HomeMy WebLinkAboutJackson St Town of Southold
P O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 09/13/18 Receipt#: 248361
Quantity Transactions Reference Subtotal
1 Excavation Permits 1287 $21,100.00
Total Paid: $21,100.00
Notes:
Payment Type Amount Paid By
CK#42518 $21,100.00 National, Grid -Gas Permits.
Dept
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: National, Grid -Gas Permits. Dept
175 E Old Country Rd
Bld 3 FI 1
Hicksville, NY 11801
Clerk ID: LYNDAR Internal ID 1287
4
Permit Nos
TOWN OF SOUTHOLD FIDj�
HIGHWAY DEPARTMENT
Peconic Lane
T102117235 Peconic,New York 11958
(631)765-3140
APPLICATION/PERMIT 1'QR HIGHWAY EXCAVATI!2N 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 her 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.
Pr ag r r- Keyspan Gas East Corp D/B/A National d
Margaret Paglia 516 545 4094 Gas Permits Dept. Bldg:3 H® f
1. 175-E. Old CoubtW-ROHMWAWA
Name of Applicant Phone Number Address of Applicant
2. _
Rime-of—&—n tractor Phone Number Address of Contractor
3.
Name of Property Owner Requesting Service(if applicable) Address of Ow4. ner
JACKSON ST-S/S, from KIMOGENOR POINT RD to 1st ST
Work Description and Location(Street Number,Hamlet,Cross Street) —
(a) is construction located within 75 feet of tidal wetlands? 'Yes K No(
°If yes,other Town permits may be required.
NOTE., All Information requested by this Sig ture of Applican
Application/Permit Form is
Required for a complete application! 9/5/18
Date
5. (a) Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan showing the
location of all proposed excavations and relationship to adjoining premises,public streets or areas,and give a detailed description of
all site and pavement restoration work.
(b) Attach all other necessary permits and licenses for this project.
(c) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk.
6. Tax Map No.: District 1000-, Section , Block Lot
7. Starting Date: 10/30/18 Completion Date: TBD
8, Work Schedule: Phase Completion Dade
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 Gas East Corporation d/b/a National Grid
See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified.
10. Estimated Cost of Proposed Work: $
11. Remarks: Directional Drill various openings/roads - please see attached sketch & summaries
D-39 I of 3
12, Insurance Coverage: (Attach Copy)
(a) Insurance Company:
(b) Policy#:- __
(c)State whether policy of certification on file with the Highway Department:
(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$2,000,000 general aggregate.
13. Security:
(a)Surety Bonder.. - or Certified Check - . provided in the total Amount of$
(b)Maintenance Bond provided: 2 years or 3 years.
14. Fees for Applications and permits:
Basic Application Fee for Each Project Location - 35 X $500.00 = $17,500.00
A Project Location would include each Bell Hole andtor every roa openi g or excavation withtn_any
50' Radius whether or not they may be 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. 72(Service Connections excavations @$50.00 $ 3600
No.
A2. /Additional Excavations same service @$20.00 $
No.
B. Trench Excavations 18" in depth or less
Total Lineal Footage of Excavation; oma.L.F.@$10.00 $
C. Trench Excavations 18"in depth to 5' in depth
Total Lineal Footage of Excavation; L.F.@$30.00 $
D. Trench Excavations 5' in depth and over
Total Lineal Footage of Excavation; L.F.@$50.00 $
E. Utility Repair Excavations @$1,000.00/Each $
-No. --
Additional Repairs of Same Service @$500.00/Each $
No,
TOTAL$ 17,50000+3600.00=21,10000
F. Official,Notice to public utilities-proof must be 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 Highway Excavation permit to:
ordan a with
this application and subject to the"General Conditions"and"Special Conditions"of ermi (if an a .a
reto.
SUPERI E EN F H YS
TOWN O U L E Y RK
V c 't O 1 nd
Date
Date Received by the Town Clerk " 13
Date Permit Issued R- Ls``T Permit No. \ Q97
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
Copy Distribution:
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
I St
2nd
A
3 rd
41h
(To Permit Clerk)
REMARKS
S
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 Reauircmentsi 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. Rcygention of the Permit by the Highway Superiniendent: 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.
