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Home My WebLink AboutBlackburn ELIZABETH A.NEVILLE,MMC �4WRY ® Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 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 OCT 2 4 2017 FROM: Sabrina Born, Southold Town Clerk's Office BIDING DEPT. TOWN OF SOUTHOLD DATED: October 24, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4532 for a Cesspool/Septic Tank Construction Permit submitted by: Rustic & Refined Renovations LLC for Christine Blackburn 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, 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 OFT E TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office DATED: October 24, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4.532 for a Cesspool/Septic Tank Construction Permit submitted by: Rustic &a Refined Renovations LLC for Christine Blackburn 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 ��SUFFII(/r� ELIZABETH A. NEVILLE �`� ®��. Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 W Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS Fax(631) 765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER �f®� �� 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 @ $10 or Non-Residential @ $25 Application No. y Permit No. Applicant Name 4; c P(41JP(�K_v)C'�/ Applicant Mailing Address Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration , %t Location of Proposed Construction/Alteration: Owner of Property: tc_0 'g Owner Mailing Address: Owner Property Address: � � �� a v. Name and phone number of contact person '' � � c Tax Map No: Section `> _Block "5 Lot _ P Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY TH HEALTH DEPARTMENT APPROVAL @) Signature of Applicant Date Received by: _ _ ��_ _ PIP S 81"26'30" T 6' STOCKADE 115.38 PIPE I EXISTING SANITA TO BE ABANDONEDRY AND DWELLINGS LOT 10 BACK FILLED WITH CLEAN < COARSE SAND. WIPUBLIC WATER ELEV. 23.6 PROPOSED 150' DRBROWN 4 BEDROOM OL 0.6' SEPTIC SYSTEM SANDY LOAM 1,000 GAL S.T. (1) 8'DlAxl2'DEEP L.P. SILTY SM SAND 1.8' -A BROWN MEDIUM TYPICAL CLEAN OU7 —N- SP TOCF V J� COARSE SLATE OR SANDSTOPPER END SUITABLE COVER OR PLUG A 14.6 - ' _ '�. f f r" 30* ELBOW �-o iq' 60 vp ip V tr NO WATER FLOW-4m.- 17' SEPT. 6, 2017 REVISED 09-13-17 K. WOYCHUK LS THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 11,309.31 SQ.FT. ®r 0.26 ACRES ELEVA77ON DATUM: NAVD88 _____----__ UNAUTHORIZED ALTERATION OR ADDIT70N TO THIS SURVEY IS A WOLAT70N OF SECTION 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE T77LE COMPANY GOVERNMENTAL AGENCY AND LENDING INS7777,177ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS777U77ON, GUARANTEES ARE NOT TRANSFERABLE THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE S7RUC-TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: LOT 8 CERTIFIED TO: CHRISTINE BLACKBURN; MAP OF: INDIAN NECK PARK FILED: MAY 27, 1913 No.551 SITUATED AT: PECONIC TOWN OF: SOUTHOLD KENNETH-M WOYCHUK IAND SURVEYING, PLIC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design --- --- P.O. Box 153 Aquebogue, New York 11931 FILE # 17- 132 SCALE: 1 `=20' DATE: SEPT. 6, 2017 PHONE (631)298-1588 FAX (631) 298-1588 N.YS. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth V. Woyehuk