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ELIZABETH A.NEVILLE ��',a 4 Town Hall, 53095 Main Road
TOWN CLERK d P.O. Box 1179
REGISTRAR OF VITAL STATISTICS w Ay i Southold, New York 11971
MARRIAGE OFFICERM•
ARRIFax (631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Ql +010 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. 3008 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : ROBERT SAMOLEWSKI
Address 1: 7800 ALVAHS LANE
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0015
Name Of Owner SAMOLEWSKI, ROBERT
Mailing Address 1 7800 ALVAHS LANE
City St Zip CUTCHOGUE NY 11935
Property Address 1 13934 COUNTY ROAD 48
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 101.00 block 1 lot 19.003
cross street ALVAHS LANE
Building Permit Number cross Reference:
Issue Date: 4/17/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE ,4141 t • Town Hall, 53095 Main Road
TOWN CLERK % o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER ; Fax�����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ao �� Telephone (631) 765-1800
4.
FREEprilyrO INFORMATION"OPFICER southoldtown.northfork.net
.
FEB 2 0 2003 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: SoutholdITown Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 20, 2003
Transmitted herewith is a copy of application No. 3131 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert S. Samolewski(in contract with J. Perry)
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: •
// I •
714%9%Signature
Vo 9/3
Dated
• r 4
O F10E OF THE TOWN CLERK ,�'
TOWN OF SOUTHOLD ►''D�J���� CQG' Application No. 31
ELIZABETH A.NEVILLE,TOWN CLERK / 0 '4
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 G T i
Alteration
Telephone ‘ 0,tif �Qro' ' $10.00 —Residential x
(631:) 765-1800 -= 1. $;,�' $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
•• o
SEPTIC TANK or CESSPOOL D c
=®� h.
Permit No. °O mac) '.
crl
Fee .$ /0.00 rn< o
DATE 0,71). .R.
APPLICANT NAME: Rort 5, Sa.vio(ewSk�
APPLICANT ADDRESS: 7F°D/4/4.4SZA.
Cold /0) 035-
SEPTIC CESSPOOL X
DESCRIPTION� / OF PROPOSED CONSTRUCTION OR ALTERATION
/V eW Cod�.Sfl1�t/i0 Sj�t 7L(eke//De c12ar &/ye,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:• /
OWNER OF PROPERTY: �O5e/6 /air/ .S C�h Cakihr " �� o/eewrk.;
OWNER MAILING ADDRESS: r43- Ck.oh Cr, #e'x, , f"//STh
V/egje / f o 7f00/04-4 coLd9tte //isr)
OWNER PROPERTY ADDRESS: / 373Y 66.0h"/
•
C'c%rP,/vY /M3S-TELEPHONE NUMBER OF CONTACT PERSON: ',7/--17354---5-71/
TAX MAP NO. : Section /0/ Block /
CROSS STREET: 4/, s ,
BUILDING PERMIT NUMBER CROSS REFERENCE: .
7&ZLIi
Signature of
g ture Applicant
RECEIVED BY: RECEIVED
Town CI rk's Office
DATE: - •
JAN 2 1 2003 -
- - - ure,veel 112,2103-
Southold Town Clerk •
1 � .�.a � f�l�/S'�u"`..+r.ia`�'v+S.)e..33.��;+- :w��:.r;'"'R,C'.;':.i� : F^�x5..._.�3 iS�"'�9< 7 c�'�
; '. _.��,.z .L, "-.� ,_ >� •Ls:,��>'b� PL EASE NOTE SURVEY OF
y RECEIVED T>�X,S ,v'- y�:;.t;_ ,t.- ._�u -.'i -r v7, -- ,,�'t Sanitary System not to be installed LOT 3
SUFFOLK I "� .�,a v ;„ :.;;�.-. t under driveway. MINOR SUBDIVIPROPERTY
ER SIGN OF PROPS
BEMJH S ICES ;.rr,Y s�R.,27 ,,�T.rf ;�"F,`.1'4T•Tt�'.,v.:: _, STANLEY SIMCHICK
/ LEST HOIE
11:r.,, u�l=..Qr �. --A,,,: .,s.'iL),�_�, ' D. �_v s SITUATED AT
1003 JAS 23pF, yq.3? _ � • 0�` 53� �� CUTCHOGUE
Ij atm ;:./....1:- Y`"s',.; —1 ---11-13:11.--.—
i
« TOWN OF SOUTHOLD
+ ' - � _V. .77.-:-,,,-).,-:v;- -i so, SUFFOLK COUNTY, NEW YORK
1
IST.1:::,S sg4;s E Y ,'�3 ?r'�FROM :_�vl� `r`�°�O?�r' t� F TAX No. 1000-101-01-19.3
S.C.y SCALE 1"=50'
7'
�� �101
St��G ..�.. - __. ,w..� .w y �.. .._...._� ,PN� moa DECEMBER 12, 2002
° o
�,�Eoo�� 99���, ® AREA = 80,005.89 sq. ft.
