20181652 Ver 1_signed_NLEB_consultation_form_20181205

Northern Lon��Eared Bat 4(d) Rule Streamlined Consultaiion Form
Federal agencies should use this form for the opkional strearnlined consultation framework for the northern long-
eared bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Witdlife Service's
(USFWS) January 5, 2016, intra-Service Programmatic Biological4pinion (BQ) on the fina14{d) rule for the
NLEB for secfion 7(a)(2) compliance by: (�) notifying the USFWS that an action agency will use the streamlined
framework; (2} describing the project with sufficient detail to support the required determination; a.nd {3} enabJ.ing
the USFWS to trac�C effects and determine if reiniixation of consulta�ion is required per 50 CFR 402.16.
This form is not necessary if an agency determines that a proposed action will have no effect to the N�EB ar if
the USFWS has concurred in writing with an agency's deternunation that a proposed action may affect, but is not
likely to adversely affect the NLEB (i.e., the standard informal consultation process}. Actions that may cause
prohibited incidental take require separate formal consulta�ion. Providing this information does not address
section 7(a)(2) comp�iance for any other listed species.
Information to Determine 4 d Rule Com liance: YES NO
1. Does the project occur wholly outside of the WNS Zone'? ❑ �
2. Have you contacted the appropriate agency2 to determine if your project is near � ❑
known lubernacula or maternit roost trees?
3. Could the project disturb hibernating NLEBs in a l�own hibernaculum? ❑ �
4. Could the proj ect alter the entrance or interiar environment of a knovcm ❑ �
hibernaculum?
5. Daes the project remove any trees within Q.25 miles of a known hibernaculum at ❑ �
an time of ear?
6. Wou1d the project cut ar destroy laiown occupied maternity roost trees, or any ❑ �
other trees within a 150-foot radius from the maternity roost tree frorn 7une 1
throu 3u1 31.
You are eligible to use this form if you have answered yes to question #1 or yes to question #2 and no to
questions 3, 4, 5 and 6. The remainder of the form will be used by the USFWS to track our assumptions in the
BO.
Agency and Applicant� (Naine, Ernail, Phone Na.}: NCDOT, Division 12, Trish Beam,
pdbeam(a�,ncdot.�ov, 704-480-9044
Project Name: Bridge #309 replacement, SR 1627 (Pruett Road), Cleveland County
Project Loeation (include coordinates if lasown}:
Basic Project Description (provide narrative below or attach additional information): Replacement of
timber deck bridge with concrete bridge on same location.
1 http://www.fws.govlmidwestlendangeredlmaminals/nleb/pdf/V��1�TSZone.pdf
z See http://www.fws.govlmidwest/endangered/mammals/nleb/nhisites.html
' If applicable - only needed for federal actions with applicants (e:g., for a permit, etc.} who are party to khe consultation.

Gener�l Pro'ect Information YES NO
Does the project occur within 0,25 miles of a known hibernaculum? ❑ �
Does the project occur within 150 feet of a known maternity roost tree? ❑ �
Does the project include forest conversion4? {if yes, report acreage below} ❑ �
Estimated total acres of forest conversion
If laiown estimated acress of forest conversion from A rii I to October 31
If known estimated acres of farest conversion from June 1 to Jul 316
Does ttxe project include tixnber harvest? {if yes, report acreage below) ❑ �
Estimated total acres of timber harvest
If l�own, esEimated acres of timber harvest from A ril 1 to October 31
If known estirnated a.cres of timber harvest from 7une 1 to Jul 31
Does the project include prescribed fire? (if yes, report acreage below) ❑ �
Estimated total acres of esc�ibed fire
If known estimated acres of rescribed fire from A ril I to October 31
If known, estimated acres of rescribed fire from June 1 to Jul 31
Does the project install new wind turbines? (if yes, report capacity in MW below} ❑ �
Estirnated wind ca aci MW
A�ency DeteTTnination:
By sigilinng this form, the action agency determines that this project may affect the NLEB, but that any
resulting incidental take of the NLEB is not prohibited by the fma14{d) rule.
If the USFWS does not respand within 30 days from submittal of this forni, the action agency may
presume that its determination is informed by the best available information and that its project
responsibilities under 7{a)(2) with respect to the NLEB are fulfilled through the USFWS January 5,
2016, Programmatic BO. The action agency will update this determination annually for multi-year
activities.
The action agency understands that the USFWS presumes that alt activities are implemented as
described herein. The action agency will promptly report any departures from the described activities to
the appropriate USFWS Field O�fice. The action agency will provide the appropriate USFWS Field
Office with the results of any surveys conducted for the NLEB. Tnvolved parties will prompt�y notify the
appropriate USFWS Field �ffice upon findir�g a ctead, injured, or sick NLEB.
Signature:
Date Submitted: !� �- 5 ���
4 Any activity that ternporarily or permanently rernoves suitable forested habitat, including, but not limited to, tree removal
from development, energy �roduction and transmission, mining, agriculture, eta (see page 48 of the BO).
5 If the proj ect removes less than 10 trees and the acreage is unknown, report the acreage as less than Q.1 acre.
6 If the acNvity includes tree cIearing in 7une and 7uly, also include those acreage in April to October.