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35511-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~uRTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-34374 Date: 05/26/10 THIS CERTIFIES that the building TANKS & ISLAND UPGRADE Location of Property: 11100 MAIN RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 122 Block 3 Lot 10 Subdivision Filed Map No. -- Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 27, 2010 pursuant to which Building Pemit NO. 35511-Z dated APRIL 27, 2010 was issued, and conforms to all of the requirements of the applicable provisions of the law. The Occupancy for which this certificate is issued is NEW TANKS, THREE ISLJ~XrDS IN EXISTING LOCATION, SIX DIPENSERS AND THREE NEW FIRE SUPPRESSION SYSTEMS. The certificate is issued to AMERADA HESS CORPORATION (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPART~glqT OF HEALTH APPROVAL ELI~CTRICAL C~KTIFICATE NO. PLI~EllS c~KTIFICATION DA'r~ N/A 35511 05/20/10 ~ ~N/A ~~'D~i~~gnature Rev. 1/81 · Form No. 6 TOWN OF SOUTHOLD BUILDINGTOWN765-1802 DEPARTMENT HALL APPLICATION FOR CERTIFICATE OF O¢ A.ThiSForapplicati°nnew buildingmUSt beor fillednew use:in by typewriter or ink and submitted to the Buff(~~l~r 1. Final survey of property with accurate location of all buildings, property ~nes, stree s, an u topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Constrection:-l'OA~ ],q--5 Location of Property: IIlO0 House No. Owner or Owners of Property: .k140 ~ ~ ~--'OCp. Suflblk County Tax Map No 1000, Section ] ~ ~ Subdivision Pernfit No. 3 ~- ~' ~ Health Dept. Approval: Old or Pre-existing Building: Street (check one) Hamlet Date of Permit. ~-/- 0"]-/0 Block 00 0-.~ Lot Filed Map. Lot: Applicant: ~'73q" Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~O. '--' Final Certificate: / (check one) Applicant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35511 Z Date APRIL 27, 2010 Permission is hereby granted to: for : TANKTOP UPGRADE TO 3 HESS CORPORATION AMERADA ONE HESS PLAZA WOODBRIDGE,NJ 07095 EXISTING TANKS PLUS NEW PIPING & DISPENSERS TO EXISTIN~ ISI~-DS AS APPLIED FOR AND PER SCDHS. ~-~5 %~1 at premises located at 11100 MAIN RD County Tax Map No. 473889 Section 122 pursuant to application dated APRIL Building Inspector to expire on OCTOBER MATTITUCK Block 0003 Lot No. 010 27, 2010 and approved by the 27, 2011. Fee $ 250.00 ORIGINAL Rev. 5/8/02 'l'oxm ltall Anm'x 5 [37.5 Main Road 1'.O. Box 1179 Southold, NY I 1!}71-09.59 Telephone (631) 76,5-18()2 FiL'(((331) 765-9,502 ro.qer, richert~town.southold, nv. us BI IILDING I)EPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Hess Address: 11100 Main Rd City: Mattituck St: NY Zip: 11952 Building Permit #: 35511 Section: ~ '~.~, Block: "~ Lot: I O WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE .3ontrector: DBA: Major Electric License No: 2579-e SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 3 ph Hot Water GFCI Recpt Main Panel A/C Condenser Single Recpt Sub Panel A/C Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures R HID Fixtures Wall Fixtures ~.~ Smoke Detectors Recessed Fixtures [~ CO Detectors Fluorescent Fixture ~.~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures ~ TVSS Gasoline dispencin~l pumps, to include hazardous location requirements Notes: 3 gasoline dispencers, 3 submersible 1.5 hp pumps, 1 parking lot pole light Inspector Signature: Date: May 20 2010 81-Cert Electrical Compliance Form FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII/3ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34391 Z Date JANUARY 16, 2009 Permission is hereby granted to: HESS CORPORATION AMERADA ONE HESS PLAZA WOODBRIDGE,NJ 07095 for : TANKTOP UPGRADE TO (3) EXISTING TANKS PLUS NEW PIPING & DISPENSERS TO EXISTING ISLANDS AS APPLIED FOR A S ID PER SCDHS. at premises located at County Tax Map No. 473889 Section 122 purs,,mnt to application dated DECEMBER Building Inspector to expire on JULY 11100 MAIN RD MATTITUCK Block 0003 Lot No. 010 2, 2008 and approved by the 16, 2010. Fee $ 250.00 ~h~i z ed~/~gnat ure ORIGINAL Rev. 5/8/02 05/26/2010 08:25 FAX 15317565944 ~002/002 Commissioner Article XH Hazardous Material Storage PACILITY REI~R.ENCE 13552 $CHD$ [~C. ISTRATION # 10-0005 SCI)RS PLAN # HM09-017XI Date of Isstmnee: May ~4, 2010 FACI~FFY NAMe' & A.DDRE.q$:. liess #~2481. 1]100Rte25 "' 1 Huispla~z ' WcMb~iEgc, N~ 07095 STORAGE FACILITY STOP-AGE FACTLrrY # 4 vor~d~ 10,000 lO, O00 C0~$ C.~0]jne O~oltng The Stornge Ftcflii,y($) may be placed lute ~rvice provided that all neeeM~lt'y permitting, imspec, tioll~ and aOJer r~uletery requiF~monls 0f fowtl, vflla{{i dad ell otltel' mun]eip~lit~es have bm~n satisfied, This inelud~ but is no~ limited ia, meeting all,loci{ building co~, xoniag, and ~ oaf~y PERMIT TO CONSTRUCT Toxic and/or Hazardous Material Storage Facility Suffolk County Department of Health Services Humayun J. Chaudry, DO, MS Commissioner SCDHS REFERENCE # 13582 SCDHS REGISTRATION # 10-0005 SCDHS PLAN # HM08-017R2 Date of Issuance: October 14, 2008 Permit expiras one year from the Date of Issuance* FACILITY NAME & ADDRESS: Hess 11100 Rte. 25 Mattituck, NY 11952 The application for permit to construct a Toxic or Hazardous Materials storage facility for the above referenced site has been reviewed for compliance with Article 7 & 12 of the Suffolk County Sanitary Code. Thc app]icatien has been approved. The items listed below and on the back of this form are conditions of this permit. A copy of the approved plan must be kept at the construction site. A copy of this permit must be kept on display at the facility during construction. 2. Safe construction practices must be followed dunng the installation of the storage facility(s). The storage facility(s) must be constructed in accordance with the approved plan. Any changes in design, materials or use requires pr/or written consent of both the design professional and the Office of Pollution Control. The changes have to be submitted in a form that is acceptable to the Office of Pollution Control. The contractor and/or des!gn professional is required to inform the owner that the changes are being made. The Office of Pollution Control has the right to inspect this installation at any time to verify its being constructed in compliance with this permit. The Office of Pollution Control must be contacted at 854-2523 at least 2 business days prior to commencement of any work to arrange for the required Construction inspections. Contact the local building department and/or fire safety enforcement office for any additional requirements that may apply to your project. The storage facility cannot be placed into service until the Office of Pollution Control performs all required installation inspections and issues an interim permit to operate. The Office of Pollution Control reserves the right to revoke this permit as allowable by law. iss DB : / Assoeigl~f~folic Health Engineer Offic~C. of'Pollution Control *CONTINUED ON REVERSE* THIS PERMIT IS VAI,ID FOR THE FOLLOWING STORAGE