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449 *_ 20
ELIZABETH A.NEVILLE ����� Town Hall, 53095 Main Road
TOWN CLERK PT =_ P.O. Box 1179
cdoi Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � s y - y° Fax(631) 765-6145® 1
MARRIAGE OFFICER � y � ,��'`®�
RECORDS MANAGEMENT OFFICER �_ %Jd �� �� 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. 2895 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : FAIRWEATHER BROWN
Address 1 : PO BOX 521
City St Zip GREENPORT NY 11944
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 #R10-02-0135
Name Of Owner CHIN, NANCY
Mailing Address 1 180 KNOLL CIRCLE
City St Zip EAST MARION NY 11939
Property Address 1 180 KNOLL CIRCLE
City St Zip EAST MARION NY 11939
Tax Map No. section 37.00 block 5 lot 17.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 9/24/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
k ,,iii,iL
le � Z®�uFFOl ..
ELIZABETH A.NEVILLE k,/67 0�; Town Hall, 53095 Main Road
TOWN CLERK % c -. % P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICSFax(631) 765-6145
MARRIAGE OFFICER `� 4, ���1',
RECORDS MANAGEMENT OFFICER �__�®1 ap ��®�,0 Telephone (631) 765-1800
FREEDOM OF INFORMATION,__OFFICER �������,r�I, southoldtown.northfork.net
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1 , 11,11;) OFFICE OF THE TOWN CLERK
t SEP % 2 2002 <
�� i TOWN OF SOUTHOLD
'
6DiL
_ t
TO:0V''4 .�Fotroown Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 11, 2002
Transmitted herewith is a copy of application No. 3005 for a Cesspool/Septic Tank Construction
Permit submitted by:
Amy Martin (FBDA)
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:
\-
9W—e-''47i
Signature .
Z?9/ /0-2--
Dated
OFFICE OF TEE TOWN CLERK �' ��FFQCK`,
TOWN OF SOUTHOLD .sOG Application No.30:_b
ELIZABETH A.NEVILLE,TOWN CLERK i :
P.O.BOX 1179 j Construction
SOUTHOLD,NEW YORK 11971v T ;
Alteration
Telephone --%0 �Q��', $10.00 -Residential J
(631) 765-1800 = "l v .'' $25.00 -Non-Residential
.4000
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE q o_
APPLICANT NAME: iicj ck )
APPLICANT ADDRESS: T p , ' 521
•
I
SEPTIC Y CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
tied ,La��c tio-r► t/ t,4.- scj r- d2.4AL is
m ci. er h
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
Gct awn.
OWNER MAILING ADDRESS: fen° ((
st 0-im✓c e-rl
OWNER PROPERTY ADDRESS: j QJ J<+'lo N
lna-✓(ov,
TELEPHONE NUMBER OF CONTACT PERSON: Aft-11
TAX MAP NO. : Section Block 05" Lot j,?
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
, 4 _
Se nature of Applicant
RECEIVED BY:
P
lO � Town Clerk's Office
DATE: Rl
,t, ��5N �� FIN.FLR.EL. 15.75'_ L. 1 E CAST COVER
Q ' GRADE CAST COVER
TO GRADE
f CONC. MON. S73° ,c,\.- Q `I V' �0 TO GRAD\E `
FOUND 221SQiE �� � ocj\ �-P P
posy F�� QP Oe - v'- c.9 LOT #35 MIN.SLOPE 1
\ a��taN sy r ___________1/4"/ FT. 1 1 MIN1/8"S SPE
° �� FFN�E Q� Q�\� PGS s$e�► .
1 _ 5 \� s ��e� .
\ ,�� �J X�st�n9 ®�P� I.E.
.; \k-��G°ao \ ► \ 15 t`�, mei�{ by �a\t�1 �, I I. (G(P� 7-17----717- G<`\\G
\ \, 14 j aW ltar� esSed N N G,�G` Q� - \,,0x \-
\(\ 82° Q robeD N. \ ' ,5,\--_,ot,cl 1 !,=' _ p N - ' te°
t 0 O a \ \ \ co\ y \i„\ — er,,, / -? :y \ T GFS 057- ,,,,„.,ENCE \ , °�'i
c- 0 •S LAMP \ \ 1 �vk 10 9 la GROUND WATER EL. 0.9'
0 1
O O POST , r♦ r I' X3.4,, 1• 8 176
,� O \ _ _ ___?-06- 4, e,,,-/T� u`� `v 3S wA4 7Nc, ° TALL I\ 17�j 79, CROSS SECTION OF
`� � \ 1 b ' o�ST74 , 6 I S".1-1°52'40"E PROPOSED SEPTIC SYSTEM
�a \ \ �M ��4, \ .\ ,� F'4MST4t, / c•J� �..;fir • 9'
\ �„ (F,P hoe, F x R 6LK.H
I 9'I i SF oFos,-No-Se / 56 p • ` d.�� _... _ SCALE: N.T.S.
