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Home My WebLink AboutDuke & Cane LLC r ® FOL,rcOG ELIZABETH A.NEVILLE,MMC may. y Town Hall,53095 Main Road TOWN CLERKC* � P.O.Box 1179 C S Southold,New York 11971 REGISTRAR OF VITAL STATISTICS S ® 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: April 17, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4476C for a Cesspool/Septic Tank Construction Permit submitted by: Duke & Cane 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 Department Signature Dated ELIZABETH A.NEVILLE a,�'4 -��i Town Hall, 53095 Main Road TOWN CLERK d ' P.O. Box 1179 REGISTRAR OF VITAL STATISTICS vo Southold,New York 11971 MARRIAGE OFFICER � , Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone 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. I j Permit No. Applicant Name Duke & Cane LLC Applicant Mailing Address 15 Clamshell Avenue, East Hampton, NY 11937 Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration ZLVI-dr�i �✓� �t,�&2nJ��1 /1�'I /JxAVs/�p -F 445/3 17 Location of Proposed Construction/Alteration: Owner of Property: Duke & Cane LLC Owner Mailing Address: 15 Clamshell Avenue, E. Hampton, NY 11937 Owner Property Adchess: 230 Corwin Street, Greenport, NY Name and phone number of contact person Robert Gruber, Arch. (631-654-4949) Tax Map No: Section 48 Block 2 Lot 44.3 Cross Street 9th Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HE ARTMENT APPROVAL k d `L- ,7 Signature of Ap cant Date Received by: COUNTY OF SUFFOLK 0 0 10 STEVEN BELLONE SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES JAMES L. TOMARKEV, MD, MPH, MBA, MSVV Commissioner PERMIT CON"'ITIONS Health Services Reference# Cl 0 /0 _ Project Name MA-7r-q4,r1c-,k' D(s 7�i—e-("-,c— (� The attached plan, when duly signed by a representative of the department, in conjunction with these conditions, constitutes a permit to construct a water supply and/or a sewage disposal or collection system for the property as depicted. The applicant should take note of any conditions of approval, which may be indicated on the plan or enclosed herein. Construction must conform with applicable standards including "Standards for Approval of Plans and Construction for Sewage Disposal Systems for Other than Single Family Residences." Omissions, inconsistencies or lack of detail on the plan do not release the applicant from the responsibility of having the construction done in conformance with applicable standards. Issuance of this permit shall in no way relieve the design professional of responsibility for the adequacy of the complete design. The pernnit (plan) expires three (3) years after the approval date. Any modification which may affect the proposed sewage disposal or water supply systems requires submission of a revised plan and additio lal fees (if applicable) for reapproval prior to construction. No inspections will be performed by the department on expired permits. Permits may be renewed, extended, transferred, or revised in accordance with the procedures described in Instructions to Renew, Extend, or Transfer an Existing Permit for Other than Single Family Residences (Form WWM-081). It is the applicant's responsibility to call the department in advance to arrange inspections of the sewage disposal and/or water supply facilities prior to backfilling. These include inspections of the sewage collection and disposal systems, water supply system components and piping, and final grading as shown on the approved plans. In certain cases, inspections of the soil excavation may be required to determine the acceptability of the soils for sewage disposal systems. The department must be notified at least 48 hours in advannce to schedule an inspection by calling 852-5754; and excavation inspections must also be confirmed by caMng 852-5700 prior to 9:30 a.m., the morning of the innspecti®n. Article VII of the Suffolk County Code, "Septic Industry Businesses," requires that all installers of septic systems within Suffolk County shall possess a valid license front the Suffolk County Office of Consumer Affairs. This office can refuse to perform inspections or grant final approval for the construction of projects that are installed by an unlicensed individual. It is, therefore, in your best interest to utilize a cesspool contractor with a valid license to avoid substantial delays in yourproject. Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to existing buildings, or for the use of sewage disposal or water supply systems. SEE PAGE.2 WWM-016 (Rev. 10/02/06) Page 1 of 2 HD Ref. No. LUI 0 Project Name J til A- � �1'C CONDITIONS FOR OBTAINING FINAL APPROVAL OF CONSTRUCTED PROJECT As a condition of this pennit to construct, the following items must be completed as a minimum, prior to building occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Other Than Single Family Residences (Form WWM-19). ❑ Excavation Inspection by the Office of Wastewater Management prior to installation of any leaching pools to determine acceptability of soils. (Call 852-5754 to schedule an inspection and confirm by calling- 852-5700 prior to 930 a.m., the morning of the inspection.) ❑ Satisfactory inspection by Office of Wastewater Management of the sewage disposal system/ sewage treatment system. (Call 852-5754 to schedule an inspection.) s �✓�� Satisfactory inspection of the water supply system by: Office of Wastewater Management (Call 852-5754 to schedule an inspection.) ❑ Office of Water Resources, Water Quality Unit (Call 852-5810 for inspection.) ❑ Satisfactory inspection by the Office of Pollution Control (Call 854-2502 for inspection.) 0 Storage tanks [7 Other: ❑ Application for a Food Permit to the Food Control Unit (Call 852-5873 for instructions.) Four (4) prints of an As-Built plan ❑ "Tap letter" from water district ❑ Certification from the licensed sewage disposal system installer ❑ "S-9"form" from Suffolk County Department of Public Works (SCDPW) Sewer district approval of sewer line installation (for other than SCDPW districts) ❑ Well drillers certificate ❑ Water analysis ❑ Certification of Sewage Disposal System Abandonment (form WWM-080) Design Professionals Certification of Constructed Works (form WWM-073, enclosed) for: Sewer lines and sewage collection system ❑] Retaining walls (approved as part of the sewage disposal system) ❑ Sewage pump station/valve chamber ❑ Sub-surface sewage disposal systern [:1 Sewage treatiuent plant XWater supply system [] Abandonment of Preexisting sewage disposal system and/or water supply ❑ Other: ❑ Other; �l r k WWM-016 (Rev. 10/02/06) Page 2 of 2 k