HomeMy WebLinkAboutMcCaffery, John (3) „ ,ice..,,..
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ELIZABETH A.NEVILLE 11* y Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘yj.. Southold, New York 11971
MARRIAGE OFFICER : O •� � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y 0��,�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER `-.. ( * �a.'i southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 /7 or Non-Residential @$25 Application No. 9a74---3
Permit No. 3 Z 09 R
Owner Name JO”) l '!• 41C CA—6--R"(
Owner Mailing Address (90 ,lam K t1/�v) Ci iC LE
cTi�AG�c �v //7/'/
Owner Property Address oA-i
c O 7?1, Li L y i/9' /
Owner Telephone No. 376 6 — 2 S 4(7
Tax Map No: Section SW .00 Block 7 Lot /r • 000
Cross Street --141-AW/NCS Ro RI>
Please check each that applies: New Construction
Alteration to Existing System
Residential v' 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 sub it copy of survey with SCHD approval.)
• )07 1.
ature of Applicant Date
Received by: if 49-6/0
•
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
WASTEWATER MANAGEMENT
COUNTY CENTER
RIVERHEAD, N.Y. 11901-3397
(631) 852-2100
********************************************************************************
JOHN M. MCCAFFERY
20 PARKVIEW CIRCLE
BETHPAGE NY 11714
CASH RECEIPT
**************
Date Processed: 08/03/04 Receipt #:116152-P-50567-13365
RESIDENTIAL UPDATE
Hdref No: R10-01-0158 Fee: $70.00
Received From: JOHN M. MCCAFFERY
Amount Paid: $70.00
Check Number: 5448
Project Name: RESIDENCE @ W/S BOOTH RD. , 157.14' N/0 JENNINGS RD.
Location: W/S BOOTH RD. , 157.14' N/0 JENNINGS RD.
GE0145
' SIWFOLIk COUNTY DEPARTMENT OF HEALTH SERVICES FOR OFFICE USE ONLY
OFFICE OF WASTEWATER MANAGEMENT
SUFFOLK COUNTY CENTER-RIVERHEAD,NY 11901 Health Department Ref.No. n/O`C,- Q/SX
(631)852-2100 ,`
APPLICATION FOR EXTENSION, RENEWAL OR TRANSFER
OF EXISTING PERMIT TO CONSTRUCT SEWAGE DISPOSAL
AND WATER SUPPLY FACILITIES FOR SINGLE FAMILY DWELLING
REFER TO REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS
PLEASE TYPE OR PRINT LEGIBLY
EXISTING REFERENCE NUMBER
4t<° _Of_o/Se'
Dist. Sect. Block Lot
Tax Map No. 301.4-FIV s-0 <Ft/ D 7
NAME OF APPLICANT Jo fir.1 M" M `CA-PF 0-12 Y
(If name is different from original applicant,see instructions for transferring a permit and complete section 6 below.)
Mailing Address 2 o ,A e*' , l/ C,e46,QEfitpf ,c lri i Phone j7' 667— 1A 7
NAME OF AGENT(If not applicant)
Mailing Address Phone
DATE OF ORIGINAL APPROVAL 11//3!0/ (If more than 6 years old,a new application will be required.)
TRANSFER OF PERMIT:I hereby transfer all rights and interest in the above referenced permit to the new applicant named
above;
SIGNATURE OF ORIGINAL PERMIT HOLDER/AGENT
PRINT NAME DATE
MAILING ADDRESS PHONE
Application is hereby made to IA extend, [ l renew,[ l transfer for a permit to construct in accordance with this application,
surveys and plans submitted. I hereby certify that I have examined this complete application and the statements gairein are true and
correct,and that all work shall be done in accordance with all applicable Town,County,State and Federal Laws. ny
statement made herein is punishable as a misdemeanor pursuant to S210.45 of New York State Penal Law."
Signa•f Applicant '�'t
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Jor�� M. M c-C-4rFa f�Y MR. $ rri�
If you are making Substantial revisions or modifications to a project that has already received a permit to constri from`'lfte
Department,or it the permit is more than six(6)years old,a new application will be required. Renewed permithfe subject to any
changes in standards enacted after the approval date of the original permit.
