HomeMy WebLinkAboutPoulos SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4423-R Residential X Non-Residential
Fee $ 10.00 New X Existing
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Name Of Owner GERI POULOS
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Mailing Address 1 1050 CAPTAIN KIDD DRIVE
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Mailing Address 2 ------------------------------ '13dJ`\QS
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City St Zip MATTITUCK NY 11952-0000
Property Address 1 1050 CAPTIN KIDD DRIVE
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Property Address 2
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City St Zip MATTITUCK NY 11952-0000
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Owner Telephone No. 203-536-2517
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Tax Map No. section 106.00 block 2 lot 47.000
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Cross Street BREAKWATER AVENUE
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Issue Date: 10/21/10 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE Town Hall,53095 Main Road \�
CD P.O.Box 1179
TOWN CLERK Go Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O� °� Fax(631)765-6145
ALARRIAGE RECORDS MANAGEMENT FFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10�--or Non-Residential @$25 Application No.
Permit No.3 5�20z
Owner Name—
Owner Mailing Address f O s-'O C APr - 4-( O c, C? --
Owner Property Address
Owner Telephone No. c2 v 3 2 sl -7
Tax Map No:/6 0--(-�) Section P067 Block 62 Lot
Cross Street
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Please check each that applies: New Construction
Alteration to Existin System
Residential , Non-Residential
NOTE: LOCATION MAP MUST BE SUBAHTTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
-- w k-7 0
Siplicant Date
Received b .
• SCDHS Ref.# R10-09-0043
DWELLING DWELL/NG (PURL/C KA TEr7J
N (PUBLIC WA TERI
(PUBLIC WATERJ SURVEY OF PROPERTY
DWELLING
LOT 138
AT MATTITUCK
s86•oo'3o"E CLF OIL TOWN 0.�' S'0U'HOLD
E, ea.7 100.00'
" .. WIRE FENCE -
' X Y SUFFOLK CO UNT Y, N. Y.
Test Boring 0w 10,00---106--02�47
air
by McDONALD GEOSCIENCEn 1 a
8126108
RALE: 1 ry0
°" SPTE/k1BER 19, 1007
Dark Brown Sandy SEPTEMBER 2, 2008 AO.H.J
1, Loom OL p B L O C K // AUG. l8, 20Q9 (addlt/,�1 s)
Brown Silly Sand DEC_l5, 2009 (REVISIONJ
N B'�xs DEEP, Marth 26, 2010 (foundation)
SM - 0 OW ! � w
3' Brown Sandy LOT 1¢g JULY 23, 2010 (final)
5111 ML N
8'
PSaad Brown Fine _,_ c E
SUFFOLK CQL1N)-Y DEF's``ATM NT OF HEALTjj,gE,:1V10E,
/71 10.4• sem. o 'ta.o• PO ROVAL(;F�w E:aT k `i'i��.@S, FD yI,ro;e% a C)
Qi A
LOT 150 - y-L)L
DWELLING _ a STY. FRAME HOUSE d GAR.4GE Ti3e::F:� ;;� cl f�s�;�,i � �v�t.�s sE pp,y far�s;itiva at.tris focaEcn have been
( In 7i.cz t TE:biIfJ'c;j+ica t, s 'g t l _ and f
(PUBLIC WA TER! CD,' � � i' �^-s� '��;�=fr����•EnE�t a,r•o, air aclenci�^.s v orsrsd to
__ro.�`— ria• " LOT 1.48 � ba satasfaci�•y FO,'R A (,p I . gEr)ROOMS.
EXISTING WELL & CESSPOOL
TO BE REMOVED OR, FILLED �W r.sa r.4, POR ►z.r N oWELLI/vG _ kA.4916er•J. #�;iE67ef�,
N /N o 5.r cri r.�� `r.s' . r69' rPueC/c WA TER) LO COVERAGE=4IEWc�f ° ie�rader Management
HOUS"- GAS_ 24LZ_sq.l
;2%RAIN RUNOFF CALOLAT/ON.Sj 248!!200020
2"RAINFALL
-
HSE R GAR. = 24/7 sq.fl. EXISTING HOUSE TO BE REMOVED
2417x I x 0.17 = 411cu.ft.
4///42.2 = /0 VF ! a"
PROVIDE 2 DWs- 8'0 x 5' deep '"o sr I am familiar with the STANDARDS FOR APPROVAL
3 AND CONSTRUCTION OF SUBSURFACE SEWAGE
p� EoUND DISPOSAL SYSTEMS FOR SINGLE FA IL Y RESIDENCES
p- y DW ;AAr�C and wi%I abide by the conditions set forth therein.and on the
379.27'
3 8'�x �oEEP permit to construct. � � ,D
'i � LP
`��3 BEDS' � -• _ _ - ,
i WM
EL The locations of wells and cesspools ALPS 16 n
N1 -6, - s -' est shown hereon are from field obser,valions SUFF.
PROPOSED SEPTIC SYSTEM _ — unLl �0 00' and 01�from data obtained from others. f,�� F�1F. Co .1-1 ;L ;, raE(r�:(
�4 BEDROOMS! POLEm — — VERHEAD _ R
_O J. �.
1- /000 GAL PRECAST SEPTIC TANK WIRES -s,� L / F y , g-
l- LEACHING POOL -8'0 x i2' DEEP WITH EDGE OF PAI�Eti/ENT r.
3'•SAND COLLAR (SWI BOTTOM OF
LEACHING POOL TO BE 3' ABOVE
GROUND WATER. EZ 66.0
CAPTAIN KIDDDRIVE
ELEVATIONS ARE REFERE'NCE'D TO PUBLIC WATER IN ST.
EL 84.8
AN ASSUMED DATUM c C oDWELLINGS (PUBLIC WA TER) =MONUMENT f � r �!! l ANO. 49618
AREA=12,000
1 VQ
000 . 1 �. -ANY ALTERA77ON OR ADDITION TO THIS SURVEY IS A IJOLAT/ON ZIPECONIC S
OF SECTION 7209OF-7HE NEW YORK STATE EDUCATION LAW. 631 765-502 765-1797
1
LOT NUMBERS REFER TO "MAP OF CAPTAIN KIDD ESTATES" EXGEPT AS PER SECT/ON 7209—SUBDIVISION 2. ALL CERTIFICA77ONS < >
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF " P.O. BOX 909
FILED IN THE SUFFOLK COUNTY.-CLERK'S—OFFICE—ON -----SAID—MAP qR—COPIES-BEAR THE IMPRESSED SEAL OF--THF-SURVE-YOR .- SOUTH R DVEN R �T-R7�r_x _191
JANUARY 19,., 1949 AS FILE NO. 1672. WHOSE S/GNATUAV APPEARS HEREON.
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