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HomeMy WebLinkAboutStarcic o��OF SO�jyol ELIZABETH A.NEVILLE,RMC, CMC O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICSSouthold,New York 11971 MARRIAGE OFFICER • �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Ol� + Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER CDUIY 1►,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4405-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner CARLA STARCIC ------------------------------ Mailing Address 1 243 MORNINGSIDE AVENUE ------------------------------ Mailing Address 2 ------------------------------- — - City St Zip CLIFFSIDE PARK NJ 07010-0000 -------------------- -- ---------- Property Address 1 205 PRIVATE ROAD #3 ------------------------------ Property Address 2 �- ------------------------------ City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 201-945-7803 ------------ Tax Map No. section 70.00 block 6 lot 9.000 ------ --- ------ Cross Street OAKLAWN AVENUE ------------------------------ ---------------------------------- Issue Date: 12/08/09 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) Sr BOG SO(/jy ELIZABETH A.NEVILLE h�� Ol0 Town Hall, 53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER G Q Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �lif'COU southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK [(Residential @ $10 or ❑ Non-Residential @ $25 Application No. � © � Permit No. 3 Owner Name: C A RI-11 S'7/1 R C I C. Owner Mailing Address: Ho R0.y&S /.b 6 AyE p70 o Property Address: 27 C7_c- VA r6 910/2-d .#-3 /-1 !f / L2 7/ Owner Telephone No. D 1 r 7.eo 3 e-G-GL Zo/ 3 76 74 Z Tax Map No.: Section: 70. too Block: o�5 Lot: Nearest Cross Street: 0A KA 4 wA'1 Please check all that apply: New Construction ❑ Alteration to existing system Residential ❑ Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit a copy of survey with SCHD approval.) " & I I, O Signature of Applicant Date Received by: r SCDHS Ref. # RIO-05-0208 FEK CR__ OCCf J�v' DOCK i r'ne 0 d\6. E Pe 4.0• / PRpt�P050��O��p� CO����p5 L� pSOF�cJ�,z AES o cps ✓ para E o m 2b VV 6 4 FE � D 0.8w 3105 - G G�\� Z I O n Ave. ��, ' ,w wafter y6 Fp�'Gc ;{� c pg \ - .6 mole , ' C) \ T (J)Lu $ 'J 8 lam• HSE DW J` ow N UNDERCONST. o� 14 10 - p fo.s / , 305 gr Q 12 � / 981 3� 1� � � :� �3�) � 6• Q cu ~ Q # 3145 Q 14�� Cl vJ LP cP o pubGe- Daklown Ave..Ave• \ pWM µrafe� 41s � -N VV cf / (ezir•1in 9•� ® of 5'00?E -S ?ail 5'Q N 83°34'40" E N 74 711_ — 97.37.' T OF 50'�vAT ROA N PR # 220 W�f er TT j.