S. Notice of Commencement: At least 24 hours prior to commencoment•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 Enuipment&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 iiia 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 Ucbrls 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 MGHWAY 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; ?his 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. CleRn gill Only: All project back-fill shall consist of clean sand,gravel of 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 andlor jute matting until weather conditions favor
germination.
13. Back6fl&Coinnactiosi of sail 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 piaced in,maximum lifts of twelve(l2')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 most 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 most 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.
IS. Schematic Plans vi(b sill Tecltnical 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
Souihold Town Highway Specifications,
16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner;
(Note.,Vhen 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. Trcuchinu of Pavement Surfaces rxceedint One Ilundred(100'1 Feet in Lensllta: All trenching of
pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item
0 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,shoulderto shoulder).
SHEET 1 OF 2
ROAD OPENING SKETCH KEY:
SUFFOLK COUNTY / TOWN OF SOUTHOLD EXCAVATION PIT IN EDGE OF PAVEMENT: _ EP —
/
EP —
/ HAMLET OF CUTCHOGUE PAVEMENT (N.T.S.):
2ND ST / 3RD ST / 4TH ST / 5TH ST/ CURB LINE: — CL —
JACKSON
CL —JACKSON ST EXCAVATION PIT �-T
GRID: 101-46-9407 BEHIND CURB (N.T.S.): INSIDE SET (POTENTIAL
WORK ORDER: T102117235 RELOCATION): I
TEST HOLE ( N.T.S.): �
ENGINEER: CLINT ROGER
CONTACT: (631) 487-6437
DRILL LINE IN PAVEMENT — — — DRILL_LINE BEHIND CURB — — —
(N.T.S.): (N.T.S.):
DRILL SUMMARY : TOTAL PROJECT 8x5:
2ND ST = 211'
3RD ST = 321'
4TH ST = 393' w W
w w 5TH ST = 327' W W
�C
JACKSON ST = 2776' F ZIZ
Z TOTAL = 4028' W w W co
a 1 'n N QIQ
c•)
O
Z 1 278'
W 1
CD
O
248' 400' 388' 373' 394' 260' 251'
EP #735 1 18'
} � #1145 CP I
3'x5' s3ssal ' � 18'
\8-'x5` 95,X5" 1 t QAC O/V S #1
KS T 245 I I i
_305' 63652 1 i18D65 #1875
3'x5 O EP I EP
_ ( 72
M128'1`V 0
575 #300 12' EP '1 1� �I,`L -YT
187 j
0
Tx 5' 77,'�\ iv i 1 29 ACKSON ST N
w w - L�18'�7� Pt 3'X5' 105' 16' N 55' 208'
, 361�,�' _ \ 99� ` — 12' — '27 101' ppp}}}5,X5�� 204'
Z #470 #800 :'8T j 1(I J ' �� ' \� ��//A ��
p $ / 3x5 / IL1LA 25
d
CPR#
418289 #2
p EP a,✓ EP I �.r.
w 0_• --" 1
#1260
#1470
W , CPR# 72'17470 #1540 17' #1780 #415 1
U 228737
O
Y � F1
= 1 #21DD
io
F °
1,68' co
i ROADWAY OPENINGS: TOTAL PROJECT 20'
QTYDESC SIZE = SUBTOTALI
BEHIND THE CURB OPENINGS: TOTAL PROJECT (2) LIVE GAS PIT 8'X5' 80 SQ.FT.
(2) LIVE GAS PIT 5'X5' 50 SQ.FT.
QTY DESC SIZE = SUBTOTAL 1126'
(2) LIVE GAS PIT 8°X5' 80 SQ.FT. (8) DRILL OPENING 3'X5' 120 SQ.FT.
I id (2) TEST HOLE 3'X3' 18 SQ.FT. (56) TEST HOLE 3'X3' 504 SQ.FT.
