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Home My WebLink About20170461 Ver 1_permit_application_package_20170418STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION ROY COOPER GDVERNOR April 18, 2017 Mr. Steve Kichefski Asheville Regulatory Field Office US Army Corp of Engineers 15 i Patton Avenue Asheville, NC 28801-5006 JAMES H. TROGDON, III SECRETARY SUBJECT: Bridge #212 Replacement on SR 1$92 (Jennings Road), Iredell County Dear Mr. Kichefski: The North Carolina Department of Transportation requests authorization to replace an existing 3- span, 120-foot long x 26-foot wide concrete and timber bridge with a 3-span, 130-ft long x 33-ft wide concrete bridge on SR 1892 (Jennings Road) in Gaston County. NCDOT proposes to place a total of 43 feet of rip rap for bank stabiiization under Bridge #212, with an additional lb feet of bank stabilization at the end of a riprap ditchline. The scope of work will result in a total af 59 feet of permanent impacts to Patterson Creek, which is classified as Class C waters by the Division of Water Resources. The Division 12 Environmental Office conducted a threatened/endangered species survey on September 20, 2015 for Bridge #212 and surroundi.ng areas. The federally listed species for Iredell County ([TSFWS listed da�e July 24, 2015) is the dwarf=flowered heartleaf (Hexasrylis naniflora)-T, the bag turtle (Glypterrays muhlenbergaa)-T/SA, and the Northern Long-Eared Bat (Myotis septentrionalis)- E. Natural Heritage Program records dacument the nearest dwarf- flowered heartleaf location approximately 11.5 miles southwest of the proposed proj ect area. The heartleaf is usually found on dry to moist ravine slopes {usually north facing and of the oak- hickory-pine forest type) and in boggy areas near springheads. There did not appear to be suitable habitat within the proposed project area and no species were observed. No impact on this species is anticipated. The Natural Heritage Program records document the nearest bog turtle occiurence approximately 5.0 miles west of the project area. Bag turtle habitat consists of open, gronndwater supplied (spring fed}, wetlands alang riparian corridors or an seepage slopes.. Species listed as threatened due to similarity of appearance da not require Section 7 cvnsultation with the USFWS. However, there is no suitable bog turtle habitat present wit�in the study area; therefore, there will no impact on this species. The Natural Heritage Pragram records document the nearest Northern Long Eared Bat location approximately 40 miles northwest of the proposed project area. During summer, northern lang-eared bats roost singly or in colonies undezxieath bark, in cavities, or in crevices of both live and dead trees. They may also roost in cooler places, like ca�es and mines. Tree species may be used based on suitability to retain bark or pzovide cavities or crevices. It has also been found, rarely, roosting in structures like barns and sheds. Northern long-eared bats spend winter hibernating in humid caves and mines. The closest listed B�idge #212, Jennings Road April 18, 2017 Page 2 underground mine, per 1Vt1Y database, is the Ylyler Chormite mine, located approximately 4.0 miles so�theast of the project site. There are currently no l�own hibemaculum or maternity roost trees in Division 12 counties for NLEB; therefore, tlie bridge replacement and any associated minor tree clearing would be exempted from the incidental take under the 4{d) Rule. I have attached a copy of the NLEB streamlined consultation form. A bat (NLEB) habitat assessment was also done on Bridge #212 (see attached form). Per guidance from USFWS personnel, concurrence is granted by citing the following website and a 30 day response period is waived. http:l/www.iws.