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HomeMy WebLinkAboutAmos, David • • SOUTHOLD WASTEWA'1'EK DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4308 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : MARJA AMOS Address 1: 15900 MAIN ROAD City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM APPROVED AS SUBMIT'. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner DAVID & MARJA AMOS Mailing Address 1 15900 MAIN ROAD City St Zip MATTITUCK NY 11952 Property Address 1 15900 MAIN ROAD City St Zip MATTITUCK NY 11952 Tax Map No. section 115.00 block 3 lot 1.003 Cross Street MILL LANE Building Permit Number Cross Reference: Issue Date: 4/24/15 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) . ,• 0�1FF0[i-�, ELIZABETH A. NEVILLE,MMC '����' �4 L Town Hall,53095 Main Road TOWN CLERK e 3 at '1P.O. Box 1179 Z ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax Fax(631)765-6145 MARRIAGE OFFICER y �' �� RECORDS MANAGEMENT OFFICER =_- * ' .' Telephone(631) nny.gov ._.,,,"'I",�����•� www , :—,-f .southoldtownny.gov FREEDOM OF INFORMATION OFFICER ___.� , ., , , , OFFICE OF THE TOWN CLERK �`�",r-- __ TOWN OF SOUTHOLD I ImI APR 2 0 2015 , , °' 1 TO: Southold Town Building Department T_. i I FROM: Carol Hydell, Southold Town Clerk's Office DATED: April 20, 2015 Transmitted herewith is a copy of application No. 4308 for a Cesspool/Septic Tank ALTERATION Permit submitted by: David & Maria Amos 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. Thank you * * * * * * * * * * * * 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 REQUIRED. . RECEIVED - Signature -- 4 APR 2 3 2015 ,012.-2,- ,5"-- Dated Southold Town Clerk ELIZABETH A.NEVILLE,MMC , _Yy Town Hall,53095 Main Road TOWN CLERK ; P.O.Box 1179 4Southold,New York 11971 REGISTRAR OF VITAL STATISTICS �� Fax(631)765-6145 MARRIAGE OFFICER " s� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER - 1 �►a ,, .�' www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD April 24,2015 Marfa Amos 15900 Main Road Mattituck,NY 11952 RE: <SCTM» Dear Sir/Madam: • Enclosed herewith is the Construction,Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars,($10.00) for a residential system and twenty-five dollars ($25.00) for a non- residential,system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, 4UL ;it Sabrina Born Clerk Typist Enclosures 3 �,, S�FFO��- rr r�r o�p CD ELIZABETH A.NEVILLE $ �`Z` �y Town Hall, 53095 Main Road TOWN CLERK % p . � P.O. Box 1179 da Z i Southold New York 11971 REGISTRAR OF VITAL STATISTICS v. ht ' MARRIAGE OFFICER O •� �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ‘';yiif ��0 Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER =0'� ���a,'rr 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. i")30S Permit No. Applicant Name a fl1k. f Applicant Mailing Address 'sq n 1 i V \ Thftfrzk [ 2 Ica Septic Tank K or Cesspool ,� Brief Description of Proposed Construction or Alteration (JCM( -J')C ec 1St) M ( —. Location of Proposed Construction/Alteration: Owner of Property: [AC4 flf 0 t;riias Owner Mailing Address: �i� %ta I On ITO .)fl 'Pa r'dtt thx fy ! lea Owner Property Address: ''lnQ Name and phone number of contact person f da 0 0,5 l I 1 -A -703 Tax Map No: Section 1 I6 Block 3 Lot / 3 Cross Street 1�1 1 11 LCA Yom. NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL iij7 /Cei(e. ow e--//90/1,5-- 01,x � PP Signature og licant Date Received by: 1. NI)�� L/1 FJ) 4 Pods 779.07 y • tit 0 IS $.g'' �1�J e ,00E 33.00 ` y N 78 spm. �x 'cFO �C 0.1'S V.A. C '� 3DO T.fl 7cN �► ' ' r� 12 7 c C c) 11 66.3 7� ,Au .