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Casey, James
r ISIIli i����®�si iy �8 60 ; ��•�°' _ 'w , ®V/ Town Hall,53095 Main Road ELIZABETH A.NEVILLE,MMC � �. � y TOWN CLERK :itV�� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS % ., . - ,,4,4,'„•• 4Lcv 0 Fax(631)765-6145 MARRIAGE OFFICER 4,4* '. � hg.°`` , ,4"�®�.0 Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®,d 7.91 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER -- ,,,,,.•' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department - ;i I ROM: Sabrina Born, Southold Town Clerk's Office L1LI DEC -4 2015 1 I I ATED: December 4, 2015 •RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4357 for a Cesspool/Septic Tank Construction Permit submitted by: Samuels and Steelman Architects for James &Mary Casey Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE i, . DISAPPROVE Comments: Final approval required from the Suffolk County Health Department Signature C9.- --(fi' 4 e9f/i/ /6 Dated ! � e I , SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK g Residential @ $10 or ❑ Non-Residential @ $25 Septic Tank XI or Cesspool ❑ Application No. Permit No. "`t 3~J '7 Applicant Name: Tom Samuels, Samuels and Steelman Architects Applicant Mailing Address: 25235 Main Road Cutchoque NY, 11935 Brief description of Propsed Construction or Alteration: New septic tank with new piping to existing leaching pools Location of Proposed Construction/Alteration: Owner of Property: James F. Casey& Mary M. Casey Owner Mailing Address: 3200 Reeve Road, Mattituck, NY 11952 Property Address: 3200 Reeve Road, Mattituck, NY 11952 Name and Telephone No. of Contact Person: Tom Samulcs, 631.734 6405 Tax Map No.: Section: 100 Block: 01 Lot: 'ter' 1- Nearest Cross Street: Bailie Beach Rd NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL. Ltki Sigan ure of Applicant ate Received by: ,, \ ,0 ...t.‘ ....(1, '';(\\ ..0-.0Z=..6:31y3S t- 0 NY1d 91IS 0s4o o 1 o . 9 - , )INV1 01.1439r v I "TIM W319J.5 OIld35 M3N - >INVl O11d35 O�60 Q KO 0 1,00154 LON G-30,11,4319,1.9(dl ) "TOld39 9NIlHOV3� H9IH N \�0�y�� oul� 15 x VIQ 19 (I) �Od NOIlVOO 13ZIf 111=1 - �O,a� c•+Q ',110 .. I d'1) 'food 9NIHOV3'1 H91H i� x VIQ 19 (I) - d���4 £9 m _';� r.` I dl) -100d 9NIHOV3'1 H9IH 19 x VII 19 (I) (dl) lOOd 9NIHOV31 H9IH 19 x via 19 (I) - �C��O 0� s OI"i9fld (M3N) (15) )INV. OIJ.d35 1V9 0051 - 4 p0 °�`� 3153•6WOOZIQ39 9 V ZIOd waLSA5 7IJ.d35 52 K' r,i I Z9 ao A'E9+ 13 \ 3'1OH 1531 0 L9 / I- poo ,I - 0 _ ®� x�Q 0N1 Q3NOQNV9V -1- .VM NIV1:IO1 TrAM 9NI1IX3 rirr ID -'111,1) - \- IQ-19 tO'r. - gON 9311 179 4r Z'19 013NT VM - + d5 Ora - 011efld . -;__ X -�'d VI' �OO1d •• M3N H11M 2 I �e�_ 00 X5 9 -lbrl0l . .