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HomeMy WebLinkAboutLenceski, Ann tir 4, ,, ," cUFFOL4►0 0 G ELIZABETH A. NEVILLE _� yd Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR.OF VITAL STATISTICS v, Southold, New York 11971 MARRIAGE OFFICER G ' Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER `--_ 4. 4„,••�, - Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER •_ .9” �•... .iii OFFICE OF THE TOWN CLERK SOUTHOLDV f 4 fl3 SAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4115-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner LENCESKI, ANN Mailing Address 1 BOX 1792 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 3700 MINNEHAHA BLVD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 631-765-5518 Tax Map No. section 87.00 block 3 lot 5.000 Cross Street OWAISSA BLVD. Issue Date: 12/14/01 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK 51FFOLt , TOWNOFSOUTHOLD COG Application No. ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential P.O.BOX 1179 SOUTHOLD,NEWYORK 11971 0 `► $25.00 - Non-Residential TelephoneO.( , y►��� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ l0 DATE / 1-)1/ } OWNER NAME: 2'fl/'Li 64/e....tt2.42' OWNER MAILING ADDRESS: if21,74 OWNER PROPERTY ADDRESS: 7. 3 00 02 ,/ „?7/ OWNER TELEPHONE NUMBER: 765- 56--/W TAX MAP NO. : Section 31 Block -3 Lot 5 CROSS STREET: ,/ ato-ittAjtet, Je� TYPE OF SYSTEM: Septic Tank )( New )( Existing Cesspool ,l . 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.) arfrpt. 4a/11k Signature of Applicant (A. /RECEIVED BY: i VAr own Clerk's Office DATE: / I( 70 / ( f Q-v\SO) 1( a lbe SLUDARDS F APPROVAL . IGE liSPOSAL SYSTEMS FOR EFAMILY RES SURVEY OF PROPERTY and d abide bye conditions aer forthE6eral and an rhe per'to construct Tee bottom A T LAUGHING WATER of cesspoolsTOWN OF S O UTHOLD shove Immo are from field observations ad or from dale oblailed from others. SUFFOLK COUNTY, NEW YORK LOT COVERAGE HSE 8 1000-87-03-05 PH 0 WIT DECK = 19.8°6 I, SCALE: l'=20' MAY 13,1999 JULY 2,1938 (prop. addition J JAA 5, 2000 f offsets 1 �� C.04.4, JAIL 24, 2000 (revised hse 1 APRIL 16, 2001 1 revised septic system,T.H.I �i q MAY 21, 2001 (revised 1 u.,,w,,, f C � JULY 20, 200/ (revision) f ) yy��AUG. 6, 200/ (revlslonl 73y� "�Cr OCT.3,2001 (rev/sion I TEST HOLE \!`,•1Q•• ""bM„ Cp..OCT./7,200/ (cont. Ioondoaon73.0_7: ,--__ £ �0�9°�,wnp� �sy r zy 2ooi/bme�dr 4Q U� 4 C �_� 1j(� - JNov 9A Tool Illy,, n TOPSOIL 0.7' � c' 07Pale brown T4s 4, 1°tl ovi`_`,�� loamy sand Za e - /1,1-., \ Pole Morn -- 1• � -,...„.-----„N2, \\ / fine sand Fie �' 900 8' h I-p 4f' Drown cows* 8 $) :and with day I N el /5 $M 8.7' . Q t7 _ --� NWNinT-- -, — ` -. / frown co se •C ly . sand SW st �0 •••• /N ..„....i,OF NEH,Y O FISCif -cf. r.W / 1r/,, a '1` l- p' ©/' ‘L--:-.9 7 I �o• 05250 �0� I - Ob ^fi ! AT, , F: NOTE; ;• 'FESSIONP�/ 4/ r •�1 SUBSURFACE SEWAGE DISPOSAL , / /I •f , SYSTEM DESIGN FIS_ ($ \ ) BY' HOBART ROAD TTI, P.E ,� 1 %� SOUTHOLD, N.Y. /1971 r° iP 'lb raa� (63/) 765 - 2954 a 4 0 i O N/6 soh ,+41 /,,,, i;� ,I lain GRADEPROPOSED 9.5 e 1400 zpp Ifl\ MSRr "'1:019'-6. a.iQ ti� Q SlpT1C MS w If CESSPOOL xi o, Lvij2 (I. 1,0 _---1/E 8.e ' 8-1 r.P C mho' of,*dam sew a�. r•• f n-• v ,e, is v _�wafer --- L-- ---- --1-— K Q et s r `�QC5'' i_: ', 1..., i��p , �G0' °f0 CROSSSECT101V - SEPTIC SYSTEM y _ i� i�9 - r1rrULKC'0LINT Y J1.1M•.."1.'6,0--..:- .tT T;NT 6;rT'AI 7H SERVICES Provide 4 Lps. 8' - g' deep%'diL I "3-'lkr'1"iTvr..'( C' 'c '$z,>_ 1d"aI N�'�A clustered with 3' clean sand aOI.•L I+I�'S 'i:1 IzF�n 'SC`L Oi��,O ipI�, and gravel collar to clean �� 2 2 sand and gravel. ah," "� ' 2001 HS REF 4, n-•ul-9 Y /4 APPROVED ! •a �..41\� f••' FOR • 'A UM OF 3:-DR.6qgg 0 I, AREA = 7, 760 sq. E ft. TO TLINE EXPIRES THREE YEARS FROM DATE OF APPROVAL � I , • =PIPE ELEVATIONS REFERENCED TO N.G.V.D. „el,„ OF NE* FLOOD ZONE FROM FIRM. � " ., 'frrMe O MAP NO. 3 61 0 3 001 66 G MAY 4, 1998 0, ' tt0 'P • � \ \J %,..4 :/ r N.Y C LIC NO. 49618 `/'\I ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ''X7ONIC 'VEYORS, P C N l OF SECTION 7209 Of THE NEW YORK STATE EDUCATION LAW /J, 4° (am 5020 FAX (63/) 765 /797 v EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS FQ �, HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF In-r DCSO 909 1 SAID MAP OR COPIES BEAR THE'IMPRESSED SEAL OF THE SURVEYOR RAVELER STREET WHOSE SIGNATURE APPEARS HEREON SOU THOL D, N.Y 11971 99-200 b.