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Home My WebLink About20170723 Ver 1_CHEC_SUPpkgs_20170607Booth�Associates, LL� engineering for the future since 1960 4/4/ 17 David Hallac Superintendent Cape Hatteras National Seashore 1401 National Park Drive Manteo, North Carolina 27954 Via Electronic Mail Subject: Request for Special Use Permit for Construction Activities To Install Underground Electric Utility as part of NCDOT TIl' Project B-2500 (Phase I), Dare County, North Carolina Dear Mr. Hallac: In response to the North Carolina Department of Highways (NCDOT) Project TIP B- 2500, Cape Hatteras Electric Cooperative (CHEC) is required to relocate its existing underground transmission power line to facilitate its realignment with the new bridge. CHEC proposes to replace its existing with a new line all within its existing right-of-way and within the right-of-way easement granted by the National Park Service (NPS) to the NCDOT for the above captioned project. The existing power line is encased in a cement "duct bank", two feet by four feet (2'X4') concert vault, which will be left in place after the new construction with the understanding that it will be removed by CHEC, if at any time it becomes exposed and NPS so requests its removal. The proposed work detailed below comes after consideration of numerous line routes and construction methods. The proposed route avoids as much environmental impact as practicaL Through the course of design, the alignment has been simplified by utilizing NC DOT right-of-way. Conflicts with road access to the nearby fishing center and area wetlands are mitigated as much as practical by utilizing a horizontal directional bore installation method for a portion of the transmission power circuit route. The proposed work is in the vicinity of the Cape Hatteras National Park Service facility at Oregon Inlet, Dare County, North Carolina. The "Proposed Project" consists of constructing the following: l. A ten foot (10') wide temporary access road using removable matting and location approved by the NPS from Oregon Inlet Road to the existing CHEC substation north of Bonner Bridge (approximately 365 feet in length). This road will mitigate impacts to the maintained wetlands to the substation and the matting will be enlarged to between fifteen and thirty feet around the substation to allow large utility vehicles to access the substation during this project The initial phase of construction will include hand clearing (if needed) and matting to support transmission power circuit relocation construction efforts. Mr. David Hallac Apri14, 2017 Page 2 2. Installing a new underground 115kV transmission power circuit consisting of: a. A total of five (5) conduits in duct bank described below — four 6" conduits and one 2" inch conduit b. Approximately 1,225 linear feet of four (4) foot wide and one (1) foot tall concrete duct bank utilizing a high early mix design for faster setting and higher likelihood to close ditch sooner than is typical. c. Approximately 420 linear feet of horizontal directional bore under Oregon Inlet Road to the proposed permanent easement drive near the substation — Total of five (5) conduits — four 6" conduits and one 2" inch conduit. Avoids impact to maintained wetlands in front of the substation. d. One below-grade utility vault — approximately ten (10) feet by twenty (20) feet by six (6) feet tall e. No less than three (3) feet below grade to top of duct bank/vault f. Duct bank to be open-cut trenched the total length of circuit from the new proposed bridge end bent #2 to Oregon Inlet Road Once the new transmission power circuit is installed and commissioned, power shall be transferred off the existing circuit to the new. The existing CHEC duct bank is planned to be abandoned in place, with the understanding that the National Park Service may require its removal at a future date. Proposed Total linear circuit length to be installed within the park is 1,645 lf. Proposed Total temporary matted access road to be installed is +/-490 lf from Oregon Inlet Drive pavement to Substation fence. Proposed Total 404 Wetland Impacts include 0.027 acres (temporary) and 0.153 acres (permanent). Proposed Total CAMA/401 Wetland Disturbance includes 0.000 acres. Per emailed confirmation on September 8, 2016 from Mr. David Hering, LG, PE (NCDOT), any required wetland mitigation resulting from transmission circuit relocation may be covered by the NCDOT B-2500 wetland restoration site. Impacts to park land were minimized in design by relocating the duct bank into the NC DOT right of way, boring under Oregon Inlet Road, and boring under wetlands in front of the substation adjacent to NC 12. Final restoration of impacts within National Park Service property will meet or exceed all requirements required by the National Park Service and all applicable regulatory agencies. Mr. David Hallac April 4, 2017 Page 3 It is our understanding that as soon as the above project is finalized and operational, CHEC will file "as built" drawing of the completed project with the Park, to be included in a comprehensive Permit of Right-of-Way (ROW) document, describing and renewing all of CHEC's active ROW's within the Park, for another term of years, pursuant to its SF-299 application filed with the Park, 12/19/2016. In the ROW application a request will be included to replace the ten (10) foot temporary access road and matted thirty (30) foot areas south and east of the substation with permanent gravel access to the substation for future maintenance. Please feel free to contact our office with any questions. Sincerely, BOOTH & ASSOCIATES, LLC William P. Jordan, PE WPJ/kpp Enclosures cc: Ms. Susan Flythe (CHEC) Mr. George Price (CHEC) 15-6803-9001 National Park Service Outer Banks Group (Cape Hatteras NS, Wright Brothers NM & Ft. Raleigh NHS) 1401 National Park Drive Manteo, NC 27954 Telephone 252-475-9000 Fax 252-473-2595 Application for Special Use Permit General HATIONAL PARK SERVECE -� =-�.