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ELIZABETH A. NEVILLE,MMC Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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: January 18, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4459 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jim Brodsky
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
®�®SUFFO(,�C
ELIZABETH A. NEVILLE �"�` ®may Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
C* Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1_� Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �f®d �y� 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 @ $10 or Non-Residential @ $25 Application No.
Permit No. 1 0—A —
Applicant Name SOA C
Applicant Mailing Address
Septic Tankor Cesspool �\ 0�
Brief Description of Proposed Construction or Alteration c� owjR it Cce�'� C_ r,ew
Location of Proposed Construction/Alteration:
Owner of Property: A®g(v%
Owner Mailing Address: 2
Owner Property Address: S QA V— v%
Name and phone number of contact person tvve ' r' 0�
Tax Map No: [060 Section ( Block Lot � c
Cross Street M flu n ILIJ
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE WITH HEALTH DEPARTMENT APPROVAL
17
Sign ture of Applicant Date
Received by:
S.C.T.M. NO. DISTRICT: 1000 SECTION: 97 BLOCK: 3 LOT(S): 13.1
I:n
S
SUFrOLK COUP'ITY Dz:PARPT.4jEN-r 0
PERMITFbr, APP�,ZOVAL OF CONST
S 1NG RU POP
A
A ftl i L'%" C E
ONLY
DA C
7�1 T-\ -ODU
APPROVED
F:'OR ;MAXI[w F
EXPIRES THRE-
FROM DATE OFAPPROVAL
f //V
DWELLINGS
W/PUBLICWATER
DWELLINGS 150.
W/'PUBLIC WATERA LAND N/F
150' 780189409) JEREMYOF ARMSTRONG
PROPOSED MARIA RIVERA
2 STY ADDITION
0 EL 21.1 (FTFL19.1) N
C) IST FL 512 S.F. 00
2ND FL 512 S.F. EXISTING SANITARY SYSTEM —
CD EARTH BERM TO BE ABANDONED AND BACK
< Qa AND EVERGREENS FILLED WITH CLEAN COARSE SAND.
GENERALLY ALONG p EL 17.4
U- = LINE. 1
--, CL EXISffz NG WELL W
Z Ld TO BE ABANDON 200.00s PROPOSED
9,00) PORTION OF EXISTING
MON. 4 BEDROOM
/DRIVEWAY TO BE REMOVE I
g d3 SANITARY SYSTEM
;0 EL 16.0
'WARA06 r 1,000 GAL S.T.
*x :2) 8'DIAx6'DEEP L.P.
0 38.0' \
........ ........
z
X 0 0
LO
EL 16.1
< 0 3
0 CONC. SLAB ':4 m::�
0 TO BE REMOVED EL 17.8 U;
L.P. so c
.... ............ LLJ
46EL 17.7
,
. j-'F rC{N1.4 7 30.7, DWELLINGS
W/PUBLIC WATER
EL 20.5 0.0' pt .8
Lip
L ROOF
150'
4
t1nN Ln z
P :D t
EL 18 2' ROPOSED Ift"OSED WATER
ORIVEW, Cn
0" jjNCSAV
,ON
4LINE I
EL 17.7
--- EL 15.5
Li
DWELLINGS ASPHALTDR"'rWAY
W/PUBLIC WATER zo )
150' ( .00
SPIKE
zi
LAND N/F70.o�
OF
ELIZABETH P. WEISS
EL 18.1
ELEV. 16.1 Z.
NB
BROWN05'
OL SANDY LOAM .
BROWN
SM LOAMY SAND 2.3'
BROWN
MEDIUM
SP TO
COARSE 11.9'
SAND
GRAVEL
— HIGHEST EXPECTED
WATER IN GROUND WATER
SW SAND EL 1.4
& 2.3'
GRAVEL
—17'
11-08-16
K. WOYCHUK LS
AREA: 17,632.88 S.F. OR 0.40 ACRES EL EVA TION DATUM: –NAVD88
------------------------
UNAUTHORIZED AL TERA TION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUC-TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: JAMES M. BRODSKY;
MAP OF: FIDELITY NATIONAL TITLE INSURANCE COMPANY;
FILED:
SITUATED AT: CUTHOGUE
TOWN OF: SOUTHOLD KENNETH-M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Box 153 Aquebogue, New York 11931
FILE # 16-153 SCALE: 1 "=30' DATE: SEPT. 8, 2016 PHONE (631)298-1588 FAX (631) 298-1588
N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk