HomeMy WebLinkAboutChapter 236 - Stormwater Management Work Sheet Scott A. Russell ��d,;�sUFFQ S'7C'O]KNIWA'7C']EIK
SUPERVISOR U I�M[A�1NAG]EIMI]EINIF
SOUTHOLD TOWN HALL-P.O.Box 1179 Q
53095 Main Road-SOUTHOLD,NEW YORK 11971 2 a Town of So u th o l d
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOLES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
Yes No (CHECK ALL THAT APPLY)
❑❑ A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
❑❑ B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑❑ C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
El El E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
❑❑ F. Installation of new or resurfaced impervious surfaces of 1,000 square
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a comDleted Check List Form to the Building Department with your Building Permit AADlication.
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other)
NAME:
(P—)
Contact Information:
(Telepha Number)
Property Address/Location of Construction Work:
I Eel NUT�*JuvLe=WIaF.'Wr.illEl
S.C.T.M. '°: 1000 Date:
District
Section Block Lot
****FOR BUILDING DEPARTMENT USE ONLY****
Reviewed By:
Date
EApproved for processing Building Permit.
Stormwater Management Control Plan Not Required.
E] Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)