20171582 Ver 1_signed_NLEB_consultation_form_20171212

Northern Lon -Eared Bat 4 d Rule Streamlined Consultarion Form
Federal agencies should use this form for the optional streamlined consultation framework for the nortl�ern lang-
eared bat (NLEB). This fraznewark allows federal agencies to rely upon the U.S. Fish and Wildlife Service's
{ti SFWS) January 5, 2016, intra-Service Programmatic BioZogical Opiziion (BO} on ihe final 4(d) rule for the
NLEB for section 7{a){2) compliance by: (1} notifying the USFWS thai an action agency will use the stxeam�ined
framework; (2} describing the project with sufficient detail to support the required detenoaination; and {3) enabling
the LTSFWS to track effects and detenuine if reinitiation of consultation is required per 50 CFR 402.16.
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 agency's determination that a proposed action may affect, but is not
likely tv adversely affect tI�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} coxnpliance for any other listed species.
Informatioa to Determine 4 d Rule Com liance:
1. Does the project occur wholly outside of the WNS Zone'?
2. Have you contacted the appropriate agencyz to determine if your proj ect is near
lrnawn hibernacula or maternity roost trees?
3. Could the project disturb hibez-nating NLEBs in a laiown hibernaculum?
4. Could the project alter the entrance or interior environment of a l�own
hibernaculum?
5. Does ihe project remove any trees within 0.25 miles of a known hi�emaculum at
an tune of ear?
6. Would ihe project cut ar destroy l�own occupied maternity roost trees, or any
other trees within a 150-foot radius from 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 remainder of the form will be used by the USFWS to track our assuznptions in the
BO.
Agency and Applicant� (Name, Email, Phone No.): NCDQT, Division 12, Trish Beam,
pdbeam _,ncdot.�ov, 980-552-42J.8
Project Name: Bridge #172 replacement, SR 1819 {Alexis High Shoals Road) over Hoyle Creek,
Gaston County
Project Location {include coordinates if known): 35.398650. -81.171760
B�sic Project Description (provide narrative be�ow or attach additionai information); Replacement of
timber and steel bridge with a concrete bridge on same locatian.
1 http://www.fws.gov/midwest/endangered/matnmals/nleb/pdf/WNSZone.pdf
Z See http://www.fws,gov/midwesdendangeredlmammals/nileb/nhisites.html
3 If applicable - only needed for federal actions with applicants (e.g., for a permit, etc.) who are party to the consultation.

s fr� I�TA
A�encv 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 prohibited by the final4{d) rule.
If the USFWS does nat respond within 30 days from submittal of this form, the acdon agency may
presume that its determination is informed by the best available informa#ion and that its project
responsibilities under 7(a)(2} with respect to the NLEB are fulfilled through the USFWS January 5,
2016, Programinatic B�. The action agency will update this determination annually for multi-year
activiti�s.
The action agency u�derstands i�hat the USFWS presumes that all activities are implemented as
described herein. The actian agency will promptly report any departures fram the described activities to
the appropriate 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 notify the
appropriate USFWS Field Office upon finding a dead, injured, or sick NLEB.
Signature:
Date Submitted: r � �
° Any activity that temporarily or permanently removes suitable forested habitat, including, but not liznited to, tree removal
from development, energy production and t�ansmission, mining, agriculture, etc. (see page 4$ of the BO).
5 If the project removes Iess than 10 trees and the acreage is unknawn, report the acreage as less than 0.1 acre.
b If the activity includes tree clearing in June and July, also include those acreage in April to October.