COASTAL ASSESSMENT FORM
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A.
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INSTRUCTIONS (Please print or type all answers.)
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1.
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Applicants or, in the case of direct actions, town agencies shall complete this CAF for proposed actions which are subject to Chapter 151, Article II, Environmental Quality and Coastal Consistency Review. This assessment is intended to supplement other information used by the Town Board 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 policy contained
in the Local Waterfront Revitalization Program (LWRP), a copy of which
is on file in the Town 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 sections
of the chapter. Thus, the action should be analyzed in more detail
and, if necessary, modified prior to making a determination that it
is consistent 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 town 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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__________________________________________________
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__________________________________________________
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3.
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Location of action: ______________________________
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__________________________________________________
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__________________________________________________
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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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__________________________________________________
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__________________________________________________
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8.
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Percentage of site which contains slopes of 15% or greater:
_______________________________
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__________________________________________________
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__________________________________________________
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9.
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Streams, lakes, ponds or wetlands existing within or contiguous
to the project area:
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(1)
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Name:___________________________________
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(2)
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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 town 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 or require funding or
approval by a state or federal agency?
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Yes ________No ________ 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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Yes
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No
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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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_____
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_____
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(a)
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Significant fish or wildlife habitats?
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_____
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_____
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(b)
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Scenic resources of local or statewide significance?
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_____
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_____
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(c)
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Important agricultural lands?
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_____
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_____
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(d)
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Natural protective features in an erosion hazard area?
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_____
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_____
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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 the potential to 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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_____
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_____
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(b)
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Scenic quality of the coastal environment?
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_____
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_____
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(c)
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Development of future or existing water-dependent uses?
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_____
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_____
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(d)
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Operation of the state's major ports?
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_____
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_____
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(e)
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Land or water uses within small harbor area?
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_____
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_____
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(f)
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Stability of the shoreline?
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_____
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_____
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(g)
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Surface or ground water quality?
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_____
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_____
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(h)
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Existing or potential public recreation opportunities?
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_____
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_____
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(i)
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Structures, sites or districts of historic, archaeological or
cultural significance to the town, state or nation?
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_____
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_____
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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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_____
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_____
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(b)
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Physical alteration of two(2) acres or more of land located
elsewhere in the coastal area?
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_____
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_____
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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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_____
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_____
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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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_____
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_____
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(e)
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Mining, excavation, filling or dredging in coastal waters?
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_____
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_____
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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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_____
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_____
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(g)
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Sale or change in lieu of publicly owned lands located on the
shoreline or under water?
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_____
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_____
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(h)
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Development within a designated flood or erosion hazard area?
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_____
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_____
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(i)
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Development on a beach, dune, barrier island or other natural
feature that provides protec tion against flooding or erosion?
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_____
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_____
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(j)
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Construction or reconstruction of erosion protective structures?
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_____
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_____
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(k)
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Diminished surface or ground water quality?
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_____
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_____
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(l)
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Removal of ground cover from site?
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_____
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_____
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4.
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Project
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(a)
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If 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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_____
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_____
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(2)
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Will public access to the foreshore be provided?
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_____
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_____
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(3)
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Does the project require a waterfront site?
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_____
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_____
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(4)
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Will it supplant a recreational or maritime use?
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_____
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_____
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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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_____
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_____
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(6)
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Is it located in a flood prone area?
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_____
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_____
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(7)
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Is it located in an area of high erosion?
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_____
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_____
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(b)
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If the project site is publicly owned:
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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 waterrelated recreation resources and
facilities?
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_____
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_____
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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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_____
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_____
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(3)
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Will it involve the siting and construction of major energy
facilities?
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_____
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_____
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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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_____
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_____
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(c)
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Is the project site presently used by the community?
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_____
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_____
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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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_____
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_____
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(e)
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Is the project site presently used for commercial fishing or
fishing processing?
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_____
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_____
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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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_____
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_____
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(g)
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Does any mature forest (over100 years old) or other locally
important vegetation exist on this site which will be removed by the
project?
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_____
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_____
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(h)
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Will the project involve any waste discharges into coastal waters?
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_____
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_____
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(i)
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Does the project involve surface or subsurface liquid waste
disposal?
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_____
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_____
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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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_____
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_____
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(k)
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Does the project involve shipment or storage of petroleum products?
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_____
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_____
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(l)
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Does the project involve discharge of toxics, hazardous substances
or other pollutants into coastal waterways?
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_____
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_____
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(m)
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Does the project involve or change existing ice management practices?
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_____
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_____
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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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_____
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_____
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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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_____
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_____
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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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_____
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_____
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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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_____
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_____
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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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_____
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_____
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D.
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REMARKS OR ADDITIONAL INFORMATION (Add any additional sheets
necessary to complete this form.)
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______________
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(____) __________
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Preparer's Name (print)
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Telephone No.
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______________
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________________
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_______________
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Title
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Agency
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Date
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FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR
PURSUANT TO § 210.45 OF THE PENAL LAW, STATE OF NEW YORK.
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__________
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Signature of Preparer
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__________
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Date
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Sworn to before me this
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______________ day of ______________ 19______
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______________
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Notary Public,
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State of New York
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