HomeMy WebLinkAboutLajda, Deborah A
ELIZABETH A.NEVILLEG.fl Town Hall, 53095 Main Road
TOWN CLERK , p _ P.O. Box 1179
y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ��% t• iFax (516) 765-1823
MARRIAGE OFFICER � yfro Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 1 I d
FREEDOM OF INFORMATION OFFICER
gtl
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2201 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DEBORAH & RONALD LAJDA
Address 1 : PO BOX 366
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-98-0135
Name Of Owner LAJDA, DEBORAH & RONALD
Mailing Address 1 PO BOX 366
City St Zip CUTCHOGUE NY 11935
Property Address 1 1640 DUCK POND LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 83.00 block 4 lot 7.000
Cross Street OLIVIA LANE
Building Permit Number Cross Reference:
Issue Date: 12/21/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
��� .....
6-0
ELIZABETH A.NEVILLE a ti'Z` y�; Town Hall, 53095 Main Road
TOWN CLERK I p 1 , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS y. Southold,New York 11971
MARRIAGE OFFICER : G `� / Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER ':'j'o 40' 11 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = '/ 41 aal'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 29, 1999
Transmitted herewith is a copy of application No. 2286 for a Cesspool/
Septic Tank Construction Permit submitted by:
Deborah and Ronald Lajda
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
4- 47C k..
Linda J. Cooper
* * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE ✓
DISAPPROVE
Comments:
Signatu
Dated
• N
'
OFFICE OF THE TOWN CLERK , COMk
TOWN OF SOUTHOLD �` QG Application No. 22_4*
ELIZABETH A.NEVILLE,TOWN CLERK /`�
P.O.BOX 1179 Construction
b(--
SOUTHOLD,NEW YORK 11971 Z •
c rn Alteration
Telephone V0� Q�'i" $10.00 - Residential
(516) 65-1801 Ol ���'�� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /05/5)9
APPLICANT NAME: b6 ( Jl n cut a_ La UCQ_
APPLICANT ADDRESS: PC 6 U x .3(o le
0.1-ililr)0( Q_ N3, l(9 3\5
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 'Von OJd L aJc(a -f \ 4e-Q.a�
OWNER MAILING ADDRESS: pc) �v k 3 oto0
ei -fr,GM 8c -- Al 1/ 9 ? S
OWNER PROPERTY ADDRESS: /6, y(:), c//( /%AUC
Cu- hlu,e /u /1? 3 5-
TELEPHONE
TELEPHONE NUMBER OF CONTACT PERSON: V6330 qtb0►7nvh /s e-c___.
TAX MAP NO. : Section Q ,' 3 Block 0 y Lot C) 7
CROSS STREET:
.41
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of A pp scant
RECEIVED BY: rf-7_5
Town Clerk's Office
DATE: ///27/5'9
.
,:n:,,,,,n421,
i
1
• TEST HOLE DATA
r
SUPPLISD BY : McDONALD GEOSCIENCE
EXISTING GRADE
•••T.i''i�{�V t, DANK MOBN LOAM a SURVEY OF
•
/ N_, mewmfr W M OL
LOTS 7
I
OIOOW LOAMY SILTK /H f
MAP OF WOODBINE MANOR
4'
SITUATE
MOtna SILTY SAND w/SOXORAYIE SM
c� ]�
TOWN OF SOUTHOLD
/ rQ " �d r
���� SUFFOLK COUNTY, N.Y.
/� NOM PINE TO most sAN0 W/IDX CRAWL SW ZONED AC
l( /C /
t°/L/t s2 16 U, 17/
r ,/„ (> t. TM 1000-083-04,07
rl/ FINISHED GRADE FM 8239
!v/�// , .� FILf/O DEC. 15, 1986
,-,7, 1' MIN.MAX. i 26 AUGUST 1998
t
�Cf I�P. ..- 1-.. 2
it" Q� �I / SCALE 1'4..50'
300S.F.
