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HomeMy WebLinkAboutPequash Ave, Midwood Rd, Stillwater Ave, Eastwood Dr, N Cross Rd Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/22/24 Receipt#: 328013 Quantity Transactions Reference Subtotal 1 Excavation Permits 1726 $9,000.00 Total Paid: $9,000.00 Notes: Payment Type Amount Paid By CK#7002643638 $9,000.00 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: JENNIFER Internal ID: 1726 Permit No.. • ,HIGHWAY DEPARTMENT Pecomc Lane P - econic,New York 11958.. v T102556780 p� . (631)765._3140 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 .. 1: . Keshia Black-(51:6)452-3374//liperm,its@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 .. 4 : PEQUASH AVE, MIDWOOD RD,STILLWATER AVE;EASTWOOD DR,&N CROSS RD --(45)TXT testholes, (7).TXT drill openings& (9) 8%5'live gas pits(see sketch) Work Description and I ocation(Street Number'Hamlet,Cross Street) (a) Is construction-located within 75'feet offidal wetlands? *'Yes No ✓.: *If yes,other;Town permits may be required: NOTE: All information requested by this :. - Signa re of Applicant Application/Permit Form ii: . Required for a complete application! 5/14/2024 Datepa a 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£or 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. Block Lot TBD b engineer. TBD b 'en ineer Z.. Starting Date: y g . Completion.Date: Y 9. 8.1 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 nati6hal grid See Town Code.Chapter 237(E)-Provide Resolution by,or authority from,the Utility.being modified. 10. Estimated Cost of Proposed.Work: $ I1.. Remarks: Mandated Bare Main Replacement D-39 ... 1 of ::3:.. 12. Insurance Coverage:(Attach Copy)" a Insurance Com an P _ (b) Policy.#: c State whether policy of certification:on file g Y..with the Hi hwa DeP artment: P Y(d)Coverage required extended to the Town: Any Loss including,Bodily injury,property or commercial injury caused-by or attributable to the work performed: $1,000,000 per Occurrence and$2,000,000 general aggregate.qs R 13. Security: (a)Surety Bond or'Certified Check. provided in the total Amount of$.. . '(b)Maintenance Bond provided:: .. 2 years or 3 years. 14. Fees for Applications and permits: Basic Application Fee for'Each Project Location - $500.00 A Project Location would include each Bell Hole and/or every road opening or excavation within any 50'Radiuswhethec or not they maybe inter-connected by.open trench or directional boring. The total number of Project Locations shall be subject to:the approval of the Highway Superintendent. Al. /Service Connections excavations:@$50.00 . • $ No. A2. /Additional Excavations.same service @$20.00 No: .. B. Trench Excavations 1.8"in depth or"less'. . 0 . . .. $ Total Line a _L.F.@$10.0 Footage of Excavation; _- - C. Trench-Excavations 18"in:depth.to 5'in depth @ $ • Total Lineal Footage of Excav L1.@$30.00.ation• D. Trench Excavations 5'in depth and over Total:Lineal Footage of Excavation; . .L.F.@$50.00--------------- E. Utility Repair Excavationns @$1,000.00/Each $ No. Additional Repairs of Same Service @$500.00%Each $' , TOTAL$• 9000:00 F. Official Notice to public utilities-proof must lie provided and Shall be attached to this application prior to issuance of permit. Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: : .. in_ accordance with •. . this application and subject to the"General Conditions"and"Special Conditions"of permit(if any),attached hereto: ' SUPS TENDENT OF HIGHWAYS. TO S OLD, W YOR& Fanileoo -� win —� e Date Received by the flown Clerk 512-Z'(.. 2'7 - Date Permit Issued NOTE: Permit-expires one(1)year from date of issuance: No work to'start without 24 hour notice to Superintendent of Highways.' Permit must be available at all times:for,inspection,on site,during construction. D-39 ... _ . 2 of 3 . . .. ... ... ... .. ... ..: :: k Copy Distribution: I Permit# �Q 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 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 1. Permittee's Contractors to Comply with Permit Requirements: The Permittee is responsible for informing its independent contractors,employees,agents and assigns of their responsibility to comply with this permit,including all special/site specific and general conditions imposed by the Highway Superintendent while acting as the permittee's agent with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Right to Trespass or Interfere with Private Property Rights: This permit does not convey to the permittee any right 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 person not a party to the permit. 