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SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4427-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner VINCENT & LAURA MANETTI
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Mailing Address 1 215-15 67TH AVENUE
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Mailing Address 2 `
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City St Zip 13AYSIDE------------- NY 11364-0000
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Property Address 1 150 WEST SHORE DRIVE
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 718-790-1538
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Tax Map No. section 80.00 block 5 — lot 5.001
Cross Street OAK DRIVE
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Issue Date: 3/16/11 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
�oSUEFot�.�,
�O OG
ELIZABETH A.NEVILLE cz Town Hall, 53095 Main Road
TOWN CLERK ria Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICSO Southold, New York 11971
MARRIAGE OFFICER • �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��l �aO 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 IV/ or Non-Residential @$25 Application No."a-A CC7
Permit No. i Z Z V2,
Owner Name A- L
Owner Mailing Address 2 1 S-- 7 'ttnwL—
Y
Owner Property Address 15 O
Soc�.'�•9�� I� � 11q� l
Owner Telephone No. `l 19 - 761 U
Tax Map No: Section h,0 D Block S Lot 0 o I
Cross Street o;i vy-,
Please check each that applies: New Construction /
Alteration to Existi System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED 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.)
Signature of Applicant Date
Received by:
SURVEY OF
LOTS 10 , 11 & P/ O 12
BLOCK A
MAP OF
® � REYDON SHORES , INC .
�d FILE No. 631 FILED JULY 2, 1931
SIT UA TE
J BAYVIEW
TOWN OF SOUTHOLD
s SUFFOLK COUNTY, NEW- YORK
S.C. TAX No. 1000-80-05-5. 1
42j�y°
SCALE 1 "=20'
NOVEMBER 21 , 2007
JANUARY 6, 2008 ADDED ADJACENT HOUSE LOCATIONS
MAY 29, 2008 ADDED PROPOSED ADDITIONS
OCTOBER 24, 2008 LOCATED EXISTING WATER LINE
JANUARY 27, 2009 ADDED SETBACK FROM DECK TO BULKHEAD
DECEMBER 22, 2009 REVISED PROPOSED DRAINAGE
cy JULY 26, 2010 ADD ADDITIONAL PARKING AREA
NOVEMBER 22, 2010 FINAL SURVEY
AREA = 15,527 sq. ft.
(TO TIE LINES) 0.356 QC.
o_ p pia CERTIFIED T0:
. �;sn, _, ,� {��41,�.. ...,., •'; .. .�_ VINCENT MANET;TI
a'� ,.:�Ft�t:f:' c3i „rv,i.,; .,7a; ,; ,,:Y; ,...�, ,', :�•;r 3 .;t."a ks.; �i:::t Y;W*� LAURA MANETTI
.. - i`;:. n,a ":. •f'.
:'tl�,if�e ak`•.;a iiri9et;S'�;S i
tE�1e:•S't�c3;�;•wif�r.;.r."a,; , t:y; ,e•,.'i.:•.,....,...'.•f .. .: ,
- � .....,�.,l;i�:ii>'�uiny4 r+i.'11�.1i.'..a,i i.z-q�..q=•o l•u ,. • � .. _ -.
yjj '�..'3'•k•rS.•T\.t4 #•i��WiEn'V.�sVi:; '.v`;,,'i'HLf li�ti�'«{�1��83•i:'i 1:'. y
t� C:.�i+v"+......,.........wm r...,m..v...u....,...�.nw...r .....,.�w,�.....-n�..e......r...,,.....�...�.�....�..�..,..�.....-a.n.—..+•s.,�.moi
John Bertani Builder, Inc.
for Vincent & Laura 'Mane'tti
150 West Shore- .Drive, Reydon Shores Southold :
- S.C.H'.S.#R-10=08-0065
by Latham- Sand & Gravel, -Inc. ._', -
Suffolk
ravel, -Inc. _ •Suffolk County ,License- #LW-180 --
49 41
MR-1 64 ec°
Suffolk County Department of Health Sciwices
0111ce of Wastewater Maaagementi,
360 Yaphank Avenue,Suite 2C I
Yaphank,New-York-11980 "
(631)8S2=S700
CERTIFICATION OF SEWAGE.DISPOSAL SYSTEM BY INSTALLER
This certification shall not be used-in lieu of inspections required by personnel of the Department
and may be duplicated on compan-yy"l-e�tterhe-ad,provided it contains the information below.
"Health Department Reference Number.
Suffolk TaxMap#:Dist:�Sect(s) �0 Blk(s) Lot(s) a
Project Name or Address: ( tf
Subdivision Name&Lot# f
Applicant'sName: I1X 0n4-1+ -LA )rp
Date of System Installation: �1/io - -
Description of System Installed: !
Septic Tank
Volume(gallons) 51 d
Shape: []Rectan ular . KCylindrical
Top: [J Slab Ktraffic Slab []Dome
Name of Precast Manufacturer: ie"'-o�e s�o. P,r4 i _
Leaching Pools
Number of Pools s �Z
Diameter and Effective Depth '
Top: []Slab []Traffic Slab [ me m D,
Name of Precast Manr.ufacturetl'nv stall T i V'P
Other.
Sketch below the measurements from-building corners to the access covers of disposal system,or
attach a separate,sketch prepared by installer.
1 hereby certify that the subsurface sewage disposal system,descnbed herein;has been installed by me in accordance
with the approved plans and stan of the Suffolk County Department of Health Services;and is operational.
Installer's Signature: Date -<9 L8-1®
' Installer's Name: D hbC. -
CotnpanyName: I cS�d elf + C Phone �,t�1 e Aced
Company Address: ,' C C �,
Consumer Affairs Liquid Waste License Number.
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WWM-078 (08/0