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ELIZABETH A.NEVILLE ���� ®�'�°� Town Hall, 53095 Main Road
TOWN CLERK k ® P.O.Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `
`` �i Fax (631) 765-6145
MARRIAGE OFFICER
Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER �_ ®� * •®,01i
FREEDOM OF INFORMATION OFFICER ,r�� 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. 2778 R Residential X Non-Residential
Fee $ 10.00 • Septic X Cesspool
PERMIT ISSUED TO:
Name : MARGARET GILBERT
Address 1 : 36 OXFORD AVENUE
City St Zip MELVILLE NY 11747
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 #R10-02-0032
Name Of Owner GILBERT, MARGARET
Mailing Address 1 36 OXFORD AVENUE
City St Zip MELVILLE NY 11747
Property Address 1 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 10 lot 15.005
Cross Street COX NECK LANE
Building Permit Number Cross Reference:
Issue Date: 3/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
6 eJ, -
ELIZABETH A.NEVILLE ,�� f;., 1 � Town Hall, 53095 Main Road
TOWN CLERK ® - P.O.Box 1179
csa
REGISTRAR OF VITAL STATISTICS � � � Pry
Southold, New York 11971
MARRIAGE OFFICER �1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _ ®� •®iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,Psi� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD Et c r c^T1
TO: Southold Town Building Department I • 61' o 3 2202
FROM: Linda J. Cooper, Southold Town Clerk's Office «f °-5� C3 r -ri n
TJ
DATED: March 18, 2002
Transmitted herewith is a copy of application No. 2878 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Margaret Gilbert
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.
iii1460:eto geoz6iz
Signature
906 1/42-
Dated
MjL� •
OFFICE OF THE TOWN CLERIC •',`� i.�./•,I��'-
S�FFotkc 7e
TOWN OFSOUTHOLD
�• • Application NoA .
Ri.i7ABETH A.NEVE F,TOWN CLERK �
P.O.BOX 1179 /�' Construction
SOUTHOLD,NEW YORK 11971
ti3 sitAlteration •
Telephone ,�� 10/ $10.00 -Residential `
(631) 765-1800 : Ol l�t ��'
$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 /1451612-
APPLICANT
NAME: _ 1/1/1 Q r r C ` L
APPLICANT ADDRESS: 3C0 ®Y , `j� � ' 1- vr
P1-e /17
V2
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Me( ares' u /1_3-ea--
OWNER
1_3-ea-OWNER MAILING ADDRESS: g6- c /Lb n
tLc_ 1/71-1
OWNER PROPERTY ADDRESS: hi/ {� C rn Aa
" 4--- %-7-4 rtJ C
TELEPHONE NUMBER OF CONTACT PERSON: 631 ' 73 vq / 1
TAX MAP NO. : Section fy3 Block 1 0 Lot / S ,
CROSS STREET: dN, 6 I a rf-e_
BUILDINGPERMIT NUMBER CROSS REFERENCE:
.1115091
nature of Applicant
RECEIVED BY: ge_
Town Cler 's Office
DATE: 3/15/ o1---
TEST HOLE DATA z SURVEY OFO P E J-�TY
(TEST HOLE DUG BY McDONALD GEOSCIENCE ON MARCH 26, 2001) Z
LOT 0 ���V Cl ��1J
AT
��/�7 DAM,BROWN SANDY LOAM OL LD ®31 MArlirlllTlly
- BROWN LOAMY SAND SM y I
1U C K.
^ /� TOWN OF SOUTHOLD
r•••r. Ell
} , :,,t'.;- `_ s 9 �-i 6' �POLIG'taP k)
w e ,•i .. - I LST O C-I 172 9 x ��psf
�. '",.r. `;� „, -_ O T 7 8 Ow0Lt.11NWPYfR) z$.6 rri , �, SUFFOLK COUNTY , NEW YORK
`.``�_ CO -J:'a. T 77 L {p5f5PJg X6,00,1 ! w S .C. TAX No . 1 000- 1 1 3- 10- 1 5. 5
CL O
5 .. L,,i;:✓(...•` _ PALE BROWN FINE 1 FOUND,ADN I I
ve:„: '� _ TO MEDIUM SAND SP f�7NG N coG •p. )7 _ 7
E,- t•-- ost,E SCALE 1 —50
t Ut
` - . _ G • I I I d
E.,-„ ._—' V,NE.130 WPI fR) FOGA N r Q
' r .. '---.5,-_,•;::?- • fSP�ep co,, I I _ OCTOBER 27, 1999
' �"5 � z I 1 " DECEMBER 1 1 , 1999 REVISED MAP
I w I I I I MARCH 27, 2001 ADDED TEST HOLE
f7 I o
I FEBRUARY 6, 2002 ADDED PROPOSED WATER LINE
I �' I I ( LOT 93 I
_. __ _ ._____..... .T AREA = 40.021 .48 sq. ft.
