20170932 Ver 1_signed_NLEB_Form_20170727

Northern Lon�-Eared Bat 4(d) Rule Streamlined Consultation Form
Federal agencies should use this form for the op�ional streamlined consultation frarne�vork for the northern long-
eared bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's
{CTSPWS} January 5, 2016, intra-Service Pro�ammatic Bialagical Opinian (BQ) on the fina� 4(d) rule for the
NLEB for section 7{a)(2) compliance by: (1) notifying the USFWS that az� action agency will use the streamlined
framework; (2} describing the projec�t with sufficient detail to support the required determination; and (3) enabling
the USFWS to track effects and determine if reinitiation of consultation is required per 50 CFR 402.16.
This form is not necessary if an agency detertnines that a proposed action will have no effect to the NLEB or if
the USFWS has concurred in writing with an agency's determination that a proposed action may affect, but is not
lilcely to adversely affect the 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) compliance 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 agencyZ to determine if yaur project is near � ❑
known hibernacula or maternity roost tr�es?
3. Could the project disturb hibemating NLEBs in a la�own hibernaculum? ❑ �
4. Could the project alter the entrance or interior environment of a known ❑ �
hibernaculum?
5. Does the project remove any trees within 0.25 miles of a known hibert�aculuin at ❑ �
an time of year?
6. Would the project cut or destroy known occupied maternity roost trees, or any ❑ �
other trees within a 150-foot radius from the matemity roost tree from June 1
throu Jul 31.
You are eligible to use this form if yon have answered yes to question #1 or yes to question #2 and na to
questions 3, 4, 5 and 6. The remainder of the form will be used by the USFW S ta track our assunnptions in the
BO.
Agency and Applicant� {Name, Email, l'hone No.): NCDOT, Division 12, Trish Beam,
pdbeam c[r�,ncdof. a�v, 744-480-9044
Project Name: Pipe Repair Hwy 27, west ot Lincolnton
Project Location (include coordinates if known): ss.469ts3, -si.z63i�s
Basic Project Description (provide narrative below or attach additional information): Maintenance,
drainage repair, Lincoln County
1 http:l/www.fws.govlmidwest/endangered/manunals/nleblpdf/WNSZone.pdf
z See http:l/www.fws.gov/midwestlendangered/matnmals/nleb/nhisites.html
3 If applicahle - only needed for federal ac�ions with applicants {e.g., for a permit, etc.) who are party to the comsul.kation.

A;�ency Determination:
By signing this form, the action agency determines that this project may affect the NLEB, but that any
resulting incidental iake of the NLEB is not prohibited by the fina14(d) rule.
If the USFWS does not respond within 30 days from submittal of this form, the action agency may
px�esume that its determination is infarmed by the best available infarma�ion and that its project
responsibilities under 7(a)(2} with respect to the NLEB are fulfilled through the U5FW5 January 5,
2016, Prograrnrnatic BO. The ac�ion agency will update this determination annually for multi-year
activiiies.
Th.e action agency understands that the USFWS presumes that a11 activities are implemer�ted as
described herein. The action agency will promptly report any departures from the described activities to
the appropriate USFWS Fie1d Office. The action agency will provide the a�propriate USFWS Field
Office with the results of any surveys conducted for the NLEB. Involved parties wi11 promptly notify the
appropriate USFWS Field Offiee upon finding a dead, injured, ar sick NLEB.
Signature: Date Submitted: �-:�. � r
4 Any activity that temporarily or permanently removes suitable forested habitat, including, but not limited to, tree removal
from development, energy production and transmission, mining, agriculture, etc. (see page 48 of the BO).
5 I�the project removes less than 10 trees and the acreage is unknown, report the acreage as less than 0.1 acre.
6 If the activity includes tree clearing in June and 7uly, also include those acreage in April to October.