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HomeMy WebLinkAboutTR-3757Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 3~57 DATE:J~i¥. 28,...1989 ISSUED TO .....B.tRBA1Lk...BIIitKE ................................................. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 18.93: and Chapter 404 of the Laws of the State of New York 1952, and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on ~!y .~]~ ..... 19 $.9.., and ]n consideration of the sum of $ paid by of ................................................................. N.Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Construct 120' retaining wall and fill with approximately 200 cu. yds. clean sand to be trucked in from an upland Property located at 1150 Blue Marlin Drive, Southold, N.Y. all in accordance with the defaiJed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of said Board as of this dat,e. Trustees TERMS ~nd CONDITIONS residing at 1150 Blue Marlin Drive~ Southold~ N.Y. N.Y., aa part of the consideration for the issuance of the Permit does undesstand and prescribe to the fol- lowing: Southold Town Trustees Permiz must be prominently displayed during period of work. t. That the said Board of Trustees and the Town of Southold are releaaed from any and aH damages, or claims for damages, of suits arising directly or indirectly as a resalt of any oper- ation performed pursuant to this Parmlg and the said Permit-tee will~ at his or her own g, defend any and ail such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, *o the complete exclusion of the Board of Trustees of the Town of Sotrtholii 2. That this Permit is valid for a period of 24 mos. which is considered to be the estimated time required to complete the work involved, but should circumstances wa~rang request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permizree wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4; That the work involved will be subject to the inspection and approvai of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no tmzeaaonable interference with navigation aa a result of the work herein authorized. 6. That there shah be no interference with the tight of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southotd require the removal and/or alterations in the location of the work herein authorized, or fi, in the opinion of the Board of Tmsxees, the work shall cause unreasonable obstrucnon to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Petmiztee ot the completion of the work auth- orized. 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. FRANK A. KUJAWSKI, JR., ~resident ALBERT J. KRUPSKI. JR., Vice-President JOHN M. BREDEMEYER, Ill JOHN L. BEDNOSKI, JR. HENRY P. SMITH TELEPHONE (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold. New York 11971 August 1, 1989 En Consultants 1329 North Sea Road Southampton, N.Y. 11968 Re: Application No. 5-13-89-57-1-33- Barbara Burke Dear Mr. Haje: The following action was taken by the Board of Town Trustees during their regular meeting held on July 27, 1989 regarding the above matter: WHEREAS, En Consultants on behalf of Barbara Burke applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 23, 1989 and, WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a public hearing was held by the Town Trustees with respect to said application on July 27, 1989 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of ~he town, NOW, THEREFORE BE IT RESOLVED that En Consultants ON BEHALF OF Barbara Burke BE AND HEREBY IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO: Construct 120' retaining wall and fill with approximately 200 cu. yds. clean fill to be trucked in from an upland site. Property located at 1150 Blue Marlin Drive, Southold, N.Y. This permit will expire two years from the date it is signed if work has not commenced by said date. Fees must be paid and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Please return to the Building Department for a determination on the need for any other permits which may be required for this project. FAK:jas cc: Bldg. Dept. Conservation file Very truly yours, ~ Frank A. Kujawski, Jr. President Board of Town Trustees Advisory Council FRANK A. KUJAWSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-Presiden: JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. HENRY P. SMITH TELEPHONE (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 May 23, 1989 Mr. John Holzapfel, Chairman Southold Town Conservation Advisory Council Southold Town Hall Main Road Southold, New York 11971 Dear