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ELIZABETH A.NEVILLE �� �� "'�'; '�'�; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER : I�i z `� '� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �___®1 Agg
�® 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. 2851 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD V WERTHNER
Address 1 : PO BOX 450
City St Zip JAMESPORT NY 00000
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 #R10-01-0235
Name Of Owner WERTHNER, EDWARD V
Mailing Address 1 PO BOX 450
City St Zip JAMESPORT NY 0000
Property Address 1 WINDY POINT ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 6 lot 2.000
Cross Street BAYVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/23/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
.° S 5 )
ELIZABETH A.NEVILLE °y Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
�, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � -,'
MARRIAGE OFFICER . .��,,�� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ®� $ ,i" Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,s' southoldtown.northfork.net
, 002 OFFICE OF THE TOWN CLERK
9 TOWN OF SOUTHOLD
Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: _July 11-2Q02-2
;,Transmitted herewith is a copy of application No. 2956 for a Cesspool/Septic Tank Construction
Permit submitted by:
Edward V. Werthner
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
* * * * * * * * * * * *
- r
I.have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE1071**
DISAPPROVE
Comments:
Signature
0 4/ 2
Dated
• OFFICEOFTHETOWNCLERK 'li''''' -=
• .
:�
TOWN OF SOUTHOLD � gt1FFOCkco _ q
FT.T7ABETHA NEVII.T.F,TOWNCLERK ;1'OO y: • Application No. l �6
P.O.BOX 1179 Construction t//
SOUTHOLD,NEW YORK 11971 % � ° '_
O
CPAlteration 1/
Telephone =0,�� �i �,' $10.00 -Residential
(631:) 765-1800 -II'. �,� 0.
„.�o,,,, $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 7/1/174'b)-
APPLICANT
/l//7 b -APPLICANT NAME: G�' �f)-1 -i) V. J/V 7 M)rZ.
APPLICANT ADDRESS: 70 -56.5-0 • '
j R / Q7'( ovy .
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: 6J/.e1�1-7TH V tA)F2 e,
OWNER MAILING ADDRESS: Po 66-/ °4(51)
OWNER PROPERTY ADDRESS: ,tib y Pr, W044
dJ'fl7 )Lb ACy _.
TELEPHONE NUMBER OF CONTACT PERSON: 6a,/ s cc -7c7/ 66o3u
TAX MAP NO. : Section O�� Block 0 C Lot �
qq 3 7
O'
CROSS STREET: t3rA- N I L-`1/) a' ,
•
BUILDING PERMIT NUMBER CROSS REFE' - - CE: 7 q
0,, ,
.094-"4/ 0/27-a , •
/ Signature of Applicant
RECEIVED BY:
4----V---dif--)
Town Clerk's Office
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IDt1 T'R L;COD,E.-THE;CON'I OCTOR':S
IS OPEE tek iONS;Wr114 1HE.VARtOlUS CO
17EREsTS WILL:BE,AFFECTEf)BY TI•IIS .
1
BACHFILL WITH Ci •
c / . P MINIMUM,Z'MPI. •
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8' DIAMETER X- -
2'EFFECTIVE
DEPTH-LEACHING , 1
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_ _ WHEN CONSIDERED '
'..-..±-2'TO GROUND Y UNDISTURBED •' 'NECESSARY BY THE DEPARTMENT
.AI - _ _,_ .. • SOIL .