=-. Please supply the information requested below. Attach additional sheets, if necessary, to provide required information. A nonrefundable processing fee of $ waived must accompany this application unless the requested use is an exercise of a First Amendment right. You must allow sufficient time for the park to process your request. You will be notified of the status of the application and if approved, the necessary steps to secure your final permit. Your permit may require the payment of cost recovery charges and proof of liability insurance naming the United States of America as also insured. * Do not enter social security number of tax ID number unless you are specifically requested by the Park to do so, and then only one, both are not required. Applicant Name: Mr. George Price, PE Telephone #: 252-995-5616 x236 Organization Name: Cape Hatteras Electric Cooperative Cell phone #: 252-475-0178 Social Security or Tax ID #:* Street/Address: 47109 Light Plant Road City/State/Zip Code: Buxton, NC 27920 Describe proposed activity: Please see attached letter. Fax#: 252-995-4088 Email: GeorgeP@chec.coop Preferred Date Preferred Location S Preferred Time 01/30/2017 to Staging area near substation, trench location along DOT right Weekdays 12/31 /2019 of way to new bridge deck. Cable connection at end bent # 2 6am-8pm Maximum Number of Participants 10 Maximum Number of Vehicles 7 List of equipment, materials and items to be brought to the site: Equipment: Power utility bucket truck, concrete trucks for duct bank, directional boring rig, medium sized support trucks, trench excavator, dewatering equipment (if necessary), cable reel and pulling machine Materials and other items: PVC conduit and underground transmission cable, concrete, wetland matting as approved by NPS, silt fencing, safety fencing & signs, temporary electrical riser structure (within substation), fill material (as necessary) Individual in charge of activity onsite and authorized to make decisions related to the permitted activity if different than listed above (include cell phone number): Have you visited the requested area? �Y ❑N Is this an exercise of a First Amendment rights? ❑Y �N The applicant by his or her signature certifies that all the information given is complete and correct, and that no false or misleading information or false statements have been given. Signature: NPS Form 10-930s New 06/2013 Date: OMB Control No. 1024-0026 Expires O8/31/2016 Note: This is an application only, and does not serve as permission to conduct any special activity in the park. The information provided will be used to determine whether a permit will be issued. Send the completed application along with the application fee in the form of a personal, business, bank check or money order only made payable to "National Park Service" to National Park Service at the Park address found on the top of the first page of this application. If your request is approved, a permit containing applicable terms and conditions will be sent you. For a the permit to be valid, it must be signed by a responsible person and returned to the park or be placed in the US Mail, postage prepaid and addressed to: Superintendent, National Park Service, 1401 National Park Drive, Manteo, NC 27954 Notice to Customers Making Payment by Personal Check: When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. NOTICES Privacy Act Statement: The Privacy Act of 1974 (5 U.S.C. 552a) provides that you be furnished with the following information in connection with information required by this application. This information is being collected to allow the park manager to make a value judgment on whether or not to allow the requested use. Applicants are required to provide their social security or taxpayer identification number for activities subject to collection of fees and charges by the National Park Service (31 U.S.C. 7701). Information from the application may be transferred to appropriate Federal, State, and local agencies, when relevant to civil, criminal or regulatory investigations or prosecutions. Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to provide the park managers the information needed to decide whether or not to allow the requested use. All applicable parts of the form must be completed in order for your request to be considered. You are not required to respond to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number. Estimated Burden Statement: Public reporting burden for this form is estimated to average 15 minutes per response, including the time it takes to read, gather and maintain data, review instructions and complete the form. Direct comments regarding this burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 1849 C Street, NW (1237), Washington, D.C. 20240. Title 18 U.S.C. Section 1001 makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. NPS Form 10-930s New 06/2013 � OMB Control No. 1024-0026 Expires 08/31/2016 Q CATEGORICAL EXLCUSION REQUEST A. PROJECT INFORMATION Project Title: Bonner Bridge Cable Replacement Utility Easement Project Type: Utility & Development Project Location: Cape Hatteras National Seashore - 1401 National Park Drive, Manteo, Dare County, North Carolina B. PROJECT DESCRIPTION The North Carolina Department of Transportation (NCDOT) replacement of the Herbert C. Bonner Bridge and NC-12 Long Term Management Plan requires relocation of the Cape Hatteras Electric Cooperative (CHEC) transmission circuit that provides service to Pea Island National Wildlife Refuge and communities on Hatteras and Ocracoke Islands. The existing transmission power circuit originates from the Oregon Inlet Riser Station located at the intersection of Oregon Inlet Road and NC 12 near the fishing center entrance across from Oregon Inlet Campground. The transmission circuit crosses west under NC12 and is encased ir a concrete duct bank from the National Park Service (NPS) underground utility Right-of-Way Grant No. ROW-5190-82-1. The power circuit exited the underground duct bank and was attached to the existing Bonner Bridge structure that will be demolished after construction of the new Bonner Bridge. The only feasible alternative for providing uninterrupted power service is to replace the transmission circuit onto the new bridge. The NCDOT TIP # B-2500 Phase I project Final Environmental Impact Statement and Section 4(f) Evaluation (FEIS) certified in 2008 as well as the Environmental Assessment (EA) certified in 2010 included the National Park Service as a member of the Merger Team. Although future phases will be subject to further NEPA documentation and permits, as appropriate, the 2015 court settlement regarding the Record of Decision approved construction of Phase I of the Project. This selected alternative was determined to meet the requirements of NEPA and Section 4(f). The DOI utility easement for the existing transmission circuit was renewed until 2005. The Bonner Bridge Replacement will require a new transmission circuit to be attached to the new bridge to maintain uninterrupted power service. Several interagency meetings were held with NCDOT, NPS, and CHEC to determine the construction route and methods that will provide the least impact to park land for the new transmission cable. The consensus was to install the new transmission circuit within the NCDOT right-of-way prior to the completion of the new bridge. The resource impacts provided in Section C for the desired cable construction methods and route were determined using the existing FEIS and EA. All applicable permits will be submitted by CHEC for the transmission circuit construction. The existing cable and duct bank will be abandoned in place to limit impacts, with the provision for removal by CHEC if required at a future date. A new DOI easement application will be processed following construction of the new transmission circuit according to the Special Use Permit (SUP) filed by CHEC in 2017. The intent of all agencies involved is to minimize disturbance to park land, reduce potential environmental impacts, and provide a cost effective and efficient method of installing the new transmission cable onto the new bridge to continue providing electrical service to the area. Measures required by the NCDOT SUP issued in 2015 for protection of park resources will apply to future CHEC construction. 15-6803-9005/111 Page 1 OO January 2017 �� sociates C. RESOURCE IMPACTS TO CONSIDER: ENVIRONMENTAL SCREENING FORM Categorical Exclusion - C.15 Installation of underground utilities in previously disturbed areas having stable soils or in an existing utility right-of-way. Resource Potential for potential Issues & Impacts Impact Air None Air Quality Issue: All construction vehicles will be pressure cleaned with water prior to arriving at and Biological Potential departing from the construction site to minimize Nonnative or Exotic Species the potential for introducing exotic plant species. Issue: Only lights approved in the Biological Biological Opinion and subsequent consultations are Species of Special Concern or Their Potential required to minimize illumination of the nesting Habitat beach and nearshore waters. Identified locations of nesting habitats will be avoided. Issue: Restoration of the site will include, but not be limited to: grading, smoothing, filling, and Biological Potential restoring native vegetation. Wetland impacts Vegetation will be mitigated in concurrence with the NCDOT approved mitigation plan. Issue: Disturbance or destruction of wildlife and Biological vegetation will be avoided to the greatest extent Wildlife and/or Wildlife Habitat including Potential and any concerns will be brought to the terrestrial and aquatic species attention of the POC immediately. Issue: The Park's Cultural Resource Program Manager will be notified during construction of the presence of culturally significant objects or structures. Operations shall not injure, alter, destroy, or collect any object, structure, or site Cultural Potential of historical, archeological, or cultural value. Archeological Resources Should construction unearth previously undiscovered archeological resources, work will be stopped in the area of any discovery. The Permittee shall immediately contact the Park's POC. Cultural Cultural Landscapes None Continued on next page 15-6803-9005/111 Page 2 OO January 2017 �� s ciates Lontinuea trom previous page Resource Potential for potential Issues & Impacts Impact Cultural None Ethnographic Resources Cultural None Museum Collections Cultural None Prehistoric/historic structures Geological Geologic Features None Geological Geologic Processes None Lightscapes None Lightscapes Other Issue: Safety fencing and signage will be Human Health and Safet Potential y provided around all construction areas. Socioeconomic None Land Use Socioeconomic Minority and low-income None populations, size, migration patterns, etc. Issue: Directional