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,'r Town Hall, 53095 Main Road
P.O. Box 1179
iii Southold, New York 11971
JUDITH T.TERRY �.��' TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 630-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner MOLLER, JOHN W.
Mailing Address 1 MOLLER, VICTORIA HELEN
Mailing Address 2 P.O. BOX 116
City St Zip MATTITUCK NY 11952-0000
Property Address 1 HOME PIKE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4208
Tax Map No. section 114. 00 block 1 lot 3 . 100
Cross Street SILKWORTH ROAD
Date Of Last Pump Out 0/00/81
•
Issue Date: 3/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Is I..
OFFICE OF THE TOWN CLERK r65SF0(A,�'`
Town of Southoldt, CQG'` Application No.
Judith T. Terry, Town Clerk r� � r
Town Hall, 53095 Main Road -'- Residential
p. O. Box 1179 , ' �` Non-Residential
Southold, New York 11971 O ®; s�
Telephone �.( %P.:
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD' WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0.617
DATE r g °26; /'9 k.
•
OWNER NAME: t7-0/4A) IAJ . A Nb U1 a_G / 1oLLEft
OWNER MAILING ADDRESS: e.o. e8bX. //6
l�ATT ,Tz4e_k N•y. /l'i,Te2_,
OWNER PROPERTY ADDRESS: .412N'i•
MHjj- 771c9 w-y, //q.ra.
OWNER TELEPHONE NUMBER: .5-/ 0
TAX MAP NO. : Section I I 6 Block ! — Lot 3,2
CROSS STREET: Cl Woe. (147A21.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: f}PPI2.0) /92/
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY: _
Town Clerk's Office
•
DATE: - - :
HOWARDS BRANCH OF 4 -T/TUCK CREEK
TIE LINE ALONO APPA /Tf mom Md TER MARK9
° '40"E N6'8438'/O•£ ° 8504' SB7°/O 55E 77-/6' N89eO6'30'f /0298' S.Ar 39;j N c
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'l'N „9, .~ SHF r I CDUNTY DEPAP•TMENT IF HEALTH S Oe
pi is
mn p4, --DEC 20 1':85 WESTPNALIA OpR.-
"T v y '. ' Haup ••uge,New York
e
04
LOT¢ ¢ Thi,I to certify that the proposed arr• gements for water supply °
Lot g
p��ovLrQ 81 Lo!E •.•sewage disposal for �nF./i 'Ce[=1..-- l G�ril-
A �� se�� LOT, + OLIr�� — °2—
J
/�] wit o total of lots aP
l PLANs'l l'OG 13°A i rJ 'U� r :• — — — — — —''— we aeopp7o ed on the aSo+a dctc. a��P w°Ac
TO‘.VIttDFS
9 Consent Is hereby given for the tili g of the mop on which this 9r
J r� �� gas' 1 SrT P4 9CL •° endorsement appears in She Office oft County Clerk In accordance v po
2 ° with provisions of the Public Health ow and the Suffolk County �pw
DAV. TR NSE. -1'57' `/Re-,s - Swldary Code.
/7t'
V SSA- /
LOCATION MAP
• �/� ~� - TEST Y '1 •
o _ CALE• /'=600'
/ - PARCELI/
WELL rT \'' Director of Enwronm.••• -
AREA r 57,888 S F /'
ti i ! NOTE / ■=MONUMENT FOUND e `
1/ - py 2 0=PIPE FOUND
•
•4, 4-TEST 7 3. TOTAL AREA=2723 ACRES _
h 4 SUBD/V/S/ON MAP F/LED/N THE OFFICE OF THE CLERK OF SUFFOL K
CCE'
HOLE COUNTY ON MAY 7,/9/6 AS FILE NO 720
—3°'— — 5. SUFF CO TAX MAP DIST/000 SECT//4 BL K.0/LOT 03/
r-�. _ 0 � 6 CONTOUR LINES SHOWN THUS ——.v°——ARE APPROXIMATED FROM •
e �� 'h) USGS CHART, MATT/TUCK,NY"
i ryA
D 7 THE WATER SUPPLY AND SEWAGE DISPOSAL FACIL IT/ES FOR ALL LOTS/N
c r • THIS DEVELOPMENT SHALL COMPLY WITH THE STANDARDS AND REQUIRE-
A
M ?tee• FR RAA. I Ory MENTS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH.
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l'ttr0 Ie REVISIONS YOUNG & YOUNG
MAY23,/983 400 OSTRANDER AVENUE. RIVERHEAD, NEW YORK
.p
— APR 25,196'5 ALDEN W YOUNG HOWARD W YOUNG
Z 10200' NOV 6,1985 PROFESSIONAL EN:1,1ER AND LAND SURVEYOR
S Bgo16'W LAND SURVEYOR M Y s uc No,IxBAs N r s UR No ♦BAP]
/53 583s. °16,W IDloo' to rood -UNAUTNORISEO AITER.TIDNDR.DDnIDN-D MINOR SUBDIVISION PLAN FOR
\ o PIKE (onvD JOHN W. MOLLER a DOROTHY MOLLER
THIS UNAUTHORIZED
IS T VIOLATION OF SECTION
TEST NOLO Laos OF,HE MET,TORR STATE EDJCSTIONo I
v LOTS 4,5,6817, 'MAP OF POINT P T.A'NT4,,•
"NOME TOP I CO IELSOF HIS SURVE IMAEDNOT BE RING S ah1D h ♦� •
SOU. O EMBOSSED SEAL SHALL NOT BE CONS DERE° Y rf
SANDY TO BE A VALID,RUE CORY AT MATTITUCK GUA I�(+1E,'b 7Q•.-.. G•
LOAM '
Cr 12 7 • GUARANTEES IND GATED NERCO,SHALL PUN r- '•I''1
SAND
,O DIE PER•r_N FOP*HCM THE TOWN OF SOUTH OLD ` ' f,!.1-C i ��IC THE T•,EP RE NTN,ON HIS fl.-L`
CO AGENCY ANO_ENDING INST.`„T,ON L,STE.. BY 't•
�IiO LENEON AND IT THE ASSIGNEES OF THE SUFFOLK CO, N Y e ° 45,,,1
'] LENDING INSTITUTION GADD• EFS SHE
iNs• r I,DN, An.E SE A� L SCALE DATE NO
NBTI,_,.DN. HSEOUEN♦ ' NERS I :50 I JAN-25,1983 \ N;82-