HomeMy WebLinkAboutKelly, Dr I,�o�ogUF F04
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JUDITH T.TERRY t Town Hall, 53095 Main Road
TOWN CLERK ; #=. P.O. Box 1179
ivy Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER 45;/0
0Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER O! `1►a .° Telephone(516) 765-1800
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FREEDOM OF INFORMATION OFFICER • ,•����,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1657 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PFENNIG CONSTRUCTION CORP.
Address 1 : P. O. BOX 244
City St Zip WADING RIVER NY 11792
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. SCHD REF. #R10-96-0104
Name Of Owner KELLY, DR. AND MRS.
Mailing Address 1 75 NORTH BERGEN PLACE
City St Zip FREEPORT NY 11520
Property Address 1 HALL'S CREEK DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.022
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 5/12/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i ••
•
• B i Town Hall, 53095 Main Road
•�I y0 P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY ,11�`t, � TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 28, 1997
Transmitted herewith is a copy of application No. 1737 for a Cesspool/
Septic Tank Construction Permit submitted by:
Pfennig Construction Corp. for Dr. & Mrs. Kelly •
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 reco dations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
)7‘
�Ilg 1997 SignaturethOlTown Crk Dated ��
t 40414"
`' CFFICL• OF UHF: TOWN CI'_ERK otfOc /73
(tt
fTown of Southold
Jnaith . berry, Town Clerk i
Application No.
Town Hall, 53095 Mein Road Construction :72
P. 0. Box 1179
Southelit, New York 11971 Alteration,�
\L! *`t', Residentialelepl tone _ +
(31O 765-1001 "'f Non-R
•
TOWN OF SOUrIIOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Pep,ni t No.
Fee $-
C)AT F.__.A,.. ri 1... .5_,__.1.9.9 7......,_._.....
APPLICANT NAME. PFENNIG CONSTRUCTION CORPS
APPLICANT ADDRESS; P.O. BOX 244 , WADING RIVER, NY 11792
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
TNG..LE__FAMILY. S.IDE.NTA1% .HOME._._.,--
LOCATION MAP; Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:...Dr_,._- &....MRS,.,,._KEI�LY _...__._._—..M.__.__ _....... ,..
OWNER MAILING ADDRESS:_ 75 No. Bergen_,P1..ace
_ ,Freeport _ NY _1 1 520 _,-
OWNER PROPERTY ADDRESS:
Mattituck
TELEPHONE NUMBER OF CONTACT'PERSON:.,_51 6 ,_929_-3456_.__ Builder
TAX MAP NO.: Section 115 Block 1 7 Lul 1 7.22
CROSS STREET: _..Me_adQW....Be.ach,••Lane . ......,.. . .
IJUIL1)INC PERMIT NUMBER CROSS REFERI NCE
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DATE;
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7.25. 4.•
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(.1k, TEST HOLD
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WATER SUPPLY AND SEWAGE DLSPOSAL SYSTEMS MUST
CONFORM WI'r NEW STANDARDS DATED NOVEMBER 13,1995.
3-
4, 4
. . .
SUFFOLK COUNTY DBPARThan OF HEALTH saviorsa. •
PBRIFT FOR APPROVAL �.`noN FOR A
DATE \ RESIDENCE Y UNATHORIZED ALTERATION
`� ! TO THIS SURVEY IS A VIO
HS RBF.NO l� SECTION 7209 . THE Nt
APPR�O ` EDUCATION LAW.
+w.OV r'fn�/1t,�11r COPIES OF THIS SURVEY
THE LAND
SURVEYOR'S TO BE A VAUD TRUE C
OPPOR MAXIMUM�_yLBBDROO
WIRESS TIYEARS FROM DATE OF APPROVAL Orua PERSp
S PREPARED,TTTLE AND
HIS
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LENSwar'TTTUnON LJ51f•.
TO THE ASSIGNEES OF THE
} TUTION. CERTIFICATIONS
s PFENNIG CONSTRUCTION CORP.
P.O.BOX 244
OI
WADING RIVER,NY 11792
PHONE(516)929-3456 AND/OR EASEMENTSSTENDE OF OF" FAX(516)929-4272 '•. ANY, NOT
SHOWN ARE
w ,
HE MINIMUM
FOR TITLE YS AS E T H
ED
""-_ /r BY lIE 11 LS MW APPR09W ANDA O
dQ. . -ts i SGS ASSOCNTION,> NEW Y STATE LArro Joseph A. In
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�. �4 Land :Sur
.- "4•�, Title Surveys - Subdivisions
Site Pions - C.
"} PHONE (516)727-2090 Fax
OFFICES LOCATED AT
N.Y.S. Lic. No. 49668 ,�
One Union Square
Aquebogue, New York 11931
Riverh
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CERTIFIED TC
'\ -., JOHN KELL',
. . , NOTES:
r`� 2. 1. REFER TO FILED MAP FOR TEST HOLE
O E s s Ib'" � - 2. EXISTING ELEVATIONS SHOWN THUS:41011
5 30if \. . '' '` 3. MINIMUM SEPTIC TANK CAPACITIES FOR
N 6g �' ° `� -4 T", 1 TANK; 8' LONG, 4'-3' WIDE, 6'-7"
�"' � `� 4. MINIMUM LEACHING SYSTEM FOR A 1 1
/ POOL; 12' DEEP, 8' dia.
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�,. •. ^ WATER SUPPLY AND SEWAGE DISPOSAL SYS
•• riSTANDARDS DATED
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SUFFOUCCOILINTY DEPARTMENTOF HEALTH SERVICES
R^011 o9 ROYAL O/CONSTRUCTION il#Oit