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ELIZABETH A.NEVILLE,MMC �y� �y Town Hall,53095 Main Road
TOWN CLERK a P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p ® Fax(631)765-6145
MARRIAGE OFFICER y,% app Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �l www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK '! ��
TOWN OF SOUTHOLD D '_,'!. , �
D
TO: Southold Town Building Department - FEB - S 201
FROM: Sabrina Born, Southold Town Clerk's Office T"► t`%-� ` ' M' "^'•
- 'TOWN OF SOU THOLD
DATED: February 6, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4563 for a Cesspool/Septic Tank Construction
Permit submitted by:
James Carballal for Ahmed & Marcella Fetyani
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
1-lzoe
Dated
o�QOf1`04�O
ELIZABETH A. NEVILLE �`Z` G� Town Hall,53096 Main Roa,
TOWN CLERK p P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER • Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 41, ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.tnet
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD � ,r
SOUTHOLD WASTEWATER DISTRICT
ie
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 V/ or Non-Residential @$25 Application No.
Pp 44
Permit No.
Applicant Name-]QWLCS C&C' C ( Ct.
Applicant Mailing Address 5 0 �Q_F ?"t'Te— - ve
-SeAC<i AlY 1-1572
Septic Tank.Xor Cesspool /� - II
Brief Description of Proposed Construction or Alteration �leuj ( 1yX4('(J C4-C1j A
Location of Proposed Construction/Alteration:
Owner of Property:_ Q 14MJ5.0 tof ecect_o FS-FJ,A*-) /'
Owner Mailing Address: SoZ _ !09 S%. A,401' 3 A -
Owner Property Address: /90 S 000- rAe-
Name and phone number of contact person 1` 4�, 0-?q 130
Tax Map No: Section l Block / Lot f�v
Cross Street jto ? )50.4eAA Ai
NOTE: LOCATION MAP MUST-BE SUBMIT WITH APPLICATION. NEW
CONSTRUCTION REQ WIT AL H NTAPPROVAL
2 5 f�
Si e of Ap licant Date
Received by:
4.-001
C
PROrEsr1m'cr�'.E (�)- X
HOUSE SEPTIC 1,200 GAL. '
F.F. S 9'
' c�.
..POSED ails s ,PROPOSED TANK—,,y I SO.00 � Ill.'s.s° _..PROPOSED 8'DIA.
X x TEFF.DEPTH ;E
_., _ 7.5' — ..•-' LEACHING POOL(TYP.6-TOTAL).
w�.� rade EL t� 0 0 � 50%Future Expansion
:..a.
�1r
_[TIS T1T 16,�f fF;-;;T IT 3l naw' _,
0
EL.
Septic
Gal
LEL.5.7 8-Daag N j.:.' n ". .
Se t1c Tk LPool� " — ao j
r
t]
.r .L
ir7.0 17,0 Ram Runoff Calculations:
f1° '11im, aHouse,Garage,Deck Area=2,552 SF -
Ground WaterE M.0.5' Ln
DECK 0
°°" 2,552 SF x 1/12=213 CF
1.Proposed Septic System-4-Bedroom Maxim 19'0 pxorosEn '
NOTES: trop.Driveway 213 CF/42.2 CF/Ft(8'-Dia Pool)=5.0 LF/Pool
GARAGE
P P Y um o PROPOSED Provide Minumum Four(4)-8'-Dia x 2-ft Deep Pools
2.Six(6)Leaching Pools-2-ft Deep x 8-ft Dia. cv'
ro HOUSE12.0 LF Total Provided
Ic
3. 1,200-gallon Septic Tank BrEc y, 22.0
4.System Shall Be Contructed to SCDHS Requirements �I Septic Requirements:
and Standards for Single Family Residences. h 17 0 311.0' 12.0 LF Min.Required Leaching Pool For Up to 4-Bedrooms.
