Appendix A
Coastal Assessment Form
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A.
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INSTRUCTIONS (Please print or type answers)
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1.
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Applicants, or in the case of direct actions
Village agencies, shall complete this CAF for proposed actions which
are subject to the Consistency Review Law. This assessment is intended
to supplement other information used by a Village agency in making
a determination of consistency.
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2.
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Before answering the questions in Section C,
the preparer of this form should review the policies and explanations
of policies contained in the Local Waterfront Revitalization Program
(LWRP), a copy of which is on file in the Village Clerk's office.
A proposed action should be evaluated as to its significant beneficial
and adverse effects upon the coastal area.
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3.
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If any question in Section C, on this form,
is answered "yes," then the proposed action may affect the achievement
of the LWRP policy standards and conditions contained in the Consistency
Review Law. Thus, the action should be analyzed in more detail and,
if necessary, modified prior to making a determination that it is
consistent to the maximum extent practicable with the LWRP policy
standards and conditions. If an action cannot be certified as consistent
with the LWRP policy standards and conditions, it shall not be undertaken.
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B.
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DESCRIPTION OF SITE AND PROPOSED ACTION
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1.
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Type of Village agency action (check appropriate
response):
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(a)
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Directly undertaken (e.g., capital construction,
planning activity, agency regulation, land transaction)
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(b)
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Financial assistance (e.g., grant, loan, subsidy)
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(c)
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Permit, approval license, certification
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(d)
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Agency undertaking action:
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2.
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Describe nature and extent of action:
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3.
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Location of action:
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4.
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Size of site:
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5.
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Present land use:
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6.
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Present zoning classification:
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7.
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Describe any unique or unusual land forms on
the project site (i.e., bluffs, dunes, swales, ground depressions,
other geological formations):
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8.
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Percentage of site which contains slopes of
15% or greater:
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9.
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Streams, ponds or wetlands existing within or
contiguous to the project area?
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(a)
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Name:
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(b)
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Size (in acres):
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10.
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If an application for the proposed action has
been filed with the Village agency, the following information shall
be provided:
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(a)
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Name of applicant:
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(b)
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Mailing address:
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(c)
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Telephone number: area code ( )
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(d)
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Application number, if any:
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11.
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Will the action be directly undertaken, require
funding, or approval by a state or federal agency?
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Yes
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No
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If yes, which state or federal agency?
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C.
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COASTAL ASSESSMENT (Check either "Yes" or "No"
for each of the following questions)
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1.
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Will the proposed action be located in or contiguous
to or have a potentially adverse effect upon any of the resource areas
identified on the coastal area map:
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YES
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NO
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(a)
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Significant fish or wildlife habitats?
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(b)
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Scenic resources of local or statewide significance?
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(c)
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Important agricultural lands?
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(d)
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Natural protective features in an erosion hazard
area?
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If the answer to any question above is "yes,"
please explain in Section D any measures which will be undertaken
to mitigate any adverse effects.
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2.
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Will the proposed action have a significant
effect upon:
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YES
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NO
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(a)
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Commercial or recreational use of fish and wildlife
resources?
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(b)
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Scenic quality of the coastal environment?
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(c)
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Development of future or existing water dependent
uses?
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(d)
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Operation of the state's major ports?
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(e)
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Land or water uses within a small harbor area?
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(f)
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Stability of the shoreline?
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(g)
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Surface or groundwater quality?
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(h)
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Existing or potential public recreation opportunities?
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(i)
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Structure, sites or districts of historic, archeological
or cultural significance to the Village, town, county, state or nation?
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3.
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Will the proposed action involve or result in
any of the following:
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YES
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NO
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(a)
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Physical alteration of land along the shoreline,
land under water or coastal waters?
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(b)
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Physical alteration of two acres or more of
land located elsewhere in the coastal area?
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(c)
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Expansion of existing public services or infrastructure
in undeveloped or low-density areas of the coastal area?
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(d)
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Energy facility not subject to Article VII or
VIII of the Public Service Law?
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(e)
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Mining, excavation, filling or dredging in coastal
waters?
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(f)
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Reduction of existing or potential public access
to or along the shore?
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(g)
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Sale or change in use of publicly owned lands
located on the shoreline or under water?
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(h)
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Development within a designated flood or erosion
hazard area? If so where?
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(i)
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Development on a beach, dune, barrier island
or other natural feature that provides protection against flooding
or erosion?
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(j)
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Construction or reconstruction of erosion protective
structures?
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(k)
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Diminished surface or groundwater quality?
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(l)
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Removal of ground cover from the site?
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4.
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PROJECT
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(a)
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If a project is to be located adjacent to shore:
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YES
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NO
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(1)
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Will water-related recreation be provided?
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(2)
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Will public access to the foreshore be provided?
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(3)
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Does the project require a waterfront site?
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(4)
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Will it supplant a recreational or maritime
use?
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(5)
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Do essential public services and facilities
presently exist at or near the site?
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(6)
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Is it located in a flood-prone area?
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(7)
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Is it located in an area of high erosion?
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(b)
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If the project site is publicly owned:
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YES
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NO
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(1)
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Will the project protect, maintain and/or increase
the level and types of public access to water-related recreation resources
and facilities?
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(2)
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If located in the foreshore, will access to
those and adjacent lands be provided?
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(3)
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Will it involve the siting and construction
of major energy facilities?
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(4)
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Will it involve the discharge of effluents from
major steam electric-generating and industrial facilities into coastal
facilities?
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(c)
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Is the project site presently used by the community
neighborhood as an open space or recreation area?
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(d)
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Does the present site offer or include scenic
views or vistas known to be important to the community?
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(e)
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Is the project site used for commercial fishing
or fish processing?
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(f)
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Will the surface area of any waterways or wetland
areas be increased or decreased by the proposal?
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(g)
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Does any mature forest (over 100 years old)
or other locally important vegetation exist on this site which will
be removed by the project?
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(h)
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Will the project involve any waste discharges
into coastal waters?
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(i)
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Does the project involve surface or subsurface
liquid waste disposal?
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(j)
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Does the project involve transport, storage,
treatment or disposal of solid waste or hazardous materials?
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(k)
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Does the project involve shipment or storage
of petroleum products?
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(l)
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Does the project involve discharge of toxins,
hazardous substances or other pollutants into coastal waters?
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(m)
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Does the project involve or change existing
ice management practices?
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(n)
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Will the project affect any area designated
as a tidal or freshwater wetland?
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(o)
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Will the project alter drainage flow, patterns
or surface water runoff on or from the site?
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(p)
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Will best management practices be utilized to
control stormwater runoff into coastal waters?
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(q)
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Will the project utilize or affect the quality
or quantity of sole source or surface water supplies?
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(r)
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Will the project cause emissions which exceed
federal or state air quality standards or generate significant amounts
of nitrates or sulfates?
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D.
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REMARKS OR ADDITIONAL INFORMATION: (Add any
additional sheets to complete this form.)
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If assistance or further information is needed
to complete this form, please contact the Village Clerk at 34 School
Street, Bayville, New York, 11109
Preparer's Name:
Telephone Number: ( )
Title: _______________________ Agency:
Date:
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