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ELIZABETH A.NEVILLE /_0 yd Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t
MARRIAGE OFFICER `� /ji l� �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _ �®� ��®'i� 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. 3027 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : LEVASSERY BUILDERS INC
Address 1: 271 OLD COUNTRY ROAD
City St Zip EASTPORT NY 11941
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR POOL HOUSE.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0030
Name Of Owner CORNELL, CLIFFORD & LORRAINE
Mailing Address 1 10946 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 10946 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 5 lot 20.008
Cross Street JACOB'S LANE
Building Permit Number cross Reference:
Issue Date: 5/14/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
ELIZABETH A.NEVILLE - til `Z 10
�` Town Hall, 53095 Main Road
TOWN CLERK p P.O.Box 1179
2 ; Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS
%.°41 /,�� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �y�o •"_,�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER = ' * 00 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK + [t! , -
TOWN OF SOUTHOLD 1
APR Z1
TO: Southold Town Building Department Y�
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 21, 2003
Transmitted herewith is a copy of application No. 3151 for a Cesspool/Septic Tank Construction
Pelluiit submitted by:
Levasseur Builders Inc for Clifford & Lorraine Cornell
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:
e ‘Ze
Signature
401.‘4„:"' ,7•Z .2003
Dated
OFFICE OF THE TOW '�i
N CLERK lc``• I���ss
TOWN OF SOUTHOLD
IO��4D Application No. �`�
ELIZABETH A NEVILIF,TOWN CLERK ; O Gy p p
P.O.BOX 1179
SOUfHOLD,NEWYORK11971 Construction (/
rT' : Alteration
5Telephone ----14966
��� t,� $10.00 - Residential
(516) 765-1801 :��1 �,,r.' $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 1 -2, 103
APPLICANT NAME: Nass-ems.,( u-\ --1.,„c
APPLICANT ADDRESS: 2-1 I O I COU,n
(/ 9 V/ -"/VZ 7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
V _.UV Se
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: CA c -3C L ccx-;V\e C dY a 11
OWNER MAILING ADDRESS: 10 C? L/ 6 A/0,17,11
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON )) 3 2_S c $ 29
TAX MAP NO. : Section -7 9 Block S Lot 02O
CROSS STREET: a.ccicya. p x\e__
BUILDING PERMIT NUMBER CROSS REFERENCE:
lka.,j
Signat' reofApplicant
RECEIVED BY: 1 �� ,
Town e -Ls Office
DATE:
SURVEY OF LOT *1
MAP OF "FLOCK N
s
SHELLFISHER SERVE" - Ir RECEIVED
6UI FO ..K COUNTYW E ir
FILED 6-14—.15 AS It .1100
SITUATE: BAYVIEN 2003 FEB 21 PH112: 146
TOYS: SOUTHOLDS
'�-E.1'T 01= HEALTH SERVICESSUI=EOL GOUTY, NY OFFICE > ASTEWA ER MGM i
•
SURVEYED 10-12-qq
AMENDED IO-30-qq,
03-28-00, o8-oq-oo, Lot#3 Lot#2
10-25-00, 10-30-00, Dwelling @ `o-°o
12-13-00,SEPTIG 08-20-0I, Dh'ELL,NG .. N 9 w tOil
Vv,FINAL 11-15-01, UPDATED 02-20-03 ?("
m
3
SUFFOLK COUNTY TAX #
1000 - -1q - 5 - 20.8 EL.g '•
• .. S81°26'11ft
SUFFOLK COUNTY DEPT. HEALTH SERVICES w
•
REF. # RIO-1q-O21-1 = 251.94'
CERTIFIED TO: cyl°O •' .•, -/ EL=12
CLIFFORD CORNELL,SR. N h
REALTY TRANSFERS ABSTRACT CO.,LLC Z 1
STEWART TITLE YNSURANCE COMPANY I •° ' I
3 P MORGAN CHASE I:,ANK(.lidded 04,-26-02) I . , 1
PROPOSED SEPTIC.
