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ELIZABETH ELIZABETH A. NEVILLE �� ®�°t�� Town Hall, 53095 Main Road
TOWN CLERK ` H P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER : Iji ��,11 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �1®,'," Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER •1'
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 'l` SEP
FROM:, Linda J. Cooper, Southold Town Clerk's Office (
DATED: September 6, 2001
Transmitted herewith is a copy of application No. 2744 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Lombardi for Waldvogel
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 1 cation 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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21%1/4'4"4:/- -
Signature
7 D/
Dated
.
•
OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD ,� OC.,UI Q� Application No.077V"1
ELIZABETH A NEVILLE,TOWN CLERK ' O 10.
P.O.BOX 1179 ; • Construction J
SOUTHOLD,NEW YORK 11971 v • •
rn
• tri 131
Alteration
Telephone -.4ro ��'� $10.00 - Residential a/
(5 6) 765-1801 _ 1 �,,.' $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 2/ _qJoi
APPLICANT NAME: ��� L�.� "'O . Iii,
APPLICANT ADDRESS: Cf ) C. ihP
otd
ent:0,1A-cleo fL, 1 (140
SEPTIC I CESSPOOL (
DESCRIPTION OF PROPOSED CONSTRUCTION OR/ALTERATION
e-Ar G 4r 0! 3 U �[o / 77- A4 /6,-24
, LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: 40 ,,y,
OWNER MAILING ADDRESS: 419 CiLeeie I' R
OWNER PROPERTY ADDRESS: le(00 enct qtrr„,,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 7 9 Block 6, Lot 3
CROSS STREET: fYirifi,weid
BUILDING PERMIT NUMBER CROSS REFERENCE:
;667,1/KOi �LllvN.d
Signature of Applicant
i
RECEIVED BY: 0
I
r'own Clerk's Office
DATE: ! j j
ter . • WELL - WELL ...�
L....'1 o�yF�</ SURVEY OF PROPERTY „�
G SITUATED AT
�ti BAY VIEW
'� TOWN OF SOUTHOLD
s soo , • �ry SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-79-06-36
A...7V
40y SCALE 111=30'
NOVEMBER 8. 2000
., / CESSPOOLS DECEMBER 6, 2000 ADDED ADD1110NAL WATER SUPPLY & CESSPOOL DATA
�O 3 :- s.• - e/ FEBRUARY 28, 2001 REVISED PROPOSED SEPTIC SYSTEM LOCATION
WELL �SOa. .:
S S�/ .• O AREA = 12.500.00 sq. ft.
'� //4)::.o 6'pa [� = Dlyc�, 0.287 ac.
10.- '0Ase3044- • --ltigt, &Y' /
5 ..% F 'Il .� c wqr ,� 1v)..6
p CERTIFIED TO:
,e..4:. ..1.??. t
��� Z ��,% h ••. `VIII �O4 �de. .!.. �iH S•. g _ WILLIAM LOMBARDI
to PHYLLIS LOMBARDI
COMMONWEALTH LAND TITLE INSURANCE COMPANY
.9, P 2 c)
: g Z
• !1 1
Gti������ % s \` 72 -4 '; p �` _ w LAVATION INSPECTION REQUIRED
�4�• a 1 o ;/ �/ �.* pp,,0 i . FOR SANITARY SYSTEM
4�' ,�; �;� �a /N �=. as
0 81 7 -A. x Kozaz.
• �' - . ` ., �4 04 �. 1. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM
CESSPOOL GT' / 2 • .• ::. OO AO W ExIST1Nti ELEVATIONS ARE SHOWN THUS:204
/ lwi- 2 NIIgYUY SEPTIC TANK CAPACRIES FORA 1 TO 4 BEDROOM HOUSE,IS 1,000 GALLONS
\ \ !,' -----l'i
3. MINIMUM LEACHDNG 4SYSTEM FOR A 1 TT 4 BEDROOM HOUSE 1S-3f 0'sq t!SIDEWAt'AREA.
DO• 1 POOL; 12' DEEP, 8' dia.(�o 4 \ B(// �' ... Q- i I� ��.i%:PRGPOSED IXPANSKN POOL - -• F•- � 'C)y f� %,PROPOSED LEACHING POOL -' Et
I 1
,,„..
OO \ / 3 ,P \O\ /O F7APROPOSED SEPTIC TANK - , ,
2 7c 'z) '� pit)�^OfJ f 4 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON
ARE fROM FIELD
O _� OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
4•�' 4,'m �� ,�/O ��1� ,� _ -
1�� � ,
^
0 °, Oes tipAt'e osyo ��= a43 TEST HOLE DATA PREPARED
FOR TITLE ICESURWITH
AS ESTABLISHED
O 4 O S O PREPARED N wOH THE MINIMUM
(,) e �Jr�+- Ny (TEST HOLE DUG BY McDONALD GEOSCIENCE ON NOVEMBER 13, 2000) ST THA, APPROVED AND AADOPIHE
1, �.,.-.,„, F' �N
,••••• DARK BROWN SANDY LOAM al ,C1:'_7
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pp, .....1 cf” SPH A.
•�pF BROWN LOAMY OHO SM ` '
Alei�• !0 •
BROWN SILTY �
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w \ f,.. ,.
N.Y.S. Lia No. 49668
- e' TO THIS
RIZEDSURVEY
ALIS A VIN OR ADDITION
TO THIS SURVEY IS A VIO ATKN OF
• - SECTION 7209 OF NE NEW YORK STATE
l
EDUCTION
LAW. Joseph A. Ingegno
'C:'° yon ' `dPALE BROWN FINE
7HEIiS OF IS SURVEY
NIS SEAL OR
NG
-7'.4p,4b.6,�0 -- Land Surveyor
III
HERM SHALL RUN
1 04,
° s LA PEIN�N,$) , CERTIFICATIONS �HfbNRSTSUIE
CESSPOOL � r• - f� 17'r G Title Surveys —Subdivisions — Ste Plans — Construction Layout
•WELL CESSPOOL `/iC)f'�1 (�0 MON. 1
�t PHONE (631)727-2090 Fax (631)727-1727
THE EXISTENCE OF RIGHT OF WAYS
OFFICES LOCATED AT
AND/OR EASEMENTS OF RECORD, IF MAILING ADDRESS
ANY, NOT SHOWN ARE NOT GUARANTEED. 1380 ROANOKE AVENUE P.O. Box 1931
RIVERHEAD. New York 11901 Warhead, New York 11901-0965
20-824A
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