HomeMy WebLinkAboutBardack ,
ELIZABETH A.NEVILLE,MMC �'�ty ,4 . ®4 Town Hall,53095 Main Road
TOWN CLERK t'..7= ti ' J .` P.O.Box 1179
t A : 4 Ze ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % ,0",' .1,-:,!-',i%'x " �ill �
F ��� Fax(631)765-6145
MARRIAGE OFFICER ,,,,,....4 . R-. '!
RECORDS MANAGEMENT OFFICER7®j 1`0®''� Telephone oldt nny.gov
aly �•' www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER -------...,..,0
OFFICE OF THE TOWN CLERK • , ,,,E[R,T.E
TOWN OF SOUTHOLD D
MAY 2 5 2016 = ,' I
TO: Southold Town Building Department
BUILDING DEPT.
FROM: Sabrina Born, Southold Town Clerk's Office TOWN OF SOUTHOLD
DATED: May 25, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4391 for a Cesspool/Septic Tank Construction
Permit submitted by:
Hampton Modular LLC for Lisa R.Bardack .
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.
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Signature
05??26/4"
Dated
l''�StFFO`at
4/1`Z`
ELIZABETH A. NEVILLE , 'r, 4\ Town Hall, 53095 Main Road
TOWN CLERK tp . . P.O . Box 1179
t y Z i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS k w ��
O Fax Fax(631) 765-6145
MARRIAGE OFFICER _
RECORDS MANAGEMENT OFFICER ‘4�p �O�I��� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =_d •
.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 or Non-Residential @$25 Application No. X13`1,
Permit No.
Applicant Name kigliv1\97py) P? A1 a-C- LLC
Applicant Mailing M.dr9s -0
-c\ ave2 )v I (1-- --D--
Septic Tank or CesspoM ,
Brief Description of Proposed Construction or Alteration `5' }-e w1, (11 .40°,.,11,4_,) _.
Location of Proposed Construction/ teration:
e
Owner of Prop rty LI - ea1NrClOtC --,
Owner Mailing Address:
Owner Property Address: I ,,,/An ,
. a,c,',/, „,,(-) -joi
.„, ,
Name and phone number of contact person \. 0`/) `---)1...1" C?1/) DI 1%)- 3-3-1>ci5
Tax Map No: Section 1 Block CI Lot I-1 1
q� /1
Cross Street l,j-%t� j )S f-
,V1ci
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES *ro`' / h H .TVH DEPARTMENT APPROVAL
`14 _ 5 i
11-6
/ Signa f Applican^ Da e
Received b WA L. ..__1: ' �fT��
`RTIFIED TO:LISA R.BARDACK w
SURVEY OF
LOT11
MAP OF
LAND'S END JOB NO.:2015-301
SI T UA TE AT MAP NO.:5909
FILED:MAY 3, 1973 1 0
ORIENT POINT PREP FOR SCDHS APP. p,N S --O
TOWN OF SOUTHOLD 12/29/15 /. --, -,0 ry/1 R�
SUFFOLK COUNTY, NEW YORK REV.HOUSE LOCATION 1/12/16 /./(,•• ,\\• �� �0'. --/
\
S.C.T.M. DIST. 1000 SEC.: 15 BLK. 09 LOT 1.11 REV. PLOT PLAN 1/14/16 - 'l '
i����� REV. PLOT PLAN 1/19/16 ..----,---,
~`~ � .r }"
20 10 0 20 40 60 80 100 120 140 160 REV PLOT PLAN 1/20/16 I; ' E 1
' REV. PLOT PLAN 1/25/16 ,444/7:::/'� JIl
SCALE.' 1"-40' DATE:DECEMBER 4, 2015
LOT AREA:42,861 SQ.FT. =0.984 ACRE •
_k'>‘ /t • a5p'3�� p� 'j
ELEVATIONS HEREON REFER TO NAVD 1988 - OF NE
NO SURFACE WATER EVIDENT WITHIN 300' �`----'---
FLOOD ZONE BOUNDARIES HEREON AS SCALED FRONM
THE F.E.M.A, FLOOD INSURANCE RATE MAP
