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CESPL – RGA/N/S/T (File Number #FOLDER_DA_NUMBER#)	DD Month YYYY

MEMORANDUM FOR RECORD 

SUBJECT:  Department of the Army Environmental Assessment and Statement of Findings for the Above-Referenced Standard Individual Permit Application 

1.0	Purpose
This document constitutes the Environmental Assessment, Section 404(b)(1) Guidelines Evaluation, Public Interest Review, and Statement of Findings for the subject application. 
2.0	Conclusion
The permit action would not have a significant impact on the quality of the human environment.  The proposed discharge complies with the 404(b)(1) Guidelines and the activity is not contrary to the public interest, provided the permittee complies with the special conditions identified in Section 12.2
3.0	Introduction and Overview
Information about the proposal subject to one or more of the United States Army Corps of Engineers’ (Corps’) regulatory authorities is provided in Section 3, detailed evaluation of the activity is found in Sections 4 through 12 and findings are documented in Section 13 of this memorandum. Further, summary information about the activity including administrative history of actions taken during project evaluation is attached (ORM2 Summary) and incorporated in this memorandum.
3.1	 Applicant name
#APPLICANT_COMPANY#, Attn: #SALUTATION# #APPLICANT_FULLNAME#  
3.2	Activity location 	
Enter a brief narrative description.
3.3	Description of activity requiring permit
#APPLICANT_COMPANY# is proposing to #ACTION_PROJECT_DESCRIPTION#
 
3.3.1	Proposed avoidance and minimization measures
Describe here
3.3.2	Proposed compensatory mitigation
Describe here 
3.4	Existing conditions and any applicable project history
Describe here 
3.4.1	Jurisdictional Determination 
Is this project supported by a Jurisdictional Determination? Yes, a Preliminary Jurisdictional Determination has been issued. *OR* Yes, an Approved Jurisdictional Determination has been issued. *OR* No Jurisdictional Determination has been issued.

Optionally, you may describe any project specific details related to the Jurisdictional Determination here.
3.5	Permit authority 

Table 1 – Permit Authority	
Section 10 of the Rivers and Harbors Act (33 USC 403) 		
Section 404 of the Clean Water Act (33 USC 1344)		
Section 103 of the Marine Protection, Research and Sanctuaries Act of 1972 (33 USC 1413)		

4.0	Scope of review for National Environmental Policy Act (i.e., scope of analysis), Section 7 of the Endangered Species Act (i.e., action area), and Section 106 of the National Historic Preservation Act (i.e., permit area)
4.1	Determination of scope of analysis for National Environmental Policy Act (NEPA)
The scope of analysis always includes the specific activity requiring a Department of the Army permit that is located within the Corps’ geographic jurisdiction.  In addition, we have applied the four factors test found in 33 CFR Part 325, Appendix B to determine if there are portions of the larger project beyond the limits of the Corps geographic jurisdiction where the federal involvement is sufficient to turn an essentially private action into a federal action.  

Based on our application of the guidance in Appendix B, we have determined that the scope of analysis for this review includes only the Corps’ geographic jurisdiction. *OR* the Corps’ geographic jurisdiction and upland portions beyond the Corps’ geographic jurisdiction.

These upland components include Describe here (e.g., the area between the regulated impacts of waters of the United States) These components have been determined to be within our scope of analysis as the extent of federal involvement is sufficient to turn this essentially private action into a federal action with the resulting environmental consequences of the larger project essentially being products of the Corps permit action. 

Final description of scope of analysis: Describe here 
4.2	Determination of the Corps action area for Section 7 of the Endangered Species Act (ESA) 
Description of ESA scope of review with rationale here.
4.3	Determination of Corps permit area for Section 106 of the National Historic Preservation Act (NHPA)
The permit area includes only those areas comprising waters of the United States that will be directly affected by the proposed work or structures.  Activities outside of waters of the United States are not included because all three tests identified in 33 CFR 325, Appendix C(g)(1) have not been met.
*OR*
those areas comprising waters of the United States that will be directly affected by the proposed work or structures, as well as activities outside of waters of the United States because all three tests identified in 33 CFR 325, Appendix C(g)(1) have been met.

