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ELIZABETH A. NEVILLE 1,1 `Z`\ �Gy �• Town Hall, 53095 Main Road
TOWN CLERK p r P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ;` ; Fax (516) 765-6145
MARRIAGE OFFICER (516) 765-1800
RECORDS MANAGEMENT OFFICER `� �fO �0111� Telephone
FREEDOM OF INFORMATION OFFICER 41 `►1/11
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2190 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : E. BROHNELL & KAREN JOHNSON
Address 1 : 3 COLDPORT DRIVE
City St Zip HUNTINGTON 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 #R10-99-0189
Name Of Owner BROHNELL,E & JOHNSON, KAREN
Mailing Address 1 3 COLDPORT DRIVE
City St Zip HUNTINGTON NY 11743
Property Address 1 4001 WELLS ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 1 lot 9.004
Cross Street WELLS ROAD
Building Permit Number Cross Reference:
Issue Date: 11/17/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 01°S
,h`Z` Gy: Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
1 CA
REGISTRAR OF VITAL STATISTICS .y Southold, New York 11971
MARRIAGE OFFICER `� 1 Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER �y4, 40.1Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .'�I '/*►,►0
ot
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 15, 1999
Transmitted herewith is a copy of application No. 2279 for a Cesspool/
Septic Tank Construction Permit submitted by:
E. Bronnecc & Karen B. Johnston
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 recommendations:
APPROVE
DISAPPROVE
Comments:
gnatur
--
1( 1t6. 1
Dated
-
N
OFFICE OF THE TOWN CLERK 1,. cAFFUL/-n
TOWN OF SOUTHOLD $,�'� W Application No. ,Q .7�
ELIZABETH A.NEVILLE,TOWN CLERK ' -
P.O.BOX 1179 } .04.ItConstruction v
SOUTHOLD,NEW YORK 11971
Alteration
s 01
Telephone O,j� �0-1: $10.00 -Residential �
(516) 765-1801 - �1 4�,,"' $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE //- 45-- -
APPLICANT NAME: 1. 7e70NNEec 1 / S. J jJ7 1
APPLICANT ADDRESS: .3 Cocom -T- ISI✓E
AiAiTI�m-To,.) Aiy 1174-13
SEPTIC J CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Ari uca,a-r J k1 O)Kf ?n Co.5) acr n 1= 385e-{ sq. �. (s ,ter)
2-S,ag.y A0 E. (ci ' ett bo,�f, A t 28/5- 54• Fr. PZIve&-'ay1 q t goo -S- Fro& / l✓A 4/CL-C. C fyr- v.,_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 'jpoN.✓cec.. 1 4a 7 -3-0,-.-077)`-�
OWNER MAILING ADDRESS: 3 Co -r..0 car De, ✓i
j/v,.rr,.. ---To A) ,i y /(7q3
OWNER PROPERTY • 'DRESS: c 'A'to .).P Ca rA7- 4J 7-0.G✓.
L4 co I W e 0.0 ''-' (4D - - ?a I-IEcc.f 7oA.�) J P.��
TELEPHONE NUMBER OF CONTACT PERSOIV:IC)537-.SAGO (5u .6gK- ►,02o�, <'-)`14T)
TAX MAP NO. : Section O g 6 Block O / Lot 0 ?,e/
CROSS STREET: A A
.41
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ 411-34/t
�/ Signature of Applicant
RECEIVED BY : /�
Town Clerk's ffice
DATE: // 6---/9, '
12
yll
___— WELLS if7
e
Young & Young, Land Surveyors i"i
SECTION SEWAGE DISPOSAL SYSTEM
1 Z Young 400 Ostrander Avenue, Riverhead New York 11901
b
goung =— — — ,G 516-727-2303 a
V7 ` Alden W. Young, P.E. & L.S. (1908-1994) X1;
`5/ Howard W. Young, Land Surveyor
�onitg jam[ r �F- Thomas C. Wolpert, Professional Engineer o
n,^ c^• J+,�$` � e5 John Schnurr, Land Surveyor
',1-� N O �+5 P` ' 1'' .;e,l�\5�tvtc I
gert tLmuny ! E,...S �" a �,,._., �i•
/ HEALTH DEPARTMENT CERTIFICATION ��In 1n.rrin ,�GAL. ,,., �; ..1�.,5 PLEASE NOTE •
j�
6nrorying L-----_ ��°� Minimum distance between well 6
534'55'31"E �P� and cesspool is to be 150 feet. §i.