FACILITIES ONLY SCDHS # LOCATION VOLUME CONTENTS NOTE 4 Under/Out I 0,000 Gasoline Piping & Dispensers 5 Under/Out 10,000 Gasoline Piping & Dispensers 6 Under/Out 10,000 Gasoline Piping & Dispensers This permit is renewable, for a fee, for up to 90 days after the Permit to Construct expires. The job file will remain open for that time. If the Office of Pollution Control does not receive a renewal application within 90 days, the file will be closed and a new application for a Permit to Construct will have to be filed if the job is to be re-opened. Ail applicable filling fees will once again become due and payable. Issuance of this permit does not supersede any existing agreements with, or mandates by, the Office of Pollution Control or any other government agency. The construction period does not supersede and existing compliance dates agreed to, or mandated by, the Office of Pollution Control or any other government agency. Issuance of this permit does not authorize the use of the storage facility(s) that are in violation of the Suffolk County Sanitary Code or any other regulation. Special Conditions: 1. None TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRB RESISTANT [ ] ELECTRICAL (ROUGH) REMARKS: DATE INSPECTOR ~:~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] FINAL ~/-,,]~RE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: Fire Guard of Long Island, Inc. Gleml Kamm - NYC ~r Fire S~ppt~ssion Piping Conlractor- Class CLic. No. 0266 40-8 Bun Drive, De~r Park, NY ! 1729 (631 )242-5315 Fax (631 )2424945 83 J. ewe~ Ave.. Staten Island, NY 10302 (718)981-7972 · ' Email -firegunrdli~ptimu~net May 24, 2010 Town of Southold BUJldin~ Department Town Hall Southold, NY 11971 MAY 2 5 '2010 BLDG. OEPT. TOWN OF SOUTHOLO Attention: Bob Fisher RE: HESS GAS STATION 11100 Main Road Mattituck. NY Dew Mr. Fisher, Please be advised that Rte Guard has completed the installation of the fueling .area fire suppression system as shown on approved plans. The system was tested, tagged, and placed into operaUon on May 24, 2010. Said system was designed and installed in accordance with NFPA 17, "LtL 1254" and the manufacturer's UL listed manual. Sincerely, FIRE GUARD OF LONG ISLAND, INC. BY: ~__ Glenn Kamm, President Suffolk County lac. llTA OATE: ~.'"% ~,. ~"- ° 7'~ [iHOl~r¢ {$31 ) 242,5315 FAX #~r'AxI (631)242-4945 COMMENTS F~ Suppression Sy~=m.Ck~d Cimuit TV' Systems.,Fim.Exlinguidm3 Design-lnsUdlaion~lmlzctiom FIELD INSPECTION REPORT ',~')'/DATcE l 'O ~. COMMENTS FO~DATION (ISm) ~ ' ' ~ ~ FOUNDATION (2ND) ROUGH F~G & PLU~G INS~ATION PER N. Y. STATE ENERGY CODE FIN~ ~DITION~ CO~ENTS / /._ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. no rth fork. net/Southold/ Examined ,20 Approved ,20 Disapproved a/c Expiration ,20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? -'~"~S Board of Health /~ 4 sets of Building Plans Plam~ing Board approval ~//.m~ ~'~ / Survey PERMIT NO. "~.~ /,~ ,/? __ __..~..~beck_ Co ~a · Building Inspector APPLICATION FOR BUILDING PERMIT Date lcd' O1 ,200~ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. £ Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months fi.om such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the consl~uction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) - -(Mailing t~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder N meofowne, ofprcmises meCCx a_ NeO R. (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders LicenseNo. Plumbers LicenseNo. Electricians LicenseNo. Othcr Trade'sLicenscNo. I. Location of land on, which proposed work will be done: I I i o0 /40U TE L~- House Number Street Hamlet County Tax Map No. 1000 Section / 0 ~ Block 0 ,~ Lot / 0 Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. lntended use and occupancy /..~AS ~'lgVtUta~ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Workffan~. ~oa~'ad, e: tlCto ,a,a, · o (Description)' 4. Estimated Cost g ]00/000 · ©0 Fee (To be paid on filing this application) 5. I f dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, anmmercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth, Height Number of Stories Rear Dimensions of entire new construction: Front Height Number of Stories .Rear Depth Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO '~ 13. Will lot be re-graded? YES No~X Will excess fill be removed from premises? YES__ NO 14. Names of Owner of premises t4~'~5 C. OQg. Address i ,q~.'i ~ Pla'l_O. Phone No. Name of Architect fo-/: 5,oo-f-~ocd ~.M/laJvldl ~t Address~Phone No &~;t. 7~lo- .y~.~r~? Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a fi'eshwater wetland? *YES NO ~( * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PER/X41TS MAY BE REQUIRED. b. ls this property within 300 feet ofatidal wetland? * YES__ NO '~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on properly is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) coum¥ OFSo GI Ks)s: ~'~IZ)O~O' 9i ~-~ {' ~ '~' being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~ C.A~F~ Yq (~Contractor A en ~ ( , g t, Corporate Officer, etc.) of said ovmer or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this appticalion are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swo~rg J~_before me thi~/~ z? Nota~ Pub~c~ State oi Ne~ York No. O1KEOO11434 Oualified in Su~olk Ooun~ C~m~sion ~pires ~g~t 1 O, ~ ~ Signature of Applicant TOWN OF SOUTHOLD BUILIM0{G DEPARTMENT T. OWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examlncd ,20 Expirabm~ .20 BIf[LD1NG PERMIT APPLICATION CI U~CKLIST D~ ~,ou ha'~c m nccd the tbllowing, before applying? Board of Health 4 sets of Building Plans Planning Board appro~ al Check llood Pemfil Mail to: Building Inspector APPLICATION FOR BUILDING PERMIT 1)ac .~'- I c~ .2t) ta2 INSTRUCTIONS a This application MI !ST bc completeb filled in by typewriter or in ink and submitted Io thc Building Inspector with 4 sets of plans, accurate plot plan 1o scale Fee according to schedule b Plot plan showing location oriel and of buildings on premises, relationship to ac[joining premises or public slrcets or areas, and watorx~ays c '11~0 work covered by Ibis appbcalion may not bc commenced bclbre issuance of Building PemfiI. d. Upon approval of tiffs application, lhe Building Ins~clor will issue a Building P~mit Io lhc applicant Such a penmt shall bc kept on the premises available lbr inspection throughout fl~e work. c. No building shall be occupied or used in x;4mle or in parl for any purpose wbal so ever until the Building Inspector issucs a Ce~ificate of f~cupanc5. [ Every building permit shall expire iffl~c work attthorized has not commenced within 12 monlhs after thc date of issuance or has'not been complclcd wiflfin 18 months lkom such date If no zoning amendmemls or o~m' regulations allbcling properB have been enacted in lhe interim, the Building Inspector may authorize, in writing, the cx~cnsion of thc permit lbr an addilion six mouths. 