Fillable Printable Fhwa Notification Form
Fillable Printable Fhwa Notification Form
Fhwa Notification Form
Form # 734-2898
Level 2 - Limited
http://www.oregon.gov/ODOT/HWY/GEOENVIRONMENTAL/
Template Last Revised October 15, 2014
ODOT Federal-Aid Highway Program ESA-MSA Programmatic
Notification
Project Information
ODOT Region
ODFW In-Water Work Window
NMFS Approval
Select Predominant Project Type
County
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Brief Project Description:
6th Field HUC
Route
Affected Species
Species Critical Habitat*
Species Critical Habitat*
May Effect EFH
Chinook Salmon
Coho Salmon Coastal Pelagics Groundfish
Additional 6th Field HUCs
Check if additional HUCs
are listed below in Project
Description.
USFW Approval
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Proponent Agency
Key Number
Project Name
Beg MP
End MP Other Road / Path Name
Anticipated Construction Start Year End Year
E-mail
ODOT Region Environmental Coordinator
Biologist E-mail
Phone
FHWA Contact
E-mail
Phone
Latitude (e.g. 45.4591° N) Longitude (e.g. -123.8442° W)
6th Field HUC (if applicable)
ODFW In-Water Work Window
to
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*Or proposed Critical Habitat if relevant.
Last Modified
Select Project Type
Select Species
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Form # 734-2898
Level 2 - Limited
http://www.oregon.gov/ODOT/HWY/GEOENVIRONMENTAL/
Template Last Revised October 15, 2014
Project Activities
Activities Requiring Approval from Services (check which apply; explain / justify below)
Not Applicable
Explanation of Activities That Require Approval or Modifications:
Not Applicable
Attachments Needed:
On-site stormwater treatment deficit Relevant plans
Net increase in artificial fill or abandoned fill in the functional floodplain
Relevant plans
Unvegetated streambank riprap; any streambank riprap above OHW, or in-stream flow control structures
Relevant plans
In-water work extension IWW Variance/Project Change
Fish passage structure or fishway (including ladder, culvert retrofit, pool-riffle structure, roughened chute) Fish passage plan or plans
Weed control that doesn't meet treatment standards Relevant plans
Blasting in or near aquatic habitat Blasting plan
Bridge replacement that doesn't meet fluvial performance standards Bridge Supplement
Stream channel modification or waterway enhancement that does not meet design standards Relevant plans
Stormwater flow management (when required) in watershed less than 100 mi
2
Drawing or plans
Other modifications to FAHP design standards in the FAHP that may result in direct impacts to covered aquatic resources
Relevant plans
Removal of Kincaid's lupine, Bradshaw's lomatium, or Fender's blue butterfly habitat Relevant plans
High noise producing work within 300ft of Marbled Murrelet habitat between April 1st & August 5th Relevant plans
Removal of mature conifer trees (18" or larger DBH) in Northern Spotted Owl or Marbled Murrelet habitat Relevant plans
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Check boxes to indicate project activities that may affect covered species or supporting habitat.
General Heavy Construction
Geotechnical Drilling
Material Sources
Mobilization, Staging and Disposal
Erosion, Sedimentation and Pollution Control
Temporary Access Roads
Barges
Temporary Bridges and Treated Materials (Attach Bridge Supplement if Aquatic)
Work Area Isolation
Clearing, Grubbing and Earthwork
Weed Removal
Trees and Down Timber Removal
Blasting
Slope Stabilization and Drainage
Streambank Stabilization and Scour Protection
Culvert and Bridge Removal
Bridge Repair and Rehabilitation (As Relevant, Attach Bridge Supplement)
Bridge Construction (Attach Bridge Supplement if Aquatic)
Pile Driving and Pile Removal (Attach Bridge Supplement if Aquatic)
Culvert Extension, Repair and/or Installation
Painting and Coating
Asphalt and Concrete Paving
Other Permanent Roadway Structures
Site Restoration and Enhancement Plantings
Channel Modification and Waterway Enhancements (Attach Relevant Plans)
Stormwater Management
Other:
Form # 734-2898
Level 2 - Limited
http://www.oregon.gov/ODOT/HWY/GEOENVIRONMENTAL/
Template Last Revised October 15, 2014
Stormwater Management
Not Applicable
Is Flow Control Provided?
