HomeMy WebLinkAboutChernushka ,•�oSUFFO(, c®
ELIZABETH A.NEVILLE ��,�� Gyd Town Hall, 53095 Main Road
TOWN CLERK % d - P.O. Box 1179
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Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ` � �����, Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �___®1 yi ' o lig Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER "' r��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
WT
SOUTHOLD ApS �A DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2871 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : AMY MARTIN
Address 1 : 413 MAIN STREET
City St Zip GREENPORT NY 11944
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 #R10-02-0083
Name Of Owner CHERNUSHKA, JOSEPH & JOANNA
Mailing Address 1 130 DEVONSHIRE DRIVE
City St Zip NEW HYDE PARK NY 0000
Property Address 1 845 BAY AVENUE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 10 lot 15.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 8/22/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �'
iut' Town Hall, 53095 Main Road
TOWN CLERK ® - P.O. Box 1179
y, Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS :%34 /
�1Fax(631) 765-6145
MARRIAGE OFFICER :®1i '- `� �,
RECORDS MANAGEMENT OFFICER \_ ®1 $ ',i" Telephone (631) 765-1800
FREEDOM OF INFORMA ION QP ICER ,0 southoldtown.northfork.net
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ftJ1 OFFICE OF THE TOWN CLERK
AUG 7 2002 TOWN OF SOUTHOLD
O: '" c' ''`" SoutI oke Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 6, 2002
Transmitted herewith is a copy of application No. 2974 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Amy Martin/Fairweather-Brown for Joseph and Joanna Chernushka
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
- _
IZet;
`'
Signature
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Dated
-
. OFFICE OF THE TOWN CLERK 11f C `FOLke _ 97 Y
. TOWN OF SOUTHOLD t. �1
FT.T7ABETHA.NEVILLE,TOWN CT.FRK 4%& �y Application No.
P.O.BOX 1179
Construction v
SOUTHOLD,NEW YORK 11971 , i
• CPyc c Alteration /
Telephone tO,f t' $10.00 - Residential
(63-1) 765-1800 = �.1ii��,��0
...w", $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee .$
DATE 0
APPLICANT NAME: Pfrni Tha,1 �d�( �G/� —
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APPLICANT ADDRESS: ��
l � /fltiv7-
SEPT
ICCESSPOOL
- lAr_e,,4{DiA-- N6rk--( it9 ((-
DESCRIPTION OF PROPOSED COpISTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: erV U 5 k a ) d pn2f h 4-J6a.v) na___
OWNER MAILING ADDRESS: I.3O Vbr) 5 ( ec Lrioe,
,)eU) blde -Perk_ Ivy
OWNER PROPERTY ADDRESS: ?EIS- DAJ-`/ flue_
( ± !2')�/ oV Ky
TELEPHONE NUMBER OF CONTACT PERSON: cj irkien l
TAX MAP NO. : Section 3/ Block /0 Loto /3"--
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ . /
4P/i ' / / ' . •
Siyature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
11191;; IPTO, Lin
V° `���` CHERNUSHKA RESIDENCE TEST HOLE DATA
�, SCALE : N.T.S.
BASED ON
• vOSURVEY OF PROPERTY DATE : 12/06/0I
�
BY . Joseph A. IngegnoOI
Land Surveyor
�� 1380 ROANOKE Ar • E % DARK BROWN SAND'
RIVERHEAD, Ne• 'ork 11901
'7�o SI /A TED AT .j♦�, 1 '
�- A ST MARION ���4
��•c-) ;,e, •WN OF SOUTHOLD ��j�j�ji BROWN -LOAMY SAN
J,-G-- �c' SUF. OLK COUNTY, NEW YORK I . j
(a'; :.C. TAX No. 100 0—31 —10—1 5 �������
;.- G ` y', 91:3, \-D,-% SCALE 1 "=40' • .. ..�Al31
C., ''' ✓ JUNE 20, 2001 to be witnessed by Hent of alt Depa ° °sani 5 lall O ° PALE BROWN FINE T(
'f= ��� O NOVEMBER 9, 2001 LOCATED WETLANDS SAND WITN 20% GRA
•O Q�QE AREA = 377,1 63.05 sq, it
Om ° 8,658 °c, ° 101
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= _ = .J ® F��N�,°� �° '��,,at;.,,.,;,.• PALE BROWN PINE T(
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G.
���y� A O s� COMMENTS : NO WATER E
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.•..f.,,,.. ��\FRP 56� G�OS� _ 1200 GAL
oFs3 i� .F.N' SEPTIC TANK (2)80x6D.
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�' ®Az�7j F\-P O VIRES• _ S�F �G G NOT4: MEASUREMENTS BELOW GRADE LEVEL
7. CF A�T� OVERHEADATE WAL ,� :+RyO°° ° FSP
• O 411 �' BEDROOMS '�'.`; ... WO ,..,., G
FOR MAXIM o .��of A���®v�� `~ ` : °�� \\ '' °S°° SEPTIC SYSTEM
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• •'\ ' .��T <� G ` .4 i`49 . .-ti ,S• DESIGN ASSOCIATES,INC.
**`` nn^ } 4'�F_ 4 13 MAIN STREET
• �� e'rry�' ♦ -.75 .3�.t `
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? '. \�'\' Ova° °C\ s '� Q, O. J03• y .qit „,..,,,„0./.,..••f•7 00 ' ° GREENI ORT, N.Y. 11944
2' GON ��� r;;~`�r=s ' _�" 631 -477-9752 (Fax) 631 -477-0973