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HomeMy WebLinkAboutStasiukiewicz • OFFICE OF THE TOWN CLERK c-IFO(/(`, Town of Southold &,%-a„46,•• Judith T. Terry, Town Clerk � .4 L- Town Hall, 53095 Main Road !4;;;'''rio4 '` P. O. Box 1179 .(3r y}� Southold, New York 11971 O �����, Telephone J'ffle/ : (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 155 Residential X Non-Residential Fee $ 10.00 Septic Cesspool X • PERMIT ISSUED TO: NAME: Henry and Deborah Stasiukiewicz ADDRESS: P.O. Box 981 Cutchogue, New York 11935 DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION New Single Family Dwelling with Sanitary System LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: OWNER OF PROPERTY: Henry and Deborah Stasiukiewicz OWNER MAILING ADDRESS: P.O. Box 981 Cutchogue, New York 11935 OWNER PROPERTY ADDRESS : Cases Lane Extension Cutchogue, New York TAX MAP NO. : Section 109 Block 5 Lot p/o 14.40 CROSS STREET: Corner of Woodland and Cases Lane BUILDING PERMIT NUMBER CROSS REFERENCE: Judith T. Terry ' Southold Town Clerk DATE : April 28, 1987 (TOWN SEAL) ''..�.: Com``�'-, %cin `' " '` ,,,;.41-,,,_ Town Hall, 53095 Main Road ,,�.. .,/ `' . „-`'' ;' P.O. Box 1 179 �f ' ,%.V� -, Southold, New York 11971 F s, t_ rte` P.:_, �R i' JUDITH T. TERRY } " TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK - TOWN OF SOUTHOLD • April 28, 1987 Henry and Deborah Stasiukiewicz P.O. Box 981 Cutchogue, New York 11935 Re: Cases Lane Extension . Cutchogue, New York Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank or Cesspool System for which you applied. Please be advised that each owner of real property operating an on-site sewage disposal system, such as a septic tank or cesspool must, prior to such operation, possess in the name of the owner an Operation Permit for the system. The Operation Permit is issued by the Town Clerk's Office. The fee for an Operation Permit is ten dollars ($10. 00) for residential use and twenty-five dollars ($25. 00) for non-residential. Please have the owner complete the enclosed Application for an Operation Permit and return it to this office along with the proper fee. • For your general information I have enclosed an Informational Bulletin regarding the Scavenger Waste Laws adopted by the Southold Town Board. Should you have any questions pertaining to either permits or the Scavenger Waste Laws, please do not hesitate to contact this office. We will be glad to assist you in any way possible. Very truly ?fours, ,�.�� Judith T. Terry Southold Town Clerk Enclosures (3) JTT/Ijc c0 r UL ,' , ''tel 4t , Town Hall, 53095 Main Road ".� Nvo loop P.O. Box 728 -�` .a �r` r�� Southold, New York 11971 JUDITH T TERRY TELEPHONE TOWN CLFRI. (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD April 20, 1987 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 159 for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by Henry and Deborah Stasiukiewicz Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if we may issue the permit. Please complete the form below and return it to my office. Thank you. • efra4 %wooer Imo, Judith T. Terry Southold Town Clerk * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendation: APPROVE - DISAPPROVE - COMMENTS: 0„, uUA1 Q,4 W-2- C ` 10 . \r:C.±\-1, Signature Date OFFICE OF THE TOWN CLERK Town of Southold Judith T. Terry, Town Clerk Application Town Hall, 53095 Main Road Construction P. 0. Box 1179 Southold, New York 11971 Alteration Tele hone Residential P (516) 765-1801 Non-Residential TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ DATE 1/' / g//(17 APPLICANT NAME: ✓ . behteai .