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ELIZABETH A.NEVILLE d � j3"'' `_
� ,, 4. .
,� �� Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` 4, - ,1 Southold, New York 11971
MARRIAGE OFFICER y 1) Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �; ®� �2 ���'�ii'� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `zs' �.
OFFICE OF THE TOWN CLERK
SOUTHOLD ilitAIMAIDATEIRTETIMPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2618 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LANDS DOWN INC
Address 1 : 855 KNOLLWOOD LANE
City St Zip MATTITUCK NY 11952
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 #R10-01-0122
Name Of Owner JORDAN, THOMAS P
Mailing Address 1 PO BOX 180
City St Zip MEDFORD NY 0000
Property Address 1 360 PRIVATE ROAD #31
City St Zip SOUTHOLD NY 11971
Tax Map No. section 77.00 block 3 lot 23.000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 7/24/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
„,,,,,,,,,,,,
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK ; a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS iso ivy Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ® ibt®i11 Telephone (631) 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: July 11, 2001
Transmitted herewith is a copy of application No. 2706 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Lands Down Inc.
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.
-%\?s. A,”
Signature rr
I I
Dated
OFFICE OF THE TOWN CLERK ,1''��F�
TOWN OF SOUTHOLD ��'OUCOG 7.61bApplication No. or �
ELIZABETH A.NEV1LLE,TOWN CLERK
P.O.BOX 1179 , Construction
SOUTHOLD,NEW YORK 11971 p • T ; Alteration
to .'�. •
Telephone ,y�o ,t0`C,' $10.00 -Residential
(63t) 765-1800 -1 1'.° $25.00 Non Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE (11 01
APPLICANT NAME: LAIJ D$ VoLL ) 1J C .
APPLICANT ADDRESS: k6s--
iJ'In71i 7 ee, 95-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION e-s`t/SrAij/ ,C}
X/ io ieD or-1��757-C 7- Dc=P% 4othcie-i)
Se TiAz A /�.5, ,L1/ Ote, e-e--/ _(,Vekv eusreatr-,o )
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:11,0m, pu-orcuti ,
OWNER MAILING ADDRESS:PO. fm< Ig i-Lf'fOy; A/.
OWNER PROPERTY ADDRESS:3(00 'PriVotk
'0L+1i() id ( f/ 7 ! / Q
TELEPHONE NUMBER OF CONTACT PERSON: 6-A,'67-a ,Z98-/666
TAX MAP NO. : Section 07iOO Block 003,00 Lot 02-3.000
CROSS STREET: ,L®,Qr*- OAtrOec.a. gy041)
BUILDING PERMIT NUMBER CROSS REFERENCE:
II 7
Si•/'ature o .licant
RECEIVED BY: (9-6c�
Town Clerl�'s Office
DATE: - y/ -0l
,), l LOT AREA= 33.468 sq. ft. cesspool
' , F:FLr ELEV.= 29.5 WELL I TEST HOLE
GAR. ELEV.= 27.5 q by wcDONALD OSOSC C
1 I (5-4-2001)
+,
J _H -.. I 5'1dai* brawn randy loam
Lu o DWELL. - WELL TTY .
WELL 62
I NOW OR FORMERLY WILLOTT 3• brown loamy sand
I
C9 \ —
Z brown silty sand
3 30' PRIVATE R.O.W. DIRT DRIVE
DIRT DRIVE — —
S 7225'30'E 139.66' 12'
SET A SEP 1
STAKE (24.5) 1 (19.4) STS pale brown fine
it to medium sand
o prop- e'
p 3
g 1
�1'. Q
(16.0‘44111
F, ces Ole Cv p
i�. w
j
1O NOTE: LOCATION OF
..\-- (I Akeir Cc ANADJOI4RNERS WELLS AND
0- CESSPOOLS HY OTHERS
^ \a i ‘41:4111% u
q €�
ci p \ \ �7.5) (27.5) r'�'1 ,
rn E. 43 _
--141-- n v� 2 >• t \ DI RI
RI
cr 0 prop. PROP. N W CJ r f j b
a. ~o septic tank (IN
DWELL M Hw�yy M 1 � (.1 , r„ 1
O Z 1.ry "� , v 4�
PI Ut-x -� ` est ;
v GAR.5 �'� \ 3 �'-
w 1 _ \ 2
61.8' 34.5' Ci
(27.5) -4
I-- (27.5) O O t
I.
wre i p O 44 �' L4
`f:: 1...,
A Imo, g
L — prop. riveway F 1 ` , W
ti _h g E u`" ).
tui
Ili, W o r4 0
TTS
�O �5.4'N. [?•�
6' N. 5 Qa El
(30.2) 0.2'N. Cil (2910 ES �i�jj , r, ^�0
FI) • FR ( COMMFD l -II ® co
PIPE SHED N 7225'30V 139.24' SLAB PIPE rsj
n x"11 I
NO OR FORMERLY WEST ++ ^ , >i�
DWELL. - WELL d CD
ri
WELL R I'..,-c€ )
v rn
ceasp I -lc, 2sa Com.
rnrn Om
NORTH BAYVIEW ROAD
-ern C a '-'11THE OFFSETS (OR DIMENSIONS) SHORN HEREON FROM Ills STRUCTURES 10 THE --I Co ( —�
PROPERTY ONES ARE FOR A sPE IPIC PURPOSE AND USE Ma THEREFORE ME NOT JOB No. 01-129 FILE No. 767F
INTENDED 10 GUIDE THE ERECTION OF FENCER, WINNING tt-W-S, NOOUL PAROB,
PLANTING AREAS.ADD(TTON To BUILDINGS OR MY OTHER u. ION. SURVEYED FOR
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOTATTOH OF SECTION
7209 OF THE NEIN YORK STATE EDUCAmow LAVI.
SURVEYMINIMIZES INDICATED HERON
R WHOM THE
PREPARED.MD ON SHALL
NF TO THEE TITLE D THE PERSON �GOYERNT SITUATED AT BAYVIEW
Away AND LENDING INSRNDON MED Hai0DN. MD TO THE ASSIGNEES OF THE
LENDING INSTRUODN. O UARAMEES ARE NOT TRAH xPa.E TO ADDITIONAL INSITTURONs TOWN OF SOUTHOLD - SUFFOLK COUNTY N.Y.
OR SUBSEQUENT OWNERS,
COPIES OF THIS SURVEY NAP NOT EEAWHG TEE LAND SURVEYOR'S INKED SEAL OR SCALE 1" = 40' DATE 4-30-2001
EMBOSSED SEAL SHALL NOT BE CONSIDERED TD BE A VALID TRUE COPY.
FILED MAP No. DATE
CERTIFIED ONLY TO: TAX MAP No. (REF ONLY) 1000-77-3-23 DISK 500
- HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
H F-7-,.5,--„,,-- 9.,
1866 WADING RIVER-MANOR RD. WADING RIVER,
NEW YORK, 11792
HAROLD F. TRANCHON JR. PENN. LICNNo. 21159E 631-929-4695
,