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Home My WebLink About7646-z Og�EFQi�c Town of Southold o�y 11/28/2021 a P.O.Box 1179 0 o _ 53095 Main Rd ��j0! gay Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42562 Date: 11/28/2021 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 345 Stratmors Road,East Marion SCTM#: 473889 Sec/Block/Lot: 21.4-14 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/2/1974 pursuant to which Building Permit No. 7646 dated 12/2/1974 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: single family dwelling with unfinished basement attached garage covered front porch and rear deck as applied for The certificate is issued to Skopelitis,Nikitas&Eleftheria of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 4SO-163 8/27/1976 ELECTRICAL CERTIFICATE NO. N298153 8/12/1976 PLUMBERS CERTIFICATION DATED t Au ori d S' nature I~OB~ NO. ~ TOWN O~ $OOTHOLD BUILDING DEPARTM~T ~N CLERK'S ~ ~U~LD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES'UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7646 Z Permission is hereby granted to: ~.a~e~..~a.~.]4e~...A/.~..~q~&-~ae.... ~kopeli~ t · ~l,~ ....... ~..~I~ ............................................ .............. A~e~t~ ................................................. to R~Ll~l..,n~...o~.e...,",a~4,~,,...d.,,~.ti.i.n,D ...................................................................................... ............. (...tstes~z--i~i~..t~..mm~) .................................................................................. at premises located at .~%~o~e-.~oe6..-..~.-.Ho~l~/..~...Ro~d ......................................... .............................................. ~&s~.Jls.~iaa ...... ~,~.,. ...................................................................... pursuant to application dated .................. ~ ......... !)~.~ ......... ~ ........ , 19~...., and approved bY the Building Inspector. Fee ~6.6~ ............ Form No.6 �- t r f "3 1 `, r'f - ro TOWN OF SOUTHOLD � � 3 BUILDING DEPARTMENT I_")r� ' 4°" L tZ V �+ ' 1 ' TOWN BALL 765-1802 OCT 1 6 2020 APPLICATION FOR CERTIFICATE OF OCCUPANCY F 1} C: �j ��f� ��1'�'B'.st13'IJYi.d This application must be filled in by typewriter or ink and submitted to the Building DepartmeWf-*it��the'-foli�iwmg' A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00` Date. V) 1\3IZQZ0 New Construction: Old or Pre-existing Building: (check one) Location of Property: S41� 15_�CC1Vmat5 �1 &GSa' I «_14/1orn House No. Street Hamlet Owner or Owners of Property: I�i kqS a C`2� kg S\C_q V�rs Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Ta'�b (,A*licanl Signature �i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEMPORARY Certificate Of Occupancy August No. 7�?2. . . . . . Date . . . . = Xxx . . . 27 1976 . . . THIS CERTIFIES that the building located at .Stratntore Road Street Map No.,tratL7=es b1-btek No. . . . . . . . . . .Lot No. . . 7. . . 'mast 1,1 rion K .Y conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . J e.c. . . .21 . . ., 19.7. . pursuant to which Building Permit No. 7646.z. dated L r2.c ., 19. . . ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P-rivate one f anii l r dire lling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . I ik t a s. _ .Scope 1 i t s . . . . Uim e r (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .�'. . . 27 . 9 . . bys Villa UNDERWRITERS CERTIFICATE No. . .N2981.53. . . . .Aug . .12. . .197? . . . . . . . . . . . . . HOUSE NUMBER . . . . .3'.�.? . . . . . Street . . . Otratrzores Road . . . . . . . . . . Building Inspector I,1- - +I _ .0 ,I,t"_,11!11!,7_i•j1 21MUNE 9A 1"-II—:11-11--'I—•!i==11t=I1 " --ril "--:1t, _,! - - ' `= ''I--�!--hl---'l' gw j- I _ { ,lI . } lI 1i =1-�: i-;l� =1i!vO RK-�B OARD T-=:O Fi=•FIR =#�lj'n1 D E;�INRIfi�RS t I 1�= _ti;_!tl -!It=-i --I, 1::-:I, ,!,-1==- �! 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I1' !1! =1f1=-!11--lil 111- I#{ 1 II I-tJt II 'lli 'i'I."11•" , -- GENERAL M +1+. ASItditi 3 '{l=-�j.Y.11!-�# +Iii=i#I;�!EI !(! _IL' {11 ,11 til il,'I Ill Itt! 111t i!I-!11.!'!(l I!J:�IIf! t - - 1-'!!1 Ili III==ft{ -I r' .i;1 -III-;+, It I( I, lit',?!l. ttf =1!, _III_==111=#il illy=(I1 _!1=:Ici=_fl!=III •H{ .l{!,�!!{; (I! -11{- til-11 Ih Itl , Ilt I!I G ul 1! a'{ -:►II III;III=�IL f=ill 1!t;�i�ll!tlllliili !I t1 i I,tl !!1{fl!'!!�h!' llijii{i! I Il{;ii,!ii ;,llii l Itli��#{I1-llPer '"f t 4 This certificate'mListriiot,�bq;laltered'in any manner'; return fo the office of the Board if incorrect.11nspectors??may be identified' by eir credentials, l ti 1 "' OF SOOIyo TOWN OF SOUTHOLD BUILDING DEPT. • 765-1802 INSPECTION [ _ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING/STRAPPING [ I FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O S REMARKS: y 64p*- w .� �. vI �h I vvli� S� DATE �� 3 INSPECTOR �Gt d2 e c7 =*U ` -e I �✓ 7 `,� YroBM 1Vo. Y r w�ol�c�„ �/ � (1J j �� G TOWN OF SOUTHOLD ,z/2Y ff�� lam' Z / BUILDING DEPARTMENT ( /7 � 6 " TOWN CLERK'S OFFICE /11 1PUT SOUTHOLD, N. Y. ` t�� Examined ...................�!.... ., 19 '�/�' �� APPIic tion No. .. .:.Z...(?. Approved ..........................................f i `� 7jr +P APP 19.��. Permit No. ... .��.............. Disapproved a/c ... . ..... .... ...... ....... ........ .......... .. az= �PAIA �- Y/3/7697 73 etc `� ,e _ 14)7 �— E / 9176 ;QW Gcd � fav-�yy g17G �.acv-\�"4, E ( 9 �t bUv,-,._, (Building' Inspector) /-7& C?/f/T-C OL (I,,dru( v�w�— �T�c o Z7-2 o �. �, /I co V� APPLICATION FOR BUILDING PERYAIT C�-�da Date ... . . .. .................................. .............................. 19.7. . i INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building � Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. 0 d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the o Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable-Laws, Ordinances or�A� Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to G admit authorized inspectors on premises and in buildings for necessary inspections. 7l � f (Signcitur of applican , or name, if a corporation) C��....: �4�.1.... .V, h&U ... .............. (Address of applicant) State whether applicant i owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .�..k�.,��'.�. .....5.... Name of owner of premises �o.��.l. �.(.�.-/.�......................................... ........................................ • . .................................... If applicant is a corporate, signature of duly authorized off icer. ................. ... ................. .. ........ (Name and title.of corporate officer) Builder's License � \ Plumber's License No. : '?. ............'.....................�� .............. Electrician's License ;No.. .........:.................................. jl a Other Trade's License 'o:I: ............................................ 1. Location of land on which proposed work will be done. Map No.: ......0?.�r�i ��. � / r r;�Lot No.7..................... Streetand Number ....................................................................................................................... .......... Municipality 2. State"existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......UACA-141........ ....................................................................................... b. Intended use and occupancy ........ Erj.!.!)ra.t: ................................................................................. 1,1 W 3. Nature of work (check which applicable): New Building, i ...... Addition Alteration Repair .................. Removal .................. Demolition.................... Other Work ........................... G 0 (Description) 4. Estimated Cost ..a.a:y.9.6.�..........................................Fee� .:..................................................................................... (to be paid on filing this application) 5. If.dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars ....ONE............................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ .....a0......... Rear 8. Dimensions of entire new construction: Front ,........••..••.. •••.k.................... Depth .3.7!............. Height .................... Number of Stories ........................................i............................................................................ a + 9. Size of lot: Front A�.r�.��................................................. Rear ..T!��................................. Depth �.-�3��...................... 10. Date of Purchase �.1...7—.............................................Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning low, ordinance or regulation: .....P6 ............................................. 13. Will lot be regraded ... . ' . ............... Will excess fill be removed from premises: ( ) Yes (() No 14. Name of,Owner of premises ...........•• Address �1. f Rix:-MAP—.// hone No. ...................... Name of Architect .................................................. ........... Address ................................ .Phone No. ...................... Name, of =Contractor ............................................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. d, !`L OI�V R,�I 0111 4 3.� N IL -- - a — 6 STATE OF NE Y t S S COUNTY OF ...... . .....................j .��.1 ?`} ......... ?... ............?.......................................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the ...... .OLVA&17................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed, the said work and to make and file this application; that all statements contained 'in this application are true to the best of his knowledge and belief; and thaT the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .} .. ay off,/ ./ /... 197` Notary Public, .._��(r (.Y. '.. . Ca'rlrtfC;ounty 1..�• ................................................ JUDITH T. BOKEN n re of applicant) Notary Public, State of New York �''p No 52-0344963 Suffolk Countw/ c (' ;mission Expires March 30, 19 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, g. Y. £xomin~l ................................... , l~ Disapproved a/c ....................................................... .. ....... / ................ ......... i ......... i ;i ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oK in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of rot and of buildings on premises, re at onsh p to adjoining premises or public streets oF areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purs,',ont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnature of app can~, or name, if a corporahon) ............... , (Address of applicant) applicant is~owne~ lessee, agent, architect, engineer, general contractor~ electrician, plumber or builder. State whether v ................................................................................. Name of owner of premises ...~.I.K ~.T~.. ~. ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No ~'.~.~.. TtI[?K~ .~sT.~.~/~~--.- ~7 .............. ,...~ ..... ~:) Lor ~1o./ .................. Street and Number · ' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~......~.~.~...~... ... . . b. Intended use and occuppncy ............ ~ .................... ~ .............................. 3. Nature of work (check which applicable): New Building....t~-,..~...~/ ...... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... Cost~ D.. O. 00 ~ ....... ~::~G67'' ~ (D,cription) 4. ~timated ................................................. ...Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flor ............................ If garage, number of ~rs ....