` O N ' I I r
I Dl
,� 1,0T ! I 0 3 0.919 ac.
, I I I y R c.) 4
' S ' I
9 1 I O :s e c,� el„ ,
I LST I I I 1;2�" �~ --
I I I i L� 63 `''p , NOTES
I 1 fl f`-. rgj
k 1. LOT NUMBERS SHOWN THUS. LOT()REFER TO
ti= .7k I �n paa MAP OF' TOLLEWOOD
- m o h I I 1 I I TM� , 1 1 FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY
-
2 A o O , } (rte 1r)) ON JANUARY 25, 1927 AS FILE No 175
II{ o rte„ ' r 3"' s./` 2. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM
co(� _r-
°
y I I 6�' w a �" 4f EXISTING ELEVATIONS ARE SHOWN THUS- 10.0
" z r _ _ I I "' Z''"' S } 3 MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 7,000 GALLONS.
o .' O I �� IITCAr 1 ' v `. 0 1 1 TANK, 8' LONG, 4'-3" WIDE, 6'-7' DEEP
t , �Pa'o Q�6�� }� ., " ``` ,, I 4 MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq f SIDEWALL AREA
'YY,'I &`^ -`-' 60' I ; „d (�1 t �r , 5 r,a.,, k. 1 POOL; 12' DEEP, 8' Ala
I I I I 1 ' • S • \7 ' PROPOSED EXPANSION POOL
I 1 I I i A T' rr
• ®/, PROPOSED LEACHING POOL
�i
O ' ' I �' ], 'r• ' t ' i"• E13 172 PROPOSED SEPTIC TANK
`� HC'4 I t�, I i!i O I I Q 1 �„-. '�" 3 e '.. ' 5 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
CTr
I I 1 I I I �/ TO A',, 1 ,.,,• j G •�}� 4 OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS
` 1 ' I TEST HOLE ,x'�q T ' • '; Lt. GI
C:';� ea f •.-1 r r}
OI N .,--0 f Of PPyfMEN •,F >� l '' r" �rZ
�. ' F110; PALE �� f1 G3 :;, �� aA4'3 ti,-2,' PREPARED IN ACCORDANCE WITH MINIMUM
r� ' I TM �5� o { J V x ' °.i. �;�, �` �' ' STANDARDS„- +R 1'.w .. ..� ESTABLISHED
O '�'"1 Q I - 7 :O�1Fa`'. / p'sr, T �.1; C+.1 i1 8p .�- it6 YID `, w''..a STATEND D TED
LAND
v .SO, 1 I TI' .7 ifi I A A[� ,1,
bn 1 , - _.._tS7IU POLE F -. r---\ C.uw....�+ "d•�...�,.,.....,..wa ._.-... ....._.�_.. ,� �(�}1t'1.fr.�. 'C/, *`
CO f _ A. j k 'e 0 T
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{ - ANO y\W��-1�� � 6D� � Os0-\"V 1-
.NfLL '?E X13("�„��' 'Cj��4
` 41.., U �,,,' NYS Lrc No 49668
I rn NI 'tEN510N UNATHORIZED ALTERATION OR ADDITION -.r;�t�.rd '''
x W ti/� DAPI TO THIS SURVEY IS A VIOLATION OF �i
iiiP ',i'�y wPS£R SECTION 7209 OF THE NEW YORK STATE ��o p� ® �ry �$ p�
r7 PROPOSED VPEANj EDUCATION LAW Joseph A. I geg o
NG
m _. W' THE EMBOSSED SEAL SHALL NKEDBSEAL OR FCOPIES OF THIS SURVEY MAP NOT IRED [
n A _ TO BE A VALID TRUE COPY Land Surveyor
- '' CERTIFICATIONS INDICATED HEREON SHALL RUN '
rnt
M ONLY TO THE PERSON FOR WHOM THE SURVEY
A IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY GOVERNMENTAL AGENCY AND Idle Surveys - Subdivisions - Site Plans - Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
Z TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727
, _. CESSPOOL (R\ OWNER) THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
(
AND/OR EASEMENTS OF RECORD, IF 1380 ROANOKE AVENUE P 0 Box 1931
I ANY, NOT SHOWN ARE NOT GUARANTEED
RIVERHEAD, New York 11901 Riverhead, New York 11901-0965
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