HomeMy WebLinkAboutPsyllos ELIZABETH A. NEVILLE, MMC F04 Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
CA
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: March 9, 2017
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4467 for a Cesspool/Septic Tank Construction
Permit submitted by:
Long Island Modular Homes for Psyllos
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:
Signature
Dated
ELIZABETH A. NEVILLEG Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �f® 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 r or Non-Residential @ $25 Application No. . @�
Permit No.
Applicant Name e41- &t
Applicant Mailing AddressU �
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration 6Q, _- 5 �/m u f
17)w t (L r
Location of Proposed Construction/Alteration:
Owner of Property: �4c'J G-1 S L i e�- L 6 -S
Owner Mailing Address: --�(p
f �S iy L C�
Owner Property Address: �� t� f` '
Name and phone number of contact person zyU
TaxMapNo:/CM Section 2 _Block C� �� Lot 61 z
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant ate
Received by: �_ '
(1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK,STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABUSH PROPERTY LINES OR FOR ERECTION OF FENCES(3)COPIES OF THIS SURVEY MAP NOT BEARING 114E LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY.(4)CERTIFICATION
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.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)&CESSPOOLS(CP)SHOWN HEREON ARE FROM HELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS.
u \ 400 Ostrander Avenue,Riverhead,New York 11901
tel.631."12"!.2303 fax. 631.'12'1.0144
NEXCAVATION IN d��l t � '"�`-• � � admineyoungengineering.com
` _SAN SYSTEM
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By HEALTHDEPARTMENT
Howard A.Young,Land 5urvayor
Thomas G. Woipert,Professional Engineer
W \ Douglas E.Adams,Professional Engineer
Robert G.Tast,Archltect
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51TE DATA
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® �� AREA = 200,,12128 5Q. FT.
3. \ / "SUBDIVISION- "SUNSET KNOLL5,SECTION 2"FILED IN THE OFFICE
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W\fir / OF THE CLERK OF SUFFOLK GOUNfY ON APR.09,1910 A5 FILE NO.
a VSO\\\t\aj �O f� ® \ \ ^ 5448.
VERTICAL DATUM
o C� \\G ® 1 ® , ® \ \ +55.1 ��\oOjG\�� \ V� w GROSS FLOOR AREA N A.V.DATUM(1988)
m \ / , \ PROPOSED FIRST FLOOR - 2,518 50.FT.
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01? ® PROPOSED SECOND = 1,492 50.FT.
® \ HEALTH DEPARTMENT USE
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House trap/cleanout must be installed $ •
on the septic tank inlet wasteline. All 2 5O°
bA\ ` fl SURVEYOR'S CERTIFICATION
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utilities require a 5ft minimum °
/ separation to the septic system.
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Lot 46 / LOAM LOT 46, "SUNSET KNOLL5, SECTION 2"
(Ol) of Mattituck, Town of 5outholel
0.5'
Suffolk County New York
BROWN
SUF�= K C-011UNI Y L1i;PAI IEE T �>"'''F "21aAL H SERI` Ic"E S ®® SANDY SILT
(ML) BUILDING PERMIT 5URVEY
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�\ FINE SAND FIELD SURVEY COMPLETED OCT. 10,2016
\ ��\ (SP) MAP PREPARED OCT. II,2016
50.0 \� a Reeord of Revisions
RECORD OF REVISIONS DATE
( �® ��(�✓� Ge\ BROWN SILTY AMENDED BUILDIN6 PERMIT DATA JAN.04.201
AppnOVED rOVA ® \.Ua SAND
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38.0' JOB NO.2016-0140
HI6HE5T EXPECTED DW6.2016_0140_bp ' OF 5
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E = MONUMENT SET = MONUMENT FOUND = STAKE 5ET A= STAKE FOUND