HomeMy WebLinkAboutKruk, Scott SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3509 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : NANCY DWYER
Address 1: PO BOX 1632
City St Zip MILLER PLACE NY 11764
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY RESIDENCE
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner SCOTT KRUK & SHAWN KRUK
Mailing Address 1 PO BOX 446
City St Zip LAUREL NY 11948
Property Address 1 40135 CR 48
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 9 lot 3.050
Cross Street KENNEY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 3/15/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
of N%
50!/jyo
ELIZABETH A.NEVILLE ,O l0 Town Hall, 53095 Main Road
TOWN CLERK , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N
Southold, New York 11971
MARRIAGE OFFICER G O A Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \. ql. ' / Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - COUIY I, southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FEB 13
TO: Southold Town Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: February 12, 2007
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3666 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Nancy Dwyer
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 location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
a/3/0 7
Dated
1
, ; OFFO 4
ELIZABETH A.NEVILLE ,1 4% Yfi Town Hall,53096 Main Roa<
TOWN CLERK .,. P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �y Southold, New York 11971
MARRIAGE OFFICER
k 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "4;* 40 �� Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICERiNg ,,,i� 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 Y or Non-Residential @$25 Application No36 Co
Permit No.35 09
Applicant Name /'JANC y DW//1k
Applicant Mailing Address PO• ( /e 3 Z
,ti,1, putee , k)y 1176
Septic Tank ) or Cesspool
Brief Description of Proposed Construction or Alteration
/Oa() S//V6GM-0//.1 ie e5/OtUGE
Location of Proposed Construction/Alteration:
Owner of Property: ,ZC2/7 k, Dk v ShNAwN k,et
Owner Mailing Address: 80x 4/9
Ny //94L
Owner Property Addres' I S AJ0t 111 12 d 4 D C L
so v f yDLb A-1)/
Name and phone number of contact person N 6 y 12w/eR 63/ 739-'/ 17
Tax Map No: /00 0 Section 59 Block D 9 Lot 30. 5
Cross Street ' Y ,QQ,Qi)
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Ln
Signature ofezIcant Date
Receiv by /( JO7
SCDHS Ref. # R10-07-0001
SURVEY OF PROPERTY
`y N/O/r AT SO UTHOLD
x
COUNTY OF SUFFOLK & STEPHEN 1l UDD TOWN OF SO UTHOLD
,-, ) (VACANT)
:' SUFFOLK COUNTY, N. Y.
\' • - - 1000-59-09-30.5
N � N36 30 30 E 183.23
m ,. I EL 371. SCALE: 1'=40'
DECEMBER 8, 2003
DEC. 5, 2006 (CERTIFICATIONS)
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I- 1000 GAL. SEPTIC TANK N
L.P. 3'SAND
!CR. - 1- L.P. 12 deep • dome B 0 / COLLAR SW
• ROAD
` EXCA VA TE TO SAND SP &s��. } BACKFILL WITH SAND SW
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. •EF�TIFIE/ TO'
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CL ERaAc atx. _. ,... s BY McDONALD GEOSCIENCE
K/ S•4/+T4' 5Y51£31
•
I am familiar with the S TAAIDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE'
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
rs...70F NF�,yand will abide by the conditions set forth therein and on the • YD
permit to construct. �3 MET'0 'Q',Elevations referenced fa am assumed datum►. �:�� \�, X11
The location of welts and cesspoo/S shown hereon are '+ t '} *'
from field observations and or from data obtained from others_ f ..... .
�� /: ,N,,. , '4.. . ,..: