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ELIZABETH A.NEVILLE d�=� •A: Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER \` 47e�11,� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_ ®j 4.„.•i1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER�� •1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2535 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 #R10-00-0140
Name Of Owner SCHEMBRI HOMES INC
Mailing Address 1 2042 NORTH COUNTRY ROAD
City St Zip WADING RIVER NY 11792
Property Address 1 1055 SMITH DRIVE SOUTH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 76.00 block 2 lot 31 .000
Cross Street TERRY PLACE
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETHA.NEVILLE a s =' ; �/ ; Town Hall, 53095 Main Road
14
TOWN CLERK T.,--��_ ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS%! �° �7 Southold, New York 11971
MARRIAGE OFFICER :®4i c g Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 4)7/i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �•11
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 15, 2001
Transmitted herewith is a copy of application No. 2623 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Schembri Homes 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.
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OFFICE OF THE TOWN CLERK ,'1 C l%04 n- / Il
TOWN OF ,,�� /rep-
=� Application No. k' ��
FI.I7ABETH A.NEVILLE,TOWN CLERK /
P.O.BOX 1179 ; /-... _ Construction 1/
SOUTHOLD,NEW YORK 11971 • v • aC t
�.� Alteration
Telephone -- *0
Dif� �Q�oe'1 $10.00 - Residential
i
(631) 765-1800 �l �,,.�� $25.00 - Non-Residential
TOWN OF SOUTHOLD ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE
APPLICANT NAME: ccLa44L
- 14.1/ C, .
APPLICANT ADDRESS: 01 ° Y-„2-- `"/L
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.„;.- AP
WC-43444 / 14, --"'J—
SEPTIC
2 —SEPTIC CESSPOOL ,k. -
DESCRIPTION OF PROPOSED CONSTRUCT ON OR ALTERATION
711-4-J '''"14'1-^'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTI N OR ALTERATION:
OWNER OF PROPERTY: --a
OWNER MAILING ADDRESS: - ' --"- " "-- -//; _-‘, �t'i� •:fe �,,./ le,e
�eT= -s L'/l is5 i-(I 79I
OWNER PROPERTY ADDRESS: / im.�e --/--'=` IUSS ,. S •
0
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 'l,-7 & Block (%)" Lot 3
CROSS STREET: - I , QC r
BUILDING PERMIT NUMBER C'OSS REFERENCE:
--.11 eel' -Ida':
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
RESIDENCE
' RESIDENCE �o�� L 0 T 101 SURVEY OF
SERVICED BY LOT 118 AND 1/2 OF LOT 117
MUNICIPAL WATER 0',,,0 �o RESIDENCE TEST HOLE DATA; 4/26/00 IN
TF`SS LOT 100 ��` SERVICED BY PERFORMED BY : McDONALD GEOSCIENCE MAP OFUGOOSE NECK ,
y��pp 0(�`)1P y� , co MUNICIPAL WATER TE
BA YI�IEW (SOUTHOLD),
of�p�
V32° �2 6 Fp FINISHED GRADE TOWN OF SOU THOLD
U 33• �� IP o ��\��\��\\� �j�\�� BROWN LOAMY SAND SM
UM 1P OOTHE• �Q° �'% 2' SUFFOLK COUNTY, N. Y.
POLE
d POLE rri
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- —k O•oo
CESSPOOL PALE BROWN FINE SAND SP SURVEYED FOR SCHEMBRI HOMES, INC.
o •r 118
III
8 \ o/,i`��9�- CESS-00L P/O LOT 102 s.s
RESIDENCE_ '
�Iv , SERVICED Br FM# 1663
p 6' MUNICIPAL WATER FILED NOV. 22 1948
iN \
.•c--Z5.
h° 8 CES WATER IN PALE BROWN FINE SAND SP ZONING : R40
`S'�Op4 16'
\ FD
IP 80
FOR S.C.D.H.S.USE ONLY —
•
\ \ SEPICO TANK `�. O'l� SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
D PROPOSED FssA
TAX MAP Na
\ HOLE I\TEST . SR3O BEDROOM �, 8 ��< 92, PERMIT FOR APPROVAL OF CONSTRUCTION FORA 1000-076-02-31
(---) \
PROPOSED �/ RESIDENCE SINGLE FAMILY RESIDENCE ONLY
CESSPOOLS 2 STORY , V
L o* • DATE I 0-`'I-c3.-° HS REF.NO. .-to-C C—0 14 p
RFSIDE�VCE — SURVEYED 24 APRIL, 2000
RESIDENCE � ' ti° APPROVED_ - 4. '
�J SCALE 1"=20'
0 I PROPOSED
SERVICED BY O 5' 150% EXPANSION / �k 0 4j` FOR MAXIMUM OF_L B .l;+-.OMS AREA= 9,048.885 SF
MUNICIPAL WATE" „ I / 1 OR
l / Q\ EXPIRES THREE YEARS FROM DATE OF APPROVAL
l l` / / 0.208 ACRES
FD
____` cM 5,\\ / o- / : _ P/O LOT 117
/ VACENT GUARANTEED TO
s / <,c)/ �,
15� 4 moo° / oQosi5ti�3h
SCHEMBRI HOMES, INC.
p�� �� Q/ j/� FIRST AMERICAN TITLE INS. CO.
65, <06x O� NORTH FORK BANK& TRUST CO.
0�
Ss
SURVEYED BY
'�s., GUARANTEES INDICATED HERE ON SHALL RUN
s'-'_) \ ONLY TO THE PERSON FOR WHOM THE SURVEY STANLEY J. ISAKSEN, JR.
IS PREPARED, AND ON HIS BEHALF TO THE
RESIDENCE TITLE COMPANY, GOVERNMENTAL AGENCY, P.O. BOX 294
aj LENDING INSTITUTION, IF LISTED HERE-CAI, AND
/ n! - TO THE ASSIGNEES OF THE LENDING h/STITUnON.FERABLE TO NE SUFFOLK, NY 11 •6
MUNICIPALSERWCPA BYW /7i v \ _ ADDTIONAL GUARANTEES ARE N ONSOT rnORSSUBSEOI NT OWNERS. 6 '1-734-5835
WATER � � _
:_ /'eV .�
UNAUTHORIZED ALTERATION OR ADDITION TO THIS R� /�'eV,
i/
(�^ 40"
SURVEY/S A VIOLATION OF SECTION 7209 OF NOTE: 1. 31 AUG., 2000 l'" . SANITARY, WATER SVC. -&1 �L
' � i. r^,' THE NEW YORK STATE EDUCATION LAW 2. 27 JUNE, 2000 REVISE SANITARY, SHOW ADJACENT OWNERS. LICEN:E LAND 7. R YOR
RESIDENCE C)/ ' ;k. , , 3. 21 SEPTEMBER, 2000 REVISE SANITARY NYS Lk,. NO. 4' 73'
z SERVICED BY COPIES OF THIS SURVEY MAP NOT BEARING
MUNICIPAL WATER
-)/ NOT BE CONSIDEREDME LAND TO BE AS SEDVALDAL TRUE�L
COPY. 00C901
3