HomeMy WebLinkAboutKulick, Larry (2) •
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3494 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LARRY B. & JOAN M. KULICK
Address 1: 21 TORLEN CT.
City St Zip HAPPAUGUE NY 11788
Descripton of Proposed Construction or Alteration
-REBUILDING HOUSE
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner LARRRY B. & JOAN M. KULICK
Mailing Address 1 SAME AS ABOVE
City St Zip 0000
Property Address 1 1895 MINNEHAHA BLVD.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 3 lot 5.300
Cross Street
Building Permit Number Cross Reference:
Issue Date: 12/11/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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,/�,�o0 SOi,,j
ELIZABETH A. NEVILLE '` O .
�� Town Hall, 53095 Main Road
TOWN CLERK ; 4 * t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % G 1 Southold, New York 11971
MARRIAGE OFFICER �.4%
o Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER %ye e • Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - COUNT(+ �
o,�� southoldtown.northfork.net
L ' OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: November 27, 2006
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3651 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Larry B. & Joan M. Kulick .
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.
* * * * * * * * * * * *
I have reviewed the application and locati map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: �fsr/ " - w �
21/4.‘-'Ztgeote.— .../t,.,
Signature
/077P6
Dated
II
.ti 11004A%
ELIZABETH A.NEVILLE - ��h`Z` •• Town Hall, 53096 Main Roar
TOWN CLERK •
i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER . . 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 41# 4� '�l Telephone (631)765-1800
FREEDOM OF INFORMATION OFFICER '_ 4( �: ' 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 @$25 App
5
Permit NA
Applicant Name Z,Mer .6. AVIS moo.✓ // 4e
Applicant Mailing Address .2/ 7bece u cr ,r,/.ouA.otelE .v/ Pe 78(
Septic Tank ✓ or Cesspool •
Brief Description of Proposed Construction or Alteration Amiga gebtac. :26
Location of Proposed Construction/Alteration:
Owner of Property: t aaray s.a.,, 4 ii c,c-
Owner Mailing Address: 02/ Ttc6V C r
i0qqo ve C 'C r/ ,/793
Owner Property Address: /d '$ /i,iA /e"�pyv 454ciA
Slwiyyve..e 4v y //4°7/
Name and phone number of contact person L46vy aer 1/eL 9t 9Sla/
Tax Map No: Section 57 Block d3 Lot 53
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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Si aturGlicant D to
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Received by 1 U1.,(Q lc ///ca-7)0
N DWELLINGHSE
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PUELIC WATER c P IDG � 4
= i UN ASPHALT �, srx� �' SURVEY OF PR PE ' M 1
I DIRT ROAD,
eL 12.05' WABUN ROAD s •
I , , „ 145.00' oFE ma._ A T LA UGHINC u W A TER I I: 5 6
N87 26 00 E
--LIT RAIL FENCE i C.LF.
--\ FE 0.I'W TOP MON TOWN OF Si'' ' cI OLD• 1
D.4'N SUFFOLK CO 1 " f, 5, h-iG
1• W W sl. 12.2 (MON 0.3'HMVNE
mm .
1000-87-03-53
S S\ 1 Abandonment of existing sanitary system must be in SCALE.' 1'=30'
If?
comformance with departm t requirement Submit MARCH 13, 2006
0 0
0 01 completed form WWM- as proof APRIL l0, 2006 (lest hole)
Z \ _---- y Ma.y i7 2006. Qa-- •..
_ t s •RV1C�y
o D _ 1 `2 a \ \ y D PARTNiEN'[o HE LTFI
\ m c� n cY .v ' . o11:�.FDLK C
-n m PE X 2.
to To .....••), OVAL Or CONST7Z4
C10tFQR
r — 1 tTt
PERMIT FOR UPPP.
FS m C JINGLI• F,n,'t91LY RasIDEz.CLY
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-iA �b X m )aATE� I t1� lv
x I.1 f " d 'i �l r- APPROVE, '�' BEI'R `' S
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o ,4 fr- • cd,\ dt' o .�/, c i.: \W, -
, ' g > r-WI PSR/ .. FR IA GATE • APPROVAL,
VI Ft° t c.d- z
/ \VA rb.7 N to 8I? 8® rna NHSE.
C ; x D FIN. FLR. 13
�! CO ® m
29, -� EL. 10 PROPOSED GRADE EL. 8
N , 1,f
l.�_ I? (k.P1 eti/y f. �.� x 6'E ZI .1 ON
a a O ��1 , 1 2 N I.E. 72-----------------------------, - .
B.� I 3'SAID
�e k`P/ 1 z 1250 Gal. LE 6.4 LE. 62- L P 2'• / COLLAR
'� 6 IS• SEPTI'C •
TEST HOLE b Maw TANK
.L 7.s fte / x 2
3/7/06 a N ZoAI A ('e/ of Z N GROUND-NAM. EL. 1.6
`_� Cs�v i PROPOSED SEWAGE DISPOSAL SYSTEM 6 POOLS
DARK BROWN SANDY LOAM a y WITH CLEAN SAND 3' COLLAR-1250 GAt. PRECAST
——_1.5• / very k� o P dy IV CONCRETE SEPTIC TANK BOTTOM OF LEACHING
BROWN SILTY SAND _SM gar \ A,� P r POOLS TO BE 2' ABOVE GROUND WATER
/ b?00„'�� SEPTIC SYSTEM CROSS SECTION
— BROWN CLAYEY SAAO SC ��A _
— — 7'4 WATER P/BROWN CLAYEY SAM)SC Fp °H Iy.
rJ2� `� EXCAVATION INSPECTION REQUIRED
WATER h/ *OAT
���i7'4f7 A�yA`T EL. 5.G
BROWN ME SAND SP d
o ��Ul� ass. �n�� • FOR SANITARY SYSTEM ...0 of NEWY°R
BYMCDONALD GEDSCIENCE.13' 44/4/ 44.41.1)
��
BY HEALTH DEPARTMENT >�� `_:/.7 ;;, �' •
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��a TF,Q tc doer tail
6`'AREA-26,253 SQ. FT. `'� 01: 4... i =--,� 4`c / A `• ,61..:
• i,ri 49618
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ��,ry C.Ps ro�jc �j//��/� or rerr/oYepl. PECONIC UR .i'S '",L'd4:�•
OF SECTION 72090F THE NEW YORK STATE EDUCA TION LAW. •
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EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERT7f7CATiONS ®= Prop. E;-, y----k-r,on (631) 765-5020 .1.165-1797
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF \ H Nw.y ELEVATIONS ARE REFERENCED TO NGVD. P.O. BOX 909 •
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR '— -� 1230 TRAVELER STREET 06-130
WHOSE SIGNATURE APPEARS HEREON. ■=MONUMENT Fz�o 2oN�5 F/Lo.� F/2M .3(oi93co/66- G SOUTHOLD, N. Y. 11971
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