�ov/asheville/htmis/project_review/NLEB_in WNC.html There are no sites listed on the National Register of Historic Places are located in the vicinity of the project nor did there appear to be any eligible struc�ures. The project has been reviewed by NCDOT's cultura� resources staff {NCDOT Cultural Resources Review — Internal Tracking No. 14-OS-0006). T�e project area is not located within 1/z xnile of any critical watershed area. SR 1892 is not a rural or urban arterial; therefore, hazardous spill basins are not required. Enclosed is the hazardous spiil basin checklist. I have enclosed a pre-construction notification for a NW#3, plan sheets, and location maps relative to the proj ect. Project information for the 401 Automated Payment Procedure is as follows: • Work order number: 150�75-55120005-17BP.12.R.49-3372 + TIP#: NA � Project Category: $2�0.00 Fee If you have any questions or concerns please feel free ta contact me at (704) 480-9044. T�ank you for your time and consideration on this matter. Sincerely, Mark Stafford, P.E. Division Engineer Twelfth Division BY: � Trish Beam Division 12 Enviranmental5upervisor Enclasures _� o�,QF WAr�RQG Ofice l�se Only: * � � Corps action ID no. �� M�' � o Y DWQ project no. Form Ver�ion 1.3 Dec 10 2008 Pre-Construction Not��cation (PC Form A. Anolicant Information 1. Processing 1 a. Type(s) of approval sought from the Corps: � Section 404 Permit ❑ Section 10 Permit 1 b. 5pecify Nationwide Perrnit (NWP) number: 3 ar General Permit (GP} number: 1c. Has the IVWP or GP number been verified by the Corps? ❑ Yes � No 1 d. Type(s) of appro�al sought from the DWQ (check all that appfy): � 401 Water Quality Certification — Regular ❑ I�on-404 Jurisdictional General Permit ❑ 4D1 Water Quality Certifcation — Express ❑ Riparian Buffer Authorization 1 e. Is this notification solely for the record For the record only for DWQ 409 For the record only for Corps Permit� because written a�pra�al is not required? Certificativn: ❑ Yes � No � Yes ❑ No 1f. Is payment into a mitigation bank or in-lieu fee program proposed for mifigatian � Yes of impacts? If so, attach the aceeptance letter from mitigation bank or in-lieu fee program. 1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes below. 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? I❑ Yes 2. Project Information T 2a. Name of project: 2b. County: 2c. Nearest municipa[ity 1 town: 2d. Subdi�ision name: 2e. NCDOT only, T.I.P. ar state project no: 3. Owner lnformation 3a. Name(s) on Recorded Deed: 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if 3d. Street address: 3e. City, state, zip: 3f. Telephone no.: 3g. �ax no.: 3h. Email address: Bridge #212, SR 1892 (Jennings Road) Iredell Olin l7BP.12.R.49 NC DOT Right of Way ►/ . ►1 . ►/ . Page 1 of 11 PCN Form — Version 1.3 December 10, 20d8 Version 4. Applicant Information (if difFerent fram ownerj 4a. Appli�ant is: ❑ Agent ❑ Other, specify: 4b. Name: Mark Stafford 4c. Business name N.C. Department of Transportation, Division 12 (if applicable): 4d. Street address: 1710 East Mar�on Street � 4e. City, state, zip: Shelby, NC 28151 4f. Telephone no.: 7Q4-48Q-9020 4g. Fax no.: 7�4-480-5401 4h. Email address: mstafford@ncdot.gov 5. AgentlConsultant Information (if applicable) 5a. Name: Trish Beam 5b. Business name N.C. Department of Transportatian, Di�ision 12 {if applicable): 5c. Street address: 1710 East Marian Street 5d. City, state, zip: Shelby, NC 28151 5e. Telephone no.: 704-48D-9044 5f. Fax no.: 704-480-5401 5g. �mail address: pdbeam@ncdotgo� Page 2 of 11 PCN Farm — Version 1.3 Decernber 1 D, 20Q8 Version B. Project Information and Prior Project History 1. Property Identification 4a. Property identification no. (tax PIN or