Mr. Holzapfel: Transmitted herewith is application No. 5-13-89-57-1-33 for a Wetland Permit submitted by Barbara Burke. Please prepare a written report of findings and recommendations with respect to this application. FAK: jas Very truly yours, Frank A. Kujawski, Jr. President Board of Town Trustees cc: Bldg. Dep't. FRANK A. KUJAWSKt, JR., President ALBERT J. KRUPSKt, .IR., Vice-President JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. HENRY P. SMITH TELEPHONE (516) 765-I892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 May 23, 1989 To Whom It May Concern: Attached hereto is a Short Environmental Assessment Form submitted by Barbara Burke for a wetland permit to construct a 120' ~etaining wall on property located at Blue Marlin Drive, jSouthold. Posted: May 23, 1989 Frank A. Kujaws~i, Jr. President Board of Town Trustees 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only )ART I--PROJECT INFORMATION (To be completed by ApplicAnt or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Barbara Burke by En-Consultants, Znc . ~3. PROJECT LOCATION: Municiba~ity 1150 Blue Marlin Drive, Southo~,,y Suffolk 1150 Blue Marlin Drive, Southold SCTM No. 1000-57-1-33 [] New [] Expansion [] Modification/alteration ' ' Construct 120' retaining wall above SHW and attached to corners of adjacent retaining .wall. Approximately 200 c.y. of clean fill w~ll be trucked in for backfill. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~] Yes [] NO If NO, describe briefly SEQF DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] t'~o [! yes, list agency name and permit/apprOval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] Yes [] No CERTIFY THAT THE fNFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE . ROy L. ,~t i~,~ent If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 ~qes,dential [] !ndustdal [] Commercial [] Agriculture [] parE/Forest/Open space [] Other STATE OR LOCAL)? [~Yes [] NO If yes, fist agency(s) and permit/approvals DEC, DOS, COE ........ u~':VlRONMENTAL ASSESSMENT (To be completed by Agency} B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS iN 6 NYCRR, PART 6t7.67 if NO. a negative C. COULD ACTION RESULT iN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers m~ay be bar~dwrinen, it lec]~t~lel C1o Existing air quality, surface or ~roundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or dispose[, po~entiat for erosion, drainage or flooding problems? Explain brieey: C2. Aesthetic, agricuRural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain bNetl~ C7. Olher impacts (incl~JdJng changes in use of either quantity or type of energy)? Explain briefly. O. IS THERE. OR IS THERE LIKELY TO BE, ~ONTROVEeSY RELATED TO POTENTIAL ADVERSE ENV RONMENTAL i ~PACTS? ~ Yes E~ NO If Yes, explain briefly PART 1))--DETERMINATION OF SIGNIFICANCE ~'o ee completed by Agency) INSTRUCTIONS: For each ac]verse ef,'ect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should De assessed ~n connection w~th its (al setting (i,e. urban or rural); (bi proPabiJity ol occurring; (c) duration; irrevers~bmly; (e) geograDmc scope: and It) magnitude. If necessary, add attachments or reference supporting materials. Ensure that expJanal~ons comam sufficient detail to show that alt relevant aaverse impacts have been identified and adequately addressed. [~ Check this box if you nave identified one or more cotentially large or significant adverse impacts which occur, Then proceed d~rectly to the FULL EAr and/or prepare a positive declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND c rovid8 on al:tacnments as necessary, the reasons supporting this determination: BO.kRI) OF TOWN TRI'STEI~ TOWN OF SOUTHOLD Town Hall. $3095 Main Road P.O. Box 728 Southold, New York 11971 {516} 765-I892 APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW yORK, FOR THE ISSUANCE OF A PERMIT PURSUANT TO THE LAWS, ORDINANCES AND REGULATIONS GOVERNING THE COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS OF SOUTHOLD TOWN, AND THE ISSUANCE OF PERMITS PURSUANT TO CHAPTER 32 OF THE CODE OF THE TOWN OF SOUTHOLD. DATE May 18, 1989 APPLICANT'S NAME: Barbara Burke TEL. NO. 516-741-3498 MAILING ADDRESS: 29 Linden Street, Garden City, New York 11530 AGENT: Eh-Consultants, Inc. ~ TEL NO. 516-283-6360 AGENT ADDRESS: 1329 North Sea Road, Southampton, New York 11968 PERMIT REQUESTED TO: construct 120' retaining wall above SHW and attached ~to corners of adjacent retaining walls. Approximately 200 c.y. of clean ?fill will be trucked in for backfill. LOCATION OF PROPERTY FOR REQUESTED