If Not Required, Why?
Flow Control Design Range:
Stormwater Manual Cited:
Drainage
Area
Treatment Method BMP
Maint.
Table***
ISA Treated
(Acres)
Receiving Water
Lower End Point Design Storm
For additional rows, please attach the Stormwater Management Data Page.
*** ODOT Stormwater Facility Maintenance Tables ( http://www.oregon.gov/ODOT/HWY/GEOENVIRONMENTAL/pages/omm.aspx) or other (attach).
Attached Aerial Photo/Site Drawing That Show: The CIA, Sub-Basins, Drainage Flow Paths, Receiving Waters and BMP Locations.
Comments:
Water Quality Design Storm
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Project Area
Upper End Point Design Storm
Off-Site Treatment Area
**Provide range if variable. If off-site is less than on-site (per ADT Range table, see User's Guide), a greater amount of ISA must be treated and describe below.
Average Daily Traffic**
Stormwater Designer Name, Phone #, E-mail:
Responsible Agency for Stormwater BMPs:
Stormwater Feature Pre-Project Anticipated Post Project
Project Impervious Surface Area (ISA)
Net New ISA (=Pre-Project-Actual Post Project)
Contributing Impervious Area (CIA)
Total ISA Treated On-site
Total ISA Treated Off-site
Stormwater Credits Used*
Total Managed ISA (on- and off-site and credits)
Net Water Quality Treatment (=Total Managed ISA-Post Project CIA)
Excess Stormwater Area Treated for Credit*
Acres
* Stormwater Credit discussions still underway, please consult with NMFS before using any sort of credit.
Acres
Acres
Acres
Acres
Acres
Acres
Acres
Acres
Acres
Acres
Acre(s)
Acre(s)
Acre(s)
Acre(s)
Acre(s)
Acre(s)
inches
inches
inches
Form # 734-2898
Level 2 - Limited
http://www.oregon.gov/ODOT/HWY/GEOENVIRONMENTAL/
Template Last Revised October 15, 2014
Anticipated Impact Anticipated Restoration
Habitat Type Linear ft Area Linear ft Area Primary Purpose
Streambank Hardening Below OHW
Riparian Habitat Disturbed
Trees & Woody Debris Anticipated Impacts / Restoration
Not Applicable
List of Attachments
Habitat Impacts / Restoration
Not Applicable
Other Anticipated Avoidance/Minimization Measures, Offsetting Measures and Enhancements
Not Applicable
Activity/Resource Purpose
Amount
On-Site Off-Site Units
* Aquatic Habitat Type(s) Disturbed:
Pool
Riffle
Glide
Trees Removed Trees Added
Habitat Type 0-6" 6-18" > 18"
# Down Timber
(LWM)
# Native Trees
Planted
# LWM
Installed
Primary Purpose
Riparian Zone
Estuarine Habitat
(<300' away)
Electronic Signatures & Authorizations:
The following individuals have reviewed the Notification for accuracy & compliance with the FAHP ESA Consultation (NMFS Ref(2011/02095)) and/or (USFW Cons
#01EOFW00-2012-F-0020) approve implementation of the project as described here in. A Biologist Qualified by ODOT under its ESA Effects Determination
Program must review this document and ensure its quality before it is submitted to the FHWA. Please sign this document electronically & forward appropriately.
Not Applicable
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Only if "approval from services required"
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Other information on impacts/restoration/enhancements (attach Additional Information form if more space needed):
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Region # Environmental Manager, ODOT
Qualified Biologist, Last Certified X/X/XX
Construction Project Manager - Organization
FHWA
NMFS or USFW
