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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK •
® act P.O. Box 1179
err �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax (516) 765-1823
MARRIAGE OFFICER ' �® �1� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 7®1
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1068 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : VIRGINIA RUMPLER
Address 1 : 30 HOFSTRA DRIVE
City St Zip GREENLAWN NY 11740
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #93-S0-99
Name Of Owner RUMPLER, VIRGINIA L.
Mailing Address 1 30 HOFSTRA DRIVE
City St Zip GREENLAWN NY 11740
Property Address 1 470 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 1 lot 5.000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 12/01/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY z Z Town Hall, 53095 Main Road
TOWN CLERK T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS %r . Southold, New York 11971
r Fax (516) 765-1823
MARRIAGE OFFICER _®44® (iia 6. Telephone (516) 765-1801
ft jIt 1 1�1 k.(.>4 L.2 �'_____'_.1, viii //I//
j 1 NOV 6 171993 4 OFFICE OF THE TOWN CLERK
i° TOWN OF SOUTHOLD
II
:L x.. 1:5,.;-r.
LE_OW1\ OF SOUT€ OLo_
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 17, 1993
Transmitted herewith is a copy of application No. 1101 for a Cesspool/
Septic Tank Construction Permit submitted by:
Vir•inia L. Rum•ler
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.
' 4-4- -164 e43-°743jj
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: cl @//0 /' ,r i' 9 2 — S o — 99 ,-
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Signatre
Dated 9'
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.OFFICE OF THE TOWN CLERK c;VrFJt' C'
JudithTT. Terry, Townown of Southol
/
Clerk z;.r O� Application No. p
l
Town Hall, 53095 Main Road ` :, •r . •;: '—, Construction
P. O. Box 1179 r:
O. �. r Alteration
Southold, New York 11971 Off- ✓..
Telephone 16)/ r4 0 Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: Vrytim L r r
APPLICANT ADDRESS: 0 t- o st eu =LJr1
"4e-eh,'a.cep n lit //71/6
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: t rQ n i a, L . r
OWNER MAILING ADDRESS: . i th S/rq , eZe
\y/se ht 4tn 1V/ 1l'r1Vo
OWNER PROPERTY ADDRESS: 47/f0 l!n&:ddse ep&e re.
� 2 2 /1/
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 79' Block / Lot :5J
_ CROSS STREET: A/or `/j //Ma) Xectel
BUILDING PERMIT NUMBER CRO S REFERENCE:.
CcJ
/ Signature of Aicant •
RECEIVED BY:
town Clerk's Office
DATE: 7/ (/ l 53 •
t'
`% :"lie J02ING WELL a SEPTIC LOCAS•2EPt�tZTEO BYOTHE�'.5. SUFFOLK CO.HEALTH DEPT.APPROVAL
-- -- --- -- -- ---
.nonsoo
E�EVATION DATUM: MEAN SEA LEVEL N,G.v.D. °�
GUM=TO COV TO II RIrSTRiCrc p:" E,9:I• ��>
Aymara la to e) • otiou
ZOOSE crzEE a M�P L P(i'�!�(=RT ctF9 D S .:1M.
SUr..VEYED FOQ
_ ' -' - STATEMENT OF INTENT I
Orzvl1.,AQY HIGH WATER MARKT > t, f I 1 ,'�. //ll II i` 1 ' {I— fl THE WATER SUPPLY AND SEWAGE DISPOSAL i
9ULICHFAD ,--- ./ 1 BV�k'FAD \V j�''J! �\.Il I/ '‘� ` . I t �J L_
SYSTEMS FOR THIS RESIDENCE WILL
- -- _^, � i FLOOD ZONE A-4 CEL-8}`
e 8 7- PT CONFORM TO THE STANDARDS OF THE
— SUFFOLK ••. DEPT. OF ATH SE-VICES.
i
EPT1 o I \ 9• ' FLOOD ZONE B — APP/j ANT
LI, 1 r i L`JI.1 :%F SCti?I,:`'t_11 –►V Y,
e
4'1'1'
/ SEPTIC A2FA �_-`---y SUFFOLK COUNTY DEPT. OF HEALTH
u +� I SERVICES - FOR APPROVAL FOR
,..! •
'.y
, am C.E55POOL . CONSTRUCTION ONLY
fit,` 1 '3
1 e�,:.�iE�•,f�S� `� ; ,/J I x I Ho. i / DATE: � � C c,
1 (�E Par+ c -a s a- , H.S.R F�F.- O. • 9, g1 7 1
1 _I FI / / ti APPRO t ' ` f 4
1':_,,,.).,:-.1.4..
