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ELIZABETH A.NEVILLE *' Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
rry Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
Fax(631) 765-6145
MARRIAGE OFFICER :® ti � f���
RECORDS MANAGEMENT OFFICER =_ ®d �� �� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,�� � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2751 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DEBRA BELLOMO
Address 1 : 7459 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
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 #R10-01-0156
Name Of Owner AILEEN MURCK & PAT BROADBRIDGE
Mailing Address 1 5431 41ST STREET NW
City St Zip WASHINGTON DC 20015
Property Address 1 400 RICHMOND ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 51 .00 block 6 lot 12.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 3/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ofFour a 75 I
ELIZABETH A.NEVILLE ti_ G'* ; Town Hall, 53095 Main Road
TOWN CLERK ` o P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS �� Fax(631) 765-6145
MARRIAGE OFFICER 4 `. �1
RECORDS MANAGEMENT OFFICER =_ '�®� $ iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,, southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
1 no
TO: Southold Town Building Department i 1.j.
•
j FEB 2 5 2002
FROM: Linda J. Cooper, Southold Town Clerk's Office '
DATED: February 25, 2002 TOWN t _:i HOLD
Transmitted herewith is a copy of application No. 2847 for a Cesspool/Septic Tank Construction
Permit submitted by:
Debra Bellomo for Aileen Murch and Patricia Broadbridge
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:
dt3,
Signature
)7/2-6/0 2—
Dated s
;//////.iii
OFFICE OF THE TOWN CLERK ll'„ ,,
kc;-
TOWN OF SOUTHOLD .�' pi;
Application No. 1 (-1-7
FJ.17ABETH A.NEVILLE,TOWN CLERK O r
P.O.BOX 1179 iG
Construction
SOUTHOLD,NEW YORK 11971v rn
•
Alteration
Telephone ,�� $10.00 - Residential
(63fi) 765-1800 —�l P ,0'' $25.00 -Non-Residential
/,//'
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE Fel®aUOI,P d0 a aco -”
APPLICANT NAME: (� C-‘100(10
APPLICANT ADDRESS: 7459 59 Sound.v8e. t j . Oli't .
Si uH O (d , a'iy 1197/
SEPTIC E/CESSPOOL ✓
DESCRIPTION OF PROPOSED/CONSTRUCTION)OR ALTERATION
Form\l l
-INAPUI;62
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSEDIORI-c.f.-4i
ALTERATION: [�
OWNER OF PROPERTY: 1"ljI-c 1► 'nurcK and PettR1G(o. 61(Ndb(/'Id
e,c.
OWNER MAILING ADDRESS: 31 L// ,S•1-.A.biA. /5- Cour+ OP is/and Po i-1-
�a�1i� b C 9o)15 /tir-Vibrni IL , Cox&'�--
OWNER PROPERTY ADDRESS: 9O® FZj ch mond d
Sou-Haoki y 119-7
TELEPHONE NUMBER OF CONTACT PERSON: 7(O5 Ca` 9(D /C1/� 57fr.53a-.-77 *L/
TAX MAP NO. : Section 051 Block 0(0 Lot 01 �—
CROSS STREET: e-RO'3 LtS
BUILDING PERMIT NUMBER CROSS REFERENCE:
G �� ���'
Signature of . . icant
•
RECEIVED BY:Yd •
Town Clerk's Office
DATE: 3.1)...<(0
a' •
f
N/F,i;PASOV
I NI)LI [MIA '�- ' - RESIDENCE WEL1
PERTnRMCo F; M,/)ONAL_I) OEUr,CIEIV .L -
27 APRIL 2(411 / , CE;�,L'UOL (RUM NO I
_i \.__�F' SURVEY OF
`_Ch'l` TIN(; (;RADE \= --_-_- ---
i• DAR/ HROWN ,ANDY LOLI4 OL N 71 ° 41 '" 30" E Deb 156.67' = TcI (F5'.F DESCRIBED PROPERTY
BROWN LOAM) [AND WITH HEAVY GRAVEL TM / / I IT H ' TO WELL SITUATE
BROWN FINE TO COARSE LAND WITH HEAVY GRAVEL _`>W / =-__ _ - o SOUTHOLD, TOWN OF SOUTHOLD
G BROWN FINE TO COARSE --,AND SW ^� !/\ / ' SUFFOLK COUNTY, N Y.
CO
7 4' O A 5'r--
_ __ \ SURVEYED FOR DOUGLAS BELLOMO
WATER IN BROWN FINE TO COARSE SANG SW \ ` , Ii_ _- PROF'O SED ' , \ \ DEBRA BELLOMO
14 F' 'OPC 5ED SEPTIC \\ 28' 40'
C)0� \ G'_SSFIC)CJLS RESIDENCE
FOR S CD H S USE ONLY N/F DOERING (,ESS \ TL- --- CO
SEMCKEN 90 _� ` - \�,%1 1.
I
RESIDENCE �5 1 _- EL__2-'--a PROPOSE SURVEYED 1 MAY, 2001
__�. __. . ___ _ _ we" O _
-� / V 18 BEDRO M I SCALE 1"-30'
.__._.-._. . x, u vs 25 \ \ � _ FI l_ c L_�4
�sr a; i CC
24 \� , ROPOSED / ?ESIDEN E
,.. r 'g' _ F F AREA= 25 592.98 SF
,! tris, 0 � � � V \` 1,501 EXF_'ANSION EL 28 0 '
. 0; ' ',amu- C F�, R t• I (1) 1 / CESSPOOL OR
CC ‹: M tW 1 ' In FINAL EL 2-' , 0.588 ACRES
..r. -1 o 41; :: :'" 20 I � G RAGE (�
�-� C.- • .k O g. . / WELL 125 HOLO) \ N / TOPD FROM EAST END
b REpNT pF I PROP. DRIVEWAY 150+' TO� W, TOPO MAPS
v (INF owNER \ ��
=IC
ep, C z; „r, y 1 ; rj AS PER �`�- Is 8' 40'
n 0 1
�?� �� 1 ZONED R-40
,/e/
.77 ..< 1 0 ... .., „ IC , '' '13 2\ , 1
rq �; p &'� :� ° M 1• 14c,SSPOOL � 1 / 1��o RESIDENCE
lz c a �" I' °�' 8 `3 �:E 0.�CTION N/F MARKDAHIS --05`
-.--,-,-
1 / GUARANTEES INDICATED HERE ON SHALL RUN
1 0 11 �1 `' ® \ s \ ' ONLY TO THE PERSON FOR WHOM THE SURVEY
rt-74 �9 � �p r-.1 ,,q MA '''OX \RESIDENCE O_ r \ / ' /S PREPARED, AND ON HIS BEHALF TO THE
5 �+ �� 0 ^O TITLE COMPANY, GOVERNMENTAL AGENCY,
^' ;� ) z �' C� \ 1 LENDING INSTITUTION, IF LISTED HEREON, AND
ii
1 O TO THE ASSIGNEES OF THE LENDING INSTITUTION
C" y ® N \ \ / GUARANTEES ARE NOT TRANSFERABLE TO
0 I O 0 � 1 ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS
..:1
� > 0 �' ® TEST
ti�
�' I ` \ 11 HOLE 111 Pr O Z UNAUTHORIZED ALTERATION OR ADDITION TO THIS
1
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C---.)
SURVEY IS A VIOLATION OF SECTION 7209 OF
fr-+ 1 ` THE NEW YORK STATE EDUCATION LAW
N, cr, -
1 ^ COPIES OF THIS SURVEY MAP NOT BEARING
ii
1 THE LAND SURVEYORS EMBOSSED SEAL SHALL
1 03 NOT BE CONSIDERED TO BE A VALID TRUE
COPY
1 l- PROPOSED 11
CO
WELL
VACANT
G4-vc)c/ S 710 41 ' 30'',,W 99.67' SURVEYED BY
F F EL HC) MIN
mak.0G Ui "4.
, N/F CARRIG o STANLEY J. ISAKSEN, JR.
-- — r__'nNISHED GRADE EL 26 E�j " RESIDENCE P.O. BOX 294
TM 1000-051-06-012 -- -- -___1-INI-,I-/LD_ c;RADE EL 25- _= II ,
LE
-� -? ,� 0�` ' ti NEW SUFFOLK NY 77956
INV FL 2.; INV 11 .'3 _ f)tq r 5:: .. I • - ., 6.37 73,—5835
GUARANTEED TO INV l I J r, _ ___ _17,1"/I ,___-_ ' r[� = _ =U C,F' � - ' ; :. _' _ -. .._ �� '�
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INV I1 24 � � 1/ OR. ki/dEil i K'
Ill
==== — II - fi- -- --- CPC ". ;:_i . -#r}~_;� ICEN' D LAND #VRVEYOI:'
DOUGLAS BELLOMO
BELLOMO =_
DEBRA BELLOMO MIN (,/ fNINI)WA III' 1 1 14 r, I `�P _„} 9”: '1'-,� NYS LIC. NO 4,2.73
US DEPT OF AGRICULTURE I / ,-� 3 17 JAN 02 REVISE SAN Lee.''- -`Ll':'
RURAL HOUSING SERVICE 2 18 DEC 01 REVISE WELL LOC., ADD WELL SANITARY OF OTHERS
SAFE HARBOR TITLE AGENCY I l Il! lAI ll, . ( •I ‘,',I 'c Jr ll_ NOTE 7 30 JUL Y, 2001 REVISE STR LOCA TION & SANI TARP 01 C700C-
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