parcei ID): NA 4h. Site coordinates {in decimal degrees): Latitude: 35.926'�3 Longitude: - 80.86355 (D�.DDDDDD) (-DD.DDdDDD) �'f c. Property size: 0.2 acres i 2. Surface Waters 2a. Name of nearest body of water (stream, river, etc.) to Patterson Creek proposed project: 2b. Water Quality Classification of nearest recei�ing water: C 2c. Ri�er basin: Yadkin 3. Project Description 3a. Describe the existing conditions on the site and the general land use in the �icinity of the project at the time of this application: Existing 3-span 120-foot bridge on paved secondary road. Land use around project site is rural farmland. 3b. Lisi the total estirx�ated acreage of all existing wetlands on the property: 0 3c. List the total estimated linear feet af a[I existing streams (intermittent and perennial) on the property: 200 feet 3d. Explain the purpose of the proposed project: The purpose of the proposed work is to replace the deteriorating bridge for the safety of the travelling public. 3e. Describe the o�erall project in detail, including the type of equipment to be used: The North Carolina Department of Transportation requests authorization to replace an existing 3-span, 120-foot long X 26-foot wide concrete and timber bridge with a 3-span, 130-ft long x 33 ft wide concrete bridge on SR 1892 (Jennings Road} in Iredefl County. NCDOT proposes to place a total of 59 feet of rip rap ior bank stabilization and ditchli�e stabil9zatian under Bridge #17fi. All Best Management Practices will be utilized d�ring the course of the project. The Project will be constructed using typica� heavy equipment (trackhae, backhoe, etc.) 4. Jurisdictional Determinatians 4a. Have jurisdictional wetland or stream determinations by the C�rps or State been requested or obtained for this property 1 project (including all prior phases) in the past? ❑ Yes � No ❑ Unknown Comments: Jurisdictional stream determination made by Division 12 DEO. 4b. If the Corps made the jurisdictional determination, what type � Preliminary ❑ Final � of determination was made? ;4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: , Name {if known): Other: 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. 5. Project History 5a. Ha�e permits or certifications been requested or obtained for � Yes � No ❑ Unknown this project (iRcluding afl prior phases) in the past? � 5b. If yes, explain in detail according to "help file" instn.Ections. Page 3 of 11 PCN Form — Version 1.3 December 10, 2008 Version 6, Future Project Plans 6a. Is this a phased project? ❑ Yes � No 6b. If yes, explain. Page 4 of 11 PCN Form — Version 1.3 December '!0, 20Q8 Version C. Pfoposed Impacts inventory 1. Impacts Summary 1 a. Whicte sections were compieted below �or your project (check all that apply): ❑ Wetlands � Streams - tributaries ❑ Buffers ❑ Dpen Waters ❑ Pond Construction 2. Wetland Impacks �f there are wetland impacts proposed on the site, then complete this question for each wetland area irnpacted. 2a. 2b. 2c. 2d. 2e. 2f. Wetland impact Type of jurisdiction number — Type of impact Type of wetland Forested {Corps - 404, 10 Area of impact Permanent (P) or (if known) DWQ — non-4D4, ather) {acre5) Temporarv (T) W'� ❑P❑T W2 ❑P❑T W3 ❑P❑T W4 ❑P❑T W5 ❑P�T W6 ❑P�]T ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Corps ❑ DWQ ❑ Corps ❑ DWQ ❑ Corps ❑ DWQ ❑ Corps ❑ OW Q ❑ Corps ❑ �WQ ❑ Corps ❑ DWQ 2g. Total wetland impacts � 2h. Comments: 3. Stream Impacts If there are perennia{ or intermittent stream impacts {i�cludir�g temporary impacts) proposed on the site, then complete this question for all stream s�tes impacted. 