boring will be used to limit Visitor Use and Experience Potential impact to Oregon Inlet Drive access for Fishing Recreation Resources Center visitors. Visitor Use and Experience Issue: Temporary one lane access on NC12 as Visitor Use and Experience Potential required during construction. Water Floodplains None Continued on next page 15-6803-9005/111 Page 3 OO January 2017 �� c� SpC1S�S Continued from previous page Resource Potential for potential Issues & Impacts Impact Issue: Barge may be required for cable Water Potential installation onto new bridge. Coordination with Marine or Estuarine Resources NCDOT ongoing construction will be required for future approval if access required from park. Issue: Dewatering may be required which will Water Potential only occur after concrete has hardened and will Water Quality or Quantity be filtered before dispersion as permitted. Water Issue: Wetland impacts will be mitigated in Wetlands Potential concurrence with the NCDOT approved mitigation plan. 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' GONSIJLTING ENGINEERS engineering for the future since 1960 February 27, 2017 Via Electronic Mail Mr. Arthur Beyer Assistant Refuge Manager Point of Contact B-2500 Pea Island National Wildlife Refuge 14500 NC-12, Rodanthe, North Carolina, 27968 Subject: Request for Special Use Permit for Construction Activities To Install Underground Electric Utility as part of NCDOT TIP Project B-2500 (Phase I), Dare County, North Carolina Dear Mr. Beyer: In response to the NCDOT Highway Project TIP B-2500, Cape Hatteras Electric Cooperative (CHEC) is required to relocate an existing underground transmission power circuit. The majority of the proposed relocation is planned to be installed within the Right-of- Way Easement granted by the United States Fish and Wildlife Service (USFWS) to the North Carolina Department of Transportation for the project referenced above. The remaining installation is in close proximity to the existing overhead transmission installation authorized by Amendment 7 of the original right-of-way Permit ES-0852. The proposed wark detailed below comes after consideration of numerous line routes and construction methods. The proposed route avoids as much environmental impact as practical. Through the course of design, the alignment has been simplified by utilizing NC DOT right-of-way. The "Proposed Project" consists of constructing the following: The initial phase of construction will include hand clearing (if needed) and matting (with USFWS approved material) the area about an existing transmission pole (Pole Structure #13) and proposed riser location (Pole Structure #12). Access to each area will be off of NC Highway 12. The temporary wetland impact area will be less than 0.06 acres. 2. Installing a new underground 115kV transmission power circuit consisting o£ a. A total of five (5) conduits in duct bank described below — four 6" conduits and one 2" conduit b. Approximately 225 linear feet of four (4) foot wide and one (1) foot tall concrete duct bank utilizing a high early mix design for faster setting and higher likelihood to close ditch sooner than is typical c. No less than three (3) feet below grade to top of duct bank d. Duct bank to be open-cut trenched the total length of circuit, from proposed bridge End Bent #1 to new riser pole Structure #12 Mr. Arthur Beyer February 27, 2017 Page 2 3. Extending the existing overhead transmission pole line consisting o£ a. 145 linear feet of new overhead 115kV transmission line and two (2) new pole structures (Structures 12 and 13) b. Removal of 1,375 linear feet of existing overhead 115kV transmission line and six (6) pole structures c. Abandon in place existing 735 linear feet of existing underground 115kV transmission power circuit Once the new transmission power circuit is installed and commissioned, power shall be transferred off the existing circuit to the new. The existing CHEC duct bank is planned to be abandoned in place. The existing CHEC overhead transmission pole line is planned to be removed and easement abandoned. At this time, it is anticipated that Amendment 8 to Permit ES-0852 will be filed after completion. Proposed Total 404 Wetland Impacts include 0.06 acres (temporary) and 0.0 acres (permanent). Proposed Total CAMA/401 Wetland Disturbance includes 0.0 acres. Per emailed confirmation on September 8, 2016 from Mr. David Hering, LG, PE (NCDOT), any required wetland mitigation resulting from transmission circuit relocation may be covered by the NCDOT B-2500 wetland restoration site. Impacts to USFWS land were minimized in design by relocating the duct bank into the NCDOT right-of-way. Final restoration of impacts within USFWS property will meet ar exceed all requirements required by the USFWS and all applicable regulatory agencies. Please feel free to contact our office with any questions. Sincerely, BOOTH & ASSOCIATES, LLC William P. Jordan, PE WPJ/kpp Enclosures cc: Ms. Susan Flythe (CHEC) Mr. George Price (CHEC) 15-6803-9001 �T'$�,�g� '�'@I�I'�i"�� C�IV1�1�$ DN18Control#;d18-{}302 � �� Expiration aate: 66p�30�2p] 7 � �pe�ial Use Perrr�it App��t��on I�ef�ge: �'�a Is��n�d Nat�4naP '�N'ildlife Refug�e A�d�ice��: �'�Q Box 19�� ►itl: (Rsfu�e Offieualp �� B��'�� -Mai�: Artt�ur_beyer�fws.