HomeMy WebLinkAbout600 Indian Neck Ln Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 10/30/23 Receipt#: 315959
Quantity Transaction Reference Subtotal
1 Excavation Permits 1690 $550.00
Total Paid: $550.00
Notes:
Payment Type Amount Paid By
CK#7002524037 $550.00 National, Grid - Keyspan Gas
East
Southold Town lerk's Office
53095 Main Ro.9d; PO Box 1179
Southold, NY 11971
Name: National, Grid - Keyspan Gas East
25 Hub Drive
Melville, NY 11747
Clerk ID: JENNIFER Internal ID: 1690
Permit No.
TOWN OF SOUTHOLD gFQt�
HIGHWAY DEPARTMENT
Peconic Lane
Peconic,New York 11958
T102571925 (631)765-3140 ,
AP LICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY ade to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit
pursuant to Chapter 237 of the ode of the Town of Southold,Suffolk County,New York,and other applicable laws,ordinances or
regulations for each individual ontiguous excavation project herein described. The applicant agrees to comply with all applicable laws,
ordinances,codes and regulatio s,the attached"General Conditions of Permit'and"Special Conditions",if any and to permit authorized
inspectors to make necessary in pections of the job site.
Print or Type
1 Keshia Black-(516)229-6 55//lipermits@nationalgrid.com Keyspan Gas East Corp d/b/a National Grid//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 R questing Service(if applicable) Address of Owner
600 Indian Neck L� -- 1 4'x4' mac bellhole on E/S, a rox. 345' N/0 Shore Ln (see sketch)
4. ( ) pp
Work Description and Loca ion(Street Number,Hamlet,Cross Street)
(a) Is constru tion located within 75 feet of tidal wetlands? *Yes No ✓,
*If y s,other Town permits may be required.
i'
NOTE: All informati n requested by this Signature of Applicant
Application/ ermit Form is
Required for complete application! 10/17/2023
Date
5. (a) Attached plot plan to re sonably and adequately describe the proposed work. Provide accurate schematic site plan showing the
location of all proposed exc vations and relationship to adjoining premises,public streets or areas,and give a detailed description of
all site and pavement restora ion work.
(b) Attach all other necessa permits and licenses for this project.
(c) Work covered by this ap lication may not commence before issuance of a Highway Excavation Permit by the Town Clerk.
976. Tax Map No.: Distri t 1000 . Section 8(f , Block —7 Lot 19-
7.
. Starting Date: 11/7 2023 (estimated date) Completion Date: 11/8/2023 (estimated date)
8. Work Schedule: Phase Completion Date
Excav tion Work Schedule
Facili Installation Must be provided
Backfi'1&Completion for consideration as a
Pave ent Replacement Complete Application.
9. Under which authority is app ication 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 ork: $
11. Remarks: New Gas Se ice
D-39 1 of 3
12. Insurance Coverage:(Att ch Copy)
(a) Insurance Company,
(b) Policy#: 1_ _
(c)State whether policy 0�certification on file with the Highway Department:
(d)Coverage required extgnded to the Town:
Any Loss including Bbdily injury,property or commercial injury caused by or attributable to the work performed:
$1,000,000 per Occu ence and$2,000,000 general aggregate.
13. Security:
(a)Surety Bond or Certified Check provided in the total Amount of$
S b)Maintenance Bond pro ided: 2 years or 3 years.
14. Fees for Applications and rmits:
Basic ApplicItion Fee for Each Project Location - X $500.00
A Project Location would include each Bell Hole and/or every road opening or excavation within any
50'Radius w ether or not they may be inter-connected by open trench or directional boring.
The total num er of Project Locations shall be subject to the approval of the Highway Superintendent.
Al. /Se ice Connections excavations @$50.00 $ 50.00
No.
A2. /Additional Excavations same service @$20.00 $
No.
B. Trench Excavtions 18"in depth or less
Total Lineal F I otage of Excavation; L.F.@$10.00 $
C. Trench Excav tions 18"in depth to 5'in depth
Total Lineal 2�o-tage of Excavation; L.F.@$30.00 $
D. Trench Excavations 5'in depth and over
Total Lineal F otage of Excavation; L.F.@$50.00 $.
E. tility Repair Excavations @$1,000.00/Each $
No.
dditional Repairs of Same Service @$500.00/Each $
No. -
TOTAL$ 550.00
F. Official Notice o public utilities-proof must be provided and
Shall be attache to this application prior to issuance of permit.
Authorization is hereby grant d to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to:
in accordance with
this application and subject to a"General Conditions"and"Special Conditions"of permit(if any)attached hereto.
SUPERINTENDENT OF HIGHWAYS
TO FSO OLD, YORK
Goodwin 1 . Goodwin
Date
Date Received by the Town Cl rk
Date Permit Issued P,66it No. I O
NOTE: Permit expires one(1)year from date of issuance.
No work to start%�ithout 24 hour notice to Superintendent of Highways.
Permit must be av ilable at all times for inspection,on site,during construction.
D-39 2 of 3
Copy Distribution:
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original
INSPECTOR'S RECORDS
Inspection ate Findings (use code) Applicant Notified
1st
2nd
3 rd
4th
(To Permit Clerk)
REMARKS
CODE
IB Improper Barricades
IL Improper Lights
ST Sunken Trench or Excav ion
UTM Unable to Measure(due t backfilling)
BUC Building Under Construction
WIP Work In Progress
DB Improper Backfill(too hi h,not sufficient)
HFS Inspector Holding for Fin 1 Settlement of Excavation
RFR Ready for Repair
D-39 3 of 3
GENERAL CONDITIONS OF PERMIT
APPLIC TION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
1. Permittee's Co tractors to Comply with Permit Requirements: The Permittee is responsible for
informing its in&pendent contractors,employees,agents and assigns of their responsibility to comply with
this permit, incl(ding all special/site specific and general conditions imposed by the Highway
Superintendent hile acting as the permittee's agent with respect to the permitted activities,and such
persons shall be equired to comply with all permit requirements.
