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HomeMy WebLinkAboutKominsky �,''jWFO(,�C' JUDITH T.TERRY tss_°® G'1< Town Hall, 53095 Main Road TOWN CLERK ` P.O. Box 1179 �` Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O �� Fax(516) 765-1823 MARRIAGE OFFICER NA RECORDS MANAGEMENT OFFICER _ O.( , *is" Telephone 1� Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3632-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner KOMINSKY Mailing Address 1 CIO ELE DEVELOPMENT CORP. Mailing Address 2 ' P. O. BOX 1143 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 1720 GABRIELLA COURT Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 000-000-000,0 Tax Map No. section 108.00 block 4 lot 7.031 Cross Street ELIJAH'S LANE Issue Date: 5/15/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) Lo# 2cp 36 3 OFFICE OF THE TOWN CLERK c$FOL, Town of Southold �� CQG Application No:� Judith T. Terry, Town Clerk y Town Hall, 53095 Main Road .� $10.00 - Residential P. O. Box 1179 u' • *► ;' $25.00 - Non-Residential _ Southold, New York 11971 O ��`� Telephone _ .( • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • 4111 DATE 4 , 1 i I '- -- OWNER NAME: (2)Yr) v OWNER MAILING ADDRESS: 17D-0 C7 a_ ba- I I Z- C71-1 M Z- ± LA clC 1 ,\) •y « s OWNER PROPERTY ADDRESS: St4YY1 G OWNER TELEPHONE NUMBER: TAX MAP NO. : Section ` ©5c Block 4 Lot 7 . J 1 CROSS STREET: Ell ,, pt h . S Lpto 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.) iin. - Applicant re of RECEIVED BY: Town Clerk's Office DATE: • DNA. well and cessols t r.-� - snown neretonnarel fromsi eld observations • ....c, and/or from data obtained from olncrs. �� VAR 2� t a O ., Q 24,\• A �+� .n Suffolk Co.Dept !;:slfft Saty n ti ^ 4 .GnvtronmentZI Protection d O t" �'D. �j io ELEVATIQN.S ARE REFERENCED dL Q ,-Is ✓ — - TO AN ASSattED DATUM. V ` �. (SI-7e ' i .' °S 2 l'I.P\ -`11,._ y / <O 6 a � j%-11:71,.._., �� ���s SUM=COti!YDDEFAMER!'OF HEALTH 90RVK:ES P Y fl15Y 4D DA FOR MAXIMUM Gr=— \ ; Trs.P.�'o YEARS FROM DATE OF APPROVAL . - \,- -/��' 6� R=25.00,- '':',./..\\\ 1,�� SURVEY OF L=38.85• _ LOT 26 . f'` ,.v - "ELIJAH'S LANE ESTATES, SECT..2 " ^ra{ •��, ` �2 - FILED OCT 8, 1996 FILE NO. 9912. 1.- -:-'1\-- , a�� AT MA TTITUCK TOWN OF SOUTHOLD ��p n "� \``, �� c �s SUFFOLK COUNTY, N_ Y. y �� o v• 1000- 108- 04 -P/O 7.1 Q .114) Scale: 1"= 40' �, Zo Dec. 4, 1996 s 9_ N . -9 o ,..,1_ . AREA = 411 417 sq.ft. . 0 \ - , . .,.t.;OF IV-7 I am familia/ with the STANDARDS FOR APPROVAL / " __ °�'"- AND CONSTn 1CTlON OF SUBSURFACE SEWAGE ANY ALTERATION F ADDITION O THIS SURVEY•'S A VIOLATION -1.7 ,.�� OF SECTION PER OF THE 209 YORK STATE ALL CER LAW, DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES - �r�y -3 N.Y. . LIC. I C. 496/8 EXCEPT AS PER SECTION 7209-SUBDIVISION Z ALL CERTIFICATIONS � w^� Yr/ , HEREON ARE VALID FOR TI-uS MAP AND COPIES THEREOF ONLY IF and will abide by the conditions set forth therein and on the SAID MAP OR COPIES BEAR TZ -IMPRESSED SEAL OF THE SURVEYOR permit to construct. f;ECONIC sSOV. YORS, P.C. WHOSE SIGNATURE APPEARS HEREON. (.5I 0%765 --3020 ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM ALTERED BY' P.`Q 18QX 909 t MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY 123 TEEI'VELER ,gTREET OF ANOTHER SURVEYOR S MAP. TERMS SUCH AS 'INSPECTED'AND SOU :` N ef 11971 ''BROUGHT-TO-DATE'ARE NC'IN COMPLIANCE WITH THE LAW. 96 - 317 26 /r Si – '�. �i�" /�« The locations of wells and cessocols . �� (i shown hereon are from field observations 'BAR 25 and/or from do/a obtained from others. • d Suffolk Co.Dept o!- tth Somme ti O .5\a `nom, 0'1` ErMronmen r otarticno P 2 m, - II y C'' Q 0 `rm tsj TO AN AS&AAED DATIONS ARE�4�� r- 9j 7 • 0 j St3Pl0[g CDjAilY D�'A8'i]�T 08 HBALTB iVFCL'S MOST T�AMC/CAL Mt C i1L^ Ii POR A - • � - t z 7A SLY ONLY 941. \d E , _ • moo. �� �W., DAIS �, Rg ,0 ,4 7 _D 1 116 — O rat kummum mr__—=soma `� ''� \ - E T YEARS FROM DATE 0 F PPL')VAL R=25.00' ''"'---------"--'::;\ \ 2�1 0 \�' SURVEY OF L=38.85' " �\ \ LOT 26 Al,v C. rc. \ . "ELIJAH'S LANE ESTATES, SECT.2 " 9,or 0; FILED OCT 8, 1996 FILE NO. 9912 ?�, cv� ''\ �� AT MATTITUCK n� t TOWN OF SOUTHOLD 0. C �Gd �s SUFFOLK COUNTY, N. Y. P� \ _ v 1000– 108- 04—P/07.1 • Scale: 1"= 40' 'n �` ,� 52\92 Dec. 4, 1996 �' S' • • AREA = 41,417 sq.ft 0 0 (//''.-------')s,.,,_at=OF r,,� . I am familiar with the STANDARDS FOR APPROVAL ANY ALTERATION F ADDITION TO TMS SURVEY IS A VIOLATION AND CONSTn"JCT10N OF SUBSURFACE SEWAGE OF SECTION 7209 OF THE AEW YORK STATE EDUCATION LAW, 7,-��EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES JTn . LlC. NO. 49618 HEREON ARE VALID FOR 71•0S MAP AND COPIES THEREOF ONLY IF :