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ELIZABETH A. NEVILLE f hTown Hall, 53095 Main Road
TOWN CLERK f P.O. Box 1179
REGISTRAR OF VITAL STATISTICS •' i Southold, New York 11971
MARRIAGE OFFICER ` ® �' �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER __ ® zn i�//',®'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2980 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : KEVORK DEMIRCIYAN
Address 1: 14 FLOWER ROAD
City St Zip VALLEY STREAM NY 11581
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 #R10-02-0079
Name Of Owner DEMIRCIYAN, KEVORK
Mailing Address 1 14 FLOWER ROAD
City St Zip VALLEY STREAM NY 11581
Property Address 1 160 OSPREY NEST ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 35.00 block 6 lot 19.000
Cross Street SNUG HARBOR ROAD
Building Permit Number Cross Reference:
Issue Date: 2/18/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
I
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ELIZABETH A.NEVILLE t,', 1 Town Hall, 53095 Main Road
TOWN CLERK ; - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold' New York 11971
MARRIAGE OFFICER `` /Bi Fax
/�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � �®1 *00 Fax
(631) 765-1800
FREEDOM OF IN��TION OFFICER southoldtown.northfork.net
; OFFICE OF THE TOWN CLERK
2 0 2002 t.�,�
_� , TOWN OF SOUTHOLD
TO:r - • Soutliold-Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 20, 2002
Transmitted herewith is a copy of application No. 3101 for a Cesspool/Septic Tank Construction
Permit submitted by:
Kevork& Janet Demirciyan
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:
4"—
`
Signature
/0,-/24/2._
Dated
i
OFFICE OF THE TOWN CLERK ,°'' FVOtK
TOWN OF SOUTHOLD ,������ COGS; Application No. 310
ELIZABETH A.NEVILLE,TOWN CLERK 'y /
P.O.BOX 1179 : Construction
SOUTHOLD,NEW YORK 11971 : Alteration
O gZr• ,,� $10.00 - Residential
Telephone � w
'
(516) 765-1801 = 1 * �0' $25.00 -Non-Residential
..�,o/P
TOWN OF SOUTHOLD
. SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
F DATE ec at? 02—
APPLICANT NAME: /(<EVOX/1( 404 :J-,----4.../, ,r ler/7,e c//,4,i/
APPLICANT ADDRESS: /7 ALok✓,,e 76 . -,.,e7 free/Qt.-,
,vvy Jis di
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Vt----Gf / /cm?7 / 2 v1 <--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A-"E!/o/z4 4,,6 d.,;.,€r ' ,11//ZC/iii,-)
OWNER MAILING ADDRESS: /5/ /Lowed . i% d 7e,a,g,
PS-1),/
�ceo
OWNER PROPERTY ADDRESS: uS ,/�l +. a
TELEPHONE NUMBER OF CONTACT,3PERSON:// A
TAX MAP NO. : Section s Block (p Lot /9
CROSS STREET: ---,/(/v6 7V,49k V23ot e
BUILDING PERMIT NUMBER CROSS4J, /.
ERENCE:
' '', (-nt,
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Signature of Applicant
5
RECEIVED BY: (b)
LL__
II Town Clerk's Office
DATE: ` �`1Se'
' JOB No 02-10 TAX I D. No. 1000-35-06-19 g'
-
NOTE
2 LP'S 6 IN DEPTH
EX POOL[50%16'IN DEPTH
TEST HOLE
2/15/02
I
0 5' DARK SANDY LOAM
'OSPREY NEST ROAD
' SM BRN LOAMY SAND
3'
PALE BRN FINE
0
swl TO COURSE SAND
Cr) f
15 1' — WATER IN PALE BRN FINE
17'
SW TO COURSE SAND N
in
Z LOT 3
M OCC RES PW
LOT 16 -I
, m OCC RES PW m
o o
q. 0
o
01
0 1 !
TEST HOLE `-', I
N 56°37'10"E 125.00' 147 I I
11 1 I t I 14.5 I
13.0 10 xEX l
N I
I
• APPR I -• 35' W I
GO'T o i
O I
ONO INET I f �, ry
o tri N I
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SEP77C ch i
53' � Q � -----1 �'`� I
/ 11 4 / - W C7 rq Q I I
0 4 W 1 I
co
/ o I i
No 41
{ °j SUBJECT LOT a I
/ 11 5 +� APPROX 12,180 SQ FT j
// - I I I
zi" 11 7 (D `�
( / corn 14 9 LOT 4
. — 35.0 0 ii / ) OCC RES PW ---
1,5., I
S81°7S / /
Fk !ti
�` A �= v,CMqP 3 � ` o
/33 -64,
/
/
CO?.7,9
•o cF
15.1 kgs / /
DEPARTMENT OF HEALTH SE>1"dICESNSv
/ /
I PERMIT FOR APPROVAL OP CONSTRUCTION FOR ACO
/
I 1 SINGLE FAMILY RE6IFwi`3CE ON 1 /
15.0 /
Cp LOT 5
D �� OCC RES PW I
1 ),"- e) ca r-,E-- .. �-z FOR MAXIMMI OP- ....._.,. Er5R00Fi�S I
cli
Icz �� EXPIRES THREE YEARS FROM DATE OF APPROVAL I
q�LL � L
t=. mact gw FIRM MAP No. 36103C0176 G
co Co..
w FLOOD ZONE X
tt
i ' FILE MAP No.2752 .
I ELEVATIONS IN MSL DATUM [5 EASTERN TOWNS TOPO MAPS I 9/10/57
I j Unauthonzed alteration or addition to this document is a violation of Section 7209
of the New York State Education Law ; SURVEY OF: LOT 17 I
i , Certifications indicated hereon shall run only to the person for whom it is prepared
and on his behalf to the Title Company,Govemmental Agency and Lending MAP OF CLEAVES POINT
Institutions listed hereon,and to the assignees of the Lending Institution or
subsequent owners SECTION 1
® NE I�y Copies of this document not beanng the professional's inked seal or embossed EAST MARION, TOWN OF SOUTHOLD
seal shall not be considered a valid true copy •
��'f' 041, The offsets[ or dimensions]shown hereon from structures to the property lines are
c� ,1. for a specific purpose and use and therefore are not intended to guide the erection of 1 SUFFOLK COUNTY, NEW YORK
®ESTE 0,GRA fences,retaining walls,pools,patios,planting areas,additionto buildings,or any other !
construction
A The existence of right of ways and/or easements of record,If any not shown are i SURVEY DATE: 03/06/02 SCALE: 1"=30'
'� `= o not guaranteed - -- -- • _____--_, I
•
,) —
t'' -i CERTIFIED ONLY TO:
( ,WS", u5i 'L7/6. I KEVORK N. DEMIRCIYAN AND DEST.,IN G. GRAF
O, k,P JANET E. DEMIRCIYAN LAND SURVEYOR
,R,l,
73 Woodlattutt Road
Rod y Point,New York, I ; .
i 631-821-3442
By DESTIN G GRAF N Y.S. LIC NO. 50067 ';
vN S'