Final description of the permit area: Final description of permit area with rationale here. Include in the rationale a discussion of any specific upland areas that are determined to be included in the permit area. 
5.0	Purpose and Need
5.1	Project purpose and need
Project purpose and need for the project as provided by the applicant and reviewed by the Corps:  

Describe here
5.2	Basic project purpose 
Basic project purpose, as determined by the Corps: N/A. *OR* or basic purpose here.
5.3	Water dependency determination
N/A, activity is not located in a special aquatic site. *OR* The activity does not require access or proximity to or siting within a special aquatic site to fulfill its basic purpose.  Therefore, the activity is not water dependent. *OR* The activity does require access or proximity to or siting within a special aquatic site to fulfill its basic purpose.  Therefore, the activity is water dependent. 

If choice is either, not water dependent or water dependent please explain in further detail.
5.4	Overall project purpose
Overall project purpose, as determined by the Corps: 

Describe here.
6.0	Coordination 
6.1	 Public Notice Results
The results of coordinating the proposal on Public Notice (PN) are identified below, including a summary of issues raised, any applicant response and the Corps’ evaluation of concerns.

Were comments received in response to the PN? Yes. *OR* No. 

Was a public meeting and/or hearing requested, and if so, was one conducted?

No, no public hearing or meeting was requested. *OR* Yes, a public meeting/hearing was requested and conducted. Comments collected during meeting(s)/hearing(s) are summarized below. *OR* Yes, a public meeting/hearing was requested but was not held.

Provide additional description/rationale here as needed.

Comments received in response to public notice: 

Comment 1: Summarize comment here.

Applicant’s Response: N/A. *OR* provide applicant’s response as appropriate.

Corps Evaluation: Summarize Corps evaluation here.

Additional discussion of submitted comments, applicant response and/or Corps’ evaluation: N/A. *OR* provide discussion as appropriate.
6.2	Additional issues raised by the Corps 
N/A. *OR* Describe if additional issues were raised by the Corps, including any as a result of coordination with other Corps offices. Provide discussion including coordination of concerns with the applicant and the Corps’ evaluation of the response.
6.3	Comments regarding activities and/or effects outside of the Corps’ scope of review
N/A. *OR* Describe if the Corps received any comments that do not require further discussion because they address activities and/or effects outside of the Corps’ scope of review.  Provide discussion. 
7.0	Alternatives Analysis 
(33 CFR Part 325 Appendix B, 40 CFR 230.5(c) and 40 CFR 1501.5(c)).  An evaluation of alternatives is required under NEPA for all jurisdictional activities.  NEPA requires discussion of a reasonable range of alternatives, including the no action alternative, and the effects of those alternatives.  An evaluation of alternatives is required under the Section 404(b)(1) Guidelines for projects that include the discharge of dredged or fill material to waters of the United States. Under the Section 404(b)(1) Guidelines, practicability of alternatives is taken into consideration and no alternative may be permitted if there is a less environmentally damaging practicable alternative.
7.1	Site selection/screening criteria 
In order to be practicable, an alternative must be available, achieve the overall project purpose (as defined by the Corps after considering the applicant’s needs and type of project being proposed), and be feasible when considering cost, logistics and existing technology. 

Criteria for evaluating alternatives as evaluated and determined by the Corps:  

Describe evaluation criteria here.  
7.2	Description of alternatives 

7.2.1	No action alternative
Description of No Action alternative.  
7.2.2	Off-site alternatives
Off-site alternative 1: Description of off-site alternative 1.

Off-site alternative 2: Description of off-site alternative 2. 
7.2.3	On-site alternatives
On-site alternative 1 (applicant’s preferred alternative): Description of on-site alternative 1.  

