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Geller, Georgia
��- ` OofFOLt:" ELIZABETH A.NEVILLE $,``10. Gy Town Hall, 53095 Main Road TOWN CLERK p 1 P.O. Box 1179 ti Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS v' Prt t O �1 Fax (516) 765-1823 MARRIAGE OFFICER :` RECORDS MANAGEMENT OFFICER 1i*0! 111) % .- Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER �•I ��i • 14 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1897 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : ROBERT STROMSKI Address 1 : 13405 MAIN ROAD City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-98-0070 Name Of Owner GELLER, GEORGIA Mailing Address 1 55 STARLIGHT DRIVE City St Zip SHIRLEY NY 11967 Property Address 1 125 PASTURE LANE City St Zip MATTITUCK NY 11952 Tax Map No. section 115.00 block 17 lot 17.006 Cross Street MEADOW BEACH LANE Building Permit Number Cross Reference: Issue Date: 7/10/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) eor/I �g�FF01it / �� ELIZABETH A.NEVILLE '��_�� A4 %` Town Hall, 53095 Main Road TOWN CLERK p _ P.O. Box 1179 Cl)• • Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS 0.•740 ��� Fax(516) 765-1823 MARRIAGE OFFICER 0�. Telephone (516) -1823765-100 RECORDS MANAGEMENT OFFICER ! . FREEDOM OF INFORMATION OFFICER --��'* ����a"�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 29, 1998 Transmitted herewith is a copy of application No. 1971 for a Cesspool/ Septic Tank Construction Permit submitted by: Robert Stromski for Georgia Gellor Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. • Thank you. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE , DISAPPROVE Comments: Si ature tit-)c Icli Dated OFFICE OF THE TOWN CLERK ,!'C�aiiULK4 TOWN OF SOUTHOLD ; Q�/= Application No./ 7/ ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 !G Construction SOUTHOLD,NEW YORK 11971 =3Alteration Telephone �,j► �Q��� $10.00 - Residential (516) 765-1801 '-�1 �,•'' $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE u Vl Z f 1y APPLICANT NAME: r�- 540yns ' CA4 ; 1rrc flo)o }`rs-) APPLICANT ADDRESS: I-201-105- t"tA-t 1`1 7E fii t t-t ct( t Hi' 11g 6-2-- SEPT I C/\_CESSPOOL DESCRIPTION� OFPROPOSED CONSTRUCTION OR ALTERATION I cTpf,t'df -ZeSrC.r rvi C� LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: C-��© rd - OWNER MAILING ADDRESS: 5 Its h-(- -17 �J � OWNER PROPERTY ADDRESS: 1z5-- a J v 'c 10 vi TELEPHONE NUMBER OF CONTACT PERSON: 21 pj — 1C2ci �1-j 6\.(01,71-(' TAX MAP NO. : Section / / -j Block L 7 Lot 1"7,4 CROSS STREET: r le-cevolQw Ackex LG tyl BUILDING PERMIT NUMBER CROSS REFERENCE-:--- ignal re o Appp ant RECEIVED BY: Tow Cler�ice DATE: �' \ et- Q4Va//' i SET til N>c................... 3' rL2. CONC. A SI p /�\ SET CONC. MON. r MON vi. Z�IVE WALL // AREA a - N 68°54 30 E /50.00 LEACHING FOOL O I a 2'M/N. _4 GROLNOWATER -, LOT 7 (VACANT) NOTE THE ELEVATIONS SHOWN HEREON WERE OBTA/HED FROM DATA PROV/DE BY THE SUFFOLK COUNTY DEPT OF NO RESIDENCE W/TH/N 150' PUBLIC WORKS AS FOUND ON TOPOGR,' TYPICAL CESSPOOL SYSTEM OFALISERVICES SHEET AA35, AND SHOWN THUS; Nrs SUFFOLK COUNTY DEPARTMENT 24.3" PERMIT FOR APPROVAL OF CON.s,TRUC'I'ION FOR A ING' FAMILY RESIDENCEONLY 7� FINISHED GRADE We.1/i4( 4 H • .NO.. % 7 Y'A/N SURVEY OF :�i'f it(UvED /�^ /�"� SURVEYED 10 JULY, 1996 SCALE: /" : 20" • /i./I1/9-,/,, FOR ' IMUMOF., BEDROOMS AREA = 40,611 SF (FM.) . ...11••••••........"IMENt. LOT 6O/ IN_� '—i t'--- ,Our D L__EXP11RES THREE YEARS FROM DATE OF APPROVAL 0.9323 Acres In 8'M/N. TO IN C ,00 