# 3325 LYNN HYA N/O/F Ooklown AVa. CHARLES O• TEST BORBVG SUR VE Y OF HARDY o 0187 0//S PROPERTY � ® HUMUS ! ,— 1,/ A T SOUTHOL D �1NE NECK ROAD DARK BROWN LOAM OL - _ i„e)1 1.5 0' BROWN SANDY LOAM SC TOWN OF SOUTHOLD AREA = 9,016 sq ft welt O BROWN LOAMY SANP SC SUFFOLK COUNTY, N. Y to tie line PALE BROWN COARSE 1000-70--06-09 LOT COVERAGE t o 151.4' sw SCA_ LE 1��=30' 92,¢ sq./t/9016 = /O Z /o C.P. W'A TE`�' W PALE BROWN e/D.0 COARSE ,,AND SW MA Y 12, 2005 6y McDONALD GEOSClr"_1\�c,r, deb /3, Zooc (rc;"ls1D'4) The locations of wells and cesspools shown hereon are from field observations APRIL 11,2006 (REVISION) and or from data oblolned from others, ` E 'f NOV. ms2 s,, Zo0os06 ( WELL , AUG. 27, 2008 Ooundalron% MA Y,8, 2009 (FINAL BPH) I am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE ,8E DISPOSAL SYSTEMS FOR SINGLE FA MIL Y RESIDENCES EL. !s and WIII abide by the conditions set forth therein and on the Fw FLR EL.13 FIN GRADE permit to construct, 'as /E 11 lE fO.B $T /E IE L.P. 10.3 FL000 Zo>vEs F2dM /�••Mq /0.0 , � 4• �r -- 3.53'► �. ^� ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW SEPTIC SYSTE D� z EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. ALL CERTIFICATIONS a HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR Y.S. LIG NO. 49618 WHOSE SIGNATURE APPEARS HEREON. ADDITIONALLY TO COMPLY WITH,SAID�LAW•TERM - ALTERED BY ' , P.C. AX 163/1 ti765 797 MUST BE USED BY ANY AND ALU.3C)RVEYORS UTILIZING A COPY $� Ir - 1 OF�4t�OTHER SURVEYOR'S MAVTERMS SUCH ' INSPECTED ' AND BROUGHT - TO - DATE ',,ASE NOT IN COMPLIANCE WITH THE LAW l2 - STREET SCUT , N.Y. 1197/ 87 - 866 De- ? ry -4 SPECTIONs«,•C.OMP_LETION',... }v,s 6y,�v�'1�LTj�1•S'ra'!'; - .. ._„�.-+r...,.�`,-+,.•-.Flt_.i,C j-�;.,: i=..x- r, -{�.*_y�. - l� t; '.SE1111AGt1'URSAL;�yWATER'SUPF?L�Y ;M�'�`:; ;;�'�•r` ' iF ak•b.`^�":�;,,.����:!>�7,,'. <:'�y l x�x.�o-ra,-y �^,+`x,:-�,'", w.+. ,,_ "•vy?:r..:. .3 xr;+;e,n 2 `y�'��r i$;k�l•' Y;: ,,.',r„d'' ;.'. .J,` ,d st'JF`d4 s f+l " ..- x` - C�`x•+sr� f.�:1k,{cx •fi a:>�,.,.-¢�-,'� -4.;Pr..S,;r at,„t�.n:-+•.+,tF'#min;,w;� .:,�^�'.�n.,4;.;g,..?',�-t,.,T�:.s��c:`"�;..,��'s iz• +'�;.. "= SCJ\Dlsposal'Sys4em'I� specllonComple ed;�1`'`�Sr'ti {'�G��etaaatii-::� �`t�" `;'c+ „^:'C;�,�,,.U.+rt,•�r` 9:r-''c."r•�.t`..,^,�''�"; r:i� .sp :s-h,�, ,::y7,�rw��..rt_�,�^r"�4. ,v y,`,�;�,>, rsA• :��y�-�;•:� ,� >Tis'U.Inspectloriallot'z;Completad:,' F }r ;;F i .,5 R"c+•°=.{.t"`? f}j-rM� �a:y Yyi-isy?ry rl.»lxT +'' Y}a :�.�;, '4i,r..4x:?�;,1 ;,�"S:u n- .{..r �. '• '3', '•_ .?�., St v4.F {ut ,,..N.,�.p..s ,! m4:• tX..,7x l ' 77, TF-7a77,rit''':�r vy j tie ��+:'�'.^a•-•7�P;•,�,.io^1,,,�•�,ti�,:--, '• ��-G11Nate�;Su,Ppl` Inspection';;ompleted-,OKto'BaCktill nspeclion'Not"Completedt "` _- • °a �t ,s ... Y�.�.c }�, �,sA�• dsy� . •crc,s_.'r:it�s`'"�"5.:."=+i.:';iPja-.a`'k C- :iv l i�/.'';:a�''JN'.<<.�'�'t,l; �j(°iit i.5-�+yj,�,PT: ="1`;.t4.