HomeMy WebLinkAboutDickerson, Betsy 00 SOU45,-
ELIZABETH A.NEVILLE /�� � lQ Town Hall, 53095 Main Road
TOWN CLERK 4g P.O. Box 1179
REGISTRAR OF VITAL STATISTICS H ��iirr Southold, New York 11971
MARRIAGE OFFICER '•\ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER1 o Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �'COUNTO°�ii' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4294-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DICKERSON, BETSY & PARKER
Mailing Address 1 403 JACOBS LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 403 JACOBS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-2435
Tax Map No. section 88.00 block 1 lot 10.000
Cross Street MAIN BYAVIEW ROAD
Issue Date: 12/05/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
/47
ELIZABETH A.NEVILLE ; Town Hall,53095 Main Road
TOWN CLERK : I P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ��O 1� Southold,New York 11971
MARRIAGE OFFICER =,'�i� 0.•s1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ' * 'j,a• Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ..,,,,,�' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
LI
Residential @$10 )( or Non-Residential @$25 Application No q2 (Qg_
Permit No.
Owner Name 13rc( .41°\iZk rL (��� rlsor3
Owner Mailing Address 4'O 3 Ac&Gs LA)
Owner Property Address .S1 K1- ,4.
Owner Telephone No. -7(9 s -o?`73S'
Tax Map No:/6°D Section R Block 0) Lot ID
Cross Street M i3Ay frac,,) 2 -
Please check each that applies: New Construction
Alteration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
1 V/
Signator ''f Applip nt ate
Received by: ,
CONTOUR LIDS FROM TOPOGRAPHIC MAP OF FIVE EASTERN TOWNS SURVEY OF R SER
LOT NUMBERS REFER TO "CLUSTERED SETOFF OF DA YTON \pti__.
cARMS" F/LED IN THE SUFFOLK COUNTY CLERK'S OFFICE. AT BA 'Vl Rd....
TOWN OF .WOv �'
HEAL 1H DEPT. REFERENCE NE ER 810-04-0021 SUFFOLK CO&i iN o N
1000--88--171-1
SCALE. z'2
r € JANUARY ',, �
'= NOV. 23, 2004P-*4 (S
o E; �� � 15p f `/,rIDTN. Ltr
_. + C JANUARY 7, 2G DC5
C
OCP.O L P O JIJN(C.29. ,2041, ini
6ct. r 8, 2005 tI
tY d
9 ON
rl 0 I�,�t� F ,c kreir D PARK & RECREATION m ..
f :SEPTIC SYSTEM MEASUREMENTS I) �.
ao 1 DR.nix
x'20' E 18019 c"J,
°� A 31' 49' 1111 ''
43.5 57'
N C 41' 33 5' 0 / - - % [
1 , ,i
20.80'
4 `' ft
// \
(DWELLING) f / ` - F
I `' I VELE 150'+-
/ \_ ��
0 :'1.EEWAFiDACRES AT�gYV1EW. /
Q X99 Fn�n �,� 4. 1971 WELL '
l� u„ i 20 (NON-POT LE)
is. tZD
_ r I.
� ,
Cti
vCti
\ ['
01 I
W .WELL (DWELLING) �/ ti
WELL 150'+ /
OCP L 11G) I P,
S5,5?'18'E /
�. , /
1 115E 54 , / [;
l
i;
—
S 62'28'40'. E/ 4,--. �'
i 3616' /
/ I'-
M in t
1 04/0N-POTABLE) g z
WELL EL. 15' 1
e
PRESERVED AREA 3
illa
AREA=10.1482 ACRES ti
�V r \ / ( d 1
TEST , X15 / I RESERVED AREA "�
1 N�� f I LOT 2 AREA=1.5446 AC.
� a Ao
W
4.-m ,,,�ua��rry
I N63'01'20"W 1 ��
140.0 p
i� (DWELLING) R s Lu / REBAR ^ CON RET. I REBAR g
VS b1 '�'F sEr WALLS 3
IN'w .138.65' � t I / 0 : • •55.9• 4
+ Qft4
1 y� N �/ 01 • i it "� N ~
~ Z / 54.3. I, I -1 I coo N
of \ N "" N63v1'20"W ti __��"
4 :+ SET At 125.14' r - - - -1
$ COMMON DRIVEWAY FOR LOT 1 3 co e FR BL�c h } \ I 1`
R�BARN " LOT 2 I ; \._ to I� r--
sEr N61'55 20 W --BMT 402.78' SET & ^� I W z I
�a
`"-- 0i• BLDG. is :W
/ Fp o
25 RIGHT OF WAYJ iz8
II
� 2 X01' `5N %z
ze'
( r BLE)f r 2"' IPOT -
FRBLDG � N I0. ILOT 1 . ' BARN , Z L — -T J
(DWELLING) WELL 2 o►�'tRE — ti 284.65 I 146.47
N 65'13'50' W ' r 431.15' W
-
r
ST til
-.1.
CP. ooI N/0/F DC I4LD C. SATES
3 as
(DWILING) L Li
to
I R OC.P. WELL 150'+
V
L� � --1
TEST HOLE DATA Z
�lN � niZeir EL 15'
LJ
RDAD BROWN SILTY L04*1 OL I-.
n familiar with the STANDARDS FOR APPROVAL
a.
CONSTRUCTION OF SUBSURFACE SEWAGE OF NEW YORE
'OSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
will abide by the conditions set forth therein and on the BROWN FINE TO COARSE S-D SW �,� ' at
nit to construct. o Z ,�1.�i+ �\
location of wells and cesspools shown hereon are - — — - 8 O . ��
field observations and orfrom data obtained from others. p ^r - ;-j,,,VA
,�
ALE BROWN FIN .-A�-- •i _ �� 1 . D. 496 i
-.- -- ----
ALTERATION OR ADDITION TO THIS SURVEY IS A NOLA TION TO MEDIUM SAND SP _ - ` �. r