HomeMy WebLinkAboutKruk, Scott & Shawn
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 1197I
Fax (631) 765-6145
Telephone (631) 765-1800
sou tholdtown. northfork. net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
FEB I 3
'Ji0:
,
Southold Town Building Department
.... __J
Michelle L. Martocchia, Southold Town Clerk's Office
FROM:
DATED:
February 12, 2007
RE:
Cesspool Construction! Alteration Application
Transmitted herewith is a copy of application No. 3666 for a Cesspool/Septic Tank
Construction! Alteration Permit submitted by:
Nancy Dwyer
Please review the application and location map and advise if this office may issue the pcmlit.
Please complete the fonn below and retum it to me. Thank you.
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
.,/"
DISAPPROVE
Comments:
~~~:~~;P~--~_./~'
Sig~
t)~/fJ/o7
Dated { ,
, :
ELIZABETH A. NEVILLE '.,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
.~ Town Hall. 53095 Main Roe
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou tholdtown. northfork. nel
OFFICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$IOL or Non-Residential @$25_
Applicant Name /J/lAJC'I Dwyt:-.e
Applicant Mailing Address PO. Box 16 3 Z
,t1 i ~LIt!Ie- pl-Mi? / 1J '/ 1/7 h cf
Septic Tank~or Cesspool_
Brief Descriptioll of Proposed Construction or Alteration
AJl:1.u StIJ6U~ FAA/I.,,! ~ eSIDI2N~
Location of Proposed Construction! Alteration:
Owner of Property: .2.'/1 /<'KVk v Si-/lw/,Id /LRVk-
Owner Mailing Address: '. Pt!. Box tJ'Ib .
IAvR i!L ,jJ 'I /If'fcf
{Jot:: 11-1 J2 oil- D
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Owner Property Address:
Application No.3~ G::, b
Permit No.
Name and phone number of contact person
Tax Map No: 1000 Section 59
Cross Street Kf3J/JI8(s' RCJ4I)
Block
/)WY&K
I
0'1
b3/- 731'- '16/7
30.5
Lot
NOTE: LOCATION MAP MUST BE SUBl\fiTTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
77~ ~&1
Signature of A icant
Receiv~~ ..;:j/Id.-/o7
d,/.,)..ol
Date
SCDHS Ref. # RIO-07-0001
SURVEY OF PROPERTY
AT SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000-59-09-30.5
SCALE: 1"=40'
DECEMBER 8. 2003
DEC. " 2006 ICERTIFICA T/ONS}
Jo-", 'l'J, 1.007 {i<Jo.fcr {11d-'r.
JA,v.30, 2001 : :e'C:51 H,)L"/
N/O/F
COUNTY OF SUFFOLK & STEPHEN MUDD
(V.A.CA/'IT)
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EXCA VA TE TO SAND SP & 8' ·
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P!::Rtdl'i' fm: tlF'!'EOVAl. ();': CY'!S7RJ.;C.,':Fj "€ERT1F1E~ TO'
SHA IYN KRUK
SCOTT 'KRUK
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EXP:RE:S 'rHf~~E:::(2'ARS ~-~T,".()i,'\: - '~
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I am familiar with the STANDARDS FOR APPROVAl..
AND CONSTRue nON OF SU8SURFACE SEWAGE!
DISPOSAL SYSTEMS FOR SINGLE FAA/It Y RESIDENCES
and will abide by the condition5 set forth therein ond on the .
permit to construe/.
Elevations referenced /0 an assumed do/urn,
The loca/ion of wells and cesspools shown hereon are
from field observations and or from data obtained from a/hers.
A1JY .A.UERA T10N OR' AOOIT/ON TO THIS SUR'>EY IS A VIOLA T10N
OF SEe T10N 7209 OF THE .NEW YoRK S TATE [DUO T10N LA w.
EXCfPT AS PER SECTION 720~SU8{)IWSJON 2- All. CERT1F1CA T10NS
HEREON ARE \lAUD FOR THis /JAP AND COPloS THEF?EOF ONL Y IF '-!
'5AID /JAR OR COPrES BEAR T1-fE IIoJPRESSEfj sEAL OF' THE SUR\'f:YOR
_ . __~ ,........... "r-n.-l'i.1
AREA=45,490 SQ, FT.
DARK BROWN LOAM aL
0.5'
BROWN CLA YEY SAND SC
__ _IS'
BROWN SfL TY SAND SY
_ __2/'
Bf?OWN FINE S~NO SP
ZS'
BY McDONALD GEOSCIENCE
~;.
ECONfC 5U
(631) 765-50
P.D. BOX 909
1230 TRAVCLER STREU
SQUTHOLD, N. Y. 11971
03-~