HomeMy WebLinkAboutAmes Town Hall,53095 Main Road
ELIZABETH A. NEVILLE,MMC P � P.O.Box 1179
TOWN CLERK �� ¢
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �,� Fax(631)765-6145
MARRIAGE OFFICER � �, F Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER p �� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: December 4, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4683 for a Cesspool/Septic Tank Construction
Permit submitted by:
Arnold R. Golz for David & Maria Anes.
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 Coupty Health Department
.........
Signature
.. .......
Dated
ELIZABETH A. NEVILLE Town Hall, 53096 Main Roo,
TOWN CLERK @' P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r Southold,o
ouo New York 11971
MARRIAGE OFFICER Fax (631) 765-6145 .
RECORDS MANAGEMENT OFFICER vo/ Telephone(691)765-1$00
` ����
FREEDOM OF iivFORMP.^L!ON 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 @$1t4_ or Non-Residential @$25 Application No i�
I'erla�it No.JkLO
Applicant Name t ° �
Applicant Mailing Address . ( _...
�
Septic Tank. °" or Cesspool
Brief D(;oription of Proposed Cons(Tuction or Alteration
Location of Proposed Construction/Alteration:
r
Owner of Property: ° IAMACS
Owner MailingAddress:
Owner Property Address: \5`I
p rty coo N\
Name and phone number of contact person
Tax Map No: Section Bloc
_. k Lot - �
"Yq
Cross Street,.�._ OVIJ�'���1
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAI,
�atu �ofApplica 0"'
Date
Received by:
CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON OR ENTITY FOR WHOM THE DOCUMENT IS PREPARED. CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEOUENT OWNERS.COPIES OF THIS DOCUMENT NOT BEARING THE PROFESSIONAL
ENGINEER'S INKED OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. UNAUTHORIZED ALTERATION OR ADDITION TO THIS DOCUMENT IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.
Ar
HEALTH DEPARTMENT USE
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OR LISM A%
LA. E P EA CONDITIONEXPIRESTHREEA ATE F APPROVAL
DING PLAN AND/OR PLOT PLAN
LOT COVERAGE CALCULATIONS
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EXIST. BUILDINGS, PORCHES DRIVEWA
Y WALKS PATIOS.•
11,1135 S.F/80,0611 S.F = 0.14q (14A%) m
ZAM Now OR PURR aY OF _ i/ire i� �, L %F PROP. BUILDING5, PORCHE5, DRIVEWAY, WALKS, PATIOS: A Q �
TOWN OF 9011772= �J1�7 w g 16 'i J
C 5 �� 5.F/80,06115.F = O.M (n.5�) -C 6
NOTE `1�°
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Suffolk Count Department of He zee crstin �&
Y F 4 � � � •s " a Cf?tYtfC� ntri1��;� rui. ta rims .R.�: ��Submit . ((1
o
completed formM— L) proof NOTES Q Q Q �
SEE INSET 'A' P.
AJ AREA = 80,06'1 50. FT., OR 1.84 ACRES p
11vix- U)
.} \ VERTICAL DATUM = NAVD 1988 Q
I``t YNIh TLS- $ BA5E MAP INFORMATION FROM SURVEY BY VHB,LA5T v v A
lJ 2 w DATED 10/31/I7. � ) � S —
V Q
EC�f (�3 � � ALL PROPERTIES WITHIN 150' ARE CONNECTED TO PUBLIClu
� WATER.
ALL EXISTING WELL5 ARE TO BE ABANDONED,OR UTILIZED a�
FOR IRRIGATION PURPOSES ONLY.
N THERE ARE NO NEIGHBORING WELLS WITHIN 150' OF THE
SUBJECT PROPERTY.
op GROUNDWATER WAS NOT ENCOUNTERED DURING TEST HOLE,
� v a Ory - $ r AND 15 EXPECTED TO BE AT APPROXIMATE ELEVATION 2,
o _ ` - BASED ON 5UFFOLK6ROUNDHATER MONITORING WELL
INFORMATION.o
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BY DAYM 1I1210OIDY 1P1—IP
Suffolk County D--3pf 0f Y1
Cag 852-5700, 48 HOWS In Advance
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To Sdiedule
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MARRATOOKA LAKE01 m E
SEE I NSET 'B' �* -,"
1 r N �T fur fI", yrs m Is o
80 O 40 80 160 240
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