HomeMy WebLinkAboutAndrade, Jeffrey e
SCUTHCLD VYsSTEW\TER D SPCC,AL PERM T
X STR..CTI CN CR ALTERATI CN PERM T
SEPTI C TAN< or CESSPOOL
Per m t Nb. 4149 R Resi dent i al X Pbn-Resi dent i al
Fee $ 10. 00 Sept i c X Cesspool
PERM T I SSLEO TO
Name : JEFFFEY APDRACE
Address 1: P O BCD( 3
a t y St Zip PEOCN C N' 11958
Ikscr i pt on of Pr oposed Const r uct i on or Al t er at i on
SAN TAR' SYSTEM FCR SI NC1E FAM LY DI'ELLI NG
APPROVED AS STEM TTED AND AS APPROIED BY THE SLFFCLK COUNTY DEPARTMENT
CF FEALTH SERA CES. Fl NAL APPROVAL FEW RED FRICM Tl-E SIFFCLK CaNTY
F EALTH DEPARTMENT. FEF #R10- 13-0035
Name a Dialer JEFFFEY APDRADE
Mai II ng Address 1 P 0 BO( 3
City St Zip PECCN C N' 11958
Property Address 1 43850 ROUTE 25
a t y St Zip PECCN C N' 11958
Tax Map Lb. sect i on 75. 00 bI ock 6 I of 4. 000
Cr oss Street V'ELLS R04D
Bui I di ng Per Tri t Number C0 oss Fef er ence:
Issue Date: 4/ 14/ 14 Elizabeth A IsbviIle
Sout hold Town a er k
��,�i�.
/��,,o��g11Ff0i�-co
ELIZABETH A. NEVILLE,MMC � � 4 Town Hall, 53095 Main Road
TOWN CLERK o= P.O. Box 1179
y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ��
Fax(631)765-6145
MARRIAGE OFFICER �'� O`. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �.( `t►� �� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER �,,,,,,�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department ` JUL 29 2013
t
FROM: Carol Hydell, Southold Town Clerk's Office �
1-4
DATED: July 29, 2013
1
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4149 for a Cesspool/Septic Tank Construction
Permit submitted by:
Pat Moore for Jeffrey Andrade
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
Signature
/ /
oe 3o /,..5
Dated
' /AP
ELIZABETH A. NEVILLE ��AP y�� Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
ai
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER : Oy � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER . �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '?O'� �a��� 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. _Li 1 9
Permit N/no.ce
Applicant Name �Fl- 4rIcL - `? 41`Y�t<<
A licant MailingAddress 0 4
Pp /� 0-/
Aiy /(7.5-a
Septic Tank or Cesspool ).c
Brie Description of Proposed Construction or A)teralion
a f 2 7rc/ •rC7 4 ' t // 71L-43 Jit(75-u 4.e 7 )4.9 S[;-pc.
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
850 cc
Owner Property Address: y �j ith �V
Pelf
Name and phone number of contact person
Tax Map No: Section 'S Block 0 Lot d ��
Cross Street L Q@,Q
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WI HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
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G\ EV
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N�5�� $ ' SURVEY OF PROPERTY
04.
g oik , 08 J TOWN OF SOUTHOLD
� ��� 5 �2' SUFFOLK COUNTY, N. Y.
/ 0. •k9• \ �. 0� SCALE: 1'-30' i
11 OCTOBER 3, 2007
g1 •�. '��^�d�o4 �� � ��o MAY 21, 2012
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Ev issi lry Tai? filiu ter; tFt i
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PROPOSED SEPTIC SYSTEM x d 1t i \=\ i
(4 BEDROOMS MAX.)
1 - 1000 GAL. PRECAST SEPTIC TANK ,, � �\n o
�� �t
2 - L.P.s 8'0 x 6' DEEP WITH 3' SAND (SW) II
COLLAR 3' MIN. ABOVE GROUND WATER ` 'A >7 e 1 S 6
r° r�OU 1�' 1� y".
I, ,.
Ia ���
;1 , Do i
+Ili✓ ,i i+\ Z
TEST HOLE DATA +,'" �'� ,,' ,�9
BY McDONALD GEOSCIENCE 3 e�+y �'���J ) < �\, ��
3/1/12 h t, . .{ r
EL. 15.8' \,� /
MIXED SAND AND LOAM c - 99 ,
- 1' \ �" Z�
BROWN SILTY SAND SM
N p tAVIN
ro.
W f
PALE BROWN FINE TO COARSE SAND SW .‘5)f,
301 '' ,t1 .�i �' p �f; L co, VA
17
r•
F EI,a f ,
1 Z
I \ z
EL.3.9' 911.9' .t..',
WATER I ;!st`, \
WATER IN PALE BROWN FINE TO ,7 \
COARSE SAND SW + r .,,._., ' r I
17' l rt i'r . 1:
I::
•
RAIN RUNOFF CALCULATIONS ` ,.:: ._ A,,, L;,�1 r C,P'r PP VAL • 1
HOUSE 2030 SO.FT. !se."*....
_ .. RF
•
CONC. SLAB 800 SO.FT. 90 '"`" .7,,,,,,,,,,,,_„,,,-... ..„,„, .A
2830 x I x 0.17 = 481 CU. FT. '. en
481/42.2 a fl VF �y •y CO V
PERVIOUS DRIVEWAY 1425 SO. FT. 9a y '�
!425 x 0.7 x 0.17 = 169.6 CU. FT. CO.
169.6/42.2OTAL 45V VF '"cm N0
PROVIDE 1 DW 8'0 x 3' DEEP .. �•
2DWs8'Ox6' DEEP V
. • � t�-ANDS
AREA = 36 ,536 sq. ft. " . L v
• V
ELEVATIONS ARE REFERENCED TO NGVD. • _ L , Z. 2.8, V
g'.
/ am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE ▪ • .
D SAL SYSTEMS FOR SINGLE FAMILY RESIDENCES -
an will abide by the conditions set forth therein and on the . 6 52 W
per it to construct. 573,2 •
1 T ocation of wells, cesspools & public water shown hereon ore
f� field observations and or from data obtained from others. / k# A •. Y.S. LIC. NO. 49618
..3 A AL TERA TION OR AUDI TION TO THIS SURVEY IS A VIOLA770N C SU" T`��RS, P.C.
'- SECTION 72090E THE NEW YORK STATE EDUCATION LAW. /631J 765-5020 FAX (631) 765-1797
EPT AS PER SECTION 7209—SUBDIVISION 2. ALL CER77F1CATJONS
EON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF R.O. BOX 909
MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET Q ry 208
a•.. i
SE SIGNATURE APPEARS HEREON. SOU THOLD, N. Y. 11971 /
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