\ \ J'8' N F F9 80
o �I
PLEASE NOTE
•
R=.0.00 , I I/ 2 ►, �O°'�T/�t o o a° ro
I °• ' �� Sanitary System not t® be installed
L= ;5.46' �I �o o' n"\ o�vf / :, m` under drivMway.
IV
mJ .®.ed
.._---pVERHE D a°�a``)P?8' (o / ��a OT #34
N
WAT R —ARES a�o`A4 4 ',h.�, r� / / 't
W E MET Rio / o ... ._ �Pi s.6.//0 0
s \ TEST ��a� �/ ��� �0o m� 02 73'-2,.
r HOLE / / .o�l1 ��I�h . . . .. •T-E-ST 10 LE DATA
1
FENCE �_��� 4L,/,
�, \I�11 �o J .. ..-
0.3'5 X00 0 /o ^l1��P •4 d'� /
ti ' 1 ��, \
,n .- I 2W 0 14w,1,.� SCALE : N.T.S.
u� ; •� r 002 m� \ +ice SUFFOL? • DEP RT�T OF FIEAL`I R SERVICES
> 'Lg�° 4o \ I ���� \ 1/ �i'`- BY: McDONALD GEOSCIENCE
-t, ` c.:nrASED ON SURVEY BY;
j \° , I I 7'-z� 3 .I: = A 'I'? 'J �4I1 CO 'S' LTCO�doRj 17'0 2
t-;' 3 JOSEPH A. INGEGNO /6. 16' / I / 1'\ GLL+F LY. Es ENCEONLY • tt .
;%,c: l;' �mw \ ss'„ I 1 - 1'IO—Oe<^� f��
v1 '1D SURVEYOR I5 qy ,o/ \ s I I , \ DATE / .S,_ __ . HS REF.NO. - . .-
„' `•, - `�;'S 80 ROANOKE AVE. �/ a I _
12-0 G ZADE ELEV. = 16.45
__Y q / . , Z ' `® DARK BROWN LOAM OL
-- R;f�/,l jR11EAD, N.Y. I 1901
14 9ti� \ ,,• •.t•• tau �rr"�- _=--
:��.�� - , I\ LOT #3 •
T,,} �.StjkiEY OF: cF /s� o \\ \ of Y ' DR ?� S BROWNLOAMYSANDSM
L0 3433 13 MAP OF \\ / FoRxIMuMoEH
''• ' S THREE YEARS DATE OF APPROVAL
I
GARDINERS BAY ESTATES 12 J I \ I •
cuz IL, BROWN FINE TO
SECTION TWO LOT #32 I 1 \I I \\\ 'R O COURSE SAND
FILE NO. 275 SEPTEMBER 23, 1927 10 \\ I �' r SPRING POND 7.0' ----
SITUATED AT EAST MARION \I \ I CD
TOWN OF SOUTHOLD _,i,,:` ,;�,f�G 8 \ I 7�\ r
SUFFOLK COUNTY, NEW YORK
S.C.TAX NO. 1000-37-05-17 Relt.takra 7 / \
JUNE 9, 2000PALE BROWN FINE TO
AREA = 14,240.95 sci.ft. / \\\ MEDIUM SAND
(TO BULKHEAD) 0.327 ac. W G
N
; ,
CHIN / 15.6' -——-
g' i
P i WATER IN PALE BROWN FINE
.Ii.: :'1 i •,-
SQ>� \\ 17 TO MEDIUM SAND
SITE PLAN SV .417-,..
& _ �J
1 SCh LAEFEC�
��' ��, "`� FENCE
SCALE: 1"= 20' 0" ' 1'a �1 0.35 05/31/02 COMMENTS: WATER ENCOUNTED 15.6'
`' = BELOW SURFACE.