20171491 Ver 1_signed_NLEB_ConsultationForm_20171120

Northern Lon -Earec� B�t 4 d Rale Streamlined Consult�tion Form
Federal agencies should use this form for the option�l streamlined consultat�on framework for the northern long-
eazed bat (NLEB}. This framework allows federal ager�cies to rely upon the U.S. Fish and Wildlife Service's
{USFWS) January 5, 2016, intra-Service Programmatic Biological Opinion (BO} on the fina14(d) rule for the
NLEB for section 7{a}(2) compliance by: (1) notifying the USFWS that an action agency will use tb.e streamlined
framework; (2} describing t�e project 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. � 6.
This form is nat 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 agency's determination 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 consultation. Providing this informatian does not address
section 7(a)(2} compliance for any other listed species.
Information to Determine 4(d) Rule
1. Does the proj ect occur wholly outside of the WNS Zonel?
2. Have you contacted the appmpriate agencyz to d�termine if your project is n.ear
known hibez-nacula or materni roost trees?
3. Could the project disturb hibernatuag NLEBs in a laiown hibernaculum?
4. Could the project alter the entrance or interior environxxaent of a known
hibernaculum?
5. Does the proj ect remove any trees within 0.25 miles of a known hibernaculum at
an time of ear?
6. Would the project cut or destroy known occupied maternity roost trees, or any
other trees within a 150-foot radius fro� the maternity roost tree from 7une 1
throu�h Julv 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 remai.nder of the form will be used by the USFWS to track our assumptians in the
BO.
Agency and Applicant� (Name, Email, Phone Na.): NCDOT, Division 12, Trish Beam,
t�dbeam�a,ncdot.�v_, 704-480-9044
Project Name: W-5212N, NC-279 {Dallas Cherryville Highway) Improvements
Gaston County, North Caxolina, Gaston County
Project Location (include coordinates if known):
Basic Project Description (provide narrative below ar attach additional information): Improvements to
sections of NC 279 (Dallas Cherryville Highway) in Gaston County.
1 http:/lww�v.fws.gov/midwest/endangered/mammalslnleblpdf/WNSZone.pdf
Z See http:llwww.fws.gov/xnidwesdendangered/ma�als/nleb/nl�isites.htmZ
3 if applicable - only needed for federal actions with applicants (e.g., for a permit, ete.) who are party to the consultation.

��.�ct sTA
A�encv Determination:
By signing this form, the action agency deterinines that this project may affect the NLEB, but that any
resul�ing incidental take of the NLEB is not prohibited by the fina14(d) rule.
If the USFWS does not respond within 30 days from submittal of this £orm, the action agency may
presume that its determination is informed by the best available information and that its project
responsibilifies under 7(a)(2) with respect to the NLEB are fulfilled through the i15FWS January 5,
2Q16, Programmatic BO. The action agency will update this determination annually for multi-year
activities.
The action agency understands that the USFWS presumes that all activities are implemented as
described herein. The action agericy will promptly report any departures from the described activities to
the apprapriate USFWS Field Office. The action agency will provide the appropriate USFWS Field
Office with the results of any surveys conducted for the NLEB. Involved parties will promptly noti�y the
appropriate USFWS �'ield Of'fice upan finding a dead, injured, ar sick NLEB.
Signature: Date Submitted: � � [D
4 Any activity that temporarily or permanently removes suitable forested habitat, including, but not limited to, tree removal
from development, energy production and transmission, xnining, agriculture, etc. (see page 48 af the BO).
5 If the project remaves 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 July, also include those acreage in April to October.