MAP NO.:36103C086 H-EFFECTIVE DATE SEPTEMBER 25, 2009 LICENSE NO.:050363
EASEMENT AND/OR SUBSURFACE
TEST HOLE STRUC1VRESPEC000ED OR
UNRECORDED ARENOT GUARANENT ATTEED
THE SS OFFSET
(OR DIYEYILINS)SHOE HANDS ON SURVEYING
TOP,EL:10.0'+/- MAEOFSURVEY
THE OFFSET(OR DIMENSIONS)SHOWN
PROPERTY
ROPER ouNE E000 A ES 26 SILVER BROOK DRIVE N
HEREON0 FROM THE
ARE SFORSTRUCTURES
SSPECIFIC
a TOPSOIL
PURPOSE MD USE AND THEREFORE
ARE NOT INTENDED TOGUIDE THE FLANDERS
-1 0' ERECTION OF ANDES,RETAINING NEW YORK
WALLS,P00LS,PATIOS,FIANTING
AREAS,ADDITIONS TO BUILDINGS W— E
AND ANY OTHER CONSTRUCTION 11901 .11r
sM LOAM UNAUTHORIZED ALTERATION OR ADDITION TEL:(631)-369-8312-:FAX.•(631)-369-8313
-2.0' WOIA770N OF
EDD�N as PIENEWYORXSTATE MARTIN D. HAND L.S
EDUCATION TM OF
•
SAND OOPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYORS INKED SEAL OR
sP & TOREAVAUDTISHALLNOTBECONSIDERED COPIES OF THIS SURVEY MAP,EITHER PAPER OR ELECTRONIC,NOT BEARING
•
EIeOSYARDLSHLLM
COPY
GRAVEL CERTIFICATIONS INwrSTEOHERDN000L00DH THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE
ONLYTOTHEPEINDICA ED HERON SHALL RUN
_8.0' TITLE GOVERNMENTAL AGENCYAND CONSIDERED TO BE A VALID COPY AND SHALL NOT BE USED FOR ANY PURPOSE.
WATER 1110 ASSIGNEES
LISTED ELHEREON,AND
HE G.W. EL.:2.0' TOUDOR E STINKS IONS ARE NOT TRANSFERABLE TUDOR avAL CERTIFICATIONS ARE OR SUSSNSFE T
owNE�Rsnouu.INsmvnaNs OR sussEausvr .x.w.«,.«..-„ �-A�a,
IN I U FOLFr CC1UN°CY DEPARTC.t d S OF HEALTHSERVICES �
SP SAND
& PERMIT FOR APFRONDL. O-7COF;S i RU4'°,0`d FOR A
GRAVEL
-14.0' SINGLE FAY/ILY RES 7OE NCE ONLY
Ii
• HANDS ON SURVEYING b
12/04/2015 CLOSEST S ARY A!i 1 8 20,1B
CLOSEST SAMTARY ATE E
H.S,�. a�I`F. P.0. �/a—Jlo-00
PROPOSED SANITARY OSS S iTION ,!q PPROVED , lb,
--��- -
LOCKING CAST IRON
CO ER GRADEIpp
PROPOSED GRADE 1 v g� e sa1.aai lyyG3m OFI�
1/4' PITCH MIN BED;Owls 1
5%MAX SLOPE
1Y87FT PITCH MIN
PROP FF EL 13 0' l MINAY EXPIRES THREE YEARS FPOR1 DATE OF ?P OV '•
PELVO' // r3SJ
I
i PEL 10 0'
NV.9 2' INV.9 0' f-1 ` ,
1,500 INV 85' / (6)8'DIA
[] GALLON INV.83 X3'DEEP 3'
S T 1 P'S
3 0'MIN. x
EL2 0' ' W E_ - i L r "'� 3�H:S. ENDORSEMENTS
`� �afx�afle N .; tfngcGROUNDWATER COunly Dep't. H,� Il
Call 852-5700, 48 Hours In Ad IP,wt.
To Schedule Ins
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WE
WELL AND LATERAL MUST BE '
8, Oh
IMPROVED it
_ $ LOT 17T
i 0i,11
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oo� CONC.CIR9 CATCH i9B t0
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\v is Vf� �' ��m TESTHOLE N 88°57'40°W 250.01 C
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES \L---)
1
OFFICE OF WASTEWATER MANAGEMENT 8
RESIDENTIAL STANDARDS•FIGURE 6 O B� —�
ALTERNATE A•CLEAN OUT DETAIL \'T. . .,... — 'S 86°09'10"W 280.09'
STOPPER ORI
ENO PLUG SLATE OR OTHER 1
SUITABLE COVER 1 LOT 12
V A j I
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hi
VACANT. �� D
SEWER PIPE •
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