DEPARTMENT USE ONLY
Permit is Extended/Renewed/Transferred Until F/3/97 Number of Bedrooms Approved 7
Signature of Department Representative L. Com_ Date 749/ y
WWM-104(Rev. 3/03) Page 1 of 2
0
SURVEY OF PROPERTY{.'1:-- ` '«
SITUATED AT i
-r
°'ti SOUTHOLD «'fit f9;u_ �r.
l� TOWN OF SOUTHOLDt. 1 •$�
1 L .
TEST HOLE DATA SUFFOLK COUNTY, NEW `+,
(rEst HOLE DUG BY SA ON OCTOBER 16. 2000) S.C. TAX No. 1000-54-07-1 1
;4:,7 p-4-• o'
SCALE 1"=40' '•;;'l
$k44,k °�"BROWN SANDY LOAM a' SEPTEMBER 21, 2000
•�'�• t.s' AUGUST 1.2001 ADDED ADDITIONAL SURROUNDING WELLS a CESSPOOLS&REVISED PROP.SEFDc SYS. LOCATION
11AREA = 19,715.56 sq. ft.
• 0.453 00.
BROWN SANDY SILT W. CERTIFIED TO:
JOHN M. MGCAFFERY
MARY A. McCAFFERY
c14 x,,•+44� ,., 20 ,rQa�
+I y 4' B O I.ELEVATIONS ARE WORN=TO.AN AIMED DAWN
�;4� ! ,. . fit, tri - - cams 0EVA110NS ARE SHOWN TNDS 02
QG � 0): ' O -I, BROWN FRE SP 2.WNMIM SEPTI:TAME CNACTR6 fait A 1 TO 4 6EDIOON NOISE IS 1,000 GALLONS.
G` .t �• : .*, ^ - . TO IEOBM SAND 1 TAME:!'LONG r-r WOE.r-7'DEEP
9 L� ii
mss- '...J� j, S.WOIWW LEACHING STERN FORA 1 TO 4 BEDROOM NOUSE IS SOO p I=MALL AREA.
/go. 05 • -yam, 26• PWOPOBm MANSON POOL
• G f IMPOSED LEACMIC POOL
®PRoroNE9 aEn1c TANK
C'o 4.THE LOCan1011 OF WELLS AND CESSPOOLS SHOWN HEREON ARE FRow Fm
aN ` y c o osEERVA11DFa AND/ae DATA MAIM Fwr OTROS.
O GC. -
,� o� , SWIN6K Coon OcrART#IBNT of HSALTN Somas
00 m, t"W
• 19 INC" Puma FOR APPROVAL OF CONSTRUCTION FOR A
h, "� + c Snout FAMILY RESIDENCE ONLY
try PO <t �'"
per.
�P .. DsTarI 13 1O(H. 40 — 0 t 5$
►I R i 1 ixp N. �� ti FOE Manua OSOROQUS
VA110NS� -,,
d.4.o FOR$A1MARY 8Y9�EA/ ,a9. 't''o. EXPIRES THREE YEARS FROM OATE• APAROVAL
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MON.CROIROVOR ME NOT TINNWERNI E. PRONE 0317727-2080 Fax(631)727-1727
111E EXISTED CE OF WONT Of WAYS OAF10E5 LOCATED AT IOUIG AGGRESS
S AND/011 EASEMENTS Of RECORD.W
ANY.NOT SOWN ARE NOT GUARANTEED. 1360 ROANOKE AIME P.O.Box 1931
RNE161610.Now York 11901 RMTINad,Hwy York 1 19 01-09 05
'LO-5O1
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 09/14/04 Receipt#: 107
Transaction(s): Subtotal
1 Septic Permit-Operation - Resid. $10.00
Check#: 107 Total Paid: $10.00
Name: Mccaffery, John
200 Parkview Circle
Bethpage, NY 11714
Clerk ID: LINDAC Internal ID:100453