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• ELIZABETH A.NEVILLE ��: Town Hall, 53095 Main Road
TOWN CLERK -y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 61410� Southold, New York 11971
MARRIAGE OFFICER ej,®t� Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �,s'�®1 .jig �� �� 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. 2534 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 #R10-99-0052
Name Of Owner SCHEMBRI HOMES INC
Mailing Address 1 2042 NORTH COUNTRY ROAD
City St Zip 'WADING RIVER NY 11792
Property Address 1 790 THREE WATERS LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 6 lot 22.000
Cross Street SOUND VIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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MAR 15 2001 !it °�VfFO`,,
ELIZABETH A.,, VILLE s��e ® , Town Hall, 53095 Main Road
TOWN-CLERK .-SC LITHO! P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER sfi � �1Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER0.1 Telephone (631) 765-1800
alg
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: March 15, 2001
Transmitted herewith is a copy of application No. 2622 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.
gnature
3� 1510k
Dated
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OFFICE OF THE TOWN CLERK ,1�,� 0UL/r ' /
2 ---
TOWN OF SOUTHOLD le.. o,o CQG Application No. G�I?
F.i7ABETH A.NEVE 1 F,TOWN CLERK ��
P.O.BOX 1179 . _ _ Construction
SOUTHOLD,NEW YORK 11971 ; =v • rn
Alteration
Telephone O,!' �Q' ',, . $10.00 - Residential /
(63't) 765-1800 �l * �;,o' $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 :91EX ,
APPLICANT NAME: _ S( 4. -- CC r
APPLICANT ADDRESS: ."-- 71(1
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--W445',7 ,-0___.
SEPTIC CESSPOOL d� '
DESCRIPTION • PROP* . e6 CO, STRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR$ TIO OR ALTERATION:
OWNER OF PROPERTY: /�
OWNER MAILING ADDRESS: 0.2---4 K)-- G�L� Z2
- '9 .
Li 'Z ' p -� 71/`1 (1 71;z-,
OWNER PROPERTY ADDRESS: 3 Wr, r Tic r i1�.trt,e_
_
P
, TELEPHONE NUMBER OF CONTACT PERSON: 9r-rf‘ Y
TAX MAP NO. : Section / ' Block 10& Lot
CROSS STREET: 6C1 Vaefn/ '
BUILDING PERMIT NUMBER CROSS REFERENCE:
//irij / / • .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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L JOB No.99-03 TAX,I.D.•No. 1000-15-06-22 - ..40
t;
SOUND VIEW ROAD R=150.00
L=227.77
ALL DISTANCES TO WELLS AND CESSPOOLS
-ARE BY LOCATIONS FROM HOMEOWNERS, .
FIELD OBSERVATIONS, AND EXISTING
SURVEYS. SINCE MOST ARE NOT VISIBLE _
THESE DIMENSIONS ARE NOT CERTIFIED
:41- ' \
d
I › 125'
(
, � n
r.
M >� C�' 8 WEU.AREA
1AS PER H.D.RECORDS
i�
r C g 4 WELL AREA
c 'il � ( l LOT14
, 1 i I< C ci
> $ OCC-RES
1 ( — ° '�
SEPTIC AREA
E-C
> AS PER H.D.RECORDS
'S i 0 1 ,
(-15 E3 LOT 37 LOT 20
OCC-{SES
/Z CA CA ""' S 88°57'40"E 125.00' J MAP OF LANDS END
o • Q• ^ 1009 100.7 to17
( C' Wto 15'
O �---- +F me'TO WELL--�
LOT 38 �, LP
Q OCC-RES , DRIVEWAY 30' 20' INV 99 2
E Q ``) O d SEPTIC C
• (, z O INV 100 5 OF Eii C) G {..--35'
>- 20IHV SteCj` , Io. L: '- TEST HOLE N ��1ao 1 r LOT 19
welt AREA i u) W b tai
(' 1 W a r�N $ b
1 L N b8 a z� 0.--�" (NN
Z
•
Ili PROPOSED /=
W WELL--
a 411.---- 15'
I 100.0 tot s
I— 100 8—
•
l 1 N 88°57'40"W 125.00'
TEST HOLE ) +/ Ism WELL AREA
`
1/261919 \ -
�
\ --/ WELL AREA
AS PER H.D.RECORDS
1' OL DRK BROWN SILTY LOAM -
LOT 12
ML BROWN LOAMY SILT $ occ-RE,s
3.5 -
LOT 39 / -
VACANT 1
SEPTIC AREA /
AS PER H.D.RECORDS
FINE TO COURSE SAND
SW WITH 10-20%GRAVEL 125'
a
43
1T j B H.D.-HEALTH DEPT
°' ELEV IN ASSUMED DATUM
Ct. p SHALLOW WELL AREA
CANNOT SATISFY 150'SEPERATION REQ
_ _ FILE MAP No.2777 11/21/57
ICD - Unauthorized alteration or addition to this document is a wotahon of Section 7209 -- — ---
•W, of me New vont State.E9ueationLaw. SURVEY OF: LOT 13
CertificationsonIns braifto h Neon shall run only men the al on for when it is prepared MAP O F ORIENT BY THE SEA
� and on Ins bAtrattto�thE Title Cbmparry,Gawemntentai Agency and Lending ,
Institutions fisted hereon,and to the assignees af.the Lending Institution or
a subsequent oSECTION 1
RIli OPOSEof this-document not bearing the professional's inked-seal or embossed
O. seal shall not be considered avalid true copy ORIENT POINT TOWN OF SOUTHOLD
The offsets 1 or danensigns I shown hereon from structures to the Properly flees are ,
amfor a ptupose arid use osintended �
fences, n patios, areas,teo anyrconsSUFFOLK COUNTY, NEW YORK
The existence of right of ways and/or easements of record,if any,not shown are - DATE: 1119199 SCALE: "=40'
not guaranteed — �t ' :ent , w..
} •
CERTIFIED ONLY TO: tsi,At ''``—\0,
�
SCHEMBRI HOMES INC ° 6TI GRAF DESTIN G. GRAF
et
IA ' ;!'lv 0 , 'ND SURVEYOR
11111111
_ -` ,_, K . ,� 73 Wootllawn Road
. 1.,....E#1 r' R.•' Punt,New York,11778
`� � , .1. : -3442
By DESTIN G.GRAF N.Y:S. LIC NO.50067 -