~ ............................................................................................................................... 6. if business, commercial or mixed occupancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ ~ ,Number of Stories ...... v....~ ................... 8. Dimensions of entire new construction: Front ....~ .......................... Rear .................... Depth .~..'~.~. .............. Height ....................,,.~-N~mber of Stor~s ........ ............................... , ....................................................... ; ..................... 9. Size of lot: Front .~.~.~" ............................................... Rear ..~.~.. .................................. Depth~.O.~ ....................... 10. Date of Purchase /~ Name of Former ~ner - 1 1. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ .............................................. 13. Will lot be regraded ...~.~. ............... Will excess fil ~ remov~ fr~ p~ises: ( ) Yes ~) No f e f r i ~ ~D ~o~1~ . A~m~ ~'~.~.~ '~" 14. Nameo ~n ro peruses ............................................ ~J ..... ~o .......... Name of Architect .............................................................. A~re~ ................................ Ph~e No ....................... Name of Contractor ............................................................ A~ress ................................ Ph~e No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or ~roposed, and indicate all set~k dimensions from pro~ lines. Give street and bilk number or description according to d~, and show ~reet names and indicate whether interior or corner lot. L ~q STATE OF NEW,/YQ~// ~ S S COUNTY ....... f ' · .................................................................. be ng duly sworn, deposes and says that he is the applicom (Nome of individual signing contract~ above named. He is the ........ ~.~..~.[l'~.L~. .................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to ?~fore me this .-~ -- - r .~ ...... ...... of c Nora, ...................................... [ ~ ) (S~ature of applicant) JUDITH T. BOKEN t ~- ~_~ ~ 1 No, 52-0344963 Suffolk Coun~ .... I ~: Commission Expires March 30, 19~ ~ 5974�� I.Z,0A D41 `o va per :" v o 04 45` yry �• A. IT F, Co N 6TY HEALTH DEPARTMENT � '2rT ' H. D. REF. � � /- ,oi�' ;✓Q'fc t"hiB ;fie i e 'di' pos31' and outer supplypa ' f.*% `3'ta_bi'i`i'tia -f o this location have,been .14 hjieo�e'd his epaa twent and '�ouxtC1 a� 1 69 � ,�tfe =esti to lir. �s (hh 'e'f of Obn6ral E� Au5•. ZO, /976•'JNA UTHORIZED ALTERATION O_RrADDLIION- �`'• X _ y , 1 9fi0'THIS;SURVEY IS A;VIOLATION OF I "'Y7aaaYie�� V�t� i SECTION'7209 OF THE NEW YORK STATE `EDUCATION LAW Y s V r .COPIES OF THIS SURVEY-MAP NOT BEARING p "+ E-+— �e,a/ 9.7.�•� THE LAND SURVEYOR'S i^:KLD SEAL OR _ '? .�Q,��,`✓ ,YY'YY o• ', EMBOSSED,SIAL SHALL NOT BE CONSIDERED - .• s'TO BE A VALID fF,Ue COPY ♦ Jam, :5�t'?��r `'f GUARANTEES INDICATED HCR;OM SHALL RUN Fy°C!I?j4 t„ ONLY TO THE FE'1SON FOR",VVOM THE SURVEY IS PRE PARED;'AND ON HIS,6CHALF TO THE Gr0ekfAar W. Y. - TITLE COMPANY,•GOVC,gPLLNTAL AGENCY-AND 1 - - �Jp f L f t7ytt7;f�L'r�d Yd s'!'. f0, t"all `Q LENDING INSTITUTION LISTED NLRCON, AND I ? - TO THE ASSIGNEES OF THE LENDING INSTI-; _ a _ v C',•r•�J 3,��QK•�. �a,�, ys.��ti �d� P/r _ rN` !cS"'u B1 _TUTiON. GUARANTL-CS ARE NOT TRANSFERABLE q - 1C� TO'ADDITIONAL INSTITUTIONS OR SUBSEQUENT S 4 11.CQ. GI.�.eld J Q f"�L%C� �'�S tC .!' 52. .'3,T Kw.'�' - OWNERS: . l...y..,..• es.ssv=.w.�..rw......, �cr=y..� - �.._.....a......�. ` .:...,�.-+.a..�...�,. ......,�.-..,....._...-- ., ..,,,."_.....,, �......�,.s .. e...- ^-- , , ,5 A rivi o g s r-?