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ELIZABETH A.NEVILLE,MMC ���yo�®.<.r,"'°'`� ®4 Town Hall,53095 Main Road
TOWN CLERK i ,{�'' P.O. Box 1179
° :"� ' Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ; ~® ', ^`, �',,� Fax(631)765-6145
MARRIAGE OFFICER � 4, '� ��� Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER : ®d ,,d www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OWN OF UTHoNCLERK R.ciEsw-E
TO: Southold Town Building Department JUN - 2 2016
FROM: Carol Hydell, Southold Town Clerk's Office BUILDING D •
DATED: June 2,2016
RE: Cesspool Construction Application TOWN OF SOUTUOLD
Transmitted herewith is a copy of application No. 4392 for a Cesspool/Septic Tank Construction
Permit submitted by:
George McDowell,Jr.
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
Aditsmighff
Signature
/ f
Dated
ELIZABETH A. NEVILLE b,`Z %V-
Town Hall, 63095 Main Roa,
• ' TOWN CLERK p . P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
10 117 t
MARRIAGE OFFICER . 0 `F 0 Fax(631) 765-6146
1
RECORDS MANAGEMENT OFFICER %%-: Ifo `���,,' Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER - '� * �`����� 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. 143°a--
.
Permit No.
Applicant Name aftirt3e, ) ( b . e If In.._
Applicant Mailing Address cr/ trA444.re...i it),V, 1 11 ii r
Septic Tank)(or Cesspool
Brief Description of Proposed Construction or Alteration
- 1000 oicLA� Sq hc. $ it Leaciqn� e�1
J
Location of Proposed Construction/Alteration:
Owner of Property: a eory e_ .Mt---.0 ow a L( J t .
Owner Mailing Address: v. f3eY 567 (.wart! A V 1 ti L/
Owner Property Address: 2,6 9 C) N 1 h 4 R.6.
• C )r o rt- A! 1 ( R
� 3S
Name and phone number of contact person Get?,1jL.M`bowel( -M (( /) '&c:y3 QS
Tax Map No: 0)C) Section 1oZ Block d$ Lot a 5
Cross Street CVbid� Lea-i ka Lo.wt
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAL H DEPARTMENT APPROVAL
. -17c. ttAdall S/Z//6
Signa e of Applicant Date
Received by:
)
IS
LS A VIOLATION OF
CTION 7209 OF THE
W YORX STATE
TON LAW
)
S SHOWN
EON FROM
ERTY LINES TO EXISTING
ARE FOR A
0
NEs at
cToN oF FENCES.(3)
SURVEYOR'S RMED SEAL OR
SEAL SHALL NOT DE CONSIDERED TO BE A VAUD
E COPY.
)collincKnoN
('NONAUTEL UNAUTHORIZED ALTERATION
SHALL RUN ONLY TO THE PERERSON FOR WHOM THE SURVEY IS�PREPARED AND ON HISE BEHALF TO INE TITLE COMPANY.GOVERNMENNTTAL AGENCY LENDINGNSTITUTION USTED HEREON.ANDTOTHETASSIGNEES OF TH¢C�ENDINGININSTIN DN CERTFlCATIONS ARTE NOT WUANSFERAABLLEE TOUADDI ONALLIINSTiTU7IDNS OR SUBSEQUENT OWNERS. U)THE LOCATIONNOT
OF BEARING
BEL1S(w).SEPTICTANKS(ST)&CESSPOOLS(CP)�'SHHONNNHEREON ARE FFRCN FIELD OBSERVATIONS AND CR DATA'OBTAINED 4FROM OTHERS. ,
SITE DATA
N � i
400 Ostrander Avenue,Riverhead,New York 11901
ws'ims -. MI tel.631.'727.2503 fax.631.721.0144
AREA = 40,011 SQ. FT. admIn®youngengineerfng.com
•SUBDIVISION- "HIGHLAND ESTATES'FILED IN THE OFFICE OF THEA : � � plut� I
CLERK OF SUFFOLK COUNTY ON APR.26,197?AS FILE NO.6551. N 1 ei '
•GROSS FLOOR AREA _ = 2,1111 SG.FT. i
; 40119
�• VERTICAL DATUM = NA.V.DATUM(1988) 9� •
Howard W.Young,Land Surveyor
• • �O• HIGHEST EXPECTED GROUNDWATER ELEVATION = 5.0 os�F A Thomas G.Wolpert,Professional Engineer
^ / �4 w��l �� o sg� Y�o,� `t _:, Douglas E.Adams,Professional Engineer
�'I'Not` NCI �Q \p�''.' - �� Citi ,cto•
h I �, ��,4 ` Robert G.Test,Architect
oar .(e_o` • �`'' q� '< eI/` `'
�Jp\ \ '<s '2 .` Lot 28 AST 9'2�J by si�� `r. HEALTH DEPARTMENT USE
�� :�' •`��
SUR OLK COUNTY DEPARTMENT OF HEALTH SERVICES
M `� �\\`c ., , fQsS ,� g S PE EMIT FOR APPROVAL (?c CONSTRUCTION RUCTION FOR A
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/ SINGLE:, FAMZ1.7 :;-7.1 ID :NC ONLY
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N s� s 0 APPRu VED QUTA 2 A '?6 ij 0�� •
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ee \ s A 4>•^ �� N up]rE5 THREE YEARS FROM DATE O APPROVAL
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\ �� `.erft 1 SURVEY FOR
N \ \ �� I GEORGE McDOYLL, JR.
a. N
LOT 28 "HIGHLAND ESTATES"
N. +s3
\ ? at Gutahogue, Town of Southold
` \ S 90 „, 1\ Suffolk County, New York
TEST HOLE •C'y \•\ �h, 'bii'ty& HUILDINe PERMIT PLOT PLAN
FROM FILED MAP Ni L, It O County Tax Mop District 1000 Section 102 Block OS Lot 25
O.O' �� \'N
FIELD SURVEY COMPLETED AUG.31,2015
�'bj/��79 \ � MAP PREPARED SEPT.01,2015
CLAYAM a ` �` iE,� \ ,pH. 5 .
Record of Revisions
4.0' ‘ �`N' RECORD OF REVISIONS DATE
ADDED Ellill DINT PERMIT DATA MAR I4.'CN19
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