HomeMy WebLinkAboutFoss, Lillian SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3505 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LILLIAN J FOSS
Address 1: 111 SO HILLSIDE AVE
City St Zip SUCCASUNNA NJ 07876
Descripton of Proposed Construction or Alteration
DEMOLISHING OLD STRUCTURE AND REBUILDING
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner LILLIAN J FOSS
Mailing Address 1 111 SO HILLSIDE AVE
City St Zip SUCCASUNNA NJ 7876
Property Address 1 135 LIBERTY LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 9 lot 7.500
Cross Street COLUMBIA RD
Building Permit Number Cross Reference:
Issue Date: 2/22/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
�• AN‘ SO1/l.
ELIZABETH A. NEVILLE ° ,`O l0 ; Town Hall, 53095 Main Road
TOWN CLERK .IL, *; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS c,,,
MARRIAGE OFFICER G $ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER . COOMy,\ ,,
' ��'l•
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
E3 - 6
TO: Southold-fwn Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: February 5, 2007
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3662 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Lillian J. Foss
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:
Signature
0 oG 17
Dated
I° N146
ELIZABETH A.NEVILLE lite"
�r I``Z`e `
- _,Town Hall,53095 Main Roa<
TOWN CLERK A ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS %:°O
� M �
Southold, New York 11971
MARRIAGE OFFICER '* 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `,y�ol 0. oil Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER * 460.1 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 App '-. 'on N O. 2--
Pe,
Pe' it No. _ ��
Applicant Name , ,'/I('oil a. S S S
Applicant Mailing Address l (/ co . i((S r'GL lie .
,Sitrz; c; S L r1na T U '`l 6
Septic Tank or Cesspool V
(��,QQ
Brief Description of Proposed Consltructigln r Alteration -1).: Pn c)1( 4'' C. `'l
ST r(Acta f e 0 dYh f/'�- w Le i 1 r` K
Location of Proposed Construction/Alteration:
Owner of Property: ci- d i/ce , -J Fo S S
Owner Mailing Address: ii( S6 . 1 /f i44Q v r
SauteSco nnet 1U Y47g'7 6
Owner Property Address: / 35 .4,'ko er-i-v 4 A a
S 0 0k M\C// "9' 71
Name and phone number of contact person 7 3 �` Z__-
Tax Map No;d} Section 7g--- C Block 7 Lot a 73
Cross Street IU CA'k f'4-, ci i
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH4DEPARTMENT PP OVAL
4:i. 62-4 i,et.,,,a - 6----y-)..-- sld 7
Signature of Applic Date
Received b t ,, _,., , a
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SURVEY OF
GUARANTEES THE INDICATED HERE WHOMT E SURUN
VEY
DESCRIBED PROPERTY
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED,AND ON HIS BEHALF TO THE •
TITLE COMPANY,GOVERNMENTAL AGENCY,
LENDING INSTITUTION,IF LISTED HEREON,AND SITUATE
GO THEGUARANTEES
LENDING INSTITUTION.
SOUTHOLD, TOWN OF SOUTHOLD
GUARANTEES ARE NOT TRANSFERABLE TO
ADDMONAL INSTITUTIONS OR SUBSEQUENT OWNERS. f
SUFFOLK COUNTY, N.Y.
UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY ISA VIOLATION OF SECTION 7209 OF
THE NEW YORK STATE EDUCATION LAW.
COPIES OFTHIS SURVEY MAPNOT BEARING WITHIN 750. OF PROPERTY UNE , SURVEYED FOR: EDWIN T. FOSS
THE LAND SURVEYORS EMBOSSED SEAL SHALL NO WELL OR CESSPOOL a_ LILLIAN tI. FOSS
COPT BE CONSIDERED TQBEAVALID TRUE 149.66'. c TM 1000-078-09-075
NSF GUILD Y. (RESIDENCE) �\WON
# GUARANTEED TO:
\
STOCKADE FENCE NORTH OF P••PERTY LINE 'm
r v M ELEVATIONS TAKEN FROM EDWIN T. FOSS
1S'1p"E WELL
o EAST END TOPO MAPS AS LILLIAN J. FOSS
S 7Z• (TO BE DISCONNECTED) \
FILED IN THE SUFFOLK COUNTY
EXISTING SANITARY THIS DEPT. OF PUBLIC WORKS.
FroU�\ AREA, TO BE, PUMPEDABANDONED i., • '�r a •
120' TO WELL FOR SCDHS USE ONLY
om .o c
AND BACKFILLED WITH '° METAL RESIDENCE ON
CLEAN MATERIAL \ TEST HOLE BY
. Ro fie/ _ BLOCK FOUNDATION 1
cm WasmucTa 1
MCDONALD GEOSCIENCE
lo
ON 26 NOV 04
..i\r
/ al • EXISTING GROUND
o —
o.o' __ __ I I 0
1 vrtobusr�Dem 5.6' DARK BROWN LOAM OL
,(\ I
BROWNSILTSILT ML
bmi2.
m ' • z Q
M PROPOSED 6.2' v)
>. P000*5. rsoroscnefloeosEo . 0 sr
D LEACH/NGSEPTIC N9( I O 0
a " ° POOL RESIDE CE W
�• M z
O PROPOSED 4 BE Y V-
o . I BROWN SILTYSAND "�
4 I IX
~ �I�\ « �"^ L SM U) 2 !4.,
N
s.
0
o g — I. a 1= N7.
ir V 'l11 FLEI
—
z W W 1–. O 0 A
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8 F .– 34'TO W �1., Q
Cr) b ..
1 K N CESSPOOL Hcr ZSECUO.
CC
ow Q Q
0 "`EXCVM1' t1 -_ 4$,66 re '~ PALE BROWN FINE Ll. W = ��..
_ EXISTING o+ TO MEDIUM SAND SP z 'Q J V� _ (a
' N 68'27 1 O O WATER METER £, C(00La
-
�50' (NO SERVICE) F3rAT0 0 O Z /
00< 0 IJ. U) !y M
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3 O W ce
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4 D. W O LL'
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h
SURVEYED: 22 NOVEMBER 2004
17'
—
SCALE 1"= 30'
AREA = 16,908 S.F.
OR
0.388 ACRES
•
SURVEYED BY
STANLEY J. ISAKSEN, JR.
P.O. BOX 294
S .,E d bZ (13s S��
hJo NEW SUF-OLK. N.Y. 1 195.
631 -73' —5835 ,!
�1
i,ilf
3 '-''''''.1%1-1.)1.j
r!Ir ‘1-71j ! 'Y .. 1/ i �-
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4 V Sr—,
u'_:J,'�I �" �'" ENS> • LA D SU'/ YOR
1 AUGUST 05 SHOW WEI I. DISCONNECTED, PROP. WATER LINE SERVICE, EXISTING STR 10 BE DEM. NYS L i c. N o. 4927- 4 R 13 Fj 7