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ELIZABE'T'H A.NEVILLE ���� , _-47.4
TOWN
Town Hall, 53095 Main Road
TOWN CLERK t w., ; P.O. Box 1179
, ry Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER er �1�
RECORDS MANAGEMENT OFFICER �s $;,60° 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. 2545 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : TED HOYLE
Address 1 : PO BOX 1656
City St Zip SOUTHOLD NY 11971
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 #R10-99-0095
Name Of Owner HOYLE, TED & RAY RODRIGUEZ
Mailing Address 1 PO BOX 1565
City St Zip SOUTHOLD NY 11971
Property Address 1 460 ANDERSON ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 2 lot 2.001
Cross Street HYATT ROAD
Building Permit Number Cross Reference:
Issue Date: 4/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
tie"
ELIZABETH A. NEVILLE tl j ;'y.:, R 3 ® 200i Town Hall, 53095 Main Road
TOWN CLERK
y ? P.O. Box 1179
REGISTRAR OF VITAL STATISTICS d' �� - -_��—(�=--"—Soutliold, New York 11971
® 1, t'9 EPG.f1�" i•
MARRIAGE OFFICER i- '0. "'TOWN�� ,r`?UTE2i's Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �Q �,o-yOTM• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 1 �� ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 30, 2001
Transmitted herewith is a copy of application No. 2633 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Ted Hoyle
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
44 /0
Dated
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OFFICE OF TEE TOWN CLERK 1'�'C��FFULKG . -(R3
TOWN OF SOUTHOLD ,��O `l(•QG Application No
RT.WABETH A.NEVILLE,TOWN CLERK 1�
P.O.BOX 1179 . Construction
SOUTHOLD,NEW YORK 11971 , 0 IP T Z
Alteration
$10.00 -Residential D�
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04, Off,��
Telephone - �
(63t) 765-1800 -=��1 0 - $25.00 -Non-Residential
. _-- -.,,,,''
TOWN OF SOUTHOLb
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 3/19/di
APPLICANT NAME: 6'ed- )
APPLICANT ADDRESS: 1? a• (G /65'6
4 e-7A.�,4a , Ai }`' !1 cl p •
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
----Ne44 11-,---(4,0-e — 4.7 a 5' • it 1.- is,--A-9-24/-e-fe- Ali-) f-e-v-4 LI 3its slit,
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ad., I /R - .L
U
OWNER MAILING ADDRESS: PO i3 ���G
ov.rLi , N « q7/
OWNER PROPERTY ADDRESS: z71(-00 047/1-6 fit 6'0)2 RV ,
(��v-7-a Lai), A/. y i( f 7
TELEPHONE NUMBER OF CONTACT PERSON: 77.5'-•3b'd3 on. 1/A. RIS &k7-9
TAX MAP NO. : Section Sisi _Block CZ Lot 2, /
Hy/9-i CROSS STREET: .
BUILDING PERMIT NUMBER CROSS REFERENCE:
>to
Si natur of Applicant licant .
. 9
RECEIVED BY: T-7Clerk's Office r
DATE: 77c3--•- 7 ••
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e4, SUFFOLK .COW4TV, NEW YO2.RK. $• •
� S.C. TAX Nb. L13C10=t4'r-02:=7:1 ',
4 9 . SCALE 1"=50' '
/; o ,r�N MAY 3, 1999 -
/ JUNE 6, 1999 ADDED NEIGHBOONG WELLS &•c*$SPOOLS :• ,
N a JULY 9, 1999 ADDED NEIGHBORING WELtS & b POOLS,
S• 6:5`• 4' AREA = 51,970.10 sq. ft.
• #� 6, a 1.193 ac. . .
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TEST HOLE DATA 0 s,,,•
(TEST HOLE DUG 6Y McDORALD DE0cYTHTS ON MARCH 28. 1998) X04
W././I. +wow aAm LOAN DL J•
„�\\ eROWNwMr CLAY a `S
Fly eROM FINE To sum,wmi los cam Si. 4y' ('�
' :• BROWN cum sum AMA l01{CRAVTi SC •e>' ...;5- 2�`sd ♦ S •
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,.,Si8i RALE BROOM FINE SAND SP 24. tNw61
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-EXCAVATION INSPECTION REQUIRE .1Av , `' +r
FOR SANITARY SYSTEM 9� GO �41OaC4A� 4. O
`� 04S �P\' •
•!�a BY HEALTH DEAAR ;6ENT 74s�t O,AG .' �g � I $. 4!04 X440
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BOZESL PA: til �,ritt
1. E A NS ARE POUNCED TO ASSUMED DATUM •M FI171' •
EXISTINO ELEVATIONS ARE TNUM J09 R� . �� �' '
2. MINIMUM SEPTIC TANK CAPACITIES. A.1 TO 4 BEDROOM HOUSE IS 1,000 GALLONS. A ; "i • 0
1 TANK: 6' LINO, 4'-3' WIDE, 6j7` DEEP
3. MINIMUM LEACHING SYSTEM rot AI TO 4 IIEDROIM HOUSE IS 300 .q H SIDEWALL AREA. A * �]�� 1
1 P0014 1r DEEP, 6' GIG. I f,
PROPOSED EXPANSION POOL - i!n• A - ' N.Y.S. Lk..No.-49 •
;% PROPO§ED LEACH1Nb POOL OMON
To A VIOLATOON OR ION ��,,,,
//r �11j 1:_'-
SEcnaN 200 Or THE NEW YORK STATE
®PROPOSED SEPTIC TANK COPIES OF LAW.THIS SURVEY���pp SEARING
Jo ; A A. 7 e O
4. THE LOCATION OF WELLS AND C�lSPOOL4 REACH ARE FROM FIELD THE S ITR(ED, oR
OUS@RVATIONS AND/OR DATA OBTAINED FRi�ES, SE T�� �UNLIE COM arid U '�
6. THIS FROPERIY IS SHOWN AS ! Oii • -
ife OF LAND MADE FOR IRLES,R. 11P1'118RSI OON CERitha+TroNs II TED HEAEON SHAU..RUN
APP O DY PLANNING BOARD TOWN OF SOUTHOLD ONLY To THE-PERSON.FOR*MOM TRE,SURVEY
ONS • EMYER 17, 1979 IS PROWLED,*MAN HIS DE Mtf THE
nigmom,osiVFRR+Mtsriv. ANO Tills Sdrveys - SUbdAdtidrt* - SA Plane - tindtiubtl07R'Leyouf
6. THE-PROPp D-SEWAGE DISPOSAL SYSTEM SHALL t!E ErFECTTVELY DUG•O11T, DOWN TOLENDING oisThutION usTED HEREON.AND
ASIX (d),r00T STRATA or ACCEPTADLE SAND AND-GRAVEL, FOR A DIAMETER SIX (6) FEET T 'ARE Nor� PHONE (518)f27-21)9G Fa (5j6)y22'5093
• GREATER THAN THE LEACHING pool .
7. AREA OF EXCAVATION TO SE BACKFILLED WITH ACCEPTAb♦LE SAND & GRAVEL THE EXISTEN OF RKN1T OF WAYS 0. S.C.O.H.S. REFERENCE NO. R10-90-0066 AND/OR I�I7S V REMO, IF .- OF1ICES LOCATED AT MAfUNC ADOt!!
ANY, NOT St10 ARREE NO GUARANTEED. • One,URiori Squar6p_•0. Box‘431
• - - ' =Aqupbog6e, Nell YorE 11931: iN6rheed, tAdir Yak
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