20181341 Ver 1_SKM_C754e18100409510_20181004

Northern Lon�-Eared Bat 4!d) Rule Stre�rnlined Consultation Form
Federal agencies should use this form for the optional streamlined consulta�ion framework for the northern long-
eared bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's
{USFWS} January 5, 2016, intra-Service Pro�atic 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 the streamlined
framework; (2) describing the project with suff'icient detail to support the required determinat�on; and (3) enabling
the USFWS to track effects and determine if reinitiation of consultation is required per 54 CFR 402.16.
This form is not necessary i� an agency determines that a proposed action vvill have no effect to the NLEB or if
the USFWS has concurred in writing with an agenc�'s determination that a proposed action may affect, but is not
likeZy to adversely affect the NLEB (i.e., the standard informal cansultation pracess). Actions t�at may cause
prohibited incidental take requu,e separate formal consultation. Pzavidan.g thas information does not address
section 7(a}(2) compliance for any other listed species.
Inform�tion to Determine 4 d Rule Com liance:
1. Does the pmj ect occur wholly outside of tl�e WNS Zonel?
2. Have yon contacted the appropriate agencyZ to determuie if your pmj ect is near
knvwn hibernacula or maternity roost trees?
3. Could the project disturb hibernating NLEBs in a known hibernaculum?
4. Could the project alter the entrance or interior envixonment of a known
hibernaculum?
5. Does the proj ect remave any trees within 0.25 miles o� a]sn�own hibernaculum at
any time of year?
6. Would the project cut or destroy known occupied maternity roost ta-ees, or any
other trees within a 150-foot radius from the maternity roost tree from June 1
throu�h Julv 31.
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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 r�na;nder of the form will be used by the USFWS to track our assumptions in the
BO.
Agency and Applicant� (Name, Email, Phone No.}: NCDOT, Division 12, Trish Beam,
pdbeam 4,ncdot.�ov, 9$0-522-421$
Project Name: WBS — 12B.101811
Project Location (include coordinates if known}:
Sasic Project Descriptian (provide narrative be�ow or attach additional information): Bridge 178 repair
on I-40 in Cata,wba County
1 http:I/www.fws.gov/midwesdendangeredlmammals/nleblpdf/WNSZone.pdf
Z See http:/lwww.fws.gov/midwesdendangered/mamma�a/nlebinhisites.html
3 If applicable - only needed for federal actions with applicants (e.g., for a permit, etc.) who are party to the consultation.

A�encv Deterinination:
By signing this form, the action agency determines that this project may a�fect the NLEB, but that any
resulting 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 form, the action agency may
presume that its determination is in£ormed by the best available information and that its project
responsibilities under 7(a)(2) with respect to the NLEB are fulfilled through the USFWS January 5,
2016, Programmatic BO. The action agency will update this detenmination annually for multi-year
activities.
The action agency understands that the USFWS presumes that all activities are implemented as
described herein. The action agency will promptly report any deparhu'es from the described activities to
t�ae appropriate USFWS Fie1d 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
Signature:
a dead, injured, ar sick NLEB.
Date Submitted: 1 �'"'l '` �U
4 Any activity that temporarily or permanently removes suitable forested habitat, including, but not lunited to, tree removal
from development, energy produc�ion and transmission, m�ining, agriculture, etc. (see page 48 of the BO).
5 If the project removes less than 14 trees and the acreage is unknown, report the acreage as less than 0.1 acre.
6 If the ac�ivi.ty includes tree clearing in June and July, also include those acreage in Ap�ril to October.

Bat Habitat
Observers: J � � (�L �5 .
pate/Ti rn e:
County: ha .
Waterbody: i'�c� �
L
Assessment Form
NCDOT Bridges
TIP or DOT project number: �1Q, I�/.��/
Road Nam�/SR iVumber: � W t✓13
Bridge Nurriber:_� f c�
% Surrounding habitat w/in 1 mi. Urban/commercial
of project footprint (apprnx)
Natural/rural�
Any trees >3" DBH within project footprint? yes
Any shaggy trees ar snags �5" DBH? yes
If yes to shag/snag, how much sunlight do they recei�e during the day?
If yes to shag/snag, list species of habitat trees >5" c�bh _
lf snags �S"DBH are present in sunlit areas, pro�ide photos and location.
if large hollow trees are present, pro�ide photos and location.
Presence of: In project footprint
Caves yes no
Abandoned mines yes no
If 'yes' to any of the above, pro�ide photos, description, and location.
Suburban/residential fU
Agricultural �
no
no
1-3 hours 4-6 hours 7+ hours
In vicinty (D.5 mi}
yes no
yes no
Major water source in project footprint: ri�er stream/creek pond lake
Suitable drinking habitat in the form of non-stagnant, smnoth or slack water? yes no
Guard rails norte concrete timber
Deck type concrete metal timber
Beam type none concrete steel
End/back wa�l type concrete timber masanry
Creosote e�idence
Shallow vertical top sealed crevices (% -1%" wide, 4-1z" deep]
Deep vertical unsealed cre�ices SYz -1.Y" wide,l2+" deep)
metal
open grid
timber
yes
j/E 5
ye5
Max height of bridge deck abo�e ground/water (ft): , �
Night roost habitat pratected es no
Bridge alignment: N/S .✓� NW/SE iVE/SW
Hours of sun exposure to bridge 0-1 2-3 >3
Human disturbance under bridge high low none
Emergence count performed? (If yes, complete farm next page) yes no
E�idence of bats using bird nests, if present? yes na
E�idence of bats using bridge? (photos needed) yes na
Bat species present:
Additional Comments:
swa m p
no
CID
no
NCDOT Bat Bridge Habitat Assessment Form
Updated 3/18/15

�
Structure Assessement - Emergence Count
If an emergence survey is needed, it should begin 1/2 hour before sunset and continue for an hour or until it is too
dark ta see bats. Sur�eyors should position themsel�es outside so that emerging bats will be silhouetted against
the sky. Do not conduct emergence count if temp is < 50F or if there is rain.
Temperature at start of count:
Emergence count starting time:
Time of sunset:
Emergence count ending time:
Number of bats lea�ing structure:
Can bat genus/species be determined?
Describe where hats exited structure:
Comments, notes:
Provide a diagram of the structure, where observers were placed for the emergence count, and location
of any points of ingress/egress for bats. Please include a narth arrow.
NCDOT Bat 6ridge Habitat Assessment Farm
Updated 3/1$/15