e(\y c. 0 55.35' •�O
Ot FO( JSti, �� dot `\N34'5531"W35' 8 90' '1`4 GtR'W1(.4+11010 9.y
h i bio O!` • WE HEREBY CERTIFY TO E. BROWNELL JOHNSTON Z8
SON Ona tl SOC l S34'S5 X35' aJR. , KAREN BREKKE JOHNSTON do FIRST
Pe::: ltp '' PR Cf,90*
s AMERICAN TITLE INSURANCE COMPANY OF e'
13"; ' %A E:)frL .� NEW YORK THAT THIS SURVEY WAS PREPARED IN `b
e ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND SURVEYS �e
OE NPS 360�Ofi o p ADOPTED BY THE NEW YORK STATE ASSOCIATION OF li
R )1119
GNt• � ,�86 - �_ O �; PROFESSIONAL LAND SURVEYORS.
\e,:„:„...„---100.6 ,2 A...111919.9911919.919. ig
'5 \<, I J O 7 `i v.
55,.; Ey>91\ \y " e `•Y ! - $UFF�'T 77;:- \ ^`.. ... ;z
1 _ 150 ,/ e //Fr-Y
hj•,��w ® iA0 0. ®" 8 751.: ! lh- �L.1 z -
"/5556 A3\3/ / O ( 02 A �O`y�° - -(`- h m --_ - _
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TEST HOLE �` -
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EL=7 0.5' 0.0' 05F'O�pY �j '�5\6 / I l.\ '// /� / w II • �� 4.,-,. •
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LOAM MON TEST HOLE Os �, _-i `:a 'sem - _ �ih:S 0 Y$5
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10----- -V / 'o, o "- j(E'P S*+ O. ...�.�. - i/J�--► �!_ b `
GRA & PROPOSED �/\ I ES-e / i I •., -:YOUNG.
'' .�F-s-- ' "y"I
GRAVEL POOL, - i-\.. , �R / PCEE N -_ :' 6,'� $ .
, HOWARD N.Y.S. L.S. NO. 458 \ 49
Lot 2 • 3C",,101 v ON
EL=OS 10.0' G.W. O CC' 51 / o �
(Vacant) c. P,- 7,;,:.. S,P1 C 1D C°N SURVEY FOR -
SAND & �� � +.
GRAVEL — �Q. N E. BROWNELL JOHNSTON ,R. & KAREN BREKKE JOHNSTON g<
20'
LANDWARD LIMIT OF TIDAL
As DETERMINED LOT 1 "RICHMOND CREEK FARMS, SECTION 2" `g`
WETLANDS \'' E3;
BY YOUNG k YOUNG �� / At Peconic, Town of Southold bye
�-' `=� 232-5'. Suffolk County, New York
�.•— N 44425°5" W County Tax Map of tact 1000 section 86 Blo k 01 Lot 9.4 gets
— _ � TITLE SURVEY 1 g-s
H.W M = MONUMENT SEL J
ALONG APPROXIMATE o
TIE LINE II = MONUMENT FOUND ADD CERTIFICATION AUG. 26, 1999
AUG. 24, 1999 .6
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A= STAKE SE ADD PROPOSED POOL gne
EEAUG. 19. 1999 0
NOTE � HMOND �RPROPOSED LOCATION OF HOUSE `
pIC A= STAKE FOUND MAP PREPARED MAY 27, 1999 Y„
AREA = 2.8926 ACRES f` -_112_ = EXISTING CONTOURS — '�a
• SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF —(112)—= PROPOSED CONTOURS Q4.2 1
SCALE 1" = 100'
SUFFOLK COUNTY ON MAY 18, 1999 AS MAP NO. 10282 112.0 = EXISTING ELEVATION JOB NO. 99-0333 re
(112.0) = PROPOSED ELEVATION DWG. NO. 990333 3 P