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ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS ca. na
MARRIAGE OFFICER ® ® Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 911 ? 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.
Todd O'Connell Architect,PC
Applicant Name 1200 Veterans Hwy,Ste 126
pp -Hauppauge,NY.-11733
Applicant Mailing Address Phone: (631) 650-6666
- Fax: (631)650-6667
Todd@TOCArchitects.com
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration: c
Owner of Property: f1,4
Owner Mailing Address: V
R5 `2
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section Block Lot
Cross Street 3 j
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature/of Applicant Date
Received by:
r
ELIZABETH A.NEVILLE MMC FOIAr Town Hall,53095 Main Road
TOWN CLERK �� �
P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ® AMFax(631)765-6145
MARRIAGE OFFICER ,�, ®�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �o�( �� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D RCRU'V[E DD
TO: Southold Town Building Department MAY — 5 2017
FROM: Sabrina Born, Southold Town Clerk's Office BUILDINGDEM.
DATED: May 4, 2017 TOWN OF SOUTHOLD
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4485 for a Cesspool/Septic Tank Construction
Permit submitted by:
Todd O'Connell Architecht for George Rocklien
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:
Jr
Signature
to
Dated
COVER To BRAVE r,
SITE INFORMATION• 500PE OF WORK: PROPOSED < N Imzr
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675 CALVES NECK ROAD ADDITIONS AC TOTAL < PINISFED E;RADs= 'o cl9
SOUTHOLD,NY 11756 f N;,
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TOWN of 50UT4OLD SECTION: 65 BLOCK'.: 7 OF 5 BEDROOMS. REGUIRE5 SEPTICIT IZT!�
LOT:51.1 <Y TO BE 1500 &AL. SEPTIC TANK WITH n nN6 �coym - � �
POOL NOTES,
Lor;51zn 55020 50.17T. ' A 10'�XI3' DEEP LEAGHIN6 POOL. - GONGRETE I.BOTTOM OF POOL SHALL Be A MIN OF s'Aeo?e RON ►�h�,M1
L e/ DDD O'CONN ELL
FOOL&
U- _ I CHIMNEY HOW ARTS• A A C Hi T ECT ? [
HITHIN 500' ea:o„�TANK NOTA. I �o' I� �O• INLET MIN.4'DIA. 3 V e WoNE 1 AREA P OA RM Fr BrASITlco�rrr�re sr�nc "s�fr�
RES!INOP DENGE WITHIN 150'RADIUS ON 1�K CCOUNTY To
Rrsance�rIN�r�Trg� �
I ry APPROVED PIPE TANK.USE[U to DIAMETER WHISH PRECAST CONCRETE LPACANING RINGS.
DD'AS_LJ a To to I0 N.D�iSTANC�e�OF �c u PIrcF;ID�•.1' 1 • ODD O CONNELL,AIA
PUBLIC WATER a INDIVIDUAL SEPTIC 9.use a•DIAMETER APPROVED PIPE THRcuGHOur.
S@'Tic TAM TO LEACHING POOL 70 B2 6 PT. - '9 I 'D 'A 0 O O ® 6.THE WASTELI E FROM THE SEPTIC TAMC SHOULD ENTER TTNB
5 MINMIM 1900 BALLON SEPTIC TAW, �M1�'a�`':�' A 0000 J DISTRtevn°N P'°°L'tis HIBH RE TO
ST 1.200�Veterans Me�no�iaLHlgtiwa
a.MINMIM M SP.LIOUID SURFACE AREA - T.ALL OUT P OF-PIPES ARE TO BE STRAIGHT a'VE THE!50 PVC,° t.��• i$UIITi�70
ABANDON EXISTING SANITARY SYSTEM THIS 15 AN ARGHITECT5 PLOT PLAN AND FLOH'HAFFLE f T,NTHOUT DROP S. AND T+xiT ee LI/B.13'ABOVB TF£eoTTDr1 OP n Hau au e �8
TM LI'XHING RINGS. _r +
IS 5Ul3 JEGT TO VERIFICATION EW A 5.A MIN oP 4•APPRDVH7 FRerAsr pp_g :rim 18x8
CONCRETE DOf7T7M S'KALLS t _
LIC4345 7 SURVEYOR. INFORMATION 6.APPROVED REINFORCED PRCCAST CONC.6' I a sLLiwi Iz MIH BEi�ow�eRADE RSE SANP A� �
OBTAINED FROM S.,•URVEY PREPARM BY, SLAB TOP IN LAWN AREAS I'' 6Al.LON �r(i 10.SOLID CONCRETE GOy®t SHALL Ba E¢'TI��6•AND IZ•LEi.OW -+'�•,_•? { z-•'(�•""•"
WILLIAM R SIMMONS III L5P.G r.DROP,'r'e nnr FIRT n Y FITaNm OR TIG TANK m S n?F(691)650-6667
BRAVE. i ,, ,t.,__ .
