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SCUTHCLD \t#STEVIATER DI SPCGAL PERM T
OCNSTRLICII CN CR ALTERATI CN PERM T
SEPTI C TAMC or CESSPOOL
Per m t Nb. 4203 R Resi dent i al X Nbn-Fesi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSLED TO
Narre : MARK RAJ SCH
Address 1: P O BOC 909
aty St Zip SCUTHOLD NY 11971
Descr i pt on of Pr oposed Const r uct i on or AI t er at i on
SAN TARP SYSTEM FCR SI N LE FAM LY DV'ELLI NG
APPRDIED AS SLEM TIED AND AS APPROJED BY Tl-E SLFFCLK OCLNrY DEPARTMENT
CF FEALTH SERA CES. Fl NAL APPROJAL RECLI FED FROM THE SUFFOLK COUNTY
I- ALTH DEPARTMENT. REF #R10- 13-0003
Narre Cf Omer NARK BAI SF+LANCM C PFEPERTI ES
Mai I i ng Address 1 475 ROUTE 25A
Qty St Zip ROCKY pa NT NY 11778
Property Address 1 1835 REM ROAD
Q t y St Zi p NATTI TUCK NY 11952
Tax M3p ND. section 100. 00 bl ock 3 I of 10. 004
Cr oss Street HAS EVVAVEN E
Bui I di ng Per ni t Nurrber Q-oss Ref er ence:
I ssue L1at e: 4/07/ 14 D i zabet h A Nevi I I e
Sout hold Town a er k
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ELIZABETH A. NEVILLE,MMC 44 Gy = Town Hall,53095 Main Road
TOWN CLERK % ! P.O.Box 1179
t y Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS k uses 4. Fax(631)765-6145
MARRIAGE OFFICER
44,_
INFORMATION f' ,k0. 1Telephone(631)765-1800
RECORDS MANAGEMENT
O'* a" www•southoldtownny.gov
FREE OOFICER ., '
OFFICE OF THE TOWN CLERK - - —_
TOWN OF SOUTHOLD +'.r-, �� 1
I`` ,'J.I�'`. MAR 1 2 2013 !' .1
TO: Southold Town Building Department 1 I �-,/
FROM: Carol Hydell, Southold Town Clerk's Office L`- t r
DATED: March 11, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4203 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mark Baisch .
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
,......ybf, _ 2,11 ,.,// _
Signature
03 %3
Dated
A „
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• ,,.,,o�Og�FfO�,�coG
ELIZABETH A.NEVILLE il p V Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
� yy. �at � Southold, New York 11971
MARRIAGE OFFICER . G 4 11 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,'
**e a0'0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =_'� 0,.�•• 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 Y or Non-Residential @ $25 Application No. t-{ 2-03
Permit No.
Applicant Name r Bcti s
Applicant Mailing AddressD e BOX (It , -)L1 toy I lq--71
Septic Tankx or Cesspool K
Brief Description of Proposed Construction o %/1 y
Alteration .' _ y, aI4 i
l s�11 c T mi -- I tiaLCh (AO
Location of Proposed Construction/ teration:
i / 47) i
Owner of Property: pi o� (` ( i ,/ )[lAper(he .j
Owner Mailing Address: to _-4- a -A
,Pi /-27 - ,vyJ/2' ?&
Owner Property Address: pee Oe Kd
oVary(76/-mck- iuy //79 .
Name and phone number of contact person 7(15--50026 /7
Tax Map Par
No: Section G ) Block 6 3 Lot 6 o -
Cross StreetEoni ite,k)
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVilY/ i WITH HE TH DEPARTMENT PR VAL
.47//11.4/ ' " //4 3 i/
ignature of Applicant Date
Received by:
EXIST.
WELL ( ) l
N a� �'#16 REEVE FARM UPS
ROAD
E 110.27 EP 110.15 EP 109.85 EP 109.5109.42
(50' WIDE)
C 110.42 CL 110.03 CL 109.67 CL 109.52
W w W w w w
EP 110.35 EP 110.03 (109.92) EP 109.73 EP 109.61 EP 109.12 I
( oZ
i S 1523'30" E 156.00' LL.z 0
�- w z 'l (109.9) •
I 175.00' ONN
moo )
> \ 2 --
73 0
tto 0
CL o: vi
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a / �-- I _noftn
/ UNDERGROUND DOG FNC.-wcd h� `ocdD1O 0.
�'('� SYST. (108.4) EXP. L.P. t F" rJ ci a I'
0 • 108.0 "• i
No. 2 z to IA-
/ 0 a% 11 .. --�'-1' + , s4. in O I
- - - - - � 50.0'1 (108.9) r r : a ) ! I
PORCH c� a `?
(108.1) R.O. PROP t..1 -
tii
w rn S.T o �' ire ? -' \% r
C o 0 0 • ( 8.5) -z, I 149�J j i /-�� C3 0
:
1 /
C 0 w w ao 56.33' OA. (1oh6' -', rr--o J PROPOSED oto f'"/a ait o DWELLING z ro / n. t& I
�+ 4L .
0 0 c EL.108.3 O II r
-/ -Or
IA_ F.F. EL. 110.7) j 1l t Z a .^
G.F. EL. 1109.0) I-0 1 = O T'
z -108- - - - - U ti .i '" cr) T.H.
Q •ORCH R.O. (107. �t 'o M
TOPSOIL b J d c + I ; Q.
Ki (1 .9) a: La
\ � /1.C) (1 7 4) Y! E1 At
/ • (107.9) �, .,.. -- - '
R
Z CD o---1
SAND z w
i� _ �rn
GRAVELiri
-0 (106.3) 0(106.8) 0_1
w
$ ST. No. 1 w M:
/ W. EL.(106.0)�,os
M
/ \\ Nt
N
---- - co. , `rl LOT No. 4 / 'JNDERG^OUND It
TESTHOLE #1 AS SHOWN o N� DOG FENCE ',
ON MAP OF INLET EAST 40'092
�`' FND.
ESTATES -' co \
III
- MON. ) f"
'
LOT No. 5 J
/
CERTIFIED T0: (DWELL) •
w J
LANDMARK PROPERTIES OF SUFFOLK, LTD. `�7 �t , •-.44-i-4rri ..,,�. :....-.; 1
CHICAGO TITLE INSURANCE.COMI ;QNY !rteBy, TH. t , �} r`''r�`' _-r �-,.
FNC. ;:
I v, w 0.3N N
1 ,: FNC.
N. 1.2N kw 4' CHAIN LIN , ENCE EL.106.9 o o
r
x x
THE EXISTENCE pr. RIGHY'1`-• WAY 0.3E1 Li w z N 15'2330 W ' � 156.00' d 3 z Z z
AND/OR EAS E'&2RERECORD IF cv zoo LOT No. 5 o a w
ANY, NOT SHOWN ARE NOT L?x (DWELL.) / J LOT No. 7 1
._, d
GUARANTEED. (DWELL.) f;
UNAUTHORIZED AL TERA TION OR ADDITION '61 ,10 4----...
TO THIS SURVEY IS A VIOLA770N OF NOTES 1:;
SECTION 7209 OF THE NEW YORK STATE ELEVATIONS SHOWN ARE
EDUCATION LAW. IN ASSUMED DATUM
COPIES OF THIS SURVEY MAP NOT BEAR/NG ALL SURROUNDING PROPERTIES WITHIN 150' OF PROPOSED SANITARY
THE LAND SURVEYORS INKED SEAL OR SYSTEM ARE CONNECTED TO PUBLIC WATER SUPPLY EXCEPT AS SHOWN
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY. DRAINAGE CALCULATIONS:
GUARANTEES INDICATED HEREON SHALL RUN
SYSTEM No. 1
FT.
ONLY TO THE PERSON FOR WHOM THE SURVEY ROOF AREA = 2591, S.F. x 2/12x2/12 x 1 x 1 = 432 CU.CU.
IS PREPARED, AND ON HIS BEHALF TO THE TOTALRASS AREA = 20,000 S.F. x x 15% = 500 FT.
TOTAL REQ. CAP. = 932 CU. FT.
TITLE COMPANY, GOVERNMENTAL AGENCY AND USE 1-10' DIA. 14 V.FT. = 958 CU. FT. ACT. CAP.
LENDING /NS77TUTION LISTED HEREON, AND SYSTEM No. 1
TO THE ASSIGNEES OF THE LENDING INSTI- DRIVEWAY AREA = 1200 S.F. x 2/12 x 100% = 200 CU. FT.
TU770N, GUARANTEES ARE NOT TRANSFERABLE. USE 1-8' DIA. 5 V.FT. = 211 CU. FT. ACT. CAP.
SURVEY OF: LOT No. 4
MAP OF INLET EAST ESTATE :D KENNETH H. BECKMAN, L.S.
(1 FILED MAY 1, 1975 FILE No. 6249 Surveying and Land Planning
SITUATED IN: MA TTI TUCK 1814 Middle Country Road
TOWN OF: SOUTHOLD Suite D
Ridge, N.Y. 11961
SUFFOLK COUNTY, NEW YORK ... (631) 345-9427
FAX (631) 345-9429
DATE: 8/1/2012 JOB NO. 812-14418 SCALE: 1" = 30'
DIST. SEC. BLK. LOT
S.C.T.M. NO. 1000 100 03 010.4 HR
REV. DWELLING 12/17/2012 B12-14711
REV. 9/10/2012
4.