'l~crcafler. a new pcmdt shall be rcquimd, APPLICATION IS IIEREBY MADE m thc Building I~pa~mmt lbr thc issuance ora Building Permil pursuanl lo the Buildin~ Zone fRdinance of~e Tom~ of SouOmld. Suflkflk CounU, Now York. m~d othcr applicable l,aws. Ordinances or Regula~ons, Ibr the conslmcti{m of buildings, additions, or allerafions or fi~r re, oval or demolition as herein described The applicanl agrees 1o compl5 xxith all applicable la~x s. ordinances, building code. housing co~d regula~, and~dmit attlborized inspectors on premises and in buildina lbr neccssar; inspeclions~ (Si~a~re of appli~nt or amc. if a co~oralion) {XIa n~ at dr~s of app t:ant) Stale whether applicant is owner, lessee, agent, archilect, engineer, general contractor, electrician, plumber or builder Name ofowncrofprem,ses M RONA Cee (As on the tax roll or latest deed) If appli~nt~ corpora~k~ature ofdulv~t~orized officer (Name and title 6f corporate othcer) Builders License No. Plumbers Liccllsc No. Electricians License No I. Ix)cation of land on which proposed xxork will bc dogc: House Number Streel I lamlel CounB Tax Map No 10(}0 Section [ ~ Block ~ Lol } ~ ~7 BLDG. DEPI. TOWN OF SOUTHOLI~ / 2,*"Slate cxistJng u~ and occt pa cy ofqaro n scs'and intended usc and occupancy of proposed conslruclion: a. Existing usc and occupancy ~ ~ ~o ~ b. Intended use and occupanc5 ~ ~ ~ ~ ~ 3. Natureofx~ork(chcckwhich applicable): New Building Addition Allcration Rcpai~ Rcmoxral Demolition Other Work ~/~ ~ ~ (Description) 4 Eslimatcd Cost [O/ ~Oo (To be paid on filing this application) 5 Ifdx~etling. number of dwelling umts Nmnber of dwelling units on each floor If ~ara~e, number of cats 6. If business, commercial or mixed occupancy, specil3 nalurc and extent of each type of usc ~ ~z~ Height. Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories 8. Dimensions et'entire new construction: Front Rear Height. Number of Stories 9 Size oflot: Front Rear _Depth Depth Rear Depth I 0 Dalc o[' PLirchase [ 1. Zone or use district m xxhich premises are situated t2. [)ocs proposed construclion xiolatc an5 zoning lax',, ordinancc or regulation? YES NO / 13 Will lot be re-graded? YES NO ~ Will excess fill bc removed l?om premises? YES NO 14 Names of Owner of premisesAvl4~-~,~l. /~ ~ t Address I. otgo~a,,~, P'~J-Phone No 7 ~ ~ NameofAmhilcct ~ ~ . .Addrcss6~&~,.~PhoneNo &~ Name of Conlractor ~t ~ ~ Address B~ ?~ ~ cf Phone No. { ~ ~ 15 a. Is this propc~' within I O0 l~ct of a tidal wetland or a ffcshx~ ater welland? *~S N() ~ * IF YES. S()U] I IOIA) TO~ TRUS'I I,'.I~S & D.E.C. PERMITS MAY BE REQUIRED. b Is this propc~' x~iflm~ 300 l~et of a tidal ~¢fland? * YES NO * iF ~S. DE C PERMH'S MAY BE RHQ[HRED ] 6 Provide surxeL ir) scale, with accmate lbundation plan and distances to propcrh lines. 17 If elex ation at an5 point on properl5 is at 10 feet or bekm. must provide topographical dala oil surxcy. 18 Are Ihere an5 covenants and restrictions with respect to Ibis properly? * YES NO ~ · IF YES. PROVIDE A COPY. SPATE OF NEW YORK) ~--.~-'J~t ~1 ~'"~l,.~ being dui, sworn, deposes arid sa3s thai ~hc is thc applicant (S)Hc i* thc ~ ~ / ~- ~ (Conlractor. Agent, Corporate Officer. etc.) of said o~cr or ox~ners, and is dui5 authorized to perlhnn or have pcrlbrmcd fl~c said work and to make and file this applicatkm: flint all statcmenls contained in Ihis application are tree to fl~e best of bis knowledge and belier~, and that the work will be perlbmled m thc manncr scl lbrth in thc application liled thercxxilh. LORRAINE ABRUZZO Notary Public, State ot New York No. 4842545 Qualified in Suffolk County_ ...,.,,. Commission F. xpites Nov. 30. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 January 12, 2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Debbie Piderit Engineering Assistant FST Engineers 500 Bi-County Blvd., Suite 118 Farmingdale, NY 11735 RE: HESS AH#32481 ROUTE 25 & BAY AVE., MATTITUCK SCTM#122-3-10 Dear Ms. Piderit: The Southold Town Board of Trustees reviewed the site plan prepared by FST Engineers last dated June 25, 2008 and determined the upgrade of three (3) existing 10,000 gallon underground gasoline tanks, new piping and new dispensers to replace existing dispensers to be out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, or within 10ff landward from the top of the bluff, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary best management practices are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Jame~'F. King, ~' Sincer~ Presiden~ Board of Trustees RECEIVED JAN1320 FSTNY of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: $.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISEION OF A 3 16 STORM*WATEr; GRADING~ DRAINAGE AND EROSION CONTROL pi a~ CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number:, (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Yes No 1 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? V/ r~ (This item will include all run-off created by site clearing end/or construction activities as well as all Site -- Improvements and the permanent creation of impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed Drainage S ructures nd cat ng Size & Location? This Item shall include all Proposed Grade Changes and S opes Con ro ng Surface WaterFIow! 3 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural r~ Existing Grade Involving more than 200 Cubic Yards of Matedal within any Parcel? V 4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? L~J 5 Is there a Natural Water Coume Running through the Site? r~ v/ is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? ~ -- 6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Hodzontal Distance? L~J -- 7 Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off [--] V/ into and/or in the direction of a Town fight-of-way? ~ -- 8 Will this Project Require the Placement of Material; Removal of Vegetation and/or the Construction of r~ any Item Within the Town Right-of-Way or Road Shoulder Area? ~ -- (This item will NOT include the Installation of Driveway Aprons.) 9 Will this Pro ecl Require Site Preparation within the One Hundred (100) Year Floodp a n of any Watercourse? ~ NOTE: tf Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building PermiU EXEMPT(ON: Yes No Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredl v/ -- STATE OF NEW YORK, cZ. ' ¢ouN oF ss That I ................................................................................. being duly sworn, deposes ;md says that he/she is tl~e apphcant for Pennih (Name of individual signing Document} CONNIE D. BUNCH And that be/she s the ........................ No(ar/Public Stateof NewYork ..................................... No'.'OtBU6t85'05'o .......... [ , , g ,corpoale~mlcer, etc) Oualified in Suffolk County Owner and/or represenmtive or the Owner of Owner's, and is duly authorized to perform or ha~?tioS~A~r~o%~g~ ~ make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before rue this; (Signature of Applican() FORM - 06/07 R Fisher ~3~-76~-~8o2x~o28 SOUTHOLD TOWN FIRE INSPECTOR roberLfisher@town.southold.ny,us Page ~~ NOTES ~~ DATE COMMENT FireNotes FST May 18, 2010 Town of Southold Building Department 54375 Main Road Southold, New York 11971 Re: Hess s/s 11100 Main Road Mattituck, New York Town Permit #35511 FST #SN-N093/200 To Mr. Gary Fish: FST Engineers, Inc. (FST) Engineering consultants for the Hess Corporation presents on their behalf, per your request this letter to certify to the best of our knowledge the concrete work for permit #3551 ] was installed as per the approved plans. We are attaching the concrete tickets for your information. This letter was based per our on-site visual inspection on May 15, 2010 and was installed according to plans. Thanks again for your time and consideration of this matter if you should have any questions please contact Mr. Kevin C. Papasian at 1-631-756-5999 (x229). Sincerely: Sr. Civil Engineer 5-10 TOWN ,~l~,, ~L~: '.L', '.., .' . ~ ~ . . ~ ~:re~,~me~ ~o~o to. ma . ~ AVA ~L promptly and thoroughly w th water. If ~ s mateH~ gem rmo eye, rln~ ~e eye lin- S~G~, ~ ~A~ ~D~I~ A~OM~'S ~SK ~"~ ' Avoi~sp~hingin~soro~inb ......... ( a~t2qu~fora~u~). MEASURE PRIC~ SUEI TOTA TAX RO. BOX 1065 · WEST B-ABYLON. NEW' YORK 11704 300'~$9 L' ' ' · ' Island park * Westbury * West BabylOn $ Sm[thrown * Ya~ohank * RIvarhead !' i ~ ' ' D SPATCH: 631-669'7000 MAIN OFFICE: 631-888-2200 , - .' , "WE BUILD CITIES" FAX; 631-669-7702 · ~ ',_~' . ~ ------'----- PROI~UCT DATA SAFETY SHEET,~V~!LAIitLE UPON REQUEST.; . '; · ADDITIONAL WATER ADDED TO ?RI~ CONCRETE WILL REDUCE ITS :,~: 5-1~ENGTH,,~I~ WATER ADDED IS AT CUEfOMER'S RISK. ....., . ~, - [' PRODUCT SAFETY WARNING ~t~ ~ I ~ " W~sh thor~)ughly after handlbg and t3e ore smok~g o eating, GALLONS ADDED AT CUSTOMER'S REQU EST ThlssaieanddetivetyissahecttothetermsaJ'~icondltlonsass~teci°nthereve~se- '' - side, Purchaser's slg.nat~'re below constitutes acceptance ot ali the s~ld Terms a~d .: . [j. Condltl= ns and Ack~0.w~[edges that He/She hs$ read and Safety Wa'n no P ~nted on tills document. RECEIVED IN GOOD CONDITION BY: ~ 'L-' 10:09 ~00!92 uNrr, AMOUNT' :_ .;: TICKET TOTAL ORDER TOTAL "WE BUILD CITIES" CUSTOMER RO. BOX 1065 · WEST BABYLON, NEW YORK11704 ~00775 Island Park · Westbu~ · West Babylon · Smithtown ,, Yaphank · RJverhead DISPATCH: 631-~69-7000 MAIN OFFICE: 631-888-2200 FAX: 631-869-7702 FAX; 631-888-2210 Load ~ Leeve Plant: :J 4"A~e:'J°b'$1te ~J~:~5 Start D['~hame~'~7 ~'~ :/<~'''"~ j';'l' 6 Finish DIsch,/~4~i ~7~/~. I 7 Leave Job Site ~ ~)'"~ I PRODUCT SAFETY WARNING Cauticnt Freshly mixed c~ncrete, cement, mortar, or grout may cause eye or s~in Injuryl as mdber gloves a~d boots, safety glasses, and moisture resistant skin coverings, etc. PRODUCT DATA SAFETY sHEET AVAILABLE UPON REQUEST. ADDmONAL WATER ADDED TO THIS CONCRETE WILL REDUCE:rfs; STRENGTH. ANY WATER ADDED IS AT CUSTOMER'S RISK. GALLON8 ADDED AT CUSTOMB:t'S REQUEST ~ sale and delivery is s~t)ject to Ine terms and condiUons as stated on the reverse side. P ~rchaser'$ slgnatuce delow.constitutes acceptance oi ~.Jl the s~.id Terms and Conditions al3a Acknowledges that He/She h~s read and urlc[erstooc[ the Product , ~.. 300~,0 884 3 000496 ~%TTI~TUCI RT 2S ~TD~AY ~VE 8.CO z°~E.0 PRODU~DESCBPTON ~rr OF UN~r AMOUNT C~ SUE~ TOTAL TAX TICKET TOTAL ORDER TOTAL - P.O BOX 10C65Oe ~',~EsTOBABYLON, NEW YORK1170¢' 300~B3 . ~ .~--~-~.' ' ; ;, ~ ~ AVAI~BLE UPON ~EQUEST, '. PRODUCT SAF~ WARNING ~ionl Fr~h[y m~ed ~n~te, ~men~ m~, or g~m may ~se'~e or skin Intel ~D~ION~ W~T~ ~DED TO ~lS CONCR~ WI~ R~UCE ~ ' - ' ' promp~y ~d ~orough y wl~ water, th s material g~ into ~e, rinse the eye ira- · MATTI';'uLa< ~T 2~ ~D ~'~ AV~ STRENGTH. ANY WATER ADDED IS AT CUSTOMER'S RISK, G/dJ_ONS ADDED AT CUSTOMER'S REQUEST - .~" mis sale ~n¢ OelNer.~ is subject to ~e ternls en~ corl~l~dons a5 sts~o os the reYerse '. soe. Putchas~-r's s~gnature DaIOW constitutes acceptance ol all the salo Terms Cond~lons and AcKnOWleages that He/StYe haS reao an~ un~erstoo~ tr,e product SyI4/Z0i0 P.O. # O00102 UNIT OF UNIT PRODUCT DESCRIPTION ~..~su R~ ~CE 4.00 AMOUNT SUB TOTAL TAX TICKET TOTAL ORDER TOTAL nd DISPATCH: 631-669-7000 : MAIN OFRCE: 631-888-2200 "WE BUILD CITIES' 2 Load FAX: 631-669-7702 FAX: 631-688-2210 I=' 3 Eeav~ plant' ~r 4 Arriv~,~O~ Site"~' ~:~;5 Start Discharge ;1:, ' 6 Finish Oisch; 7Leave job. Site PRODUCT SAF~-I'¥ WARNING Cauflonl Freall,! m~eo concrete, cement, mortar, or g rout may c~use eye or saln injury[ In c~se this material or its components contact skin aree. s. w~h the .contacted area promptly anO tlnoroughl¥ with water. If this material gets Into eye, r nse the eye Ira- 8 Arrive Plant PRbDUCT DATA SAFETY SHEET'AVAILABLE UPON REQUE$'F.~. ADDmONAL WATER ~DED TO THIS CONCR~-m W~LL Ra~JCE rrs! Sll~ENGTH. ANY WATER ADDED IS AT CUSTOMER'S RISK, · -DEUVERY ADDHESS RBADY'MIX , '"-" · RO. BOX 10~ · WEST BABYLON, .- ..... · . - '. ~ i--".- :. Island P~ · W~bu~ · We~ B~y[on · Sm~n · Y~p~k - Riverhe~d ~O0~0~ .~. ' - - ~:' ~ ~ PRODUCT DATA SAF~ SHE~ AV~S~ UPON REQUEST. -~1.~. - ' ' PRODUCT SAFE~ WARNING *~'~" In ~e this m~d~ or ~ compo~ co~ s~n are~, w~h the ~n~ ~ S~EN~H. ANY WA~ ~O~ IS AT CU~OM~S RIS~ , ~ ' S~TO ~ ~ P.o.~ ~ · ;' i -' ~ UNff~ u~" AMOU~ ~: -. .. ORDER RO. BOX 1065 · WEST BA'BYLON, NEW YOI )slandPark .,Wsstbury · West Ba~3~ Sm{thto~n Yapnam< · Riverhead · : DISPATCH: 631-669-7000 -~'~'" MAIN OFFICE; 631-888-2200 . ~WE BUILD CITIES" FAX:. I .631-669-7702 ~ FAX: 631-688-2210 2 Load'*" *''' 3 Leave'Pi~ht"='<l,',4 A~veJob$ite I -5, Staff Dlsc~arqe I" 6 Finish Disch. 'r 7 Leave Job Site I 8 Arrive Plant : ..... PRODUCT SAFETY WA~NI~G ~,' ;autionlFresh~ymlxedconcrete. cemenLmo~ar, orgroutrn~yca~seeyeorsklnlnjur~'l ADDiTIONALWATERADDEDTOTI'IIScONCRETEWILLREDUCEITS'q::~'~: . in case this material or ItS componentS contact s~ln areas, wash me con~acte{3 a~ea STRENGTH. ANY WATER ADDED IS AT CUSTOMER'S RISK. - ~ . ..... ~,o~)uc'r . ~:?,BQD UC;I': DESCRI ,PTION ' N,~,? , (3UAN'rrrv .o~,lvnw r~u~,iwm¢,', , MU~c.~uOi~ y~r~ . .. '.' '.:AMOU 1'1 O0 22,~3 22.80'~ C3' .~ :;" · 424' ~,~oo..s'~¢~-~ ~-~ . , : ~' · .L";." '. ' ~: ? FST ENIGNEERS~ INC. ENGINEERS-PLANNERS-SCIENTISTS 505 BI-COUNTY BLVD,, SUITE 118, FARMINGDALE, NY 11735 TEL: 631.756.5999 FAX: 631.756.5944 TO: Town of Southold Building Department 54375 Route25 Southold, NY LETTER OF TRANSMITTAL ENGINEERS FST ~ Since 191~ DATE: 5-21-10 JOB NO. Sn-n093/200 RE: Hess Mattituck Permit #34391 WE ARE SENDING: [-~ Estimates [~ Drawings ~'] Concrete tickets ~ Plans [~ Reports ~ Permits VIA: ~-] UPS [~ FedEx [~ Courier [-x~ Certification letter [-~ Photos ----]Hand Delivery [----] NO. DRAWING LAST COPIES NUMBER DATED DESCRIPTION 1 Engineers Certification letter 1 Site photos 1 Concrete tickets THESE ARE TRANSMITTED: [~ For Approval ~ As Requested [~ For Your Info [~ For Review and Comment [-~ Reviewed for General Consistency with Plans and Specifications ----]Reviewed for General Consistency-Comments Noted [~ Revise & Resubmit __ Revised Copies Remarks: Should you have any questions or concerns please do not hesitate to contact our office. Thank you, Debbie Piderit COPY TO: SIGNED: If enclosure(s) are not as noted, please notify us at once. 05/12/2010 17:15 FAX 5162932797 ]17.0. li.x 11/~ 15,%G2g327g7 TOWN O JOI/ISITIE iNFORMATION: (*ll3dloates required Inf *Name; *Address: *Cross street; *phorle No.: permit No.: Tax Map District: * IEF DESCRIPTION OF WORK (Please print Clearly) .......... ~_. ........... BR -_ ,.,, r_~.")