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ELIZABETH A. NEVILLE d i tits f: �� Town Hall, 53095 Main Road
TOWN CLERK , ® 0`t>4 CA P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS n _« >^ Lk Southold, New York 11971
MARRIAGE OFFICER ® �
���1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 491 V9,10. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .9"
OFFICE OF THE TOWN CLERK
SOUTHOLD fli roJRLPSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2706 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : BRUCE ANDERSON
Address 1 : PO BOX 2003
City St Zip BRIDGEHAMPTON NY 11932
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 #R10-00-0078
Name Of Owner COOMBE, ROGER
Mailing Address 1 1050 PARK AVENUE
City St Zip NEW YORK NY 10028
Property Address 1 4294 WUNNEWETA ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 14 lot 27.001
Cross Street PECONIC BAY ROAD
Building Permit Number Cross Reference:
Issue Date: 12/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
0111 ORA°
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ELIZABETH A. NEVILLE ,"4& t4 4 , � Town Hall, 53095 Main Road
TOWN CLERK ; ;' ''_ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , Southold, New York 11971
MARRIAGE OFFICER ®�i �"��11, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER RI AP +0����01 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ southoldtown.northfork.net
OFFICE OF THE TOWN CLERK M
TOWN OF SOUTHOLD �, Q C
TO: Southold Town Building Department
BLDG.DEPT. 1
FROM: Linda J. Cooper, Southold Town Clerk's Office -.ANN •F S LIT OLD
DATED: December 7, 2001
Transmitted herewith is a copy of application No. 2802 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Suffolk Environmental Consulting for Roger Coombe
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 RE•UIRED. r
7/4-Z-,aef
Signature
�` O/
Dated
X
It
OFFICE OF THE TOWN CLERK �� •
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TOWN OF SOUTHOLD �" Oc��FfOApplication No. � 5IJ
F J7ABETH A.NEVE JP,TOWN CLERK O ;
P.O.BOX 1179 L
Construction k
SOUTHOLD,NEW YORK 11971 • : O • rn
• csa Alteration
Telephone
%•:.%$'
��0 ...0/' • $10.00 - Residential l
(631:) 765-1800 _ .� '��
-- -...,...,,,-
TOWN
.,,,,�' $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No. _cc.
Fee •$
DATE / /7 /of
APPLICANT NAME:// 40Cr •. / A/ ,�, s�`r•"- -- ,,J C ,
APPLICANT ADDRESS: 7. O• 7k Za = 3
'4/, r, ...- /U Y' / `! ?
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION_5?'AX.L
— des''?/ LH '-p w(C` `f N cs- -
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: d 7Z- -- C-62----01l"---15E
OWNER MAILING ADDRESS: /4) S"' 7 '4r'L0C , 7 -K-'
// ��eg-Le--„ /v 7 / o z-.g
OWNER PROPERTY ADDRESS: - ' / WA1-1-74 - �/ 1C
C.f.-5
--'re--{ 6---0 e e/4 y //- �+
TELEPHONE NUMBER OF CONTACT PERSON:(Z4) .56. --- 7�O 6o to
4
TAX MAP NO. : Section //l Block /e71 Lot 0-7.
CROSS STREET' Z()4V L L �l/-1J 04-16
BUILDING PERMIT NUMBER CROSS REFERENCE: i
d.g.._ . .
Sig ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: •
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J
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ti •
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0
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AREA DATA .
DESCRIPTION AREA % LOT COVERAGE
PROPOSED HOUSE 2,564 sq. ft. 3.47%
PROPOSED POOL 800 sq. ft. 1.08%
' 14, 1999)
PROPOSED DECK 995 sq. ft. 1.35%
PROPOSED PATIO 544 sq. ft. 0.74%
TOTAL 4,903 sq. ft. 6.64% SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE'S
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
2SE SAND SW
DATE 0-7/o Hs �.NO. /f/c) — aC —62 7
APPROVED, /./ (g(--
OR MAXIMUM OP BEDROOMS
EXPIRES THREE ISATIS PROM GATE OF APPROVAL
'
IE NOTES-
1.
OTES-1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM
EXISTING ELEVATIONS ARE SHOWN THUS: 10,Q
EXISTING CONTOUR LINES ARE SHOWN THUS: 10 — — — — —
PROPOSED CONTOUR LINES ARE SHOWN THUS: 10 '." dA4.) ' ..%R -
2. PROPOSED SEPTIC STRUCTURES SHOWN THUS: Approved in accordance with ' .' ` of Review
determination date. 6 /.5—
�.:::v PROPOSED EXPANSION POOL
°f
PROPOSED LEACHING POOL
OPROPOSED SEPTIC TANK
3. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
• 4. FLOOD ZONE INFORMATION TAKEN FROM:
FLOOD INSURANCE RATE MAP No. 36103C0502 G
UNAUTHORIZED ALTERATION OR ADDITION
ZONE AE BASE FLOOD ELEVATIONS DETERMINED TO THIS SURVEY ISA VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
ZONE X" AREAS OF 500-YEAR FLOOD, AREAS OF 100-YEAR FLOOD WITH AVERAGE EDUCATION LAW.
•
DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN COPIES OF THIS SURVEY MAP NOT BEARING
1 SQUARE MILE, AND AREAS PROTECTED BY LEVEES FROM 100-YEAR FLOOD THE LAND SURVEYOR'S INKED SEAL OR
5. PROPOSED DRIVEWAYS ARE TO BE CONSTRUCTED OF GRAVEL. EMBOSSED SEAL SHALL NOT BE CONSIDERED
6. 750± cu. yds. WILL HAVE TO BE EXCAVATED ALONG THE WESTERN PORTION OF PROPOSED HOUSE. TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
• ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
1 TUTION CERTIFICATIONS ARE NOT TRANSFERABLE
THE EXISTENCE OF RIGHT OF WAYS
AND/OR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
VD BY QC-
"B PROPERTIES, INC.
:D AUGUST 16, 1922
TED AT
-IOGUE '
SOUTHOLD
ITY, NEW YORK -
100- 111 - 14-27. 1
1 "=30'
,0N
',ES &
18, 1999
NORTH RIGHT OF WAY h�°p�55 ,bp:' c,
REVISED SITE PLAN ebb
VI SUFFOLK ENVIRONMENTAL CONSULTING, Inc NN ri,;S
PROPOSED CONTOUR LINES VS) S
/ISED PROPOSED HOUSE
335.83 sq. ft. F,
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