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ELIZABETH A.NEVILLE ��� Ptok : Town Hall, 53095 Main Road
TOWN CLERK ; y a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t Southold, New York 11971
MARRIAGE OFFICER y �1�, Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER __�®1 Alp_ _ 4.„0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ et'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2474 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SHARON VALEK
Address 1 : 120 SPRINGVILLE ROAD
City`St Zip HAMPTON BAYS NY 11946
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 # R10-00-0105
Name Of Owner VALEK, SHARON & RICHARD
Mailing Address 1 120 SPRINGVILLE ROAD
City St Zip HAMPTON BAYS NY 11946
Property Address 1 250 CONDOR COURT
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 9 lot 13.000
Cross Street WHITE EAGLE DRIVE
Building Permit Number Cross Reference:
Issue Date: 11/30/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� y1: Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� y ���1, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�®1 .0000 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,•1
.. .�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office P i '1 2 $ 2000 !;
DATED: November 28, 2000 L--DEPT.=
Transmitted herewith is a copy of application No. 2562 for a Cesspool/Septic Tank Construction
Permit submitted by:
Sharon Valek
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.
Linda J. Cooper '
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
ltj a._00 a
Dated
gid►
,I,IIIIIIIi���';'
`A)FFICE OF THE TOWN CLERK VVV.111 C V OLkV
TOWN OF SOUTHOLD �� BG Application No. oQj(°ELIZABETH A.NEVILLE,TOWN CLERK gf
P.O.BOX 1179 . • Construction L/-
SOUTHOLD,
SOUTHOLD,NEW YORK 11971
v ^' Alteration
TelephoneO,y �Q���' $10.00 - Residential
(631) 765-1800 = 1 , ,'�o $25.00 - Non-Residential
,..,,III
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Q E C E I V E D
APPLICATION
for NOV 2 fw
2000
CONSTRUCTION or ALTERATION PERMIT4f61®atedv Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE f\fc v ,2F/ 0'OOD
APPLICANT NAME: 5 hU,rc v1 I 0, ( Q,IL
APPLICANT ADDRESS: / O p lYl V! Ile_ Rd,
l a vvtp 10 vi Bar
t Y. //95t6
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
GC/014 camily bwe_l1i a .s-Eory
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: , hr.,ro,- R r cha v-d IJc (e K
OWNER MAILING ADDRESS: lao Sprrn4tJi//e 1?((
(kw f o✓) t\J 17L4
OWNER PROPERTY ADDRESS: ate. 7'
/cure ( iuY
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block ,��C�`j Lot /
CROSS STREET: Li \-14 E e4,5 it.
BUILDING PERMIT NUMBER CROSS REFERENCE:
7,/,4-#77
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
_ _ _ __.-___ _
v CAST IRON
COVER GIST IRON
•
COVER WELL WELL
TEST HOLE IMPROVED cP
Z McDONALD GEOSCIENCE 9/19/2000 LOT 14
DARK 0 Cis
BROWN '� •1 �. _% 1
v U -0.5' SANDY LOAM �1 t,
3 o BROWNAN LOAMY S32'33'42"E `�
CltOC 270.00
= a - --
Wa0 ,�
rt PALE BROWN g~ Ng
`n VACANT -
.;c FINE TO $QC, / / WOODED / /
MEDIUM SAND ^N� o / / LOT 13 O
O 2
IZ
(.....) (., 6171 (
y _ /
Z -15.7' m ' �l� � � OZ I / / /i � U D-) ^ ,
WATER IN i I
\ l -I MLN. L' �' U U a �)
PALE BROWN , k
FINE TO / / O
o ''� I
MEDIUM SAND I 99.7\ \ ,E5 W- '�
-17' ' + / �.� O 90.1 I 1 / / QQ. tu '� �O CP
01 9
10 N Et
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I PROPOS / /
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MAINTAINS 00 WMIN. / Z I O O Ca
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Z: o SEPA ON FROM =�
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( E fi G do PRO CONC. MON. I. r� O
Y SANITARY SYSTEA:0 / - W o
�CONC. MON / -/ -- ,� 0.3' E. , Q ; ►a tn
o N32'33'42"W a o
0 270.00' A a / i 1
N
LOT 12 0 WELL W a
I a � a
IMPROVED o �O U w 1 w
AREA: 40,500 S.F. = 0.930 AC. '' O W
ELEVATIONS ARE IN ASSUMED DATUM. a RL a 8 CP
VO SURFACE WATER EVIDENT WITHIN 300 FEET. WHITE E4 G L E DRIVE
CERTIFIED TO: JOB NO. F2841 WELL A
RICHARD & SHARON VALEK MAP NO. 7770 ( = i,•-•.--. ' SURVEY OF
FILED:AUG. 30, 1984 • 'Y LOT 13
REVISIONS: �, ;AY'�`�' F,. 3' ■ .-
LOCATE ADJOINERS WELLS & + MAP OF RI 0 T �*'7 �e o
ISEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED SANITARY 05/30/2000 =���,Rr,�, GOLDEN VIEW ESTATES • H �—%, I '�' `-'
?E NOT G UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT REV. 9/20/2000 / �,
IE TME,of THE c 'RVEY �� SITUATE A T
•PES INDICATED HEREON SHALL RUN ONLY TO THE PERSON(S)FOR O+M 132 • • • : hw
40N 7}��'i.'SUR?EY/S PREPARED.AND ON HIS BEHALF 7D THE TYLE COM- C‘1. - ; "•+ �-I LAUREL HL7!J°% on Ba N.Y. 4+` 6
JARAHWY, GOVERNMENTAL AGENCY AND LENDING INSTTULONS LISTED HEREON, '' 01¢� �v.
ID 7 J THE ASSIGNER_OF THE LENDING INSTITUTION. GUARANTEES ARE . 4c, TOWN OF SOUTHOLD (631) "8-5330
IT TRUVSFERABLE 1�ADDITONAL INSTTUTONS OR SUBSEQUENT OWNERS •
'E OFE t)IIS (OP DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO +p�A 0� Q' SUFFOLK COUNTY, NEW YORK
PROPERTY U155 ARE FOR A SP£Clf1C PURPOSE AND USE AND THERE- _ Marc E. Chore t, LS.
RE ARE NOT INTENDED TO GUIDE THE ER£CTON OF FENCES, RETAINING Successors... . to
'V O .Pf,,OLS,C SARUC, PLANTING AREAS, ADDRIONS TO BULLRINGS AND SCALE. 1'=50' DATE: APRIL 13, 2000 Paul T. Canalize, LS Robert A Kart LS.
IL OIN_R CONSTRUCTION.
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