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ELIZABETH A. NEVILLE,MMC may. pry Town Hall,53095 Main Road
TOWN CLERKo U PO Box 1179
CA ae Southold,New York 11971
REGISTRAR OF VITAL STATISTICS _ .� Fax(631)765-6145
MARRIAGE OFFICER y !
RECORDS MANAGEMENT OFFICER '�0,� �� Telephone(631)765-1800
www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
DEC - 7 2017
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: December 6 2017 T".
T T
' TOWN OF SO"tTIHOLD
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4548 for a Cesspool/Septic Tank
Construction Permit submitted by:
Louis Pagnotti
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 V
DISAPPROVE
Comments:
. 46
Signature
0� I Arl a
Dated
ELIZABETH A. NEVILLE,MMC � Town Hall,53095 Main Road
F
TOWN CLERK jj. 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 ��` pl 4f www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER ,, ,l ,f
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: December 6, 2017
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4548 for a Cesspool/Septic Tank
Construction Permit submitted by:
Louis Pa notti
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:
Signature
Dated
17
ji"
t
ELIZA.BETa A. NEVILLE ��"� Town Hall, 53096 Main Roe.
TOWN CLERK CP P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,,,
Southold, New York 11971
MAR
RIA GE OFFICER ' r Fax (631) 766-6146
RECORDS MANAGEMENT OFFICERTelephone (631) 766-1800
F,REEDOM OF INFORMATION OFFICER southoldtown.nortfor .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.
. "
Applicant Name
Applicant Mailing Address
Septic TankL._Zor Cesspool�
Brief Description p
ion of Proposed Construction or .1teration__
p � . '
Location oProposed Construction/Alteration,
Owner of Property:_;
Owner Mailing Addi"ess:
gym:
r
Owner Property Address '
Name and phone number of contact person °
Tax Map No: Section lock Lot
Cross Street
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH eAL'11 6P.I -,RnuNT APPROVAL
r .umm
Signature of Applicant Date
.. o
Received by:
u
CovM To BRAVE
Ir PROF,r 15 Lem
MWwmMe6c A MINIM4 OF VMOVI! INLET
2 STORY RMIDENCE ACWWOOATIN& SMA50HAL SROLM WA7M F
2.5HOK NMA FOR W%no-WA145ION Or THE LEAC+HNS
A TOTAL or-: 4 5EVROOM5. REGUIRMS N1 INLET MIN.4'VIA-
FOOLS. rl 11,,r'4 c,1,
SEPTIC TO BE 1000 &AL. SEPTIC TANK S.LM(V 1000 aALLM lelwmcw"zc-,#aT Cowmm LOCXIN&CASTINS, APPROVIED PIM 0,c"
V"cl TAW�
LEACHING POOL.
WITH (5) VOXV 4,V5E(0)6-DIAWMR,S'HISH PRECAST C4w-fwm
WN", I 0ONCRETE
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vgloppaugCjHr,6 I I
6.VA44MLL HATMAL,SH&L W COAP-w SAW AND
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q
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OPENING FOR"NTENANCE
VIE t6 W41)CIA85 2400 PIM
IN=HO=
PITCHM V FM I t.PER PARASRAPH 0-1,00-A�4 OFTHM WTaX COUNlY HEALTH PWARn4ENT
6TA4CPAF425�REH7M AND FM*LjWA WWTAOLM 0011-9 WITH diRA
4V CA-ASS 2400 PIPE PiTaMPA,PM I,
4" rM A 121M-�Or 51X FEET a"ZONTCR THAN THE LEACHI"
N�n
EXTISVIN&DOM INTO A MWKH Or A VSTRATA Or
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SA9,01.9 C4VHlY 5.V4TARY C40t
0- 'A
Ea w PV Fvr,rtm To czWlOW To MTM 0-5054.PIM TO HAVE MR aAMFf6A
�KTHIN 20�—F=D StrrO(X C4M4TY HEALTH VtPT,MWP*"WM or w
A
2.MIS
allTYM4 E15-Vo TANK AM
V"!LLj%q To W 10 PT4 Hlk rh6TAWA OF
FLOOD SEPTIC TAW TO LVAIIHNS POOL TO VE,b FT.
S.""KH 1000 aALLON SEW10r,TANK
4,MtNlKWI 27 S7.1-14010 OLPFACE ARZA
S.A HK oil 4�AFFROVW PFMC-AST
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ALL&*W55 SLAM TOP N LA�*Aft,46
TO ALLOK I-ORt OTHER
,DROP"KIST VE FIFOOLY PRIN!"Oft
OTHERW FIM4-Y ATTACQV
W-H CONSTMOTION. I , I
r=l,:RLZ,lO 1 6, ID DOPM"T BE 4' 5
FIX OR DROP Ir iA
N Ek^-*W WON HAVE
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OTE.13"ATIONS -:2Lowe
I PLF AprAADJACENT 0
04 9 h )l
(IMPRDV=9
W, ON PUBLIC,KATEIR
Abandonment of existing sanitary system must be in
pr:5IvewlE quircinev Submit
-iwancc 514-75 C4"TY FWAD 46
-OVED) conf61 with depailment r�l,
(IMPIR as proof. c4REEMPoRT,NY I1944
ON PUBLIC KATEcompleted form TOM or-SOUTHOLD Its)
SECTIONc 44 BLOCKt 2 LOTH 5
LOT SIZE. 58454 50.FT. LH
LP, LR KT14IN 500' LU
ALL IVENCIE WITHIN 150"RADIUS ON
TEST HOLE!DATA LAI EX �04, PML C HATER 4 INDIVIDUAL SEPTIC, fs.
MCCOONALD MOSVENCE LR L P ' V—
b--2-10 EX, HMe
EL.IOX— 1+ LEOENP Xc,-n-v,,jtjon inspedlon Requir EXISTIN&SANITARY SYSTEM
(OL) PAW,MOM LOAM E r.%
,b- TEST HOLE0 ystern <
`)-`);"itr�lT'Y —
(54 nw**SILTY SAW PROPERTY LINE
c.4 AFIROX.KATER LINE 1--jealth Department
NATEIR moo N
LOCATION
07.
KATM IN BROM SILTY SAND I LP, PROP05W LEACHIN6 POOL
LSI.T.] pRoro5W SEPTIC,TANK
KA,TM IN BROM FINE TO UTIL VH5 51
SNUw ( EX
PROPOSED SO%ExrANTION TANK
COARSE SAND 0 .1.�-11,�'l "",-.,,.,,.,.I
0 qM —" SUFFG.LK, C113UN-Ty Dr-PAR-,VMr-..NT OF �jr-,ALrjj Sr-,p-vgcEs
AaANPONM Dk4 PROP05W VRYViELL
"!LL PEMMIT F'OR A,PF-ROVAL OF` CONSTRUMOr,;. FORAO A
5;HJCLF ONLY
PROPOSED D19TRIOUTION BOX\00.\ �
tp DEC 0 6 201T
F -Hltqe POOL
EXISTING LEACHING lolo"
DA,
0
A.rv�iz o v ia
v, r),.�
i'l , D E U k ZO 0',4'!3
� - A NEIGHBORING PROPERTIES Ila
FL
SUPPLIED BY PUBLIC WATER E X P I f 3 5;. F, Y Et",Qc 9 P'R,10 N1 D IJE 0 F A PF1 R 0 W,L OT FLAN ...... ....... <
50ALE. I" = 50'-C" ........................ .... . .....