HomeMy WebLinkAboutFerlin ELMBRM A.NEVUJAI RMC,CMC �� Y! Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4384-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DENNIS FERLIN
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Mailing Address 1 C/O DEMPSEY
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Mailing Address 2 200 PARKWOOD STREET
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City St Zip RONKONKOMA NY 11779-0000
Property Address 1 735 COREY CREEK LANE
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-6582
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Tax Map No. section 78.00 block 4 lot 2.040
Cross Street MAIN BAYVIEW
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Issue Date: 11/18/08 Elizabeth A. Neville
------ Southold Town Clerk
(TOWN SEAL)
..oS�FFOI�-cam
ELIZABETH A. NEVILLE
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TOWN CLERK P.O. Box 1179
Southold, New fork 119i1
REGISTRAR OF VITAL,STATISTICSMARRIAGE OFFICER Fax ,G;i 1i 765-E1 1.15
RECORDS MANAGEMENTOFFICER 'Telephone (631 765-1800
FREEDOM OF INFORMATION OFFICER Southoldto%Vll northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOI D
SOUTHOI.D WASTEWATER DISTIZICI'
APPIACATION
OPERATION PERMIT
CESSPOOL or SEPTI(' TANK
Residential (iv $1U V or Non-Residential (i). $25 Application No.
Permit No. 3 52-
Owner Name- ,D e n n I S
Owner Mailing; Address C/o C Q
ST
Owner Property Address _7 3 _C� og E' 4 C/Q f'
- SP ufhold ;—A4 _ / /92 - -_
Owner Telephone No. �p _3 / (p S — (p .S Z
'fax Map No: Section -7o'. e o Block Lol `7�p0
-
Cross Street R/9 Gyje1 �
Please check each that applies: I New Construction ✓
Alteration to Existing System
Residential Non-Residential
'.VOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (1,ocatc
building and system; give north arrow and approximate distance in Leet lrom systcnl to huildinL�
and closest road. New construction may submit copy of survey with SCHD approval.;
Signature of Applicant Datc
Received hv:
i
AWN Bd���, RD S:C.O.H.S REF. N0. R10-07-0016
. •
R
S�
v
GP
LOT 21
WELL
03'N SURVEY OF PROPERTY
�g ► � N 85.e3'.40• � -='10 MON AT BA YVIEW
° EL 13,1' &-N e TOWN OF SO UTHOLD
0. 'B' �"•5; LPA SUFFOLK COUNTY, N. Y.
Z 36.0 a #2 M 2 O W q
1000-78-04-24
5. m
� SCALE: 1 --40
�• y � o m o.. MARCH 20, 2000 D HOUSE
m' j s.o' JANUARY 12, 2007 (PROPOSE )
�=+ JULY 17, 2007 (FNDTN. LOC.)
6• 0' SEPTEMBER 10, 2008 (FINAL)
SEPTIC MEASUREMENTS '�! ,� 56•, fix► o OCT. 29, 2006 (SEPTIC SYSTEM)
2 a9•o a9•
A
A, B' Vol �6 30.4LOT 22
�� N MprJ
S T#I 536 22' v OR/VFW, y � FC WELL
ST#2 55' 27'
" 21050 ai w
L.P#1 72 55 V4 S 86'31 1
LP#2 67' 62' EL 11.6' CP
LOT 23
(DWELLING)
(WELL LOCATION UNKNOWN)
VXMXCOUNW DEPARTMENT OF HEALTH SERVICES
t43FfWp.OF CONS'TpucTED WORKS FOR ;
A SINGLE FAMILY RESIDENCE �
�- 0.t. v 0 72008 F.S.Ref.No.�-0 -0o 16
'
I
ELEVATIONS REFERENCED TO AN ASSUMED DATUM. j The at ft 10 ; have De9n ":r
I am familiar with the STANDARDS FOR APPROVAL t4 �s Mvoerd4ased yra r i ane fmW to
Y,�p,cleo andrrrs�aartltfed by tMs Departrl►+snt a otter a9endes
AND CONSTRUCTION OF SUBSURFACE SEWAGE �M FOR A MAXI OF_ ,� BEDROOMS. �vt1F r�E�v'}.
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCESME� OOf�
and will abide by the conditions set forth thereinie
and on the j :� c fi
permit to construct. '�' ' eM
P'E•'
go- �/E! Manalem - ;
The location of wells and cesspools shown hereon are
N. Y.S. LIC. N0. 49618
from field observations and or from data obtained from others.
RS P.C. I�
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION FA ,
X (631) 765-1797
nF sFCTiON 7209 OF THE NEW YORK STATE EDUCATION LAW.
i
�I
WN B.4 ,&C.D.H.S. REF. NO. RI0-07-0016
AyFUJI RW
N
LOT 21
0 (DWELLING)
KELL FC
9.3 IN SURVEY OF PROPERTY
W-LL N 85.03'4e' i��--!�—�• . 223101 19
MON AT BA YVIEW(A
0 EL 1' 0,4 FE IN *1LP TOWN OF SOUTHOLD
C*1 .
0 P
'B ST 0
LP SUFFOLK COUNTY, N. Y
-Z #2 1000-78-04-24
CL 5.0,
SCALE: 1'--40'
MARCH 20, 2000
-0, JANUARY 12, 2007 (PROPOSED HOUSE)
JULY 17, 2007 (FNDTN. LOC.)
8.9. 10, 2008 (FINAL)
SEPTIC MEASUREMENTS b
0, Z, SEPTEMBER 5 OCT. 29, 2008 !SEPTIC SYSTEM!
% 4.9.0 tt &�
via 0 '
30.4 A LOT 22
A' 'B'
1 CONE-Ir MON
ST#1 536' 22' CRWWA y FC DRy WELL
5A� 0
ST#2 55' 27' a3,s -%
I;z
I-P#/ 72' 55, M S86-31
LP#2 67' 62' EL 11-6'
LOT 23
(DWELLING)
(KILL LOCA170N
LINKNOK")
9XF%X COUNTY DEPARTMENT OF
HE
ALTH SERVICES ICE
S
NAPF0VAL OF CONSTRUCTED W=RKS FR
A SINGLE FAMILY RESIDENCE ,
Z,
DateNOV 0 7 2008 H.s.Ref.No-Fe-n
ELEVATIONS REFERENCED TO AN ASSUMED DATUM. j The$swag disposal ar4 water supplyfac�at ft 1000tw have beon
I am familiar with the STANDARDS FOR APPROVAL tWocied XxIbroartfled by ft Department or other Veld"and ftur4 to
F N E V,
AND CONSTRUCTION OF SUBSURFACE SEWAGE agonfiKgwy FOR A MAXIMW OF BEDROOMS.
4,
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES METS
and
C-
and will abide by the conditions set forth therein and on the
WaIWALiftert P.E., ie
permit to construct. 4WWWWWONAW manarment
The location of wells and cesspools shown hereon are N. Y.S. LIC. NO. 49618
from field observations and or from data obtained from o th ers. RS, P.C.
ANY ALTERATION OR ADDITION To THIS SURVEY 15 A VIOLATION FAX (631) 765-1797
OF SFCTION 7209 OF THE NEW YORK STATE EDUCATION LAW