EDUCASECTION 7209 DF THE NEW YORK STATE r►
O •
COPIES ON LAW. ph A. Ingegno
Cf THIS ptY MAP
BY HEALTH D E PART M E NT TO BE A VALID TRUE COPY.
SEAL stou tar QED d Surveyor
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY 10 THE FOR WHOM THE SURVEY
IS PREPARED. ON H5 BEHALF TO THE •
/ E€INC COMP
R51DD HERAGENCY AND EON.AND Title Surveys — Subdivisions — Site Plane — Cornstrlxilbn Layout
IGNEES OF TIE LOONS Ti: NSTL-
TUIDN. CERTIFICATIONS PRE NOT TRINSITRIBLE. PHONE (631)727-2090 Fax (631)727-1727
THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT *MUG ADDRFSS
AND/OR EASEMENTS OF RECORD, IF
ANY. NOT SHOWN ARE NOT GUARANTEED. 322 RoAMOKE AVENUE P.O. Box 1931
RWINNEAD, New York 11901 RIv,dMod, (iri.Yodt 11901-0965
Ztt—Wiz
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