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HomeMy WebLinkAboutSouth Fork Properties (2) ELIZABETH A. NEVILLE � l0 Town Hall, 53095 Main Road TOWN CLERK * * P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ; G Q Southold, New York 11971 MARRIAGE OFFICER : . 3 1� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER `_'?'4 ,M a ' . Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER OUry"+ southoldtown.northfork.net _#, -" OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4346-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner SOUTH FORK PROPERTIES Mailing Address 1 THOMAS FISCHER Mailing Address 2 PO BOX 684 City St Zip SOUTHAMPTON NY 11969-0000 Property Address 1 560 KENNEYS ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 000-287-7800 Tax Map No. section 59.00 block 3 lot 3.500 Cross Street NORTH ROAD Issue Date: 6/26/07 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) . a �iii���'FFO I OSS �� - Ate C, ELIZABETH A. NEVILLE 01. * %; Town Hall, 53095 Main ttoad TOWN CLERK ; y • , P.O . Box 1179 $ Southold, New York 11971 REGISTRAR OF VITAL STATISTICS v. A� MARRIAGE OFFICER ? Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER \y,� a��'��1 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER = '� 4. -0, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 /or Non-Residential @ $25 Application No! 3 y too Permit No. Owner Name s 0 ✓jH J rkx f nc,P64.-0 6:S t. . _ Owner Mailing Address ft'' aox CV S -rIAM,7oA1, .N.Y PM Owner Property Address c(O Kev v6.YS 1ZD S'i'/at1), ,Jy Owner Telephone No. Z. 7-7(;(00 Tax Map No: Section/10 57 Block 0 3 Lot 35 Cross Street A.6c-r}j R...c D Please check each that applies: New Construction kV- Alteration to Existing System Residential .1/-- 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.) 4/ -0111-1°' / 'CA-7 x ture of licant0. I D e Received K-10- ©y -- O 13 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES I s �o Q� O G pct• �� PERMIT FOR AiPPROVAt.OF CONSTRUCTION FOR A ���. S�` `�`� '6. `�6 SINGLE FAMILY RESIDENCE ONLY v,o .-/-:,;:t.o SURVEY OF PROPERTY DATE 10" %q—OL} HS • O. ' 0--013-•t -7a,ce, SITUATED Al' tpr ., SOOT IIOLL) APPROVED �A► L ..... ....it.. A �� TOWN OF SOUTHOLD FOR MAXIMUM( i B , +I •MS , ����� SUFFOLK COUNTY, NEW YORK EXPIRES THREE YEARS I.OM DATE OF APPROVAL o o S.C. TAX No. 1000-59-03-35 SCALE 1"=40' 5 SEPTEMBER 30, 2003 Y... 4 40�V0 c��o� GUS A ' [F, 2004 AU(3EL ('kPi` O � F l, N JO`;1 dr. W./itliAt6- EXCAVATION INSPECTION REQUIRED ��sQt�P� \ AREA = 37,70123 sq. f1. FOR SANITARY SYSTEM G ^� 0.866 vc. �p5 �P 6 81r HEALTH DEPARTMENT 9 �h�• I ,�o CERTIFIED TO. THOMAS FISCHER / LAWYERS TITLE INSURANCE CORP. f. NORTH FORK BANK / , 15 ir 7j� 7,,,v" �`� NOTES: \ I. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM - \:\ EXISTING ELEVATIONS ARE SHOWN THUS: :6... 'S. 2. REFER TO FILED MAP FOR TEST HOLE DATA. \ •° // - 3. MINIMUM SEPTI; TANK CAPACITIES FORA 1 TO 4 BEDROOM HOUSE IS 1,000 GALLONS. 