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tta ` tc m Town Hall, 53095 Main Road ,4 P.O. Box 1179 ® � ,��,����• Southold, New York 11971 JUDITH T.TERRY Is ot° TELEPHONE TOWN CLERK —"wav io (516)765-1801 REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 435 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : RILEY, ANNE K. Address 1 : 333 PEAKHAM ROAD City St Zip SUDBURY MA 01776 Descripton of Proposed Construction or Alteration NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM. APPROVEDAS SHOWN ON SUBMITTED SKETCH AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ON 11/29/88. Name Of Owner RILEY, ANNE K. Mailing Address 1 333 PEAKHAM ROAD City St Zip SUDBURY MA 01776 Property Address 1 420 ROGERS ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 66.00 block 2 lot 15.000 Cross Street HIPPODROME DRIVE Building Permit Number Cross Reference: Issue Date: 12/08/88 Judith T. Terry Southold Town Clerk rb-s,g©Tcg[71-grq-----S €�u � r L\SBLDG. DEPT. —...1 �. �''zj •yf T TOWN UP SOl9TFfOLD cr Town Hall 53095 Main Road ® ��� P.O. Box 1179 � a =_�® �` 1 �� Southold, New York 11971 = 1z � JUDITH T.TERRY �Ao.z„„i,� TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Victor Lessard, Southold Town Building Department From: Linda Cooper, Southold Town Clerk's Office - Dated: December 6, 1988 Transmitted herewith is a copy of application No. 442 for a Cesspool/ Septic Tank Construction Permit submitted by: Anne K. Riley' 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: qa A.....,..LL. o,.l caret cS-- 'Z lc.. c1.,-„S1- Q-1 tru-2-g- It\zsc\\11 -U-1/4- , % R, WiLa212,Q, si_ Nci ___. . (17.0frc.)._.k, ...0.----J.-2 O.&SL. ci) ._.„ Signature 11._.\ -1\si Dated OFFICE OF THE TOWN CLERKC$FQUr Town of Southold r � COJ� Application No. yy.z- Judith T. Terry, Town Clerk 1 Town Hall, 53095 Main Road _cr3Construction c/ P. O. Box 1179 Alteration Southold, New York 11971 Olt 'e " Residential ---""Telephone (516) 765-1801 Non-Residential • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee •$ /6 oy DATE �-C- � ?e APPLICANT NAME: Ay 6 JE Li APPLICANT ADDRESS: 3 171.-=_--174K h o'1 � d (0vtek,i , !'}SGL O077L7 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /V)L-"-i 5 i'rel ci l L= -ct4 i c d 1 ! 101 LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: hJYU�= OWNER MAILING ADDRESS: 3 3 3 PE K h i HC) -dbU 12,ui , c9 OWNER PROPERTY ADDRESS: 1-,/c�O •�O c141 © i d ►\l C' l 15 7 TELEPHONE NUMBER OF CONTACT PERSON: CS6g- ) 4/4 3 —6 e g---- TAX --"TAX MAP NO. : Section e966''0U Block CV '00 Lot DSS, OD O CROSS STREET: /-i/ Pp OIJ(rint/n DIQ1 U� BUILDING PERMIT NUMBER CROSS REFERENCE: • Signature of Applicant RECEIVED BY:4 -L - Town erk's O ' ice DATE: Lj:(; ( UWE_LiNG , c_v ( „E__,,,3i i1 j;_s, the applic,?.n i-4 ire3pol ibiiity fo i maintain adequate ,erftary d1St3nce I between all water sut ''oly alit! -v.v:-? , disposal facilities. N. PP Pi•_EASF NOTE AREA = 7, 888 SQ. FT. p� Y._� ., :•;,` ui e: septic farm cover to grade. The !rater supply and sewage disposal `� �/_ _..