Marbled Murrelet Form - Western Washington Forest Practices Application / Notification
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1
2Marbled Murrelet Form
Western Washington Forest Practices Application/Notification
Complete this form only if you are harvesting timber (including salvage) or constructing roads.
Do not complete this form if you have an HCP for marbled murrelets.
Answer every question.
1.
No
Yes
For this FPA/N, has a protocol survey(s) been completed that includes:
[ ]
[ ]
•
Harvest units (and within 300 ft on your ownership), or
•
Salvage units (and within 300 ft on your ownership), or
•
Any area of proposed road construction (and within 300 ft on your ownership)?
If 'Yes', fill out the table and check the appropriate findings below.
Survey was
Survey is complete
Survey has been
Survey was
disapproved by
but has not yet
submitted to
approved by
WDFW and is
been submitted to
WDFW and
being
Survey ID
WDFW
WDFW
survey approval is
Township,
resubmitted with
unknown
(Name or
Range, &
(Submit survey
(Attach approval
this FPA/N
Unit #)
Section
with FPA/N)
letter from WDFW)
(Explain below)
(Explain below)
Occupancy
[
[ ]
Occupancy
[ ]
Occupancy
[ ]
Occupancy
Presence
Presence
Presence
Presence
[ ]
[ ]
[ ]
[ ]
No Detections
No Detections
No Detections
No Detections
[ ]
[ ]
[ ]
[ ]
Occupancy
Occupancy
Occupancy
Occupancy
[ ]
[ ]
[ ]
[ ]
[ ]
Presence
Presence
Presence
[ ]
Presence
[ ]
[ ]
[ ]
No Detections
[ ]
No Detections
[ ]
No Detections
[ ]
No Detections
[ ]
Occupancy
[ ]
Occupancy
[ ]
Occupancy
[ ]
Occupancy
Presence
Presence
Presence
Presence
[ ]
[ ]
[ ]
[ ]
No Detections
No Detections
No Detections
No Detections
[ ]
[ ]
[ ]
[ ]
Explanation:
2.
[ ]
No
[ ]
Yes
[ ]
Unknown
Will you harvest, salvage, or construct roads within 0.25 miles of an
occupied site?
3.
[ ]
No
[ ]
Yes
[ ]
Unknown
Will you fly helicopter(s) over or within 0.25 miles of an occupied site?
4.
[ ]
No
[ ]
Yes
Will you harvest live trees in a buffer of an occupied site?
If Yes, describe the leave trees and buffer widths you will leave.
NOTE: If you leave less than required in WAC 222-16-080(1) (h) (v) this
is a Class IV-Special and an Environmental Checklist is required
Description of managed buffers:
Appendix J - 6/1/2016
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