�i. ,1,��.3,._(,�x „�.:tb;°?i-:.":'':•,��'n''• - �y�� ;.,\�w<'S'-*• 1 ,,Y(, .r7T4S:•,'g, F'�,�y'".. -4,Y:rY�r°ti--:�;;•;'• = �• - '�_ -".,. } g;oate''1C3 'xanspecl`ed°by._ f" �F; ;3i§•.SU FOLK COUNTY RPARThIIENT, EALTHMSE-RV ICES.,. I `,INSPEC1ION COMPLETION DOES NO'�-GONSTITUTEAPPROxALOF NSTALLATION ' di;: p.:i!3;-�`'�.."�='..a"�r ;tf'��'�i':�<.,�E.ttS.:.;��• Ytt,ti�_ti.%i�r't�:3'.,�;.'s?,�'yv,n: .'1^. - d.,4Y yi..'.,+• y_e. s �F ��1t`,.; `%��+.t.Y�s7;_.Y - -,�K?'-."e�REV,(j/85)':' , - ;:si'"��'-.;.:`!;i." -t�,;rr"' ,;.r'�' ,x'r *z-�tti?:-� ?,+�`,�.�`'rs:r=e�.^:�c�'^�,;wzi:,•. �;�'.-'-�•..t .•,�� :-..,• »,i f^,;'r•�:i to- �'�:c:�ve-r y7k�;J :ty�, s,7.4.E°{ rn.',_i,.�,',L`.1,.4�%�r�•F;`'��lw't�'�a,•-r::`r t nary - �'x'-7 ,r> "°F�>;i ,:F'%a.J,:1t':,^y?,�PF��,`J- �?:aFs,':,i�:,.i:i?-+5�.-?<j w ."�.`'....tj vc,� •�,i r.',,'',.,`%'� ,'_ �";-+.:`'�_ti :�3.t•''- iF: TF./ �• ..`J .si ^i':CF.s;'t-r � "ti "r= ,� ", ..-�`�1•,j K•'(�r t;�ti.:,,:"� ,.-i"'?";Y .:. ,1 �;��:' �-�"-�f T'.'.r. .� 1q, K.. „ .,M..:{F. ,. •s.�^-::• Y�y'tia =[r F'' -}J L� '.iy�e -+0.y S-n,y_�'..1• �v��G:�lh, y .:e Xi.wf..,.+,,,�w�%.[:v' -_...-.s.... F.FA, :SEEK �! SUFFOLIC COUNTY DEPARTMENT OF HEALTH SERVICE v' PE.XV1i'I'FOR APPROVAL OF CONSTRUCTION r,OR lj°a 10" &1NCLE FAMILY R MIDENCEr ONLY U;\e rD 4.0' f'e / DATF, h�•22g 5$ ,„ u, MOVED � FOit I` XIR1UIvI OF }3fDROOMS • P ' � �6 AE`i+•� o/ i EXI'IP\ES THREE YEARS FROM DATE OF APPROVAL 12� NWA _ '14 16 PPROVcD IN ACCORDANCE WITH BPARD OF �l '✓G�° - �, G oerr 1 y REVIEW DETERMINATION DATED�1 12-II7`d� Z31 05 a> E i,FXATI®N INSPECTION REQUIR tr aklawrl FJ, '1TA1ZY cjYSTEM P w���rol �'fo s o p BY Hc;, LTH DEPARTMENT v y 1 •�'� � g / P % cn ' tL `�I i r 00` �'e� %d' Q' 1 Of op 1 1 (5. O� e T c� P� 31 Q p�bl� R pro P 3 14 Q� �1}him 150 - Q•be�x-r el I•: - a: 0 05 f/rel 13.5 gy -97'} i 2 dun°� s 116• 3145 Q I�' w %� 20 � Oaklawn AVr,,. ._ rte 0.� �rc -- mom.^ r,`rr PRI SRU; S j��j 5,00r W�� F r4F Ir,0 N8.3 ,34 ` -N X717'— I ., 97.37 ' _ 76'r _ _. _. _._ _.._ _.--_--- 5 0, 'ROAD i TV 33 25 N N101F 0 klawn �1 yea. I,YN CHARLES 0• >Esr BORING SUR Y OF (-LARDY o loi2oie7�i�5 _ �7RQP TY iHUMUS A T SOOT OLD NE NECK ROAD ei• DARK BROWN LOAM OL we BROWN SANDY LOAM SC TOWN OF Jl SO THOLD 1.51 a9,016 sq_ft_ aROWN LOAMY SAND SC ,_SUFFOLK COUNTY, N. Y. Well c ' line F_ BROWN COARSE -1000-70-06-09----- ---- ,W -' --- --- - -_- - COVERAGE SCALE 1�-30r s .fl/90/6 = X0.2 �° C,P.4 M%�r"`i ,:v i'ALE 4ROM'N e/Q,m' ' 9 c,,�AR-,F' A;vP SW MA Y 12, 2005 17' feb /3 2ovG ('rCV'/.$ rt3� by McDUNA(.&) GF.L�:': ','r:,-: localiogs of wells and cesspools APRIL 11,2oo6 (REVISION) hereon are from field observal/ons sept z? 2006 �f ' from dato.oblained from others. NOV. 29, �006 I WELL lamiltar with the STANDARDS FOR APPROVAL ' ONSTRUCTION OF SUBSURFACE SEWAGE 11se I E�.is SAL SYSTEMS FOR SINGLE FAMILY RESIDENCES , FIN FLH FL.13.5 FW�p°c I abide by the condilions set lorlh /herein and on(he to construct-