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HomeMy WebLinkAboutJester w t SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4440-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner ROBERT & DIANE JESTER ------------------------------ Mailing Address 1 314CHAMPLINPLACE ------------------------------- ------------ Mailing Address 2 ` ------------------------------ City St Zip GREENPORT NY 11944-0000 Property Address 1 415 SOUND ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip GREENPORT NY 11944-0000 -------------------- -- ---------- Owner Telephone No. 631-477-1868 ------------ Tax Map No. section 35.00 block 1 lot 4.005 ------ --- ------ Cross Street SUTTON PLACE ------------------------------ ---------------------------------- Issue Date: 7/10/12Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) � ®G ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road TOWN CLERKcz @ P.O.Box 1179 REGISTRAR,OF VITAL STATISTICS O Southold, New York 11971 �� MARRIAGE OFFICER Fax(631) 765-6145 �� aO RECORDS MANAGEMENT OFFICER 1 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. Owner Name CA- Owner Mailing Address Lb rn D{l rl P Lck-C-e- Owner Property Address !J1 S� &c « A Gtee R m Owner Telephone No. Tax Map No: Section 35 Block ` Lot .yr Cross Street Please check each that applies: New Construction Alteration to Existing 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 Applit Date Received by: Suffolk County Department of Health Services Office of Wastewater Management 360 Yaphank Avenue,Suite 2C Yaphank,New York 11980 (631)852-5700 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 company letterhead,provided it contains the information below. Health Department Reference Number: z m - k` ^ O o O Q Suffolk Tax Map#:Dist: Sect(s) Blk(s) Lot(s) Project Name or Address: Subdivision Name&Lot# Applicant's Name: Date of System Installation: L\ Description of System Installed: Septic Tank Volume(gallons) . ..� b o c Shape: [Rectangular [] Cylindrical Top: [] Slab [] Traffic Slab [] Dome Name of Precast Manufacturer: Leaching Pools Number of Pools I, Diameter and Effective Depth3' LJ 2( Top: XSlab [] Traffic Slab [] Dome Name of Precast Manufacturer: Other: Sketch below the measurements from building corners to the access covers of disposal system,or attach a separate sketch prepared by installer. A b Tanl�- 3-7, 8'C`' Ces ft:1 -3? 3►`6 N A I hereby certify that the subsurface sewage disposal system,described herein,has been installed by me in accordance with the approved plans and standards of the Suffolk County Department of Health Services;and is operational. Installer's Signature Date (2-19 201k Installer's Name: air, ley �Clre i�ec_ -rte Company Name: 5-t-dN y re-2-ePhone &3l -LOI-1?2a Company Address: SO C;,) lL Consumer Affairs Liquid Waste License Number: WWM-078 (08/05) I SURVEY OF LOT 3 ' "FINAL PLAT FOR THE PROPERTY OF MIGHAEL VERITY" // FILED JULY 26,-2007 AS FILE NO. 11545 SITUATE: 67REENPORT TOWN: SOUTHOLD �Q SUFFOLK COUNTY, NY S SURVEYED: APRIL 14. 2010 SUFFOLK COUNTY TAX # os I 1000 - 35 - I - 4.5 m� 1 DWELLING I PUBLIC WATER CIERTIIIFI[ED TOe i VACANT ]ROBERT W.JESTER _ -DIANE 0.JESTER { LAIRS TITLE 1NSURANCE CORPORATION - SOIJTIIII BAY ABSTRACT,Hnc. ' � frl _ - - - - - -L N — — — N63°03'S7°'E LOT 4 287.03' '��°' EL=20' rA >® Q 0 -------------- EL=21' 2 ®N D _ _ _ — � 2b' G6MMON DRIVEWAENTT -SERA _• ------------- � TEST HOLE ---- - m 157.02' a EL=20 � � � NO I FROM — � � I FILED MAP q 1,-, ;. EL=1C,' 563°03'57"iii,' GLAY O o 0 ; LOT 2 z I I SAND ti I+ ao 1 ! I , I 4 y 1 if 200 a ° W GRAVEL r ,,p�er , O 00 as. +�1 A m r j ? V7 25, 1 _ GFs >:z I, �R4G�D s O to m 917- 70 IP O L TE5T HOLE NO I c FROM FILED MAP N Su Ot)1R1TY ®EP+'�i?TP4�E NT of EA i S I I PERMIT FOR APPROVAL OF CONS i a FOR A LOT GOVERA6E DATA. LOT 5 ; r p SING--E F/iP'rILY I�LZE �IDZN�CP L� ��OF Eye HOUSE AREA 2,321 S.F OR 8.2 96 LOT GOVERA6E NN i� N HAR 2 3 201 DRAINAGE SYSTEM GALGULATIONS + ; ©ATE 1-1.103 �0— � HOUSE ROOF INCLUDING COVERED PORCH4 w � - ' 25215G[ ft X O 11 = 3GAPPaov•5 cu. ft � �u :�•-•- � �<C i 3c15 cu ft / 422 = cl 4 vertical ft of 8' dla leaching pool required41 p —•-- PROVIDE (2) 8' dla X 5' STORM DRAIN POOL FOR MA-x p r. �a'r�o t�O Xl�fi Es r �' .RS f 110 T y rn EL=1ql Quit _ G'`' ;��tfAL NOTES: (-� 'Ihtauthor@etl lit-1"'"ion,d atlNtlon to 0 of.. 1 11 z map bearing f licensed I�sl,rveyor's seal is a I vlobtbn of section 12 :17d,—]I..2'.f the 130.01 New Yo k 5tote Educatlon Low° ® STAKE SET S63°03 57"W m � gars °Only copies From the orlgNgl of this survey inked with an or Iwi of the land serve EL=20' stamped seal sholl b. Ed to be valid Oce copies' Land now or formerlu Of Gertlficotions Ngicated hereon signify that this PROPOSED SEPTIC, FOR MAX. 4 BEDROOM OPEN rV' >v vey as p epa ed n a co do cee ith the ex- HOUSE 1200 GALLON SEPTIC TANK AND 12 SPACE JUSTIN MATHESO >tmg Dade of Prac ce For Land Sere ys adopted by the New York State Assoclatbn of Professionpl VERTICAL FEET OF 5' DIAM GESSPOOL Land now or former) of Land Surveyors of certi0catlans ahailr only u b the person ro whom he eurvey is ove e� SOPHIE RAYNOR DWELLING and an y hada.`°t e tltle`amp°ny 9 - lot agency anQ IertlVlg NsdW[bn listed hereon and to the >signees of the lenDing dstitutlon GarGf�o- PUBLIG WATER �" � flora are H ROAD) not trwuFerdble to adpitlarbl rzutltotlam I Area = 28,1x2 S. F. PUBLIC WA ER AA[P°IFd ®� ®�' O C. ' L� Area = 0.6472 Acres LAND ORAPHIG SCALE I 40' 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 ®r RIVERBEAD,N.Y. 11901 369-8288 Fax 369-8287 i REF.-CADocuments and Settings\Owner\My Documents\My Dropbox\10\10-125 A.pro I J.11dll 9.33.1'mn G.buu,ments od Settry W.ner benwmtl.+ xtIOVO-t35 F