`i NaLVM 9 119IX3 ,,1 - gis9+ A3'13 Ogg, "1d NId 61 • / 4 Y a 1 f I ' it Y 3 d5• SWO02ICI39 9 �0 /. 1�'�1 1� ' S311•d015 OAA.L AVM3/�Nci 19 ,,AA N`' 9N119 ,, - ,e,241,0,-,--=''' Ato (g -- '',7`"`44",.`''''..- _ aVN1RcIlS • 1 dl I {' ,. .. 0 4 1(‘Q 4 1 ' ,_. F r r.iv, ,.,,,,,,„,,,,T +1L 9 / .,.... ��� /110 �O� 19'I9+� /� wo 60® Si' 4NOIlIQQ'� ) // N, / M31V / waivm / 179 1VOIdJ.1A.l1/Q / ------- ddONf2I bl31VM NIVI:1 ('s'1'N) 1I-14+ ›1NVl OI-L35 31 I I Otl d J I1d 3 S 1V -rdA21 ninon £9 NIW 1G .0Z 1 101 / N31VM QNnOJ9 'wee* '31 1914+ '31 - Z9 - ld 9Z'19 100d dO .10E1 '-- 11'b3+ .3 >INVl 19 b5+ 3I lOOd OIld35 9N11-0 1d SCI2G 1OOd 40 dOJ ,s .1-409/1 14/..17/1 / .z"bs+ •ai a AGHIN6 POOL PUBLIC S ITREVISIONS:E DATA 10129115 BE ABANDONED 60 WATER 11/16/15 7 IN SCTM# 1000-100-1-4 PROPERTY: 3200 Reeve Road Z'�9 Mattituck, NY 11952 61 201 1 (PRIVATE OWNER: James F.Casey&Mary M.Casey / / 3200 Reeve Road a WELL) Mattituck,NY 11952 20,871 SQ. FT. =0.479 AC. iLl . C�A`I/A`I")OIN INSInt...1 6RI 411 AREA 1NEO ZONING: R-40 ONt t' 'S! ' SURVEYOR:Young&Young, Land Surveyors 0 TH DEPA 1 400 Ostrander Avenue .� Z Riverhead, New York 11901 *' W z / \ /59 License# 49999 0 0 / Dated: Feb. 13, 1998 co ( / Elevations based upon NAVD(1988), Z / NEI6HBORIN6- USC&GS Datum O Ui L LOCATION MAP Mater Line(s) T Be Inspecte% By The a J Suffolk Cccl ty{ Dept 7f Health &-Dices. �� .11. 1�a ,al W Call i35`�- ZOCD, 48 Hours !��Ac'lt�.iI�j58 �; SITE co Z � che �Ile Inspection(s). � o voc) o 11‘, W �1' �I ISS m.�ua m 4d Po0 t NOp/4\ 58 , I N RgDiu LsTEST HOLE Sx VACANT BY MARK McDONALD GEOSCIENCE •e Z• I 00.• LAND SOUTHOLD,NEW YORK 11971 NO SCALE n<• s / TEST HOLE DATA(9/18115) ELEV+6.9' J s' &i a 59 2.0 FT. BROWN LOAM OL w•e Pc g g ....-.o....._ ._... --.A-...®<-.mei.-..-.�.-5P.--- - 61,..x. _ 6.61.....3 - w• 5 8.0 FT. BROWN SILT ML <�. -„a / ' AUS.rr' er�t of E}�as`tireg sanitary system must `f a N• comfonnance with department requirement Submit FT. PALE BROWN FINE SAND SP 4 Ci) MAGA'Tcom Yete form WV/M-13_as proof._ 36 F . =ROWN SILTY SAND SM �„,--------- . 1)P �W YO ��f ` 4z FT. PALE BR FINE SAND SP %, .� e,,,,‘‘` COMMENTS:NO WAT .. COU TE`Epi A, $:; i \' 1I 3 F� I �` ../83 9RO_El.0;, �u�,. ►11 510_ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES E�> l tl I' UT PERMIT FOP APPROVAL OF CONSTRUCTION FOR A IV 1 ED BY: TS SINGLE FAMILY RESIDENCE ONLY DATE: 9!24!15 KISTIN6) / SCALE: <ISTIN6) 1"=so -o SHEET TITLE: DATE 114.21_H.S. REF. No. r p--f�—©0S )lam A APPROVED // i.�.-� / SITE PLAN 4 NEIN FOR MAXIMUM OF 1, BEDROOMS EXPIRES THREE YEARS FROM DATE OF APPROVAL SHEET NO: