HomeMy WebLinkAboutFlood ELIZABETH A.NEVILLE,MMC �� /,� Town Hall,53095 Main Road
�
P.O.Box 1179
TOWN CLERK C
C* Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p " Fax(631)765-6145
MARRIAGE OFFICER �' aQTelephone(631)765-1800
RECORDS MANAGEMENT OFFICER Ol �` www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE �TOFEOUOTHOIiD CLERK D _ AUG 2 2 2017
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office BUILDING DEPT-
TOWN OF SOUTHOLID
DATED: August 22, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy application of a lication No. 4509 for a Cesspool/Septic Tank Construction
J Permit submitted by:
Richard J. Flood
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
I
I have reviewed the application and location map 'of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE �G%y
I '•
Comments: Final qpproval required from the Suffolk County Health Department
°I
Signature
Dated
I
ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK a P.O. Box 1179
CA Southold,New York 11971
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 22, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4509 for a Cesspool/Septic Tank Construction
Permit submitted by:
Richard J. Flood
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 `Z` ®� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1_� Fax (631) 765-6145
MARRIAGE OFFICER
00
RECORDS MANAGEMENT OFFICER ��� ��®� Telephone (631) 765-18
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 @ $104or Non-Residential @ $25 Application No.
Permit No. 6::-(µ@_00[ j
Applicant Name "
Applicant Mailing Address FO 1F7011-/ i
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration ®°'
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address: \ 1 l v ,
f .
Name and phone number of contact person
Tax Map No: I OW Section ` Block Lot _
Cross Street 'Ji Ie'y n ;y-o
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY ITH H T DEPARTMENT APPROVAL
Si ature of App I nt Date
._..�
Received by: _ —
CERTIFIED TO: OPH CONSTRUCTION
SURVEY OFRICHARD FLOOD
LOT 92
MAP OF
EASTWOOD ESTATES JOB NO.:2016-285
MAP NO.:3683
c'T FILED:NOVEMBER 16, 1962
V i/ U �+ �+J REVISIONS:
CV TI�H®�7 l>E PREP. FOR HEALTH PERMIT 1/18/20 7
TOWN OF SOUTHOLD `
SUFFOLK COUNTY, NEW YORK
S.C.T.M. DIST. 1000 SEC. 110 BLK. 3 LOT 21 -
d_"
0 10 0 20 40 60 80 100 120 140 160 180
SCALE: IN=40' DATE:NOVEMBER 23, 2016
COtUN7f 0EP R'I'rszZ:'--, Off- HEALTH SERVICES
LICENSE N0. 050363
i� ' IC'iiv'm E OFA
Ii .+:; s` Y tis 7t:.e L° 40 N LY HANDS ON SURVEYING
26 SiLVER BROOK DRiVE N
�� x f-' t �eqo-6 00 FLANDERS, NEW YORK
OA7 3 I r R . 3 11901 w e
TEL: (631)-369-8312—FAX:(631)-369-8313
-- MARTIN D. HAND L"S
3'o R, . I I v i3 f4 t=— BEDROOMS COPIES OF THiS SURVEY MAP,EITHER PAPER OR ELECTRONIC,NOT BEARING
EXP REAS T H REE YEARS FROM Dry 9 E 0 F AP P ROVAL THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE
ONSIDERED TO BEA VALID COPY AND SHALL NOT BE USED FOR ANY PURPOSE.
LOT AREA:20,250 SQ.FT. =0.465 ACRE
ELEVATIONS SHOWN HEREON REFER TO NAVD 1988
S.C.D.H.S. ENDORSEMENTS AND ARE THE RESULTS OF ACTUAL FIELD MEASUREMENTS
NO SURFACE WATER EVIDENT WITHIN 300'
ALL PROPERTIES WITHIN 150'ARE IMPROVED AND
TEST HOLE DATA SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES SERVICED BY PUBLIC WATER UNLESS NOTED AS VACANT
OFFICEOF WASTEWATER MANAGEMENT NO VISIBLE WELLS EVIDENT WITHIN 150'OF SUBJECT BOUNDARY
AL SANDARDS-FIGURE
EL.-33.0'+I— RALTERNATE A-CLEANOUT DETAIL6
TOPSOIL STOPPER OR SLATE OR OTHER
ENDPLUG S(TABLE COVER
(OL) -0.5'
COARSE h
SAND SEWER PIPE
(S -2.5'
45'ELBOWS
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STRUC TURES RECORDEDOR G
UNRECORDED aRE NOTGUARANTEEO
u PHYSICAL!YEVIOENT ai THE
11-1 SURVEv I
THE OFFSET(OROIMENSIONSf SHOWN
HEREONFROM THE STRUCTURES TO THE
PRRPOSE AOUD USE--THEREEO EC
ERECTION OF FENCES, RET.vT G V
.us.POOLS.PA TIGE PUNTING
AE45,ADOf TIONS TO BUILDINGS
�IWDANYOTHERGONSTFucwN ^ O�
TNAUTHORII£D ALTERATIONOR
0 THIS SURVEv15 AVIOLATIO.
SECTIONT}O90FTHENEW KSTATE
ED-,N Low.
CDFES OF THIS MAP NOT BEARING
THE 1ANpS YORS S'INKED SEAL OR
EMBQSS EAL SHALL NOT RECONSIDERED
TO AUp TITLE COPv,
RiIFICATIONE INp0a IE O HERON SHALL RUN
ONLY TO THE PERSONS)FOR WHOM THE SURVEY
IS PREPARED AN0 ON HIS BEHALF TO THE
PTLECOMPPNY.GOVERNMENTALAGENCY ANO
LENDING INSTITUTION USIE D HEREON,aN0
TO THE ASSIGNEES OF THE LENpING INSTI"
TUTION.CERTIFICATIONS ARE NOT iRANSFERAELE
TO ADDITIONAL 1-TUTIONS OR SUESEOUENT
OWNERS.