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ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
CD
co Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 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 27, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4440 for a Cesspool/Septic Tank Construction
Permit submitted by:
Lefkara LLC
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 Dppartment
Signature
Dated
®�®�,VFFPIj�c
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ELIZABETH A. NEVILLE `�` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �s
Southold, New York 11971
MARRIAGE OFFICER ® Fax (631) 765-6145
40-RECORDS MANAGEMENT OFFICER � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �'� � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@ $10G' fir or Non-Residential @ $25 Application No.�-1 i i.
r Permit No.
Applicant Name °mfk(AllC
Applicant Mailing Address G6--ov/40
G-W Ld ( S d
Septic Tankor Cesspool
Brief Descriptioof Proposed Construction or Alteration
J t A
Location of Proposed Construction/Alteration(:
Owner of Property: u
Owner Mailing Address:
yG
Owner Property Address: f ) 0 T11A
Name and phone number of contact person f o
Tax Map No: Section Block c Z Lot
�
Cross Street I h'k 't ")
NOTE: LOCATION MAP MUST B4 SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE WITH HEALTH DEPARTMENT APPROVAL
Signa"ure of Applicant Date
Received by:(,,,, , '
SURVEY OF
0� TEST HOLE DATA L 0 T 125
h (TEST HOLE DUG BY McDONALD GEOSCIENCE ON JANUARY 4, 2007) MAP OF
^ FF�� EL. 52.7' DARK BROWN LOAM OL PEBBLE BEACH FARMS
(\Y\J \ 4 1 FILE No. 6266 FILED JUNE 11, 1975
4.6 \p�� 10 �s � 4 1 SITUATED A T
Y Q 10 SiS',,,' J��
F 0�� EAST MARION
�( `'°'�`'�1� p� `,6 /' '/'/ 'L�0 P���°`�Pe ` a TOWN OF SOUTHOLD
i a/ iii !'i E J�o�p� Pe
38 °�� ;�$ ° S� SUFFOLK COUNTY, NEW YORK
,( P BROWN SILTY SAND AND SANDY SILT SM & ML
` i / / ',���5 VNO pN POF 0.9 S.C. TAX No. 1000-30-02-77
'/ '/'i'� '// 'i t`6 v� P,�PR 6Rp5'( 1y a a „
�9,
54 sxpNpps"s s� ; SCALE 1 =40
�Q, ERpN p p9'$ ` JANUARY 16 2007
o /'i iii moi'///'j / / / j�/ 5��5., �GpPgNp�X o 5,�6 44' MARCH 7, 2007 ADDED CLEARING LIMIT
//� /i// // / /////// / P>Np.�p BROWN FINE TO COARSE SAND SW NOVEMBER 29, 2012 ADD PROPOSED HOUSE
/ / 'i/ / j / / / / / / p
'i / // /i / / % C� EL. 6.7' 46AREA = 22,427 sq. ft.
c'9' tiN '. /'i'� i/'// 'i i' 0.515 ac.
WATER IN BROWN FINE TO COARSE SAND SW
cP0,
/, x58.2 --60 52'
N�k' am / �/ o
F
\
64.5„
lb
60.z \y`— / / � `To\ CERTIFIED T0:
eo 0 1�1 STEFANIDES
° 62.9 /' j ; 58,0 0q V�Q '
I ?•o/ / �::� :..ate,+, 0��-56
ti 57.6 9 sem•.•. .'•::: jo'
60.0 00 '
S,.:. x54.2 !
STr.VlS� t
:::...:. }3'i�. Sq � ” IM`w i`+ is 1i"•
os Com ` QO/ s�ox �F'� Ot ta1bU it 0 '� .K= 0
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�l l$O OQQp •`;tj10:. A�S2 61wal. ' t
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4-
NOTE: 9J C(y�•QIn
p PREPARED IN ACCORDANCE WITH THE MINIMUM
1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM �°Q e�w 9!Y F ''''!? �j� , ° p�' °Q STANDARDS FOR TITLE SURVEYS AS ESTABLISHED _
�pnBY
EXISTING CONTOTURNLINESE ARE SHOWN THUS: — 10 — 1" O� •�:':,;� �O, `' 53.2 FGO�G.� ��Q°��' I ��, FOR
TS TITLE S AND AP;;NROVFO�yANpSICPTE
DD
OCIA
2. FLOOD ZONE INFORMATION TAKEN FROM: ��}��fj1 � C -� b 1 al
co'
FLOOD INSURANCE RATE MAP No. 361030063 G �A i Q I
T a '
ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); A' 52..• .. ' ' �'J -( 'I" —"""'"'" � I i
BASE FLOOD ELEVATIONS DETERMINED 2� °; ^ i } (4�V 1 } 'Z' '�`"~•-'"'^ .._ �� 6
i�
ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN. 54.6 6'1)., �f � �, BEDROOMS� �M 1 L
3. MINIMUM SEPTIC TANK CAPACITIES FOR 5 BEDROOM HOUSE IS 1,500 GALLONS. ���y��,,,,, •� Ti f
1 TANK; 8' DIA. 5' LIQUID DEPTH 0�'� '� ��` * 'Gr .a
4. MINIMUM LEACHING SYSTEM FOR 5 BEDROOM HOUSE IS 400 sq ft SIDEWALL AREA. v,'�.,,aa •`--•
1 POOL; 16' DEEP, 8' dia. is �}� �...,
T Lam..__YEAR,-,,
PROPOSED EXPANSION POOL �.. IY1 F°p�'6� .°" \Y,` '^•.°w`..'"'�":.' '.F....ns..ra. ,�a �wscT. - tk
®PROPOSED LEACHING POOL p.' {d 5 L�.r'No. 50467
PROPOSED SEPTIC TANKc 6
7� , \C`11 CTONA HIS SURVEY 13 AA VIOLATION RATION OR DRK)N �{m�a W' "'
5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD �4 {°'t. <€e ,j �s $� v��' �P' SECTION 7209 OF THE NEW YORK STATE
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. { TyG,,, + P EDUCATION LAW.
,mob•' -J Surve%ror
�' G COPIES OF THIS SURVEY MAP NOT BEARING Lanu
`(_ "� _.«--^' THE LPND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
�" �`'< ,•„.: "°" TO BE A VAUD TRUE COPY.
1506 " CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
IS PREPARED,AND ON HIS BEHALF TO THE
LMLE ENDING MPANY, GO LISTED ED L AGENCY
AND
Title Surveys - Subdivisions - Site Plans - Construction Layout
TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fox (631)727-1727
Q TUITION. CERTIFICATIONS ARE NOT TRANSFERABLE.
THE EXISTENCE OF RIGHT OF WAYS OMCES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jannesport, New York 11947 Jamesport, New York 11947