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ELIZABETH A. NEVILLE, MMC ,10�' QGy Town Hall,53095 Main Road
TOWN CLERKP.O.Box 1179
a
CO2 Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS I Fax(631)765-6145
MARRIAGE OFFICER ,y ®�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF'SOUTHOLD
D D
TO: Southold Town Building Department
AUG 1 6 2018
FROM: Sabrina Born, Southold Town Clerk's Office
BUILDING DEPT•
DATED: August 16, 2018 'TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4637 for a Cesspool/Septic Tank Construction
Permit submitted by:
Chris Neimeth.
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
Dated
o��S13FFO(/-e,
ELIZABETH A.NEVILLE ®Gy Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
C** Z Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS W � Fax(631) 765-6145
MARRIAGE OFFICER �.ti � oTelephone (631) 765-1800
RECORDS MANAGEMENT OFFICER ®1 �►a
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
437
Residential @ $10 or Non-Residential @$25 Application No.
11's Permit No.
ApplicantName V��
Applicant Mailing Address �I w' ��•
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alterat'on.
Owner of Property: 11 )
Owner Mailing Address: 3 Int � L. A 40
N`A /`J
Owner Property Address: 023° w4-r5 L l`"?U (riles ( 0,,,L
A /\J I I r T? I
Name and phone number of contact person C L�+3 M 6 o^ k
Tax Map No: Section Block 0-3 Lot i
Cross Street M01,'1V1
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY HEALTH DEPARTMENT APPROVAL
/r3 /l J
S ure of Applicant Date'
Received by:
SCDHS REF-u 18-0156
HOUSE ATE OR OTHER SEPTIC SYSEEM DETAIL 1. A MINIMUM OF 4 I
F.F. EL. 9.9' SUITALE COVER NOT M 5121LE CONCRETE BOTTOM'
STOPPER END PLUG LOCKING CASTING 2. AN 8 FEET IN DIAi
I.E. EL 7.9' FINISHED GRADE TO GRADE EL;49n REINFORCED 1 RIeC
- 3. AN APPROVED EI
( COVER ro c�RADE i' r>N F- E E CHIIINEY THICK SLAB TOP N
CLEAN OUT �ON� rMAX 4. DROP T'S MUST B
s'ufN. Lur �ATa+�rrlo ATTACHED.
6" FOR ��E 5. LIQUID DEPTH MUS
I.E. 1 8" 12" s' 10
INLET 6.0LE
ML f DU CLASS 1 " 18' S.5' I.E CENTER POOL
2400 PPE OR 1/8"per foot trt''
EGMAIENT PITCHED8" S° pitch mh 4"dla pipe 5.1' IN (6) POOL SYSTEM
1/,f PER FOOTE=FE T dm 2400 pipe or equal
DEPTH
FLOW LINE % 7'rr.In [6]LEACHING POOLS
1 (8/ x 2'DEEP)
4" MIN.
6'-0" DIAMETER EL 0.6' GROUND—WATER—
HIGHEST
ROUNDmWATER_HIGHEST EXPECTED GROUNDWATER
BACKFILL MATERIAL TO BE CLEAN SAND k GRAVEL
1,200 CALLON CYLINDRICAL SEPTIC TANK DETAIL •
NTS
-
MCDONALD GEO5GIENGE
09/13/2017
0..8.3' 0'
_ - DARK GROWN LOAM OL V
DROWN 51LTY 5AND 5M
a� L
DROWN FINE TO GOAK5E 5AND 15M 04k AO '
0..0.6' ---= 7.7
F
WATER IN DROWN FINEt
TO COARSE SAND (SW) ' k `
n ,
� `
G)
WATER ENCOUNTERED 7.7 DELOW 5URFACE404
0.
/ ,
��
s
Nk \\y
0
h ♦ r s�f r t,F a - 1 I
t t1t / 11
RAIR U T dill Q I l4 * 4
PROP05ED DWELLING • 2290+ 5QFT.
2290 X 1 X 0.17 • 390 CUFT.
390/42.2 • 9 VF
PROVIDE 3 1)W5 8� X 3'
OK EQUAL
DRY WELL CONNECT TO HOUSE + GARAGE
WITH GUTTERS + LEADERS
Jv
iROPOS S SYS `
4 6EDROOM HOU5E ,C `O '
1-PKEGA5T 1200 GALLON 8'+ 4' LIQUID DEPTH 5EPTIG TARN'.
