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ELIZABETH A.NEVILLE,1V MC ��� ��y� Town Hall,53095 Main Road �
TOWN CLERK RO,Box 1179
CA 29 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS & Fax(631)765-6145
MARRIAGE OFFICER A$+.
RECORDS MANAGEMENT OFFICER Q! .� Telephone(631)7
FREEDOM OF INFORMATION OFFICER www-southoldtownny.gov
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ny.go
OFFICE OF THE TOWN CLERK D
TOWN OF SOUTHOLD SEP 1 5 2017
TO: Southold Town Building Department BUILDING DM.
TOWN OF SOUTHOLD
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: September 15, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4520 for a Cesspool/Septic Tank Construction
Permit submitted by:
J. C. Quinninc.
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
jrecommendations:
APPROVE
1 DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
�9,9 5 i7
Dated
F �
ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
r� 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: September 15, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4520 for a Cesspool/Septic Tank Construction
Permit submitted by:
J. C. QuinnInc.
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 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
CA Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ►
Fax(631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1500
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
I
OF'F'ICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
i
APPLICATION j
CONSTRUCTION or ALTERATION PERMIT j
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 !application No.
Permit No.1?1D
Applicant Name- jivtn� i .
Applicant bailing Address "l-�1 �e r Ac,-, d
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: _m C_ _( u v,_ Th_C-
Owner bailing Address.,,, �P V71-e---
Owner Property Address:_ q'
o
Name and phone number of contact personTax Map bap No: Section_ ._.__.. 'D Bloc} Lot
Cross Street j1 C' C
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WE T DEPARTMENT ENT APPRO
Signa@ of Applicant Date
Received by: _ �AV
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Cleanout must be installed on the o DR�IINAGE SYSTEM CALCULATIONS_
septic tank inlet waste line. All utilities — HOUSE ROOF AREA: 2,050 sq. ft.
N 2,050 sq. ft. X 0.17 = 349 cu. ft.
require a 5ft minimum separation to 349 cu. ft.
h / 42.2 = 8.3 vertical ft. 01
the septic system. 0 PROVIDE (2) 8' dia. X 5' high STORM D
GARAGE ROOF AREA: 2,050 sq. ft.
360 sq. ft. X 0.17 = 62 cu. ft.
62 cu. ft. / 42.2 = 1.5 vertical ft. of
- 84.44' PROVIDE (1) 8' dia. X 2' high STORM D
— .----- _-- N 86'27'45" E DRIVEWAY AREA: 1,600 sq. ft.
1,600 sq. ft. X 0.17 = 272 cu. ft.
272 cu. ft. / 42.2 = 6.4 vertical ft. a1
WAY
�j 47Sr HOLE No. t PROVIDE (1) 8' dia. X 7' high STORM D
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'THE cRoss