- 0 A L) MA�0 y N, JuRvEyng F,6'ro 4, A7* Htl-'-rle I't 7G UNAUTHORIZED ALTERATION OR ADDITION Z2j TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE )20 EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING S.77 3 Ct I THE LAND SURVEYOR'S INI,,D SEAL OR EMBOSSED SEAL SHALL NZ,7 C.' CONSIDERED 0 To BE A VALID MU= COPY. GUARANTEES INDICATED HEREON SHALL RUN Land, saps*eyqrs ONLY TO TI-IE K-310,11 FOR Wf:OM THE SURVEY! IS PREPARED, Ai\D 0; H:s a',,;8,Lr ro mE AA0 TITLE COMPANY, GOVE,16\,, t-7� .,'!,A- A—C, AFDLENDING INST,TUTJON LISTED H-RU,, A.,D TO THE ASSIGNEES OF T;jE LE,,�Di;�G 1;,�ISTI- TUTiON GUARANTEES ARCNL-A I.A--'KTABLE W,7,6 w. 3? .7 TO ADDITIONAL iiNSfITUII0NS OR Sub-QUi,NT OWNERS. )17'0 Nikitas Skopelitis October 17, 2017 345 Stratmors Rd. East Marion, NY 11939 In order for the town to issue a Certificate of Occupancy for the house located at 345 Stratmors Rd., East Marion, NY,the following must be completed: • Complete the first four lines and sign the enclosed certificate of occupancy application form then return it to our office with a payment of$50.00. • Call the Building Department @ 1-(631)765-1802 to set up a final building Inspection. Once you have completed the above we can issue the Certificate of Occupancy. Sincerely, Southold Town Building Department. Hello, Enclosed please find our application for Certificate of Occupancy and a check for$92.50. 1 spoke to Sue over the phone and she mentioned that there is an open electrical permit on the property as well. The check is for the$50 application fee and$42.50 for the open electrical permit. The property is located at 345 Stratmores Road in East Marion. The house is currently owned by my inlaws,Nikitas and Elefteria Skopelitis. It is my understanding that the are in the process of transferring the house to their daughter(my wife) Rani Skopelitis. My apologies in advance if I've missed anything, I haven't gone through this process before. I'm trying to help my inlaws as their English is not the greatest. Please feel free to contact me for any additional information,my cell phone number is 732-259-8902. Thank you so very much for your time and assistance, Tom Xenofanes 0 C, 6 2020 „r•e K/x^ may_'i s.,,c) IT � � C-0 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance. to -.nearest intersection of main thoroughfare, also Hamlet/Village and Township. 3-Enter- name of Public Water Supply District, together with the distance to their main. 4-Enter Length and Width of Lot under appropriate heading; also enter these dimensions on center- plot"plan shown on the face of this application. 5-Name of- subdivision. 6-Section- number. 7-Lot number. , 8-Priv_.ate :well „-- Enter "No” if public water supply is available. Enter "Yes" otherwise. 9-Public-water-'- Enter "Yes" if public water supply is available. Enter "No" otherwise. PROPOSED SYSTEMS-: Answer to Item Number 10, consult the Suffolk County Department of Health Services ' Standards for Sewage and Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I - Residential Subsurface Disposal Systems Covering Cesspools. 'WELL LOCATION: To locate the well and sewage disposal systems, on applicant's lot, the following standards must be observed: i Well-100 feet minimum distance from the nearest cesspools. Well-25 feet distance from rear and rear sides of property lines when possible. Well-10 feet distance from front, and front sides of property lines when possible. Well-50 feet minimum below grade for well point. Well-40 feet minimum into ground water for well point. Well-4 feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATION: Upon _determination of the Sewage and Waste Disposal "type of systems" required, the fon owing standards must be observed for the location of same: 1-Cesspool-5 feet minimum distance from lot lines to exterior of cesspool . 2-Cesspools exterior must be 100 feet minimum distance from nearest well . 3-Septic tank exterior must be 75 feet from nearest well . 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be 10 feet from house foundation. 