~:,~,,,,~_~ ~&A5°u-Sc'~/e'g - · .% ..~ .-'a, ~ ...... *IS Job ready for Inspection; yES / NO 3Pflaae 100 150 200 300 3~0 400 Other UndergwurKI Number of Meters Change of Sel¥ice Overhead *Do you need a Tamp certificate: Tamp Information (if needed} *$ervlo~ SiZe: 1 Phase *New Service: Re-connect Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY ! 1971-0959 Telephone (631) 765-1802 · ax (631) 765- 5 ro, er, nohe. own.soutg o .nv.us BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION EOUESTED BY: Date: Company Name: ~-~ '~4qcR ~¢."¢~ \ ¢~C.. Name: License No.: Address: Phone No.: JOBSlTE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone No.: Permit No.: ~5'5-~ I Tax Map District: 1000 Section: Block: 0o0.% Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly), '~'(~rl ~,3 Lz Oc ¢'C~ c~ JrC~ ,J ' ' kJ ' ' - ',,,J (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If needed] *Service Size: 1 Phase *New Service: Re-connect Additional Information: YES/~) YES ~) Rough In Final 3Phase 100 150 200 300 350 400 Other Underground Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form PERMIT TO CONSTRUCT Toxic and/or Hazardous Material Storage Facility Suffolk County Department of Health Services Humayun J. Chaudry, DO, MS Commissioner SCDHS REFERENCE # 13582 SCDHS REGISTRATION # 10-0005 SCDHS PLAN # HM08-017R2 Date oflssuance: October 14, 2008 Permit expires one year from the Date of Issuance* FACILITY NAME & ADDRESS: Hess II100 Rte. 25 Matfltuck, NY 119S2 The appl!cation for pem~t t0,construct a Toxic or Hazardous Materials storag~ facility for the abov~e referenced sit· has been reviewed for cOmpliance with A~cle 7 & 12 of the Suffolk CoUnty~an!ta~ Code~ The apP!ication has been approved. The items listed below and on the back of this form are conditions ~fthls permit. A copy of the approved plan must be kept at the construction site. A copy of this permit must be kept on display at the facility during conslru¢fion. 2. Safe construction practices must be followed during the installation of the storage facility(s). The storage facility(s) must be constructed in accordance with the approved plan. Any changes in design, materials or use requires prior written consent of both-the design professional and the O~fice of Pollution Control. The changes have to be submitmd in a form that is acceptable to the Off~ce of Pollution Control. The contractor and/or design professional is required to inform the owner that the changes are being made. The Office of Pollution Control has the right to inspect this installation at any time to verify its being constructed in compliance with this permit. The Office of Pollution Control must be contacted at 854-2523 at least 2 business days prior to commencement of any work to arrange for the required Consm~ction inspections. Contact the local building department and/or fire safety enforcement office for any additional requirements that may apply to your project. The storage facility cannot be placed into service unffi the Office of Pollution control performs all required installation inspections and issues an interim permit to operate. The Office of Pollution Control reserves the right to revoke this permit as allowable by law. ISS,,~D BY: Assoeij~,ff~blic Health Engineer OffieeflofPollution Control *CONTINUED ON RE'~ERSE* ENGINEERS FST Since 191~ FST ENGINEERS, INC. 500 Bi~Eounty Blvd., Suite 118 Farmlngdale, NY 11735 Toll Free: 866.37&6369 T: 631.756.5999 F 631.756.5944 www.fstinc.com April 21,2010 Town of Southoid Building Department 53095 Route 25 Southold, NY 11971 Reference: Hess Service Station 11100 Main Rd. Mattituck, New York Permit #34391 To Whom It May Concern; As consultant engineers for Hess Oil Corporation, we are submitting to you new contractors information for the above-mentioned site. The contractor on record is G & M Dege Inc., the new contractor will be Island Pump and Tank. There is an existing permit for this site; permit #34391 is the permit for which we are requesting the change in contractors. If you have any questions and/or concerns please do not hesitate to call. Thanks for your time. /'ery/~¥ you~ ~' ENGINEERS - PLANNERS - SCIENTISTS Trusted Partners for Design Solutions CERTIFICATE OF LIABILITY INSURANCE opic = 'rB~-lO 02//25/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER8 NO RIGHT8 UPON THE CERTIFICATE INSIGHT CO~PJ~TZEB INC. HOLDER. THISCERTIFICATEDOEBNOTAMEND, EXTENDOR' 125 East Bethpage Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pla/nview NY 11803 X)hone; 516-465-0200 Fax: 516-465-0201 INSURERS AFFORDING COVERAGE NAIC# Island Pump & Tank Corp 40 Dovle wu INSURERD: E. No~thport NZ 11731 COVERAGES LTR HBR~ TYPE OF }RBURANDE POL~OY NUMBER LIMIT8 GENERAL LIABILITY EACH OCCURRENCE $1000000 C X X COMMERC~GENENALL~BE~Y SXEIEXL?0021309 11/01/09 11/01/10 PRBM~S~='u"="'="(~) $ 50000 I CLA~B MADE ~1 OCCUR UEO EXP (N',y ore ~er~e) ;5000 PERSONAL &AOV~NJURY = 1000000 eENE~ ~GRE~TE S 2000000 AUTOMOBILE ~IUW COMBINED S]NmE L~ S 1,000,000 B X ~0 ~P2610390 11/01/09 11/01/10 E. a~de~) , C ~ OCCUR ~ C~IMS~ SZSZ~71010409 11/01/09 11/01/10 A~R~E ~ 5000000 A Prope~y Section ~197063534 11/01/09 11/01/10 C Pollutton/Professi 8ISZEILT0021309 11/01/09 11/01/10 $~/~2M $2r500 Dad Certificate holder is tnolud*d as additional insured as respects ~neral Li~ility when =e~i=ed ~ written and exeou~d oon~aot. CER~FIDATEHOLDER~,'::, Town of $outhold Building Department Town Hall Southold NY 11971 ACORD2E ~009101) TOWNOFS, CANCELLATION (,/ ~ 1988-200g ACORD CORPORATION, All rlgM~ reeewed. The ACORD namo and logo are registered marks of ACORD 199 CHURCH STREET, NEW YORK, N.Y. 10007~1100 Phone: (888) 997,t863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISLAND PUMP & TANK CORP 40 DOYLE COURT EAST NORTHPORT NY 11731 POLICYHOLDER CERTIFICATE HOLDER ISLAND PUMP & TANK CORP TOWN OF SOUTHOLD 40 DOYLE COURT BUILDING DEPARTMENT EAST NORTHPORT NY 11731 TOWN HALL SOUTHHOLD NY 11971 G 796 438-0 986467 06/29/2009 TO 06/2912010 3/212010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNOER POLICY NO. 796438-0 UNTIL 06/29/2010, COVERING THE ENTIRE O~LIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT A8 INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S"REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 06/2g/20t0 IN SUCH MANNER AB TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY' IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-28.3 NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https:#www.nysif, com/cer~cedval.asp or by calling (888) 875-$790 VALIDATION NUMBER: 327978784 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured (Usa sb'cat address only) ISLAND PUMP & TANK CORP 4O DOYLE CT EAST NORTHPORT, NY 11731 lb. Business Telephone Number of Insured 631-462-2226 lc. NYS Unemployment Insurance Employer Registration Number of Insured 20003610 ld. Federal Employer Identification Number OF Insured or Scalal Security Number 112564960 Name and Address of the Entity requesting Proof of Coverage Name of Insurance Carrier (Entity being listed as the CertlBeste Holder} TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD NY 11971 The First Rehabilitation Life Insurance Company of America 3b. Policy Number of Entity listed In box D34339 3c. Policy effective period: 10/1/2009 to 09/30/2010 4. Poi icy covers: a, [] All of the employer's employees eligible under the New York Disability Benefits Law b.