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ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
ca Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %9 Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: October 20, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4438 for a Cesspool/Septic Tank Construction
Permit submitted by:
Tom Samuels of Samuels & Steelman for Jack& Nancy Armo
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
Dated
FO�,�co
ELIZABETH A. NEVILLE Gey Town Hall, 53095 Main Road
TOWN CLERK cz P.O. Box 1179
en Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS W
MARRIAGE OFFICER Gp ♦ �`� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �f Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� �a southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 1/ or Non-Residential @$25 Application No.
Permit No.
Applicant Name 3�""w
Applicant Mailing Address 223
Septic Tank or Cesspool
Brief Description Qf Pro osed Construction or Alteration A40k Ot 1,11dfiq
CAJ �Wfl 6,ew s �
Location of Proposed Construction/Alteration:
Owner of Property: 444 4 UMCA ArWD
Owner Mailing Address: fc)• •
IN 111st
Owner Property Address: -tivoQ
� -y-
Name
Name and phone number of contact person
Tax Map No: Section Block 6 Lot
Cross Street ®��
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Sign ure of Applicant . ate
Received by:
III i Urfllwhlilill!
REVISIONS:
SITE DATA 5/6/16
BUILDING WALL FF EL 01.5 FT SCTM# 1000-117-02-11
Ay,NSUFFOL!, COU,'Ti_Y DE-PAR TMEtff OF HEALTH SERVICES GRADE LINE ELEVATION '7.0 FT. PROPERTY: 2400 Grathwohl Road
�AE5T PERMI r Pc�,,APPROVAL 01F CONS TRUCTiof4 FORA GRADE LINE ELEVATION t 6.8 FT. SLOPE 5% Now Suffolk NY 11956
GREEK .4 FT OWNER: Jack and Nancy Armo
I' MIN. 2' MAX.
Rr-isiDENCE AND PO Box 39
All
T.
LEAC,
T*
5. -TIC
(13AI30 New Suffolk,NY 1195
6h, ct(/I ..........I/4"/FT. T. TOP OF POOL SITE AREA: 12,509 SQ. FT. =0.29 AC.
MEAN HIGH LEAOHIN14.1 FT. FLOOD: AE&X
POOL ZONE
NATER MARK DATE 11'.S. RUv. No 5EPTIC, E. +45 E30T OF POOL
IE. +5.0' TANK ELEVATIONS ARE REFERENCED TO Uj Uj >-
z 2.1 FT.
N.A.V.D. 1989 DATUM z
GROUND INATER
r
Buggancy Calculation 0 Septic Tank AF-PROVED BOT OF SURVEYOR: John C.Ehlers
(1,200 gal, ELEV 0.-1 FT 6 East Main Street 0 "Now
TOTAL MAximum BEDROOMS TANK +05' Riverhead,N.Y. 11901 Z 0
Septic. Tank, 1,200 gal (Wt dIa/X 5Pt ht) weight = 4,4100 lbs (ampt Tel,#631369 8288 W LL
z
1,200 gal liquid = 10,008 lbs THREE YEARS FR0111,�n_AT,-,, 65 A, P'rl_�'OVAL LICENSE#50202 D
5atic, Tank Cover (5ft; dia roln thk) = 5,r-W The SEPTIC, TANK W DATED: 8-31-2005 2 Uj
Soil Cover 0.5 ft deep x ata = 402 caf x '75 lbs/cf 5,015 The a
MONOLITIC, 5A5E SEPTIC PROFILE LOCATION MAP ® W
So tl' Tank empty. (N.T.S.) CO Z
4, 00 1125 + 10,005 ll�/+ 5,5W lbs + 15 21,415 The d
LU <
Water Line(s) 0
Z Septic Tank fulh Be Inspecled By The PROPOSED NEW 5EPTIC, SYSTEM W
10 Wo P_ FOR A 4 BEDROOM RESIDENCE AND GARAGE 4,4100 The + 1 08 11:15 + 10,008 lbs + 5,550 1 3 15 5,461, lk County De t. Of Health Servicc-)s. I
�p Call 852-5700, 48 Hours In Advance, - 1200 GAL SEPTIC TANK (ST) z 0
L 0
