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ELIZABETH A. NEVILLE 1�� OG'j Town Hall, 53095 Main Road
TOWN CLERK ` H ; P.O. Box 1179
v t Southold, New York 11971
1
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER :Gy
RECORDS MANAGEMENT OFFICER '/Q .0) ri' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �1si
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2343 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : INLAND HOMES INC
Address 1 : PO BOX 117
City St Zip MATTITUCK NY 11952
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 #R10-99-0138
Name Of Owner H I LTZ, ROBERT
Mailing Address 1 PO BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 PLUM ISLAND LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 6 lot 8.000
Cross Street KING FARM ROAD
Building Permit Number Cross Reference:
Issue Date: 6/13/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•111 OFF04 a3t3
ELIZABETH A. NEVILLE /� * ; Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �' Southold, New York 11971
MARRIAGE OFFICER ,ti ������ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ;"'/Q 4 I,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ .9"
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 13, 2000
Transmitted herewith is a copy of application No. 2431 for a Cesspool/
Septic Tank Construction Permit submitted by:
Inland Homes (Robert Hiltz) .
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
ignature
Cis 3l o �J
Dated
,,,,.,,..,.,
OFFICE OF THE TOWN CLERK , '' •,„ �1 // 2
3
TOWN OF SOUTHOLD ��KnO Application No. o- T
FLUABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 : F► Construction
SOUTHOLD,NEW YORK 11971 a T
• in Alteration
Telephone , $10.00 - Residential
(516) 765-1801 l4t �.
'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 6/13/00
APPLICANT NAME: Inland Homes
APPLICANT ADDRESS: PO Box 117,Mattituck,N.Y. , 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New single family dwelling
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Robert Hiltz
OWNER MAILING ADDRESS: PO Box 117,Mattituck,N.Y. , 11952
OWNER PROPERTY ADDRESS: Plum Island Lane,Orient
TELEPHONE NUMBER OF CONTACT PERSON:
298 J9696
TAX MAP NO. : Section 015 Block 06 Lot 08
CROSS STREET: King Farm rd.
BUILDING PERMIT NUMBER CROSS REFERE CE:
Via
Signature of Ap• - .
RECEIVED BY: Ok)g
Ta Clerk's Office
DATE: (e,. // ( 6a
LOT 87 O
CESSPOOL
VACANT LOT 88
S 87 15' 30' E \ 180.0' .SET
rArr
PR. OSED
CES '00.
O
O
(N cj
i N
(N PROPOSED
`so , SEPTIC TANK
• T".
LOT 94
LOT 96
PROP. PROP. 3 VACANT
GARAGE 4 BEORO•
RESIn
-
VACAN T
fr.) 551' 25' 0 501'
i O
N
o
PROPOSED
WELL
SIT
A emirs �� KIYF \
SJ.I N 87. .i.5----30____11:,...' ' 180.0' TEST HOLE
nE 552so'
�o�c` �e ,j,, PLUM ISLAND LANE 19.9i �o 'so
rn 0
in
co 4
0.
VACANT
I I -v.%
N
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V
'M
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TEST HOLE DATA
SUPPLIED BY: McDONALD GEOSCIENCE
r £XISIING GRADE
PALE BROWN SILTY LOAM OL •
J'
SURVEY OF
BROWN SILTY SAND WI HEAVY GRAVEL SN LOT,{r
a' IN
BROWN TINE TO COARSE SAND WI HEAVY GRAVEL SW ORIENT-BY-THE,-SEA _
SECTION TWO ••
SITUATE
'
ORIENT,
OF SOUTHOLD
BROWN FINE ro COARSE SAN SW SUFFOLK COUNTY, N.Y.
ZONED R40
n
EXCAVATION INSPECTION REQUIRED
FOR SANITARY SYSTEM-
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BY HEALTH DEPARTMENT
r FINISHED GRADE
'*`•"`V>10..._ 1''MIN.
r/e' �' 2MAX. TM 1000-015-06-08
/ \ FM 1 3444
FILED: OCT. 26, 1961
300 S.F.
SIDE WALL 23 JUNE, 1999
AREA
LEACHING I-I SCALE 1"=30'
POOL AREA= 21,960 SF
OR
2' MIN. GROUNDWATER 0.504 ACRES
GUARANTEED TO
TYPICAL CESSPOOL SYSTEM
INLAND HOMES
N. T. S. TOWN OF SOUTHOLD
NO1E ELEVATIONS SHOWN HEREON
ARE ASSUMED DATUM
r FIN:SHED GRADE
1'MIN.
2'MAX.
r/4"/ r' I/B-/r •
MIN. TO CESSPOOL SURVEYED FOR: INLAND HOMES
1000 GAL. SEPTIC TANK
RD TYPICAL SEPTIC TANK
F�I'`� ARM Guarantees indicated here on shall run
only to the person for v,hcm the svNery
is pr:pored, end on his be,ialf fo w:e
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company. GOverrr.ental Agency,
instih.tion, if listed hefeon, afd
cssionees of tha lending in?tifuti5n.
,:,•� Cucrrntees are nct 'fhnsfeicble to
additional Irittitvtianu or t,t ee neet a+uwte
x-13 X61 to-qq-01.38
/ . Unauthorized alteration er addition to this
survey is a violation cf Section
7209 of
the New `"ark State Education law,
i.:::;';'.:f° : a l?.•"c :i APPI'.OVAL
_---_—_— --- —,—y Copies of this survey mop not bearing
the Land Surveyors embossed seal shall
not be considered to be a valid true
PLEASE NOTE copy.
Minimum distance between well
and cesspool is to be 150 feet.
SURVEYED BY
STANLEY J. ISAKSEN, JR.
P.O. BOX 294
NEW SUFFOLK.. N 11956
516— 34-5,.35 /
/
CENS=D A I SURVEY
NYS LIC. NO 49273
99C807
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