___.. •... systems for /his residence will conform -----'----"'"-----"SU R V E 1 O F to /he standards of The Suffolk County Department of Health Services. L®1 6 MAP OF BEIXEDON ESTATES , BLOCK 4 " Prepared In accordance with the minimum F I L ED MAR . 16 , 1946 FILE NO 14 72 standards for title surveys as established by the L./.A.L.S and approved and adopted for such use by The New York Stale Land AT S 0 U T H 0 L D Title Association. 7 I TOWN OF SOUTHOLD' SUFFOLK COUNTY, N: Y TEST E 1000 • - 066 - 01 - 15 DATA --DARK BROWN LOAM s• SCALE I = 2 0 BROWN saivY Loam 0• SE P. 29 , 1988 PALE BROWN LOAMY SAND 3• PALE BROWN COARSE SAND 132• WATER IN PALE CERTIFIED TO BROWN COARSE sAno 17LONG ISLAND MORTGAGE CORP. AMERICAN TITLE INSURANCE COMPANY a -. / ANNE RI LEY / N.Y.S. LIC. NO. 49616 mac:; ... . �' J �IC( kiiikYORS, P.C. /Vole; �x,s>'ic), i'/% / /,_,_G GC,i1e,A- or rci' �c,tc A e -Vii-- k 7 MA(,l 9 s . /O /ru.+-, Se;_)t c /4�.•01<, /co, /-, f r:J :/s ► r D or /C c r, ,---1-, ./- ;,,( a 0:a1 11971 r NA 4 - ELEVATIONS ARE REFERENCED rev,/ '� d� .11- 4/0 , 8 ihQ' . TO AN ASSUMED DATUM. renis£ io �� 88 /etc.' eo°') pF E 7 ._ The locations of wells and cesspools shown hereon are from field observations and or from data obtained from others. `\-;\C\o • r � r,r, T3s-r-' : SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES LC s •a /( y \ .+>. 0.17;FOR APPROVAL OF CONSTRUCTION ONLY : j001101A ' --41 14.1T"� i DATE \\1��\ HS REF. NO. <)��v NOV1L\ 28 X88 , APPROVED �� F _. �1�3I S1i�i1(�CrS J LOT 10 LOT 5 W ( DWELLING ) ° ( DWELLING ) N. 60° 20140"E . . . .D . 116.00' _ - FEN \ - _ ASPHALT - RIVEWAY . . W1 GARAGE N - 18 ` I 13\7. 3.(� \ el 15 \\ -- rcm `, � - .� CM el. 12 6 ----..— .--- - ----- --e1-P1 2 -- ‘ I Pr°P 2c-'-' 54 Ft I /0r6,p // ye ' _1 C_)F:_..5) \ if 8- 0 \03-- r• fie//is _ p w V\) \- 2J a ,54,CF-, I- r, w Qo�d/>`/ort 12 3. F- cn o LOT 9 LOTS 6 3, 011000.t , 900 _ J \ Sc �� C W W (-BiYE LLING ) 3 a ( _ EXISTING r` ; I STY FR r' 1- a CPS.r� �� es d HOUSE m f� �/� W 3 ; { LA s \_ \ o J \ -I-..be f‘11ed"� ENCLOSED F F = 1568 o ' - in oC re".""sic PORCH N ____________,,..-----7------01,J ,irop /_ r., 0 SP1 �^ r N V ' rn ��� M "' O II'' ' 8 0 4 5 2 0� ® m yECr w r TEST Z \ 'RFS ; 12 3 I HOLE N - O O el 13 3 Uj w FEN C(.I �_ WOOD 0� + 3 I2 W t ® 0/L N/S el 11 5 CM FENCE CD J OH WIRES ? el 13 4 PIPE el 13 41 —iii . i i ) 8 I' / i i i Iis'Z 3 - GARAGE 1 GARAGE zo. W 1 t S. 60° 20i 40"W. - • .._116:O 0-,,..,,�_...-�.---•. .�_-......,,.�..r..._r-.-__�,w.�_,.,...r. i I PLEASE NOTE LOT 8 the 1�{�v f7p �e p �y j 9 $ 'r' OT }t is the aDpl csInr_ , 1 i e 3pons bilitl f 13 I UW E'_LiNG ( OW E__iNG 1 - • 3 maintain adequate �ti'•r?it.,,ry r!;�r- J 7 No i1,1Jtw-,Pi M QT i"rr16,, ,-� t, _ ' ' 1` a