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ELIZABETH A.NEVILLE,MMC O Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 • Fax(631)765-6145
MARRIAGE OFFICER ,y ��. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER- �Ol �`� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department DD
APR 2 0 2018
FROM: Sabrina Born, Southold Town Clerk's Office
BUILDING DEPT.
DATED: April 20, 2018 TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4602 for a Cesspool/Septic Tank Construction
Permit submitted by:
Krzvsztof Zebrowski for Pamela Parma.
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
POO—
Dated
Town Hall,Hall 53095 Main Road
ELIZABE Fk�A.NEVII.LE `�` TO � ,
TOWN CLERK P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS w ha
Southold,New York 11971
MARRIAGE OFFICER `�1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �� ,��Q� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
G
OFFICE OF THE TOWN CLERK RECEIVED
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT pPR 1 9 2018
APPLICATION Southold Town Clerk
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 V or Non-Residential @$25 Application No.
� II Permit No.
Applicant NameKRU.50E. �V � ��
Applicant Mailing Address `��
Mfw� �,,
Septic Tank_or Cesspool
Brief Description of Proposed Construction or Alteration 1l� �c�ON It
I, pNS
lL l I 1-m x
Location of Proposed Construction/Alteration:
Owner of Property:_�RM_ UR, ft m _
Owner Mailing Address:— Q0 fla/K LO F
Owner Property Address:— Aol!i owA&VI L H I/IRN E
MOTMG0 I W 110til
Name and phone number of contact person lw5ATO� a +:�may,
w
Tax Map No: Section 'n_��BlockLot
Cross Street RAI N 1� ( V I_�W � 1/
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENTA�PPJR�OVAL
4ti---/z ��(fure of Applicant Date
Received by: _
S.C.T.M. NO. DISTRICT: 1000 SECTION: 88 BLOCK: 5 LOT(S):3 I
TYPICAL SILT -
SCREEN SECTION -
GEOTMLE FABRIC -- 7 y.a 3 I°g"�y y�g+ T
SUPPOgr- STS
W00 ORD METAL RA CAL+�& '�t Tr IdLY.?
FLOW @ € t1 ,
DWELLING 1Y/ PORCH 1 O 1
EXCAVATED AND1,810 X 0.166- 1
W"MUM TMN`N MAIN BAYVIEW ROAD 4) s x 4...
EXlsnNQ GROUND I
RTA x 0.166
14tIRi 232sf _
• DRYWELL� EO }
:N NOTE CHANGE(S)• E13 :o=4C p38 Health
i# c £
By
LOT 26
I LOT 25LU
DWELLINGS U.x
PROPOSED UNDER W/PUBUC WATER
GROUND UTJUITES 150'
/ S 6800'30" Eco
CL 17.0 U'P` m :4�t 8' DEER FENCE x
DWELLINGS
W/PUBUC WATER ~ — — — EL 17.1 PROP. WATER SERVICE rn ,�. EL 17.8 0.
EL 17.8
•� y0 vh��:nd C�� a�6°_ •_
t1 EL(18.0)
�0'rt PROPOSED UMfr
/_ #{ OF DMTURBAJ4CZ
I °
CL 16.7 41 , *'
PROP JSED D � FRA,
3-4 BEDROOM nG LOT 50SYSTEM
AN lQq 40 SE p'
7 17.7 a 'h
(1)8'D x12'OEEP L.P.
Clio
GAR '- t i LOT 28
AID CONi1d s,
i ENTRANCE 86 0, I
EL(17.0) I
DWELLINGS
W/PUBLIC WATER
7. Q s� i � 150'
/ CL 15.7 ~\
— O ? _ CONCRETE NkSHopa OW AM
IN
Suffolk BED OF PROPOSED DRNENNY. O
By County Departmentbi _1 EL 16.40
- SILT 00
/ C LOT 29
CO
LOT 49 EL 15.2
TYPICAL GLEAN OUT tV� �� DWELLINGS
W/PUB50C WATER 1 y5 DO,
SLATE OR STOPPER EVD
SUITABLE COZIER OR PLUG EL 14.9
6D•WN.
BUT SUFFICIENT
SEDIMENT SITE
HAY BNL AND/OR
30' ELBOW SILT FENCING
Ij
60' WYE -
FLOW; —
o
U+
0
ELEV. 22.5 C0WRUCTION ENTRANCE — FOUNDATION OF COMPACTED
.3/4' STONE BLEND OR N.Y. STATE D.O.T. APPROVED R.C.A.
TYPICAL DRYWELL CROSS SECTION FILL TO 18' (Min.) ABOVE EXISTING GRADE FOR DRAINAGE
OL DR BROWN 1.2' (CONC. PRECAST COMPONENTS)
SANDY LOAM
W t1U!FOR NarT%VnO WARM
BROW'sAe rat Tr*m sAts,C
SM OAMYWSAND 1.5' A ROWD'NU Pff Aro ATPNOWD ounn PrE �. .
�/ s�"Dw SUF FOLK OU m E_k TF T!SEIRVIt,
f m,/ey,•
PALE ® 0 0 0❑ -
E gUs FOR A TS L g N NOR A
BROWN ❑ 0❑ 1 S I �GLi FA M_L V'.Z 2- D j2C' N','
MEDIUM Q�ii
SP SAND rb�—�,—d2)3 I
HS
GRAVELARfPPIR00' El I
14.3'
I
FOR_ 1 _ 0 P i1 r
r
I Y e
5 WN. -- 8' € - -P3 SS��RE .z`x._�-.. T'- gym, �°a' =,= 'a' .m TV. _
COLLAR S
BACK FILL MATERIAL TO BE
CLEAN SAND AND GRAVEL
NO WATER
JUNE 1, 2015
— 17' ZONED R-40
K. WOYCHUK LS NON–CONFORMING <20,000 S.F. THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL
FRONT: 35 MIN LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS
SIDE: 10' MIN, 35' TOTAL AND OR DATA OBTAINED FROM OTHERS
AREA: 17,250.00 SQ.FT. or 0.40 ACRES REAR: 35' MIN ELEVATION DATUM: NAVD88��
UNAUTHORIZED ALTERA77ON OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INST7TU77ON
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT 7RANSFERABLE.
7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 7HE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE 77-1E ERECT70N OF FENCES, ADD177ONAL STRUCTURES OR AND 07HER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EWDENT ON THE PREMISES AT THE 77ME OF SURVEY
SURVEY OF: LOT 50 CERTIFIED TO: PAMELA PARMA;
MAP OF: TERRY WATERS ADVOCATE'S ABSTRACT, INC;
FILED: DEC. 29, 1958 No.2901 STEWART TITLE INSURANCE COMPANY;
SITUATED AT: SOUTHOLD
TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
- -- P.O. Boz 153 Aquebogue, New York 11931
FILE # 17-107 SCALE: "_ ' PHONE (631)298-1588 FAX (631) 298-1588
1 30 DATE:JULY 1 0, 201 7 N.Y.S LISC. NO. 050882 maintsiainj the records of Robert J. Hennessy & Kenneth Y. eoychuk