111- �1i / a� 1 TAM(; 8' LONG, 4'-3' WIDE, 8'-7- DEEP ,{ // •\d'4' `T `` 4, MINIUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq f1 SIDEWALL AREA, _.P i -- ,, (//:<41-r. . / _ \ 1 POOL; 12' DEEP. 8' dia. l i V_ V { , \ ,\� ` ° � �Yry / / PROPOSED EXPANSION POOL 1 Q� ���% 3, ��� / o+ � ��1 0 PROPOSED LEACHING POOL Je '7' PROPOSED SEPTIC TANK �/ .. .b� Vim. , - T' Q4O� I li i } 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD �p�' ••• j Q d QJ 10 4 OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. e / \ ♦ C, 1` �`�6�. �g moo. ,•� / ,,,,..01S TEST HOLE DATA rLS� 4,• � +/ 411040 S%P (TEST HOLE DUG BY Mc DONALD GEOSCIENCE ON JULY 27, 2004) s�rirh�✓OO sq�4ie ,' tJ/ /O, o G�/ xof---,.. • s'' ,/Y a 1f�'�H F 0' C�. 1/45'0,,\ �Q(' •• - -_ PREPARED IN • .•a • SYS THE MAw/SM DARK BROWN LOAM OI HED 9� •• STANDARDS FOR ANDSURVAPPROVED� �`�J ��> • + �F '-;, NEW YORK STATE LAW) • b� BROWN CLAYEY SAND SC ® - 1 SGS . A tio�� �j ,, h F .1.. •- Yi ,, ��';• Vii` y CY f. AGB tP •Q OCG tL�Q / 20' .. 0 , �o - . - ti SGS, ` s- - ��0 4 �0) `243 E.� '' .o {� Y PALE BROWN FINE A� 74.70._ j. G F J • TO COURSE SAND I �r .�, z� ..�«,'F N.Y.S. Lic. No. 49668 `'C`'� • �} *•• O w9 TO THIS K)-.ZED ALTERATION OR ADN ` f K(~ . vIOLADON 0 4, \C-` F `rte• OP SECTION 7209 oFSTHE NEW YORK�STATE 9<;J $`� s°s� �4 —_ EDBCA uw. Jo . eph A. Ingegno 27' COPIES OF THIS SURVEY MAP NOT BEARING �9� R ; ., . S CONSIDERED and Surveyor 36 E TO BE A VALID TRUE COPY. n N.$1\\ - 0-,r. :; `1 t� Z` E CERTIFICATKINS INDICATED HEREON MALL RING , 1l{Y�,/ ONLY TO THE PERSON FOR WHOM THE SURVEY Y IS PREPARED,AND ON HIS BEHALF TO THE �� I TITLE COMPANY, GOVERNMENTAL AGENCY AND I Title Surveys - Subdivisions - Site Plans - Construction Layout 2 1 O ..C..,'_ '-7I, .�.`i" LENDING MSIITUf10N LISTED HEREON.AND -OS" emsY\1It-:11--i103 TO THE ASSIGNEES OF THE LENDING INSTI- TUTION.� °`"� TImoN. CERTIFICATIONS APE NOT TRANSFERABLE. PHONE (631)727-2090 Fax (631)727-1727 N 87'59'50" W f� 33.74' THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF OFFICES LOCATED AT MAUNG ADDRESS ANY, NOT SHOWN ARE NOT GUARANTEED. 322 ROANOKE AVENUE P.0. Box 1931 WARHEAD, Nes York 11901 Riverhead New York 11901-0965 Suffolk County Department of Health Services Office of Wastewater Management Suffolk County Center • Riverhead,New York 11901 (631)852-2100 CERTIFICATION OF SEWAGE DISPOSAL SYSTEM BY INSTALLER Health Department Reference Number: Suffolk Tax Map#: Dist: Sect(s) Blk(s) Lot(s) Project Name or Address: J✓dc -'. Ro ' 4 Subdivision Name&Lot# Applicant's Name: Description of System Installed: Septic Tank Volume(gallons) 1 Coca Shape: [4 Rectangular [] Cylindrical Name of Precast Manufacturer: ,)P-aI k Cc Pre caa . Leaching Pools Number of Pools • j Diameter and Depth g'x I a Name of Precast Manufacturer: 5c) ' f k Ce.e.J frecaa- Other: Attach or sketch below the measurements from building corners to the access covers of disposal system. I r%. ,. 37' sg() , sig' 33 I hereby certify that the subsurface sewage disposal system,described herein,has been installed by me in accordance with the approved plans and standards ofthe �Suffolk County Department of Health Services;and is operational. Installer Signature: ��% 7/e =r-rl Date a/e V 7 Print Name/Company: isivcn Si De_veicem torp , Phone os--3-6'016.2 Consumer Affairs License Number: 3TaoGa d.lcJ This certification shall not be used in lieu of inspections required by personnel of the Department and may be duplicated on company letterhead, provided it contains the above information. WWM-078 (1/2/01)