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ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� �i �� ', Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =__ 1 *� 0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �� .9'�
OFFICE OF THE TOWN CLERK
SOUTHOLD HPH[QSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2627 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN MOGLIA
Address 1 : 10 POPLAR STREET
City St Zip SAYVILLE NY 11782
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 #R10-01-0025
Name Of Owner MOGLIA, JOHN
Mailing Address 1 10 POPLAR STREET
City St Zip SAYVILLE NY 11782
Property Address 1 HOBART ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 1 lot 32.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 8/08/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1 W
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ELIZABETH A.NEVILLE / d Town Hall, 53095 Main Road
TOWN CLERK ` C P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V' Pry t Southold, New York 11971
MARRIAGE OFFICER �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = �l 4te"®ei� 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 23, 2001
Transmitted herewith is a copy of application No. 2714 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
John Moalia
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.
zEiVi
ignature / /
7/ 3 ° / °J
Dated
OFFICE OF THE TOWN CLERK 01 �`F Oix/y;
TOWN OF SOUTHOLD , � � `�G`/ • Application No.a.7/
Fr.r7ABETH A.NEVII1.F,TOWN CLERK 7<1
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 Z
cc13 Alteration
Telephone O. Qi/` ' $10.00 -Residential
(63t) 765-1800 =-70 Jilt ,�' $25.00 —Non—Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE
APPLICANT NAM : JdlaE.
APPLICANT ADDRESS: /O Pop 4,r, Sfre�-/
S of//e, Aiy //76)-
SEPTIC
a-
SEPTIC vESSPOOL -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/�/eaJ co-h.S"Ip- ch o
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT ON OR ALTERATION:
OWNER OF PROPERTY: \'d//7 G // &"
OWNER MAILING ADDRESS: /fJ fop/a-t SIreeJ
LS cel/l %
OWNER PROPERTY ADDRESS: tf Ciea
ZSz-borlict, i/7 //9'7/
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TELEPHONE NUMBER OF CONTACT PERSON: 6 3 / 'S' 7 3,-9/
TAX MAP NO. : Section 64 Block / Lot
CROSS STREET: 1-7/0�09 c5ca.34/ al) /taut )61
BUILDING PERMIT NUMBER CROSS RE ER NCE: 4
Signature of A licant
RECEIVED BY: (`L� /
T wn Cler 's Office
DATE: 7 7/5 0 1
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-., „ - = SURVEY OF PROPERTY
1VOTESs • N• Boa • SITUATED A7'
9 T. ELEVATIONS ISTIN ARE RTIONS ARE TO WN..YA, 1929 DATUM - "Rte- s o =OU`THOLD
EXISTING ELEVATIONS ARE SHOWN.7HUS: 1'0 0
2. MINIMUM 51:PT1C.TANK CAPACmES•FOR A I TO .4 BEDROOM HOUSE IS 1,000 GALLONS. 1
I TANI(; 8' LONG. 4'-3' WIDE 6`-7- DEER ' ��� TOWN QF SOVTHQLD
0 4-
3. ►11NIWUW LEACHING,SYSTEM-FOR-A I TO 4 BEDROOM HOUSE is 300 89 ft SIDEWALL AREA.
' P001-2",DEEP. B dTc. - ��Z SUFFOLK COUNTY, NEW YORK
PROPOSED EXPANSION POOL '
ar S.C. TAX No. 1000-•64-01-32
,/I/',PROPOSED LEACHING POOL - - 6a J SCALE 1"=40'
p�� •
,� MARCH 15, 2000
[H/i1 PROPOSED SEPTIC TANK '
4.THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD - -
•OBSERVATIONS'AND/OR DATA OBTAINED FROM OTHERS. .
5. FLOOD.ZONE INFORMATION.TAKEN FROM: -
FLOOD INSURANCE-RSTE.14AQ'No. 36103C0158 G _ G •
ZONE AE BASE FLOOR ELEVATIONS DETERMINED \6'
ZONE X': AREAS.OF 500-YF.AR..FLOG0f.AREAS'OF 100-YEAR FLOOD WITH AVERAGE , pTTH DRAINAGE AREA§LESS THAN5 ofIP,,,ED 1 - �co •\ "t, AREA = 48,280.52 sq_ ft_
DEPTH• SO,D OF LESMILMLD S THAN ARE LS 1 T OR'PLED BY LEVEES FROM'-100-YEAR FLOOD N%0/F' �p �SUL Cts s� \ 1 \\�° °� 1.108 cm. ,
ZONE X_ AREAS DETERMINED TO BE OUTSIDE'500-YEAR FLOODPLAIN: SO[J1'HOLD jgISTO$ICA'L SOCIETY ESE Or 'I• !�' .1-COtj G \ \\ yo .
(USES PUBLIC WATER) _
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\ �' i1a'+� N.Y.S. Lic. .No. 49668
t4� y ^ PERMIT FOR APPROVAL OF CONSTRUCTION FOR A ', _ .
`10,-4
� UNAUTHORIZED ALTERATION OR ADDTIION * OF' ' N
�n r",4-•, TO THIS SURVEY IS A VIOLATION OF
tviSINGLE FAMILY RESIDENCE ONLY BRDWN F>IE.To WORSE SECTION 7209 OF THE NEW YORK STATE
SAND WInR,a<CRAWL s~ EDUCATION TAW. oseph A. Ingegno
>-•+.3 COPES OF THIS SURVEY MAP NOT BEARING
-
y' r ,� ., THE LAND SURVEYOR'S INKED SEAL OR Land Surveyor
DATE D (SIC)C) \14.9 :'E; • •. `�v ~ b 1 ^ O C ' EMBOSSEDOBEAVALIDSEDL ALL NOT BE CONSIDERED
TO BE A TRUE COPY.
•
F1'''I'B' , .. 11.1' CERTIFICATIONS INDICATED HEREON SHALL RUN
MIL ONLY 10 THE PERSON FOR WHOM THE,SURVEY
7y IS PREPARED.AND ON HIS BEHALF TO 714E
APPROVED TmE COMPANY. GOVERNMENTAL AGENCY AND rifle.Surveys - Subdivisions - Sde Plans - Construction Layout •
n t� WATER IN ME BROWN FINE TO LENDING INSTITUTION OSTEO HEREON,AND
FOR MAXIMUM OP 1 BEDROOMS COifg•SAND WITH 10X GRAM_ SW - TO THE ASSIGNEfS,OF THE LENDING -
�� TUDOR:CERTIFICATIONS ARE Nor TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727
EXPIRES THREE YEARS FROM DATE OF APPROVAL =mum - THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCArtI)A7 MAILING ADDRESS ti
ei 1- - t7 AND/OR,EASMENTS OF RECORD. IF •1380 ROANOKE AVENUE P.O. Box 1931
� _� ANYW
-. NOT SHOWN ARE NOT ARAK7EED.
RNERHEAD._New York 11901 Riverhead, New'kirk 11901-0965
I . . 20L15