La. G^ sQ, DECK. \ �. !!J ' WELL---1---�, 1 / y�k'�d',��.1-^ ��' �i�'A!�"�r! g7 ,v
�� •
C ,`� --/ 1 �; FLOOD ZONE+G` SUFFOLK CO.TAX MAP DESIGNATION:
r DIST. SECT. BLOCK PCL.
•' -t I PrZOP. HESE I I 6'
WELL' Q. 0 1\ •, ^ WELL _ ; • HO. L—r-1 //i
1000 79 I S
a 3 q+ qg ` //T�ot: ` Rkl una*T�- ;' OWNERS ADDRESS:
N I IS =Lfo�/ II _N 1¢ru�wEcl`�� utc,-' 2�r> Fc• /1' 30 HOFSTI A U21V
;M n'exl�T�` j� j GREENL/LWIV,N.Y. 11740
°o/ f b 1 T8ST F`' 'a, ,
Cass POOLS , �4 I N EL.L N� �:
_ PrZOP PAC AT 1-I17YJSE• 11.0; '
6 _ iv'FL..tS.G, GA Q..: h='.:- . SCALE -4O_-I TEL._427-'[,03
- NotSE p$b�`G� fi ' \� / AI2EA'16,100 t 5 F DEED: L.aO.t P. 30
,, : „� i / ' f — - TEST HOLE STAMP�J'PIPE
, / t ' / tl5 - -------
,t y;,�P¢ap t i /y UnauUion=ed alterucn or addition
_ '�‘i, K' \ 6 ' • AMENDED FEE'. 8, •9r -2 to this survey of the :!onot
_ ��- Sedan 72La 0l the Now York Stale
• ' UTII.ITV LINE rn
So7 EXPN �''•�`._, 1/PALL'! - SEPT I, I l3 KOY.':J Education Lar
O 5 V 1 �, t I' < SANDY Copies of Sus survey map not bearing I
l / _FE}�CE AT C.,,-...e I VGQM the lard surveyor's hated Beal or
�_�. FENCE i_N 0 2ttil ,`Z° 4//'r -=N+"I'�/,--z r o B i<owr! i' e`nb°ssedseal shall rotbeoonslderod
i r �O.S Fl.,O t� to be avabd Wp
�," ---- ---------- Guamnteea lndcatedhenon shell tun
5614720 W 75,0 .95'yo N SAYVIE�.i RD. •_o,ay,Y
20 BIGHT gra QF k WAY only touwperson for rrhommesurvey
Z i _ s•a t.!D - 3• in prepared and on by behalf a the
We company,governmental agency and
_---_-_-__----_ry Pa L.t lending Instnu on listed hereon and
'�-- — --' ------- - -------__ ---- 15110 w N to the assignees of the lending Inst-
` Pita ro tuuon Guarantees are not translatable
N
VACAT) - o 25E to additional Irseluuons or subsequent
owners.
ItrR. i ,
AI.iEt'JEU JUNE Z•t, 1992. S�hh}J
15.0 i j GRADING_PLAN .• - JULY__ , 19Q-21, __ - 96 AL
61'L,wATPc
90 2n rIN �¢ AUG =-' .- "'o
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FNDA• Iss • 9s 9.2� CPOOL�2�l AS SURVEYED MAY 13,1992 t
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_;GROUND WATEC - LZ l2 LICENSED LAND SURVEYORS ' C1'
00 GREENPORT NEW YORK