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JUDITH T.TERRY A°a ''�``�• Town Hall,53095 Main Road
TOWN CLERK ' t P.O.Box 1179
• N _4,11 FIT 3 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS • '+ 11 Fax(516)765-1823
MARRIAGE OFFICER '' •• �
RECORDS MANAGEMENT OFFICER i #.00. Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER -------
OFFICE
--„OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3328-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner NELSON, ROBERT AND STACY
Mailing Address 1 C/O RIVERSIDE HOMES
Mailing Address 2 P. O.BOX 274
City St Zip RIVERHEAD NY 11901-0000
Property Address 1 LUTHER'S ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-243-5530
Tax Map No. section 106.00 block 9 lot 7.009
Cross Street MILL ROAD
Issue Date: 5/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
rite •_
'w:.( � 9s
/
OFFICE bF THE TOWN CLERK �FFO
Town of Southold �� �CQi Application No. ,3-3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road < I $10.00 - Residential
P. 0. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 OL •• _ '0r i
Art ‘N1)Telephone 0� ./�
(516) 765-1801 /
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $ 10
DATE s//O�
OWNER NAME: ROBERT & STACEY NELSON .- C/
Po- o a4-1.0%:,7`T
OWNER MAILING ADDRESS: 34 Ida Lane, � / 9d't
N. Babylon, NY 11703
OWNER PROPERTY ADDRESS : e/s Luther's Road 405.77' n/o Mill Road
Mattituck, NY
OWNER TELEPHONE NUMBER: 243-5530
TAX MAP NO. : Section 106 Block 9 Lot 7.9
CROSS STREET: M;11 Rona
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New x Existing
Residential X Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to build"ng and closest road.)
RIVERS i DE Ho! ES, INC.
• f nature of Appli'ant
S. •rdq , President
RECEIVED BY: oC,
Town CIerk's Office
DATE:
N�O/� ANY ALTERATION OR ADD/TION TO THIS SURVEY IS A VIOLATION t
OF SECTION 7209 OF 17€NEW YORK STATE EDUCATION LAW,
\.k'•F KATHERINE PARCKYS IXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERI7F/CA77ONs
LOT O
1•E7tEON ARE VALID FOR 7715 MAP AND COPIES 77EREOF ONLY F >'
SAID MAP OR COPES BEAR 7}E DIPRESSED SEAL OF 7}E SURVEYOR
£ WHOSE SIGNATURE APPEARS HEREON. r
S. 86. 04' 00'E
= ao ADDITIONALLY TO COMPLY WITH SAID LAW TIE TERM 'ALTERED BY'
24 MAST USED BY ANY AK)ALL SURVEYORS UT1JZ1 ,A COPY
`� 264.44' OF ANOTHER SURVEYOR'S D'MAP. TERNS SUCH AS TEFEC7EAHD
-„ 'BROUGHT-TO-DATE"ARE NOT N COMPLIANCE WITH 77E LAW.
C. z <
N o well 35 p LOT M.WERS ARE REFERENCED TO'AMVOR SUBDIVISION PREPARED
o. a. \\ - FOR CHARLES R/ZZO d VIRGINIA R/ZZO'HIED GV 771E OFFICE OF 7715
SOUTHOLD TOWN CLERIC
re®_ c.' 3 The locations of wells and cesspools
09 hors '� shown hereon are from field observalions
N11\ Os �\9� and or from data ob/ained from others.
\Ny'j CERTIFIED TO:
(SI NZa a • !*t USDA FARMERS HOME ADMINISTRATION
�1 ROBERT AND STACEY NELSON
' I Z TERRA ABS TRACT
�'4o.� 4 .'"-Z„..,.1.c.A . I / 11i FIRST AMERICAN TITLE INSURANCE CO. OF NEW YORK
• e 4 \\'
1.5°. 0 LOT0 "C
0 Z SURVEY FOR
1 ROBERT & STACEY NELSON
0 WN ^% AT MATTITUCK
>es r'hole O yf .
04 ,P, mora. TOWN OF SOUTHOLD
Ib - z SUFFOLK COUNTY,N. Y.
1 �_ 1' �t! T I'm 1000-106-09-Z9 •
Iv sa,d l Q}t 1 S•//,00-K' o SCALE: 1"= 40'
I 9 '� Nio/p 30 NOV. 8, 1994
N /e s Jan. 17, 1995 (hse. stk. out)
H4-1
RY s./ " Mar. 17, 1995(Foundation)
141 I 1+`rr
/.5 c.* La
s April 24, 1995(final)
I
I e
AREA - 40,176 sq.ft
I --, -
I V l am familiar eh the STANDARDS FOR APPROVAL
AND CONSTRUCT/ON OF SUBSURFACE SEWAGE
�. DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
;' • =-- :.r,=:\ I and will abide by the'conditions set forth therein and on the
;,, to I permit to construct.
