HomeMy WebLinkAboutAllen �t fY
,04 t
II/® 1`,%
Town Hall, 53095 Main Road
® O �� P.O. Pox 1179
i,‘\4::,,%/;, -/' 02 �®-�J 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. 3577-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner ALLEN, JOHN AND PATRICIA
Mailing Address 1 290 VILLAGE LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 290 VILLAGE LANE -
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-3576
Tax Map No. section 115.00 block 1 lot 1 .000
Cross Street MAIN ROAD
Issue Date: 1/21/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c31Fo
Town of Southold , o��� CQ =� Application No35 77
Judith T. Terry, Town Clerk 1
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971
Telephone -.e1 ��
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit
Fee
$ •
DATE /2-///q7
•
OWNER NAME: 01-01-1i✓ 1U 4,0 PAr /O/4 m. /'/GLt•N
OWNER MAILING ADDRESS: c29O V/LLA&/= /,itw
MAr truck A/)/ //952.
OWNER PROPERTY ADDRESS : a-qo hez46F
OWNER TELEPHONE NUMBER: (5/) z9,65- .35^7 ,
TAX MAP NO. : Section Pr Block 0 Lot
CROSS STREET: 44,99 Rd ( gam
TYPE OF SYSTEM: Septic .Tank 1/ New Existing
Cesspool // New Existing v _
Residential j/ 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 building and closest road.)
/
Signature of Applicant •
RECEIVED BY:
Town Clerks Office - - -- - - -
DATE:
0.1 SUFFOLK COUNTY - DEPARTMENT OF HEALTH �/
H.D. Reference No . 501=;X
APPLICATION FOR APPROVAL TO ,CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM -
Richard R. Nemschick 2984191V111`a r
1. Applicant Phone 5 . Subdiv.
•
Address Rel, Box 55, Mattituck, N.Y. 11952 6 . Section n/a
2 . Property location Village Lane 7 . Lot No . 24.
Dist. to Intersection 2341 to Rt. 25 8 . Private well yes
Village Hattituck Township Southold 9 . Public water no _
3. Public Water Company name n/a Distance to main
4 . Lot size: Width 110 feet Length 215 feet (Enter on center plot below)
LO . Sewage Dispos -1- ystem:
A. ' 00 _allon septic tank: Precast 1 Eq ivalent Block
B . Ie ching pools : Number 2 Precast lock Special
If private well fill
in blanks below:
--Miss lined ne
Tank c-apacity-aG-al-s ..
JAS"''r
N Pump G.P .M. 18
Total well depth 601
Ito, a , Depth to G.W. 201
0 0 eP 1, •-1 .
65' Amount of water in
i i8S" t j, ,a •�- well 40'
3 -:.WV 'I 3) 37, I / p Test Hole #2
= a,• T 2.c.° Qf Data Feet
�Q�w P �t v, 0 _ on Filed map
366911/24162 2
- Street Villa Lane approx. 501 4
`' J from lot 24 6
oma? ‘ 8
10
- 1(A UvX 12
4AcA m r 14
16
18
' Oo - cP
The undersigned CERTIFIES : "Construction of authorized installations will
be in accordance with the Suffolk County Department of Health' s current stand-
ards thereto . "
Date 11/6/72 Signed .--"- irj-6444-,---14,
Owner or Builder
FOR HEALTH DEPARTMENT USE ONLY . Based on the information presented herewith, it
is ' the opinion of the Health Department , that an adequate and satisfactory Sewag,
Disposal System can be installed on this plot .
Date ,,/ l - - Signed C:--------7 -- ------____
, G(1) Pr? i "
' 4
I - ''l
-15
vises 4/1 /72
a - '
1000 115:00 01.00-061','000 . 'f
'AT M ATT I TUC K )
MAP or- PaoPEp�.T Y .S•1TUATE,.
TOWN OF SOUTHOLD -• C0UN7Y ' 0& SUFFOLK."
• 'I o ; it-00 AC RES
NEW YORK SCALE I =40 AREA ?3 96L O,
BE( HG LOT No. 24 - MAP OF vILLAGE MANOR r
,, FILED 10-24-62 AS 'N0. 3669
MADE • FOR. RICHARD IN. ,NEMSCHICK
•GUARANTEED TO ' D11UE-S SAVINGS F,ANKc.r,,.:s,,,t, G'
. -: P ''.
000,
S uNDEvELoPED ST�REl.`•,r •
0O
--,, r r ' ,N 7 •oo;- Or• _ , •
N ••
W
•
< o 2.3Sr- 0 rn
LoTr
r ' r0 , HLLE I%) ,.CLIr.IESKI N
D r ;, I Z
Tin . 7A - Oo' f04E: .,, .... 2.20, 23 o T
r � ' N •
y w00; , • (�_ '
3Ir o` 0
r
NQ ?L1.9 r O r
� N, r b
0ASPHALT v GAPWGEI
n
a W -I :r r
o • d
� D . J '
. rn
1' _
0Z MI , a
16'1
, N ' 0
g h a
ti
11 1sa .
' rn- ' I- o/ � �c p ;IC'. n uo:._. in
te .
n1'2 76.
, _ r, T
i
-urn
1 • ,-• ,',t
Iu r 1,1-
, .� 2I4.11S rp
• B ° r � • - ..�. . S' .70, 07 - 5'OW r
IV r � r
I``< R
1 f L 5S••� o •+, 11,
: 5 ,
( W. 1 o n
FP
J..,. y Ct r ` 5 D
0 �OND UPDATE SUPIVEY MADE APRIL 1996
M� M, G.NE,MSGIiIGK d ASSOC ,
'
•LO GU.S T y 37 AktE -Q, - _` • .DONALD L. ANAL
LIG NO , 39307
e .. .erlOa .MTe - 72 SHAW AVE, 'ISLIP' I4, Y,
, -
_ _.-.._