CESSPOOL MAP OF HARBOR VIEW AT MATT/ TUCK ZONED AC 900 GAL. SEPTIC TANK SITUATE FILE MA4 8377, FILED AUG. 2/, 1987 TAX MAP. 18377, 76 MATTITUCK, TOWN OF SOUTHOLD TYPICAL SEPTIC TANK SUFFOLK COUNTY, N.Y. NTS i WATER.S`'PPL'v AND SEWAGE fi SPOSA.L SYSTEMS MUST 1 cCU v URi'll'WIT'xi NEW STAiNl:A ZDS DA E U NOVL M12,,Eie I.5,31'.;95. SUFFOLK CO. HEALTH DEPT APPROVAL t___ H.S. NO. SURVEYED BY: SURVEYED FOR : GEORGIA GELLE mw. . ,,,, ..,,,r !;nes must be inspected by the STANLEY J. ISAKSEN, JR STATEMENT OF INTENT County Dept. of Health Services. NEW BSUFFOLK,NY,11956 THE WATER SUPPLY AND SEWAGE DISPOSAL k ''. 7) 91 3'vi /Y l-Ours in advance, (5/6) 734-5835 .YSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE _ + , ;TANDAROS OF THE SUFFOLK CO. DEPT. OF HEALTH ERV(CES, TO INCLUDE REVISIONS UP TO AND INCLUD- GUARANTEED TD GEORG/A GEL L ER (o a c h e d Li l e inspection(s). VG NOVEMBER 13, (995- PEERLES ABSTRA T Unauthorized oiteraNat or addition to this TOWN OFSOUTHOL Guarantees indieeMod icons pt d,on r1ie survey is a violation of Section 7209 of S :ner: litepersettfir► witemtt1eytheNew York State Education Law. APPL/CANT ared, andonItisbehofftoffieTOWN OF SOUTHOLD tlmpany, Covermental Agency•9R APPROVAL OF CONSTRUCT/ON ONLY institution, if listed hereon, and Ccpies of this sumo), map not bearing to the cssignees of the (ending instih/tion the Land Surveyors embossed seal shall IPPR Guercntees are nct transf ruble to net be considered to be a v• d Out, 9PPROVE:D additional institutions or s,bsaquent • f . y. OWNER /, / I ` '/ ,- , _ GEORGIA GEL L AR ,�� 44 i`'.; ti4r I LICEN7 O AND SU" YOR N.Y.S.I• IC. NO. 492v A 0.r, `w LEPi: ret 2. CHANGED TEST HOLE DATA,ADD PROP WATER SERVICE,SANITARY EXPANSION SYSTEM, STRUCTURE ELEVATIONS. 1 SER!..::-.`� 1. 29 JULY, /996 ADD 150 ADJACENT PROPERTY NOTE FOR SANITARY 96R604 E S CORRECT ELEC.,MANHOLE,ADD SANITARY. 1 ^"" ..wN_.a ...a; ,,.r . ,, P. ..`_ ,.:« -..w n .".7-,,.., ., 'IP1MI'llfYl'6mIWIWm�79Yp�Ydtl4Itl` d, ra...b „a...✓,a - ., a._. .tia yew-�-- NO RE''ENCE WITH/N /50 TEST HOLE DATA HYDRANT-1 1. REFERENCE: TEST HOLE PERFORMED BY `,�{,' A MCDONALD GEOSCIENCE,8/26/96 • EL. 243' e, . „ii /PROPOSED 6"ITER MA/N AS PER FIL ED MAP i- DARK BROWN SANDY LOAM SM ; / PASTURE LANE - BROWN LOAMY SAND SM 3 A = ELECTRIC BOX (BURIED) ASPHALT PAVE MENT 28' WIDE .--------"°.I` / GREYISHROWN SANDY B = ELECTRIC MANHOLE (BURIED) ,yCLAY r� 4' C = TELEPHONE SERVICE (BURIED) I 2g9 ZR� + CONCRETE LEACHING CURB AT GRADE--•-•"" • POOL 1 1 titi�0 A.30.554)6 1. S 68° 54'30"W 2�. 97. 75' 2R=gO.. 2sX., '"400,1, tD. FD. CONC.MON. , /;ALE CQARSBROWN FINE C !y'��i�• CONC rJ ` B 0 SET MON. 12 DRAINAGE E 4 `S F ' CONC. ,� AOO MON. / { F2 N r 10) 50% EXPANSION WI W R=50.00 SEWAGE SYSTEM a ac us, SET: A=8.78' (�''� rEsr HOLE 0 MON. 1 2 \ \9• (L! PROPOSED/LEACH/NG Lu ~ Poocs. . d 1$FD. (16 Zy.3 CONC. —/7' Q ; o Ztt MON. �p4 VDR/VEWA -,\ m et NOTE VNI Vc / ( A �o o6 0 Ne I PROPOSED -0-0 ' 60' TOP NEAREST 21.1' SEPTIC (o CESSPOOL ON LOT*5 „S _ 1 N o } n F, s��`as. ) 60' TO BUILDING ENVELOPE �,• C71 y rr.... 5cpa P\j , 90 70' TO PROPOSED STRUCTURE I = 0 (11 n / Q�. P\� PROPOSED r s- c& GARAGE PROPOSED 2400 S.F. RESIDENCE ti f \ N (MIN) no\� 0 PROPOSED EL. 1800 S.F MAIN FLOOR O 0 A`i 24.5 600 S.F.' 2nd. FLOOR In c:10$ j V PROPOSED /sl. FLR. ELEV.= 26.0' con i -- 24' BUILDING n zO O CONC.MON. ENVELOPE • 60 ti m AC ZONING 2 n y 1' )P - / (511. \ � n TP 20.0 O r so, F . 18.0 -- �_ GENERAL TERRAIN OF LOT UN/FOR M - 20.0 =z,___. . - f0 -s7o L 9