PERMIT: 1150 Blue Marlin Drive, Southold HAMLET:- Arshamamoque TAX'MAP NO: 1000- 57-1-33 CREEK, BAY OR HARBOR FRONTING PROPERTY: SIZE OF PROPOSED WORK: LENGTH: See Project description Peconic Bay WIDTH: N/A YDS. TO BE EXCAVATED: 0 YDS. TO BE FILLED: 200 MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED: Trucked in, dumped and graded. WIDTH OF CANAL, CREEK OR BAY DEPTH AT LOW TIDE: N/A DISTANCE TO NEAREST CHANNEL: DISTANCE PROJECT EXTENDS AREA ZONING: Residential INTENDED USE OF PROPERTY: FRONTING PROPERTY: 1+ mile AVER. RISE IN TIDE: 2'6" N/A BEYOND SIMILAR PROJECTS IN AREA: AIS PROJECT FOR PRIVATE OR BUS. USE: No change. DESCRIBE KNOWN PRIOR OPERATIONS CONDUCTED ON PREMISES: None known. 0 Private HAS ANY PRIOR LICENSE OR PERMIT BEEN ISSUED TO ERECT STRUCTURES, DREDGE, OR DEPOSIT FILL ON SAID PREMISES: N/A HAS ANY LICENSE OR PERMIT EVER BEEN REVOKED OR SUSPENDED BY A GOVERNMENTAL AGENCY: No DESCRIBE FULLY THE REHABILITATION OF PROPERTY: N/A DESCRIBE PROPOSED CONDITION OF PROPERTY AFTER WORK IS COMPLETED. INCLUDE AN ADDITIONAL SURVEY OF PROPERTY SITE IF NECESSARY: Backfill will be planted to stabilize ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED WHICH WOULD PROHIBIT THIS PROJECT: No WRITTEN CONSENT OF OWNER IF NOT THE SAME AS APPLICANT: See attached. COUNTY OF SUFFOLK STATE OF NEW YORK Roy L. Haje BEING DULY SWORN DEPOSES AND SAYS THAT HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS, AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE TOWN BOARD OF THE TOWN OF SOUTHOLD. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT, IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT OR REPRESENTATIVE, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature ©f Appt~can~ SWORN TO BEFORE ME THIS ~-~?~ ~ NOTARY~'BLIC~ ~AY M. DOUOHERW N~ARY PUBLIC, ~ate of New York N~. OZDO4g01601, Suffolk County ~ EXAMINED BY APPROVED DISAPPROVED CONDITIONS (If any) SIGNATURE OF CHAIPd~AN 'COMPUTATION OF FEES Approved 2/27/85 PART 1--PROJECT INFORMATION · " Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be consi as part of the application for approval and may be subject to further verification and public review. Provide any addl information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAr will be dependent on information currently available and will not in new studies, research or investigation. If information requiring such additional work is unavaihble, so indicate and 5~ each instance. NAME OF ACTION LOCATtON OF ACTION ( nc ude S~reet Address Municioa[~ty and County,~ 1150 Blue Marlin Drive, Southold NAME OF APPLICANTJEPONSOFt I BUSINESS TELEPHONE Roy L. Haje', President, En-Consultants, Inc. t ~16 )283-6360 ADDRESS 1329 North Sea Road CI~IPO I STATE I ZiPCODE Southampton N.Y. 11968 NAME OF OWNER {if dif[erentl t BUSINESS TELEPHONE Barbara Burke 1 516 , 741-3498 ADDRESS 29 Linden Street CITY/PO STATE I ZIP CODE Garden City I N.Y. 11530 DESCRIPTIONOPACT[ON Construct 120' retaining wall above SHW and attached to corners of adjacent-retaznlng walls. Approximately 200 c.y. of clean fill will be trucked in for backfill. Please Complete Each Question--indicate N.A, if not applicable A. Site Description Physical setting of overall 3roject, both develooed and undevelooed areas. 1 Present la nd use: ~Uroan ~lndustrial ~Commercial ~Residential (suburban) []Rural {non-L []Fores~ ~Agriculture ~Other 2, Total acreage of project area: .48 acres. APPROXIMATE ACREAGE PRESE,"ATLY AFTER CO,MPLET[O.~ Meadow or Brushland (Non-agricultural] - ~ acres ' ~ acre Forested _ acres ~ acre Agricultural dnctudes orchards, cropland, pasture, etc.) acres . _ acre Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acre Water Surface Area .05 . acres .05 acre Unvegetated (Rock, earth or fill) acres acre Roads, buildings and other paved surfaces ,1 acres .1 Other (Indicate type)~a~dscapin~ ~ _ acres . 23 acre ] What is predominant sod type(s) on prol,'~ t s~h-~ a Sod drainage: ~Me]J drained 90 93 of ~e ~Modera~eJy ~,l~ drau~ed 5~ 93 of site ~Poorly drained 5 _ % or s~te b. If any agr,cuituraI land ~s nvolved howrnanyacruso~od arecla~nedw,thm ~o,J~roupl ~hruu~h4of the> Land CJa~sd~cauon Sy~[em? ~o _ acres (See ~ NYCRR 370) 4 Are there bedrock ou~croppmss on pro;eot s~te? ~cs ~No a. What ~s depth to bedrock? Unknown 0n feeU 617.21 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM SEC Purpose: The full EAF is designed to help applicants and agencies determine, in an ordedy manner, whether a proie, or action may be significant. The question of whether an action may be significant is not always