3a. 3b. 3c. 3d. 3e. 3f. 3g. Stream impact Type of impact Stream name Perennial Type ofjurisdiction Average Impact number - (PER) or (Corps - 4d4, 10 strearn length Perrrtanent (P) or intermittent DWQ — non-404, width (linear Temparary (T) ([NT)? other) {feet) �eet) S1 �P❑T S2 �P❑T S3 ❑POT S4 ❑P❑T S5 ❑P❑T 56 ❑P❑T Rip rap bank stabilization under Ditchline bank stabilization 3h. Total stream �nd tributary impacts 3i. Commenks: Patterson Creek Patterson Creek � PER ❑ INT � PER ❑ INT ❑ PER ❑ INT ❑ PER ❑ I�T ❑ PER ❑ INT ❑ PER ❑ INS � Corps � DWQ � Corps � DWQ ❑ Corps ❑ DWQ ❑ Corps ❑ DWQ ❑ Corps ❑ DWQ ❑ Corps ❑ DWQ 25 43 25 16 Page 5 of 11 PCN Form — Version 1.3 December 10, 2008 Uersion 59 4. Open Water Impacts � If there are proposed impacts to lakes, ponds, eskuaries, tributaries, sounds, the Atlantic Ocean, or any o#her operi water of E the U.S. khen indi�idually list all open water impacts below. ; 4a. 4b. 4c. 4d. 4e. � Open water Name of waterbody impact number-- (if applicable) Type of impact Waterbody type Area of impact (acres) � Pe�manent (P} or � Tem ora T � 01 ❑P❑T 02 ❑P❑T � 03 ❑P❑T E 04 ❑P❑T I � 4f. Total open w�ter impacts � 4g. Comments: ; 5. Pond or Lake Construction ' If ond or lake construction ro osed, then cam lete the chart below. , 5a. 5b. 5c. 5d. 5e. Wetland Impacts (acres) Stream Impacts (feet} Upland Pond ID Proposed use or purpose (acres) number of pond Floaded Fi3leci Excavated Flooded Filled Exca�ated Flaoded P1 P2 Sf. Total 5g. Comments: 5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permi# ID no: 5i. Expected pond surface area (acres}: 5j. Size of pond watershed {acres): 5k. Method af construction: 6. Buffer Impacts (for DWQ) If project will impact a protected riparia� buffer, then eomplete the chart below. if yes, then individually list all buffer impacts below. If any impacts require miti ation, then ou MUST fiil aut Section D of this form. 6a. ❑ Neuse ❑ Tar-Pamlico ❑ Other: Project is in which protecked basin? ❑ Catawba ❑ Randleman 6b. 6c. 6d. 6e. 6f. 6g. Buffer impact number— Reason Buffer Zone 1 impact Zone 2 impact Permanent {P) or for Stream name mitigation {sc{uare feet) (square feet) 7em ora T im act re uired? B1 ❑P❑T ❑Yes ❑ No B2 ❑ P ❑ T ❑ Yes ❑ Na B3 ❑P❑T ❑�os I 6h. TotaE buffer impacts 6i. Comments: Page 6 of 11 PCN Form — Version 1.3 December 10, 2008 Version D. Impact Justification and Mitigation 1. A�oidar�ce and Minimization 1a. Specifically describe measures taken to a�oid or minimize the proposed impacts in designing project. Bridge being replaced with bridge, no bridge supports in water. iVo direct discharge to stream from bridge. Proposed alignment same as existing alignment. 5houlder slopes maximized at 7 feet to promote infiltration from roadway runoff. Stormwater runoff directed to riprap energy dissipation prior to entering stream. Riprap bank stabilization unrSer new bridge to reduce bank erosion. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacks through construction tec�niquas. 2. Compensatory MiEigation for Impacts to Waters of the U.S. or Waters of the State 2a. boes the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State? 2b. Tf yes, mitigation is required by (check all that apply): 2c. If yes, which mitigation opkior� will ba used for this project? 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) 3c. Comments: 4. Complete if Making a Payment to In-lieu Fee Program 4a. Approval IetEer frorn in-lieu fee program 9s attached. 