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ELIZABETH A.NEVILLEt��� - �"k Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER V� A� O �C�®Q��I', Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �� ��I Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - ,,,vl
OFFICE OF THE TOWN CLERK
SOUTHOLD INA,S111THOIRIDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2609 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ANN & EDWARD LENCESKI
Address 1 : BOX 1792
City St Zip SOUTHOLD NY 11971
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 #R10-01-0094
Name Of Owner LENCESKI, ANN & EDWARD
Mailing Address 1 PO BOX 1792
City St Zip SOUTHOLD NY 11971
Property Address 1 3700 MINNEHAHA BLVD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 3 lot 5.000
Cross Street OWAISSA BLVD
Building Permit Number Cross Reference:
Issue Date: 6/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
R62 0
ELIZABETH A. NEVILLE Town Hall, 53095 Main oad
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� ���,,,, � �I Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "�% ����1� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER vol
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 25, 2001
Transmitted herewith is a copy of application No. 2698 for a Cesspool/Septic Tank Construction
Permit submitted by:
Ann & Edward Lenceski
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:
9 -
/Signatur�
Dated
( L.
! OFFICE OF THE TOWN CLERK �' O�
TOWN OF SOUTHOLD '•
O�� KCOG Application No.���
F J7ABETH A.NEVILLE,TOWN CLERK i44# Construction t/P.O.BOX 1179 1
SOUTHOLD,NEW YORK 11971 p • T : Alteration /
� � •
V
Telephone �y0/� �0��',, • $10.00 -Residential
(631) 765-1800 Ol �,I° $25.00 -Non--Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for JUN 2 5 2001
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL Southold Town Clerk
Permit No. •
Fee •$ , _
DATE �� 0 ( 2,0
APPLICANT NAME: • al,11/
4G -C fe,ek,`
APPLICANT ADDRESS: J1LTh3f //9% 376 ,5 i/ LdLL, dirj--e(
SEPTIC CESSPOOL
DESC IPTION OF PROPOSED C N TRUCTION OR ALTERATION
ThaidAr4.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTATION:
OWNER OF PROPERTY: rd'ctivotsale okc-
OWNER MAILING ADDRESS: _ 9)ot. _
OWNER PROPERTY ADDRESS: 3 76, 6 " t / /Lei
PWelt '(f 7j. , i197/
TELEPHONE NUMBER OF CONTACT PERSON: ./6s-o/01
TAX MAP NO. : Seclifo7 3 pry/ Block e Lot eS. •
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: .
ig atu
n re
S •f Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
I an fans the STAAVAROS FAR APPROVAL
AM.)CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR fAMth Y RESIDENCES SURVEY OF PR OPER T Y
and abide by the conditions
ns set set forth therein ono on the
perndl to construct
AT LAUGHING WATER
The locations of wells and cesspools T O WN OF SO UTHOLD
SilOWn hereon are from field observations
and or from data obtained from others. SUFFOLK C O UNT Y, NEW YORK
1000-87-03-05
SCALE: 1 '=20'
MAY 13 1999
ss� JULY 2, 1999 (prop. addition 1
y� JAN.'5, 2000 ( o//sets 1
c r Ct} JAN 24, 2000 f revised hse 1
�frlr APRIL 16, 2001 ( revised sep/ic system,T.H. 1
/� �i MAY 21, 200/ ( rev/sed 1
/ vh WM -
tAl
73.0711n,h (C0�er TEST HOLE
�` 0" r w M ai C��
_� ` e `�rkAP�(1 ..14') TOPSOIL
_ 0.7'
-- -- -- c'mQs Woos=auk O7'_ -� Pale brown -
- r�� h d— _` loamy sand
tF - - �c./-- - Sc 3'
(O .�� /FF
r ;C ( / °f Pole brown
•- _ 4•e- / N fine sand
SW
(`,� ti` �9e, •
8'
/ 4
( �` � Brown line
E 8 44 Jr Q ��``` E z la with clay
el SAI 8.7'
z, \ \ / N s
xC� —.- �! — . � \ ^ Water In pale
�
C ® \ l sand coarseSW
1O' - I 4 —
9'/ AA' -...''::-.:;' .,o,- — I------- , ' 7. \\ b ity:
i ,
1 , is 1\,: ,' • "- 4' x, 01(
W \ .. 1:1:.e
-a '°`$ r R+ »°c. �.l f '` ` ' �1 �CI NOTE:- �' fi'l if SUBSURFACE SEWAGE DISPOSAL
E / • o �� 1 be peg � ` ' ' r c R, �\') SYSTEM DESIGN -
�. Z i �, 1'/-ems/( d 1. 3 �� �`p
BY: JOSEPH FISChIETTl, P.E.
f y j I`/ 1i _ -„ 13 Zr \ HOBART ROAD
.»-..... _ , ��f, .� ��� ; SYs�� i`�c I- k SOUTHOLD, N.Y. 1197/
ft w'i, ! I p (63/1 765 2954
l ! 1 0 MOUSE
.ed./Co
AG ,-r $CIO efi 1I, '' / /,,a p I ^ _ } • •
tri of i2
�, S 1 a 1�5 St" So '8• ` • _ I �I 4" '�,
PROPOSED GRADE
�Jlo•5
9:>• 12 A. ro A% 00•, i`� / fi I ab.
,°7 O , o O 4.I' ",,,,;(r. fE sEP77C TAP k , IP .8.1 , CESSPOOL ,T.I
0 " 6 P
Wi' Q ��4 0, °• W I 9r wafer 1 cosier o%�n eldest seed
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w 1° s
1 6M ,9, _
isa PI . wI 2 ,
A �,..9.?
CROSS SECTION - SEPTIC SYSTEM
k; / _
.?4 g c.4 I- - ...v -,„:, •
o lit.
Provide 4 Lps. 8' 0 4' deep
8 is, z 5k clustered with 3' clean sand / �'
g and gravel collar to clean \ ,_,
'Q,
1.
O OF NE /
o sand and grave% w
w P.a 04 .,� csscHF °'8._
AREA = 7, 760 sq. ft. ,.. �,:. 01
To TIE LINE 1. .. .x'1 x
t
• =PIPE � '. �o a5z5�� " �° �,u_„^
ELEVATIONS REFERENCED TO N.G.V.D. `�Ro ssio�P��+ .‘t OF NE - ^''`; �-: ' '
�.,
FLOOD ZONE FROM FIRM. .. 'P', lYp • . �;:�.5 c, . 1
MAP NO. 36103C0I66 G MAY 4, 1998 `o o�4'�•MEr�r,+,'p u~= cs�
Z-3 c”)
e / r0,, • YS L1C NO 49618
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ' Vit` 1 - F "IIEYIP Z, , F C
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW
EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS ( ''° /��'S�d4d��J! r AX (63/1 765 - 1797
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P I SSI •'NI `
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 STRZEET
WHOSE SIGNATURE APPEARS HEREON SOUTHOLD, N Y 11971 99-200