TOTAL 98 SQ.FT. TOTAL 754 SQ.FT. 3'x5'
EP
1
SHEET 2 OF 2 ROADWAY OPENINGS: TOTAL PROJECT
ROAD OPENING SKETCH QTY DESC SIZE = SUBTOTAL BEHIND THE CURB OPENINGS: TOTAL PROJECT
SUFFOLK COUNTY /TOWN OF SOUTHOLD (2) LIVE GAS PIT 8'X5' 80 SQ.FT. QTY DESC SIZE SUBTOTAL
/ HAMLET OF CUTCHOGUE (2) LIVE GAS PIT 5'X5' 50 SQ.FT. 1(2) LIVE GAS PIT 8'X5' 80 SQ.FT. N o
2ND ST/ 3RD ST /4TH ST / 5TH ST/ 8 DRILL OPENING 3X5 120 SQ.FT. (2) TEST HOLE 3'X3' 18 SQ.FT.
JACKSON ST (56) TEST HOLE 3'X3' 504 SQ.FT. TOTAL 98 SQ.FT.
GRID: 101-46-9407 TOTAL 754 SQ.FT.
WORK ORDER: T102117235
ENGINEER: CLINT ROGER f
CONTACT: (631) 487-6437
EP �EP EP
I
KEY: RN
MAIN ST 8x5 N
N
EXCAVATION PIT IN EP 23' EP EP
PAVEMENT (N.T.S.): 1
EXCAVATION PIT 1 F CPR# I
23 4,205
5
I 1
BEHIND CURB (N.T.S.): ,
EEO—
TEST
,5740 TEST HOLE ( N.T.S.): N 43' _
®
c.,
S = �. N 28'
DRILL LINE IN PAVEMENT — — — w1w 1-7 #44U I F
(N.T.S.): =I= w 168' o o co
< � I M N
F-
U w
DRILL LINE BEHIND CURB — — — r1
i #515
(N.T.S.): `I�' 35
260' 202'
I I #415
EDGE OF PAVEMENT: — EP
CURB LINE: — CL — #21 183' #2395 #2625 #2665
EP I EP EP
I
INSIDE SET (POTENTIAL I
') JACKSON JACKSON ST
RELOCATION): I N
55—•� 75---�/"•� _ 120' / 50. 5x"5
EP
3'x5'
DRILL SUMMARY : TOTAL PROJECT 1150' $'x5'
2ND ST = 211' #2350 #2450
I w l w
3RD ST = 321'
4TH ST = 393' I
5TH ST = 327' o 135'o fn
co
JACKSON ST = 2776' I co #75 g N
TOTAL = 4028' �8' 30'
I33'
#55
n tl l I I 10''
3'x5' o
I ,
EP EP EP
T102117235
Town of Southold
Street: I Jackson St
Road Way Openings Behind the Curb Openings
Qty Opening Size Sqft Qty Opening Size Sqft
2 5'x5' 50 1 8'x5' 40
6 3'x5' 90 2 3'x3' 18
37 3'x3' 333
Drill (2776')
45 Total 4731 3 Tota 1 58
Street: I 5th St
Road Way Openings Behind the Curb Openings
Qty Opening Size Sqft Qty Opening Size Sqft
1 3'x3' 9 1 8'x5' 40
Drill (327')
1 Total 91 1 Tota 1 40
Street: I 4th St
Road Way Openings Behind the Curb Openings
Qty Opening Size Sqft Qty Opening Size Sqft
1 3'x5' 15
4 3'x3' 36
Drill (393')
5 Total 51 0 Total 0
Street: I 3rd St
Road Way Openings Behind the Curb Openings
Qty Opening Size Sqft Qty Opening Size Sqft
1 8'x5' 40
8 3'x3' 72
Drill (321')
9 Total 112t-- 0 Tota 1 0
Street: I 2nd St
Road Way Openings Behind the Curb Openings
Qty Opening Size Sqft Qty Opening Size Sqft
1 3'x5' 15
6 3'x3' 54
Drill (211')
7 Tota 1 691 0 Tota 1 :01
Street: Kimogenor Point Rd
Road Way Openings Behind the Curb Openings
Qty Opening Size Sqft Qty Opening Size Sqft
1 8'x5' 40
1 Tota 1 401 0 Tota 1 0