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ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
CD
CA Southold,New York 11971
REGISTRAR OF VITAL STATISTICS W- 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 31, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4442 for a Cesspool/Septic Tank Construction
Permit submitted by:
George GeorEiadis
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
O
ELIZABETH A. NEVILLE �`�� G¢,� Town HAIL, 63096 Main Roa,
TOWN CLERK - P.O. Box 1179
ti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y
MARRIAGE OFFICER Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER 41, Telephone(631) 766-1800
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 @$10 `.�or Non-Residential @$25 Application No.
Permit No.
Applicant Name G*4_ C!jk
Applicant Mailing Add_ress
N .� �'
� PCVt cY�()°s t L 5
Septic Tank. or Cesspool
Brief Description of
L Proposed
roposed C—o-_nTstru.ct.ion or Alteration
df-1 s4. . z_
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Location of Proposed Construction/Alteration:
a
Owner of Property:
Owner Mailing Address:
Owner Property Address: 1 S',S' siv n.A '�k r z_ V C
Name and phone number of contact person C.j.p ;, �.:`�ag .� �J d 9 -- q m 311
Tax Map No: Section S a Block :3 Lot
Cross Street 13 c�u k c,cr a L- A vim..
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION RE'QUIRE S SURVEY II HEALTH EPARTME NT APPROVAL
Signature of App icant Date
Received by: ((%'1 ��
SURVEY OF PROPERTY
AT GREENPORT
TOWN OF SOUTHOLD
COUNTY,SUFFOLK N. Y.
1000-52-03-23
SCALE1'-5 0'
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FEB. 22, 2016
MARCH 0.3, 2016 (PROP. HOUSE)
APRIL 21, 2016 (REVISIONS) `p�gE�LwN�R)
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LYFC3LYa COUNTY DEPARTMENT OF SEL § E, RICES
Excavation InSPection PERNUT FOR APPROVAL OF CONSTRUCTION
,q c- SINGLE I-A MILY RES'DENCE ONLY
By Health apartment
JUN 0 2 2016
" SLE DAT�4. N�__ II, E i�. 5F.
McDONALD GEOSCIENCE
12/23/15 AP?RO`JEO
EL. 14.3 BROWN LOAM OL FOR MIAY,1114
1' F-XPIRES t i IRF1 YEARS FR-01'4 DATE Or A1.=TR1%) AL
PALE BROWN SILT AND SANDY SILT ML
PROPOSED SEP77C SYSTEM
(4 BEDROOMS)
9 [1] 1,000 GALLON PRECAST SEPTIC TANK
[11 8 FT. DIA.x 12 FT. DEEP PRECAST CONCRETE LEACHING POOL
PALE BROWN FINE TO COARSE SAND SW w7H 3' SAND (SW) COLLAR, 3' ABOVE GROUND WATER
WITH 10% GRAVEL. RAIN RUNOFF CONTAINMENT
HOUSE 1048.8 sq.ft.
17' 1048.8 x 1 x 0.17 = 178 Cu. ft.
PFFNE
178/42.2 = 4.2 VF •w r
NOTE. NO WATER ENCOUNTERED PROVIDE 1 DW 8'0 X 6'DEEP
OR EQUAL
SUBDIVISION "MAP OF SHORECREST" FILED IN THE OFFICE 3
OF THE CLERK OF SUFFOLK COUNTY ON I
APRIL 6, 1971 AS FILE NO.5584
ELEVAT70NS ARE REFERENCED TO NA VD 88
LIC. N0.
ANY ALTERA770N OR ADD177ON TO THIS SURVEY ISA VIOLATION ECO ORS, P.C.
OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. 631) 765-5020 FAX (631) 765-1
EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY 1F P.O. BOX 909
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR TOTAL AREA=26,782 SQ.FT 12JO TRA VELEF,SOU7HOLD, N.Y. 11971 T 15-2
WHOSE SIGNATURE APPEARS HEREON.