HomeMy WebLinkAboutKrupski, Eugene (2) ` 1
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3464 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EUGENE KRUPSKI
Address 1: 1095 TRACK AVE
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
-NEW CONSTRUCTION OF SINGLE FAMILY DWELLING WITH NEW SEPTIC SYSTEM
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner EUGENE KRUPSKI
Mailing Address 1 1095 TRACK AVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 SOUNDVIEW AVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 100.00 block 20 lot 3.010
Cross Street SALTAIRE WAY
Building Permit Number Cross Reference:
Issue Date: 9/18/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
��,of 0 SOUTy.
ELIZABETH A. NEVILLE �O l0 Town Hall, 53095 Main Road
TOWN CLERK 4; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N �r Southold, New York 11971
MARRIAGE OFFICER G O Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 't. iv- A�,,1r Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '- eOUNTY,WO° southoldtown.northfork.net
men S 041
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Ici- i1
T : 'Southold ligyvaluilding Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: August 1, 2006
:-: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3619 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Eugene Krupski .
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.
* * * * * * * * * * * *
r have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE1 .
DISAPPROVE
,04e,ge,
Comments: e
t.4: "...,-- ..„,41
Gus71/4-1:41t .
Signature
DOVO t
Dated
ii
tyro roO�,�00;
r
ELIZABETH A.NEVILLE 1.1°S 4\ Town Hall, 53095 Main Road
TOWN CLERK ' a , 1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS yj. Southold, New York 11971
MARRIAGE OFFICER : '� 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \-#4 O6r.1l Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER O.' 4, 1',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@ @$25Appllc on No. (p 1 ci
Permi No
Applicant Name t1 vie.Q. 41 r t kl
Applicant Mailing Address (og 5 `C"rat.,k. Ave.....
Septic Tank )( orresspool
Brief De crip ' n of Proposed Construction or Alteration I4Lt,) C-0,16i/SLOCC01. el
sc�n Ic - �c 1 w d i fic. s ski
Location of Proposed Construction/Alteration:
e
p .E.,t.
Owner of Property: � � �� fru 1Osk.s
Owner Mailing Address: lO Q6 T o.ck AV -
C4A4-chen ift_12 tit.i%/ if cA36
Owner Property Address: .5074.ticiV/-eZ o2_
YVAa-I '- - KU 1I
Name and phone number of contact person 0/C.t! Tvfk.. oil J aa/9
Tax Map No: Section /00 Block 02 Lo4.3. 00/
Cross Street(SaL am..e.
NOTE: LOCATION MAP MUST B SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WIT HEALTH DEPARTMENT APPROVAL
\r 7 ,6 eh /0&
Signature of Applicant Date
Received by: ` \ L4
N i
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VO
Op N/O/F GORDON&MOUNT
N 7 •270 r E 22.00'
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OMS M X. 4°r• /soj• THERE ARE NO WELLS OR CESSPOOLS
WITHIN 150' OF THE. PROPOSED WELL 8
q� I ` ' CESSPOOLS.
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SURVEY OF PROPERTY
AT MATT/TUCK
-3/5 TOWN OF SOUTHOLD
-
,SUFFOLK COUNTYNY
k 1000-700-02-Pio 03
SCALEYc4200.'
MARCH.% 2008
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LOT NUMBERS ARE REFERENCED TO
SUBDIVISION OF 'KRUPSKI FAMILY LC" S 64175. 0'W .i
175.660' tv
CONTOURS ARE REFS ENCED TO THE I 14.
FIVE EASTERN TOWN TOPOGRAPHIC I 0 i
MAPS �� w
LOT I S
186.87'—_'
S 60'
The loc
ations lsspawn hetionsGON
avid or frs. ORE
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ta.
0
• 2
= 55.9985 Acres
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abid- by the conditions sel forth therein and on the
permit to conslrucl.
2,
PLEASE NoTg
Minimum distance between wall
and cesspool Is tabs 150 feet
EXCAVATION INSPECTION REQUIRED
9.1m) FOR SANITARY SYSTEM
BY HEALTH DEPARTMENT
I •
SUFFOLK COUNTY TWPARTMENT OF REA LTH SERVICES
I 564 Tr vrr wZ's ipir !4; /.0:9.'-"T`;',17 -rryrak Fo
.$1NGLE FAM-I'Ve
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( NORTH RD. ) 4 fl •
IAD P oNic SURV"i"'"fR -14•11
16311 765 - 502' i4:4106.466:3006--
P. 0. BOX 909 Iv%
1230 TRAVELER
SOUTHOLD, N.Y. 11."4 -
0 5 - 102
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