4b. Stream mitigation requested: 4c. If using stream rnitigation, stream temperature: 4d. Buffer mitigation requested (DWQ only): 4e. Riparian wetland mitig�tion requested: ❑ Yes � No ❑ DWQ ❑ Corps ❑ Mitigakion bank ❑ Payment to in-lieu fee program ❑ Permittee Responsible Mitigation Type Quantity ❑ Yes linear feet ❑ warm ❑ caol square feet acres 4f. Non-riparian wetland mitigation requested: 4g. Coastal (tidal) wetland mitigation requested: 4h. Comments: 5. Complete if Using a Permittee Responsible Mitigat9on �lan acres acres ❑cold 5a. If using a permitkee responsible mitigation plan, pro�ide a description of the proposed mitigation plan. Page 7 of 11 PCN Form — Version 1.3 December 1fl, 2008 Version 6, Buffer Mitigation (State Regulated Riparian BufFer Rules} — required by DWQ 6a. Will the project result in an impact within a protected riparian buffer that requires ❑ Yes � No huffer mitigatian? 6b. If yes, then identify khe square feet of impact to each zone of ihe riparian buffer that requires mitigatian. Calcuiate the amount of mitigation required. 6c. Sd. 6e. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) {square feet) Zone 1 3(2 for Catawba) Zone 2 1.5 Bf. Total bufFer mitigation required: 6g. If buffer rnitigation is required, discuss what type of mitigation is proposed (e.g., payment ta pri�ate mitigation bank, permittee responsible riparian buffer restaration, payment into an appro�ed in-lieu fee fund). 6h. Comments: Page 8 of 11 PCN Form — Version 1.3 December 10, 2008 Version E. Stormwater Management and Diffuse Flow Plan (required by DWQ} 1. �iffuse Flow Plan 1a. Does the project include or is it ad3acent to protected riparian buffers identified � Yes � No with�n one of the NC Ripar�an Buffer Protection Rules? 1 b. If yes, then is a diffuse flow plan included? If no, explain why. ❑ Yes ❑ No Comments: 2. Stormwater Mana ement Plan Existing bridge is 26 ft wide New bridge will be 33 ft wide; 2a. What is the overall percent impervfousness of this project? therefore increase in impervious surface width is 27 % 2b. Does this project require a 5tormwater Managemenk Plan? � Yes ❑ No 2c. If this project DOES NOT require a Stormwater Management Plan, ex�lain why: 2d. If this project DOES require a 5tormwater Management Plan, then provide a brief, r�arrative description of the plan: See attached SMP spreadsheet documentation ❑ Certified Local Government 2e. Who will be responsible for the re�iew of the Stormwater Management Plan? ❑ DWQ Starmwater Program � DWQ 4Q1 Unit 3. Certifieci Local Government Stormwater Review 3a. In which local government's jurisdiction is this project? NA ❑ Phase II 3b. Which of the following locafly-implemented stormwater managernent programs ❑ NSW apply {check all that apply): ❑ USMP ❑ Water Supply Watershed ❑ Other: 3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? ' � 4. DWQ Stormwater Pro ram Re�iew ❑ Coastal counties ❑ HQW 4a. Which of the following state-implemer�ted stormwater managemenk programs apply j� ORW {check aIl t�at apply): �❑ 5ession Law 2006-246 ❑ Other: 4b. Has the approved Stormwater Management Pian with proof of appro�al been attached? � ❑ Yes ❑ No 5. DWQ 401 Unit Starmwater Review 5a. Does the Stormwater Management Plan meet the appropriate requirements? � Yes ❑ No 5b. Ha�e all of the 401 Unit submittal requlrements been met? �� Yes ❑ No Page 9 of 11 PCN Form — Version 'f .3 December 10, 2008 Version F. Supplementary Information 1. En�ironmental Documentatian (DWQ Requirement) 1a. Does the project involve an expenditure of public (federallstakellocal) funds or the use of public {federallstate) land? 1 b. If you answered "yes° to the above, does khe project require preparakion of an environmental document pursuani to the requirements of the Naiionai or 5tate (North Carolina) Environmental Policy Act (NEPA/SEPA)? � Yes ❑ No ❑ Yes � No 1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing Ho�se? {If so, attach a copy of the NEPA or SEPA final approval letter.) ❑ Yes Comments: 2. Vio{ations (DWQ Requirement� ❑ No � 2a. Is the site in violation of DWQ Wetland R�les {15A NCAC 2H .0500), Isolated 4 Wetland Rules (15A �CAC 2H .1300), DWQ SurFace Water or Wetland Standards, ❑ Yes � No i or Riparian Buffer Rules {15A NCAC 2B .02Q0)? 