��u Phar�e #: ��2-�, �-� 1�z xz�s �ar Off�icial Use Oniy: Permit #: 5tat�an �: Pern�it T�rr�n: from � to�! Note: We do not rec�q,aire all inforrr�ation fu�r each use. See instru�tiou�s at th� end af the n�4ice and ccrntact th� refuge ide�tifed abave tt� deterntine applicabid�ty of a particu'dar item. Attach �d�'itior�al sheets to ihe application if 4tae text spaces provided are inadequate. '�} Identify the ty�e of Perm6t you are applying for: �C�w � RenewaV '�AAodification � O#hee � Appli�ar��t Ir�forr�at�+an 2� ��ti r��r��: Ge�r�e Price s} ��ar,��t�on: Cap� H'a�teras Electric Cc�o�erativ� 4y Stre�t AdcEress �� c�ty�stat�rz��: 8) Phane #: Sh �-mail 47� �l'� Li��i F�I'a�t iRaad g�Xt�tl, fVC 2�g2a {��2) 995-5�16 �} Fax �: �252) 9'95-4�7$8 c� ec�rge�� c�ec. ce�v� 9) LISd kf9�Wn �SSISt�lltSlSUb�Cb�lrf�Ct�GSISUb�]�fmif�2@S: (Gn;y Tet�uured �f the assrstantslsubca�tractorslsubpern�itkees will he opaeating an khe refuge wethouS the permittee bei c� g ,pres�nt. ) A�c#ivit�► Infarr��tian 10J Actiuity tY�e: ��ent �'4�Wr�od Cutting � Gtau� Vusi4 ��c�a�catianal Acti�ity � CabiralS��$��St�nc� c��n *"' Other B�nner @rid'ge tr�nsrni�si�n cab�� relocalion �lote: mepe�nding on t�e actuvity for which you a�r� �equesting a perroiit, we may as& you for the folMmwing activityr inforQnatuon. �lease cmnAact the specific eefuge where the activiiy is being con�iuct�d to deterrn�ne w�a4 ie�fao�mation is required. 11 } S�eci�eall'y i�entify tirv�ing, freq�e�ency. and how khe activity is expected tv proc�ed �a�e Fiatleras �lectric Cmoperatrve (CH�Cj is requestmg a SUP to conduct transnadssion eabPe �efocatiort E� cqnjuncUo� wilh the new �ionner �ridge canstructian. fihe replacement oi the �ridge ��equores Ihe followorsg: 1. extend the existfng ov2rheadi tran&missian pole dine 145 linear feet, 2. 6nsta9l (2) new ppfe strsic�ures (Structures 12 and 13j, 3. rernpve 9,375 linear Feet of exis�ing ove�tsead 115kV cransmisseon line, 4. remov� six (6j pole structures, 5, �ab��tdan ic� pdace 735 linear (�et of exist�ng undergraund 115kV tra�sm�ssian power circuiT Go:�sCrucEian is curreratly scheelul�d to eammence Augus# 2'f3� 7. FinaE sysEem tests and cle�nup aa�e scheduied before ,Euly 2018. 7he ca�Ee will be eroerglaed afler campleEion of the new briclge and prior to dest�uction of the ald bridgs. �WS Forrn 3-1383-G �5/14 OM$ Contral # 1fl18-d1�2 P � ExpiraYipr� Date: Oh/3Q/2fl17 I i Zj �IC�IVI'��'�Sif� OCCUp�11Clf �III'lQOI�90: {Specifscally identiiy heginning and �nd�ng d�tes. si6� �ceupatican Eimel+ne. hours, clean-up, and othee majar events.j C�Qrast��tur�n is �urr��tly sch�d'u,led tca co�me�ce August 2017. Final syste�n tests ar�d �Ieanup are ��ui�� r� ,��y ,�a�s. Tn� c��i� w�ii be e�u�rgf�zed a�te� �ornp�e�ion �f t�e ��w b��dge �und prior ta destructia� �f t�e old brid�e. �ons�ructic�n will �r�ir�c6�ie with current �J�a(�Ti agu�eed w�rk h�urs wi#hir�� the Y�mits specifiec� c�n the att�che� plan d�auvir�g. 13} Expected number of parkicipants, if applicable: Chi�ldren (1-18 j IP'�11,Q ,4d�t4s � Tatal � 14�) Grade le+r�l of educaiional group, ii applicabVe: Grade �1J j�{ � 5aj tr"ti,+iU staf� timelass�stance be re�uireti for grtiup activitie�7 Yes � Nc� � N1q � 15b) If yes, what's the antici�axed t�me frame? 16a) Ptlan o6 C3p�ra#�on required? Yes'� No ��11A � ��b) �I�n� o# C�perati�n attached? Yes'� �1� � �� pG'CIfG��y fdBf7lPfy �DC$tfflfl�S}: EGPS Poc�tiondsj pr�fe�red) Wark 4ocati�ns are shown on the attached s�ueets. �Sa} Is map df I�catian(sy required? Yes � No � N!A � 1�b) Es map of lacation(s) atiachec�? Yes� No� f�s�ra�nc� �aver�g�JLic�nsel�ertific�eti�r�sJP�rrr��s Note: Contact t�he spe�ific refuge headqu2vter� o�ce where the activity is goimg to be c�andueted to determine if any type of i�nsurance, certification{sj, ar perrrtit(s) w691 be requured. We may proc�ss thi� $peCiad Use Perr�pit while the applicant obt�lll�s t1��rt1. 19} List any insuranc+e e�verage yo� have such as general Roabrlity, avia�ian, �raunding liability, contaminants applicator, mediCal e+�ac�aation, or others, if req�uired: Prosvrance Type ra;a, Carrier Narne CDj ldentiiy li�erases, certifications, and permits, if required: L6cense/Ce�rf�fieationJPer�n it N.xA MUmb�r (�A applicable� Policy Nur�ber ISS�le� �O: Cvpy A#taehed? Yes or �a �Op]f ptt�C�!@�? �+e'S Or IVQ FWWS Farm 3-1383-G [35,! 14 ar�� cont�oi � ao�s-oioz 3 Expiration Date. fl6J3[l�'2�17 'L��istic� ar�� Trar�saar�ati�on hlo2e: Not all inforni�4it�n i� r�quired f�r eaeh use. Please contact t�ae s�ecifibe refa�ge who�e the aetivity os bein� conductedl ta deleemime what iniormation is �requir�;d, Attach addi�io�ar sheets to tF�€ apprication if the t�xt spaces provided are inadeq�at�. 2a } Does activity require personnef ta stay overn�ght onsite7 Yes � Nv �i �2) List narr�es of persorsnel involv�d: L�st Na�mes Li5t Narr�es List Narnes 23y Speci��afly describe ail majcar ec�uipmenU'g�ar �R�i materlals us�ecY, if r�quirted Pavfrer l�ine "B�c�et" Truc�s, Crar�e, Cable reel, tre�ci� excav�t�r„ �imaer mat�ing, silt fenci�ng, safety fe�acinc� & signs, co�dui�, duct bank and coc��rete truc4�, fif� rnaterial. 24a) Prowid� deta�led ir�iorrrraUon on 4he I�gistics far onsite, intersite, andlrar ship-ft�-shore transpartation to or an tYa� �e�uge, if �requered: �JC �lighway 1� r�+vi�J be the priu�-t�ary m�ade c�� transp�rtati�� f�r the project. �JC �QT �r�� ass�cuated' s��contracto�rs will coor�i�at� c�n sharin9 pcevi��s�y appr�ved �taging areas. Work wili be cond��ted w�th tl�� t�rn�c�ra�r a�ud ��rm�c��nt easemerats indicated o� tf�e �ttached s�eets� 24b) Rrovide d�scraptions, licens� plate, ar I.D. n�rnbers of wehicles us�c6 far ons6t�, intersife, andl�r ship-to-shore transportatior�, if reqUir�d: 25} Sp�:cifically cfescribe �rr�site wor� an�ilof living accQ�n�mo�atians: C)nsite vv�o-k invoe+�es instal�ing new transmi�sia� e�ble in a trench enea��d com�crete duct '��k frarn bridge end bent #�1. ��d �oles and wires wilf b� remowed frrsr� n�ar th� bridge +�ithin the ex�sting e�s��nent up to t�e propp�ed aerial riser structaare (pale structure #�2) to b�: �-eturned to the park, Thuer� wpll not be anyone li�irrg c��a�ite. 26j Speciiical9y desc�it�e �snsite haz�rdous �r�terial storage or ath�r onsufi� material siaraga space There wull b� nQ h��a�rdous �materi�l stvra�� c�n the r�f�ge. Sign, date. a�d print thi� form ar�dV retvrr� if 4a trye refuge'E,�t�rocassdng. 