HomeMy WebLinkAboutFfolliott ELIZABETH A. NEVILLE,MMC ::;-� - Town Hall,53095 Main Road
TOWN CLERIC P.Q. Box,1179
SUUlhold, New York 11971
REGISTRAR OF VITAL STATISTICS' - x, Fax (631)765-6145
MARRIAGEOFFICER• �`�ra. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ? ''�,!
FREEDOM OF INFORMATION OFFICER www southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation PermitNo.• 4503=R Residential X Non-Residential -
Fee $ 10.00 New X Existing
Name Of Owner' AIT FFOLLIOTT
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Mailing Address 1 PO BOX 568
Mailing Address 2
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City St zip ORIENT - NY 11957-0000
Property Address 11 390 OYSTER POND LANE
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Property Address 2 °
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City St zip ORIENT NY 11957-0000
Owner Telephone No. 631-276-3346
-Tax Map No. section 24.00 block 1 lot 2.000
Cross Street, -MAIN ROAD
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Issue Date: 6/22/17 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ® Southold, New York 11971
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MARRIAGE OFFICER Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER 1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 V""or Non-Residential @ $25 Application No. q,50 i5
Permit No.
Owner Name AMA)
Owner Mailing Address Pd 9OX Jr6 9
OP-11-1164- &J -( 111S-4
Owner Property Address 310 *S4w' (Pr4-d IVAO-L
ar r - l) `r r i S�---
Owner Telephone No. 01 241,— 33 y L
Tax Map No: Section Zq , Dt5 Block ! Lot 2. 000
Cross Street Mou ki 2caJ
Please check each that applies: New Construction ✓
Alteration to Existing System
Residential t.-- Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
Ctq,Lk q MCO* 1 2 7-/
Received by: Signature o plicant Date
TKF Excavating&Demolition
P.O.Box 27
Westhampton Beach,NY 11978
Phone:(631)878-2700/Fax:(631)653-7430
' CERTIFICATION Or SEWAGE DISPOSAL SYSTEM BY INSTALLER
Health Department Reference Number: 10 1 S —vI ,
Suffolk Tax Map#Dist. U Sect(s). c2�— Blk(s). Lot(s)
Project Name or Address: Ac/Ye(—
Subdivision Name&Lot#: e
Applicant's Name:
Description of System Installed:
Septic Tank
Volume(gallons):
Shape:(#Q Rectangular( )Cylindrical
Name of Precast Manufacturer:
Leaching Pools
Number of Pools:
Diameter&Depth: xwult
Name of Precast Manufacturer: �—krxz 1 GYL °
Other:
n
Attach or sketch below the measurements from building corners to the access covers o disposal system.
r
I hereby certify that the subsurface se a disposal syst bove has been installed b e' acc dan
.11
with the approval plans and stand ds a folk Cou y artment of Health Services and is
operational. f /
Installer Signature: Date:
Print Name/Company:Ttr as K. eunO Kc a
.1 vating&Demolition,Ltd. Phone: 631 878-2700
Consumer Affairs License Number:31742LW
