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HomeMy WebLinkAboutReinertsen SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4412-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner JOHN & ANGELA REINERTSEN ------------------------------ Mailing Address 1 1227 84TH STREET �1� a ------------------------------ Mailing Address 2 ------------------------------ City St Zip BROOKLYN NY 11228-0000 -------------------- -- ---------- Property Address 1 590 ARROWHEAD LANE ------------------------------ Property Address 2 ------------------------------ City St Zip PECONIC NY 11958-0000 -------------------- -- ---------- Owner Telephone No. 718-238-9767 ------------ Tax Map No. section 98.00 block 2 lot 4.001 ------ --- ------ Cross Street INDIAN NECK LANE ------------------------------ ---------------------------------- Issue Date: 4/01/10 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK g - t � P.O.Box 1179 b�h1, Southold New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ,F .v''r Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��{fir �y Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER- , southoldtown.northfork.net OFFICE OF THE.TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3515 R Residential•X Non-Residential Fee $ 10.00 Septic X cesspool--- 0, PERMIT ISSUED TO: Name JOHN REINERTSEN Address 1: 1227 84TH STREET City St Zip BROOKLYN NY -11228 Descripton of Proposed Construction or Alteration BUILDING NEW HOUSE FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT Name Of Owner JOHN & ANGELA REINERTSEN ------------------------------ Mailing Address 1 1227 84TH STREET ------------------------------ ------------------------------ City St Zip BROOKLYN NY 11228 -------------------- -- ---------- Property Address 1 590 ARROWHEAD LANE ------------------------------ ------------------------------ City St Zip PECONIC NY 11958 -------------------- -- ---------- Tax Map No. section 98.00 block 2 lot 410 n Cross Street INDIAN NECK ROAD ------------------------------ Building Permit Number Cross Reference: Issue Date: 3/21/07Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE �``�® "c � Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 ti Z Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS v. MARRIAGE OFFICER Gy • Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �JJ O Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �'� 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 @$25 Application No. Permit No. L4c4l��Z r �I V Owner Name i/ /���� Owner Mailing Address X-7 " © _ S _ /V l 1 Owner Property Address U W,01A1 h PnoF 4,- � 1P-1 Owner Telephone No. 917 6 Tax Map No: 1666 Section Block Lot ' Cross Street Please check each that applies: New Construction Alteration to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey th SCHD approval.) 3130110 S'7 i e of App ican � Date Received by: TKF Excavating&Demolition, Ltd. 4 Pepperidge Lane East Moriches,NY 11940 631-878-2700 Phone/Fax CERTIFICATION OF SEWAGE DISPOSAL SYSTEM BY INSTALLER Health Department Reference Number Q — —D0 I P�, Suffolk Tax Map#Dist. /pp Sect(s). C$ Blk(s). 0 Lot(S)--O, d p Project Name or Address: 5 0 Subdivision Name&Lot#: Applicant's Name: :z Description of System Installed: Septic Tank Volume(gallons): Shape: ( )Rectangular ( mdrica Name of Precast Manufacturer: prem S f— Leaching Pools f Number of Pools: I Diameter&Depth: Y---Ox /� Name of Precast Manufacturer: lantood Paco- a Other: Atfach'or sketch.below the'measurements from building corners to the access covers of isposal system. Pr�rc�dl p � �. �' •iRJJY'' 7 I hereby certify that the subsurface sewage disposal system described above has been installed by me in accordance with the approved plans and standards of the Suffolk County Department of Health Services and is operational. Installer Signature:. Prini-Name/Company: zeavatin &Demolition Ltd. Phone: 631-878-2700 Consumer Affairs License Number: 31742LW