INSTRUCTIONS: This letter and the checklist on the next page should be provided to MaineDOT’s Environmental Office.

, Project Manager

Maine Department of Transportation

Bureau of Project Development, Multimodal Program

16 State House Station

Augusta, ME 04333-0016

Subject: National Environmental Policy Act (NEPA) Documentation

MaineDOT WIN : project

Dear :

Attached is the required National Environmental Policy Act (NEPA) documentation checklist for in the Municipality of .

Also attached is Communication 10, certifying that the Municipality conducted a public process in accordance with requirements identified in the project agreement with MaineDOT.

If you need additional information, please let me know.

Sincerely,

, Local Project Administrator

Enclosures:

NEPA documentation checklist

Public process certification (Communication 10)

NEPA DOCUMENTATION

For the Maine Department of Transportation, Federally Funded Projects

Project Title & Location:

Federal Project #:	MaineDOT WIN:

Description of Work:

MaineDOT Project Manager:

Answer the following questions and attach supporting documentation as requested. If there is a “yes” response, explain on a separate sheet or contact your MaineDOT Project Manager for guidance.

1.) Public Involvement: Is there substantial public opposition to proposed action? Yes No

The answer should become apparent at a public meeting.

Documentation: Approved capital plan; meeting records; letters from the public; board meeting minutes; or Communication 10 (Public Process).

2.) Right-of-Way: Does action include a residential or commercial displacement Yes No

or acquisition of property rights that will result in substantial abutter impacts?

For help with “substantial,” contact your Project Manager at MaineDOT.

Documentation: Design Plan Impacts Complete for the project

3.) Endangered Species & Essential Fish Habitat:

a. Has a qualified person surveyed the project area for streams, rivers, tidal waters, wetlands, or vernal pools identified coastal waters, wetlands, and vernal pools? Provide details below	Yes No

b. Is any work proposed in or adjacent to a stream, river or coastal waters?	Yes No

c. Does the project require clearing trees or trimming limbs 3” or greater in diameter?	Yes No

d. Does the project require night work or percussive noise (e.g. pile driving)? See below	Yes No

e. Can clearing or limbing be completed between November and April? See below	Yes No

Additional Details: _____________________________________________________________________

Documentation: Resource delineation and plans with location of resource and work planned. THe project will be screened by the MaineDOT Environmental Office for intersection with habitat for Endangered Species and fish habitat. If in-water work is proposed, additional coordination with the Environmental Office will be required for compliance with the Maine Atlantic Salmon Programmatic Agreement or other bat species considerations.

4.) Section 4(f) or 6(f):

a. Does project area include or abut resources protected by Section 4(f) of the

Department of Transportation Act: publicly owned land, parks, recreation areas,

wildlife and waterfowl refuges, or historic sites?	Yes No

b. Will project require temporary or permanent rights on any protected 4(f) resource	Yes No

listed above?

Documentation: Existing and proposed right-of-way plan, and a description of how impacts to these properties were avoided and minimized. The Local Agency will provide contact information to the park’s Official with Jurisdiction (as applicable).

Signed by:	Date: