HomeMy WebLinkAboutKapassakis, Georgia (2) ,��,,o��SUFFOL,rco;
ELIZABETH A.NEVILLE �� 1 Town Hall, 53095 Main Road
TOWN CLERK o . P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Af • Southold,New York 11971
MARRIAGE OFFICER `� i& ���1�, Fax(631) 765-6145
,ffRECORDS MANAGEMENT OFFICER ; � i� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �i' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3199 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : SUFFOLK ENVIRONMENTAL CONSULT
Address 1: PO BOX 2003
City St Zip BRIDGEHAMPTON NY 11937
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0101
Name Of Owner KAPASSAKIS, GEORGIA
Mailing Address 1 230 E 81ST STREET
City St Zip BROOKLYN NY 11209
Property Address 1 955 CEDAR DRIVE
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 2 lot 43.000
Cross Street SOUTHERN BLVD
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
southold Town clerk
(TOWN SEAL)
,,,,,O�, Fot, �V3
ELIZABETH A.NEVILLE ��ti� Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
cis ae
REGISTRAR OF VITAL STATISTICS i Southold,New York 11971
MARRIAGE OFFICER ��, ���,�� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `;_��l ,i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
,,ma�yy TOWN OF SOUTHOLD fF
22`
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 25, 2004
Transmitted herewith is a copy of application No. 3340 for a Cesspool/Septic Tank Construction
Permit submitted by:
Suffolk Environmental Consulting(for Georgia Kapassakis)
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
91(0-. 4?7
Signature
ae,"„eig-, 7p-
Dated
s 1
,,,iii,.,
,I0 x#01 OfFO4,�c
ELIZABETH A.NEVILLE �� O4 : Town Hall, 53095 Main Road
TOWN CLERK ; p - 1 P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ;v. �',�
MARRIAGE OFFICER . Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ="4 �/ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =0.' * 1 �1' 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 X or Non-Residential @$25 Application No. 7)3'
`
Permit
it No.
Applicant Name 5 k.44:51 ComtA.4,1 Ata
Applicant Mailing Address ge t. 2.007?) � n0"‘ N`(
I o 3 /-
Septic
Tank IC or Cesspool x
Brief Description of Proposed C nstruction or Alteration c, SvfAe",.
Location of Proposed Construction/Alteration:
Owner of Property: cit,. r-hiN\,c,�.5
Owner Mailing Address: ?3 0 \\ ((\�� r w-\.
Zc 1v\v.1 NSC < <ZO )
Owner Property Address: CR 1)rL -e444, /,�n
0,,t,.o✓\
Name and phone number of contact person S3.4 -
Tax Map No:\,COU Section 2.2- Block 2 Lot 43
Cross Street 5346rr,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
, 6p_A/6'j
Signature of Applicant Date
Received by: It '
• ..
,. r A C.‘ I am fonfikrivitir___me srAmtows FOR APPROVAL
RECEN t-u ,,..v AND oik.:CWWM, ' ,: FORO r : : -LOPACE SEWAGE
cur F()LK COW' ' ' ' DISPOSAL SYSTEMS "'--, -44 E FAMILY RESYDENCES
0 ' '
,, nu ilit and WM ab by the oohigh),It oof forth Morello and On the
5 01 Vat 4,-. -. permit to construct l '
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let: V:ASA LVIMER 1-1" ,, eiliel
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M 89•57'40' E. 122.13'
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73 '*r I TS TEST HOLE
•Sso, , 4111
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. - <_76) , Dark brown
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tit sandy loam OL
,..sr . 0.5'
0 .lax ..pu ,
Brown Si
31. lty sand
with 10% gravel
. 1s) ;;;1' .., fir el ' _
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Pole brown
fine to coarse
sand with
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o
LO
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... 73 ar,
7,-(r)
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c I ITi tfk EXCAVAt461. INSPITARECTly sOnNTRZAARED
•It- - el 3t"3 vrA t_••-i TH DEPARTMENT
I q,
\S NOTE, al 4
3 1ga° 1 LOT NUMBERS REFER TO " MAP OF
4. • W 1
, • I WOO - t AQUA VIEW PARK ' FILED IN THE
' s
4 791
4 33. . SUFFOLK COUNTY CLERK'S OFF/CE
ON JUL. 30, 1971 AS MAP NO. 5621
LOTS
- 4D
CD
soy 0 • 4111
SOULEVARP • ,1 ',
SURVEY OF PROPERTY AI II 24 ,
_. .
_-------1 0. AT EAST MARION -63
SUFFOLKTO g 12% 5
OFCOS COUNTY,
zs.
• wa • TOWN
z 0 co ix
1000 - 22 - 02 - 43
\ 7` ill u; co a
CO ° al
§ 3. , ...
c to 2 aj
g ° cu 41)
— CT .,...
The locations of wells and cesspools - — ____ , , nifry.s:cp. :i:40- 0.AISTALY 3'1"2;°°34°'
LA, Ckk 'EL 41:0 %
shown hereon are from field observations 0.12
as al co as
and or from data obtained from others. ,.1,„,,„„
, "wcri Al ON AT EA s s 41 ,e
$44**Potir EN MARioNco c ci
Couivry
1 A I , Fitz ., ...... OS .V1•
0 C°
AREA 2 32319 sqft. No 7680 ,40= E .o -a
k
ANY ALTERATION OR ADDITION TO. IS THIS SURVEY A VIOLATION NEwOp •
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. _, A.- 1.MErz 4-
EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. ALL CERTIRCATIONS '')' •4\1' %
HEREON ARE VALI) FOR THIS MAP AND COPES THEREOF ONLY F . ') Joy .
SAID MAP OR___ _ S"BEAR rft imPREssED SEAL OF THE SURVEYOR 1,1 \ %,0*,,aV..,.. •c..'..-77'., /sipkvAs:,..71 yoRsNt.Y.pS.c.•LIC. Na 49618
'WHOSE SISNAE APPEARS HEREOM , i ,
ADDITIMALLY ro COMPLY WITS SAID LAW TERM "ALTERED BY "
must 103 USED BY ANY AN)ALL SURVEYORS UTILIZINS A COPY ' \. OS& 4'765 c:3420 FAX (63/) 765 - 1797
OF ANOTHER SURVEYOR'S MAX TERMS SUCH "INSPECTED 'AND `, - te„, .9,: 19
•
BROUGHT - TO - DATE 'ARE NOT IN COMPLIANCE WITH THE LAW. \ / a .' ,I.::-. LER STREET
Si, • d, N.Y. 11971
• /
03 - 171
___________ _. _ ____ ,...4..,__ ____________. •,