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ELIZABETH A. NEVILLE 10 4% O4. : Town Hall, 53095 Main Road
TOWN CLERK % o P.O. Box 1179
H Z
v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax(631) 765-6145
MARRIAGE OFFICER ,L
RECORDS MANAGEMENT OFFICER �_y"'/Ql jig
Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER _ 0"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2354 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ALEXANDRA JONES
Address 1 : 11A BAYVIEW LANE
City St Zip HUNTINGTON BAY NY 11743
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 #R10-00-0067
Name Of Owner STONE, NORMAN
Mailing Address 1 14 OAK ROAD
City St Zip SETAUKET NY 0000
Property Address 1 5055 SKUNK LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 138.00 block 2 lot 3.004
Cross Street PINE TREE ROAD
Building Permit Number Cross Reference:
Issue Date: 6/28/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
" "�`' I�,,�'o fFOL,'c
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ELIZABETH A. NEVILLE t����1%- Gt; Town Hall, 53095 Main Road
TOWN CLERK `% o P.O. Box 1179
Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS
%
MARRIAGE OFFICER : 1�i1. 1*. It Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �__"'/Q! +t��iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ----. �
._. • IS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 26, 2000
Transmitted herewith is a copy of application No. 2442 for a Cesspool/Septic Tank Construction
Permit submitted by:
Alexandra Jones
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:
j2
ignature
(, 1 -3-71 v
Dated
OFFICE OF THE TOWN CLERK ''•�uFFULK
TOWN OF SOUTHOLD • CQG Application No..=D
ELIZABETH A.NEVI'IF,TOWN CLERK
P.O.BOX 1179 ti Construction
SOUTHOLD,NEW YORK 1197 1
Alteration
•` $10.00 - Residential
Telephone -�j',yo �•a0���•
(516) 765-1801 = 1 1 ,P' $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 (0I 02(0,00
APPLICANT NAME: AL AODE.A 30 nes
APPLICANT ADDRESS: ILA eR i vl eu, Lo.. 14(A I11134Vn rJ14 Y M Y
SEPTIC CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION con,51.,{„d_,
3S(?.. Sl nykt. dh.,0.-t(I,1A...ri
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: NoQ•mcti .ct r e-
OWNER MAILING ADDRESS: tkk (210..k. Roc
OWNER PROPERTY ADDRESS:(. 05,S tlit -t,_
TELEPHONE NUMBER OF CONTACT PERSON: Ca..Ch_P.I[in� (\est. .e 27S'-??9S i
TAX MAP NO. : Section 13V Block o2 Lot 3.4 + 35
CROSS STREET: Pirte, Ikei✓ R 0 0,41
BUILDING PERMIT NUMBER CROSS REFERENCE:
i74.24,cezz
Signature of Applicant
RECEIVED BY: IZ
Town Clerk',?,,Office
DATE: V,( \ OU
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SURVEY OF PROPERTY
Norim.
ELEVATIONS ARE RfE1EPc[D TO N.QvO.+9rDAU11 SITUATED AT
EXAM=ELEVATIONS ARE SHOWN NUN L
031x110 CONroUl1 IBES ME SHOWN THUS. 5 - - CUTC ROGUE
• PROPOSED°°"'°"'MNES ARE SHmos: o PINE TREE ROAD
TOWN OF SOUTHOLD
EN
Z.SEPTIC STSTSTRUCTURE MOWN HIM 1=.
el PROVO= U SUFFOLK COUNTY, NEW YORK
EvNNIOW POOL W S.C. TAX No. 1000-138-02-3.4
CONC.Mol
�� PROM=LEAN=P001 2 WELL1000-138-02-35
o
L P"0'D°=•1 T1c T4Mk " o SCALE 1".30'
3.THE LOCATION OF HELM AND CESSPOOLS SHOWN NEREON ARE FROM FIELD W MARCH 1, 2000
ORSERVAT ION AND/OR DATA MANED rRNA 07»01W 5. c o MARCH 9, 2000 REVISED PROP. WELL & SEPTIC SYSTEM LOCATIONS
4.LOT NUMBERS SHOWN 111110:LOT/®REFER TO 1 = •-
MAP OF NASSAU PA1018 1�
VOL NI TE 0R10E Of TE CLEAR OF SUFFOLK COUNTY F-
oN MARCH!s.1935 AS F1Ile.. 1179 W p/0 LOT AREA DATA
s.TI.000 ZONE RFORYATION TAKEN FROA• ce P
8000 INSURANCE RATE IIP No.3.10300114 G I- •M S.C.C. TAX No.
ZONE AE: RASE FLOG ELEVATIONS OE7ETII1e1Ep N O/ 17,561.99 • . ft.
/ .
ZONE R: ARDS OF 500-1EAR FLOOD:MFRS OF.00-YEAR 11000 MTM AVERAGE Z 1000-138-02-3.4
OEPM OF LEs5 TNM 1 FOOT OR MTM ORANAGC MCAS LESS DON O 3 JOSEPH P. KIRWIN CESSp00� 0.103 OC.
S.C. TAX No. 2.973.56 s ---
1 SOME AEF:ANO UFAs PROIECRD 9Y(EWES MOM loo-YFM 11000. / + 1000-138-02-35q• ft.r ' n o & MARYDE KIRWIN (TO nE UNE) 0.066 00.
�� Pub ,,J.,:1-,/-
� Az. i 3 "+ 180.00' ! TOTAL 20,535.55 sq. ft.
4 (� ff QD f a (BEING CONNECTED PUBLIC WATER)
t�l C9 ( rbr 1`t\/�a1 Q(( m ` ) > v o N 86'58'40" E "' I I€ ( ) 0.171 cc.
TO TIE LINE
ay�, d EDGE Of INN
Cir)n�9-��1�A ��L t t.12%.
il L/`L ,n - �. i, SPLIT R N FENLE '. / 0.5'5.
c. I �o FENCE . / r\
�, o .I'STAKE 0.55. f / v TEST HOLE DATA
1 30.1 6' O d; C 1�IV Vann •. •L S / P/O LOTCt) 0 1J (TEST MOLE Nuc BY MAMMAL,CF(15OFAM•F ON FEEIRURRY 7,2000)
N 86'58'30" E .:5 W o
- -_S 8.5840 - - -- -_\ n ar
•0/19' �I 4 D
") KNEAD Row Of WODO P057S • --j CONC.MON. 7J /..I / I.�j tip.DARK NOIM SOW EOW a
• \ _ •'�-7 4 •I: ri - - /
�..3 �i` EpMN LOW'MAID 91
y o.s'N. i / S.C. TAX No. 1000 138-+2-3.4
\TAS' RAISED DIRT'AREA / / :71::,'
�.�.'�'' \ F,� q 4(I,A g -11 I rrn ,r:;:•� .•' Qi4.of -:)_ �• , a� S.C. TAX No.„1000-136-OZr35I �.1'� �,�� jj ® 4 a -
�fQ�iS,I R'- ,l'• ,Buuc I� 7-1'
�,. / L9 _ _I_ oL. r Pl �1� O '�nuc mm"m.'"`RSE v°1o"".a sr�• •97.10••'! �0lUBALTHSt�VlCffi 08 �o w� ,� � �' / -`� o _ _o LOT O1i d o o M 4 �_ 1
381�AIITPOR APP VALE C�OlV141IUCtlONi FOR A ""� : . IRE ►- LEv , a ON REGU
�RIss�NRPvr.� MEC'nY� ARMY s•Ye�R+Pi OMPY o �Fy MR�P�9�A�a M4. r Rss �iDE>�v X a TREE.n } +9! 2V' QoA •Rio-oo. v&7 o =� r`` MAF, - -r_.�_TM EP ENT
FENCE /yo, 4,9'
.�' r•C SPIN FENCE
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O.e'N. lJ
�' 3.15. sIIED oFEis o.zw.
MIME 3.4M.
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PIFPMED N ACCORD= ARENAI
OF BEDROOMS m SED 176.1 5' • x TRF 1W EST/RUSHED
a bS 86'58 w;,. ��.�'oR"MDxAAOE°P1 o
EXPIRES THREE YEARS FROM DATE OF APPROVAL � ��<. /� 40
Trs,a.-•.-w..� �- - {`,\„O. i= D f`zt„Tl i w. 1 co��l�QH A.(�a��
PROPOSED SEPTIC SYSTEM DETAIL (r - I�,r S \ t o r �7, r EDWARD W. NIXON V�O -,.;,40
.
g GLORIA T. NIXON saY,•II'1.4
HOWL RHI m soNq WELL r �Vil
_ �u� �a•� /•+ �1- DWELLING �.ra��
u• ---I t r a �y f\��C CC! GSA (BEING CONNECTED TO PUBLIC WATER) • 01. O /,��
TOP EL PS -1•INC MIP EL if ,w 3 .q i�+, Ot"
4 oa A
to»c - T •/-a auN ��1.5IL �.rL.)Q l •Tif•F 4 N.Y.S. Lic. No. 49668 j
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1 a�U 1011*UNAUTHORIZED ALTERATION OR ACOMON
S3�)I.�JJHL ro=1not GRAMM Land Surveyor
I
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10 ZZ I Wd h V 8tl50 CESSPOOL
COPIES OF RRC SURVEY WP NOT REAMS
OR
SEPTIC TANK(11 EM LSE A RAKED T >CO OR
Aa A,a I PLUM=ar .LOW a.ew LEACHING POOLS rs •'O J1S
TRE A SGL UEC NOT RE CWSOEI®
max'a�ianwif- rd ss ) -` \1 TO 9E A VOID NUE COPE.
S r.M A I a!emme sem a Mr 1 s 70 9 f s,,� I r Mk Surveys-SIrbMNaonF - SR.Pions - Construction Layout
OW�4 TILL NOR A 111••••=.0311:1r7 Zr.rlx a P+o fP ma a I `aaA i No.r Y n y I,. `, 0011112 IONS WrA==EON SIAL Ow
".NaO°�'•':k'1oi ii.a AS:""v+a� "� L wools� or I..w�aPC[ q r� 10 ONLY TO NE PERRO Fal TOM ME sonar
, L.Asn rNL OP SOLS Mrr s ow a wow. sr es AI�J� a�y�.OM 011 MS r ro PHONE(516)727-2090 Fox (516)722-5093
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Ra L> w w Sao aI aW�°a�»'�'=on'o/'5 a i Ir..............v..POOLS wo V=IBC Mu.IR VIP= THE EXISTENCE OF RR=OF WAYS TIC
TITLE ' •OPTE=ED 111 AGENCY MD
w r r uveae IOMmI Au Inure IONS 00 pNc pr reu t Irro.m 10 TIC el IONEES TIC LOOM
460 OFFICES LOCATED AT WILING ADDRESS
a•It MAMA eeaa!NM NM CO MO INC eau t aaNUPa. AND/OR NR OF RECORD.F TO THE A9SaEFi of THE INOT 11 Nm-
ANY,NOT SHOWN ARE NOT GUARANTEED. 10110».CFRIRIC'A1pNs ARE NOT 11VPISF1OONE Orro Union Square P.O.BOR York
. 1 '� AgNOogIA,Ker York 11931 R'IVM11AaO.NMA Ypk 11901
20-152-1
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