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ELIZABETH A.NEVILLE,MMC ��•"��� �4 Town Hall,53095 Main Road
TOWN CLERK ;'
' �' ��'�. P.O.Box 1179
H Southold,New York 11971
PPR
REGISTRAR OF VITAL STATISTICS ® v 414.e Fax(631)765-6145
MARRIAGE OFFICER ' a ,
RECORDS MANAGEMENT OFFICER =-°7Q1 %roil Telephone(631) nny.gov
�• www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D ECEDVE 1-5\
TO: Southold Town Building Department — APR 1 5 2016
FROM: Sabrina Born, Southold Town Clerk's Office
BUILDING DEPT.
DATED: April 15, 2016 TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4380 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mike Cioffi for Young-Ja Park
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: Final approval required from the Suffolk County Health Department.
4 .07/:
Signature
Dated
-' ELIZABETH A.NEVILLE . 1 V ..
Town Hall, 53096 Main Row
TOWN CLERK , y, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % %• rrr Southold, New York 11971
MARRIAGE OFFICER :‘.\.-V60
c _/0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;,-V Vol Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER - - Alp i'�,�' southoldtown.northfork.net
.....-'
•
OFFICE OF THE TOWN CLERK
1 TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION •
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential®$25 Application No. Li S U 0
Permit No.
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. Applicant Name k 'te, 0c)
5 . .
Applicant Mailing Address 4 7 ( , A
Septic Tank V or Cesspool •
{ Brief Description of Proposed Construction or Alteration I d• ‘.42/-7 %hale
Location of Proposed Construction/Alteration:
Owner of e Pro SI cirL
Property: 4
-
6
Owner Mailing Address: 35 9 3 cz y l -+•AL ' 0Lf1,0k., •
•
•
Owner Property Address: '5 5 q,c (, ,,LIi‘cgc4, (R-r4f4:4,,(`
Name and phone number of contact person
. Tax Map No: Section 103 Block Lot -1...e4-( •
Cross Street c$ i-d f ,_ •
NOTE: LOCATION MAP MUST.BE SUBMITTED WITH APPLICATION. NEW
• ' CONSTRUCTION REQUIRES SURVI+ ' : . • ' DEPARTMENT APPROVAL
:1 • /i ,
. /' Signa , - 6 App 'cant Date
• Received by: / �� •
•
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S.C.T.M. NO. DISTRICT: 1000 SECTION: 108 BLOCK: 4 LOT(S): Z21 ,
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES l
PERMIT FOR APPROVAL OF CONSTRUCTION -
SINGLE FAMILY RESIDENCE ONLY
1 DATE _Eg 1 0 2016
1 ?�� VACANT - R1CUliURAL—ow--
150' U.P.
1 H.S. REF. No. I ' �d- 0 0 t i .
I
APPROVED ,.--•?----L `
_.._.._.._.._.._.._.._.._.._.._..r.._.._.._.._. WATER MAIN
FOR MAXIMUM OF_ BEDROOMS
ELIJAH' S LANE CL 42.6
EXPIRES THREE YEARS FROM DATE OF APPROVA
__ •j
43'5-"-'' _ S38"38'50"E j 151.02' MON.
4.I V" By) — --
[L�i� MON. • EL 42.0 VI
1%4/ . iNS1
/ I �+
EL 42.2
CL 41.8
O
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IN Ww
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Co
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cv LOT 18 I
EL 41.8 1
j LOT 17
tn m I 3-4 BEDROOM
VACANT u j SYSTEM DWELLING
�- 150' 1 1,000 GAL. TANK W/PUBLIC WATER
�L{ Z 1 (1) 8'DIAx 12'DEEP POOL 150'--
a U I ci
���ppp��� \ I
1 _ 1_.
/ < \\'-: EL(41.5) EL(41.5) 0 MIN I
258'
50.0' 1 I GARAG EL 41.3
131 I 0 • ;,1 GF(42.0)
0 " 10'MIN
0 I • N PROPOSED n
d, 1 & I 2 STY FRM.:
I DWELLING
ELEV. 47.3 ' 1 I 21.2' 8.6'I 1ST: 1,882 S.F.
o 12ND: 930 S.F.
OL DR BROWN 1 0' CL 41.7 tC) I�
SANDY LOAM et' I GARAGE FFL(44.0) CA
— Z I10 GF(42.0)
vi 19.0' 30.0'
BROWN I N o 01
SM LOAMY SAND 2.0' -.I , C�
RESERVED AREA FOR 01 365'0 _ _ II
POSSIBLE FUTURE1 EL(41.5) EL(41.5) "
HIGHWAY DEDICATION. o 1 ,.,
SC CLAYEY (AS SHOWN ON FILED MAP) I
7.5'N
SAND 3.8' I ,,,
,,,
.,
—
I d LAWN "l
10.2' 1 to
ENCROACHMENT ;'
PALE I
BROWN I
MEDIUM I '
SP TO
COARSE EL 41.3 I - EL 40.4
SAND — — - -
NO WATER N38°14'50"W 155.87'
— 1 7' MAP OF ELIJAH'S LANE ESTATES SEC. 3
DEC. 5,C 2015L JAN
1z,e VACANT FILED OCT. 8 1996 #9913
K. WOYCHUK LS J�1V 1 3 2J ik?,
't THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL
SHOWN AREIELD
ZONED R-40 ANDATIONS OR DATA OBTAINEDFROM FROMFSOTHERSERVATIONS
AREA: 41,601. 19 SQ.FT. or 0.96 ACRES ELEVATION DATUM: NAVD88
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: LOT 18 CERTIFIED TO: WAYNE GOLDBERG;
MAP OF: ELIJAH'S LANE ESTATES, SEC. 1
FILED: FEB. 14, 1974 No.6065
SITUATED AT: MATTITUCK
TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
47frfq 4110Cie P.O. Box 153 Aquebogue, New York 11931
• FILE # -220 SCALE: 1 "=30' DATE: DEC. 1, 2015 PHONE (631)298-1588 FAX (631) 29 -1598
N.Y.S. NO. 050882 maintaining the records of Robert .1. Hennessy & Ke ' M. Woychuk