I . I1000 GAL.SEPTIC. TAN
I � I I 4'DEEP 8'DIA LEECHING POOL
, III 1 II 1 N
,_%1%..-. 1 Lot I ®4O . Okr)Record Test o ' 0f,) .• g
Hole Data ; mo ys�o
Lot#4 00
not to scale) Dweliing "\ .. ••11 i `',o. --- 35 ----
\ \
��L Flood Zone
dark 11 \I I A'P > \'�'° AE(5)
brown \ • \ / • •
Bondy 1 \ I •�4e ---A-46„------ Flood Zone
loam /
0 5' \\ I • . .\\ � ate” nxu�
brown \ I\ t° 14 p® ¢ ;
loamy •.�. A, \ r.:Nr
,d 'd 'v\ ,q,4.\
send b \ a •`
2 5 ' ',4`41 % s+
C,\1 • n9 J�F J o 0 c
\ __ , a�� CC s E. �0
pale \\ \\ "�'�° \�w s> N°'� x.0�J� O(L N lU
brown \ .. \ (0 q- 0`01 Z
medium \ \ '• Z 6i 0 --
to ray.`. \ .�®'y�`sA' 4 ; 0
GOar5e 111 1 \\ _. •J• _.57• - —_ c'13 1J 1-I
•
sand :6 11 QQS 'Vp-ryb '�4 ,�ST J
l J► • l HOLE .
Ground 9 7' $ o ' II 0`\�
Water 4. y \ to Flood Zone
• l x'
i 1
1 • Flood Zone
1 ' 1 AE(a)
f a
pole 1 • 1
1 ,-4' I
• brown I
. medium I I
1 1
to I • 1
1
coarse
sand ' I1
1 1 1
. 1 p, 1
. afl' l
ex,Istini g F \
well 1 °y• 1 a
9 e \
17' \ • a \
• i \
'7. • ,.\ existing
vf\ \` \\ wells e
U t e \
tit \\
��
EXCAVATION INSPECTION REQUIRED
FOR SANITARY SYSTEM . . \
m
• m
• , \ 00
__ �_ O
~SUFFOLKCOUNINDEPAR'I? '- T'rii BALTh SERVICES 1 . \\\
cam.
PERMIT VOR APPROVAL OF CONSTRUCTION FOR A �'�. : . \\ ��
NG1LE F.� LY R� 'SI DENCE ONLY o •,' �5 q8 ��
o o6'1
APPROVED_
3"
mi,
, „,, ,, ,,
F oR tviAximui+„ o 0,,BEI MI/M .sJ .'.-'t'°' �'
E�CFiPEu T`iar&'.i E YEARS FROM DATE OF APPROVAL I`meq 1 ' *
A ,,
... 'I._>r ASE NOTA 0 N '�o.5 -`'r` O�
Minimum distance bet ;JCCn well , .*.'R �L�4NEa`�v
NOTES: aril cesspool is tC be 1 0 ie�'t. ,
• MONUMENT
unauthorized alteration oraddition to a survey
map bearing a licensed land s s
surveyor s seal is a
violation of section 7209 sub-division 2 of the
O PIPE New York State Education Lau
Only copies from the original pf this survey
marked with an original of tie land surveyor s
AREA = 2.11 ACRES stamped seal shall be considered to be valid true
copies.
"Certifications Indicated hereon signify that thiscLand
POOL LOCATED AFTER HEAVY SNOW survey was prepared in accordance with the ex-
isting Code of Practice for Land Surveys adopted
ANY PATIO NOT OBSERVED OR LOCATED by the New York State Association of Professional
Lana Surveyors Said certifications shall r only
to the person for whom the survey is prepared
and an his behalf to the title company governmen-
FLOOD ZONE ANNOTATED FROM FEMA tel agency and lending institution listed hereon and
to the assignees of the lending institution CertlfIca-
MAP # 36103G0167GMAY 4, IggB
tions are not transferable to additional institutions
y�
PROPOSED ACTIVITY OVER 100' TO ANY SURFACE WATER J O� ;w,.', Cm Epi ,LE 1.S L Int \., ,J,, IS' ' ,,V Y•R
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
a
GRAPHIC, SCALE 111= 60' RIVERHEAD,N.Y. 11901
== IM IINNI 369-8288 Fax 369-8287 REF.-TIGER\PROS\99-260C