1� ti � 1.837 ac.
-;:i,
cl
04
-(1f TEST HOLE DATA
Fy (AS SHOWN ON MINOR SUBDIVISION MAP)
x.,4.44 BROTH Loaf
2 2-
�• GRAY CLAYEY SILT
-- ;— OvID, � 1 ' �°
•
O % a5 ' _ L002:2 4.. . d y -
• • • ' a
-
daa - cIOOrof`, // 't---'2Z.,---:T47--.4:k
_—•i _ __ - - -
Ci -
COARSE SAND.. 59.0 =_ • Ctpt N a LAYERS OF GR
AVEL_ _ - _
,1`F , --u'�' 4 rV / tarilsxF - '5 a . .• • •
C •,?�•- ,I�/A - i FPO ' d - -- n,.
ABLISHED
i
so,a ,1. d • �
`�- • ° .4-
17.
/j a
Y i '51�-
c n • �0:�. NOTES:
_ �o'9 9 / 1. LOT NUMBERS SHOWN THUS:LOT 3 REFER TO
�- , .:14›:
` ;' , _ O .44 ._ -B MAP OF PROPOSED MINOR SUBDIVISION OF PROPERTY PREPARED FOR STANLEY SIMCHICK PREPARs' IN ACCORDANCE WITH THE MINIMUM
•
.6).. - ' .a 2. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUMBY THE', SURVEYS�� �
EXISTING ELEVATIONS ARE SHOWN THUS:329 LALS.AND
pr _ :T. : -
OR 5;;+ USE BY/HE NEW YORK STATE LAND
- I +• ' C •. - s 3. REFER TO FILED MAP FOR TEST HOLE DATA. - • TK>N
�*- TTI . - - / is _ .. 4 - n _ �� 4. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1,000 GALLON Of ,. :.i
c'sYYY 1 TANK; 8' LONG, 4'-3' WIDE. 6'-7' DEEP
�' \ 5. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDEW • \' A,
�'t'C �,/�. �' ' .d - - O • �a l i POOL; 12' DEEP. 8' dla. �r� ,.�° 41-'0� :
a• "�,, '� \<C SY ~ � PROPOSED EXPANSION POOL CO o ----
6 ---
• a 4)*„.--
°�czi. / / - .c �.Q �� PROPOSED LEACHING POOL �' '
tr - ', As,..,,,,,
«y9, , �yf �4 ® PROPOSED SEPTIC TANK ' C9
o �Q % ,_ ! ti, IND ORAeTION OF W€I1, AND Oo1300�$ t1OWN b R€OM AK FROM FI€I� �4' /' �`_ v' N'f N I-1@- NB
-�'-`- s , . a,
OBSERVATIONS AND/0 DATA OBTAINED FROM OTHER. -
CA 0'- L1 I<
9D`�
'� L=11•1 • . ...4• - • seph A. Ingegno
•_ - TO THIS
ALTERATION I1 ADDtifON
�• TO THIS SURVEY ISA VIOLATION OF
y :44; a a SECTION 7209 OF THE NEW YORK STATE F Land Surveyor
EDUCATION LAW.
OOSNIP COPIES OF THIS SURREY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
.59.22 TO BE A VALID TRUE COPY. Title Surveys - Subdivisions - Site Plans - Construction Layout
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY PHONE (631)727-2090 Fax (631)727-1727
IS PREPARED,AND ON HIS BEHALF TO THE
THE EXISTENCE OF RIGHT OF WAYS TRS COMPANY,GOVERNMENTAL AGENCY AND
AND/OR EASEMENTS OF RECORD, IF LENDING SSGNEES FSTED HEREON, AND OFFICES LOCATED AT MAILING ADDRESS
-
ANY, NOT SHOWN ARE NOT GUARANTEED. TURONE CERTIFICATIONSC
• OF- NOT TTLENDINp NSFFEERABLE. 13130 ROANOKE AVENUE P.O. Box 1931
RNERHEA , New York 11901 Riverhead, New York 11901-0965
22=48