�`' _ .; 31n�; SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR APPROVAL OF CONSTRUCTION ONLY
'i• ` r ..Y.S LI,. NO. 49618 I
• ''.*Ger L 4.; -
PECON/C; i r' YO"S I. R 10-94-0124 •
DATE HS. REF. NO.
(516) 765°` -,e�040AAs� 0 '
P. O. BO U1' N...._.a/ r ELEVATIONS ARE REFERENCED
. MAIN ROAD _/ TO AN ASSUMED
DA TL.
SOUTHOLD, N.Y. 11971 ?hc/9•- weu° !, MILL ROADTEST HOLE FROM AO
SUBDIVISION
APPROVED
11/30/94 ADD CERTIFICATIONS FOR CHARLES RIZZO & VARGINL4 R1ZZ0
94-331
N/O/F ANY ALTERATION OR ADDITION TO THIS SURVEY/S A VIOLATION
KA T/L/. \‘,,9 , ERI/�/� PA�CKY4S OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW,
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE. VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
- LOT O SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
t - WHOSE SIGNATURE APPEARS HEREON.
CO S. 86° 04' 00° E. MUST ADDITIONALLY
USED BYCOMPLY SAID
LAW
VEYORS UTL�ITING A COPYBY'
,. 30� 2�
OF ANOTHER SURVEYORS MAP. TERMS SUCH AS 'INSPECTED'AND
264.44' "BROUGHT-TO-DATE'ARE NOT MI COMPLIANCE WITH THE LAW.
-...t. G
N o we'! js A LOT NUMBERS ARE REFERENCED TO'MINOR SUBDIVISION PREPARED
o _ m FOR CHARLES RIZZO.8 VIRGINIA R/ZZO' FILED IN THE OFFICE OF THE
o_ ® ib
SOUTHOLD TOWN CLERK.
613 iL o The locations of wells and cesspools
o '`h ie N '1, shown hereon are from field observations
o 1 P and or from data obtained from others.
SI \99.• 51 (r.
N
CERTIFIED TO:
Ci) 2a �1 USDA FARMERS HOME ADMINISTRATION
11 ROBERT AND STACEY NELSON
/- ',- 4 :�"� Z TERRA ABS TRACT
5 I Ry FIRST AMERICAN. TITLE INSURANCE CO. OF NEW YORK
- ‹ 3i.- 4, -?, Z
co \\% ,\\
4 i.y 4 LOT 0
• ' 22.9
1 l2'i
® Z SURVEY FOR
l • . ROBERT & STACEY NEL SON
. y1
61 AT MA TTITUCK
�e f ho/e ® �5, " TOWN OF SOUTHOLD
�. fops.;/+ "''^a.
�o� 2. .1 ►, SUFFOLK COUNTY,N. Y.
$ ,� N ,S° N . 1000-106-09-7.9
t //' °O~ p SCALE : 1" = 40'
sa•0„.. k I o ,
NOV 8, 1994
"wed I �/0/p 3o o Jan. 17, 1995 hse. stk. out
��NRY )94, 6i3. Mar. 17, 1995(Foundation)
�4 ' ``P� 'Sa"t NN April 24, 1995(final)
-
0
I o AREA zzi 40, 176 sq.ft
(31
1 ' I am familiar iWith.;the STANDARDS FOR APPROVAL
„�. :e-.-_a.�.z AND CONSTRUCTION OF SUBSURFACE..SEWAGE
,, ,_a.0 9.. DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
,-,: .-- •<,- I and will abide by` ihe"'condillons set forth therein and on the
? .1,1:74� ' ":f\t., permit to conslrlich '
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
'Zt, 4\ I
�'7 ' I FOR APPROVAL OF CONSTRUCTION ONLY
1 •
<� `� 4,;;;!--7c-, �Y S ��l NO. 496/8
PECONIC L 4•E'YORsS, :AlDATE HS. REF. NO,R 10-94-0124 `'
(5161 765\---g -0 GAS_ A > , ,
P. O. BO "`N `
�' � ���� � { ELEVATIONS ARE REFERENCED
MAIN ROAD / TO AN ASSUMED DATUM. i
SOUTHOLD, N.Y. 11971 /2/24/9..- wed, <A. M I-*L LK` 1 0 A 0 TEST HOLE FROM MINOR SUBDIVISION APPROVED
' /1/30/94 ADD CERTIFICATIONS ,r FOR CHARLES RIZZO 8 VIRGINIA RIZZO --
.
�- -- - `....ems
94-331