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ELIZABETH A.NEVILLE ���j �: Town Hall, 53095 Main Road
TOWN CLERK ;• y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � I Southold, New York 11971
MARRIAGE OFFICER y I1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �_��� � I.�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - i�
• •01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2434 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHARLES THOMPSON
Address 1 : PO BOX 71
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-98-0095
Name Of Owner ROMANS, MARY & E BIRENBAUM
Mailing Address 1 160 EAST THIRD STREET
City St Zip NEW YORK NY 10003
Property Address 1 740 POQUATUCK LANE
City St Zip ORIENT NY 11957
Tax Map No. section 27.00 block 3 lot 4.005
Cross Street KINGS STREET
Building Permit Number Cross Reference:
Issue Date: 10/13/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ti „„ iii.
coG
ELIZABETH `
A. NEVILLE � h Town Hall, 53095 Main Road
TOWN CLERK ` o -y� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 0Pri i Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER ��y4' 4;0” Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER /
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 12, 2000
Transmitted herewith is a copy of application No. 2522 for a Cesspool/
Septic Tank Construction Permit submitted by:
Charles Thompson for Mary Roman & Ellen Birenbaum •
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco endations:
APPROVE
DISAPPROVE
Comments:
Si ature
(oJ 6
Dated
e OFFICE OF THE TOWN CLERK ,,
,. ,F10L�in
TOWN OF SOUTHOLD ,4 ° r 6QG=. Application No.
ELIZABETH A.NEVILLE,TOWN CLERK O ^/
P.O.BOX 1179 Construction 1)(
SOUTHOLD,NEW YORK 11971 O T ;
Alteration
Telephone /� 0.9. $10.00 - Residential
(516) 765-1801 �l �,��'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /
DATE c<— //j ,2,O06
APPLICANT NAME: agv./L`LP lay)
APPLICANT ADDRESS: �0,,, oX 7/
�CGY►l C ,V Jv //i 8
SEPTIC /CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /IhcA.,
£ r5/, 4h%V; Ao4.cC
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /VA,/ Rr,,,,,Q . A JJeh , ;v,eilZGuw
OWNER MAILING ADDRESS: ,fo'b .�-�►c? 7Airld s71 At/, Al y! .10603
OWNER PROPERTY ADDRESS:ripvig
\/
ay-) cv� j /v
TELEPHONE NUMBER OF CONTACT PERSON: 74',S=,S.717
TAX MAP NO. : Section ,2 7 Block .3 Lot �.
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signa ure Applicant
9 PP
RECEIVED BY :
T. e k's 0 ice
DATE: D /.
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PO , SURLY OF LOT #5
' MINOR SUBDIVISION: il
111ii
`der r 1 I NCS BAY PARTNERS"
� .' L/\r A�_) r )L ut 1,r .dl� , , )\)1.11 q 11
p110.,,-).1(:)Y I 11 FILED WITH SOUHOLD TORN
, )�,r • �Ir ; A)\ \ �r 1 i • �
I Ilr ,r �Y 1 a� YYu 1� I ,�r ON AUG. 30, Ici88
' I, c 1 III . ( , 1 Z�I en 11,.',,.,,, I SITUATE: ORIENT
11 ����43 OO11� TOWN KOCOUNTY,SOUTNY
/ / (I I I SUFFOLK NY
1 Q8
I
"' SURVEYED: 06-05- 1'
ISI, I MONS. SET: 07-03-98
I • . -. 1 hl ,I W�"`1 AMENDED: 07-28-98
I ' 1 SUFFOLK COUNTY TAX
0>O) ''r''I 1000 - 27 - 3 - 4S
(1 L 2.t_,'1_
N MARY ROMAN
.1 CERTIFIED TO: r
N:t..., ELLEN BIRENBAUM
\ ,4ti \ �`;\ `��,
�j ,, \ , NOTES:
C
,,,,)., \ O .0 ,�,\ 0 STAKE FOUND
\\ i rk ',. \`� ■ MONUMENT FOUND
\ \
0 PIPE FOUND
\ :7:.`i.:71::'7. 1.:; HEDGE _=
5(� \ AREA = 217,783 SF OR 5.0 ACRES :
\ l f
\ ; '' ELEVATIONS ARE FROM FILED MAP
\V I;fli' I Y'
REFERENCE DEED: L 9683 P 341
_ I „1 1 nlNr lirn
0- V.•.rI11 171ll
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Record Test
Hole Date
• No (not to scale)
Obrows 0.0'
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2.9
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SUFFOLK COUNTY DEPARTMENT OF IIEALTN SERVICES
I:
SEPTIC, DETAIL PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
PROPOSED ==
not to scale DWELLING
SINGLE FAMILY RESIDENCE ONLY f
DATIAUG 0 6 l U -ct 8-OC9R
proposed -• - HS RE NO
greoes .
-__EL= 13.5 existing grade max: '
max. 2' min. 1' in APPROVED '
min. 1' inv.. cover Inc.. 11.5 _
cover Inv 10.6 '
leaching 10.6 900 gal. '_'
pools (2� Ilff— p septic min. pitch
FOR MAXIMUM OF BEDR S
6' deep min Per ch tank 1/4" per ft
300 s.f. EXPIRES THREE YEARS FROM DATE OF APPROVAL
sloewall
V
min. 3' w . .. r
separation
ground water EL= 1.5
'unautn r
p Ig•a alterationn...l or Surveyor to•survey
map bearing• Iltione 7 lona surv•yor seal of.a
violation of.Educn Peps, sub-division 2. of the
New York state Educal len law.'
'Only copies IrDA the original of tnla survey
marked with an original nofS tee to surveyor's
atoataapea seal Shall be conuv
ded
to be valid true
Copia.'
'Certifications indicated nereon signify tnat this I(_.)())
survey was prepared in accordant,with the en- (1.'_
ine cede of Practice for Land surveys adopted
by the New York stat.Aeeociation of Prof...ional -A')O) fYl(JY1.
Una sure. io ]Tubo:::all run only
to the eon tY19a. ne rey fs preparer. �`-�- ,`
and nj/ f s1.• t4t a epanY. grvernnen- .,r
to a r lendfll�'T[rZI o ]Teter nrrmn, and OIII A�
forw•vF n n s tution. certifies- 12 r 1
... '-'ltf)) = 1 Snatltutione 500 14
P� 4" Til a. /_� AV YY1r`I I.
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O. 502 ' � + ., .f:I 221.6
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6),�- • .� N. Y.S. LIC. NO. 50202 �' ZK� �- Q�d .7.1 O 02310
6 "5 •EETD SURVEYOR ✓ 1
RIVER Edo, .Y. 11901
YSr,I 1\r%� ')
369-8288 Fax 369-8287 ,', F ( `- :-+Ai J I Y 1` I� 1 V 1t Y 1A' �1 :A r,
GRAPHIC SCALE 1 "= 60 ' ;,?Nr', i,) ' �O3 i(1c \! I 1 .1� ,A V 1r , A'
j, REFERENCE # 98-0189) 1
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