On-site alternative 2: Description of on-site alternative 2. 
7.3	Alternatives evaluation under the Section 404(b)(1) Guidelines and NEPA 
Evaluate alternatives under NEPA and whether each is practicable under the Section 404(b)(1) Guidelines or reasonable.  Provide appropriate discussion here.

7.4	Least environmentally damaging practicable alternative under the Section 404(b)(1) Guidelines 
Identify the least environmentally damaging practicable alternative.  If more than one alternative is practicable based on the analysis above, include discussion of environmental effects of each and rationale for selecting the least environmentally damaging practicable alternative. 
8.0	Evaluation for Compliance with the Section 404(b)(1) Guidelines
The following sequence of evaluation is consistent with 40 CFR 230.5. *OR* N/A, the proposed project is subject only to Section 10 of the Rivers and Harbors Act of 1899. *OR* N/A, the proposed project is subject to only Section 103 of the Marine Protection, Research, and Sanctuaries Act of 1972. *OR* N/A, the proposed project is subject to only Section 10 of the Rivers and Harbors Act of 1899 and Section 103 of the Marine Protection, Research, and Sanctuaries Act of 1972.
8.1	Practicable alternatives  
Practicable alternatives to the proposed discharge consistent with 40 CFR 230.5(c) are evaluated in Section 7

The statements below summarize the analysis of alternatives:

In summary, based on the analysis in Section 7 above, the no-action alternative, which would not involve discharge into waters of the United States, is not practicable.

For those projects that would discharge into a special aquatic site and are not water dependent, the applicant has demonstrated there are no practicable alternatives that do not involve special aquatic sites.  

It has been determined that there are no alternatives to the proposed discharge that would be less environmentally damaging (Subpart B, 40 CFR 230.10(a)). 

The proposed discharge in this evaluation is the practicable alternative with the least adverse impact on the aquatic ecosystem, and it does not have other significant environmental consequences. *OR* The proposed discharge in this evaluation has more adverse impacts on the aquatic ecosystem than other practicable alternative(s), but those other alternative(s) would have other significant environmental consequences.

Provide any additional discussion here if needed.  
8.2	Candidate disposal site delineation (Subpart B, 40 CFR 230.11(f)) 
Each disposal site shall be specified through the application of these Section 404(b)(1) Guidelines:

Provide appropriate discussion here.
8.3	Potential impacts on physical and chemical characteristics of the aquatic ecosystem (Subpart C 40 CFR 230.20-40 CFR 230.25)
The following has been considered in evaluating the potential impacts on physical and chemical characteristics (see Table 2):

Table 2 – Potential Impacts on Physical and Chemical Characteristics	
Physical and Chemical Characteristics	N/A	No Effect	Negligible Effect	Minor Effect (Short Term)	Minor Effect (Long Term)	Major Effect	
Substrate							
Suspended particulates/ turbidity							
Water							
Current patterns and water circulation							
Normal water fluctuations							
Salinity gradients							

Discussion: Provide appropriate discussion here. 
8.4	Potential impacts on the living communities or human uses (Subparts D, E and F)
8.4.1	Potential impacts on the biological characteristics of the aquatic ecosystem (Subpart D 40 CFR 230.30)
The following has been considered in evaluating the potential impacts on biological characteristics (see Table 3):

Table 3 – Potential Impacts on Biological Characteristics	
Biological characteristics	N/A	No Effect	Negligible Effect	Minor Effect (Short Term)	Minor Effect (Long Term)	Major Effect	
Threatened and endangered species							
Fish, crustaceans, mollusk, and other aquatic organisms							
Other wildlife							

Discussion: Provide appropriate discussion here. 
8.4.2	Potential impacts on special aquatic sites (Subpart E 40 CFR 230.40)
The following has been considered in evaluating the potential impacts on special aquatic sites (see Table 4): 

Table 4 – Potential Impacts on Special Aquatic Sites	
Special Aquatic Sites	N/A	No Effect	Negligible Effect	Minor Effect (Short Term)	Minor Effect (Long Term)	Major Effect	
Sanctuaries and refuges							
Wetlands							
Mud flats							
Vegetated shallows							
Coral reefs							
Riffle pool complex							

