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ELIZABETH A.NEVILLE - -jtf;i7tg `� Town Hall, 53095 Main Road
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TOWN CLERK Ucii-46.wy m ; P.O. Box 1179
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Southold New York 11971
REGISTRAR,OF VITAL STATISTICS 0 ;� ' ,a $ '
."" Fax(631) 765-6145
MARRIAGE OFFICER '�1
RECORDS MANAGEMENT OFFICER =__ ®� �� ,i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2554 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GEORGE PAULSON
Address 1 : 4996 EXPRESS DRIVE SOUTH
City St Zip RONKONKOMA NY 11779
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 #R10-99-0270
Name Of Owner CAPECI, RAY
Mailing Address 1 205 EAST 77TH STREET
City St Zip NEW YORK NY 10021
Property Address 1 GREENWAY EAST
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 1 lot 18.000
Cross Street PARK VIEW LANE
Building Permit Number Cross Reference:
Issue Date: 4/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
IlL16116-.
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ELIZABETH A.NEVILLE / �� Town Hall, 53095 Main Road
TOWN CLERK % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER ®d ,ss22, ��� .�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �gI
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 12, 2001
Transmitted herewith is a copy of application No. 4643 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
George Paulson for Ray Capeci
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.
ignature
Dated
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OFFICE OF THE TOWN CLERK '1114Q�J '
UL/r " 563
TOWN OF SOUTHOLD �� �QG= Application No
ELIZABETH A.NEVILLE,TOWN CLERK �T y /
P.O.BOX 1179 ; F Construction C� F
SOUTHOLD,NEW YORK 11971
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t^_' Alteration•
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Telephone Off' �Q�.�'� $10.00 - Residential,
(63'k) 765-1800 - 1 ,,�� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE 44.- /2- —
APPLICANT NAME: Ge,o/ZGQ- 6 1JS
APPLICANT ADDRESS: 1--( %� )4P/ S S ,012i v� 5 �7'I
N�,vg,- y. •/( 772
SEPTIC IV CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
C vov 5 7-g-v C7— --.ted 9 4 Ie C 01-6(y 3 2
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIONrr�� OR ALTERATION: •
OWNER OF PROPERTY: R y C Pec%
OWNER MAILING APORgSS; X05 5, 7 7 7'
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OWNER PROPERTY ADDRESS; ��.,� �✓ �' -7C��
TELEPHONE NUMBER OF CONTACT PERSON: "73 7
TAX MAP NO. : Section / $ Block / Lot /8 •
CROSS STREET: IK
BUILDING PERMIT NUMBER CROSS REFERENCE:
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ignature of Applicant
RECEIVED BY:
Town C er s O ice
DATE:
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WELL,
3 SUFFOLK COUNTY O$PAR L LO'I `; "
4R7'VOR k$PIt®VA1�OF-CON5TAUC"1'[�N i
MAP OF
siNGi, V ,,, y IDENCE ONLY GREEN ACRES. Tv
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14 o — o;Z • FILE No. 3540 FILED RIL 13, 1962
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APPROVED r� 1
1 -ORM AX MOF. ...BEDR '•M` Mp TOWN OF SOUTHOLD
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1 y RS�ttOM GA'i`E�U �ppR�YAL Ek_�1NG \ r� 42 ,FENCE SUFFOLK COUNTY, NEW YORK
1 EXARES V'HRLE m ..9 13F NC£ .8N ;-1:-
.- S.C. TAX No. 1000-15-01 —18
WN gyp N SCALE 1"=40'
1: �0,+ Ep[E 0 �i..�1,F DECEMBER 6, 1999
m z 40' i. W FEBRUARY 22, 2000 REVISED SEPTIC SYSTEM
j f" s N X oc RGR£Et15 \ , m,� MAY 26, 2000 RELOCATED PROPOSED NEL`_
1 OF
oo Row / o oos-"„t1 JULY 25 2000 ADDED WELL ON LOT 46
- , _� CES• =v1N T. AREA 20,879.99 sq ft.
, EppE of _ O, ` 450, 0.479 ,c.
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o , u11 .� / : \ o r E�,s„N. CERTIFIED TO
; N\ o *EL' - COMMONWEALTH LAND TITLE INSURANCE COMPANY
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�+ , 1 F ,I-' 6 i _ 1 ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM
t �^ EXISTING ELEVATIONS ARE SHOWN THUS 50.0
'70 t � \ /AO i-/ , k�.-h' '! p y 2 REFER TO FILED MAP FOR TEST HOLE DATA
�-t� 3 MINIMUM SEPTIC TANK CAPACITIES FORA 1 70 4 BEDROOM HOUSE IS 1,000 GALLONS
9 1t I / , ]� \ I TANK, 8' LONG, 4•-3” WIDE, 6•-7" DEEP
'-'t , d \ . 4 MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA
t , a $ / \<,,d
y IP I POOL, 12' DEEP. 8' dia
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- I , `6/ / /'t \ N PROPOSED EXPANSION POOL
\, �t _ ••,�.,npQ7l^' wP� `�, PROPOSED LEACHING POOL
m YF , 03O
,..•,, ... • .' I� \ h,%4,.j PROPOSED SEPTIC TANK
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Approved in accordance ,1 0 2 N O 6 E _/` r 1 5 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
0 OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS
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-,. ...,.... .�.- _.... ... .�cc,.� x;��^�j , of �'-3 PREPARED IN ACCORDANCE WITH THE MINIMUM
SUBJECT"Y'�qq,,��aa,, g��Ry�•t�•.+s� p��gN '� ' y�+�y� R�.•3,nffi�e
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� GOND MO f ST Fc0R,TITLE SURVEYS AS ESTABLISHED
fy�'iso 1'F.Zf wd�'2. i t'?Ct3:i.....n d �iJ B St rd'• P FO N " � I H. AT •PROVED AND ADOPTED
Y � �•. 6'27'20 3 \ ''�•�&b1JC •S75F,• `•f NEW YORK STATE LAND
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\ 7\ J/ N Y S Lie No 49668
' UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EP- 001 —{� .. _ EDUCATION LAW J •'seph A. Ingegno
CES`', l�
CONES OF THIS SURVEY MAP NOT BEARING
. LAouslING THE LAND SURVEYOR'S INKED SEAL OR
'-_-_�` s /.W£LL EMBOSSED SEAL SHALL NOT BE CONSIDERED Land Surveyor
O TO BE A VALID TRUE COPY
G SVSPooL •�l .. —
CERTIFICATIONS INDICATED HEREON SHALL RUN
-, ONLY TO THE PERSON FOR WHOM THE SURVEY
AA STI IS PREPARED,AND ON HIS BEHALF TO THE
.--'` p -1-J0
i V T TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout
` T�� �.J�l LENDING INSTITUTION LISTED HEREON, AND
K V TO THE ASSIGNEES OF THE LENDING INSTI-
TUITON CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727
- AIR THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF
ANY. NOT SHOWN ARE NOT GUARANTEED 1380 ROANOKE AVENUE P 0 Box 1931
- RIVERHEAD, New York 11901 Riverhead, New York 11901-0965
— 99-748-