6-LEACHING P001-5 8'f X 2' DEEP C �
WITH 3' 5AND COLLAR 2' MIN. ADOVE
GROUND WATER S
T,P�F IR
T�
E
EXI5TING HOU5E • 1697 5QFT,
1697/17143.9.9X9
SAC
O OS9G L o-1 OO, AOR SANITI
A � OICI Ol CX71 ,g M-litarymMus �C Y
HOU5E + ADDITION, DECK + PORCH 2635
2635/17143.15.4X CO O. _ A department requirement SubmIt
Aa as proof
PIPE
• MONUMENT ,
ELEVATIONS ARE REFERENCED TO NAVD 1988
FLOOD ZONES FROM FIRM 36103G0166H �
MAP EFFECTIVE DATE- 5EPTEM15EK 25, 2009 411C
I AM FAMILIAR WITH THE 5TANOAKD5 FOR APPROVAL AND CON57RUGTION
OF 5UD5URFAGE 5EWAGE DISPOSAL SYSTEMS FOR 51NGLE FAMILY
KE5IDENCE5 AND WILL ADIDE DY THE GONDITION5 5ET FORTH THEREIN
AND ON THE PERMIT TO CON5TRUGT.
THE LOCATION OF PUDLIG WATER, WELL5 AND GE55POOL5
ANY ALTERATION OK ADDITION TO TH15 SURVEY 15 A VIOLATION SHOWN HEREON ARE FROM FIELD OD5ERVATION5 AND OR
OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. FROM DATA OBTAINED FROM OTHER5.
EXCEPT A5 PER 5ECT ION 7209-5UDD I V 1510N 2. ALL
GERTIFIGATION5 HEREON ARE VALID FOR TH15 MAP AND GOPIE5 ADDITIONALLY TO COMPLY WITH 5AID LAW THE TERM "ALTERED DY" MU5T DE U5E1)
THEKEOF ONLY IF SAID MAP OK GOP1E5 DEAR THE IMPRE55ED ANY AND ALL 5URVEYOR5 UTILIZING A COPY OF ANOTHER5 5UKVEYOK5 MAP.TEKM5 5UG
SEAL OF THE 5UKVEYOK WH05E 516NATLRE APPEAR5 HEREON A5 "IN5PEGTED" AND "DROUGHT- TO- DATE" ARE NOT IN COMPLIANCE WITH THE LAW
1. A MINIMUM OF 4 INCHES APPROVED REINFORCED PRECAST SURVEY
CONCRETE BOTTOM AND 3 INCH WALLS AT BA Y
2. AN 8 FEET IN DIAMETER BY 5 FEET HIGH APPROVED
EL9n TO OF SO UTHOLD
REINFORCED PRECAST CONCTERE SOLID RING.
i 3. AN APPROVED REINFORCED PRECAST CONCRETE 6 INCH
5 S COUNTY, N. Y.
M,I THICK SLAB TOP IN LAWN AREAS.
4. DROP T'S MUST BE PINNED OR OTHERWISE FIRMLY
ope"TANCE 5. ATTACHED.
LIQUIDEPTH MUST BE 4 FEET. 1000-88-03-19
SCALE: 1'= 30'
r NOVEMBER 18, 1988
I.E _ CENTER POOL
s.r IN (6) POOL SYSTEM t ) SEP7EMBER 28, 2017
3 OCTOBER 26, 2017 (PROPOSED ADDI770N)
[6]LEA CHINO POOLS
a.
(6/ X s'DEEP) g�) MARCH 28, 2018 (SCDHS REVISIONS)
JUNE 25, 2018 (SCDHS REV1S/ONS)
KJ
® JUL Y 91 2018 (re visions)
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SUFFOLK COUNTY DEPARTMENT OF IAEA-.LTH SERVICES
PERMIT 1�O ARw rA rOiTRU ON SOF A
oN
REQUIRM
FOR SA-N,,NqTARY Tom$ DATE AUG
Y
AI�PROVE� 1
1
FOR MA:umum OF BEDROOMS
ARES THREE YEARS 'zj-MM DATE OF APPROVAL
i �
OF NO
/ /V,ICIA177
O
:R, WELLS AND CE55POOL5 N.Y.S. LIG. NO. 49618
OI35EKVATION5 AND OK
HEK5.
:-I SAID LAW THE TERM "ALTERED 15Y" MU5T 6E U5ED 6Y - � m `50 FAX (631) 765-179-7
ZIN& A COPY OF ANOTHER5 5UKVEYOK5 MAP.TEP.M5 5UCH P.O. 15OX 909
- TO- DATE" ARE NOT IN COMPLIANCE WITH THE LAW. AREA = 17,143 SO. FT. 1230 TRAVELER STREET 8�—ryo�
5OUTHOLD, N.Y. 11971