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Home My WebLink AboutJacques, Peter SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4023 N Residential Non-Residential X Fee $ 25.00 Septic X Cesspool PERMIT ISSUED TO: Name : MARINA RECINOS-PRESIDENT Address 1: 316 FRONT STREET City St Zip GREENPORT NY 11944 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 #C10-11-0003 FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT. Name Of Owner PETER J. JACQUES Mailing Address 1 11185 MAIN BAYVIEW AVE City St Zip SOUTHOLD NY 11971 Property Address 1 13000 MAIN ROAD City St Zip MATTITUCK NY 11952 Tax Map No. section 114.00 block 11 lot 12.000 Cross Street REEVE AVENUE Building Permit Number Cross Reference: Issue Date: 2/03/12 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) /'g_pF SOUIy- ELIZABETH A. NEVILLE,RMC, CMC ,o I'`'l O4 : Town Hall, 53095 Main Road TOWN CLERK 111 4 , P.O. Box 1179 cn Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ; G ,� MARRIAGE OFFICER ,O /� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ,M ,`(_,a �I Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ` =yCOUN 1►," I ' southoldtown.northfork.net • i�� ,' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: July 13, 2011 Transmitted herewith is a copy of application No. 4023 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Marina Recinos for Peter J Jacuuest 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 me. T . • you 4 Carol Hy. - 1 * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water Bodies. EXCAVATION INSPECTION RE•UIRED. .., . , '_ ri..-e-r ."--0-..- V--e_.. Ze- w-- 1 •Zwr7- /-4.-664 Signature �` "--‘1 C9)---AV/2., Dated Page 1 of 1 Robert Barratt From: "Rudder, Lynda" <lynda.rudder@town.southold.ny.us> To: <robertbarratt@optonline.net> Sent: Wednesday,July 06,2011 12:20 PM Subject: Construction Permit application.doc SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK ❑ Residential @$10 or Ig(1)11-Residential @$25 Septic Tank or Cesspool ❑ Application No. 1 Permit No. Applicant Name: M ArLttt) RrC INO$— PQESI D£NT- l..A Q L* PJ J 1 Ra STAU a AN i INC. Applicant Mailing Address: al. 512.o N T S T , C,a e E N PO RX N y t 1 4¢4 Brief description of Proposed Construction or Alteration: ADD CoLEME. ?ItiAP AMID ASSOCtATF D PiviN ` To E%IS?INCL PTI C.. %%( Si M . Location of Proposed Construction/Alteration: Owner of Property: PETS S. ZA C et.U ES — t 3000 !i At N LI.,C. Owner Mailing Address: I I I g S fr1 A i NI FS AN t ECJ 4.0 AD So , , 'y 11 9'? ( Property Address: 13000 NIA;N1 2.o A A , M AT T t'COCK- , 1V`( t 1 9'i ( Name and Telephone No. of Contact Person: S 44- U I Li.Ertz`'M-- (031- 4 t 4—Q7 C7 kg5 Tax Map No.: l l oo Section: 114. Block: 11 Lot: 1'Z. 3q7-157 Nearest Cross Street: REE,V t AV 1 MATT 1 T V Cie, 1"21tYo cs E,AS i -- 94q O NOTE:LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL. 1� 0 .2_O l 1 Signature of Applicant Date Received by: Ia,TTACti4E D tt C1+GGt� troy *?S PA,{ACal.tz "Co "'TovoN1 OI= Sc:, "1-14.z. 7/7/20.11 COUNTY OF SUFFOLK v t! STEVE LEVY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES JAMES L.TOMARKEN,MD MSW,MPH,MBA,FRCPC,FACP COMMISSIONER PERMIT CONDITIONS Health Services Reference# C(c /1 ciovI Project Name Lt G,„ IArl(ci V, The attached plan, when duly signed by a representative of the department, in conjunction with these conditions, constitutes a permit to construct a water supply and/or a sewage disposal or collection system for the property as depicted. The applicant should take note of any conditions of approval, which may be indicated on the plan or enclosed herein. Construction must conform with applicable standards including "Standards for Approval of Plans and Construction for Sewage Disposal Systems for Other than Single Family Residences." Omissions, inconsistencies or lack of detail on the plan do not release the applicant from the responsibility of having the construction done in conformance with applicable standards. Issuance of this permit shall in no way relieve the design professional of responsibility for the adequacy of the complete design. The permit (plan) expires three (3) years after the approval date. Any modification which may affect the proposed sewage disposal or water supply systems requires submission of a revised plan and additional fees (if applicable) for reapproval prior to construction. No inspections will be performed by the department on expired permits. Permits may be renewed, extended, transferred, or revised in accordance with the procedures described in Instructions to Renew, Extend, or Transfer an Existing Permit for Other than Single Family Residences (Form WWM-081). It is the applicant's responsibility to call the department in advance to arrange inspections of the sewage disposal and/or water supply facilities prior to backfilling. These include inspections of the sewage collection and disposal systems, water supply system components and piping, and final grading as shown on the approved plans. In certain cases, inspections of the soil excavation may be required to determine the acceptability of the soils for sewage disposal systems. The department must be notified at least 48 hours in advance to schedule an inspection by calling 852-5754; and excavation inspections must also be confirmed by calling 852-5700 prior to 9:30 a.m., the morning of the inspection. Article VII of the Suffolk County Code, "Septic Industry Businesses," requires that all installers of septic systems within Suffolk County shall possess a valid license from the Suffolk County Office of Consumer Affairs. This office can refuse to perform inspections or grant final approval for the construction of projects that are installed by an unlicensed individual. It is, therefore, in your best interest to utilize a cesspool contractor with a valid license to avoid substantial delays in your project. Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to existing buildings, or for the use of sewage disposal or water supply systems. SEE PAGE 2 WWM-016 (Rev. 10/02/06) Page 1 of 2 HD Rem No. C(V ll-ovo3 Project Name 4 6' e (VZ4 /2e. CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT As a condition of this permit to construct, the following items must be completed as a minimum, prior to building occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Other Than Single Family Residences (Form WWM-19). ❑ Excavation Inspection by the Office of Wastewater Management prior to installation of any leaching pools to determine acceptability of soils. (Call 852-5754 to schedule an inspection and confirm by calling 852-5700 prior to 9:30 a.m., the morning of the inspection.) ;g:Satisfactory inspection by Office of Wastewater Management of the sewage disposal system/ sewage treatment system. (Call 852-5754 to schedule an inspection.) ❑ Satisfactory inspection of the water supply system by: ❑ Office of Wastewater Management(Call 852-5754 to schedule an inspection.) ❑ Office of Water Resources, Water Quality Unit(Call 852-5810 for inspection.) ❑` Satisfactory inspection by the Office of Pollution Control (Call 854-2502 for inspection.) ❑ Storage tanks ❑ Other: ot_Pplication for a Food Permit to the Food Control Unit(Call 852-5873 for instructions.) ,Four(4)prints of an As-Built plan ❑ "Tap letter from water district Certification from the licensed sewage disposal system installer Q'-"S 9form"from SffolkCounty Department of Public Works(SCDPW) n qerdistrict,app' val of sewer line installation(for other than SCDPW districts) ❑ Well drillers certificate ❑ Water analysis ❑ Certification of Sewage Disposal System Abandonment(form WWM-080) ❑ DesignProfessionals certification of Constructed Works (form WWM-073, enclosed) for: O Sewer lines and sewage collection system ❑, Retaining walls (approved as part of the sewage disposal system) ❑ Sewage pump station/valve chamber ❑ Sub-surface sewage disposal system ❑ Sewage treatment plant .;dater supply,system. ❑ Abandonment of Preexisting sewage disposal system and/or water supply ❑ Other: ❑ Other: WWM-016 (Rev. 10/02/06) • Page 2.of 2 ii 11I • pg � I I `C P n 11, a �$ ; y ° °" • • 1 :+ _Hy sem,Ws zs IAA Rom z G. I • ML-Ap••aUte f Ab i dated Y-r (,� 4$ o S Public Wl$0 Vault v- fMiT*•.. • • 1 S N 1s�al'01:11. E i A M . St aw tit`U1 r \ , / vic ;i 0 � � 1 l going'IN C., . M p pyNMAM Spaces Spac0 i W Gws • Includes 1 Msd spice ! r ' - A \oro ' ' SCTW31000-11411-12 t > } '1 e �^\ 2 I Ana:11,11.57 so RroA66dues) County Water Authority 'I. ( Watsr service:tomrctnd m SuRoa \ ' ' Wetlands:Nola within 1008 W premises elevation 20 R dna is shwa Rood coma R ` a V ExYaMq sewage system:Approved through C10-00-0005 Vanawa Raid 10127/00 j `` µ b N I Calm of York.SWmR ComNy Health Dept.Southold Town \ [ a*qr cervica rsstnnlrrlt permitted \ 1( GiMknO HNyIIt Aa OWaNga an Wean eklgb stprY 1siIsar' ' Mahn w bounds;See spacial nobs \ •_ _ _. _ I [**ding r: Exbtkq Prop0.d 011d9q R 17Pd gpd _ J O P ed b0dlaa Mina Amlquelay emn 1213 12e 0.03 13 3 = J.`I C \ vaarf �r+6 G�11.11.1. I Ski Sar*ery flow 884 0.03 26 }}} `� 3 7 Kitchen flow - 699 x 0.12 _ 101 .. J w w \ M Z u P w 7 k.r c rc.. .-I 6 \ Fitness studio(no showers) 067 667 0.10 06 M - 7 ' a s E,_ 1T-- 8WMtn0It 0 sJ • ' I Ofilm Imo 450 491006 cess sIy z "_ M w s ` PTepeaa/paws trap Smrspadlrustrial ) 732 a1 0.03 15 a A _• 0 eels caw.- ._6 * N N u3 \ a.. I Total:• 7170pR 3176 so ft - 161 104 W141 3 a \ \ I Site*amity analysis: • CL(Wit' / "Td.9•Modic carne N \ IAllowabh eve tinnily(600gpd x 0.455) 277gPd • At / Ac 'L'Gm. Actual total hydraulic flow(169.104) 27 j / Read ST capacity(2:2771 5 6 galla S: Existing ST capacity 1200 galesRend GT capacity(2 x 104) 200 yaks {'rt ISTIMG0 1" 't Ex.arlNa SFPTIG TO u LI- LP Proposed dram trap capacity capacity 1500 gaily CESS POOL. ni I 0 -i.e.-T Ho L.E-In 1z / /P Required LP capacity �pf so ft J /to sl.n c.e.RC) i d d / CE7 12 and meters x-06-00is 05 documented in W c W T Exirdng grads at building 20.70 R Z i Kitchen ane outlet EI M budding 1637 R M GT inlet El 17.22 R 9 u ` RLS 1. 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