2b. Is this an after-the-fact permit application? ❑ Yes � No 2c. If yau answered "yes" to one or boih of the abo�e questions, pro�ide an explanation of the violation(s): 3. Cumulative lmpacts (DWQ Requirement) 3a. Will this project (based on past and reasonably anticipated fiuture impacts) result in � Yes � No additional development, which could impact nearby downstfeam water quality? 3b. ff you answered "yes" to the abo►re, submit a qualitative or quantitati�e cumulative impact analysis in accordance with the most recent DWQ policy. If you answerecf "no,A pro�ide a short narrati�e description. The project is a minimum criteria project which has low potential far cumulatE�elindirect impacts and will not result in additiona! development which could impact water quality. 4. Sewage Disposal (DWQ Requirement} 4a. Clearly detail the ultimate treatment methods and disposition {non-discharge or discharge) of wastewater generated from the proposed project, or available capacity of the subject facility. No wastewater generated form proejct. Page 10 of 11 PCN Form — Version 1.3 December 10, 2008 Version 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or habitat? 5b. Ha�e you checked with the USFWS concerning Endangered Species Act impacts? 5c. !f yes, indicate the USFWS Fiefd OfFice you have contacted. ❑ Yes � No � Yes ❑ No ❑ Raleigh � Asheville 5d. What data sources did you use to determine whether your site wou[d impact Endangered Species or Designated Critical Habitat? NC Natural Heritage Program database and on-site surveys. 6. Essential Fish Habitat (Corps Requirement) 6a. WiIE this project occur in or near an area designated as essenkial fish habitat? �❑ Yes 6b. What data sources did you use to determine whether your site would impact �ssential Fish Habitat? No salt marshes, oyster reefs, or seagrass beds located in �icinity of praject. 7. Historic or Prehistoric Cultural Resources {Corps Requirement) 7a. Wili this projeck occur in or near an area that the state, federal or tribal go�ernments have designated as ha�ing historic or cu[tural preservation sta#us (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeolagy)? ❑ Yes ►/ . ►1 . 7b. What data sources did you use to determine whether your site wouEd impact historic or archeological resources? Culturaf Resources review. Tracking number (14-05-0006}. 8. Flood Zone Qesignation (Corps Requirement) Sa. Will this projeck accur in a FEMA�lesignated 1Q0-year floodplain? �� Yes ❑ No 8b. If yes, explain how project meets FEMA requirements: NCD07 Hydraulics coordination with FEMA 8c. What source(s) did you use to make the floadplain determination? NC Floodplain Mapping Program http:llfris.nc.gov/fris/lndex.aspx?FI�S=097&ST=NC&user=General%20Public �� 5�� ApplicanklAgent's Printed Name /� -%�'l�% � � � ApplicantlAgen s ignature Date {AgenYs signature is �alid only if an authorization letterfrom the applicant is oro�ided.) Page11of11 PCN Form — Version 1.3 December 10, 2008 Versian Bridge #212 Replacemen� Jennings Road (SR 1 S92} Iredell County Uicinity Map N 0 0.1250.25 0.5 MiEes I� i i I i� i I i�i . .V�4 Y ` � ��- � �.-.� ��. �" � � �'"'� . � ,�, ,�� .� �,�.�� ti f �4 � t �c�..-'� y. 