HomeMy WebLinkAboutFurse c
ELIZABETII A. NEVILLE, MMC 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: August 8, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4504 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuel W. Fitzgerald for Elizabeth Furse
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 ____
®�®SVFF°(fie®
ELIZABETH A. NEVILLE � Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
C* -ILI Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS _rP7 Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER f�l �.�®� 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 V or Non-Residential @ $25 Application No.
Permit No.
Applicant Name �� ✓
Applicant Mailing Address �
Septic Tank ,/ or Cesspool
Brief Description of Proposed Construction or Alteration ���� ' wk'p p1j
Location of Proposed Construction/Alteration:
Owner of Property: .® ) S�
Owner Mailing Address: `Z 41*'QWV 1
Owner Property Address:
.s -,5 � � b
Name and phone number of contact person
Tax Map No: Section 10 Block Lot
Cross Street orl'eyd-aj
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE WITH HE H DEPA TMENT APPROVAL
56 Signat re of Applican Date
Received by: _
I
COASTAL EROSION HAZARD LINE PER MAP REF. #2
N/F BRADFORD &
ELIZABETH BURNHAM
SINGLE FAMILY
RESIDENCE— MUNICIPAL
WATER—ON SITE SEPTIC
SYSTEM
101'±
90.00
ga-0.
is
/ WELL \ I
/ HOUSE
° (WELL FOR
IRRIGATION \
USE ONLY)
f
I � I
/ / \ 1o" I
TREE 1
10
CON
\ STOCKPILE
._ Z
s�eps/ / / / AREA
STAGING I Z
BASEMENT 2 •3
AREA
FF
�
FF EL. 9.11 13"
BIRCH EXISTINGWA SERVICE
w
w
EXISTING >
EXISTING 2 STORY i o
DECK ry RESIDENCE
FF EL. 17.68
4 BEDROOMS J' 35'
AFTER ADDITION 17_
EXISTING I
_ 1 GRAVEL PARKING / -a
X F \ ` y,� J rri
z I
7.68`
W I
35.3 I
SEPTI N �
Aw
/ aOSED�aoorno� /
' FF \� I
CyRY WELL
0DIAD
14" �� / V TH
_CHER Yeo
Y�c O
136°� \\ // I � •�`I� �
BUILDING LINE\ / J' I 20'
(TYP.)
PROVIDE 60 SF RAIN APPROX LIMITS OF FLOOD ZONE VE
GARDEN IN EXISTING ELEV. 19 PER FIRM 36103CO019H
2 LA AREA FOR NEW MAP REVISED SEPTEMBER 25TH 2009 I
ROOF DRAINAGE— PROVIDE
4" PVC DRAIN W/STONE PROVIDE SILT
SPLASH PAD—PLANT FENCE— MAINTAIN
AS DIRECTED BY OWNER
DURING CONSTRUCTION
I
C
0
.. ,..✓ < o r .
t
Ll
N4 N j{
8'-6"
KNOCKOUT INLET AND
OUTLET OPENINGS
RIBS INSIDE—�� F
o_
0
�l �J LJ J co
cl,)
Z
CAST Y 0
CONCRETE COVERS M D,
PLAN z o 0 z
Q
COVER LOCKING CASTING I o p
TO GRADE TO GRADE r z
IF DROP 'T' Q 0
IS USED FINISHED GRADE cn W
CHIMNEY � (j U) v
4 x 4 12.6/12.6 GA. WIRE MESH zO� 0
d X 20" 6 x 6 6/6 GA WIRE MESHw =
In
� min. mi.� 6 N 0- tL 0
T.�. N ry
INLET
a 3" VENT—��a 3" VENT—f OUTLET W N
LIQUID LEVEL 9
CONTINUOUS HOT 4" OUTLET d
1 _0 ASPHALT SEAL BAFFLE
LINED WITH
4" SCHEDULE #40 a )/8.. PVC �
INLET BAFFLE 60' GAS
In
°. 4 DEFLECTOR Q
4 5 —8" '`3
CROSS SECTION m cr Cf
z z
1000 GALLON cn o
z cn
2 COMPARTMENT ~ 0
O � W o
SEPTIC TANK _ W o - 0 z
� i 0 r
NOT TO SCALE o
= z
c, o
SUFFOLK COUNTY DEPARTMENT SAF HEALTH ERVICES > � `U m
w
PERT,AIT FOR APPROVAL OF CONSTRUCTION FOR A cl�
0 0
W N N N
INGLi FAmiLY RESIDENICE ONLY X �
d N C
F DATE <.' E
.S. RF, No, -• o O o 0
z N M
APPROVED
AGMir MRAX � U , OF W BEDROOMS
EXPIRES THREE TEARS FROM DATE OF APPROVAL Q
Q d
a �
LEGENDcc
o
PROPERTY LINE cn v (n
ABUTTERS LINE — — M O L� cr� m Q� o o
EDGE OF GRAVEL ------------------- O o 0 0 l
qq,,,, rr'�qq EXISTING CpLaQ,U-a v z "-' w
3.) 'ii �Jn.i iw..�i *�' Li z
I < e ;�.,•:!,.,iT"- :;,�r�i:�`.-:ea�,;Ist l'.• xi Y O � O O
O O cn Q w O w
4a 1" O w = O w
�tI.E�A�':,r'a'%is'•'.`,''��«arst,.'>4.!•.. _a:.::�:.,.t .%..�S+:K.�.,_a a�*'.s:ssrx&
completed fo m W`,v: N DATE: 10/12/2016
DESEGN EOR 4 QE EMU RESIDENCE SCALE: 1 " = 10'
) GALLON SEPTIC TANK PROJECT: # 2016816
ACHING POOLS (SEE DETAIL)
NS–
_ET– 15.00 10 5 0 10
UTLET– 14.5 SHEET
INLET- 14.3 GRAPHIC SCALE IN FEET 1 OF 1
e