30j Sign�ture ofA�pdicant: _�_ �' c� bate ofAppdication:_ S'/� �� — — FWS Fofm 3-1383-G ��/].4 OMB Cantroi # 1018-016� I � Expiratian Date:06�36�2017 MOtice In accordance with the PrivacyAct [5 U.S.C. 552a) and the Paperwork Raduction Act {44 U.S.G. 3501), please nate the foflowing informat'rvn: The issuanre of a permit and collaction of fees an lands af the National �Idlife Refuge System are authorized by t€�e Nationaf Wildlife Refuge Sysiem Administrafian Act {16 U.S.C. 6fi8dd-ee) as amended, and the Ftefuge Racreatian Act {16 U.S.C. 460k-460k�). The i�formation that you provide is voluntary; however, we require submission of requested information taevaluate the qualifications, determine eligibility, and document permit applicanis under the aba�e Acts. It is nur policy not to use your name for any other purpose. We mat`ntain the information in accordance with the Privacy Act. We will c.�nsider all informatian you provide in reviewing this application. Faise, fictitious, or fraudulent statements ar represenfafions made in the application may be graunds for reaocation of the Special Usa Permit and may be punishable by fine or irr►prisonment {18 kJ.S.C. 10bi). Failure to pra�ide all required inforrnation is sufficient cause for the U.S. Fish and Wildlife 5ervice to deny a permit. No Members af Congress or Resident Cammissioner shaU participate in any part af this cankract or to any henefit that may arise from it, but this provision shall not pertain to this contract if made with a carporation for its general benefit. Ths Permittee agrees to be bound by the equal oppvrtunity "nvndiseriminatian in empfoyment° clause af Exeeutive arder 11246. Routine use disclosures may also he made: (a} to the U.S. departrnentofJusticewhen related to litigaaon aranticipated litigabon; {b} ofinfarmatian indicating � violation or patential �iolation of a statute, ruie, arder, or license to appropriate Federal, State, local, or fareign agencies responsible far investigating or prosecuting the viol2tion or far enforcing ar implementing the statute, rule, regulations, order, pr license; (c) from the recard of the indi�idual in respanse to an inquiry frem a Congressional office made at the r�quest af the indi�idual {42 FR 19083; Aprif 11,1977); and (dJ to pro�ide addresses obiained from the intemal Revenue Service to debt collectian agencies for purpases of locating a debtor to callect or compromise a Federa! Claim against the debtar, or ta consumer reporting agencies ta prepare a commercial credit report for use by the Department of Justice (48 FR 54716; Qecem6er 6, 1983}. An agency may nat conduct or spansor and a person is not required to respand to a collection of information unless it displays a currenUy �alid OMB cantrol n�mber. OMB has appro�ed this information collecti�n and assigned control number 1018--�1a2. The public neporting burden far this inforrnatian coUection varies based on the requested specifiG refuge use. We estinate the relevant public reporting burden for the General Acti�ity Special Use Permit Applicatian form to average 0.5 hours per response, inGuding time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Mail camments on this form to the Infarmation Collection GEearance Dfficer, U.S. Fish and Wildlife Service, 4441 N. Fairfax prive, MS BPHC, 5275 Leesburg Pike, Falts Ghurch, VA 22041-3803. General Canditions and Requirements 1) Raspansibility of Pennittee: Vlkshaloa�si�rthe permittee, by operating on the premises, to have accepted these premises with all facilities, fixtures, or improvements in their existing conditian as af the date of thrs permit. At the end of the period specified or upon earlier terminatian, the pertnittee shail give up the premises In as gvvd order and condition as when received except for reasonable wear, isar, or damage occurring without fautt or negligence. The permittee will fully repay the Ser�ice far any and all damage directiy or indirectly resulting from negligence or failure on his/her part, and/or the part of anyone of hislher associates, to use reasonable care. 2) Operat'rng Rules and Laws: ihe permittee shall keep the premises in a nea# and orderly condition a# all times, and shall comply with all municipal, county, and State laws applicable to the operations under the perrnit as well as all Federal laws, rules, and regulations governing national wildlife refuges and the area described in this germit. The permitkee shatl comply witti al! instructions applicable ta this permit issued by the refuge o�cial in charge. The permittee shall take all reasonable precautions to prevent the escape of fires and to suppress fires and shall render all reasonable assistance in the auppressian of refuge fires. 3} Use Limitatians: The permitiee's use af tha described premises is limited tn the purposes herein specified and does not, untess provided for in this permit, allow himlher to restrict other authorized entry onto hislher area; and allows kh� U.S. Fish and Wildlife 5ervice to �arry on whatever aCti�ities are necessary for: (1) protectipn and maintenance of the premises and adjar,ent lands administered by the U.S. Fish and Wiidlife Service; and {2) the management a# wildlife and fish using the premises and other U.S. Fish and Wildlife 5ervice lands. 