HomeMy WebLinkAboutAlbertson Ln Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 01/22/19 Receipt#: 251094
Quantity Transactions Reference Subtotal
1 Excavation Permits 1318 $4,050.00
Total Paid: $4,050.00
Notes:
Payment Type Amount Paid By
CK#43626 $2,05000 National, Grid - Gas Permits
Dept
CK#43741 $2,00000 National, Grid -Gas Permits
Dept
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: National, Grid -Gas Permits. Dept
175 E Old Country Rd
Bid 3 FI 1
Hicksville, NY 11801
Clerk ID: LYNDAR Internal ID. 1318
" p�rinit`No.
Y
TOWN&SOUTHOLD - 1�fF _A
HIGHWAY DEPARTMENT ,
Peconic Lane `
W.O. T1.02150263 Peconic,New York 11958 `$
(631)765-3140 4
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 indi'vidual 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.
Keyspan Gas East Corp D/B/A Nedonall Wd
Gas Permits Dept Bldg:3 fl: 1
Keshia Black (516)545-4686- t
Name of Applicant Phone NumberAddress of Applicant
Name of Contractor Piione
Number Address of Contractor
3 -
Name of Property Owner Requestmg•SC-Mce(if applicable Address of Owner
a. Alberston Ln -- W/S, 1/0 North Rd-- (1) 10'_x F gas pit & 100' x 2' trench
Work Descei tion and Location;Street Number Hamlet,Cross Street)
(a) is construciiontlocated within 75 feet of tidal wetlands? °Yes No X
•If yes,other Town permits may be required.
NOTE: All Information requested by thls Signature of Applicant
Application/Permit Form is
Required fora complete application!
Date
5. (a) Attached plot plan to reasonably and adequately,describe the'proposed work. Provide accurate schematic site plan showing the
-location oral)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 10 , Section Block Lot
7. Starting Date: 1/30/19 Completion Date: 3/30/19
8. Work Schedule: Phase Coinale ion Date
Excavation _ _ _ Work Schedule
Facility Installation Most be provided
Backfill&Completion (or 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: S. +W _ d- s• :.<, �= -_, �<< -:5: 5�K 7
11. Remarks: Mandated Bare Main Replacement.
D-39' l of 3
k
12. Insurance Coverage:(Attach Copy)
(a) Insurance Company:_ r
(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$2,000,000 general aggregate.
13. Security:
(a)Surety Bond or Certified Check- _,=provided in the total Amount of$
(b)Maintenance Bond provided: 2 years or 3 years.
14. Fees for Applications and permits:
Basic Application Fee for Each Project Location - 2 $500.00 1000.00
A Project Location would include each Bell Hole and For every roa opening or excavation within 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. /Service Connections excavations @$50.00 $ 50.00
No.
A2. /Additional Excavations same service @$20.00 $
No.
B. Trench Excavations 18"in depth or less
Total Lineal Footage of Excavation; L.F. n@$10.00 $ 00
C. Trench Excavations 18"in depth to 5' in de th.
Total Lineal Footage of Excavation; O-'J L.F.@$30.00 $, r OQ 0
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$ 26J8$fl
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 a Highway Excavation permit to:
in accordance wi
this application and subject'to the"General'Conditions"and"Special Conditions"of permit(if iiy)att hed here
SUPERINTE NT A S
TOWN OF S TH D N W RK
V ncent .O'�l" 1 10
Date
Date Received by the Town Clerk
Date Permit Issued L- 22-- ,p 1, Permit No.
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: 2 `
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
1 s�
2nd
0.
3rd
41h
(To Permit Clerk)
REMARKS
CODE
IB Improper Barricades
1L 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
APPLICATIONMERMIT FOR HIGHWAY EXCAVATION AND REPAIR
!. Permittea's Coutiactors to.Com 1 l with Permit Re uircuiiZs:The Permittee is responsible for
informing its'independent contractors,employees,agents and assigns of their responsibility to comply with
this permit, including all speciallsite 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 Pro err 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 nota party to the permit.
3. Protection of the Riahway and Future HighwalMnintcnnncc:_ 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. Reyocntion of the Permit-by the.Highway Su eAni ndent: 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 hoursprior 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 she completed work to the Town Highway Department and request a.Final
inspection.
6. 3lornec of Eauinment&�-terials: 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 beresponsible for veritication 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 traf o 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
atthe NYS DOT Construction Standards.'
GENERAL CONDI'T'IONS OF PERMIT
APPLICATION/PERMIT FOR HIGIIWAY 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'goo_d functional condition until thick vegetative
cover is established.
11. Cleats Fill Only: Allproject 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,ate.)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. Backlill&Cornnaction of ail 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(IT)inches thick and shall be mechanically compacted to a Ninety-
five(950/0)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 Ruad Shoulder Area: All manmade 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 vitb all Technical informs ion'a d Scone-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.,Envement Reconstruction: All Pavement sections must be reconstructed in the following manner;
-(Note'iWhen Concrete Pavements are Present,Please review Restoration requirements with the Highway Superintondont)
a) Complete all back-till&soil compaction work as needed to_provide a suitable sub-base;
b).Over-cut existing asphalt bell hole or trench by twelve(1211)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(1.511)inch of Asphalt(Type 6)Wearing Course. (Provide AC at all joints)
Al I work listed herein must meet the minimum requirements of the Southold Town Highway
Specifications.
17.Tretrehine of Pavement Sur faces rheeedina One Iitrndred(1004 Fee-11 in Length: All trenching of
pavement surfaces exceeding 1007 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,shoulder to shoulder).,
r
,1
T#T102150263
TOWN OF SOUTHOLD/VILLAGE OF GREENPORT
Street: ALBERSTON LN
Road Way Openings ,Behinci,tnings,
Qty, . . OpeniiigSize -- Soft ` Qty . Opening Size Sqft
3'x3' 0 3'x3' 0
3'x5' 0 3'x5' 0
5'x5' 0 5'x5' 0
4'x8' 0 4'x8' 0
6'x10' 0 6'x10' 0
8'x5' 0 8'x5' 0
1 10'x5' 50
Trench Attributes° . Trench.Attributes
LnFt .Trench Width . 'Sgft LnFt- Trench Width Sqft
100 2' 200 0 2' 0
0 Total 250 0 Total 0
ROAD OPENING SKETCH-SHEET 1 OF 1
KEY ,
TOWN OF SOUTHOLD/VILLAGE OF GREENPORT EXCAVATION PIT IN ® EDGE OF PAVEMENT —EP—
ALBERSTON LN PAVEMENT (N T S)
CURB LINE —CL— °
WORK07-21-9006 TEST HOLE N T.S) ® INSIDE SET(POTENTIAL I
WORK ORDER 7102150263 (
ENGINEER:RAPHAEL SANCHEZ RELOCATION):
CONTACT.(631)206-7435 TRENCH LINE IN PAVEMENT TRENCH LINE IN COUNTY
(N T S) PERMIT(N T.S)
ROADWAY OPENINGS:TOTAL PROJECT
QTY DESC SIZE
(1) LIVE GAS PIT 10'(L)x 5'(W)x 3'(D) d(�
40'
TRENCH SUMMARY:TOTAL PROJECT
ALBERTSON LN = 100'(L)x 2'(W')x 3'(D)
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