L
AmiandLcOa�dCtu
Abandonment of isting s. 'tary system mus be in +R c H r E T
ry comfonmance w] departm emt requirement Su mit
5U FO K Cot NTY DEPARTMENT OF HEALTH$ RV(CE8
PERMIT FOR APPROVAL OFCONSTRUCT(O �a m -d� as proo€
N�ORA N/O/F IRENE TRE REVOCABLE LIVING TRUST N completed for7WM2=���,FL
91 �
BER REVOCABLE LIVING TRUST �y N<«rmk Ne rakSINGLE{=A Gild =S(DENCE OtdLY E)CCA1PATtOAI IN3PEanONREQCl�RED EXISTING UTILI POLE T4'-'=R' 'r..xH,$I IYIo
I r FOR SANITARY SyGTM
DAT: Zy 16, EF.p RIO—IS- TH DEP RETAINING WAIL m D IS
APP OVED iI '49� EXISTING PO R
i ST CKADE FENCE — — — LINES ABOVE
FOR XIMUf4OF_ ' V EXISTING UTILI LINES
BEDRO� - `fl /'� ABOVE TO BE BURIED
EXP RES THREE YEARS FRONI DATE%Fqz R -}
m
OO_R W Lu _ - - E EXISTING WELL TO BE
U Cl FLOOR - ABANDONED
FR' fDW�
+ 35' 12 5' N
A PROVED IN ACCORDANCE WIT B OF IT'G (4) NEW RYWELL5,J FRONT Y IYO
VEGETABLE I
R VIEW DETERMINATION DATE I GARDEN MS" ro' DIA., DEEP 5ETBAC ST 7 W
FENCEATIO DECK I5 IL Z
pEXIST SEP J
/ TANK TO E- N w
EE AY'TACHED SPECIAL CONDI / 1 REMOVED(pygi 0 I I O w
GRADING PLAN AND/OR PLOT P 3 O P
AR yARD rI5 � ?L
SETB O o i I EXI5TING GA5 LINE w O 0
1 m f--I
NEW SEPTIC TANK, I e�
LEACHING POOLS LP p LINE OF EX15T NO HOUSE
AND EXPANSION I Oslo 20' MIN. _ (D }r'
/ �_ TO BE REMOV D.STEPS, Z
vg POOL - _ - - _ _ m - - q �Is�/ DOCK AND O HEDNVATION L- O
cv1
tl: TEST HOLE EP LF 14 I C t: C I'-•'( "
EL.13.8' i ��5 e0gR0 T� a 0
`P" N 'O '' •• N64'19'00"Y4 n9 65' PROPERTY I O
W O
11,7 P � • �—-(� - LINE
x N/O/F REGINA ABERSMITH S EMILY DEERKO 't w
d a TEST HOLE DATA [ +1AATND LATERAL
MUST BE r r T
McDONALD GEOSGIENGE
SHOWN rv+y ON YIN �'9�. 01894'Tw
IV 5/14NOTES OF NES
13.8 DARK BROWN LOAM-OL
______ 2, I SITE PLAN DEVELOPED FROM INFORMATION PROVIDED PROPERTY TAX# 1000-24-I-2
ON SURVEY PREPARED ON 06-18-14 BY PECONIC ZONING CLASS =R-40
BROWN AND PALE BROWN SILT AND SANDY SILT SURVEYORS,PG ELEVATIONS BASED ON 1988 USG5 DATUM LOT AREA = 15,830 FT 2(O 36 ACRE) 02102/15 DON APP
(VERY HEAVY GRAVEL FROM T'-9')-ML 03/02/15DOHREVISIo
2. SCOPE OF WORK TO INCLUDE: REMOVAL OF EXISTING PROPOSED FIRST FLOOR AREA = 2,1'75 FT.'
------ -" BROWN AND PALE BROWN FINE TO COARSE 1-1/2 STORY HOUSE, DEMOLITION OF EXISTING FOUNDATION, PROPOSED SECOND FLOOR AREA= 1,134 FT.'
SAND WITH 5-I0%GRAVEL-SW STEPS AND DECK. EXISTING SEWAGE SYSTEM TO BE
REMOVED EXISTING WELL TO BE ABANDONED PROPOSED SEPTIC.
WATER IN PALE BROWN FINE TO COARSE SAND
WITH 5-I0%GRAVEL-SW NEW BASEMENT AND 1-1/2 STORY HOUSE PROPOSED.EXISTING NO OF BEDROOMS: 4
IT GARAGE AND SHED TO REMAIN NEW SEPTIC TANK, TANK CAPACITY: 1,000 GALLONS PROPOSED
LEACHING POOLS AND EXPANSION POOL TO BE INSTALLED IN [3]LEACHING POOL5 V DIA,4'DEEP SITE PLAN
NOTE. WATER ENCOUNTERED 12T BELOW REAR YARD NEW PRIVATE WELL TO BE LOCATED IN FRONT [I]EXPANSION POOL. 8'DIA,4'DEEP
SURFACE YARD. (�),
I A-001
SCALE.
I PROPOSED SITE PLAN