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ELIZABETH A.NEVILLE ��h`Z` am► ` Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; Fax (516) 765 6145
MARRIAGE OFFICER ` Tele hone (516) 765-1800
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RECORDS MANAGEMENT OFFICER
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FREEDOM OF INFORMATION OFFICER Q *1 **sell
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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. 2064 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC
Address 1 : 2042 NORTH COUNTRY ROAD
City St Zip WADING RIVER NY 11792
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 #R10-99-0046
Name Of Owner POCILLINO CONSTRUCTION
Mailing Address 1 31 TENNYSON AVENUE
City St Zip WESTBURY NY 11590
Property Address 1 AUGUST LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 53.00 block 4 lot 44.019
Cross Street KERWIN BLVD
Building Permit Number Cross Reference:
Issue Date: 5/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� �0 Gym Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
(;:25 z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS (?
MARRIAGE OFFICER Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER Telephone (516) 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: May 3, 1999
Transmitted herewith is a copy of application No. 2150 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes
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:
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Dated
5-14/4
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OFFICE OF THE TOWN CLERK ,,''',,,,"" _ -�,
Town of Southold .'�.1�j��VOLke'� = Application No. ...,/ `� G�
Judith T. Terry, Town Clerk ����� Gy
Town Hall, 53095 Main Road ; ' !� ; Construction
P. O. Box 1179 `s o rn ; Alteration
Southold, New York 11971 �� //------
Telephone
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Telephone O.y,�, ����i' $10.00 - Residential C/
(516) 765-1801 = �l * r $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 i
APPLICANT NAME: 5 ut/J/4' '‘fifl--k-ZL'o
APPLICANT ADDRESS: O l� W6-11,..S Ir ^A ` :1-- I 11 �--
SEPTIC CESSPOOL V
DESCRIPTION OF PROPOSED CONSTRUCTION ORATERATI
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST CTIO OR ALTERATION:
OWNER OF PROPERTY :
OWNER MAILING ADDRESS:
OWNER PROPERTY ADD: SS: / / ,
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TELEPHONE NUMBER OF C•NTACT PERSON: Z 7" 57
TAX MAP NO. : Section 0BI ck 6 Lot _ //
CROSS STREET: CG..W.44--
BUILDING PERMIT NUMBER CROSS REFERE e :
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Signature o Applicant
RECEIVED BY : /4l (52-_
own Clerk's Office
DATE: /?
THE vvA-mR SUPPLY&SEWAGE
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DISPOSAL FOR THIS RESIDENCE
WIi L CON FROM TO THF STAND-
JOB No. AUG-17 ARDS OF THE SUFFOLK COUNTY TAX I.D. No. 1000-53-04-44.19
ULI'I.UI- HLAL1 H Strivwt5.
AMENDED MAP
R BAY ESTgTESoF ECONtC
S 44°12,4Q„E 175 00,
94.3
EXCAVATION INSPECTION - . -c
FOR SANITARY SYSTEM
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SINGLE FAMILY
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JEEPric LOT 18
LIFir--25.00
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TEST HOLE 956
LOT 19
5/13/98 '
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ELEV 93.9 J.1i-� 4,-,',..-..,. N 43°09'40,, 95.2
1' •
OL LOAM -_.i , . w 15000'
ML LOAMY SILT `
3.9 SM WL SILTY SAND ,:j�i� AUGUST L
SM-ML WATER IN NE [50,1
6 SILTY SAND
�iMilkCo.Dept of i'�"' l th S@N 95.0
WAT `'tttii'°RfrfE;ltal Pi`t ie jE 25
SW SAND/GRAVEN R CONST
12' FILE MAP NO. 9107 6/03/91 VACANT
GROUNDWATER AT ELEV+/-90,0
Unauthorized alteration or addition to this document is a violation of Section 7209
of the New York State Education Law.
Certifications indicated hereon shall run only to the person for whom it is prepared SURVEY OF: LOT 17
and on his behalf to the Title Company,Governmental Agency and LendingInst -
se ion listed hereon,and to the assignees of the lending institutions or
MAP OF AUGUST ACRES, SECTION 1
subsequent owners.
Copies of this document not bearing the professional's inked seal or embossed
Thelshall ffsets°tbeime�dorsdsvo shownhereonARSHAMOMAQUE, TOWN OF SOUTHOLD
The offsets[or dimensions]shown hereon from structures to the property lines are
for ac specific purpose and use and therefore and not intended to guide the erection of SUFFOLK COUNTY, NEW YORK
fences,retaining walls,pools,planting areas,addition to buildings or any other
construction.
Theexistence meed. fight of ways and/or easements of record,If any,not shown are SURVEY DATE: 2/19/99 SCALE: 1"=401
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CERTIFIED ONLY TO: y�P,�k OF NEeo9
SCHEMBRI HOME DESTIN G.GRAF\'f'' DESTIN G.GRAF
cr, LAND SURVEYOR
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v5. 1 ;rr. 73 Woodlawn Road
• ' lii#o "• 4,J Rocky Point, N.Y. 11778
By DESTIN G. GRAF N.Y.S. LIC No. 50067 .90� fONA `�,�O 516-821-3442