HomeMy WebLinkAboutSiejka, Roger l,<01 ,•c
OG .
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK y Z % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
t Southold, New York 11971
MARRIAGE OFFICER �41,* 0.�/� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER * i0 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,si
t.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1721 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROGER SIEJKA
Address 1 : P. O. BOX 2562
City St Zip AQUEBOGUE NY 11931
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 #R10-97-0104
Name Of Owner SIEJKA, ROGER K.
Mailing Address 1 P. O. BOX 2462
City St Zip AQUEBOGUE NY 11931
Property Address 1 WILLIS CREEK DRIVE
LOT 8 - HARBOR FARMS
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.008
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 8/25/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
_ow Aro
oz/
iiioofFO/4-Co
1$ y1
JUDITH T.TERRY 1Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
Pr
REGISTRAR OF VITAL STATISTICS p 1� Southold, New York 11971
MARRIAGE OFFICER �� y 1 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER =�0( igg ��p Jl�/ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER • ��
OFFICE OF THE TOWN CLERK -b77,...--
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 21 , 1997
Transmitted herewith is a copy of application No. 1792 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ro.er Sie'ka
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:
•
Signatur-
Dated
�tcucc‘
OFFICE OF THE TOWN CLERK -CSF�(�' ,
Town of Southold Application No. /7 7.P.-
Judith T. Terry, Town Clerk �..
Town Ilall, 53095 Main Road ` •
> Construction__
P. O. B o x 1179
Southold, New York 11971 Alteration
Telephone )1( t‘ Residential
(516) 765-1801 Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCT ION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE SLX.9.7
APPLICANT NAME : Czyc;.FA, S!
APPLICANT ADDRESS: 0111Utp5 AQ ,_/0y _—
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTI CTION OR ALTERATION :
OWNER OF PROPERTY : (L 'S-70e
OWNER MAILING ADDRESS: Pd OW °`7(c;a' -1 ()E.expo A)I
/1531
OWNER PROPERTY ADDRESS: 407-448- /442 / 5 / /ir<1T?crcIC
may 1 (N.I Ws' C,e ,oz).
TELEPHONE NUMBER OF CONTACT PERSON : SUP--7)-D.-S-3/4_
TAX MAP NO. : Section 1 )5 Block 11 Lot 1-7,
CROSS STREET : /`4 t(/ gf'1 Got/e
BUILDING PERMIT NUMBER CROSS REFERENCE:
.1110,
nature of Alacant
RECEIVED BY : r
To n Cleric's Office
DATE:
r
11)1 40.141'1644
G,�t$A` 1 I,�arc SUFFOLK COUNTY DEPARTMENT CF HEALTH SERVICES
Lb'• �PO*APPROVAL OF OQI TRUCTION FOR A
— �� LE FAMILY ' , •�, OPB.Y
���� .0- v o
DATE �/ // / �/
APPROVED �� -
POR MAXIMUM OF BEDROOMS �Q
EXPIRES THREE YEARS FROM DATE OF APPROVAL O�
60.
i
,/ Dro�no9e
r,
Oreo. Water lines must be inspected by the
(owELLot SING> Suffolk County Dept.of Health Services. �y
WithWPING Call 852-2100, 24 hours in advance,
Water Ec•G S.6 , ,ublic
� to schedule inspection(s). (
o/ m r SO 17....,
�
` � ^1 o / Lot7
1 �� S - .�I \ (I/4c4Nrl
\ •R-
O
\N/°y I / ��,� Rq/NgOF \� .1
\.%
•
11 I I a 1.6°G'�0..4\ I +rf ,Ago �AS\NN �M N
Z4040.0
'a�Q'" Ic. „I* o° FAN, 3T4/O, K e. /'si,P/('
Ito \ % Il R, StTf1.CK ad���'8_•0 --cif
iS_' 1 Cf Ar. �o/ EC. Q4' /� \�"
u, .. r�F ,1EfLAC "� \ o -4 e
�+ \:1 11•: 9 P, �* s (� 9/3 Q
O. �$ 9 °• 'sa° \ u F \\�\ �S,f EL=IT.s•
cu
Z is \\ ' ,o° ,�'Vole� \�0 b N s�o�cwt\ ,it,
��0� /��V
CD tO V' 7 �, Y I \ v�J \A /
CI A'I \ ' .`�� Y I �,\�• OW .00 4000 P`/
�� I
.A- � i.. '8.: '., 6 CO\ / EL•16./
.• z 5.038.1516:,. ..,........".4: 145.31:1 'Nil 'S'
i 7 / iii
.......... .10
A
r r 4"' Lot 9 I
?
