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JUDITH T. TERRY xt 4 Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax 516) 765-1823
MARRIAGE OFFICER
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1$� Telephone (516) 765-1801
•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 852 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GARY MATZ
Address 1 : P. O. BOX 1300
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 6/1/92.
Name Of Owner MATZ, GARY AND EILEEN
Mailing Address 1 P. O. BOX 1300
City St Zip CUTCHOGUE NY 11935
Property Address 1 1340 DUCK POND ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 83.00 block 4 lot 9.000
Cross Street OLIVIA LANE
Building Permit Number Cross Reference:
Issue Date: 6/19/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
111�® ®��
® Town Hall, 53095 Main Road
JUDITH T. TERRY a
TOWN CLERK ; ® •
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .: Southold, New York 11971
MARRIAGE OFFICER � i�� Fax (516) 765-1823
® s! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
IP) -12 5TM7\37rrfl
TO: Southold Town Building Department a ti 1)
FROM: Linda J. Cooper, Southold Town Clerk's Office. JUN 1992
DATED: June 8, 1992B ---"J 1/1
- G. DEPTOWN OF _.
HOLD
31�._Z �tisY•hv.�i3'cv.�r
Transmitted herewith is a copy of application No. 876 for a Cesspool/
Septic Tank Construction Permit submitted by:
Gary and Eileen Matz _ •
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 X
DISAPPROVE �
Comments: _ e�ditCa�l! L �,1 0.t'oan()c1�4��a.WL 9t
ctrx,IALA .=,...4:1A2k 451. A . rvx
1I1c �
WED
UN 171992 \(45,4-64..
Signature
Tom CIO Soithofd (QS {(o ot
Dated
OFFICE OF THE TOWN CLERK 0c.31FO(,'`O
Town of Southold
�i Application No. �7C
Judith T. Terry, Town Clerk � E� .` � .•C�
Town Hall, 53095 Main Road � ut�3. Construction J
P. 0. Box 1179 �,.
' �• � Alteration
Southold, New York 11971 �-
Telephone '�1 1'14—
� Residential -'
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $ (U
DATE /q2--
APPLICANT
NAME: 6filet
APPLICANT ADDRESS: i%)7, p /300
SEPTIC X CESSPOOL X
DES RIPTION OF PROPOSED CONSTRUCTION ORA TERATION
ry oSeO' QUO a/ 1 J� 1`(d 20® s. .417---
,c;
•a
1 /Pae kitx,
eCSS roc' ( e 4-
-tis
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: a/ d� � �i/ei�
OWNER MAILING ADDRESS: .0. '&\ /200
OWNER PROPERTY ADDRESS: / Ile. aria
(1-01tri_ A-0 ty.1
TELEPHONE NUMBER OF CONTACT PERSON: 349- /010
TAX MAP NO. : Section 063 Block 4- Lot
_ CROSS STREET: OtQ 1/(�. h�
BUILDING PERMIT NUMBER CROSS REFERENCE:.
e . ..
Sign..ture of Ap.licant
RECEIVED BY: u'
wn Clerk's Office
DATE: RECOIVID
JUN 08199
town Clerk swore
S.(S TAX MAP NO. DIST. 1000 SECT. 083 BLOCK 4 LOT 9 FILE NO. PROJECT NO.
fa -t ,'iiVil?� i U 1
�
FINAL P ROS;AL. i
LOT #G VERTICAL LOT #13
DWELLING SAND DRAIN VACANT
.q,
oro
S 39'00'00" E 150.00'
MON 101 0 MON 100.1
p + 100.2 20' DRAINAGE EASEMENT + 1000 1O
O
+ 101.2 O
t\ t 101.3 t\
\411IIN ci;
N CVn,',fi
l ( -1 (r?c.—r1lM-,t, l
I
b
10'
E
a
LOT #8 6 LOT #10
VACANT Z VACANT
ce
0
100.8- \\. \ b
a 101.0+ +CLSWALE1002
101 4+
fa \
\ :o
s°W 8.0' 1, 2 ' 0111.83`01 \ -'s'icr k''1 -^;'"
z 20 V5. 1 STORY 1617 101 5 t e4,'' w:)Citi GL—;:S Nt.
DMEUJNG
n F.F.103 5 O� b . �C� ;�,
12.5' 140P 120' 1020 S 7 1"' (+J f 1 "1'�1 �
Q
:; 127 s • 3 `,„ie 06r772. „ .,
O b O _,_
O ^ o O '
O 't' O +Cl.SWALE 99.5
R-25.00' n n
L=-__39,_.27'--:•;.:3,), Z 20' DRAINAGE EASEMENT to
ASSUMED El_
_ ' .: ` _ ,245.00 ON 99 5 w +CL SYIAIE 91x.5 YON;oa0r HYDRANT
- :r ` - ` S 39'00'00” E 150.00
100.1 I 100.0 14'CULVERT I 1000
VV 4 1992 1°05+ DUCK POND ROAD (49.5') +10°.4 * ELEVATIONS ARE ASSUMED
99.8-I 199.5
O NTT 90 O NTT 89
'sJ liG1j CG
I AM F �1A�tRS E STANDARDS FOR APPROVAL SUFFOLK COUNTY DEPT. OF HEALTH SERVICES
AND CONSTRUC11ON OF SUBSURFACE SEWAGE DISPOSAL SHED -FOR APPROVAL FOR CONSTRUC11ON ONLY-
SYSTEMS FOR SINGLE FAMILY RESIDENCES AND WILL
ABIDE BY THE CONDITIONS SET FORTH THEREIN AND ON DATE: JUN 0 1 19(12
THE PERMIT TO CONSTRUCT. .� c;,`
H.S. REF. NO.:, /-- 7 �•s f-C
APPLICANTAPPROVED: e1'�"- `- n
Unauthorized alteration or addition tbi./14 --
this document 4 a violation of Section 7209 PROJECT: MAP OF PROPERTY
of the New York State Educotion Low. i
Certifications Indicated hereon shall run only to the person for whom It is prepared LOT #9
and on his behalf to the Title Company, Governmental Agency and Lending institution MAP OF WOODBINE MANOR
listed hereon, and to the assignees of the lending Institutions or subsequent owners
Copies of this document not bearing the professional's inked seal or embossed seal
shall not be considered a valid true copy.
The offsets (or dimensions) shown hereon from structures to the property lines ore SITUATE AT: CUTCHOGUE, TOWN OF SOUTHOLD, N.Y.
fr a specific purpose and use and therefore ore not Intended to guide the erection of
fences, retaining walls, pool., patios, planting areok addition to buildings or any other DATE: MARCH 1992 SCALE: i" = 50'
construction.
OWNERS: GARY D. MATZ & EILEEN C. MATZ SURVEY DATE: FEBRUARY 1992 AREA 40,500 SQ. FT.
P.O. BOX 1300 FILED MAP NO. 8239 DATE FILED DEC. 15, 1986
CUTCHOGUE, N.Y. 11935
PHONE (516) 474-0600 • FIELD BOOKS DATA DISC
FND. UND, CONST. FINAL
MIMED BY
4. 14-Liz BY GARY D. MATY, PROFESSIONAL ENgNEER
GAR D. MA , P.E., N.Y.S. C. NO. 066772 fi ® P 0 BOX 1300, CUTCHOGUE, NEW YORK 11935
DESIGNED G.D.M. DRAWN G.D.M. CKD.
"lbw (516) 474-0600, N.Y.S. LICENSE No. 066772 P.E.