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams , lakes, and bays, etc. 7-Cesspools must ,be 20 feet minimum distance from large trees. 8-Cesspool °exterior to cesspool exterior must be at least 8 feet. 9-Cesspool cover top to grade must be held to minimum of 1 foot to maximum of 2 feet. 10-Bottom of cesspool to ground water must be held to minimum of 2 feet. -3UFFO�K COUNTY DEPARTMENT OF HEALTH SERVICES Health Services '� Reference Number 6-3 APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 . Applicant N ,K{A-(-, SK n PC-Lr r1 s Phone 5. Subdi v j'JL,thj es k Address 6. Section 2. PrZ rty Location S STZ ;- ;�ZS i� p ' tx/ n r 7. Lot Number 7 ck q pr K IV L:�Jj M Are I n rf 8. Private Well 1 Village Township 9. Public Water 3. Public Water Company Name - Distance to main 4. Lot size: Width ` 0 feet Length �,n® feet 10. Sewage Disposal System: (For Health Services Dept. Use) A. 0 gallon septic tank: Precast ve' Equivalent Block B. Leaching pools: - Number of pools rte' Precast 10 Block Special 11 . If private well , fill in the foi- lowing� blanks: A. Tank capacity �gallons B. Pump- G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in wel l_ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date �3 '�`� Signed i�111khA9411:�t�VV FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE � (�7�Y SIGNED S-15 Rev. 4/l/73 �nr-nn rn,r^n� If f��l�u��litcll�u1111 �llu�'��li uuil� 11•` ��L'�''� -SUFFOt K COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number —Sd-r63 APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 . Applicant KJ w, ..."%ko PFIAT-i 5, Phone 5. Subdiv.�' k_,LT�y, 4r- Address I!- -� �-j ASTO l �1 v 6. Section 2. Prorperty Location r :�T --r- ;i�� j W r" Lot Number (�0 r f,- Or 4 i\ Y hag,0 d bi1. 8. Private Well Village Towns i p Sg jj-r{ .71 n ; _ _ 9. Publ i c Water 3. Public Water Company Name ance to main 4. Lot size: Width 1 o feet LengthT r�o feet 10. Sewage Disposal System: (For Health Services Dept. Use A. 06 . 0 gallon septic tank: Precast v," Equivalent Block B. Leaching pools: - Number of pools • { Precast 10 Block Special 11 . If private well , fill in the fol- lowing blanks: (� A. Tank capacity W-rf- gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in welly"� The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' 'current standards thereto®" This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date . 1 Signed FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Basedonthe information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ( SIGNED S-15 Rev. 4/1/73 I I ' �;�-111}-•• '--- ,�I>._'-l.�I�.�•�-,-;_;' . ' •f-' 1��+:_ � - ,. �i k+-- � •- �,- {I:.;_ ; .f i. '. I -- , t--- •.fit_ :(.i.- �3-�/_ V Gi`.- - --- � ! i,I IIL . '�-.�.�,,,,.,...,�N•r�! e.,,�..,...'-`—e m=+ o mT..Y,_,•a..�,::...,'"1:......,e"-- - -- .:.,'�• .-.+-v.[�-+�-:-..,).pe,.nnq�;✓;xr^a..reess{n_ _ _ �a�" `J�`r�"1��'"— `, � '` .-..:- - j ' I "OLS AS i i I J s.p G ?TOTED DATE, d. y, � N 0 gy tyr• ' IIFY BUILDINGDEPPARTMENT A,+ , ,5.7060 9AM TO IPM FOW RLQUIR- - }--___�.__ II1610CTIONS: -^'I I,h,Kb bACKFILLING'FCUNDA. A" ` " �• i •V jAr�\v/Q* it h "START FRAVJNG •---r'--yam— _.. _._ .-.- _ _. 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I - - I �II a'7.iO4''T•�Y AS NOTED i DATE; ' •• 1 � i � POIli1✓✓�ILp�•IyG p-ppART"-,MEM AI'1 .5.IFY }-----r---�_.._____ _-_._--u_� -- _�_.—._ -._ _..•_- _ IT TO 41M FOIL REQUIR. i1vSPECTIONS• I•�RE BACKFILLINGFCUNDA• - I _ II h LK START FRANJNG r •'d�F.Jk.,COVERING PIP,LINC !.FINAL WHEN JOB COMPLEFED / Ws o1� E »OCL mm MUCH OB _ 4EW -I , � Gi21t -� ...y-._...--_•'_•_ ' y yam._._..... ..-_._ _-...... ..._-__-_...- , .'Fi -7m 4v ' �j -- ^��, — '.�.+.,.:.'F_�.��. �— G-.'L�- -'I- 1:•�ci..IL�L_Ji..-' �{ --- I � Y`�-��- ,ca•_� *�f w C'� ' •• - ,..ufN Go.'2..'I - - r�. ?J r,�� • ��1I �- _i�-1-1-2 ''.-_ F I•• "'�-� '� I I .�' r. k4 .lriT '8.=745iTiCr?rinT