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ELIZABETH A. NEVILLE, MMC Off' Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 Fax(631)765-6145
MARRIAGE OFFICERO Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER y�01 .�L, `�►'1! www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER T
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLDD
V D
TO: Southold Town Building Department FEB 2 6 2018
FROM: Sabrina Born, Southold Town Clerk's Office " BUILDING DEW-
TOWN OF SOUTHOLD
DATED: February 26, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4581 for a Cesspool/Septic Tank Construction
Permit submitted by:
James Mooney for Kathryn Farrand.
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
D 3 6-7
Dated
ELIZABETH A. NEVILLE,MMC ���a� �� w � � � Town Hall,53095 Main Rc
TOWN CLERK P.O.Box 1179
�o Southold,New York 1197
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-180
RECORDS MANAGEMENT OFFICER www.southoldtownny.go
FREEDOM OF INFORMATION OFFICER P � "
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: February 26, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4581 for a Cesspool/Septic Tank Constr
Permit submitted by:
.Tames Mooney for Kathryn Farrand.
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 folloi
recommendations:
APPROVE
DISAPPROVE
Comments: Final a proyal r clt�ired from the Suffolk County Health Department
artment
Signature
Dated
ELIZABETH A.NEVILLE *� � Town Hall, 53095 Main Road
TOWN CLERKcz
s P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS +Y Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "� �� Telephone (631) 765-1800
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!4--- or Non-Residential @ $25 Application No.
Permit No.
Applicant Name_°°)
Applicant Mailing Address l " �
Septic Tank or Cesspool
Brief Description of Proposed Consta'Laetion or Alterationw_IT �
Location of Proposed Construction/Alteration:
Owner of Property:_ leftT14RV, ....
Owner Mailing Address:_ `'"r 14 f
Owner Property Address:_ v � E
..
. ...._.. w- _... -//4-I
Name and phone number of contact person
�....( _ .... � . _a
Tax Map No: SectionBlock Lot_
Cross Street— ( ,,..-1 0 ..IT
NOTE: LOCATION MAP IN IST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S R 'EY IT -[ HEALTH DEPARTMENT APPROVAL
w
Signature of Appli 0- q1t �_... Date
Received by: ..
S
L
3 SURVEY OF PROPERTY
a
AT NASSA U POINT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
ro
1000-111-08-12.1
SCALE: 1'-30'
�Gy JANUARY 12, 2012
J JUNE 15, 2012 (PROPOSED SEPTIC SYSTEM)
NOVEMBER 2, 2012 (PROPOSED ADD1 TIONS)
NOVEMBER 8, 2012 (REVISED PROPOSED PORCH)
MAY 7, 2014 (RNAL SURVEY)
' APRIL 19, 2017
JUNE 15, 2017 (PROPOSED GARAGE)
JUNE 26, 2017 (PROP. CONTOURS & ELEVATIONS)
40
SEPT. 11, 2017, (PROP. HOUSE ADDITIONS)
SEPT. 27, (PROP. HOUSE REVISIONS)
2017,
JANUARY 03, 2018 (SEPTIC REVISIONS)
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COLN 6,
a_ SUFFOLK vUltfY EP R M�'f � {,i° Iis°�.L7!°i i. EF'dlC
ES
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r�fJ3p UP', 4, i
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FOR
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EXPIRES THREE YEARS FROM DATE 0�APPROVAL
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ARA& KAIN ISN ( ONTA I NMENT
PROPOSED GARAGE + DRIVEWAY
t0
3 PKOPO5ED GARAGE = 594 5Q.FT.
591 X 1 X 0.17 - 101 CU.FT.
rcy5v } 922/22.3 - 4.5 VF
X02.80 PROVIDE (1) DRY WELLS 6'� X 5' DEEP
OR EQUAL
'w000 kol") DRY WELL CONNECT TO GARAGE
WITH &UTTEK5 + LEADER5
PKOP05ED DRIVEWAY • 2943 5Q.FT.
ATER) 2943 X 0.1 X 0.17 - 501 CU.FT.
TEST HOLE DATA
BY MCDONALD GEOSCIENCE 501/42.2 119 VF
1/11/12
X11X12 PROVIDE (1) DRY WELL5 64 X 12' DEEP
BROWN SILTY SAND SM OR EQUAL
-- z.s' WITH GRATE
s�/:,tm rrrustbem
PALE BROWN RNE TO MEDIUM SAND SPSubmit
c,m °
17'
CERTIFIED TO' �OFREIy
PROP05ED NEW CONTOUR 70.9 KATHRYN FARRAND ME
5TEWAKT TITLE IN5UKANCE COMPANY
ADVOGATE5 A65TRACT (ADA-03097-�*
PROPOSED ELEVATION
' LIC. Na
�T PECO x P.C.
AREA=46,045 SO. P 0.1 BOX 909 FAX (631) 765—
TO TIE LINES 1230 TRAVELER Si.c.ET 07_1
SOUTHOLI). N_ Y. 11.971
ROCS SEPI 1C, 5Y5TEM
4 6EDROOM HOU5E
1-PKEGA5T 1000 GALLON SEPTIC, TANK
2-LEAGHING POOL5 8'� X 6' DEEP
WITH 3' SAND GOLLAK 3' MIN. A60VE
GROUND WATER
ell
,rte Cleanout must be installed o the
septic tank inlet waste line.All utilities
require a 5ft minimurn separation to
the septic system.
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=MONUMENT
• =KEf5AK SET
A =STAKE SET
I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL AND
ELEVATIONS ARE REFERENCED TO N.A.V.D. GONSTRUGTION OF SU65URFAGE SEWAGE DISPOSAL SYSTEMS FOR
51 NGLE FAMILY KE51 DENGE5 AND WILL AD I DE 6Y THE
GONOITION5 5ET FORTH THEREIN AND ON THE PERMIT TO
LOT NUMI ER5 REFER TO "AMENDED MAP A OF NASSAU GON5TKUCT.
POINT, OWNED DY NASSAU POINT OLUD PROPE;TIE5,
INC" FILED IN THE SUFFOLK COUNTY GLE90 OFFICE THE LOCATION OF PUDLIG WATER, WELL5 AND GE55POOL5 SHOWN
ON AUGUST 16, 1922 A5 FILE NO. 156. HEREON ARE FROM FIELD 0155ERVAT I ON5 AND OK FROM DATA
06TAINED FROM OTHERS.
ANY ALTERATION OR ADDITION TO THI5 SURVEY 15 A VIOLATION ADDITIONALLY TO GOMPLY WITH SAID LAW THE TERM "ALTERED 611
OF SECTION 72019OF TFIE NISI YORK STATE EDUGAT ION LAW.
EXCEPT AS PER SECTION `7 -SUISDIVISION ALL �.ER'rIF[CATlOS 6E USED 6Y ANY AND ALL SURVEYORS UTILIZING A DOPY OF ANOI
HEREON ARE VALID FOR THI5 AND COPIES TrEREOF ONLY IF SURVEYORS MAP.TERMS SUCH AS "INSPECTED" AND "�ROUC�HT- TO- I
SAID IAP OIC COPIES DEAR THE IMPRESSED SEAT- OF THE 5UKVEYOK ARE NOT IN COMPLIANCE WITH THE LAW.
WH05E SIGNATURE APPEAK5 HEREON.