SIDE WALL I-I OR
AREA-. 4,0,50.5:0 sr
•
a S/f �`LEACHING 0.9266 ACRES
I
I GUARANTEED TO
/ (G�� / 5- 2' MIN.
RONALD HUG
AJDA
if-E,/e.47 I GROUNDWATER DEBORAH HUGHES
I/ FIDEUTY NATIONAL TITLE INS. CO.
TOWN OF SOUTHOLD
TYPICAL CESSPOOL SYSTEM
N. T. S. NOTE: ELEVATIONS SHOWN HEREON
ARE ASSUMED DATUM
r FINISHED GRADE
n.rn,/xyi
.„.czt
1' MIN.
2'MAX.
SURVEYED FOR RONALD LAJDA
I/e /i• --� r--- !/1' DEBORAH HUGHES
0
I
8' MIN. TO CESSPOOL
9001GAL. SEPTIC TANK
Guarantees indicated here on shall net
only to the person for whom the survey
TYPICAL SEPTIC TANK is prepared, and on his behalf to the
title cempeny, C overmentat Agency,
tending irstit•.ticn, if listed hereon, and
tc the cssignees of the lending institution.
Cucrcntees cre nct tronsfershie to
SUFFOLK CO. HEALTH DEPT. APPROVAL additional institutions or s,bsequzm rR
owne
H.S. NO.
Unauthorized alteration or addition to Min
STATEMENT OF INTENT survey i; o violation of Section 7209 of
THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS the New York State Education Law,
FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS
OF THE SUFFOLK CO. DEPT OF HEATH SERVICES Copies of this survey map not bearing
J the Land Surveyors embossed seal shah
S - /4Rd-T"
not be considered to be a valid true
PLIGNT copy.
TOWN OF SOUTHOLD
FOR APPROVAL OF CONSTRUCTION ONLY
DATE :
APPROVAL :
•
SUFFOLK CO. TAX MAP DESIGINATION SURVEYED BY
DIST. SECT. BLOCK PCL. STANLEY J. ISAKSEN, JR.
1000 083 04 07 P.O. BRX 294
OWNER — NEW ' FFOLK, >Y 1195
516 «, ,- ,
,' RONALD LAJDA, DEBORAH HUGHES
f
, ENS NO SU�; I R
NYS . NO. 492 --
,R/ 98C730
N
DEPT.C"
.
1
r LOT# 6
NV -go
'98 OCT 14 P 1 :5
Seer p U'
/� 9s. H i NO3
cit." V h 411‘).
...411, /36.
S sr 00' 00' E 150.00' _
WELL>150' 50.51 'fr '-
547.0
WA
s 1 d fp-er
20' DRAINAGE EASEMENT /if-
.'k177/�JW� �- r sir-gel �orn®r
�" ! PROP WELL
oval '74
f
LOT GENERALLY LEVEL . 'tet
alliV f
-r Gaye/ a/v ' fin/
C LOTS 0 I
25
/
PREP. DW. FRAME GARAGE U�44 {
PRI
25
leie/*S 4'
60' 2,000± SF
*'" SINGLE FAMILY RES. 35'
Et W/3 BEDROOMS
g
CI)
3
h 1J60
1
SEPTIC 70' 8
PROPpS£D TANK L.
1 tel
50 39 49.95
I CESSPOOL
Rs 25'.
A= 39.27'
TEST HOLED
Q N 39' 00' 00' W 125.00'
49.60 49.41
• 50.07 50.14 DUCK POND — ROAD 49.87 q
I SUPPOL1C COUNTY DEPARTMENT OF HEALTH SERVICES
MOOT FOR APPROVAL OF CONSTRUCTION FOR A
FAMILY RESIDENCE ONLY
- 11j,
FOR MAXIMUM OF BEDROOMS
1 IDCPMEST FIREE TEARS ' . DATE OF APPROVAL
li
I REV. WELL 9 SANITARY LOC. 7 OCT.98