HomeMy WebLinkAboutPolenas ELIZABETH A.NEVILLE, MMCF" p 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 u 4 Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: December 12, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4686 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert Wilson for So hir Polen s
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:
Signature
Dated
✓' Town Hall, 53095 Main Road
ELIZABETH A.NEVILLE
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS00—
Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ' Telephone (631) 765-1800
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
Residential @ $11) or Non-Residential @ $25 Application No. W@ So
Permit No.
Applicant Name F O
Applicant Mailing Address
Septic Tank-7
or Cesspool_
Brief Description Proposed ons
truction or Alteration
�;Ar. fle- -
---S .
Location of Proposed Construction/Alteration:
Owner of Pro ert - �. _.
Y'.
µ
Property:—
Owner MailingAddress: � ��� � �......_ �.......
Owner Property Address i, — � .. �Llal ._ -.....
Name andhone
p number of contact person
Tax Map No:lCGae/ Section Block� .._..
Oro Lot 4C,1 ....�
Cross Street �� __........
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Sign cif A
fi't bat6
Received by: _ _._
SHEET I OF 2
—777�
NOTE CHANGE(S)
I 'F PRESS Vfrc .,._WM1M µ w-
.. NF CK SURVEY FOR
RG
100 By Suffolk County Department of Health Seee S O P H R POLE AS
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I PIPFa CREEK d " p�� .• �Dt 11 0 X74 ���
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Det 4
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PARADISE ISLES
FILE No. 11881 FILED JANUARY 8, 2003
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v TOWN OF SOUTHOLD
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SUFFOLK COUNTY, NEW YORK
J,
S.C. TAX No. 1000-53-06-46.10
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SCALE 1' =100'
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KEY MAP . AREA = 330,2 4C. ff.
"� ,�,Y �. �„ 330,253 sq.
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SCALE 1 "=1 ,000'—1 ,000
J°
ISLAr,p aaEW QArr � ,;�.� r, ;.-.+, ..�� ...�.f.- w" a; :. " �' ",. �.� �;�`„� ",� ,r,:�,,. , � w.,"• M �` "-°� '�� "�, CERTIFIED TO;.
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ITY .H. 1 w„w
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PERMIT F`O! : �x��gfA; OF Ot�STRU0, 0+ SERVICES � ` � � r r �{,� r, •” d �ZEd `�'� C�s��
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APPROVED
+ .1. 9� P 1�' 1 w i I` Sy
�OR 1 $ �HE ”
FOR MAXIMUM OF
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EXPIRES g
EE YEARS FROM AT
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TEST HOLE
NOTES:
1. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM y " 01J" ' 1 ��
EXISTING ELEVATIONS ARE SHOWN THUS: +o.o
2. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD Wq A :oPKmm
r,v a .y 4
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
�C„0 PREPARED IY ACC( 41
F
'.nrt aMT tl1+1E�, �°
y t kD„ ..-''y
by THESTANDARDSUOR DNI rlu .v,�
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TITLE r',y'u�3.
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7
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rEsr MOLE DUG
TEST PTE'S T WN"'O NI)A.........I
E—ASSHOWN"' ON SUBDIVISION MAP —~"' � �� '
___.,. ON SEPTEMBER 23, 1997 �{ ° '"
EL
.,,
DARK BROWN SILTY LOAM OL "" ..'^ �...",...-^ "' D"�t mar_ fir&r� 5(147
BROWN LOAMYall_t MI_ ,y
�IT x. EDUCATION LAW. f111110EN Lathan aft Corwin III
ev f,,'"; BROWN 51L'1'Y SAND wrrH 10% GRAVEL SM , ?. ",,,.""� n UNAU[HOdYT'ER",A&TFF°,A'IAt}i1 UIT A
,. "''T",,.T''�"""" 4° � T,1 THIS L"T+FY 1 A 1"9":L1lkkliN OF
✓'' 1`�"''" ,ECT10V11 7701P Or IHl'OEW YORK STArE
HCHE 1 EXPECTED GROUND WATZR � Land Surveyor
TEST VIDA. U C NO �`' BROWN MEDIUM TO COARSE SAND WITH 10% GRAVEL SP .„.,.-'''�" �. �` LOT ❑3 COPIES OF THISURV SURVEY MAP NOT BEARING
A 9 a I , 1 y 4'@'"'4 THE SSE SURVEYOR'S INKED SEAL OR
I��� 9P ASM
17 8FI WATq I TELry �6T 7.0' r l �L tyk'„'� 2. � 5 TO BE SEAL
BE CONSIDERED ,,,,,,,,,,,,,,,,_... li
VACAI�T
�.
TEST H01 E. sy, ,” 1� y, 4 1� CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr L.S.
GROUND WATER EL :-41 6�, C" } mtt 5 ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
��', y 1 IS PREPARED, AND ON HIS BEHALF TO THE
{r;Argil I TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys — Subdivisions — Site Plans — Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
p. *' TO THE ASSIGNEES OF THE LENDING INSTI— PHONE (631)727-2090 FOR (631)727-1727
•- WATER IN BROWN MEDII.IM TO COARSE \ TUITION. CERTIFICATIONS ARE NOT TRANSFERABLE.
OFFICES LOCATED AT MAILINC ADDRESS
SAND WITH 10% GRAVEL. SP ("// Y"E.^" THE EXISTENCE OF RIGHT OF WAYS
LOT 2❑ AND/OR EASEMENTS OF RECORD, IF 9566 Main Road P.d Box 16
.,....... " 75° I 9 DRIVE AY ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jomesport, New York 11947
VACANT I I a I I EASENEhTT
m,,,,—------ .,