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Section 404 - Pre-Construction Notification Form For State And County Projects - Oklahoma Department Of Transportation

KLAHOMA

EPARTMENT OF

RANSPORTATION

404 P

-C

ECTION

ONSTRUCTION

OTIFICATION

ORM

TATE

ATE

ROJECTS

Project No.:

J/P:

Facility:

County:

Description:

Programmed Construction Project

Let Date:

Division:

Sta or

Waterbody

Str. No.

Location

Description

Calculations

Cubic

Critical Resource

Existing

Yards of

Linear Feet of

Area

Latitude

Longitude

Legal

Water?

Type

Structure/Condition

New Structure

Fill*

Impacts

Notes

acre

Structure

Name of

Length of

Township,

Area of

Cubic

name and

Decimal

Waterbody and if

See

Size, Type, and Condition

Size and Type of

Impacts to

Number 1, 2, etc. List

Range,

Fill below

Yards of

Station

Degrees

it is a Critical

below

of Structure

Structure

Blue Line

note description below

Section

OHWM

fill

from plans

Resource Water

Stream

AVOIDANCE AND MINIMIZATION:

Provide a brief explanation describing how impacts to waters of the United States are being avoided and minimized on the project site. Also provide a brief description of how impacts to waters of the

United States will be compensated for, or a brief statement explaining why compensatory mitigation should not be required for those impacts.

Types:

BP--Bank Protection, CC—Channel Change, Chan--Channel Work, RCB--Reinforced Concrete Box, SB--Span Bridge,** Wet--Wetlands, Misc—Miscellaneous

*Only necessary if impacts are over 0.1

acres

**Wetland Information will be added from the delineation report by ODOT

Notes:

Number 1, 2, etc. Describe note here

Note whether the impact is fill or excavation in existing channel



Note type of fill (rip rap, drilled shafts, dirt, etc.)



Note Ordinary High Water Mark (OHWM) elevation



Note any other important information pertaining to the calculations and impacts

FHWA Approved Clearance type:

CE:

FONSI/EA:

EIS:

Date:

Pending:

None:

Applicant:

Name:

Oklahoma Department of Transportation

Phone No: (405) 522-0734

Address:

200 Northeast 21

Street, Oklahoma City, OK 73105-3204

ODOT Designer or Consultant Name

Name:

Phone No:

Application Prepared By:

Oklahoma Department of Transportation

Processing Agent:

This is not an official United States Army Corps of Engineers form. It is for use by the Oklahoma Department of Transportation only.

Revised October 23, 2013

Section 404 - Pre-Construction Notification Form For State And County Projects - Oklahoma Department Of Transportation

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