Y SURVEY DATE:NOVE7 8ER 4,2015 6 �D PTH MU rUNDERi d j : 51b.658 D325.'- ';_,'I
Qu LOCATE Drop O AINTENAW-E i' L �
EXI5TINFi HOUSE: 2398 SQ.FT. Q 4.T7�W 9A�L8 oR DROP'T'REGMRBD OPENING FOR MAINTBiMY.E 1 �� � L PEii PAW�6RAPi1 5-IOC-A-4 GP THE Gg1MY HEN.rH DEPARrME37T
PROPOSED ADDITION: 1431 SG.FT. Q 4.0 GLASS 2400 FIPE -!K - STANDARDS,REMOVE AM REPLACE UNSUITABLE SOILS NTH SAW AND GRAVEL - f
TOWN CREEK PITG}0VYs'FER I �7Lf oINS EXTENDING DOVN INTO FOR A DIAMETER OF IA MMINTMIM OP AA V STRAGREATER TRAIN TA ACCEPTABLE'SAND FWO LE&CHINC,POOL ' , II
4'0 CLASS 2400 PIPE PITCFiV)b'FER I' GRAVEL
ELEVATIONS BASED UPON NAVD 1 �' 2.PVC RPE TO BE INSTALLED IN ACCORDANCE NTH AFPEWX a of TINE
ODE
100155),USG 3 55 DATUM a �s — 51=PTI�i TAMC x7a Lr oo. 5.PV LK OPUPE TO HIFOR RT AST O
PVC,RPB To colr�Rt t TO ASTM D EOGs RFe TO kAVE 5OR ICA
1„1•�.W ' BACK FILL MATERIAL TO W_/
CLEM SAND AND 6RAVEL b'MIN.FB,I]ET"TION
LEACHING POOL INTO A viR81N STRATA
1LTd. of 5AND AND 6RAVB- `4 ='� i ' M
EXISTING LOT SIZE: 25188 SQ'.FT.
PROPOSED LOT SIZE: 55020 SQ.PT.
0 1L
I viNOTE: %V11 - Off
S.G.T.M#: 1000-63-�-31.1 NF-IOHBORINO PROPERTIES
E_ _ SUPPLIED BY PUBLIC WATER
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w°? �': = 7 �`' G��?= i a rr.1 ry u-I-Is TEST HOLE
TOP of BANK EL.20.2 -- TOPSOIL PROPERTY LINE
051(o) \ ^
—GW— APROX. WATER LINE
mm1 /` LOCATION
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EL.16OAM 7 I 35'(O L.P. PROPOSED LEAGHINe POOL
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FROSTS® Iq�yg CLAYEY SAND a /
0 ,I ,;flI,1 ,,STORY � , "••• I • • • s%6R°'VEL (3_T� PROPOSED SEPTIC TANK
O6.0'(5G)
SAND a 10% /
Q �- PROPOSED 505YD EXPANTION TANK
PROPOS» I : ::':: ':'::'I STORY FRAME HOUSE':': \/
Q FORA EX.
} aroADSDrmoRr :AND 6ARAr7E ON }
n, ' •5•F•El-•: 20.85' _ I DW PROPOSED DRYWELL 1�1
n W31.PED
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OL ' IFIROPOSPo EL 20.1 / a.19 ' \
ADVIVONDITT , .G.
w PE PROPOSED DISTRIBUTION BOXlu (� O
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1 HOLE / UA-A O
Exismo STEL 1 w 1 18.0 WATER
COVIN - I MIL-20.2 I 16' ENCOUNTERED ` \
tJ ' j o;; LOT 31.1 I '
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200 ,,, / I SGDHS APPROVAL STAMP
wI' z' p� L. 0
��/ L.P. s IX SUFFOLK'COUNTY D EPAP;:',m•EN_11 JF HEA sI SI:R'-,/ICES
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FIE ��OIRi laPt='r-IOLA; OF"CiDINSTRUC ICON FOR A
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g; ^ C-� /60_0' FIs 50.00' / 21125 �e.4�� _� El 21S ... IC: �/0 -_ /jPp}t1 I Z
EL.21s a.2os pp
PLOT PLAN FOR `Tt : %;U M O 1 d
GALVES NEGiG ROD EXPIRE :
11
SGALE: 30 -O„ V A
L m -1
GL.21.6 GL 213 GL 20.6 ~�� Q Q