►t a t'" ` ( VACANT) ORA AQE E T
iASEMEN
s's a TEST HOLE
ti,-
-PI i FROM FILED MAP
E1-1:.5 TOPSOIL ° SANITARY DETAIL
g: • //cf NEW. AND LOAM SEWAGE DISPOSAL SYSTEM - 2 POOL
r � -L '.O. N.T.S. *OUSE
* .
�W Y
rr.1NAt
yy y^ * SAND SMASHED covet
fig 1 T T l 111 ]!
°„jt, COMM HATER1141.4 11.1'
�"rsjL� MATER ININN s•104 �6 1E•11.1 0.11..3
45. SAND P 1
4DLAND •� GRO ..wAl[R_1,N
+
NOTES: SURVEY FOR
I. ELEVATIONS SHOWN HEREON ARE FROM ACTUAL SURVEY ROGER K. SIEJKA
AND ARE REFENCED TO N.O.V.D.(M.S.L 1929). LOT NO.8,i1HARBOR VIEW AT MATTITUCK" APR. 2, 1997
2.THIS PARCEL IS LOCATED IN FIRM ZONE A4 BASE AT MATTITUCK DATE' JAN. 61997
ELEVATION 8.0 AS INDICATED ON FLOOD INSURANCE
RATE MAP PANEL NUMBER 360813 01160 LAST DATED TOWN OF SOUTHOLD SCALE I".5d
AUG.16,1993. SUFFOLK COUNTY, NEW YORK NO. 96 - 1113
3 (I)O=NUMBERED LATH SET FOR PROPOSED LOCATION
OF HOUSE NINMUTMONIESO ALTERATION OR ADDITION TD 1111/ CERTIFIED TO:
4.(W12)9: NUMBERED LATH SET SURV[r M A VIOLATION OF SECTION TEON OF THE
NEW TORS STATE EDUCATION LAW
*COPIES O►THIS SURVEY NOT SCARING THE LAND ROGER K.SIEJKA
SURVEYOR'S NIKE0 ftAL OREMDO8/[D SEAL SHALL THE SUFFOLK COUNTY NATIONAL BANK
NOT U CONSIDERED TO D[A RA110 TRU[COPY
NGUARANTUS INONCATED N[nON SMALL RUN ONLY 10 COMMONWEALTH LAND TITLE
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT TME PINSON POR WHOM THE SURVEY ISP INSURANCE COMPANY
�q f�1 �,j�1DL ANO ON HIS /SHALE TO THE TITLE COMPANY,GOVERN-
*> f tfT TAX MAP AOMT .SECTNHIC�L DLACK WATER.
Loa tz■ IC MENTAL MINION,AND TOY ANO TTIE ASSISMUS OF THE LENDING LIVEDS INSTITUTION
N THERE ARC ND DWILLMS WITHIN 10O/[ET OF THIS PROPERTY SSTITUTION. GUARANTEES ARt NOT T1YW$�//EERASLt
OTHER THAN THOSE SHOWN MERLON. TO ADDITIONAL INSTITUTIONS OR SUDKOUENT
*THE WATER SUPPLY AND MUNI DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS >11FM,4ULIL /J"""'�r
WILL CONFORM 10 THE STANDARDS Of THE!IRFOLK COUNTY DEPARTMENT TO fNOWN N[R[Oon /ROM PROPERTY meow
UN[f
Of HEALTH SERVICES. PURPOSE
POSEING ',RoeENTARE/M A S►LCAUL
APPLICANT. PROCCCC AND ARE NOT TO E[USED OTEf TAGIISM
PROP(RTY LINES OR FOR THE ERIC TION 0►FENCES
ADDRESS
TEL. YOUNG YOUNG a YOUNG RIVERRSHET D,NE YA10R E
NOTE •2 STAKE FOUND
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W.YOUNG,PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON AUG.21,1987 AS FILE NO.8377 AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
HOWARD W.YOUNG, LAND SURVEYOR
*DIE LOCATION Of W5LIW),SEPTIC TANKIST)D CEESPOOISICP)SHOWN HEREON N.Y.S.LICENSE N0.45893 „
ARC PROW P1ESI
1D OtIIMTIONI AHD ON DATA MMON ON OTHER S
,, 0001. A \M1• Mr. 2*.