4) Transfer of PriviEeges: This permit is not transferabfe, and no pri�ileges herein rnentioned may be sublet vr made available to any persfln or interest not mentioned iR ihis permit. No interest hereunder may accrue through lien or be transferred to a third party without the approval of the Regianal �irector of tha U.S, Fish and Wildlife Service and the permit shall not be used far speculative purposes. 5} Compliance: The L1.S. Fish and Wildlife Service's failure to require sVict compliance with any of this permit's terms, conditions, and requirem�nts shall not constitute a waiver or be cansidered as a giving up af the U.S. Fish and Wildlife Serrrice's right to thereafter enforce any of the permft's terms ar canditions. fi) Canditivns of Permit not Fu�lled: If the permittee fails to fulfill any of the conditions and requirements set forth herein, the U.S. Fish arxi Wildlife Service shal retain all mr�ney paid under this permit ta be used to satisfy as much of the permittee's obligation as possible. 7} Payments: A!I payment shall be made on or before the due date to the local representative of the U.S. Fish and Witdlife 5ervioe by a postai money order or check made payable ta tfie U.S. Fish and Wildlife 5ervice. 8�7ermination Policy: At the termination of this permit the permittee shall immediately give up possession to the U.S. Fish and Wildlife Servir.e represeniative, reserving, however, the rights specified in paragraph 11 below. !f helshe fails to do so, he/she will pay the U.S. Fish and Wildlife Service, as liquidated damages, an amount dauble the rate specified in this permik for the entire time possession is withheld. Upon yielding FWS Form 3-1383-G OS/24 DMB Control q 1018-0102 � � Expiration l7ate: Ofi/3fl/ZQ17 possessian, we will still allow the perrnittee to reenter as needed to remove hislher property as skated in paragraph i1below. The acceptance af any fee for the liquid8ted damages or any r�ther act of administration relating to the cantinued tenancy is rtot to be considered as an affirmation of the perrnittee's acFidn nvr shal! it operate as a wai�er of the U.S. Fish and Wildlife ServiCe's r'rght ta terminate or cancel the permit for the breach of any specified condition or requirement. 9J Revocation Policy: The Regional pirector af the U.S. Fish and Wildiife Service may revake this permit withaut notice €or noncompliance with the terms hereof, or for viala#iort of general andlorspecific laws orregulafions governing nationaf witdfife refuges, orfornvnuse. It is at all times sub�ectto discretionary revocation by ihe Director af the Service. Upc�n such revocation the U.S. Fish and Wildiife Serriics, by and through any authvrized repr�:sentative, may take possession of said premises for its own and sole use, andlor may enter and possess the premises as the agent csf the permi#tee and for hislher account. 10} Damages: The U.S. Fish and Wiidlife 5ervice shail not be responsible for: any loss or damage to praperty inciuding but not limited ta crops, animals, and maahinery; injury to the permittee or hislher relati�es, pr to the afficers, agents, employees, ar any other(s) whv are instructed to be on the premises; the sufferance from wi€dlife or emplayees or representa#ives of the U.S. Fish and Wildlife Service carrying out their afficial responsik�ilities. The permittee agrees to hold the U.S. Fish and Wildlife Service harmless from any and aU cfaims for damages or lasses that may anse fa be incident to the floading o# the premises rssulting from any associated government river and harbar, flaod cantral, reclamation, or Tennessee Val6ey Autharity actiuity. 11 j Removal of Permittee's Praperty: Upan the explration or terminatian of this permit, if all rental eharges andlor damage claims due to the U.S. Fish and Wildlife Service have been paid, the permittee may, within a reasonable period as stated in the permit or as detertnined hy the U.S. Fish and Wildlife 5ervice oftida! in charge, but not ta exceed 60 days, rema�e all s#ructures, machinery, andlor equipment, etc., from the premises for which helshe is responsible. Within this period ths permiftee also must remove any other of his/her property including hfslher acknowledged share of praducts or crops grown, cut, harvested, st�red, or stacketi on the premises. Upcm failure to rsmove any of the abo�e items within the afvresaid period, they shall t�ecorrte the property of the U.S. Fish and �Idlife Servrce, lnstructfans for Completing Applicatlon Yo� may complete the application portion verbally, in person, or electrvnically and submit to the refuge for review. Note: Please read instructions carefully as not all tnfarmatian is required far each act'tvity. Contact the speciflc refuge headquarters csffice where the acti�ity is going to be conducted to determine applicahility of a particular item. We may add special canditions or permit stipulations tc� permit prior ta approval. 1 j Identify if permit appGcation is for new, renewal, vr modificatfon of an existing permit. Permit renewels may not need all informatifln requestecf. Contact the spec�c refuge headquarters office where th� activity is going to be conducted if you have questions re�arding the applicability of a particular item, 2-8) ProVide full name, organi2ation (if applieable), address, phone, fax, and e-mail. 9) Provide knawn names and addresses af asslstants, suGcontracEvrs or subperrnittees. Names and address are only required if the assis;ants, subcontractors or subpermittees will be operating on the refuge without the permittee being present. Vofunteers, assistants, subcontractors or subpermittees that are accompanied by the perenittee need not be identified. 