easy to answer Frequen [y, there are aspects of a proiect that are subiective or unmeasureable. ]t is also understood that those who determm significance may have little or no formal knowledge of the environment or may be technically expert in environment; analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affectin the question of significance The full EAF is intended to provide a method whereby applicants and agencies can be assured thai the determinatio process has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or actior Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic projec data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possib[eimpacts that may occur from a proiect or action. It provide guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentiall'~ large impact. The form also identifies 'whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used ~/o evaluate whether or not th, impact is actually important. DETERMINATION OF SIGNIFICANCE--Type I and Unlisted Actions Identify the Portions of EAF completed for this project: [] Part 1 [] Part 2 ' []Part 3 Upon review of the informatio~ recorded on this EAF (Parts I and 2 ~,nd 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead agency that: [] A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. EEl g. Although the proiect could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* [] C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or 1'ype Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Title of I(espons~ble Orlicer Signature of Preparer (If different from responsible otficer} Date 1 ~. Approximate percentage of proposed project site withsiopes: ~.0-10% 100 % ~10q5% '~ ~15% or greater __ % 6. t,s proiect substanti~lly conti~uous to, or coflta~n a building, site, or district, listed on the State or the Nation Re~ister~ of Historic Places? ~Yes ~No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landm~rks~ ~Yes 8. What is the depth of the water table? ~ [tn feet) 9. Is site located over a primary, principal, or sole source aquifer? ~Yes ~No 10. Do hunting, f[shin~ or s~el] fishing opportunities presently exist ~n the proiect area? ~Yes ~No 11. Does project site contain any species of plant or animal life that ~s identi[ied as threatened or endange~e( ~Yes ~o According to ~o~' ~, Identify each species 12. Are there any unique or unusual land forms on the project site? [i.e., cliffs, dunes, other geological formation Describe 13. Is the project site presently used by the community or neighborhood as an open space or recreation area If yes, explain 14. Does the present site include scenic views known to be important to the community? [~]Yes 15. Streams within or conti§uous to proiect area: a. Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland areas within or contzguous to proiect area: a. Name Peconic Bay 17 Is the site served by~'xisting public utilities? E3Yes ~No a) If Yes, does sufficient capacity exist to allow connection? b] If Yes, will improvements be necessary to allow connection? b. Size (in acres) ~]Yes ~No OYes ~No 16. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA Section 303 and 304? OYes 19. Is the site located in or substantially contiguous to a Critical [~nvironmenta[ ,\rea designated pursuant to Article of the ECL, and 6 NYCRR 6177 [~Yes ]~]No 20. Has the site ever been used for the disposal of solid or hazardous wastes? OYes ~No 13. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor .48 b. Project acreaqe to be developed: .8 acres initially; .48 c, Project acreage to remain undeveloped -- acres. d. Length of project, in miles: ~/A [if appropriate) e. If the project is an expansion, indicate percent of expansion proposed N/A f. Number of oft-street parkin~ spaces ex~shn8 ~/~ ' proposed g. K~aximum vehicular tr~ps generated per hour ~/A [upon complcuon of pro~ect]~ h. If resident.al: Number and type of housm~ un,ts: One Famdy Two [-,]mdy ~lult~plc Parody Initially N/A _.. Ulumaw/v i. Dimensions ~in teat) oi largest proposed structure 6+ height; .,. width; _, length. j. Linear feet of frontage along a public thorough/are project wdl occupy i~? acres ultimately. 3 2. How much na[urai material (i.e., rock, earth, etc.) will be removed from the site? 3. \¥~1 disturbed areas be reclaimed? ~Yes [~No ~]NIA a. If yes, for what intend._d purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? [~Yes c. Will upper subsoil be stockpiled for reclamation? ~Yes ~]No 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? · ]- . acres. 