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8100-FM-FR0161 02/2016 PNDI Form Page 1 of 2 P e n n s y l v a n i a N a t u r a l D i v e r s i t y I n v e n t o r y M A N U A L P R O J E C T S U B M I S S I O N F O R M When to Use the Manual Project Submission Form Use this form if you do not want to use the online Conservation Explorer to submit your project of any size for environmental review. Due to system limitations and agency requirements, projects should not be submitted piecemeal. The entire project area including roads and infrastructure should be submitted as a single unit. Fill out this form and send it along with your project materials (see What to Send to Jurisdictional Agencies) to all four agencies listed at the bottom of this PNDI Project Submission Form. There is no charge for submitting a project manually; however, due to the additional work required of agency staff, online submission is more efficient. Note: All Projects may be submitted using the Conservation Explorer online tool (a $40 fee will be charged per project). Online submission results in greater convenience and possibly faster response times. What to Send to Jurisdictional Agencies Send the following information to all of the agencies listed on the Project Submission Form. Check-list of Minimum Materials to be submitted: ____Completed Manual Project Submission Form ____Supplemental project narrative with a description of the overall project, the work to be performed, current physical characteristics of the site and acreage to be impacted. ____Relevant portion of the USGS 7.5-minute Quadrangle with project boundary clearly indicated, and quad name on the map The inclusion of the following information may expedite the review process. ____GIS shapefiles depicting the project extent basic site plan (particularly showing the relationship of the project to the physical features such as wetlands, streams, ponds, rock outcrops, etc.) ____Color photos keyed to the basic site plan (i.e. showing on the site plan where and in what direction each photo was taken and the date of the photos) ____Information about the presence and location of wetlands in the project area, and how this was determined by a qualified wetlands biologist), if wetlands are present in the project area, provide project plans showing the location of all project features, as well as wetlands and streams. PNDI Project Submission Form Definitions Applicant: Person that owns the property or is proposing the project or activity Contact Person: Person to receive response if different than applicant (e.g. Consultant) Project Name: Descriptive title of project (e.g. Twin Pines Subdivision, Miller Bridge Replacement) Proposed Activity: Include all earth disturbance activities for project (e.g. for a timber sale—include stream crossings, cutting areas and new roadway accesses). Also include Current Conditions (e.g. housing, farmland, current land cover), and how Construction/Maintenance Activity is to be accomplished. Total Acres of Property: Entire site acreage (e.g. timber sale property—including road access (200 acres) Acreage to be Impacted: Disturbance acreage (e.g. timber sale—if the property is 200 acres, but only 100 acres will be disturbed, for example: cutting on 90 acres, a road impacting 10 acres); include all temporary and permanent activities. ---PAGE BREAK--- 8100-FM-FR0161 02/2016 PNDI Form Page 2 of 2 P e n n s y l v a n i a N a t u r a l D i v e r s i t y I n v e n t o r y M A N U A L P R O J E C T S U B M I S S I O N F O R M This form provides site information necessary to perform an Environmental Review for special concern species and resources listed under the Endangered Species Act of 1973, the Wild Resource Conservation Act, the Fish and Boat Code or the Game and Wildlife Code. A p p l i c a n t I n f o r m a t i o n Name: Address: Phone Number: Email: C o n t a c t P e r s o n I n f o r m a t i o n - if different from applicant Name: Address: Phone Number: Email: P r o j e c t I n f o r m a t i o n Project Name: Project Reference Point (center point of project): Latitude: Longitude: Datum: Municipality: County: Attach a portion of a U.S.G.S. 7 ½ Minute Quadrangle Map with Project Boundaries clearly marked. U.S.G.S. Quad Name: Provide GIS shapefiles showing the project boundary (strongly recommended) P r o j e c t D e s c r i p t i o n Proposed Project Activity (including ALL earth disturbance areas and current conditions) Total Acres of Property: Acreage to be Impacted: 1. Will the entire project occur in or on an existing building, parking lot, driveway, road, maintained road shoulder, street, runway, paved area, railroad bed, or maintained lawn? Yes No 2. Are there any waterways or waterbodies (intermittent or perennial rivers, streams, creeks, tributaries, lakes or ponds) in or near the project area, or on the land parcel? If so, how many feet away is the project? Yes Feet No 3. Are wetlands located in or within 300 feet of the project area? Yes No If No, is this the result of a wetland delineation? 4. How many acres of tree removal, tree cutting or forest clearing will be necessary to implement all aspects of this project? Dept. of Conservation and Natural Resources Bureau of Forestry, Ecological Services Section 400 Market St., PO Box 8552 Harrisburg, PA 17105 Email: [EMAIL REDACTED] fax: [PHONE REDACTED] PA Fish and Boat Commission Natural Diversity Section 450 Robinson Lane Bellefonte, PA 16823 Email: [EMAIL REDACTED] PA Game Commission Bureau of Wildlife Habitat Management Division of Environmental Planning & Habitat Protection 2001 Elmerton Avenue Harrisburg, PA 17110-9797 [EMAIL REDACTED] US Fish and Wildlife Service Field Office 110 Radnor Rd; Suite 101 State College, PA 16801 no faxes please