3. Protection of the Highway and Future Highway Maintenance: If future operations or highway maintenance projects by the Town of Southold require an alteration in the position of the utility, structure or work herein authorized,or if,in the opinion of the Highway Superintendent the work performed under this permit shall cause unreasonable obstruction to required highway maintenance or endanger the health, safety and/or welfare of vehicular or pedestrian traffic,this permit shall be revoked and the utility, structure,fill,excavation,or other modification of the highway hereby authorized shall not be completed. Additionally,the permit 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 permit or Chapter 237 of the Town Code. 4. Revocation of the Permit by the Highway Superintendent: If the Highway Superintendent deems it necessary to revoke this 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,remove all or any portion of the uncompleted utility, structure or fill and restore the site to its former condition. 5. Notice of Commencement: At least 24 hours prior to commencement of the project,the permittee and/or contractor shall notify 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. Storage of Equipment&Materials: The storage of construction equipment and/or materials shall be confined within the project work area and/or adjacent areas where permission/legal access has been obtained in a manner 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: All scheduled road closures must first receive written permission from the Southold Town Board prior to closing 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 restoration of the Work Zone. 9. No Construction Debris in Road Shoulder Area: All Construction Debris shall be removed from the job site on a daily basis. All 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 Construction Standards. 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). TOWN OF SOUTHOLD . CUTCHOGWE. ... q nation a Q rid b PEQUASH AVE/MIDWOOD RD/STILLWATER AVE GRID:101-42-9977 WORK ORDER:T102556780 KEVIN MCGOUGH 631-263-2928 yyy GAS MAIN REPLACEMENT' SHEET 1 OF 2 .. ... ylsy o� 2 Fs / j l "� � " ]15J(✓ DRILL SUMMARY:TOTAL PROJECT - �O PEQUASH AVE 3,460' MIDWOOD RD 510' STILLWATER AVE 260' �p o s off. EASTWOOD DR 220' `y�0 titi/ 2i� /��• N CROSS RD 110, gyp`' �. .. 0... . ... ... ... .. TOTAL: ... "4,560'. 000. l`3 ... ... ... - ... .. d ROADWAY OPENINGS:TOTAL PROJECT QTY DESC :_ SIZE = SUBTOTAL / (45) TEST HOLE '' TXT 405 SQ.FT. 7 DRILL OPENING 3 X5' 105 SQ.FT. (9).:: LIVE GAS PIT 8'X5'.: :': 360 SQ.FT. TOTAL 870 SQ.FT. DRILL OPENING: ® 'LIVE GAS PIT: TEST HOLE:' '® DRILL LINE:. NOT TO SCALE TOWN OF SOUTHOLD ' CUTCHOGWE. nationalgrid. PEQUASH AVE/MIDWOOD RD/STILLWATER AVE GRID:10..1 42-9977 sm WORK ORDER`.T102556780 KEVIN MCGOUGH 631-263-2928 GAS MAIN REPLACEMENT• �! SHEET 2 OF 2 !0 t / : % DRILL f SUMMARY: . MI WOOD RD TOTALPROJECT 510' Q STILLWATER AVE 260' ' / EASTWOOD DR 220' / N CROSS RD' 110' - �ri�• TOTAL: 4,560' - ROADWAY OPENINGS TOTAL PROJECT' �!O / QTY DESC SIZE. = SUBTOTAL, / (45) TEST HOLE 3'X3' 405 SQ FT ys . ' � (7).� DRILL OPENING. N 3'X5' 105 SQ.FT.(9) LIVE GAS PIT 8'X5' 360 SQ.FT. ,p TOTAL 870 SQ.FT. O O / OG�y ... .. .. .. ... Y. ... .. DRILL OPENING: ® LIVE GAS PIT: TEST HOLE: ® :DRILLLINE:. . NOT TO'SCALE T102556780 Town of Southold Street:.. . :.. Pequash,Ave Road Way'Openings -Behind the Curb Openings Qty Opening Size Sgft Qty. Opening Size Sqft 288 6 .3'x5 90 ::: _ 2 8'x5': '80 : m w ; .. Trench Attributes ... Trench Attributes LnFt Trench Width.- Sqft LnFt Trench Width Sqft Total:-- 458 .. Street: Midwood Rd Road WayOpenings .Behind the Curb Openings Qty Opening Size Sqft Qty. Opening Size Sgft 1 3'x5' 15 - 4 8'x5-' 160 Trench Attributes Trench Attributes = LnFt Trench Width' " Sqft LnFt , Trench Width Sq ft. Total: 202 Street: Eastwood Dr Road Way Openings -Behind the Curb Openings Qty Opening Size Sqft Qty Opening Size; "-Sqft 3 . . :: 3'x3. :: '. 27 ... 1. ... 81x51. 40 Trench Attributes Trench Attributes LnFt - Trench Width Sqft LnFt Trench;Width Sqft - - Total 67 Street: = Stillwater Ave Road Way Openings Behind the Curb Openings Qty- = ----- Opening Size- - —Saft -- - = -- Qty— ;_ Opening Size — -Sgft----- - : :. 6 .. 3'x3,. 54 1 . . ... 8'x5' 40 --�--- ------------.�---------------�-�-------- -------:_------------- --- --�--Trench Attributes Attributes Trench Attributes LnFt Trench Width Sqft LnFt. Trench Width Sqft Total ..: :.. 94 Street: N Cross R Road Way Openings Behind the Curb Openings , Qty Opening Size Sqft Qty Opening Size Sqft 1 3'x3' .9 - 1 8'x5' 40 Trench Attributes Trench Attributes- LnFt Trench Width Sqft - LnFt Trench Width -Sqft Total .. 49 .. .