9aj Ac#ivity type: check Qrse af the following categories: • Event; • Wood cutting; - Group �isit; • CabinlSubsistence cabin {subsistenr,e caG'tns are only allawed on Alaska Refuges); • Edu�ational activity; ar • ather—any ather acti�ity(s) not mentioned above. Please descnbe "other" activity. 't 1} Provide detail+ed infarmation on the activity, including times, frequency, and haw the activity is expected to proceed, etc. Permit renewals may not need activity description if the activity is unchanged from previous permit. Mast rapetitive activities, such as group visits, do nat require an activity description for each visit. Cantaci the specifi� refuge headquarters o�ice where the acti�ity is goEng tv he conducted to deterrnine if we require an activity description. 12} Identify beginning and ending dates, site occupation timeline, hours, dearrup, and other majpr events, Permit renewals may not need an acti�itylsite occupancy timBline, if the acti�ty is unchanged from previous permit. Mast repetitius acti�ities, such as group visits, do nat require an activity/site csccupancy t'rmeline fnr each visit Contact the speeific refuge headquarters offir,e where the activity is going to b� conducted to determine if we require an acti�itylsite accupancy timeline. 13-14} Provide an estimate of the number of adults, and children and grade level af group, if applicabte. 15a-15b) fdentify if group acYrWit�es wiA require onsite refuge staff and the anticipatect 2ime frame, if applicable, 16a-16b) Identify and attach a Plan of Uperation, if required. Mast repetiti�e activities, such as group visits, do no# require a Plan of Operatian for each visif. In addition, permit renewafs rnay not require a Plan of Operation if the acti�ity is essent�ally unchanged from the previous permit. Contact the speCific re#uge headquarters office where the activity is going to be canducted to determine if a Plan af Operation is required. FWS Farm 3-1383-G 05�14 �M$ Contra! ti 1d18-OS02 � Expiration [7aZe: 06j3QJ2p17 1�� dentNfy specific location (G€'S �oordinates prefe�red}„ if not a named' fac�lity. Me�st r�petitive aGtivities, such as group visits, da nmt requgre a location. !n additiQn, permit r�newals may not require a Eocation if the activiity is essenfiaVEq unehanged irorn 4he previaus permit. Contact the sp�cif�c refuge headquarters o�ce where the acti�ity is �Qing to be �onducted to det�rmine if we require a Oocation. 18a-1$b) A#tach a rt°ia,p af IaC7Cion, if requi�ed', and if the acfivity �s not conducted at a named facili[y. [vtost re}aetitive accivities. such as grou� visit�, dcr not require a rna,p. In addi�ion, p�rmit reneuuals may nok require a ma� uf tfae activity as essentially unehanged frarai ihe prevEcrus �ermit. Contact t�te specifc refuge headqua�ters offuce where the activity is going to be canducted do det�rmine if we require a map. 19p Pre�vide r�ar-o�, type, and ca�roer of ir�surance, if reqwre�. Contaet the s�ecific refuge headquart�rs o�ce where the activity is godng to be c�nducte� to determine if we require insu�anc� a�nd ty�e of i�surance. 20) Speciticaily identify typ�(s) and numbar(s) o# other licenses, certificatians ar �ermits, df req�uired. Contact the specifc re#uge headquar�ers office whsee ih� actgvity is gring Co be conducted ta ctetermine the type(s) af flcens�s, ceRifications or permits requored, and to caordina#e the sir�-rult�neaus appl�icazian pf several types of ficenses, ce�kifications or perrrau�s. We r€tay fl� may not issue this Special Llse permit (SUP) while the permitt�� abiains other Cicertses, ceriificati�ns, andJor q�rmit�. 21-22j Pr�vide nam�(s] af any persannel reqe�ired �o stay avernight, if ap�licable. 23y Iderotify aVV equupment and materials that will pe usecf, i# r�quired. MQst repetitiv� events, such �s grpup visits, da noi r�quire a fist af ee�uipment. In �ddition, permit �ene+�rals may a��t require a Vist af equiprnent if the event is essenEially unchanged frpm dhe prewious permit. Conkac� the specific refuge headt�uarters office where the activity us going to be coraducted to deterrr�i�e if we require a pist of equip�neni. 24a-24b) Pravide vehic0e deseriptions and license �IaQe or identificatiorr numbers af aIV vehicles, incVuding boats and air,planes, if required. We only nequir� mfltor u�hicl� descriptions for p�rmittee ve�icle, andfor if the vehicle wifB be aper�ted on the refuge uvithout the perrtiittee being preser�t. V�lator vehicdes accompar�ied by the peerriittee as part of s grQup (Canvay� activify ne�d nof �e identifie� if cl�ared �n advance by th� refuge supe�,risor. SpecificaBBy d�scribe ship-to-shc�re, Intersite ibetween islands, eamps, or �4her sites} ar�d onsite trans�ar�ation mechanisms, and I'icense pla#e or identifieation �umbers, if eeq�ired. 25) Sp�ci€�calEy describe onsite work andlo� living acc�r�madations, u# appfcabie. 26} Specifically descr�be onsite hazardous rraateriaf st�rage, �r other ansite material sforage space (i�cluding an anct offsitc fuel cachesy. 27} Sign, date, and print the appEication. Click or� the Print butkan to print the applicatian {oi u�ing #he fil}able versi�n). �ite refuge o�cial wol� rev6ew 2�nd, af ap�roved, fill ou4 the r�maining informatican, sign, artd rekurn a co�ry to y�u far sig�a�atuT� and ac�eptance. This applicatian iarrn is r�ot valWci as a permit but ra7ay be vsed as a re6erenc� dmcurro�nt attached te the ofificual permit. Or�ly offecial refuge personnel rr�ay assign a vadoc� permet number and permit terr� to this �pplae�tion form after the �ermit has he�n approved. 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