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`uLIZABETR A. NEVILLE �Z� G�� Town Hail, 63096 Main Roa.
TOWN CLERK C� P.O Box 1179
REGISTRAR OF VITAL STATISTICS Py
Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER y�01 ��� Telephone (631)766-1800
FREEDOM OF INFORMATION OFFICER �' so u tho Id town.northfork.net
OFFICE OF THE TOWN CLE ID
TOWN OF SOUTHOLD D SOUTHOLD WASTEWATER DISTRICT DEC 2 1 2017
APPLICATION
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TO W11*1 OF.SO:iTT'HOI,V
CONSTRUCTION or ALTERATION PERMIT
. CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application No. LlL
Permit No.
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Applicant Name L zude. 0+ L�
Applicant Mailing Address IPO (jb)s
Septic Tank. or Cesspool " I
Brief Description of Proposed Construction or Alteration SI��UC Fav,ILi ('e$A-ACZ,
Location of Proposed Construction/Alteration:
Owner of Property: t 8 LO-.tSG' C'-L c
Owner Mailing Address: )p h6- km
Owner Property Address: :lop Chli cl2
Sw4t,�o L c� t
Name and phone number of contact person
Tax Map No: Section Block 3 Lot 9
Cross Street wo,-4-s MLe (, ,A-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
4/11C A--e l2-2��
Signa e of Applicant Date
Received by:
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i.
SURVEY OF: __ ._�� _ x*
PROPERTY LOCATED AT S0UTH0LD SUFFOLK COiAIWDEPARTMENT OFHEALTH SERVICES
LOT No. 4 AS SHOWN ON ..... .; .>
MAP OF BAY HAVEN PERMIT FOR APPROVAL OF OONSTRU ON FOR A LJ �.
FILED' JANUARY 22. 1959: FILE No. 2916 SINGLEF�iYRESIDENCEOiNLY
DEC 1 1 2017 =
TOWN OF SOUTHOLD DATE HSO,
SUFFOLK COUNTY. NEW YORK i APPROVED
S.C.T M. # 1000-68-3-9 -,J�
AREA = 14.519 5 S F. FUr�",vFA7iI . I ter jDvD ...�`1:�,
SCALE: 1"=30' EXPIRES THjPREE'Y ' S FR01A DA'I�*-,t) >�V.PROVAL
NOTE: THE EXISTENCE OF RIGHT OF WAYS. - ^--`
WETLANDS AND/OR EASEMENTS OF RECORD Cleanout must be installed on the
IF ANY, NOT SHOWN ARE NOT GUARANTEED. septic tank inlet waste line.All utilities
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION require a 5ft minimum separation OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. re Q p ation to
COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED the septic system.
OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY p
GUARANTEES OR CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO
THE PERSON FOR WHOM THE SURVEY IS PREPARED.AND ON HIS BEHALF TO
THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.
GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
/ ALL RESIDENCES
ELEVATIONS REFER TO 1988 NAVD WITHIN 150' HAVE
ELEVATIONS SHOWN THUS +_+ yah PUBLIC WATER
F�O� � TICO
tK ) S9> LOT 3
LOJ� �� O �a`� RESIDENCE
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S� m ^' P�� 6 �`� l%rFQ S•' PIPE
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A0 4,) 0 TEST
1 Se ,hm 0 HOLE EP 12
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RESIDENCE
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COVERAGE CALCULATION PIPE
PROPOSED RES. = 1492.5 SF. 1��
PROPOSED GARAGE = 360.0 SF. FIRE
PROPOSED PORCHS, ROOF, CE = 668.0 SF HYDRANT
TOTAL = 2520.5 SF. = 17% 0���/ v
SURVEYED BY. q�,�'d PJB SA y4 }`
PAUL BARYLSKI LAND SURVEYING C�
PATCHOGUE NY 11772
PHONE 631-294-6985 o
FAX 631-627-3166
PAULBARYLSKIaYAH00.COM ��LAo osN
NOVEMBER 17. 2017
s
FINISHED GRADE
TEST HOLE DATA CONCRETE LOCKING CASTING
I'MIN a TO GRADE
(NOT TO SCALEI z' MAx. SLAB
BY: ROY K. REISSIG. PE INLET 1/B•PITC/{
OCTOBER 26. 2017 0 8:30 AM MIN 4•DIA D D D D 24' 1' MIN. 24"
D D D 2' MAX.
0.0'-0.2' TOP SOIL PT ` D D n 114' PITCH 20• 20• 6' MIN TOP
0.2'-2.5' SILTY SAND SM z i 4- DIA SLAB
LU _ e.0' CLASS 2408 !O Uj
a = z PIPE C)I.. m 1/8' PITCH
2.5'-4.0' BROWN SAND SP N 3.0'MIN. N OR EOUIV Uj U_
o r° 3 AND GRAVEL 7 COLLAR o' ALENT �? _< q•
o w O — 2 e.o'ouMETErt z = m 4.0 m CLASS
MIN.
fV a LEACHING SECTION a DEPTH PIPE
LIGHT BRWON w w
4.0'-16.5' SAND 8 GRAVEL SP E BACKFILL WITH GROUND WATER OR EOUIVALENT
CLEAN SAND AND 3.0'MIN.
WATER GRAVEL MATEI
REAL 8.0'
WET LIGHT BROWN B'PENETRATION' LENGTH
16.5'-20.0' SAND 8 GRAVEL SP INTO A VIRGIN STRATA
OF SAND AND GRAVEL SEPTIC TANK
TYPICAL LEACHING POOL TYPICAL 1000 GALLON SEPTIC TANK w
2954 IN.T.S.I