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Home My WebLink AboutIsle of Cedars LLC �sufFat ELIZABETH A. NEVILLE, MMCO CD' Town Hall,53095 Main Road TOWN CLERK �y� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER ,j► ��. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ��l �`� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK D LS((�� C o V L5 TOWN OF SOUTHOLD D FEB 2 7 2018 TO: Southold Town Building Department BUILDING DEPT. FROM: Sabrina Born, Southold Town Clerk's Office TOWN OF SOUTHOLD DATED: January 22, 2018 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4580 for a Cesspool/Septic Tank Construction Permit submitted by: Isle of Cedars LLC 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: G&-o-�40 e Signature 03169 �� Dated ELIZABETH A. NEVILLE, MMC I� lip Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971Fax(631)765-6145 MARRIAGE OFFICER �; o " Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER � ,� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICERk + o,w ' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office DATED: January 22, 2018 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No, 4580 for a Cesspool/Septic Tank Construction Permit submitted by: Isle of Cedars LLC 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 mITITITITITITITITITITITITITITITITmmITITITIT Comments: Signature Dated 101 ELIZABETH A. NEVILLE11 Town Hall, 63095 Main Roa. TOWN CLERK P.O. Box 1179 REGISTRAR CE VI'T'AL STATISTICS (�A'�/000'z + Southold Mew York 11971 RIAGE OF'F`ICER �` � Fax (631} 765®6746 RECORDS MANAGEMENT OFFICER Telephone(631) 766-1800 FREEDOM OF INFO TION OFI�ICER MwaW��.a' southoldtown.northfork.ne( OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residdntial @$10 or Non-Residential @$25 Application No n Permit No. Applicant Name 1 Applicant Mailing Address��:� �. - l �C` Septic Tati.k. or, Cesspool_ Brief Description of Proposed Construction or Alteration----_ Location of Proposed Construction/Alteration: Owner of Proporty: VS L (L) r– Q_ _........� _v Owner Mailing,Address:_ .. \ Owner Property Address: Name and phone number of contact person' A—e\� Tax Map No: Section � 2 Block l Lot Cross Street NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL l Signature of Applicant Date Received by: d SuITb"()" j '011N'Jf"Y 1)El'ART,MTl'V"1 OF H1WALTII SERVICE LI'A1v11CNUHealth Department Ref.No. VASE SUJTE 2C YAPHANK,NY 11980x60 YAf i (6 '1, S"2 5 00 R� al�iW"�@,suiflolkrouotyny.gov 3 „ P 1 a TE AN EXISTING PERMIT TO CONSTRUCT SEWAGE DISPOSAL AND `4VATFAk SUPPLY FACILITIES FOR A SINGLE FAM[LY DWELLING REFER EICAI3T Tx IDE OF TIHISFO ORMNI�FOR INNS NSSTRI D SO ST BE O W91r NA C �" �,��„� FOR ALL RENEWALS AND TRANSFERS EXISTING REFERENCE NUMBER: a — _ 007 District Section Block Lot la � . lca.: O Q nae urr n Applicant: �, a C L 7 elf: - . Mating,Addr ss: Einaal Address: Name of Current Agent L Tel#: (631) Iul Mailing Address: t Say �! Email Address: " �_ c�r . c c►v * If more than 6 years old and SCDHS site inspections have not been V�� "1l, tt�:��,�, DATE OF ORIGINAL APPROVAerfotaned,a new a lication will be required '� ',. � N, FOR I . SIGEPPLICANT I/PsOE1T I�ERI'�'tISSION Name of Previous Applii!W gen Tel#: I hereby transfer all rights and interest in the above referenced permit to the new applicant named above; Signature of Previous Applicant/Agent: Date: �wSSIOIV FOR"r'RA1"gR;SFE"I�S"' '1'1'`;I�1t, 1L�T PREVIOUS AI'P°l:,I�CA.I '°I"IAO:INT PE' Name of Previous Applicant's Tel#: ArchitectlEn ;neerlSure or: I hereby authorize the above named current applicant to use the previous applicant's survey/site plan for this project prepared by me; for the purpose of transferring the above named reference number and its site design. Architect/Engineer/Surveyor's signature: Date; FolkALL RENEWALS AND TRANSFERS Application is hereby made to [ ]TRANSFER,W RENEW(check applicable) a permit to construct in accordance with this application,surveys and plans submitted. I hereby certify that I have examined this complete application and the statements therein are true and correct,and that all work shall be done in accordance with all applicable Town,County,State and Federal Laws. "Any false statement made herein is punishable as a misdemeanor pursuant to S210.45 of New York State Penal Law." Signature of Current Applicant/Agent Date -- 0 ' � Print Name of Current Applicant/Agent Title LLC iwty ILEI' T �.EN I USE Permit is`"I'ransferredll era d Until N' . ber of Bedrooms ,Approved d Date Signature of De artxrentI presentative �. � .� .. TF-55T -TOLE DATA DY McDONALD GE05CIENCE -t 05/ 14/2012 4 � J � / I IODf DARK DROWN LOAM OL � DROWN CLAYEY SAND 5WATcER IN DROWN 3,71 4' CLAYEY SAND 5C I - � L WATER I N SALE BROWN / 1 � � v_ � � �, /. r? EINE TO / t / 1 COARSE SAND 5W e NATER ENCOUNTERED ' { / 3.7' BELOW SURFACE 0 r c� t ° 44- CO. At{ER iOtt 4ZARD LINE AS SCALED FROM \ i s[ r, FHO its. 4 —62 -83 SHEET 26-0 OF 44 a g f # 4t `d AE (EL, 6) _ _ ti E VE iEL. as rte€ P IROP 0 e _ / � t �`��F t,� mss: � �i C(U ih=`V r `. a5 c FU i RAF y , SITE PLAN 4 � y La u, `-LES.l$.�° Al -- 2 1 €L:`'r':t ;. � �. A_ _ s r A.,7 SCALE : 1'° = 40'-0'° ARfA 1 mi0 I1<NT HAR50P, - 1 M€ QED CAST IRON COVER z %' .0,07' KA E'L 5.5` TO GSE GRAD G..2' '" 7 ,C .r yes �. P3NI5NED GPADE EL.5.0 5CD1115 APPROVED ': Pi 1,200 GAL. - 5EPTICTANK51 1 1 - E.A. CL 1,V 5O..OM Of LEAC:"!!NG")OL5 541 0 GROUN .-; a fir"' � { , i c 3r moi-__ 3 E•'% Yi t FDROPOSED SEPTIC SYSTEM DETAIL s E �- SN NT-5. RTMENT OF HEALTH SE,-,-VICES PERMIT FOR PPS _r,, . �_ N70R 1—`5 L Oi CEDAR Er 1 'u.2 E 'S NECr, COAD , OKINT, NY DATE „ . O— REV,s �_ . 0aI1 I ,20 12 3 FOR EXPIRES TH YEARS �� AT I DrS1N ASSOC ATS 11 t .' 1INC. _ �0 - 205 F,A I�E ANUE GREEN OR.7, N.Y. 1 1 344 Cq ! _ � r� 3.� � �77-:,75 2 {, �x} , 11 477-0073