2 - 14 CONSTRUCTION OF SSDS TO BE IN ACCORDANCE WITH'THESE PLANS ANY FIELD CHANGES TO THE
t
LOCATION OF THE PROPOSED SEPTIC STRUCTURES SHOWN HEREON WILL REQUIRE REVIEW AND
/iVril
APPROVAL BY THE CERTIFYING ENGINEER IN CONSULTATION WITH THE PUTNAM COUNTY HEALTH
et a Q QEPARl MENT'PRIOR TO INSTALLATION„
m 2 '� - }' S HE TOTAL SEPTIC SYSTEM CAPACITY SHALL BE FOR A 3 BEDROOM SINGLE FAMILY RESIDENCE
Q V q �A. , a..i:.. �...»..v,..-.�...cc,�,7..+v-,,.,„...,,,,.....,,,,+,w�,, � .. -• - l
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EXISTING CL • • • : •ND GRAVEL ,'
16 PROVIDE A PRECAST CONCRETE SEPTIC TANK HAVING A NOMINAL LIQUID CAPACITY OF 1500 GALLONS
�+ /� • (� IT IS THE CONTRACTOR'S RESPONSIBILITY TO CONDUCT ALL SITE INSPECTIONS,THE CONTRACTOR SHALL
7. � - � c i2 )1c £h 3Q)- 1 C c-i , 01,) s -- )vim✓ ^ ' NOTIFY THE SUPFOLKL:OUNTY HEALTH DEPARTMENT AND THE CERTIFYING ENGINEER AT LEAST 24 HRS
' /..:If _ / PRIOR TO THE START OF CONSTRUCTION OF THE SEPTIC SYSTEM
C �� v 10 vJ ' `, J. ''1l' �
�� 17 THIS PLAN IS FOR SEPTIC APPLICATION ONLY FOR THE PROPOSED AND IS NOT TO BE USED AS A SITE ,
PLAN UNLESS OTHERWISE APPROVED-BY THE DESIGN ENGINEER
k L LEACHING PIT SECTION 18 EXISTING SURVEY AND TOPOGRAPHIC INFORMATION SHOWN ON THIS PLAN WAS TAKEN FROM MAP
ENTITLED>'RO•BA'AIEVON SOLM-0D AS PREPARED BY NORTHSTAR .DATED 10R6/2G01
BE WITNESSED BY THE SUFFOLK COUNTY DEPARTMENT OF' 19 EXACT SETBACK LINESAND PROPERTY LINES TO BE DETERMINED BY A LICENSED LAND SURVEYOR PRIOR
TO CONSTRUCTION (NOT PART OF THIS CONTRACT)
5 20 AREA IS SERVICED BY WELL NO WELL IS WITHIN 100 FEET OF SEPTIC SYSTEM OR OIL TANK UNLESS
OTHERWISE NOTED ON MAP,NO WELLS OR SEPTIC SYSTEMS ARE WITHIN 200'DOWN SLOPE OF THE
PROPOSED SYSTEM
DE 21 THIS SYSTEM IS NOT DESIGNED TO ACCEPT THE WASTES FROM CELLAR DRAINS,FOOTINGS,AREA OR
ROOF DRAINAGE,CONNECTION FROM POOLS,BACKWASH FROM WATER TREATMENT DEVICES OR
• DISCHARGE FROM LARGE WHIRLPOOL TYPE BATHS OR THEIR FILTER SYSTEMS
22 ALL EXISTING OR PROPOSED ROOF LEADERS,DRAINAGE OR,CURTAIN DRAIN DISCHARGE LINES SHALL
HAVE A MINIMUM OF 25 FEET SEPARATION DISTANCE IF LOCATED UPGRADE OF THE SEPTIC SYSTEM
' SHOWN HEREON(OR 60 FEET MINIMUM,IF LOCATED DOWNGRADE)AND FLOW SHALL BE DIRECTED AWAY
FROM THE SEPTIC SYSTEM
' 6 WPFOLbf COMITY DEMMENT OF HEAL EI SERVICES
PIT
ar°�
AL O�PCONSTitUCrION FORA -. •'-r'.---2.: CO
iVIGLE FAMILY RESIDEN!<S ONLY , ,
°ATOM-.. , 0----5, n ' KS RE Aigp* a.1 0 - 61 -GI -5.."' '::;- -... '''....7.s.:'.
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DETAIL OR MAXIMUM OP__ =
'ROOMS _; ; : L
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EXPIR138 THEE8YEARSFROMDATEOPAPPROVAL ' ' : .-
,34
I ' ' RETAINING WALL �!
NTS H.S.REFERENCE N0:R 10-01-235
. OWNER:
10 EDWARD WERTHNER
PO BOX 450
JAMESPORT, NEW YORK 11947
. ...:.....]
• 516-333-2630 1516-A 19-3966
.
•
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��of NEyv ., '',,4 / DATE'
(4 • ':A SEPTI1C SYSTEM STEM DE�IGN 1211012001
o * SCALE
JAS NOTED
id.
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.h� .:: r.:., L., PROPERTY LOCATION:
#�FoA�°727701P. WINDY POINT LANE-"MAIN BAYVIEW" ROAD DRAWN BY
o_Fr��'a� BAYVIEW
TOWN OF SOUTHHOLD, D. KNAPP, PE
SUFFOLK COUNTY, NEW YORK LOTs:2 8 3
)
S.C.T.M: DISTRICT 4000; SECTION 078,;BLOCK'OS; FILE NO.
, • :. • j I .•
,,< l.: :, : : - • _ DRK CONSULTING -ENGINEERS IIJI II))
DATE BY 2 DALE AVENUE, SOMERS, NEW YORK 10989
(914)-248-7726, FAX(914)-248-7726' ' DWG. NO. R E O.
DATE BY I
. WERTHNER _ :; _