HomeMy WebLinkAboutReinertsen, John SCUTHCLD WSTEWTER CI SPOSAL PERM T
OCNSTRUCTI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPOOL
Per ni t No. 4143 R Resi dent i al X WI-Fbsi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSL ED TO
Nave : J CI-N REI NERTSEN
Address 1: 1227 84TH STREET
City St Zip ERD<LYN NY 11228
Dascr i pt on of Proposed Const r uct i on or AJ t er at i on
SAN TARP SYSTEM FCR SI NCiE FAM LY UI'ELLI NG
APPROJED AS SWM TIED AND AS APPRCtiED BY THE SU=FCLK COUNTY CEPARTWENT
CF I-EALTH SERVICES. Fl NAL APPRO✓AL FEW RED FR1CM TI-E SUFFOLK COUNTY
I-EALTH CEPARTNENr. FEF #R10- 13-0047
Name a Qnner J J-N REI NERTSEN
Nbi I i ng Address 1 1227 84TH STREET
Qty St Zip BROOKLYN NY 0000
Property Address 1 590 ARRCVEAD LADE
City St Zip PECCN C NY 11958
Tax Mira No. sect i on 98. 00 bI ock 2 I of 4. 001
Cross Street I ND AN NECK LADE
Bui I di ng Per m t Nanber Cr oss Fief er ence:
I ssue Dat e: 4/ 14/ 14 EI i zabet h A Nevi I I e
Sout hold Tow CI er k
��,/ofOFFO(,rc
ELIZABETH A.NEVILLE,MMC ill Town Hall,53095 Main Road
TOWN CLERK C I P.O.Box 1179
t cn = Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % `" ivy �t
O *` 1 Fax(631)765-6145
MARRIAGE OFFICER `.tip t).of Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ell 1ailli „.. www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER ---. ...,.00
OFFICE OF THE TOWN CLERK I _ i `-','1 ,',
TOWN OF SOUTHOLD , ��
1 JUL 17 2013 ;'
1-U J
TO: Southold Town Building Department
____J
FROM: Carol Hydell, Southold Town Clerk's Office E. 'T.
DATED: July 16, 2013
Transmitted herewith is a copy of application No. 4143 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
John Reinertsen
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. \72'...4-1,-. 4e7re.,4--m-..--t0
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27.4.4_,.....24
Signature
C.,40(../...3'
Dated
N
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
i
CESSPOOL or SEPTIC TANK
sidential @ $10 or ❑ Non-Residential @ $25 Septic Tank ❑or Cesspool ❑
Application No. Permit No. W 1 9 3
Applicant Name: TS; r\0 e ( n e r'k
Applicant Mailing Address: 1 c),A1_ g I ST 6 afl) ( k,1 N y
to__2_.?
Brief description of Propsed Construction or Alteration: 4,,t A\ ,i 1(1-.1 rtp
Location of Proposed Construction/Alteration:
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Owner of Property: • . i I - (C.*
Owner Mailing Address: 1.- - ), Cr * <
t (i)3 -A,1 vt, /Q q ,
Property Address: cg o Ayw head bane
1eCv n ( c (Iv
Name and Telephone No. of Contact Person: f 2 71 6`)
Tax Map No.: Section: ) 9 Block: 0 Lot: 11. I
Nearest Cross Street: ) Vt Ck 1 Cr✓1 ge G i -. e-o
NOTE: LOCATION MAP MUST BE SUBMITTED WITH ..'PLICATION. NEW
CONSTRUCTION REQUIRES SUR WITH HEALT ' I PARTMENT APPROVAL.
4411111_,„,4
-70 (.3
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Si..�: 't e of Appli'. ate
Received by:
t
I" AJ(,) V l wt co.-.
LOT NUMBERS REFER TO 'MAP OF ARROWHEAD COVE' SURVEY OF PROPERTY
AT PECONIC
FILED IN THE SUFFOLK COUNTY CLERK'S ❑FFICE ❑N
JUNE 20, 1963 AS MAP N❑, 3810.
RECEIVED TOWN OF SOUTHOLD
JUL i 0 2013ERVICES SUFFOLK COUNTY, NEW YO
SUFF.CO,HEALTH S1000-98-0203 & 04
OFFICE OF WASTEWATER MGT. - SCALE: 1-=50
MARCH 1, 2000
JUNE 28, 2006
Sept 2,6) 2004.Voie"--ver cf e)
ir ROAD Feb 22, 'Zoo'7(Waf.r /,q G)
IND NE c o
W m
CO w u,
O
VACANT C
Q .c
n
LOT 39 � �
I SUFFOLK COUNTY DEPART
\t
124,14 (map) PERMIT FOR APPROVAL ,MENT QEALT SERVICES
N 88'42'20' E 124.09' (actuat) er 3 er
25.z• � 4q.i t�vl�iYS�(»R�
N u, 2r 2G N
�q FE fest
Ap,,pps7vico
z 10.3E LOT 38 bnr'73 t)1 40, d 41
.P DATE �� K S.
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a o \ APPRQVl;D ., ,P�
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z 4 T01 , IMUM BEDR MS ��
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f": h WaterLtBe Ins ec
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N rys o Suffolk County De P ted Eiy The
a a 1 y ar Q Call 852-5700, 48tHof feaf.h Services.
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. a ° _ P�'_P_ .�- 31?),..
5 To Schedule!ns eC in'�dvance,
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CERTIFIED TO'
P JOHN RE7NERTSEN
`t ANGELA REINERTSEN
N� 1. Z4��, r�
ep 2s . 24.c k'
F 88'42'20' W 134.93' (actuat)
FE 135as'a\ .00' (map) +1
• LOT 36
Lo/ Covera-e
(dwelling) L
WATER METER
hse 3500 #
ELEVATIONS ARE REFERENCED Poo/ goo g.-f.
TO AN ASSUMED DATUM.
ccbaoa, 50o S.f•
G ''ve. /5 8o s,f',
AREA= 41,815 S.F. owet' Co/Sas•-14.15/$S.f. =/4:8 0w
C,P.s /50'-t
TEST HOLE DATA i
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE Dark brown silty loam DL
DISPOSAL SYSTEMS FOR SINGLE FAMILYRESIDENCES 1.5'
i
and will abide by the conditions set !forth therein and Brown loamy sand SM
on the permit to construct. I. , 3'
43,5 I •Qk.ce,OF NEI
The location of wells and cesspools shown hereon are 5 "t. MEr 0
from field observations and or data' obtained from others. Pate Brown fine to coarse nd �'c '�f-
'^-
/ / 7. Nit_.riT " ' NHIk, C
.41 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION 'ECONIC SU" hZ `. liff
.1
OF SECTION 7209 OF THE NEV YORK STATE EDUCATION LAW. �' 1
(631) 765 - .r•-.� � ,�X: .�) 7t
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS ' 4'••
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P. D. BOX 909 �®
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER •- ;•pv
WHOSE SIGNATURE APPEARS HEREON. 17' SOUTHOLD, N.Y. 11971 ,00
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