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Home My WebLink AboutTomaszewski o��pf SO(/l�ol ELIZABETH A.NEVILLE,RMC, CMC O Town Hall, 53095 Main Road TOWN CLERIC l J P.O. Box 1179 REGISTRAR OF VITAL STATISTICSco Southold, New York 11971 MARRIAGE OFFICER • �Q�O Fax(631) 765-6145 RECO AGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Telephone " s utho dtown northfork.net OFFICE OF THE TOWN CLE TOWN OF SOUTHOLD Ann LS ((� 2 0 pp 2 TO: Southold Town Building Department AUG 2 7 M 15 D FROM: Linda J. Cooper, Southold Town Clerk's Office TOWNLOF DG-SOUTNOLD DATED: August 27, 2009 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3894 for a Cesspool/Septic Tank Construction Permit submitted by: Zachary and Michelle Tomaszewski 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: Or Signature D 8028 �, Dated FFO[,r�,o ELIZABETH A.NEVILLE Town Hall,53095 Main Road TOWN CLERK pZ P.O.Box 1179 Z REGISTRAR OF VITAL STATISTICS v. Af Southold, New York 11971 MARRIAGE OFFICER Oy �'1C Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERTelephone(631)765-1800 FREEDOM OF INFORMATION OFFICER �'� �'a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 •/ or Non-Residential @$25_ Application No. 3 9 7 Permit No. Applicant Name.[� q,va n�f.aNcur �aszr-zki Applicant Mailing Address z> 44Iie if a -A , .[,pint t C Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration �tle((J Location of Proposed Construction/Alteration: Owner of Property: 2g( ,e2 Cccr arzrwsrci Owner Mailing Address: 32-95' 4e b ee e w Owner Property.Address: 3i os 4t bz,ew .l /,4",ZJC . NY i/fs/d" Name and phone number of contact person zc Tax Map No: Section 12-,l Block / Lot Sz Cross Street T/QfINkG� U U!c G � NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL SignafFe of ApplicarV Received by: �Q d�a7Z<22: NfFS. AY SURVEY OF PROPERTY THDb�jo; SITUATED AT LAUREL °mow TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK KENNNT i� 1EWDYBE") S.C. TAX No. 1000-124-01-04 V SCALE 1"=40' W I DCF 3011 IT . SEPTEMBER S. 2003 WON. Q0. '.- .,i: SEPTEMBER 23. 2003 REVISED HOUSE LOCATION AREA = 41,881.47 Sq. it. _t�„_-- � '0 0.961 ac. OOF OF woo°Ff"rE T. in gyp' e 7G < O b}.E. \ ` 1. acYAmis ARE REFERENCED To AN ASSUMED DATUM M3osrEw EIEYATIONS ARE SHOWN NIOR \b ;yd %- :•. L MM"s•FTANS YCAPACIDES FOR I TO 4 BEDROOM NOUSE IS lj= OEIIaMS. Z \ _ _ q,- . ' 3. RSM IA'AGIR6 S1S= FOR A 1 TO 4 BEDROOM MOM B 300 W, N SIOEWA AREA P1Eoposm PH.L 1 row 11• Ow. S' 4d c O NlDrosED tnANWo1M ROa >. M`•'O LEACHING FOOL 0 Oi .AB1 - - - yI ®rWacam SF►Mc iANR ,.C� 0 E,• TEST IPMOLE -. • 4. THE MDTION OF Wna AIO (E7YSHERRIODI3 OON I HEREON ARE NFInD Tn 'S ~ N. °r. _ �- , G 06SEWYATNM6 AID/aM DATA OBTALED FROM OTHM rTFI•� 51 f0,, Pion Lm T�/1 - �wETiIn F O E>#; - � 1 I F g NEEEL S S CH1TU FsADMED 2i gpG6N u1 A� Tlaa rnatis>enew a e�"n �-- -� ,, wa TEST HOLE DATA oy Fc29�`. - (TEST HOLE DUG BY k4cQQN4LD - O CI N ON AUGUST 20, 2003) er AR7 Tf IF HEALTH SERVICES f $ BROWN San LOAN OL ( f r D F AN 1 PERMIT FOR APPROVAL OF CONSTRUCTION FOR A - I N.Y.S. Uc. No. s BBB J GLM;FAMILY RESIDENCE ONLY - uwRNaSUM K6 A VKX aE AD F TO 11O SOIRtY E n NDUl10N OF gcTluR TSw. THE NETF YORE STARE DATE `a 03 swsw a3tv,n a �Na , __ JO ph A. klgegno HS NO. smemws y; : Tar aEc amcr rw uw