2. No RiLFht to Tre ass or Interfere with Private Property Rights: This permit does not convey to the
permittee any rig t to trespass upon the lands of adjacent property owners in order to perform the permitted
work nor does it Authorize the impairment of any rights,title,or interest in real or personal property held or
vested in a perso not a party to the permit.
3. Protection of the Highway and Future Highway Maintenance. If future operations or highway
maintenance prof cts by the Town of Southold require an alteration in the position of the utility, structure
or work herein auhorized, or if,in the opinion of the Highway Superintendent the work performed under
this permit shall c use unreasonable obstruction to required highway maintenance or endanger the health,
safety and/or wel are of vehicular or pedestrian traffic,this permit shall be revoked and the utility,
structure,fill,exc,vation,or other modification of the highway hereby authorized shall not be completed.
Additionally,the ermit may be revoked if the Highway Superintendent finds that the issuance of the
permit was illegal or unauthorized or that the applicant failed to comply with any of the terms and
conditions of the ermit or Chapter 237 of the Town Code.
4. Revocation of the Permit by the Highway Superintendent: If the Highway Superintendent deems it
necessary to revokthis permit and the project hereby authorized has not been completed,the applicant
shall,without expense to the Town and to such extent and in such time and manner as the Superintendent
may require,remo a all or any portion of the uncompleted utility, structure or fill and restore the site to its
former condition.
5. Notice of Comme cement: At least 24 hours prior to commencement of the project,the permittee and/or
contractor shall no�ify the Town Highway Department in writing that they are fully aware of and
understand all terms and project conditions of this permit. Upon completion of the work,the contractor
shall provide photographs of the completed work to the Town Highway Department and request a Final
inspection.
6. Stora a of Equient&Materials: The storage of construction equipment and/or materials shall be
confined within theproject work area and/or adjacent areas where permission/legal access has been
obtained in a mann�.r that does not interfere with normal highway traffic.
7. Utility Mark-Outs The Applicant/Contractor shall be responsible for verification of all existing utility
mark-outs and shall take all precautions to protect same. Damage to existing utilities shall be the
responsibility of the contractor and shall be repaired at the contractor's expense.
8. Road Closures: Al scheduled road closures must first receive written permission from the Southold Town
Board prior to closi g a road. Temporary lane closures may be permitted with the approval of the Highway
Superintendent. This item will included but not be limited to the installation of appropriate signage and
flag men to stop and start traffic to allow for single lane traffic. Road Closures due to unforeseen
emergencies require immediate notification of the Highway Department and shall be limited to immediate
and/or expedited res oration of the Work Zone.
9. No Construction D bris in Road Shoulder Area: All Construction Debris shall be removed from the job
site on a daily basis.IAll stockpiled soil as well as all other project materials that will be staged within the
Right-of Way must be delineated with reflective signage or other means to meet the minimum requirements
of the NYS DOT Co struction Standards.
GENERAL CONDITIONS OF PERMIT
APPLIC TION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
(Continued)
10. Install,Mainta n Erosion Controls: Required Erosion Control Measures (i.e. silt fencing)is to be placed
on the downsl0e edge of any disturbed area. This sediment barrier is to be put in place before any
disturbance oft e ground occurs and is to be maintained in good functional condition until thick vegetative
cover is establis ed.
11. Clean Fill Onl 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 fro 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 atisfaction 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 tabilized with straw,hay mulch and/or jute matting until weather conditions favor
germination.
13. Backfill& Com action of all Excavations: Back Fill shall consist of clean fill or soils which exhibit a
well-defined moi ture 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%)perce It 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 mut be protected to the greatest extent practical. Items would include but not be limited to
driveway&privat road aprons,mail boxes,sprinkler systems,trees and ornamental plantings.
Excavations throu h 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 cnstruction must be replaced or repaired by the contractor to the satisfaction of the
Highway Superint ndent.
15. Schematic Plans with all Technical information and Scope of Work: To reasonably and adequately
describe the propo ed work, accurate schematic site plans must be provided to show or indicate all
proposed construct on 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 requi ed to meet the requirements of these General Conditions and requirements found in the
Southold Town Hi ,hway Specifications.
16. Pavement Reconst uction: 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 bac -fill&soil compaction work as needed to provide a suitable sub-base;
b) Over-cut existin 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 lone half(2.5")inch compacted lift of Asphalt Base Course;
e) Install a one and ne half(1.5")inch of Asphalt(Type 6)Wearing Course. (Provide AC at all joints)
All work listed herei must meet the minimum requirements of the Southold Town Highway
Specifications.
17. Trenching of Pave ent Surfaces Exceeding One Hundred(100')Feet in Length: All trenching of
pavement surfaces a seeding 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).
PER. N- W- ; T-1 ,WETCH.
Village-'Of
`DATE: TO/1?/2023
L'OCAT-II T: 600 INDIAN NECK LNCROSS STREET-1: SHORES.LN
T.OVM: P E CONIC Cxoss..srUE.T 2::
WCRK:ORDER: 7102571925
SUItFi4CE:
Macadam-Road
600 �u
0
- u7
L
346'
INDIAN-NE-C,K LN