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ELIZABETH A. NEVILLE �� �d Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER :. s�- 4 t.0.1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ® too Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER *��
OFFICE OF THE TOWN CLERK
SOUTHOLD rfolOWNEitasTMIEntilhOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2698 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DANIEL NICKOLA
Address 1 : 37 9TH AVENUE
City St Zip FARMINGDALE NY 11735
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 #R10-01-0096
Name Of Owner NICKOLA, DANIEL & EUGENE
Mailing Address 1 37 9TH AVENUE
City St Zip FARMINGDALE NY 11735
Property Address 1 120 LANDS END ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 9 lot 1 .013
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 11/19/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE d *tel 4 - Town Hall, 53095 Main Road
TOWN CLERK ® sz P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS • nv 1 Southold, New York 11971
MARRIAGE OFFICER " �� �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �__ ®1 ,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER °moi'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office NOV i 3 7rirll'
DATED: November 13, 2001 a►cG o'"PT
Transmitted herewith is a copy of application No. 2792 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Daniel Nickola
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 to ation 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.Yfritete
Signature
n/V,i1/
Dated '
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OFFICE OF THE TOWN CLERK .'''c," OLkc -
TOWN OF SOUTHOLD os QGy Application N%2_22,FT i7ABETH A.NEVILLE,TOWN CLERK O
P.O.BOX 1179 iG Construction
SOUTHOLD,NEW YORK 11971 o rn
•
Alteration
Telephone ,j 0 , $10.00 -Residential cs/-----,
(631) 765-1800 — 1. * ,,0' $25.00 -Non-Residential
TOWN OF SOUTHOLD
e •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /4/or
APPLICANT NAME: Qfl(ie dU,661
APPLICANT ADDRESS:5-) I� FAfr�� 4�� iV /1735
SEPT I C)( CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
W ) P I1014.411,A
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CO STRUCTION OR ALTERATION: •
OWNER OF PROPERTY: J UA
OWNER MAILING ADDRESS: 5')
FAs-r4; l � lO)/ 11--)35-
OWNER
1°735OWNER PROPERTY ADDRESS: I a() L aLRf.
Ocierk- 1\57
TELEPHONE NUMBER OF CONTACT PERSON: (() l.�'-kQ(glO
TAX MAP NO. : Section )5-
Block 0 J Lot ) ,C),\
CROSS STREET: 1Y41_A q3(
BUILDING PERMIT NUMBER CROSS REFERENCE: -
0../7-i
Signature o pplicant
RECEIVED BY: L ,
itA) -
Town Clerk's Office
DATE: 6
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1 y - rr ` �_ r 1 7tl I SURVEY
-4---, .1 I 1R EY OF
OVA��{y�TARY �' I LOT 13
n 10.
52' 1
z BY HEALTH 1.�-�- 2 ;FGUND MAP OF
- 1 , CGN MDQ-- LAND'S END
E I -8'g - JI2.0/ -FENCE
P .N g2°52 20 ,9\ �,9 I ;sF FILE No 5909 FILED MAY 3, 1973
/ 11) SITUATED AT
i - — - ELECTRIC . As ,(,AL R On-___-�°' � - _ ,.�V // ORIENT POINT
Box •+�� I COVER �_ !,� �- --- -------• TOWN
(� TOWN O F S O U T H O SOUTHOLD
z \I ---� -� I ; ' �' o SUFFOLK COUNTY, NEW YORK
O !�I 'I l ',PROpp5Ent7gVEWAY- \, '`� vx/ I 1 .1., S.C. TAX No. 1000-15-09-1 .13
Ivo / ' b \ \ SCALE 1"=50'
N..) \I I __75, A / f \ MARCH 1 1, 2001
.� II 91 Q \ \ \
Li `�' �! 1 g'i / °% \ o \ ?. r TEST HOLE DATA
?!''� I I - - // .� \ `\ x 'o Z (TEST HOLE DUG 6) McDONALD GEOSCIENCE ON MARCH 15 2001) AREA = 41,781.493 sq. ft.
Cr I
/ \ 7 v EL 54 D. 0 959 ac. " I.,
A1 II ` N / ` 2,2 \ �• \ m D �� i/, Dr BROWN LOAM OL _ C'_l CO
// - 66'---
1 \ n o
_. Z II / / \9 >e \ -4 L-0 EL i g BROWN LOAMY SAND SM CERTIFIED TO ru'..'� Y-� _�
r (4 6121 •$ �--- �� \ DANIEL F. NICKOLA _ J -,` `
/� I ".......2<:. o MARY NICKOLA ;_ ; _,�
1 I �a �(, —' ` I•` EUGENE NICKOLA - c _ '
JJ r,.. _
— r N STACIE NICKOLA I
/ _
I m'. 1 22 `� ,63 \ B WATER IN BROWN FINE TO COARSE I--'T=I
r 1 // // \\ SAND WITH HEA\S GRAVEL SW NOTES - ') T`.
