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ELIZABETH A. NEVILLE,MMC 0 Gy 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 AA ��. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ' ,� �`1 www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D ���a V
D
TO: Southold Town Building Department MAY 1 1 2016
FROM: Sabrina Born, Southold Town C'lerk's Office BUILDING DE"-
DATED: May 11, 2018 TORN OF SOUWHOLD
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4607 for a Cesspool/Septic Tank
Construction Permit submitted by:
Susan Vanderpool
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: ,
APPROVEy
DISAPPROVE
Comments:
Signature
Dry O</Z 5;9
Dated
,2
ELIZABETH A. NEVILLE �`�`� �� Town Hall, 53095 Main Roa.
TOWN CLERK q _ P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER o • `� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ���� y�O� Telephone(631)765-1800
FREEDOM OF INFOR.MA^1 TON OFFICER southoIdtown.northfork.tie(
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION c'
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 / or Non-Residential @$25 Application No.
CC Permit No.
Applicant Name
Applicant Mailing Address P� �� x "J� , Pe��n�� N-Y n 15S
Septic Tank. or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration: A
Owner of Property-
Owner
ro e Owner Mailing Address: f b
C cc-
Owner Property Address: �Z
,3
Name and phone number of contact personycc
Tax Map No: Section Block Lot 2�
Cross Street -1 ) L-G H
_ U
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
tl ,
i �
COVER TO GRADE
LOCKING C.I. COVER TO GRADE 8" TRAFFIC BEARING (TYP•)
(TYP•) CONCRETE SLAB
1' MIN.
2'MA24° Z
24 X.
8" TRAFFIC
CONCRETE SLAABRIN 1' MIN. 2'MAX. N O cn
18' cq
DROP
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ON O n'
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3'-G" - 3'-Gil v a N U O
8' 8'-0" -d 39
MIN. CL GW.. O. Z
MIN.
1,000 GAL SEPTIC TANK DETAIL n GROUNDWATER
NOTE: PITCH OF PIPE BETWEEN BUILDING AND PROPOSED
SEPTIC TANK IS 1/4' / FT. Mitt. Z
USE DUMMY RINGS TO GRADE WH REQUIRED LEECHING POOL DETAIL P4 IZZI
NOTE: PITCH OF PIPE BETWEEN SEPTIC TANK 0 Q
AND CESSPOOL IS 1/8° / FT MIN. O C)
/ (34) DENOTES FILED 1
+ NUMBERS
\ \ SURVEY NOTES:
90p / 1.UNAUIIORIZED ALTERATION ORADDI ION
IM
YORKSTAT EDUCATION uw CIES OF
L9`Oji MAP NOT BEARING TSURVEYORS Dat:O c
1 r OIE
CIO,
COPY.CERTITIFIICCATIONS HE GATED HETO REwJ 3
, ONLY TO TNM PEA80WPERSONS FOR WHOM
G IS PREPARED,AND ON Hl&NOU HEIR BEHAL
` COMPANY,GOVERNMENTAL AGENCY,AND LU
INSTITUTION LISTED HEREON.CEITIF=TIOI
TRANSFERABLE TO ASL INSTfftfl10N
I -_—I_—---`—---__-- — ----- SUBSEGUENTOwNERS.- _
2.THIS SURVEY E SUBJECT TdANY EAsEmm
BORING 2?� AND OTHER PERTINENT FACTS WHICH AN A13
I TRLE MIGHT DISCLOSE
I
3.OFFSETS SHOWN HEREON ARE FOR A SPE,
f AND SHOULD NOT 13E USED AS A BASIS FOR
CONSTRUCTION OF FENCES OR OTHER STRUT
` 4.SUBSURFACE STRUCTURES AND/OR UTBlT
NOT SHOWN.
S.HEDGE AND FENCE OFFSETS SHOWN ARE1
?6 ` CENTERLINE UNLESS OTHERWISE MOM
S.ELEVATIONSSHOWNREFERTONAVDpa
` �� Q T^� 1 CERTIFY THAT THIS MAP REPRESENTS ANA
1S NG �'�� `.S`\ SF`F� O4F ��Fc�o TRUEACCOUNFOFASURVEY,PERFORMED1
\ UNDER MY SUPERVISION ON 3H012017,OF TW
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J O�� THE RECORD DESCRIPTION OF TIE SUBJECT
FORKS
AMATHEMATICALLY
GURE
ED FI
WAS ED IN ACCORDANCE TUE
\� 4,\L Rlt.SANITA ' c � CODE OF PRACTICE FOR LAND SURVEYORS A
_ THE NEW YORK STATE ASSOCIATION OF PRO
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/ SHE PLAN
/ SUFFOLKCOUNTYDlS'T, 1(
SEC. 74 BLK 02 LO'
DATE: 3-10-17 SCALE: 1
TAX LOT 22.1 RO CTNUMBER: TEA17
AREA= 417,896.91 SO FT _:.•,
9.59 ACRES
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BROWN SLTY SAND SM X
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136'BElOW'SURFACE (34)
TEST BORING DATA SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Gam`/p��"s
BORMG DCN
A1E 03/11/17
M000NALD GEOSCIENCEY PERMIT FOR APPROVAL. OF CONSTRUCTION FOR A
SINGLE FAMILY RCSIDENCE ONLY
DATE I H.S. fEC No
F
PROPOSED SANITARY SYSTEM APPROVER I �G��p�2
PROPOSED 1000 GAL SEPTIC TANK
(1)8'x 12'DEEP LEACHING POOL PROPOSED FOR MAXIMUM OF BEDROOMS �� 6
50%EXPANSION LEACHING POOL EXPIRES THREE YEARS FROM DATE OF APPROVAL
300
IL 27.50
INV. COVER
25.5 EL 27.0 COVER
INV. EL,2G 50
25.25 24,75
1 EL.21.0
BLDG 12'
INV. MIN.5.0'
30'40'
PROPOSED - �4 3 --
/ ` 1,000 GALLON/'r PROPOSED
SEPTIC TANK) LEACHING POOL /
12'EFFECTIVE
DEPTH