�� �/� ew/ G2-- APPLICANT ADDRESS: /' tL• ,&)( / 1/ 9 `j1-.� / QA CCirC hOc3 je-y, • SEPTIC CESSPOOL DESCRIPTION OF PROPOSED C NSTRUCTION OR ALTERATION ,c7152(,' f(Yf)///f2)6(1E1 If, LOCATION MAP: .Must be attached hereto before permit may be issued. 'LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER. OF PROPERTY: 7fI712 2e1ea* S 1)-5/U� etA6 • v r OWNER MAILING ADDRESS: (P-o- 6a&C GSI , /6A GeohiPa. iho 1e/ ,i- _ .11935 OWNER PROPERTY ADDRESS: 08505 pie ,C'7 , d' CO7C boe5 TELEPHONE NUMBER OF CONTACT PERSON: n TAX MAP NO. : Section l01 Block 5 Lot P �• ��______ CROSS STREET: c/o hjfa©o � �'/]��-C 1I'5t s 0,4441 BUILDING PERMIT NUMBER CROSS REFERENCE: /941612-104 . .441 Signature of Applicant RECEIVED 113Y1IVni, Town Clerk's Office DATE: r JGU?hi ld _ u 1_) 1— I / 4 4043, . ►� Qm ti 4.3 / 40000 /� � � C.7 / Ralph H. Cosi Or f Drmerl , o 1._ f & R . .. usse 4, c„ B Ca �," _ CO czQ NOTE: 0 „, TEST HOLE 0.0' • 12 0 / �� AREA TO TIE LINE = 690495 F AREA TO CREEK = 75120 S.• F LOAM 3' Q s ‘,-.,,,,i, -, " --10-- INDICATES CONTOUR LINEA COARSE Ct �N SAND r. ' GR WATER 66' EL_ - 5.2 4/JA • ELEVATIONS SHOWN HEREON COARSE 6SAND ARE REFERENCED TO N G.VD. 1929 13' /y LP !`S8 T SINGLE FAMILY DWELLING ONLY �4 '.--- ... -_-_- as FOR 0 Sit � Y SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES HENS' ST, U.' IEWIC B DEBORAH STASIUKIEWICZ MARCH 18, 1987 JAN 23,1986 '. DEC 12,1985 FOR APPROVAL OF CONSTRUCTION ONLY CU T DATE NOV 18,1985 TOWN OF SOUTHOLDSCALE I"= 60' DATE 9— 7` r 7 HS REF. NO. %-? -S 0-31 SUFFOLK COUNTY, NEW YORK NO 85-1481 a UHAUTHOR1zE0 ALTERATION OR ADDITION TO THIS GUARANTEED TO SURVEY ISA VIOLATION Of SECTION 7209 OF THE USLIFE TITLE INSURANCE CO OF NY. APPROVEn NEW YORK STATE EDUCATION LAW N COPIES Cr THIS SURVEY NOT QEARIt1G THE LAND HENRY ST•'-` K I1 ,E. SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL DEBORA - p It K'c 'A 6 t 63 4 3 476 NOT DE CONSIDERED TO BE A VALID TRUE COPY *GUARANTEES INDICATED HEREON SHALL RUN ONLY TO FID t•% O� HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED �P ro AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERN- O N NEAREST WATER S3AIN_E91 ~ N SOURCE OF WATER PRIVATE_PUOLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED 4 . '� it G SUFF CO TAX MAP DIST 1000 SECTION 129 BLOCK...5___LOT WO 14 40 HEREON, AND TO THE ASSIGNEES OF THE LENDING s� _ *THEREARE HO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE / ! OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT {tt. OWNERS �` D THE WATER SUPPLY AND SE 1GE DISPOSAL SYSTEM FOR THIS RESIDENCE *DISTANCES SHOWN HEREON FROM PROPERTY LINES j WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC r .�� b��,. OF HEALTH ERVICES C PURPOSE Ado ARE NOT TO BE USED TO ESTABLISH ase APPLICANT •0�7dait®gifG._ VC Z- PROPERTY LINES OR FOR THE ERECTION OF FENCES 4,s I - �rff //�Y�(� iiii�d G(OV C. �0 too SE1���0 ADDRESS po )30 y 4S1 0o it D Lip t ItiN,v ai L TEL 131-i /2-72- ,p YOUNG a YOUNGE RIVERHEAD, NEW YORK RE- LOT NO 2 MINOR SUBDIVISION "ESTATE OF FRANK H ....„ •,. ,„ CASE s? =L ALDEN W YOUNG,PROFESSIONAL ENGINEER n.STAKE AND LAND SURVEYOR N Y.S UCENSE NO 12845 HOWARD W YOUNG, LAND SURVEYOR *THE LOCATION OF WELL(W),SEPTIC TANK(3T)8 CESSPOOLS(CP)S N I<RECNa N Y S LICENSE NO 45893 r^s "?'"'". 'rIFI I) O!^{CNAT)O.19 d{'0 O1)DATA ODTR.IKED FROM OTHERS _ ,_ _ _ 0 Er - o EX T E�S� -- ...,N /5002, 0/V L.'s 3 . E /?.5 rr . 0 C o qs .' E S , ,, . Ot' �S p�02130,, (EST 0 E EA 7- �z �, �S`no- 'G ' 0 Fk CAS� ) RI ry N, cI cm r�, m / / U , / .-: mNI Qi )'\1 'm I ..i • r iF . Iii,`,,T.F. ii f:: i i i .0 , ./ W CIr N OY�L-JL' if 0 ! 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