5. Will any mature forest [over 100 years o]d) or other locaHy3mportant vegetation be removed by this project? [~Yes )]~]No ' 6, If single phase project: Anticipated period of construction 7. If multi-phased: gl/A a. Total number of phases anticipated b. Anticipated date of commencement phase 1 c. Approximate completion date of final phase d, Is phase 1 functionally dependent on subsequent phases? 8. Wig blasting occur during construction? fqYes l~]No 9. Number of jobs generated: during construction 3 10. Number of jobs eliminated by this project 0 .. 11. Will proiect ~'equire relocation of any projects or facilities? (number). 0 __ tans/cubic ,yards months, (including demolition). month · month rE]Yes year, [including demolition) year. ; after project is complete rE]Yes :~]No If yes, explain 12, Is surface liquid waste disposal involved? [~Yes a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? [-IYes [~No.. Type 14. \viii surface area of an existing water body increase or decrease by proposal? Expiain ~]Yes E~No 15. Is proiect or any portiqn of project located in a 100 year flood plain? :~Yes 16. 'Will the project generate solid waste? []Yes ~No a. If yes. what is the amoL:nt per month tons b. If yes, will an existing solid waste facility be used? EZ]Yes [~No c. If yes. give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? e. if Yes, explain ~No ~Yes ~No 17. Will the project involve the disposal of solid waste? a. If yes, what is the anticipated rate of disposal? b. If yes, what is the anticipated site life? 18. Will project use herbicides or pesticides? ~Yes [Z]Yes ~No tons/month. years, 19. Will project routinely produce odors (more than one hour p. er day)? f~Yes 20. \viii project produce operating noise exceeding the local ambient noise levels? 21. Will project result in an increase in energy use? ~Yes ~No If yes , indicate type(s) ~CJNo ~]Yes E]No 22. If water supply is from wells, indicate pumping capacity N/A 23. Total anticipated water usage per day N/A gallons/day. 24. Does proiect involve Local, State or Federal funding? ~]Yes if Yes. explain gallons/minute. 4 25;'..Approvals Required: City, Town, Village. Board -lYes City, To~;n. Vii]age Planning Board [:]Yes City, Town Zoning Board [:]Yes City, County Health Department r-lYes Other Local Agencies I~Yes Other Regional Agencies I~Yes State Agencies IX'lyes Federal Agencies i--lYes Zoning and Planning Information [No [No [No []No [No TW I~No Submittal Type Date Does proposed action involve a planning or zoning decision? [:]Yes [~o ~ If Yes, indicate decision required: . . ~ [:]zoning amendment [:]zoning variance I--/special use permit I-lsubdivision i-[site plan [ne~/'revision of master Dian I--]resource management plan [-Iother 5/89 2. What is the zoning classification(s)of the site? R-40 3. What is the maximum potential develooment of the site if developed as permitted by the present zoning? N/A 4. What is the proposed zoning of the site? N/A · 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? N/A 6. Is the proposed action consistent with the recommended uses in'adopted local land use plans? X]Yes '7. What are the predominant land use(s) and zoning classifications within a 1/~ mile radius of proposed action? R-40 8. Is the proposed action compatible with adjoining/surrounding land uses within a Y; mile? ][[]Yes ImF 9. if the proposed action is the subdivision of land, how many lots are proposed? a. What is the minimum lot size .proposed? 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? 11. Will the proposed action create a demand for any community provided services [recreation, education, polic fire protection)? ~]Yes ]~No a. If yes, is existing capacity sufficient to handle projected demand? []Yes rUNo 12. Will the proposed action result in the generation of traffic significantly above present levels? ~Yes a. If yes, is the exisdng road network adequate to handle the additional traffic~ ~Yes ~No D. Informational Details Attach any additional JnformatJon as may be needed to clarify your project. [f ther~ are or ~ay be any adver impacts associated with your proposal, please discuss such impacts and the measures wltich you propose to mitigate avoid them. E. Verification I certify that the in~rmat~ provided above is true to the best of my knowledge. Applicant,'Sponsor Na~.~.~ ~,' ~'' ~ 'R~. Haje, President, En-Consultants, ~ 5./]~/~9 Signature . ~ ~ Title Presiden~ Ii the action is in the Coast~ Area, and you are a st~te aRency, complete the Coastal Assessment Form before proceedin wilh ~his assessment. 5 ADDISON J. BURKE,