HomeMy WebLinkAboutSmith SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4438-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ANDREW & JENNIFER SMITH
------------------------------
Mailing Address 1 26 LEFURGY STREET
------------------------------
Mailing Address 2 'L0 Z
City St Zip HASTINGS ON HUDSON NY 10706-0000
Property Address 1 28100 MAIN ROAD
------------------------------
Property Address 2
------------------------------
City St Zip ORIENT NY 11957-0000
-------------------- -- ----------
Owner Telephone No. 212-455-7939
------------
Tax Map No. section 18.00 block 6 lot 22.001
------ --- ------
Cross Street NARROW RIVER ROAD
------------------------------
----------------------------------
Issue Date: 4/26/12 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
� ®G
ELIZABETH A.NEVILLE y� Town Hall, 53095 Main Road
TOWN CLERK C#* P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICER yif' ® ��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �! `1oa Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK RECEIVED
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT APR 2 512
APPLICATION
Southold Town Clerk
OPERATION PERMIT,
CESSPOOL or SEPTIC TANK
Residential @$10 v or Non-Residential @$25 Application No.
Permit No.,
Owner Name A-n&('P"J O A�- 1�-n n l u cl m
Owner Mailing Address ��
Owner Property Address � bo ► 1 f cu r,- de u c`-v
AJ 110
Owner Telephone No. ! 21 2 �CS!r -19 3 j
Tax Map No: Section ,/ Block Lot 7-2- 1
Cross Street apry r i'�p Lue..r e0c,
Please check each that applies: New Construction ✓
Alteration to Existing System
Residential 7 Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from systemAo building
and closest road. New construction may submit copy of survey with SCHD approval.)
Signature of Applicant date
Received by:
SCDHS °R,ef-.# =RID-11,-0.023
SURVEY ,OF PROPERTY
N. , " ', ' .• A T ORIENT
TOW THIOL
OF SO UOLD
SUFFOLK. COUNTY,. N. Y.
:• _ , 6 1000-1a-06 22.1
SCALE.- V--30
VACANT-' SEPTEMBER 21, 2010
EL 13.9 OCT.'200 2010 40(w FND.)
=` JUNE 21, 2011 (ADDITIONS)
5 ,AUC 15t 2011 (ADDITIONS!
"' _•. ' _ ��2 Feb. S; 2012 (final)
LLRO Cps 160'• IWAD RAi-T
WE�4 D ��j` APRON . 1 50
MAIN
^ �� , rQ
l+- J 36.52 Ra itOAD
E� 16.3 EDGE OF PARENT ES _ 4 3 NARROW R GPS Of
q O�HEE The locations of wells and cesspools
N-9*2p'40 E shown hereon are from field observalions
and or'from data obtained from others.
uTio' Therefore their locations and or existenFe
is not gaaranleed.
m i
at
1 4 '
C�
-c
---=RUNOFF FLOCy W
RA,!N RUNOFF CALCULATIONS' \ `—�\ — .. - . • -•
\ �O
HOUSE - 3934,s%1& � $� .A
DRIVEWAY (PERVIOUS) 3807 sgdl. ,
3934 x 1 1' 0.17 a 669-crk(1. . '
3807 x .7.0 x 0,17 a 453 cu. ft.
I5 - PRO_ P •ELEVA TION O
C
�
TEST BORING
1/29/D000ld QsoscAmes `r \
'EL 12.4 G� \ , \N
DARK BR, LOAM, ��0
0.5
BROWN SIL T AIL2. \
5 PALE-BROWN PROP. NEW SEPTIC SYSTEM 001
FW SAIV'SP 5 BEDROOMS
4' o ,
PALE BROWN l - I500 4AL.'PRECAST-,'Cy41ND$1CAL
SAL TY SAND SM SEP TIC: TANK
B•- 3 - 0.0 - 45'DEPTH LEACHING POOLS
PALE_9ROWN WITH 3' SAND'„COLLAR fSWI.
FM SAND SP-` 3' ABOVE,C+ROUND WATER. � �►�� G�
V 0.3
WATER IN PALE REMOVE EX/STING SEPTIC SYSTEM
81t FINE SAND \�o
I2 Sp REPLACE WITH 1500 gal SEPTIC TANK 00» o
' WATER /N PALE
SALTY
SAAV '
SAID SM
1 WATER AM PALE , I am' /amillar w/Ih the STANDARDS FOR APPROVAL
��
FAV AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FA'M/L Y RESIDENCES
z3' ,aod wry/ a&*`by'the condi!/ons'sel_Iorlh /herein and-on the
permit to solislrucl.
EL EVA TIONS ARE REFERENCED TO AN ASSUMED DA TUM., ��C1 A��
)'
CERTIFIED TO: �� ��
ANDREW SMITHOF N3?'.Y
J�IVNIFER' SMITH ' ` ”
FIRST AMERICAN TITLE INSURANCE COMPANY
CITIMORTGAGE, INC., ITS SUCCESSORS' OR ASSIGNS_ -- � ��_��f��:`,•,;T:u`` � V�,;�
A E'A=39 773 SQ. FT. G--�
=MONUMENT
' P� =PIPE - / �~ t, a
"�_ 1C. NO. ,49618
AL7'FRA77ON OR'ADDI77ON TO-THIS SURVEY IS A WOLA77ON 16tC6NIC YO S -P.C."
C ® SEC77ON 720,QQF 774E NEW YORK STATE EDUCA77ON LAW. (631) 765-5020 `FAX (631) 765-9797
EPT AS PER SEC77ON 7209-SOBDI VISION'2, ALL CER77F/CA 770NS / P.O,. BOX 909
c EON ARE VA41D FOR THIS IAP AND COPIES THEREOF ONLY IF `
Q MAP OR COPIES BEAR 77-IE IMPRESSED'SEAL OF THE SURVEYOR 1230 TRAVELER STREET O_,210
OSE S_IGNATURF APPEARS HEREON. ' ��' SDUTHOLD, N.Y. 11971
lr