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Home My WebLink About6190 Peconic Bay Blvd Permit No. �D�$ RECEIVED TOWN HIGHWAY DEPARTMENT F SOUTHOLDSI�FfUt,�c�Gs Peconic Lane F 1,6 1 4 2023 Peconic,New York 11958 0 7102515171 (631)765-3140 1*1 Southold Town Clerk APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 237 of the Code of the Town of Southold,Suffolk County,New York,and other applicable laws,ordinances or regulations for each individual contiguous excavation project herein described. The applicant agrees to comply with all applicable laws, ordinances,codes and regulations,the attached"General Conditions of Permit"and"Special Conditions",if any and to permit authorized inspectors:to make necessary inspections of the job site. Print or Type I Liz Ricks-(516)229-6369//lipermits@nationalgrid.com Keyspan Gas East Corp d/b/a National Grid H 25 Hub Drive.,Melville,NY 11747 Name of Applicant Phone Number Address of Applicant 2. Name of Contractor Phone Number Address of Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner W70. 4 E/S OF PECONIC BAY BLVD; 715' N/0 BIRCH DR --.4' X 4' GRASS BELLHOLE (see sketch) Work.Description and Location(Street Number,Hamlet,Cross Street) ✓ (a) Is construction located within 75 feet of tidal wetlands? *Yes No *If yes,other Town permits may be required. Liz Ricks NOTE: All information requested by this Signature of Applicant Application/Permit Form is 2/$/2023 Required for a complete application! Date 5. (a) Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan showing the location of all proposed excavations and relationship to adjoining premises,public streets or areas,and give a detailed description of all site and pavement restoration work. (b) Attach all other necessary permits and licenses for this project. (c) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 Section a`� Block 'd� Lot C5 7. Starting Date: 2/10/2023 (estimated date) Completion Date: 5/1/2023 (estimated date) 8. Work Schedule: Phase Completion Date Excavation Work Schedule Facility Installation Must be provided Backfill&Completion for consideration as a Pavement Replacement Complete Application. 9. Under which authority is application being made: keyspan d/b/a national grid See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: $ 11. Remarks: Gas Service Retire/Demo related 6190 Peconic Bay Blvd D-39 1 of 3 Copy Distribution: Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings (use code) Applicant Notified 1 St 2nd 3rd 4th (To Permit Clerk) REMARKS c CODE IB Improper Barricades IL Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfilling) BUC Building Under Construction WIP Work In Progress DB Improper Backfill(too high,not sufficient) HFS Inspector Holding for Final Settlement of Excavation RFR Ready for Repair D-39 3 of 3 GENERAL CONDITIONS OF PERMIT APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR (Continued) 10. Install,Maintain Erosion Controls: Required Erosion Control Measures(i.e. silt fencing)is to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good functional condition until thick vegetative cover is established. 11. Clean Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt, slag,flyash, broken concrete or demolition debris). All unsuitable soils excavated at the site(i.e. Clay,Bog, etc.) are to be removed from the site and not used to backfill any excavation within a Town Highway. 12. All Areas of Soil Disturbance: All areas of soil disturbance resulting from the approved project shall be stabilized to the satisfaction of the Highway Superintendent immediately following project completion. If the project site remains inactive for more than 48 hours or planting is impractical due to the season,then the area shall be stabilized with straw,hay mulch and/or jute matting until weather conditions favor germination. 13. Backfill& Compaction of all Excavations: Back Fill shall consist of clean fill or soils which exhibit a well-defined moisture density relationship as determined to be in accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve(12")inches thick and shall be mechanically compacted to a Ninety- five(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at three-foot intervals will also be permitted subject to a project specific approval by the Highway Superintendent. 14. Restoration of the Road Shoulder Area: All man-made improvements located within existing road shoulder areas must be protected to the greatest extent practical. Items would include but not be limited to driveway&private road aprons,mail boxes,sprinkler systems,trees and ornamental plantings. Excavations through driveways and private road pavements must be'reconstructed to meet all requirements of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15. Schematic Plans with all Technical information and Scope of Work: To reasonably and adequately describe the proposed work, accurate schematic site plans must be provided to show or indicate all proposed construction activity required under this permit. All Pavement surfaces scheduled for excavation must be saw cut to the full depth of asphalt and/or concrete pavements. Accurate size of bell holes or width of trenching must be indicated by dimension or labeling. This schematic site plan must provide details on all restoration required to meet the requirements of these General Conditions and requirements found in the Southold Town Highway Specifications. 16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner; (Note:When Concrete Pavements are Present,Please review Restoration requirements with the Highway Superintendent) a) Complete all back-fill&soil compaction work as needed to provide a suitable sub-base; b) Over-cut existing asphalt bell hole or trench by twelve(12")inches on all sides; c) Install a compacted lift of 4"thick Stone Blend base(RCA Blend must meet NYS DOT Specification); d) Install a two and one half(2.5")inch compacted lift of Asphalt Base Course; e) Install a one and one half(1.5")inch of Asphalt(Type 6)Wearing Course. (Provide AC at all joints) All work listed herein must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenching of Pavement Surfaces Exceeding One Hundred(1001)Feet in Length: All trenching of .,pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item # 16 as noted above. Once all pavement reconstruction is completed to the satisfaction of the Highway Superintendent,the entire road section and/or width of road over the entire length of trench shall be repaved with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). nafiionalgrid PERMIT APPLICATION SKETCH Village Of DATE: .21812023 LOCATIM 6190 PECONIC BAY BWD STREET 1: BIRCH DR TO%W- LAUREL CROSS STREET 2: 00 x WORK ORDER: T102515171 'r 00 R am cn 06 SURFACE: Co Grass/Di rto. m —E� 6190 _ L) 0 U ) m c m. U (h Ci. N L r � IQI - 715' N 4'x 4 Bell Hole x x CL N (0 PECONIC BAY BLVD °' m E 4-0 co0 J U CL ' N C N O ql N Q NN � - 5 N C rn - a N L Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 02/14/23 Receipt#: 308229 Quantity Transactions Reference Subtotal 1 Excavation Permits 1638 $550.00 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#7002392751 $550.00 National, Grid - Keyspan Gas East Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: National, Grid - Keyspan Gas East 25 Hub Drive Melville, NY 11747 Clerk ID: SABRINA Internal ID: 1638