C'" DECK o 12.0 LF Total Provided
GMIDING El AN L
� 17.0 �"'�.•
SCALE: NTS '
` SIjPFOLK i:0'1;%+f-V DEPARTMENTt)F HEALTH&ERVICES
ax
By McDonald Geoscience,6/1/12
�'ERA�"i'li'�r�::�;&"PI�'3'�1'�tl`OF CUN'S?'TxI1CT� rl FOR A
Grade EL. 7.5' -- ~~~ - Dark Brown Loam 6INGLF-FAMILY RESID°ENCS ONLY `
0.5' 1 I� `Z
3'
APPROVED
Brown Clayey Sand DATE
Brown&Pale
Brown to Medium Sand MAXIMUM� � (�(�'+ �
EL.0.5' Water T i
IMMS THREE YEARS FROM DATE OF APPROVAL
Water in Pale Brown
Fine to Medium Sand "
13,
aE1= AT TAM-lED SPECIAL CONDITION
0A T W - - GRADING PLAN AND/OR PLOT PLAN
FOR SANITARY SYSTEM
OTMENT
SCALE: NTS Y HEALTH DEPA
ALL DATA IS BASED ON SURVEY FROM PECONIC SURVEYORS, P.C., EL.6.0' " 115.64'
SOUTHOLD DATED 10/19/12. THIS DRAWING IS FOR SITING OF PROPOSED LOT m(DWB-NQ
SANITARY EQUIPMENT O K COUNTY DEPARTMENT OF PLOTPLAIN APPROVAL
HEALTH SERVICES AP D. SCALE: l' - 30' LOT AREA 26,442 SO. Fr.
zPROPOSED LOCATION OF SANITARY SYSTEM DIS 100FISHER ENGINEERING SERVICEST
w , P.C.
P.O. BOX 30 ❑AKDALE NEW YORK 11765' SEWELL RESIDENCE SECTION BLOCK
�.
07 631-563-9028 180 SUNRISE WAY 91 01
SOUTHOLD LoT
-
REV. 2 6/19/13 PER SCDHS LETTER REF NO. R10-13-0020 16
..
LAI REV. 1 5/25/13 PER SCDHS LETTER REF N0. R10-13-0020 AIM 4
WILLIAM G. FISHER, P.E. DATE 3/1113 DRAWN BY WGF '5
NYS P.E. LICENSE NO. 074659 "'
SCALE AS NOTED CHECKED BY WGF
VACANT (DWELLING WITH
PUBLIC WATER
C ..
150.00'
O t N r �
JW KVI ;
� a,AIN
PROPOSEDr�i
"
(,--� D HO F.USE
Z Q w
0
O� O
OO I co
Q o
+
O ch
LOT 176
zs
a 0
L —JO
EL.6.0' — 115.64'
LOT 177(DWELLING)
LOT AREA 26,442 SO. FT.
PLOTI PLAN
SCALE: 1" = 50'
ALL DATA IS BAS®ON SURVEY FROM PEMW SURVEYORS,P.C,
SOUn-KX D DAT®10/19/12 THIS DRAWM IS FOR STM OF PROPOSED
SANITARY EOUPMEWr ONLY. SUFFOLK 000M Y DEPAR Mffrr OF APPROVAL
HEALTH APPROVAL ,
Ire NEW
w ,, 1,S' °. DISTRICT
O. ...
A� `�
FISHER ENGINEERING SERVICES, P.C. ADJACENT PROPERTY INFORMATION ,000
._.... _
co SEWELL RESIDENCE SECTION BLOCK
P.O. BOX 30 ❑AKDALE NEW YORK 11769 91 01
'" 180 SUNRISE WAY
O� � 631-563-9028
SOUTHOLDLOT
07 1r REV. 2 6/19/13 PER SCDHS LETTER REF NO. R10-13-0020 16
REV. 1 5/25/13 PER SCDHS LETTER REF NO. R10-13-0020
_ __
WILLIAM G. FISHER, P.E. DATE 7/5/13 DRAWN BY WGF S-2
NYS P.E. LICENSE NO. 074659 SCALE AS NOTED CHECKED BY WGF