HomeMy WebLinkAboutO'Sullivan, Michael 0#01 FFOL',;
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ELIZABETH A.NEVILLE 1''� 0 G'y� Town Hall, 53095 Main Road
TOWN CLERK •• ocij P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 0 Southold, New York 11971
MARRIAGE OFFICER �����, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER - lalig �aOw Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER �:�� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4192-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner O'SULLIVAN, MICHAEL & VICTORIA
Mailing Address 1 22-49 23 ST
Mailing Address 2
City St Zip ASTORIA NY 11105-0000
Property Address 1 2430 STARS RD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 718-204-2352
Tax Map No. section 220.00 block 400 lot 24.001
Cross Street MAIN RD
elLQ6104:114'
Issue Date: 2/27/03 E i
abeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
• •.rem.
OFFICE OF THE TOWN CLERK
TOWNOFSOUTHOLD �OS�FF - Application No. .2
��
ELIZABETH A.NEVILLE,TOWN CLERK ` `1
P.O,BOX 1179 :4 a $10.00 - Residential
SOUTHOLD,NEW YORK 11971 �� $25.00 - Non-Residential
Telephone 0 sge. '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ] EB 3
OWNER NAME: �TC 7- pi/4 091.10416 L• IS U L L7 V /V
OWNER MAILING ADDRESS: ,1-.4 [ - 01_3 gTi7�6L'y-
AsToR_TA / ite.y. //os
OWNER PROPERTY ADDRESS: ( 4 —3 O s-7'1)Q., Re 1
cAst/91"Wink! , /1/ . // 6137
OWNER TELEPHONE NUMBER: 7/3 6 4 - a 3 S(;21
as -
TAX MAP NO. : Section a dL Block 4 Lot Q.414
CROSS STREET: /)j/ ft , lV "ROA")
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
r(Azia_12
Signa re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
STEVEN MEZYNIESKI , INC .
• 110 NORTH MAGEE STREET •
SOUTHAMPTON, NY 11968
PHONE 631-204-0001 • 1-7/1X 631-204-0606
Health Department Reference Number: �`� ��
Suffolk Tax Map# Sect(s) Blk(s) Lot(s)
Project Name or Address: (-3 S(.1( C SY-4re s gon-/1 eil "NW/A)
Subdivision Name & Lot#
Applicant's Name:
Description of System Installed:
Septic tank a)Volume(gallons) f 6,7p `' 1—
b)
b) Shape: J1 Rectangular [ 1 Cylindrical
c) Name of Precast Manufacturer k a A
Leaching pools
a) Number of pools
• b) Diameter and Depth , 1 ,
c) Name of Precast Manufacturer .� yea
Attach or Sketch below the measurements from building corners to the access covers of disposal system
1-y
I y Alb
f o _r
I hereby certify that the subsurface sewage disposal system, described herein has been installed by me in accordance with the
approved plans and standards of the Suffolk County De ment of Health Services;and is operational
Installer Signature Date / 3 /e' .5
Steven M.Mezynieski, Inc. Phone: 631.204.0001
Consumer Affairs License Number: 31790-LW
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CERTIFIED TO: MICHAEL J.O'SUWVAN
VICTORIA J.O'SUWVAN
SURVEY OF
LOTS 18 & 19 JOB NO.2002-159
MAP NO.5315
MAP OF FILED:JUNE 9, 1969
REVISIONS:
SOUNDCREST WOODS FINAL SURVEY 2/4/03 n
SECTION ONE rj
S1TUA TEAT ' Uv
EAST MARION {
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK LICENSE NO.050363
S.C.T.M. DIST. 1000 SEC. 022 BLK 04 LOT 23&24 -
•
---------- HANDS ON SURVEY --_ _
20 10 0 20 40 60 80 100 120 140 46 NORTH ROAD N
HAMPTON BAYS,NEW YORK • ,
SCALE: 1"=40' DATE:MARCH 14, 2002 11946 ' ..... `
TEL:(631)-723-1954-FAX:(631)-723-1329
• MARTIN D. HAND LS 4;
LOT AREA:41,378 SQ.FT.=0.95 ACRE
CLEARING: 16,161 SQ.FT.
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