~] Only the foliowingelassorclessssoftheemployer*semployees: Under penalty of per. Jury, I cattily that I am an authorized representative or Ilcanaed agent of the Insurance carrier referenced above and that tho named insured has NYS Disability Benefits Insurance coverage as described above. (Slgmlturi oi~lr~urance carder's sufll0rlzed repre~eniatlve or ~Y$ LIO~ Insurlmce Agent or that Insurance carrier TelapheneNumber. 516-829-8100 TlU, Sr. Vice President PART 2. To be completed by NYS Worker's Compensation Board (Only if box '4b" of Part I has been checked) State of New York Worker's Compensation Board Date Signed Telephone Number Please Note: Only insurance carriers licensed to write NYS Disability Bananas Insurance poll~les and NYS Licanssd Insurance Agcnb of those Insurance carriers are authorized to issue Form DB.120.1. Insurance brokers ara NOT authozlzed to issue this Frown. DB-lZ0.1 (5-06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in Box "3~ on this form is certifying that it is Insuring the business referenced In Box "la" for disability benefits under the New York State Disability Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box "2". This certificate Is valid far the eerlier ef one year after this form is approved by the Insurance carrier or Its licensed agent, or the policy expiration data listed In Box Please Note: Upon the cancellation of the dlsebllJty benefits policy Indlceted on this form, if the business continues to be named on a permit, license or contract Issued by a certificate holder, the business must provide that cert;flcete holder with a new Certificate of NYS Dlsebllity Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State DlsebrJlty Benefits Law. DISABILITY BENEFITS LAW Section 220. Subd. 8 (a) The head of state or municipal department, board, commission or office authorized or required by law to issue any perm it for or in connection with any work involving the employment of employees in employment as defined in thfs article, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not Issue such permit unless proof duly subscribed by an Insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits I~or all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of'such state or municipal department, board, commission or office to pay any disability benefits to any such employee ffso employed. (b) The head of state or municipal department, board, corem lesion, or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding eny general or special statute requiring or at~thorlzlng any such contract, shall not enter fnto any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment ol= disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) Reverse OWNER RES. "/-~Z'~ SEAS. VL. TOTAL DATE LAND DISTRICT SUB. LOT AGE NEW Fa rm Tillable 1 Tillable 2 Tillable, 3 Woodland Swampland Brushland House Plot ~.,~, Tcta I IMP. /300 NORMAL Ac re REMARKS ACREAGE TYPE OF BUIL'DING J CB. BUILDING CONDITION B E LOW Value Per Acre ABOVE MISC. Value Extension ..4 --Ext. Walls ~ ¥1 c./~ Interior Finish Extension Fire Place ~ He~ ~ Porch Attic 7~ ~ /~ ~1~ I*.~ ~ ~10 / ~ ~ tV Porch Rooms 1st Flor Breezewayl ~ Patio Rooms 2nd Floor Garage I Driveway O.B. ~WNER -~T-REET I1~ (~(~ V-IL~,GE -b~ST7 SUB. L~T AOR. REMARKS TYPE OF BLD. LAND . TOTAL DATE FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL COLOR TRIM p c Bath Dinette M. Bldg, Foundation c s FULL Extension Basement C"AWL Floors Kit. Extension Ext. Walls Interior Finish L.R. Extension Fire Place Heat D.R. Patio Woodstove BR. Porch Dormer Fin. B. Deck Attic Breezeway Rooms 1st Floor Garage Driveway Rooms 2nd Floor Pool EAST LEGION SITE DATA APPLICANT: AMERADA HESS CORPORA]ION SECTION 122, BLOCK 03, LOT 010 AREA: 23,035 S.F. - 0.53 ACRES HAMLET: MATTI~JCK TOWN: SOU~OLD KEY MAP N \ MH CB 8.37 00000 ~LB - 8 95 , UNIDENTIFIED MANHOLE W/ RIM ELEVATION CATCH BASIN W/ RIM ELEVATION CATCH BASIN CIRCULAR CATCH BASIN W/ RIM ELEVATION 5" COVER W/ RIM ELEVATION WOOD UTILITY POLE METAL STANCHION W/ LIGHT SEWER CLEANOUT TELEPHONE KIOSK W/ BOLLARDS GASOLINE FILLER GAS VENT PIPES BOLLARD AIR PUMP SIGNS SPOT ELEVATION FOUND MONUMENT 8.95 9.26 WITH ELEVATIONS WOOD LINE WATER LINE ELECTRIC AND TELEPHONE OAS LINE 6' WOOD STOCKADE FENCE PUMP ISLAND AND FUEL DISPENSER N 06'50'00" 6' CHAIN LINK FENCE LINE (A.G.) 6' METAL FENCE CONTOUR W/ VALUE CONCRETE CURB / DROP CURB E PROPERTY LINE W/ BEARING AND DISTANCE >0o z AS-BUILT SURVEY SECTION 122, BLOCK 03, LOT 10 1"=20' 2O 0 10 APPLICANT HESS CORPORA~ON ONE HESS PLAZA WOODBRIDGE, NEW JERSEY 07095 ATTENTION: JIM HOWARD (732) 750-6220 GRAPHIC SCALE 1 inch =20 ft. 32481 FST 1"=10' DRAWN BY: MB CHECKED BY:J.McW. DATE: 5/2~/~o ~OJECT NO.~_N~3/2~ DWG. NO. 1 01_osbuilt.dw§ 32481 MAN ( ROLJ$ / / / / NBW PUBblkI~ IbbANt2 / W PROPOSB[2 PIRB IJb i2S4 PIIRB 51JPPRBbSION SYSI'BM (TYP) PRO?OS~t2 A,B,5, CONTI~OL. 5 fO BB UOCAI'BO IN ATI~NPB[2 AREA, TAX MAP INPO 5BCTIQN BLOCK L-Of I0 PROPUP.~ BINB / / 5TU PLAN I'1 ~ 20' 5lTL NBW 5UPPOLK AV~ KBY MAP N APPROVAB5 16 dA dAbVANIZBP CHANNEL NOZZL~ CLIJSfgP. (S/P) LIQHTPOL~ 22S ' HBAI' PBTICCTOR MPP I LB CYblN~;BR ( 108" (~lIl BNP OF 15LANP AIM FTS, ( TYP; PI. AN VIBW N,T,S, MAIN 15bANI 6'-0 MAX 51PB BLUVATION ( TYPICAB OP P) 22S ' HBAT PROPOS~P ~AS PlSPBNSBP- (?YP) ~ 1' NOZZLB SPAEIN~ PBTdCTOR 5?ACINd NOZZbB CLUSTER (TYP) PLAN VIP_-W ( TYPICAL- ~/4" CLO~ NIIPPLB ~/4u×1/2u BLL~x N ~AI12 NOZZLB /4" ~- ~/4II dLOSg NIrFL~ MAIN 15LANP NOZZLB CLLIST/BR NOZZLB BNP OP iSLANP/ZON~ NOZZLB CbLSSR PETAL N,?,5, ~ ~/4'× 1/2u I/2I' CLOSB NIFPL~ I/2' *tS' BLL ~/4" I,P,5, PiSCHANNB OLITbBT ,~4" O,P, COPPBR TUBINN \ ATt~-TS t 8'-0 /' 6'-0 MAX~ 8'-0 MAIN 15LANI¢ AIMIN~ POINT5 (TYP) BNI? BLBVATION PRY CHBMICAb CYblNI2BR5 PNBLJMATIC ACTUATION 12BI'AIB N,T,5, WIX WIX 2II lb dALldb . ~.~b COLLBCTOR HBA? COLbBCTQR PBTAIL ~P_-NBRAB 120 VAC NOTB5 ~I~CI'ORS I doll. 5M-120 FLIMP CONTACfOP. 120 VAC WlPdN 5CHBMAr'IC N I, SYSTEM TO i~B "PYRO-CHUM" ATTeNI~ANT MOI~BL ATI2-~S/7S A5 APPROVBI~ LINI~BR "LB" 5TANI2ARI~ I~S4 for I0 MPH WINI¢ CONI~ITIONS, ~. HBAT 12BTeCTOR5 TO BB "PUN-WAU" MOI2Bb I~-B::ZTI21 ;2~S° PATe ANTICIPATet~, ~,AI.b PUBB [215PBNSBR5 5HAUt 5HLJT B~OWN LiPON 5YSBM AcJqVATION, THBRB 5HArt NO MANLIAU RBSBI' OP THB 1:215PBNSINN _SYSTEM AVAiL-ABBB, THB 1:215PIf-NSBR5 5HAtB NOT I~B CAPABBB OP I~BINN RBSTARTeI:2 UNTIL THB PIRB 5LIPPRB55iON SYSTEM 15 TO OPBPATINOi CON[:21TION, ANY LINAUTHORIZB~ ACTION TAKBN TO RBSTORB THB 1215PBN- IN~ OPBPATION WITHOUT PIRST HAVIN~ THB 5LiPPRBSSION SYSTEM CONSII:21¢RBI:2 A VIOBATION OP THt~ NBW YORK STATe PIRB PRBVBNTION ~, Att PIPINEi TO I~B 5CHU[2LIBB 40 ~AtVANIZBI~ 5TeBb WiTH ~00 BB CL-A55 ~AtVANIZBI~ MAtUEA~UE IRON PITTIN~5, S, SYSTeM TO B~B 51NNI. B ZONB PNICUMATIC RUBBASB LITIblZIN~ I/4"0,1~, RBPRI~BPATION TUBIN~ ~ I/dII 4P° PUARP- TYPB BRAS5 PITTIkld5 CONPORMIN~ TO 5AB JPlPc, ~, CYLINI2BRS ARB TO I~B PIBL-Ut~ WITH MONO AMMONiLIM PHOSPHATe ( ACC TYPB) CHAR~BI:2 TO PPO PSI~ WITH ~RY NITRONBN, 7, NOZZLB CAP5 ARB OPPICB, ANI~ TO CB INSTAtLBI~ APTeR PINAt TeST1NOi POR THB PIRB MARSHAb'5 FIRE GUARD OF LONG ISLAND, INC. ~ 40-8 BURT DRIVE - DEER PARK, N.Y. 11729 ~ (631) 242-5315 FAX (631) 242-4945 REV 9ATE DESCRIPTION TITLE: PROJECTI REViS!~NS PYEO*CHBM MOPBL II AI~-P¢/7~t HBSS STATION P24E]I DRAWN BY, SCALE [Jb 12P4 PIRB 5LIPPRBSSlON SYSTEM ROL.~ 2S a BAY AVBNLIB OFI( l/4" ~ I'-0 UP~RAPB, MATTITLICK, kl,Y, x 10.90 // LEGEND ~ CATCH BASIN ! ~ / TO 10:8 ~ ~ N, '' 08.37 5' COVER W/ RIM ELEVATION / ~ / ///~ ~ g ~ ~/~D-~E X METAL STANCHION W/ LIGHT ¢~ CE ELECmlC AND ~LEPHONE LINE (A.O.) 97 10 59 X TC 10.03 / /~// ~/ ~ ~ ~ ~ ~/ .... . OSC SE~R CLEANOUT '5~ ~' ~LEPHONE KIOSK W/ BOLLARDS 6' x x x WOOD STOCKADE FENCE / o GASOLINE FILLER : 0 ~ 9.55 ' ~ ooooo GAS VENT PIPES ~ ' BC 9.~6 ASPHALT BOLLA~D 6' LOT 9 ~ AIR PUMP ~ 9.21 / ~ ~ ~ //~ / % I ~ N/F ~ ~ SIGNS ~ ~ CONTOUR W/ VALUE / [ T~~ J~ X ~/ _X ~3 ~ 5 MAGEN / x 8.g3 SPOT ELEVAnON CONCREm CURB / DROP CURB / ' FOUND MONUMENT N 06'50'00"j I E PROPERW LINE W/ BEARING ( 304.04' . . · 47.3 ~ ~ ALL THAT CERTAIN PLOT. PIECE OR PARCEL OF LAND, ~5q-- SI~ATE, L~NG AND BEING AT MA~ITUCK, IN THE TOWN OF 5 ~ SOU~OLD, COUN~ OF SUFFOLK AND STATE OF NEW YORK AND DESIGNATED AS TAX LOT 10 OF DIS~ICT 1000, SEC~ON 122, BLOCK 3, MORE PAR~CULARLY BOUNDED AND DESCRIBED AS FOLLOW: BEGINNING AT ~E CORNER FORMED BY ~E IN~RSEC~ON OF THE SOU~EAS~RLY SIDE OF MAIN ROAD (ROU~ 25) WI~ 7 HEA~LY WOODED AREA THE EAS~RLY SIDE OF BAY A~NUE; RUNNING THENCE NORTH 51 DEGREES 50 MINUTES O0 SECONDS EAST, 150,00 FEET TO A POINT; THENCE SOU~ 60 DEGREES 25 MINU~S 10 SECONDS ~ST. ' 191.61 FEET TO A POINT ON ~E EAS~RLY SIDE OF BAY AVENUE; 9.5O THENCE NORTH 04 DEGREES 54 MINUTES O0 SECONDS WEST, 140.Q0 FEET OR PLAOE OF BEGINNING. CONTAINING 23,035~ SQUARE FEET OR 0,53 ACRES MORE OR LESS. NO S: 1, SURVEY OF DIS~ICT 1000, SEC~ON 122, BLOCK 5, LOT 10. 2. ELEVATIONS ARE IN FEET AND ARE REFERRED TO THE 2.5' DIA. ON CONCRE~ PADS 3. THE PRIMARY BENCHMARK IS USC~GS BM L 526 RESET 1966, ELEVA~ON 27.759'. 4. USERS OF THIS MAP ARE CAUTIONED ~AT THE UNDERGROUND U~LI~ LOCATIONS ARE NOT GUARAN~ED, NOR IS ~ERE ANY GUARANTEE ~ ASP THAT ALL EXIS~NG U~LI~ES, WHE~ER FUNC~ONAL OR ABANDONED, ~THIN OR ADJACENT TO ~E SI~ ARE SHO~ ON ~IS MAP. ~E 6. PROPER~ IS ZONED M-1 BUSINESS. 7. BUILDING SETBACK LINES ARE 35' TO THE FRONT, WHICH MAY BE VARIED BY ~E PLANNING BOARD, 25' TO ~E REAR AND 20' COMBIN~ T~ ~F SIDE. 0 6.48 FLO~ INSURANCE RA~ MA~ PANEL 112 Of 120 COMMUNI~ NUMBER 36081501~ ,92 ~H AN EFFECTI~ DATE OF AUGUST 16. 1995, THE PROPERTY DEPIC~D ON ~IS ~ /SURLY IS LOCA~D ~THIN ZONE B-AREAS BE~EN LIMI~ OF ~E 100 ~AR / ~ ~ FLOOD AND 500 YEAR FLOOD; OR CERTAIN AREAS SUBJECT TO 100 YEAR ~ FLOODING WI~ AVERAGE DEPTHS LESS ~AN 1 FOOT OR WHERE THE / ~ON~IBU~NG DRAINAGE AREA IS ~SS ~AN 1 SQUARE MILE; or ARE~ BC ~Y LEGES FROM THE BASE FLOOD. ~ o TO AMERADA HESS CORPORATION: ~ THIS IS TO CER~FY ~AT ~IS MAP OR PLAT AND ~E SURVEY ON ~ICH IT IS BASED ~RE MADE (i) IN ACCORDANCE ~TH MINIMUM STANDARD BC 6.75 DETAIL REQUIREMEN~ FOR "ALTA/ACSM LAND ~TLE SUR~YS," JOIN%Y ESTABLISHED AND ADOPTED BY ALTA AND ACSM IN 1992. AND INCLUDES I~MS 4,5,8.9,10 AND 11 OF TABLE A ~EREOF, AND (ii) PURSUANT TO ~E 0 ACCURACY STANDARDS (AS ADOP~D BY ~ LTA AND ACSM AND IN EFFECT ON me O. SU.VE . 0 FST uc o5o2 'SCALE: '~r~ DRA~ BY: CHECKED GRAPHIC SCALE a~: ~ PROJECT 1 ~cb =20 tr. DWG. NO. 8581TOPO 32481 SITE DATA APPUCANT: AMEEADA HESS CORPORATION SECTION 122, BLOCK 0,3, LOT 010 AREA: 25,055 S.F. - 0.5,3 ACRES HAMLET: MATTITIJCK TOWN: SOUTHOLD KEY MAP FILL PORT LEGEND - COLORS* [] #1 FUEL OIL PURPLE W/YELLOW BAR [] #~ ruE~ ol~ OREEN A CIRCLE FOR GASOLINE PRODUCTS AND VAPOR RECOVERY UNES. A HEXAGON FOR OTHER DIS]~LLERIES, AND A BORDER MUST BE PAINTED AROUND FUEL PRODUCTS CONTAINING EXTENDERS SUCH AS ALCOHOL THE BORDER Will BE BLACK AROUND A WHITE SYMBOL AND WHITE AROUND ALL OTHER N 5' ,]~' 3 1/2" O.D. SCHE~.ULE 40 eTAINLESS /// "U::. ?'; ;;.;.;'ii 1' FOR SEALANT 'u' TYPF BUMPER POST DETAIL / GENERAL NOTES PIPING LEGEND 1. CONTRACTOR TO VERIFY N..L UNDERGROUND U~LmES AND EXISTING SITE CONDmONS PRIOR TO THE COMMENCEMENT OF WORK. --'P PREMIMM PRODUCT PIPING (2' PRIMARY ' '~" 2. coNTRACTor TO VERIFY & CONFIRM PROJECT SCOPE OF WORK WITH TI'IR Wl~H 3' SECONDARY CONTAINMENT) HESS OIL CORPORA'PON PRIOR TO ~HE COMMENCEMENT OF WORK. --R REGULAR PRODUCT PIPING (2" PRIMARY ' WITH 3' SECONDARY CONTAINMENT) 3: CON~CTOR TO BE RESPONSIBLE FOR PROVIDING .AND MAINTAINING PROPISR . ~SAFETY & SECURI'P¢ MEASURES THROUGHOUT PROJECT. CONTRACTOR MUST --V VAPOR EKE (5" SWFG) dURrSD~CTION. *NO'E:: : zm zd LEGEND ~YM BOL DESCRIPTION STAINLESS S~EL INVER~D "U" BUMPER B POSTS; SEE OETAIL. ~ CURB RAMP MEETING REQUIREMENTS OF ALL AUTHOBIllES HAVING JURISDICTION. E,J FULL DEPTH EXPANSION JOINT. PROVIDE SEALER AND BACKER ROD AT ALL 6" THICK AND 9' THICK CONCRETE MATS. SEE SPECIFICATIONS, P PREMIUM UNLEADED GASOLINE· PL PLUS UNLEADED GASOLINE. ROG 6" THICK 4000 P.S.L CONCRETE MAT REINFORCED WITH 1 LAYER OF 66-W2.OxW2.9 WELDED WIRE MESH SET 2-1/2" BELOW TOP. SEE SPECIFICATIONS FOR AIR ENTRAINMENT, ETC. RCS B" THICK 4000 P,S.I. CONCRETE MAT REINFORCED WITH 1 LAYER OF 66-W4.0xW4.0 WELDED WIRe MESH SET 2-1/2" BELOW TOP OF SLAB. SEE TANK INSTALLATION DWGS. SEE SPECIFICATIONS FOR AIR ENTRAINMENT, ETC. R REGULAR UNLEADED GASOUNE. APPROXIMATE, LOCATION OF EXISTING WATER SUPPLY LINE. NEW MPD BLEND DISPENSER (GILBARCO ADVANTAGE B65324) WITH NEW SUMPS (TYP. 3 PLACES) NEWIFIRE EXTINGUISHERS (T'/P. 3 / * PLACES) 0 NEW EMERGENCY SHUT OFF SWITCHES (1 PER ISLAND) NEW FULL-DEPTH ASPHALT TO ~ BE INSTALLED~t~t~t~t~t~t~t~t~t~ , NEW 5" FIBER'GLASS VAPOR LINE EXISTING YARDLIGHT PROPER~¢ LINE SHUT-OFF SWITCH TO REMAIN 2" PrIMarY WITH 3" SECONDARY DOUBLE WALL FIBERGLASS PRODUCT LINE (SLOPE PIPING 1/B~:1" MIN. BACK TO TANKS) -- EXISTING EMERGIENCY " EXISTING VEEDER ROOT TLS-350 MONITORING PANEL TO REMAIN J POL~S &, FIRE · SUPP~i~SSION TO J.,,RE~MAIN (TYP.).-~ ~" N EXISTING PNEUMERCATER lClO03 AUDIBLE/VISuAL HIGH LEVEL ALARM TO REMAIN 0 -- EXISTING THREE (3) 10,000 GALLON DOUBLE WALL FIBERGLASS TANIKS TO BE UPGRADED PER '~lE REQUIREMENTS OF SCHD & TO 'Q-tE SATISFACTiON OF HESS OIL CORPORATION BORING .EXISTiNG 12'--0' HIGH VENT I DA"-r][]RTARTgD: FE. BRUAI:CY 28, 2001 RISERS TO REMAIN (INSTALL NEW VENT UNES; TO RISERS) : DATB COMPLBTED: FEBRUARY 28, 2001 INSTALL NEW SELF-CONTAINED -.-, ~ ELOWS MAT~P~AL A,R TOW . - : ~zl OTO6,6TO ~J CRIPTION EI~EVA~I~ON: 7~98 INSTALL NEW YARDLIGHT TO ' J ~ e~ C;O~v'PLf v,q-;H ,~,Lk ,?; :S OF 6 ~ ~~ ZgfF~( I CODES' REPLACE EXISTING NEW CONCRETE CURB J , ~J~.AC, E S]%T (?O.L) m~IM~/~T~ 4~& ~ ':~--- ~ MEETTHE REQU[F~EMENFS~-IE BUF, E*',U UF EHViRONi,4ZNTAL ENGINEERING ~ : n~¢¢al~/[~ OR ZheseplansBnds23~;"~E°nhgvebeeqrevieweO / I~--l; :--;IW'THOUTCERT/F S~rma,'y Coda requirements b.,usd ir, formation -~.- OF CUPANOy expireson RRTI R 2009 OCT ] 4 2DR8 ' ~ APPROVED AS NOTED~E 1 ~ PURSUANT TO CHAPTER 236 APPROVAL DATE RE~Gi~ER DATE: ///~ ~ B P. ¢¢ ,¢~v P/ OF THE TOWN CODE. pl_site_Ol.dwg BITUMINOUS PAVING DETAIL SCALE: I 1/2" = 1'-0' SITE UTILITY PLAN SECTION 122, BLOCK 03, LOT 10 APPLICANT AMERADA HESS CORPORA~ON ONE HESS PLAZA WOODBRiDGE, NEW JERSEY 07095 AIIbN~ON: diM HOWARD (732) 750-6220 - FA,Y, SPOFFORD & THORNDIKE OF NEW YORK, lNG. ENGtNEERS· PLANNERS - SCIENTISTS ~ LANDSCAPE ARCHITECTS 500 BI'COUNTY BOULEVARD. SUITE 118 FKRMINGDALE, NEW YORK 1~735 TEL (831) 756-5999 FAX (631) 756~6944 . BY NOTIFY BUILD!N3 DEPARTMENT 765-1802 8AM qO 4PM FOR FOLLOWING IHSPECTIONS: 1. FOUNDATJ.ON - TWO REQUIRE FOR POURED COHCRETE 2, ROUGH - FRAMING & PLUMS 3. iNSULATION 4. FINAL - CONSTRUCTION BE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEE REQUIREMENTS OF THE CODES C YORK STAle. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, ~32481 IRE INSPECTION REQUIRED BEFORE FST of NY 1"= 20'-0" DRAWN BY: VFR CHECKED BY:Kp DATE: 4/~ PROJECT NO. SN-N095/200 ' DWG. NO. 1 GENERAL SCOPE: UPGRADE EXIS~NG DWFG TANKS ~1 NEW TANK SUMPS, NEW BRINE RESERVOIR, NEW ,MONITORING. NEW PEODUCT~VAPOR PIPING, t HESS EXPRESS, FUELING FACILITY #32481 ROUTE 25 & BAY AVENUE, MATTITUCK, SUFFOLK COUNTY, NEW YORK TANK TOP APRON UPGRAD WITH EXISTING TANKS Hess Corpe.ration One Hess Plaza, Woodbndge, Nj 07095 S.C.D.H.S APPROVAL STAMP AREA ~CORE E N G I N STATE S ~.c. E E FI I N G DRAWING LIST DRAWING TITLE DRAWING No. SITE SPECIFIC COVER SHEET MATERIALS LIST UST INSTALLATION DETAILS UST DETAILS GENERAL EQUIPMENT DETAILS CS-1 DWT-00 DWT-1 DWT-2 DWT-3 STANDARD WARNING SIGN No Smoking Stop Engine Credit Card Sales May Require Driver's License After Dark, Exact Sash or Approved Credit Cards ~Jc Checks Wcming: It is Unlawful and Dangerous to Dispense QDsoline into Unproved Containers Never Uncap Hot Radiator FILL PORT COLOR CODES [] .,DB G^SOL, NE ~] kIDDLE GASOLINE [] LOWER GASOLINE [] HIGHER UNLEADED GASOLINE [] MIDDLE UNLEADED GASOLINE [] LOWER UNLEADED GASOLINE [] VAPOR RECOVERy [] DIESEL [] ~, FUEL 0~L [] #2 FUEL 0IL [] KF-~ ,ENE RED BLUE WHITE RED W/WHITE CROSS BLUE W/WHITE CROSS WHITE W/BLACK CROSS ORANGE YELLOW PURPLE W/YELLOW BAR GREEN BROWN PURPLE SfLVER A CIRCLE FOR GASOLINE PRODUCTS AND VA~POR RECOVERY LINES. A HEXAGON FOR OTHER DISTILLATES, AND A BORDER MUST BE PAINTED AROUND FUEL PRODUElS CONTAINIqG EXTENDERS SUCH AS ALCOHOL. THE BORDER WILL BE BLACK ;,:( ff4D A WHITE SYMBOL AND WHITE AR~tIND ALL OTHER, ALL~TAN~S AND FILL PORTS MUST BE LABELED AS PER SUFFOLK COUNTY '~ HEALTP FF~ARTMENT ORDINANCE ARTICLE 7 & 12 FOR UNDERGROUND TANKS REOUL,-, VAPOR RECOVERY PREMIL" DIESEL FILL ~ (,IRT COLOR CODES UJ O~ Z ~ ~ O ',~,,, ,,' ~ ~ > Drawing fl CS-1 PART # ITEM / MODEL NO. DESCRSPTION HESS CON~ TANK HOLD-DOWN HARDWARE c-o3 N/.*, !PART # ITEM / MODEL NO. DESCRIPTION , .~ HESS CONT E-o, ~/A w/^ __ X - E-lO - VEEDER-~ B~7OBO~i2 24' ~ STP SUMp PROBE X____ -- MATERIALS LIST PART # ITEM / MODEL NO, )ESCRIPTION HESS CONT _ ~-~o_2 .... "/^ --- -- -- ~_?o__9.__ ./,', M-20 - GLBARCO 500 SFRgES - 1 PRODUCT - E ~mpEB ..... 'oAF ~ HO~, ~ SIDED D ~?_(_~0 DIESEL) X -- M-65 . -2fFS~R~ON ~731 - !OD 2' GALV. S~ UN~ON PART # ITEM / MODEL NO. DESCRIPTION HESS CONT M-75 - U_N.VE~A~L._6_5_TI~-~I_2 ............. TRL~NGUL~E [~NHOLE BOLTED -- ~ M-75 N/A ~-~ - ~Pw -~-~s ~LON ~S ~ON S~IL~ CO~A~N~ENT ~H9~ _. X . _ X H l~i08 ._- 017R2 IlIz O~ O~ TANK PAD PLAN O8 ~ '(~'P ) / (r'P) .I I: I o,ooo(a') 1 o,oao(s') ~ o.ooo(a3 UNDERGROUND STORAGE TANK AREA CROSS SECTION SCALE: 1/4" = DIRECT VAPOR RECOVERy/ STICK GAUGE pORT SPILL CONTAJNMENT MANHOLE (OA~OLINE ONLY) PORT SCALE: 1/4" = 1'-0" 1'-o" ~] TANK UPLIFt- CALCULATIONS - PO',- CONSTRUCTION r=4,00' L=22.75' . J ~ ~PICAL VENt SUPPORT D~AIL SCALE: NOT TO SCALI TANK FINISHED TANK MANWAy TANK GEOTEXTILE DEADMAN 10'-0" I 33'-3" V~.,~ = (15')(40')(50,5'} + 2(1/2)(TAN 10~(15')(1~')(50.5')) - (320) SCALE' 1/2" = 1'-O" MANWAY CONCR~E A TANKS AND A~OUND SUMPS; TYPICAL MANHOLE INSTALLATION DETAIL SCAt_E: 1"= 1'-0" ~ ~'PICAL CONSTRUCTION JOINT DETAIL SCALE: 1"= 6xG-W4,0xW4,0 W.W,M, REINFORCEMENT SET 2 1/2' 6xG-W40xW4,0 W,W,M, SUPPORT ~'~EL ANGLES WITH STEEL VENT PIPE BE CAPPED PNEUMERCATOR OVERFILL ALARM WITH ACKNOWLEDGEMENT SWITCH OVER PRIMER GRA~E TANK UPLIFT CALCULATIONS m' D. UR NG CONSTRUCTION SCALE: NOT TO SCALE z NOTE: DUE TO KNOWN HIGI~ WATER TABLE AT THIS LOCATION, CONTRACTOR IS EXISTING TANKS ARE FILLED TO 75% CAPACITY WITH PRODUCT PRIOR TO ORDER TO BALLAST ip-IE TANKS. DEWATER EXCAVATED AREA AS NEEDED. CONTRACTOR TO CONTACT ENGINEER IMMEDIATELY IF ANY EVIDENCE IS FOUND DURING CONSTRUCTION THAT THE EXISTING TANKS ARE NOT PROPERLY ANCHORED WITH DEADMEN. DETAIL TO ENSURE THAT EXCAVATING IN HM0$ _- 017R2 F~NISHED SCALE: - Drawing # DWT-1 TANK ELEVATION BRINE RESERVOIR AND 42" DETAIL SCALE: 1/2" = 1'-0" FINISHED GRADE -[ COMPACT SUBGRADE TO REOUIRED BE&RING CAPACI~f OF TANK, FILL, CONCRE]E AND TANK TQP EQUIPMENT GROTE×TILE MATER~AL ABOVE TOP OF TANKS MANUFACTURER'S APPROVED BACKFILL BEW/EEN GEOTEXTILE AND TANKS AND AROUND SUMPS: Xp JUNCT DN ENTRY FI~ING OPENINaS (WP.) 15 GALLON SPILL CONTAINMENT MANHOLE ¢' FILL CAP (~ XP JUNCTION BOX VEEDER ROOT INTERSTTIAL SPACE MONITOR EXISTING 10,000 GALl ~N DOUBLE WALL FRP U REGULAR OR PREMH UNLEADED ¢"x¢"x2"" VAPOR EXTRACTOR TEE WITH NO BALL AND CAGE POINT C FROM TANK INVENTORY SENSOR MdLTI-PORT MANWAY WATER SHROUD TANK CONTAINMENT SUMP Hltl08 _- 017R2 SCALE: - Drawing # DWT-2 ~ TYPICA_ PLAN VIEW - SUBMERSIBLE PUMP TANK SUMP- GASOLINE TANK TYPICAL SCALE: 1"=1'-o° TYPICAL PLAN VIEW - FILL TYPIC,AL ) FLEXIBLE ENTRY BOOT 1" ELECTRICAL CONDUIT FOR SUBMER$1@LE PUMP ELEVATION - SUBMERSIBLE PUMP TANK SUMP- GASOLINE TANK UN,O.-- FIELD BONDED JOINT KiT "AD" PIPING DOGLEG AND CROSSOVER DETAILS 14;--0" MIN. STRAIGHT LENGT~ OF PIPE FOU-OWINO= V~T) 3"e RBERGLASS SECONDARY PIPE OVER 2"¢ ~BERGLAS~ PRODUCT LINE OW SCALE 11 =1'-0" mo~o (~) SCALE: 1/~ & VENT TANK SUMP- BASOLINE TANK PIPING SUMP SENSOR 4"x4"x2" VAPOR EXTRACTOR TEE WITHOUT CAGE CAGE DEFLECTION PORT TYPICAL ELE'VATION - FILL & VENT TANK SUMP- GASOLINE TANK ~¢PICAL PIPING TRENCH REQUIREMENTS DETAIL PIPE DIAMETER /**MINIMUM BACKRLL COVER MIN CLEARANCE BETWEEN PIPE~ 1'-2" O UNPAVED AREAS DOUBLE WALL FRp PRODUCT PIPING SCALE: 1 "= 1'-0" VENT SCALE: 1"=1'-0" DETAIL I~ DETAIL SCALE: NEW EX)STiNG HM08 r 0 SCALE: - SCALE: - TYPICAL DISPENSER FUEL PIPING DETAIL SCALE: 1/2"=1'-0" ~ TYPICAL DISPENSER STAGE II PIPING DETAIL SCALE: 1/2"=1'-0" NOTE (wp.) 3"x2" RUeBER TEST (wp.) - .D -awing # DWT-3