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Home My WebLink AboutMacintyre SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4474-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner PATRICIA K. MACINTYRE ----------------- ------------ Mailing Address 1 9875 MAIN BAYVIEW RD ------------------------------ Mailing Address 2 ------------------------------ City St zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Property Address 1 9875 MAIN BAYVIEW RD ------------------------------ Property Address 2 ------------------------------ City St zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 631-765-5135 ------------ Tax Map No. section 88.00 block 1 lot 2.001 ------ --- ------ Cross Street JACOBS LANE ------------------------------ ------------------ --------------- Issue --------------------------------------------------------------- Issue Date: 10/02/14 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) O��S�ffO��►co � G ELIZABETH A. NEVILLE o y� Town Hall, 53095 Main Road TOWN CLERK co Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICSO Southold, New York 11971 yRIAGE OFFICER Fax(631) 765-6145 RECORDS MAN GEMENT OFFICER �Ol `�►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 @ $10-4or Non-Residential @$25 Application No. Permit No. Owner Name PI�Z Owner Mailing Address SauL4 Owner Property Address / Owner Telephone No. 6 3 / Tax Map No: Section 1 0 Block b b, i Lot$ • Cross Street /__� 1—"q A-1 Please check each that applies: New Construction Alteration to Existing System �— Residential l--- 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: ED CORK & SONS, INC. 62 CAMPBELL ST. PATCHOGUE, NY 11772 PHONE: 631-207-9290 FAX: 631-207-9293 Health Department Ref. No. R10-14-0029 Suffolk Tax Map# : Dist : 1000 Sect (s) 88 Blk(s) 01 Lot (s) 2 . 1 Applicant' s Name Pat Macintyre Phone .,;,- . . . . Address 9875 Main Bayview Rd, Southold, NY 11971 Property location (include the distance to nearest cross street) 9875 Main Bayview Rd, Southold(Nearest cross St. Jacobs La. ) Hamlet Southold Township Southold Subdivision Lot No. Date of System Installation: 7/31/14 Description of System Installed: Septic tank Volume (1) 1500 gal. Septic Tank Shape: [ ] Rectangular [X] Cylindrical Name of Precast Manufacturer: Long Island Precast Inc. Leaching Pools Number of Pools (8) Diameter and Depth 8 ' x 2 ' Top: [ ] Slab [X] Traffic Slab [ ] Dome Name of Precast Manufacturer: Long Island Precast Inc. Other: I hereby CERTIFY that the subsurface sewage disposal system, described herein, has been installed in accordance with the approve plans and standards of the Suffolk County Department of Health rvices; aN is operational. SignatuWAfair5s Date Diane 0ffice Manager Ed CorkInc. 631-207-9290 ConsumeLicense Number: 199-LW n RIC - � -002q Q � a O 0 ly r� NJTf CE OF INSPECTION CQMPLETI,OiV SIrWAGIr;QIWWI LO,INATEfl IJPPLY Job Permit iVo n t)iapo al Sybt�in Inspection Complof It to ackfit STV C1 Inspection Not Completed ' C7 Water Supply fnspectioro t:ompteto `OK to Back fill - Ci lnapecUon Hot.Completed:. Dale Inspected by ^ _ tFlAK.fR4iltIt<YRI"P.A1�� ' >In 1SlR!(IC Y.. .ECOONCOM�IETWNOQESNQTCA tITUT O At OFINSTAUAtWN REM IM)