HomeMy WebLinkAboutConsiglio ELIZABETH A. NEVILLE,MMC � Town Hall,53095 Main Road
TOWN CLERK m P.O. Box 1179
CA 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: November 9, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4445 for a Cesspool/Septic Tank Construction
Permit submitted by:
John Consiglio
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
�Qco
ELIZABETH A. NEVILLE e �•Za G� Town Hall, 63096 Main Roa,
TOWN CLERK p P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �, Southold, New York 11971
MARRIAGE OFFICER 7 Fax(631) 766-6146
RECORDS MANAGEMENT OFFICER y�Jf5 �O� Telephone (631)766-1800
FREEDOM OF INFORMATION OFFICER sou tholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential $10 /or Non-Residential 2 @@$ 5 Application N .
Permit No.
Applicant Name
Applicant Mailing Address ,4 vt T- � a.
Septic Tank. or Cesspool
Brief Description of Proposed Construction or Alteration / ria _®&I l4e
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address: So
Owner Property Address: q
Name and phone number of contact person J° i"` '" /t '
Tax Map No: Section ' �� CSU Block 0, '00 Lot 0/`'' 000
Cross Street
NOTE: LOCATION MUST DE SUBNHTTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WFFH HEAL H DEPART +NT APPROVAL,
Si e of Applicant Date
Received by:
The location of public water, wells and cesspools shown hereon are SCDHS Ref.# Pre-15-0425
from field observations and or from data obtained from others. SURVEY OF PROPERTY
ELEVA77ONS & CON77OURS ARE REFERENCED TO AN NAM 86 IN SO ou UTHOLD
BASED ON THE FrW EASTERN 7oWS TOPOGRAPHIC MAPS AND TOWN OF SOUTHOLD
ACTUAL FIELD OBSERVATIONS.
SUFFOLK COUNTY N. Y
1000-54-03-15
N SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES SCALE: 1'--40'
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A JANUARY 8, 2015
+
SUFFOLK DEPARTMENT
APRIL 8, 2015 (REVISIONS)
COUNTY
F
P
P 4 OLK 7F -
RMIT OR APP€
SINGLE FAMILY RESIDENa ONLY
MAY 0 1 .204
/'q;� DATE 1-1.S• RE F, NC.
APPROVED
D HEALTH
HOLE DATA
FOR MAXIMUM OF BEDROOMS cDONALD GEOSCfENCE
YEARSPARES THREE FROM DATE OF APPROVAL 40.8, DARK BROW LOAM OL
0.5,
0 WELL
BROWN SILTY SAND SW
20'
Cj BROW FINE TO
MEDIUM SAND SP
28'
\X / o QGP NOTE.• NO WATER ENCOUNTERED
0-
'A\
T
DW
THOLE 0
ES
EL 40.8'
kle
Cb
EXCAVATIoN INSpECT, U-nLITY ev
LJ Ul POLE %Kq
FOR SANITARY Sy x
13Y ALTI!tj�t PROP..
LEACHING POOL W/L LAMP
lo- Ar
/ 44
F-1 2 MAX'. cw
CHIMNEY 4/1'
4K 0,
ST Moon
3' SAND
COLLAR to '0
APPROX AREA
G)
OF WELL
41 1
Dig down 8' dia. to sand (SP).
Remove material and
back fill w i thsond (SW).
PROPOSED SEPTC S YS 7EM
(4 BEDROOMS)
[1]5 FT DIAx 12 FT DEEP PRECAST CONCRETE LEACMNG RINGS
BACKFILL WTH J'SANG (5*) COLLAR, 3'ABOW 0?aAD WATER NE.py
[1]1,000 GALLON PRECAST SEPTIC TANK
5
AREA 23T315 SO. FT. 4_6 -.4
I Aild FAMILIAR WTH THr STANDARDS FW APPROVAL
AND CONSTRUCWN OF'S"WACE SEWAGE DISPOSAL
SYSTEMS FOR SINGLE FAMILY REMENCES AND WLL ASIDE
BY THE COM77ONS SET MR7H nfiRUN AND ON THE
PERMIT TO CONSMCT . . . Ll NO. 49!
ANY ALTERA77ON OR ADD177ON TO THIS SURVEY IS A VIOLATION RAIN RUNOFF CONTAINMENT- PECONle'SURVEYORS, P.C.
OF SEC71ON 72090F THE NEW YORK STATE EDUCATION LAW
O.
7209—SUBDIVISION 2. ALL CERTIFICATIONS DWEWNG: 3226 Sq. Ft. (631) 765-5020 FAX (6JI) 765-179
EXCEPT AS PER sEC77ON COPIES THEREOF ONLY IF 3226 x 0.17 x 1 — 548.4 CuSt. P. BOX 909 —
HEREON ARE VALID FOR THIS MAP AND Provide 4 DW9. 8'9f x 3.5' Deep
cC'Al fIC 77Jr* C11PWVrAP 4nY^ 'rMA%TIC-E)