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SQ1rHCLD VOSTEMTER DI SPO AL PERM T
CPERATI CN PERM T
SEPTI C TANG or CESSPOOL
Cper at i on Per M t Nb. 4466-R Resi dent i al X Nbn-Resi dent i al
Fee $ 10. 00 ww X Exi st i ng
Imine Cf Owner JCFN PI THAN
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Nbi I i ng Address 1 2 OCPPEL.L DRI VE
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W I i ng Addr ess 2
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O t y St Zip TEN AFLY NJ 07670-0000
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Property Address 1 1100 RJCH LANE
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Property
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Property Address 2
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O t y St Zip SCU FICLD W 11971-0000
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Owner Telephone Nb. 201-575-3529
Tax Ntp W. sect i on 52. 00 block 2 1 of 34. 000
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Cross St r eet RCUfE 48
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I ssue Date: 4/25/ 14 B i zabet h A Nevi I I e
-------- Sout hol d Tomn d erk
(TCVIN SEAL)
e
O��S�FFO��-cOG
ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS O � Southold, New York 11971
MARRIAGE OFFICER y�• a��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 1 `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 @$25 Application No.
Permit No.
Owner Name O ��R Pt +man
Owner Mailing Address Q
Owner Property Address
Owner Telephone No. of)b l- 5 '�`J ' 3 a c c i l o�t-
Tax Map No: Section Block DO. Lot 34�
Cross Street
Please check each that applies: New Construction a✓
Alteration to Existing System
Residential ✓ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
Signature of Applicant Date
Received by:
SCDHS Ref.# RIO-12-0018
TEST BORING
y McDonald Geoscience
b
7/21/10EL 16.5 'Ikpe ` sr SFO �,t� '
Dark Brown The locations of wells and cesspools '. Qt ,<y0�
Loam OL shown hereon are from field observations ` ,
0.5' and or from data obtained from others.
Brown sett ML Therefore their locations and or existence ;,:5.,
3• is not guaranteed. 0
Brown Silty Sand o�Q�4T �0 0.�q
with IOx Gravel + A+0
SM
06
Brown fine to Coarse ' hQ p3
Sand SW o'
15.8 EL 7'
Water In grown Fine '
to Coarse Sand
SW
1T
48) ,
.�H ROAD
NOR � �p o� �;,\\Q�• �Q ,, o�
� y•�h ,' opo �P� y f=
PROPOSED SEPTIC SYSTEM
14 BEDROOMS) y°��• i' \° P �h �' 0 \ "
1 - 1000 GAL. PRECAST SEPTIC TANK
1- LEACHING POOL 8'0 12' DEEP WITH
3' SAND COLLAR (SW) BOTTOM TO BE ` p s��[/,� 0` C.)
3' ABOVE GROUND NATER . rp
PROPOSED DWELLING TO DISCONNECT rQ `Sp0/ � •p0 Q
FROM EXISTING SEPTIC SYSTEM �
'10 o
r
sr` 0 O0.
EXISTING HOUSE NOT SHOWN HEREON �� • .0 + 0- J ,
TO BE REMOVED
R
A/N RUNOFF CONTAWMENT
HOUSE . 1145 sq.
1145 X l x 0.17 = 195 c0
195/22.3 9 W. 1•
1PROVW 2 DWe e'o x 1'deep
� HOUSE
A\ Fh Fir. at 18.5 f
EL 17.9 EL 17.4
�1•°� i- �1► `V IE 16.3 !E . ST 0.5, pppp€
���`• ���! / ��� 16.0 IS 51E 15.4 LP
\� Gly o�, �, CQ %a A �$ �Q ��° 12 �,
EL 3. 8
ORO" WATER EL 0.7 EXPOO" µ-
� � �'' tea,, �.• P `Z' —
����` SEPTIC SYSTEM CROSSECTION
C.,
0 ` •a0v��v NO SCALE
0
Q kV �• g
\o°P `� ,00 , ° w SUR VE Y OF PROPER TIES
ARSHAMOMOOUE
,te ?oN� ��° TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
rte„ .i a 1000 - 52 - 02 - 34
J 1000 - 52 -03 - 11
Scale. 1"= 30'
A/ gs`� Aug' 18, 2010
?� , 3p, Aug. 31,'2010 (cesspools)
S®pT. l4, 2QQ1/(PROP HOUSEI
FeblS, 20I P (rev/slonsJ
March /3, 201? (revls/ons)
oP �q0 vislanO
�l 2M, 2a21rembl
• 1- 1 TH F May /5, 2012 (revisions)
v - WETLA FLAG 04/,0 «��3
LANDWARD EDGE OF TIDAL WETLANDS AS DELINEA TED BY �' i • �'
SUFFOLK ENVIRONMENTAL CONSULTING, INr- AUGUST B, 2011
I am familiar with the STANDARDS FOR APPROVAL ;
AND-CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FA/UIL Y RESIDENCES
and will abide by the conditions set forlh therein and on the
permit to construct.
FLOOD ZONES FROM FIRM
0I58H
ANY AL � � 5. V9618
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION LIC. I� .4
i
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. J
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS PECON/C SURVEYORS, P.C.
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY (63/) 765-5020 FAX 765-1797
IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE
SURVEYOR WHOSE SIGNATURE APPEARS HEREON. P.O. BOX 909 O–I 86
1230 TRAVELER STREET
' ELEVATIONS ARE REFERENCED TO NAVD 88 SOUTHOLD, N.Y. 1197/ 10-187
(fit
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