The URL can be used to link to this page

Home My WebLink AboutShipman, Joseph r ' o��OF SO(/lyol ELIZABETH A.NEVILLE,RMC,CMC h O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS C42 Southold, New York 11971 MARRIAGE OFFICERGFax(631) 765-6145 RECORDS MANAGEMENT OFFICERUl� Telephone(631) 765-1800 C FREEDOM OF INFORMATION OFFICER COU �N southoldtown.northfork.net OFFICE OF THE TOWN CLERK R 3SOUT�OLD TOWN OF SOUTHOLD TO: Southold Town Building Department NOVFROM: Carol Hydell, Southold Town Clerk's Office BTOWN DATED: August 21, 2009 Transmitted herewith is a copy of application No. 3891 for a Cesspool/Septic Tank Construction Permit submitted by: Joe Shipman 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. I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE DISAPPROVE Comments: 01 ✓"'meg Signature Dated r , o�SUFF01,(�o ELIZABETH A.NEVILLE Town Hall,53095 Main Road TO"CLERK o P.O. Box 1179 CIO Z Southold, New York 11971 .REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER • Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER O'� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK q Residential @$10 or Non-Residential @ $25_ Application No. Permit No. � r Applicant Name J 05 to R t:( Sh i A t✓ Applicant Mailing Address ;?Y t TAN'< / N 1 1- C Septic Tank 1 Ar Cesspool Brief Description of Proposed onstruction or Alteration . ,S i N az,1_6 IF Location of Proposed Construction/Alteration: Owner of Property: ®/// IJ129� (�ATNLEtoit/ s�,r /Js lJiyfl Owner Mailing Address: Owner Property Address: Name and phone number of contact person Tax Map No: Section_f Block_,Za 57 Lot -1 ,67 f Cross Street ".,2 ., NOTE: LOCATION MAP MUST BE BMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL gnature of Applicant Date Received by: r Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT Date: 08/21/09 Receipt#: 57999 Transaction(s): Reference Subtotal 1 1 Septic Permit- Construct- Resid. 3891 $10.00 Cash Total Paid: $10.00 Name: Shipman, Joe Elijah'slane Mattituck, NY 11952 Clerk ID: LYNDAR Internal ID:3891 LAND NOW OR FORMERLY OF: CATHLEEN &JOESPH SHIPMAN (VACANT-TREE FARM) [NO WELLS WITHIN 150'] S502 8 150" E 14494 EL -7-7 VDIA. X ' X GDEEP D.W48DIA.DRYWELL DRYW PROPOSED 50.0 AGRICULTURE BUILDING PROPOSED�PARKING 60.0. PROPOSED GRAVEL r. DRIVEWAY - - - - - - - - - - - - - 5 50.0 IQ WEL NOTE; I.T. B-a L.P. NO NEIGHBORING WELLS WITHIN 150' PROPOSED s5pTlc SYSTEM IPA -p 0 7 fi H ---0—LE V*dw Line(s) MUST 88 Inspected By The &die*County Dept. Of Health SL4vm$. CaN 852-5754,48 Hours In Advanm To Sdwdtdo lnspecd*s)- TREE FARM V i \ \ O \ \ O .G..1 — EL 2�' t I 1 OF PAVEMENT Im Cd c m v G�lU Suffolk County Department of Health Services Approval for Construction-Other Than Single Family Reference No.C 10—02-000 2 Design Flow f 0 3 Ueele�—hs i SiLp.ODPf�_S�'� v 1 These ave been reviewed Eut�`en`eral confonaaace withMlffWk County Department of Health Services standards, ,elating to water DRAWN: MH/MS supply and sewage disposal. RegaMeas of any omissions. SCALE: va^=r-o^ inconsistencies or lack of detail uoaetructim is required to k JOB a: accord"" wi& the attached permit csaditiens and applicaDls August 06,2009 staadank,uoleas spciically waived by the Departmeut, leis approval SHEET NUMBER: Mil"3 years ion the approval date, unless erteaded or renewed. SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4408-N Residential Non-Residential X Fee $ 25.00 New X Existing Name Of Owner JOEY & CATHLEEN SHIPMAN ------------------------------ Mailing Address 1 985 ELIJAH'S LANE ------------------------------ Mailing Address 2 ------------------------------ City St Zip MATTITUCK ---------- NY 11952-0000 ---------- ---------- Property Address 1 985 ELIJAH'S LANE ------------------------------ Property Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Owner Telephone No. 631-298-4619 ------------ Tax.Map No. section 108.00 block 35 lot 50.000 ------ --- ------ Cross Street ROUTE 25 ------------------------------ ---------------------------------- Issue Date: 12/28/09Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) . UFFO��c� 4 � G ELIZABETH A.NEVILLE cz� y1 Town Hall, 53095 Main Road TOWN CLERK co P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O - - Southold, New York 11971 MARRIAGE OFFICER y • �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��l �a Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF•SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION c � OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25� Application No. "P Permit No. Owner Name 0 �,�4 r l�) LE'0 6\) n m%V` Owner Mailing Address M11 77 T u ue Owner Property Address Owner Telephone No. �J l 12-q 9-y Tax Map No: , Section /a Block 35 Lot 5' H Cross Street / Please check each that applies: New Construction r/ Alteration to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) L i ture of Applicant UDate Received by: - 'RVEF OF LOT MAP P OE 6REENBRIAR ACRES N FILED OCTOBER Z, IcM, FILE No. 660q rFsr t+oLe 51T ATE: MATT'ITUGk N0.3 ♦ % w TO�/ N Land No �` �` E ' " "_ Gathleen 5hi w ar Pormerl ap; ` SUFFOyy ��/ man d ` LK � It 1 �i Tree Form—� &IPman SURVEYED 03-25-2005 Set $$5°2',50«E S CORNS MARKED 05-04-2005 144.44 , PROP. AG. BUILDGING 01-08-2008 �`Stake� REVI5ED 11-05-2008, 11-15-2000 01-Iq-200q, FOUNDATION LOO. 08-21-200q r 0>,,� FINAL 5URVEY Oq-25-200q SUFFOLK COUNTY REPT. OF HEALTH SERVICES ` REFERENCE NUMER CIO - Oq - 0002 ` L 63J2. -% j SUFFOLK COUNTY TAX --------- • . , 1000-108-5-55 S CMTS TO: t �`� �`, ``,VIP, jowph Shi1 ° ('00�' p � L O 0 5T _ n �LF o Lot �. tz ' a �'QO, "kin s� pF fyi;� Y W water main o c, o �C.; EN4`�' 2kfain ; ® s 2 0 o Rftd 25 cont curb \' V (hlcr�titu -R• 5 ck- 6 „i. J�.. ' vtuac.ttw oa.�an..aa>am to.«,v.y tw..-art State bacataaa La. NOTESt .ta.,p.a..a.ndi a caetan.a w a,bm at.. waw• 0 M�IENT FOUND �•�»�tW.a, �w. t.t �. �a.tt�,ra.a a xot.�.ta�w tabe.ic„a, toga s...yo.. sot,rrv�aua/.r,oa M a.y to o..o«.an tar t,n.et..v..y.pcpn.a. on N.t.tca to•,.tt canpany dW e.°�awtg:: eta..ar.rot uorr«+m..m oa,etant t.t�e,wo ARI=A = 40054 5F or OA4 Acres JOHN C. EHLERS LAND SURVEYOR CGRAPHIG SCALE in= 401 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 RIVERBEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.-\\Compagserver\pros\05\05-142 FINAL MAP.pr