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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 Fax(631)765-6145
MARRIAGE OFFICER ,y ®�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER O( �`� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D
DD
TO: Southold Town Building Department JUL 5 2018
FROM: Sabrina Born, Southold Town Clerk's Office BUILDING DEPT.
TOWN OF SOUTHOLD
DATED: July 5, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4625 for a Cesspool/Septic Tank Construction
Permit submitted by: '
Clifford and All Ohl.
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
1?
Dated
rl t
FF
0
ELIZABETH A. NEWLLE ��`� G� Town Hall,63096 Main Roa,
_ TOWN CLERK o P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS by
MARRIAGE OFFICER Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER y�f�� s�O� Telephone(631) 765-1800
FREEDOM OFINFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residdntial @$10 or Non-Residential @$25 Application No. bic
1 1 Permit No.
Applicant Nameo�? C: J i 1 h
Applicant Mailing Address 21 O 0���15i fl Q K1 OCAd
Septic Tank- or Cesspool
Brief Descri tion of Proposed Construction or Alteration
Aa Q
Location of Proposed Construction/Alteration:
Owner of Property: C1\
Owner Mailing Address: 5 \ n n ®Q
-
Owner Property Address: MA 0 ock r`O(-2�
`` I
Name and phone number of contact person J r 1 W 51 lv 301
Tax Map No: Section -Bl ock Lot
Cross Street j 0
NOTE: LOCATION MAP MUST-BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH
TH DEPARTMENT APPROVAL
- (�u . - q ba
Signat of Applicant lbatel
Received by:
DWELLING � SCDHS REF.# R10-06-0057 SURVEY OF P
PUBLIC WATER PROPERTY
A T CUTCHOG UE
/
� \ DWELLING TOWN OF SO UTHOLD
\ PUBLIC WATER SUFFOLK COUNTY,
\ N, 1000-137-05-09
JR
EL-2,.r SCALE: 1'=30
UFEO IC Coum T F Ai MAY 11, 2018
C l3C E IT Fo P VA L CMF -22.8' \ \SINOL A ILY ��C�I cE TEST HOLE DATA
4' CAMcDO ALD GE 18/ENCE
0 „� DWELLING+r—'-7
Exlsr. cPO 0 � PUBLIC WATER E�® �3c7® BE DONEO REL. 34.3� itI�S'�0'�EI3Z 1a"OAK �� BROWN SILTY
EOFA tA}tII OF �_ 14^oAK SAND SM
^p 1�S"OAhA C3TE Ola TREE UNE \ i 3
14" locust
11
20"OAK ,
AK '
+' 1 " v �
� 15"OA
1�"OPpAa' SOAK �p X22" locust EL-30.8'
11"OAK 14"f)AK 15" pine
BROWN f7NE TO
PROPOSED SEPTIC SYSTEM E �`°�' � w �� �.�,�„ ��w
(4 BROOMS) w a 11"OAK � � a���„� 19°„�� 21"O � I®N�LWORKING MEDIUM SANDS i
PROP. 10'OAK w:. EL-30.5' �
I—)- . GAL SEPTIC TANK p COVERED M ��
1-80 X 12' DEEP LEACHING POOL N/O/F 16"locust s tlCH 18'loin s”op �''=' t1"OAK N � _
RAIN RUNOFF CONTAINMENT HANSEN LP ��� � R' I q�1�
VACANT • ;
'.. C 1k t s"OAK - r
HOUSE 0.1 ADDITION. 1,405 Sq, Ft. ",,,, .� z3 w�1� C �0. REMOVED To BE ,'MAETER ` I 21'
1,405 X 0.17 x 1 239 Cu.Ft. . ,
Provide 1 DW 8 0 x 6 Deep= 8 VF °gypv1,'t' µnnk11 1� .. V�
PROP
v� r.L M 1 ,q m D O NOTE NO WATER
2J9142.2
1 w , .. ch r O ENCOUNTERED
2 — 5.7 VF es.2
r1^Uy t OAK DWELLING
Connected by Gutters & Leaderst Y 1 „ -" to"OAKG, 11" OAK_
.. r l 11s. ` 0 �c1t
Z I PUBLIC WATER
1 �w11,M�11 .X, „ ,wtop
KEY Cca
,
1�t ��
ti " "4 na pone � y 9"C1AK
RE �"� t c1 PROP. STOOP , "1 0 m
1 Nt„
� w. & STEPS
BAR 1J � n oC 10
1t 1a EX. WELL TO 1 �1 anl�� ' �€3 OAK (.7) �—
® = WELL �µ —w..... EXIST. CP TO BE /1BIWDONED 1 Jul, r 1" OAK �����p,1�"OA,K
= STAKE BE ABANDONED «p1,t t"OAK
Gpa
+ � „-.1t 1- OAK CMF I
'All 9"locust �' ,'p
= TEST HOLE µ 124 EL-33.5' a-31.2'
• = PIPE OMS +„ .75
= MONUMENTEL-33.9'
� 120"W I DWELLING
PUBLIC WATER "
_0_) = U77LITY POLE Ieco EW
N/O/F MEP
:LEVA770NS REFERENCED TO NA VD 88 HANSEN
DWELLING
XISTING CPS TO BE ABANDONED TO SCDHS SPECS. PUBLIC WATER
OME TREES MAY NEED TO BE REMOVED IF EXPANSION OF DWELLING IS NEEDED /N THE — �
JTi NUMBER OF TREES REMOVED SHOULD BE LIMITED TO THE MINIMUM EXTENT POSSIBLE. DWELLING
am familiar with the STANDARDS FOR APPROVAL AND CONS7RUC77ON OF SUBSURFACE I PUBLIC WA .J'5
SWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions
?t forth therein and on the permit to construct. The location of wells and cesspools shown . NO. 49618
9reon are from field observations and or from data obtained from others.
C NJC SURVEY! ', P.C.
JY ALTERATION OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209OF THE NEW (631) 765-5020 FAX (631) 765-1797
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