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CouMy, North Cerolina [NC087j Map UnR Symbol Map Unn Name Aeres m Apl Pe�ce�rt of AOI $sq u Codo�us loam, 0 to 2 percelrt 1.2 51.0% slopes, frequently Iloadad RxB Ronda-0omus camplex, 0 to 5 0.9 37.995 percenl alopes, accasionaUyr ftooded W Watar 0.3 11.196 Totala far Area of Irkerest 2.4 10�.095 �Naturel Reaources Weh Sall Survey 3l772U17 Comaervation 8ervica N�lfanal Goopera4+re Soil Survey Page 3 af 3 Northern Lon�-Eared Bat 4(d) Rule Streamlined Consultation Form Federal agencies should use this form for ihe optional streamlined consultatian framework for the nortbern long- eared bat (�TLEB}. This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's (USFWS) January 5, 2016, intra-Service Programmatic Biological Opinion {BO) on the final4{d) rule for the NLEB for section 7(a}(2) compliance by: (1) notifying the USFWS that an action agency will use the streamlined framework; (2) describing the project with sufficient detail to support the required deternunation; and (3) enabling the USFWS to track effects and determine if reinitiation of consultatian is required per 50 CFR 4Q2.16. This form is not necessary if an agency determines that a proposed action will have no effect to the NLEB or if the USFWS has concurred in writing with an agez�cy's determination that a proposed action may affect, hut is nat likely to adversely affect tk�e NLEB {i.e., the standard informal consultation process}. Actions that may cause prohibited incidental take require separate formal consultation. Providing this information does not address section 7(a){2) compiiance for any other listed species. Information to Determine 4(d) Rule Com liance: YES NO 1. Does the project occur wholly outside of ihe WNS Zone�? ❑ � 2. Have you contacted tbe appropriate agencyz to deternune if your project is near � ❑ l�own hibemacula or maternity roast trees? 3. Could the project dishub hibernating NLEBs in a known hibernaculum? ❑ � 4. Could the project alter the entrance or interior envimnment of a lmown ❑ � hiber�naculum? 5. Does the project remove any trees within 0.25 miles of a l�own hibemaculum at ❑ � any time of ear? 6. Would the project cut or destroy known occupiad matemity roost trees, or any ❑ � other trees within a 150-foot radius fronn the maternity roost tree from June 1 through July 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� (Name, Email, Phone No.): NCDOT, Division 12, Trish Beam, �dbeam(a7ncdot.gov, 744-�480-9044 Pxoject Name: Bridge #212 replacement, SR 1892 (Jennings Road), Iredell County Praject Location (include Coordinates if known): 35.926144, -80.863529 Basic Praject Description (provide narrative below or attach additional information): Replacement of timber deck bridge with concrete bridge in same location. 1 http://www.fws.govlmidwesdendangeredlmammals/nleblpdf/WNSZone.pdf Z See http://www.fws.govlmidwest/endangered/maminals/nlebinhisites.htrnl 3 If applicable - only needed �or federal actions with applicants (e.g., for a permit, etc.) who are party to the consultation. General Pro'ect �nformation 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, repart acreage below) Estimated total acres of forest conversion If known, estimated acres5 of forest conversion from April 1 to October 31 If known. estimated acres of forest conversion from June 1 to Julv 316 Does the project include timber harvest? {if yes, report acreage below} Estimated total acres of tiinber harvest If known, estirnated acres of timber harvest from April 1 to October 31 If �own, estimated acres of timber harvest from June 1 to JuI 31 Does the project include prescribed fire? (if yes, report acreage below) Estimated total acres of prescribed fire _ If l�own, estimated acres of prescribed fire from A ri11 to �ctober 31 If l�own, estimated acres o��resc�ribed fire from June 1 to Julv 31 Does the project install new vvind turbines? (if yes, report capacity in MW below) Estimated wind canacitv (MW� A enc Determination: By signing this form, the action agency determines that this project may affect the NLEB, but that any resulting incidental take of the NLEB is not prohihited by the fina14(d) rule. If the USFWS does not respond within 30 