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ELIZABETH A. NEVILLE ��,aO ?'�, Town Hall, 53095 Main Road
TOWN CLERK ; y Z % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971
MARRIAGE OFFICER �� y ��,1� Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER �,�01iiii .�„.0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER s.,•11'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 211.39 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD ROBERT SCHMIDT JR
Address 1 : PO BOX 263
City St Zip NEW SUFFOLK NY 11956
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner SCHMIDT JR, EDWARD ROBERT
Mailing Address 1 PO BOX 263
City St Zip NEW SUFFOLK NY 11956
Property Address 1 NEW SUFFOLK AVENUE
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 6 lot 16.0011.
Cross Street GRATHWOHL ROAD
Building Permit Number Cross Reference:
Issue Date: 10/30/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
''OFF0Li• aq37•
ELIZABETH A.NEVILLE 00
_� : Town Hall,53095 Main Road
TOWN CLERK vda Z 0 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �'�� Southold,New York 11971
MARRIAGE OFFICER `. �� Fax(631)765-6145
RECORDS MANAGEMENT OFFICER ‘44A_ ! .. ',�� , • telephdhe(631) 765-1800
FREEDOM OF INFORMATIQN 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 23, 2000
Transmitted herewith is a copy of application No. 2527 for a Cesspool/Septic Tank
CONSTRUCTION Permit submitted by:
Edward Robert Schmidt Jr.
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
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Dated
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OFFICE OF THE TOWN CLERK CO Fair —7
TOWN OF SOUTHOLD :1,.. '
��% COG - Application No. �-/
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 Residential P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 0 *.$ $25.00 - Non-Residential
Telephone 01 09Off";'
i'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
6 ISAILS71ERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE Oci- ` 2-0l X00
OWNER NAME: eat/-) � b} .. C VV t c)1- -V
OWNER MAILING ADDRESS: F. 0 . Bow- 2103 Nisuf olic iry •Y•
OWNER PROPERTY ADDRESS: N sjf-t01 f- Avc. ,
t_)-Rn I • v i T4s
OWNER TELEPHONE NUMBER: ( 1 X344 — 721q
(,-, ..
TAX MAP NO. : Section i i I Block Lot '
CROSS STREET: t -73 W /0 12-I`7 / PA .
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool New Existing
Residential Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
_L.,--A.,,i=2 i--4,/_ _P-, 4,,/, , - ‘,
---4
Signature of Applicant
RECEIVED BY: .-.:5
Town Clerk's Office
DATE: / d/e9-3/d
II
•
CESSPOOLS ..
- r: 1•,
SURVEY OF r,
s
LOT 3
MAP of
a�, KOUROS ACRES
FILE No. 6692 FILED JUNE 20, 1978
CYT. A}y- S s8. EK, D,�°�E SITUATED AT
a 40 00 0' f °"EwNoRD ' NEW SUFFOLK
SUFFOLK TOWN
OF COUNTY,UTHOLD
NEW YORK
()co', 43k JO' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
4C-----------....______________ .
o -ERN IT FOR APPROVAL OF CONSTRUCTION FOR A S.C. TAX No. 1000-117-06-16.4
ti01�� ci
SING
SCALE R'22,5 2000
LY RESIDENCE ONLY SEPTEMBER
Or N
NO DATE tö-11-00 H.S. REF. NO.' V!0`O 0 . o _ AREA = 42,162.04 sq. ft.
IP E.s APPROVED � 0� / AL •
0.968 ac.
CP 6,0' FOR MAXIMUM OF FOU ,-ODMS
EXPIRES THREE YEARS FROM DATE OF APPROVAL
marm
al `r \ le L07' O ...)----E.....," ELEVATIONS ARE TO AN ASSUMED DATUM
PLEASE NOTE *: EXISTING ELEVATIONS ARE MOWN 114.14:
'M \s• // % el 7 2. REFER TOTo FILED MAPFOR TEST HOLE �
b
A N ��� Minimum distance between�weiis
3. `"""�'"d m TANK CAPACITIES FORA , TO 4 BEDROOM HOUSE Ts 1.000 GALLONS.
1 TAMC; °� LONG. !'-3• WIDE, 6'-7' DEEP
t 4. MINIMUM LEACHING SYSTEM FORA 1 TO 4 BEDROOM HOUSE IS 300 p H =MAU. AREA.
Q' Oz and cesspool FS to e 150 feet. 1 POOL: 12' DEEP, e• db.o
Ir WELL J
TV *7c-c4'C '! .,j 0 W PROPOSED EXPANSION POOL
0 I
1P mac +�E?t z fre 31� ,. _ PROPOSED LEACHING POOL
J 1W ti43 i • , fO0 ,,, y ,, t et - _ ®PROPOSED SEPTIC TANK
(^1 .Pp. -- 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
H i ! \ �• —_ _ - = OBSERVATIONS AHD/OR DATA OBTAI ED FROM OTTERS.
a } .' - 6. PROPERTY FLOOD ZONE ATION TAIEN FROM:
- y s7bii-3, `17-
r :xLq:z: FIDOD INSURANCE RATE MAP Ne. 3610300301 G
( . ZONE X: AREAS DETF.RIAIIED TO BE OUTSIDE 50D-YEAR FLOODPLAIN.
1FOUNDS ��3<.00* E O Q` .c.c. Mao. 1 z ( # I a 3
72.9g• w / ' x
tL i cc" NN. I II I 0
N 1 I Rt PREPARED el ACWROANCE WITH ST SURVEYS ASEESTAAB BED
• • •.-A 7$' 34,0`O 1 • io ' Y niE L 6 DAAr SAND ADOPTED
LAND
• ,W ■ 0 CERTIFIED TO: ME Assn IAN
NE Ij`j ,,, As EDWARD ROBERT SCHMIDT Jr. �® �i
N1>L "P
S U FF 195-16 �l,`O�� , g�� co
ELLIPIr, P SIC WA1FR IH •A���T U Axc ' 1 '�O
DWEl?tfTLLING UNDER COH U`� �l •
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D it-
? m"f•49668•' 6� .Y.S. Lic. No. 49668
DWELLING
uHMmla6zEn ALTEMT,ON OR ADDITION ``•. n1 ..TVy d
TO TH5 SURVEY IS A VIOLATION OF _V
SECTION 7209 OF DE NEW YORK STATE
DWELLING �"G°'°" LAW. Josep • . Ingegno
COPES OF 1115 SURVEY MM NOT BEARING
PIE�D "® OR
Land Surveyor
E]6085ED SEAL s�NOT 6E DDNSDEItED
TO BE A HUD TRUE COPY.
CERTIFICATIONS ROWED HEREON SHALL 141
ONLY TO 11E PORTON FOR WHOM THE SURVEY
IS PREPARED.AND ON 115 BE}MLF TO TIE
TITLE COMPANY. OUNOW ENTAL AGENCY AND TIM Surveys - SuA6Ni/a s - Site Plans - Construction Layout
LDEIG NSIf1 ER LISTED HEREON.NO
TO INSTI-
TUTION.OASSIGNEES ATI s�gT TRANSFERAMLL PHONE (631)727-2090 Fax (631)727-1727
THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT RAMC'ADDRESS
AND/OR EASEMENTS OF RECORD. IF
ANY. NOT SHOWN ARE NOT GUARANTEED. 1380 RDANOKE AVENUE P.O. Box 1931
R?NERFEAI. Nee York 11901 Trverheod, FMN York 11901-0965
20-5
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