\. SPIE7 tzSC FOUND7 C 0.1 S C 0.1.E 77 C % 7 C 7 y C I 7 cA C \ . 7 b• C .1 7vaC UTIL. . 7 y C POLE 7 r C „ 0.9'W \ 7 a 7 C N/F TOWN OF SOUTHOLD 7 c I i 'Z` 7 d c Y+ 7 C I { CO 7 C J7 tg1 C 0 J J J C I CD 0JJJ 9 I rr ;ID. ,a4��'�'� .G etc 1 _ - r aCJJJ IC •Y JJ gr-ii" CrJ JJ I O J J J JJ C JJ J,J I _C 77 I CC f 77 IC 7_) I C 0WELL j7 I C 4.7E ,7 C 77 3 C 7 t., N/F TOWN OF SOUTHOLD 77 OII c= AO '-- C 0 OD !)) \ vitir2t-aqf:-'4-- tp- \ c! 24.5 .. r a, 0 01 00 L >> Sr F' "" G 12.0 U 2 w / C- Fes.. 1 Ora 511•m C 84.8' 12.0' D + sviti3OV p C in 69.4' • r , - J 00® mt.,. RA+"' C ). ---,I:04 ) 9°1( / A fir_ 4�, �m I( �_� 4-C �0�, I _C .�� "ilL"--------) . t n o C S 81°48'p0"� 105.07 �; .e) � r O -'- a C c 77 C - -,-, �--) C 7I C. 7 s k.- N/F TOWN OF SOUTHOLD •-. ( O� � ) 1 c 3g0 _ • pfd �� q? c8 c m �-)43 - B X91 ti �'.. 15 -,-, e 4 i:. 41ty- -)� .• w rr -,r rr rr AREA: 80,069 Sq. Ft. = 1.838 Ac. '-,--) �' �- rr rr\rr CLEARING AREA: 32,839 S.F. = 41.0% 6'2e ,�-,-, err('r pit r BRICK • SURVEY OF CERTIFIED TO: 0p�*BB r r w D 3 COMMONWEALTH LAND TITLE INSURANCE COMPANY DESCRIBED PROPERTY DAVID AMES & MARIA ALES (f/k/a MARIATORR°"' l S 88'55'00"W 79.37' PO LIL-5C -- 0.8'E SITUATE AT FILE NO. 50612 REVISIONS: Of NEN, MA TTI TUCK )0 TOWN OF SOUTHOLD �P SUFFOLK COUNTY, NEW YORK 4� ° SCALE: 1" = DATE: MAY 16, 2006 = •�!a�"` O N/F TOWN OF SOUTHOLD 30' n0+1 049281 S.C.-M. DIST. 1000 SEC. 115 BLK. 3 LOT 1.3 SFS LAND S EAsarovr✓'AAA,/QR SUBSURFACE STRLCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON flit PREMISES AT 771E TIME OF THE SURVEY. INOCAP:D HEREON SHALL RUN ONLY TO THE PERSOFOR WHOM PAT T. SECCAFI CO THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TIRE COMPANY. GOVERNMENTAL AGENCY AND LENDING INSTTRn7ONS USIED HEREON, AND 70 PE �THE LENDING RTRANSFERABLE �' A INSTITUTIONS SUBSEQUENT ) PROFESSIONAL LAN© SURVEYOR, P.C. SHOWN HEREON FROM 771E STRUCTURES 70 THE PROPERTY LINES ARE FOR A SPECW7C .URNS£AND USE AND THEREFORE ARE NOT INTENDED 70 GUIDE THE 107-5 W Montauk Highway 328A Main Street ERECTION OF FENCES, RETAINING MALLS„ POOLS, PATIOS PLANTING AREAS, ADDITIONS To SWINGS AND ANY OTHER CONS7RUCrpnL Hampton Bays, NY 11946 Center Moriches, NY 11934 ALL Loco roNs Or AND DISTANCES TO *ELLS AND Doors ARE BY LOCATIONS PHONE: (631) 728-5330 PHONE: (631) 878-0120 FROM HOMEOWNERS FIELD OBSERVATIONS AND/OR NORMADO" OMTA "ED FROM FAX: (631) 728-6707 FAX: (631) 878-7190 OTHERS. SINCE MOST ARE NOT VISIBLE THESE LOCATIONS AND DMtE? IONS CANNOT BE CERTIFER • UNAUTHORIZED ALTERATION OR ADDITION T THIS SURVEY IS A VIOLATION OF N.Y.S. LIC. NO. 049287 SECTION 7209 OF THE NEW YORK STATE EDUCATION LAWCOPIES OF IHS SURVEY MAP MIT BEA?thE THE LAND SUR'.)) RS SIGIW RARE AND RID INK OR EMBOSSED COPYRIGHT — 2006 PAT T. SECCAF/CO P.L.S., P.C. SEAL SHALL NOT BE CONSIDERED A TRUE VALID COPY. i;