eErnlc r' ON WEE BROWN FINE APPROVED (tn c^ �, ro � �"D f s T r } m°�n WSLI�'aori E°°co°'W®W Land Surveyor r F'.a 6CCl�, TD THE Fn ':IOI'1Kwm MR MA%MIOM OF �' BEDROOMS E ANDRWDyft WISS Enver m of r, i i(/ �.' O •)��WBi aF 1K IHiEC9 mAND m- � �" - STAdNEb� - 9b HaW - CaWEvelbn LOaIR $XPIRES 78REE YEARS FROM DATE OF APPROVAL J aFWnFaATWMs AAE Na TWYBFMNE PHONE (831)727-2090 EDz (831)727-1727 THE EIRIFIENGE OFrsNIGHT �1ap�WAYS prFlIZS tDG17m At AVJ.M ADDRESS AN NOT LIOWM AWf NOf q/YAI1TEYp. 373 RWOIE AVENUE P.O. B.. 1931 ..Mn.Yark-.}1901 fEwligd. l4r YaE-119QI-am ,—_, o��OF SO(/ryol ELIZABETH A.NEVILLE,RMC,CMC h O Town Hall, 53095 Main Road TOWN CLERK l P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER • COQ Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �YCOU southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4406-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner ZACHARY & MICHELLE TOMASZEWSKI ------------------------------ Mailing Address 1 3205 ALDRICH LANE ------------------------------ Mailing Address 2 -J�OV-A.CSS Z 2w S1c.t ------------------------------ City St Zip LAUREL NY 11948-0000 -2, O Ol Property Address 1 3205 ALDRICH LANE ------------------------------ Property Address 2 ------------------------------ City St Zip LAUREL NY 11948-0000 -------------------- -- ---------- Owner Telephone No. 631-879-1553 ------------ Tax Map No. section 124.00 block 1 lot 4.000 ------ --- ------ Cross Street FRANKLINVILLE ROAD ------------------------------ ---------------------------------- Issue Date: 12/08/09 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) .y o�oSUFFot�.�oG ELIZABETH A.NEVILLEo� y�e Town Hall, 53095 Main Road TOWN CLERK coo Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold,New York 11971 MARRIAGE OFFICER • � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Ol �a Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 -1 or Non-Residential @$25 Application No. O Permit No. Owner Namem t c,L f1, Owner Mailing Address Owner Property Address 'gg-cs AlAric-1, \-A "LAure t ng-- G Owner Telephone No. to 3-)- '''79- \'S 5r 3 Tax Map No: Section v 2y Block I Lot Cross Street �"Qjt c.,t1i"14i u-€ Lz- Please check each that applies: New Construction_>!e Alteration to Existing System Residential �' Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) i4c- 2 d Signatur f Applicant Date Received by: �- / r Y' P.O.Boz 481 Calverton,NY 11933-0481 (631)369-3886 INA Health Department Reference Number: Iq 10-o 3 , 0/ 3 5 Suffolk Tax Map#: Dist: -Sect(s): Blk(s): Lots(s): Project Name or Address: Subdivision Name&LOT#: Applicant: �'—A& Wh o W A s z z w s �"� 3 Z 5 C'4 / System Design Installed: -Septic Tank Volume(gallons): �� a Shape: 6&Rectangular ❑ Cylindrical Name of Precast Manufacturer: S c n :- -Leaching Pool f Number of Pools: Diameter:, Depth: z Z' r Name ofPrecast'Manufacturer: 3 CP 7- As,buiit: , �2 o 38 a 101le z 4 Z -,L.� I hereby certify that the subsurface sewage disposal system described here in has been installed by me in accordance with the approved plans and stan f the olk County Department of Health Services and' operational. Installers Signature: Date: z z o 5 Company:Bano Drainage•Corp. . Phone:_(631)369-3886 Consumer Affairs License: 32546LW and 15-4461-H