20150717 Ver 2_Signed page 10_20170508

u. Endangered Species and Designated Critical Habitat, (Corps Requirement)
5a. Will thls project occur in or , .ear an area witFi t.aeraliy prQtv.ttcd 3pet 63 or
❑ res Q no
RaOitat r
5b. Have you checked with the I ISFWS concerning Endangered Species Act
Yes ❑ Ro
impae[�r
ac. Ir yes, intlicate !Re 05Pvv5 Pielu voice you Have contacte0.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Fl..6itarf
135FW3 Information, Planning, alfa Conservation System IIPZI interactive wemite anO 1Re RC Natural Reritage Prouram (IECMRP) Natural Reritaye
VataEase search Interactive website. Amec Poster vvReeler 30 not luenilty any leaerady iistO species'uuring the site evaluations in April 2015.
5. Essential Fish Habitat (Corps Royuiromant)
6a. will alis project occur In or near an area aeslgnate0 as essendal nsR na0itatr ❑ res 91 no
00. WRat data sources did you use to determine whether your site would impact Essential Fish Habitat?
I Umm Rational Marine Fisheries Service - online Interactive software 'I•ssentlal PiSR Rabltat IOlapper v3.0'.
r. RIstorlc or PreMistORC Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the slate, federal or tribal
governments Rave designatet7 as having nistoric or cunurat preservation
❑ t as 0 No
status (e.y., National Historic Trust designation or properties significant in
AoFIM C-.vlirf. nlsto;y aha W)-f
►a. vvRat aata sources Oia you use to Determine wRetiler your site woul'u impact Ristoric or archeological resources?
IAC Dept at Cultural resources, state Historic Preservation Office I5RrOf Interactive wellsite IRP'uvvES1.
a. rlooa cone Destgnailon t%orps Requlremeng
aa. Will this project occur in a FEMA-designated 100-year floodplain?
❑ Yes ® No
85. It pas, ..plain nor. pro;oot ,.,emits Ft_MA reyuirerm.n(3:
sc. wflat source(s) u0 you use to mage the noo0pialn Oetermination r
A graphic exhibit of the . 00-year floodplain for the proicct vie' in ty 13 a;.achaa. Sam.: FEMA FIRM map numbers 37107989001, 3710799900J, Ona
3710709000J, dated July 3, 2007.
'51C t.+n
Appliv.muxgemes t-rinte0 name
pplicant/Agenfs Signature
uate
Im-genCs signature is valid only if an authorization
letter from the applicant Is rovideu.
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