days from submittal of this form, the action agency may presuxne 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 thraugla the USFWS January 5, 201 b, Programinatic BO. The action agency will update this de�e�mination annually for multi-year activities. The action agency understands that the USFWS presumes that all activifies are implemented as described herein. The actian agency will promptly report any departures from the described activities to the appropriate USFWS Field D�fice. The action agency will provide the appropriate US�'WS Field Office with the results of any surveys condueted for the NLEB. Involved parties wi11 promptly notify th� appropriate USFWS Field �ffice upon finding a dead, injurad, or sick NLEB. Signature: Date Submitted: � _� � � 4 Any activity that temporarily or permanently removes suitable foz�ested habitat, izicluding, but not limited to, tree removal from development, energy production and transmission, mining, agriculture, ete. (see page 4$ of the BO). 5 If the project removes less than 10 trees and the acreage is nnlmown, report the acreage as less than 0.1 acre. 6 If the activity includes tr�e clearing in June and Ju�y, also include those acreage in April to October. � - �� ss�ss��: �or� IVCD{�T B�idges Observers: �� -�i✓ T1P or DOT praject number: .__ f��f� I?./� ;�y Date/Time: C1/� �b,�a�,a, RoadNameJSRNumber: '�,i� IfA 5",('1�`i� ��. ,._.. . County: ��v.y,.�� Bridge Number, � ,�r Waterbady: (�r.r.�'�i'�� G��.,i,�_ 9'o Surraunding habitat w/in 1 mi. of praject foDtprint (approx) Urbar�/commercial �. �faturalJrural,� � Any irees >3 DBH within project footprint? yes Any shaggy trees or snags >5" DBFi? yes If yes to shag/snag, how much sunlight da they recei�e during the day? ��' �f yes to shag/snag, 4ist species csf habitat firees >5" dhh. if snags >5"DBH are present in sunlit areas, provide phatos and lacation. if large holiow trees are present, pravide phntos ar�d locaxian. SuburbanJresidential � Agricultural /� no na �-3 hours 4-6 hours 7+ hours Presence of: In �aroject fQvt rint lr� vicinty (0.5 mij Caves yes yes � Abandoned mine� yes o yes o� lf'yes' ta any of the ahove, pro�'sde �hotos, descriptian, anc! �ocatior�. Majar water source in project footprint: river tream/cree pand ialce 5u�table drinking hab�tat in the form of nor�-stagnant, smac�th or slack water? es no Guard rails none on�rete timbet� Deck type co eta timber Beam type none concrete � End/back walk ty�e oncr t9rr�ber masonry Creasote evidence 5hafiow vertical top sealed crevices ('h -1%" wide, 4-12" deep) peep uertical unsealed crevices (%z -1�" wide, 12+" deepj Max height af bridge deck above ground/water (ftj: Night roost habitat protec#eci i� no Bridge alignment: E/1N NW/SE �kours of sun exposure to pridge 4-1 2-3 �� Human disturban�e under hridge 'igh lo�ni non Emergence count �erfarmed7 (If yes, campEete form next pagej yes Evidence af bat� using bird nests, if pr�sent? yes Evidence af bats us9ng bridge? (pt�otos needed) yes Bat species present: Additianal Comments: swamp metal apen grid t9mber � p��+�s �a es no yes nQ N E/5W rro 0 NCQ4T Bat Brldge Habitat Assessment Fc llpdated 3/ig, NCDOT HAZARDOUS SPILL BASIN CHE�KLIST Division: 1 � County: Tr�jell Project ID:17BP.12.R.49 River Basin: Yadkin Pee-Dee Bridge No: 212 Route: SR 1892 (Jennin s� Road� Water 4uality Criteria: S�ream: Patterson Creek Stream Crossing Blue Line On USGS oxw wsz WS II,III OR N, Crossing Within 0.5mi of W.S. Critical Area Roadwav Criteria: Route Designation- Arterial Urban Arterial Rural Additional Site Information: Is a Hazardous Spill Basin Required? Yes No Yes No �'" r Criteria Ba�ed Upon NCDOT "Best Management Practices for the Protection of Surface Waters" (March, 1997). Yes No r r r r r- r � �