Displacement of ground water due to Septle, Tank To - (1) 8' DIA x 2' 141611 LEACHING POOL (L11) \0 0
acHAaos
Schedule Inspection(s). LOCATION OF EXISTING
Septic.Ir,/nk displacement (partially submerged) SANITARY SYSTEM To _ FUTURE LOCATION FOR (4) 5' DIA x 2' HIGH
CD
(5epfir, Tank EMPTY) BE REMOVED AS LEACHINGPOOL ❑(EXP LP) 0000 >
&Kound victor elevation.+0:71,Bottom of Septic, Tank +05' NOTE: PROVIDE OR0550\/ER PIPES BETWEEN
REOUIRED oun 1 0
DISTRIBUTION POOLS AND LEACHING POOLS
total displacement of ground Hat4or = 02' %i®/ z
Displacement height x area of septla tank, 02' x 50.2i' = 10.05 r-f water ❑ W CD
water = 62.45 Ibs/6f WSUFFOLKAVE. ❑ M It
C14
,ed ground water of septle, tank)62.45 x 10.05 = 62*7.42 lbs (weight of displaced
[if 1000-117-2-10 JAC
Tank empty 7-- 21,4715 The LAND N/F OF
Uj_j 1
21, lbs /621.42 The = 54.22 safety factor CUROTT PHYLLIS W
LAND N/F OF RESIDENCE WITH
Septic Tank displacement (partially submerged) CUROTT PHYLLIS W PUBLIC WATER & SANITARY SYSTEM
to
VACANT 2500 Grathwohl Rd, New Suffolk, NY 11956 CI IQ
(Septic. Tank FULL)
&round water elevation +01', Bottom of Septic, Tank +05 S73*21'00"E 153.72
Total displacement of ground water = 02' L -6
Displacement height x area of 5aptic, tank,0.2' x = 0.05 raf wo r
water = 62.45 lbs/of z
6:2.45 x 10.05 = 62"7.42 lbs (weight of displaced ground water of sept r tank) +
SepticTank full = 51,461 lbs ZN
C14 LP -7.2 W-J,H;
51,481 Ib5 / (221.42 lbs = 50.11 safety far co
,tor LAND N/F OF 4 LF
00
WICKHAM WILLIAM
5aptir, Tank displacement (fully submerged) VACANT LP, ST 1000-117.-2-20.1
'Septic EXI5TIN6 LAND N/F OF
. Tank FULL) 21-211 EX15TIN6
Area of Septic. Tank(Wt dia x 5Pt ht) = 50.21ef (8ft d1a) x 5ft ht = 2 135 r Nr-.E WELL TO BE el GRODSKI STAN
Displacement of ground water if septic, tank (full) is fully submerged Exp L ABANDONED GRODSKI,,AL-EXI
RESIP
P�l ;
4 BEDR OM55 I�fl X
251.55 c-f x 62.45 lbs/cf (water) 15,6cli.15 The W VE " �E:
Tj/
&.4+ IN/ BASEMENT S T. tsp V
I�
5FAT�AOHI LF 4 PROPOSED Aoo I-Rd_,/��
5e tic Tank full = 51,451 lbs EXCAVATIO Iwell
fc
31,461 The l5kcil.16 lbs 2.0 safety factor N SPECTION RI ��u F_XP LP PUBLIC, JAATE5 4ew u.
C! k (P
2
--ff- 50 ef (3ro
FOR SA ITARY SYSTE 0 Exp
5 SHOWN LP floo
--------- 13Y HEAL H DEPARTME 4T TE T Hk
TWO OR'i- ?
4+ F�N FLR
+
V
(0) 52' 25, 1514
N& LIT
TEST HOLE CD IxEXU511
NO SCALE t,4' z GARAGE_ n
()N 0 �9DA R
Ts
BY MARK McDONALD GEOS r ji jjf C"I'LlStU3, 0 ;,.y CN X ONO 4/4116
r c, in
SOUTHOLD, NEW YORK 1197
mi i t sf gro,95 22' C)
1, 1 1 vtc-Ljz SU
TEST HOLE DATA 7/2/12 ELEV.+6 ,v U, —®— — /Pfoor prea
721 SHEET TITLE:
-/6�,Nrz STORY' FIN
FT. DARK BROWN LOAMI OL Vq
C\j
co EXIST IRIVENA FLMISLEV +,45
C/)
4.0 FT. BROWN SANDY SILT ML
2 SITE
5.6 FT. BROWN SILTY SAND SM I I PLAN
150.00' X sting
I n 1000-117-2-17.4
WATER IN BROWN nes 1193 hloo r I n*9
16.0 FT. SILTY SAND SM N74*29 0 W LAND N/F OF
LAND N/F OF 1000-117-2-12 5EFTIC� LINE FROM well GRODSKI STANELY SHEETN
GRODSKI ALEXIS
WATER IN BROWN SUFFOLK COUNTY LAND N/F OF &ARA&E TO RESIDENCE VACANT
23 FT. FINE TO MEDIUM SAND SP VACANT FIROF05EP N NATER KLOS LOIS A FAM 2011 IRR TRT _.;�k SITF PLAN