cZ ?� II N \ \. LOT �3� \\ FENCE~ = _- .'j
J I ELEVATIONS ARE REFERENCED TO N D V D 1929 DATUM T
�'Ni \ ( // 1 EXISTING ELEVATIONS ARE SHOWN THUS 700 `i
J (S \ - \ 0 4,E ---- --
.P \ /� - \ 2 SEPTIC SOYSTEMC STRUCTURE LINES
NWTHUS THUS �-r{' ��
0• e' 4. i e ,fz2 \ • PROPOSED EXPANSION POOL
S \ \ tail/ T ,. •Q ee 'i1e 111 N 10 f.'i 1 PROPOSED LEACHING POOL
,- 1-9\\ \`_ uCr1 d1 ASO C�0 feet'. 1\\ �CONC -�/ [,,'�� PROPOSED SEPTIC TANK
•
A (\\\ CeSSF _-_ \,. C001,OO aE _I' 2 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
and iwP- OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS
N \ - ' \ _1 3 THIS PROPERTY IS IN FLOOD•ZONE AE (EL 10)
O,0 .I \ \\\ .. / 1 54.04� -.---+nsn/a-e,-rrc.:meue-aAI.,As,,,..wo -.rem,a.,Pvn r;,-y.,s•-mwxx»x.>�«-,.s.•F�.4�.t,1,� .. No 3610300088 G
\ \\ / TEST HOLE 1 SUFFOLK !T }°L.,.. tie w„p�e�,A 1 q-,4 ',` i,,,,,TZON yA FLQQO,.ELEVATIHNS DETERMINED
t <<' ,n 6 2 / +4 ,5_5 • 90'4 P YEMEN U.. 6't, .1 i ..,�l:s Cy- �q{{
Fn:SF51 e -.P ROv Au- OF CoNGl R.LI Te00',.i FOR A
S'`z ` A EDGE 0 A
p a �° rev
0 p0 z _ ,1 S 76 sl N-9 6br=^F=K; aF''s:I:)?L k'/,.,,a4,:'-:,;uCS� Y E„Y'
1-47 12 S' _ SCH- SIGN .1Z1 '� -
b
Q9ATCy.... e ,
J c �Q PREPAR .� - TH THE MINIMUM
SUi `z J 41 / STA . 6QR T',p, AS ESTABLISHED
,5,0 (S R — D [v isi. �, t nFA�., l,J_�s D �..,w �����YYY 1 BY :ii, -'• ..S, �r�,ND ADOPTED
I- ' •V�• STATE LAND
'1 .$ Y'r+'T5:%'I°.i i`aS':J - __ _.n.a.-,.,.s.�. l Lin,,,,,,,. ..,. 1 V� ..
PROPOSED SEPTIC SYSTEM DETAIL ''` 'a'- A .=m ./_. .�_ v`'€ E0E+i } "' � O
HOUSE (NOT TO SCALE) ry 1e • .401-,ia •�
- / EI.EV FINISHED GRADE 7 nEINEVH90 I:.t1� L a-. ., s e__ -- -A 1 S' 3ra� ¢ APPROVAL,
t 1 -
11.1 GRADE l.-J-'F. ry e.33: !1'i..1co•E:-a DATE OF APPROfif7 L, ...x-r4
ii
j rIS 100 r _ __. ..".�_-_ ..�..,....�...a>�-.....=a.-... A
' PAR TOP EL 90'� I-� �'-1 MIN TOP EL 79� ^^ �_1 YIN • f� °�I Q�
S-7 MIN 4"DIA r 6' ` O
I SEPTC LEACHING T 3 CLEAN Op.. cal
INV APPROVED PIPE TANK APPROVED A'./ POOL LEACHING I,4 //'SAND tl cal
''l 83 min PITCH f/4"/I ,n PITCN I1 INV EL 69' POOL '1 COLLAR
-INV EL 80' ,M, EL
1-.--8--{ 75 . F 13---a I--8'»-"1 iI.A. UNAUTHORIZED ALTERATION OR ADDITION-_____ NYS Llc No 49668
— TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF NE NEW YORK STATE
DISTRIBUTION POOL OF BOT EL 4 9 GROUND WATER EDUCATION LAW Joseph A. I n g e g n o
5 POOL SYSTEM ELEV 1 9 ,
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR Land Surveyor
SEPTIC TANK (l) SHALL EMBOSSEDSEAL NOT BE CONSIDERED
, MIMEIUM SEPTIC TANK CAPACmEs FOR A I To 3 BEDROOM HOUSE IS 1000 GALLONS LEACHING POOLS (5) TO BEA VALID TRUE COPY
I TANK,0 LONG 4'-3•WIDE 6-r DEEP 1 M@NIYVM LEACHING SrsMM FOR A I TO 3 BEDROOM HOUSE IS 300 m II SD6Wur_AREA. CERTIFICATIONS INDICATED HEREON SHALL RUN
2 CONCRETE SHALL NAVE A MINIMUM COMPRE551VE STRENGTH OF 3,000 p°i AT 28 OATS 5 POOLS 2 DEEP 8 do ONLY TO THE PERSON FOR WHOM THE SURVEY
3 WALL THICKNESS SHALL BEA MINIMUM OF 3',A TOP THICKNESS OF 8"ANDA BOTTOM THKIWEss Or 4' ] LEACHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REINFORCED CONCRETE(OH EQUAL) IS PREPARED,AND ON H5 BEHALF TO NE
ALL WAILS BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 300 PM LEACHING POO StAREy, BE DOMES AND/OR SUBS
4 A11 JOINTS SNAIL BE SEALED SO THAT THE TANK IS WATERTIGHT 3 / TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout
ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE(OR EOUAL) LENDINGSIGNS INSTITUTION LISTED HEREON, AND
5 THE ON SEPTIC .5 BEROCK S Of INSTALLED �D NJ.DIRECTIONS(WITH A MAX TOIFAINCE OF s1/+')GRAvEL 4 3010 P"" DISTANCE BETWEEN 0EA ISNG POOLS M5 141TEx UNE SHALL BE.BE MAINTAINED
TO THE ASSIGNEES OF THE LENDING INSTI-
8 A 10 nun DISTANCE EETATN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED 8 men.DISTANCE BETW47N ALL LEACHING POOLS AND SEPTIC TANK SNAIL BE MALMAIN[D TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fox (631)727-1727
THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED 1380 ROANOKE AVENUE P 0 Box 1931
RIVERHEAD. New York 11901 Riverhead, New York 11901-0965
I21-195