Discussion: Provide appropriate discussion here. 
8.4.3	Potential impacts on human use characteristics (Subpart F 40 CFR 230.50)
The following has been considered in evaluating the potential impacts on human use characteristics (see Table 5):

Table 5 – Potential Impacts on Human Use Characteristics	
Human Use Characteristics	N/A	No Effect	Negligible Effect	Minor Effect (Short Term)	Minor Effect (Long Term)	Major Effect	
Municipal and private water supplies							
Recreational and commercial fisheries							
Water-related recreation							
Aesthetics							
Parks, national and historical monuments, national seashores, wilderness areas, research sites, and similar preserves							

Discussion: Provide appropriate discussion here. 
8.5	Pre-testing evaluation (Subpart G, 40 CFR 230.60)
The following has been considered in evaluating the biological availability of possible contaminants in dredged or fill material (see Table 6):

Table 6 – Possible Contaminants in Dredged/Fill Material	
Physical substrate characteristics		
Hydrography in relation to known or anticipated sources of contaminants		
Results from previous testing of the material or similar material in the vicinity of the project		
Known, significant sources of persistent pesticides from land runoff or percolation		
Spill records for petroleum products or designated (Section 331 of CWA) hazardous substances		
Other public records or significant introduction of contaminants from industries, municipalities, or other sources		
Known existence of substantial material deposits of substances which could be released in harmful quantities to the aquatic environment by man-induced discharge activities		

Discussion: Provide appropriate discussion here.

It has been determined that testing is *OR* is not required because the proposed material is not likely to be a carrier of contaminants because it is comprised of sand, gravel or other naturally occurring inert material. *OR* the discharge and extraction sites are adjacent, subject to the same sources of contaminants and have substantially similar materials.  Although the discharge material may be a carrier of contaminants, it is not likely to degrade the disposal site. *OR* of the availability of constraints to reduce contamination to acceptable levels within the disposal site and to prevent contaminants from being transported beyond the boundaries of the disposal site. *OR* the likelihood of contamination by contaminants is acceptably low and the material may be excluded from evaluation procedures. *OR* of known contamination.
8.6	Evaluation and testing (Subpart G, 40 CFR 230.61)
Discussion: Provide appropriate discussion of the above factors in Table 6 as appropriate. 
8.7	Actions to minimize adverse impacts (Subpart H) 
The following actions, as appropriate, have been taken through application of 40 CFR 230.70-230.77 to ensure no more than minimal adverse effects of the proposed discharge (see Table 7):

Table 7 – Actions to Ensure Adverse Effects are Minimized	
Actions concerning the location of the discharge		
Actions concerning the material to be discharged		
Actions controlling the material after discharge		
Actions affecting the method of dispersion		
Actions affecting plant and animal populations		
Actions affecting human use		

Discussion: Provide appropriate discussion here. 
8.8	Factual Determinations (Subpart B, 40 CFR 230.11) 
The following determinations are made based on the applicable information above, including actions to minimize effects and consideration for contaminants (see Table 8):

Table 8 – Factual Determinations of Potential Impacts	
Site	N/A	No Effect	Negligible Effect	Minor Effect (Short Term)	Minor Effect (Long Term)	Major Effect	
Physical substrate							
Water circulation, fluctuation and salinity							
Suspended particulates/turbidity							
Contaminants							
Aquatic ecosystem and organisms							
Proposed disposal site							
Cumulative effects on the aquatic ecosystem							
Secondary effects on the aquatic ecosystem							

Discussion: Provide appropriate discussion here. 
8.9	Findings of compliance or non-compliance with the restrictions on discharges (40 CFR 230.10(a-d) and 230.12)
Based on the information above, including the factual determinations, the proposed discharge has been evaluated to determine whether any of the restrictions on discharge would occur (see Table 9):

Table 9 – Compliance with Restrictions on Discharge	
Subject	Yes	No	
1. Is there a practicable alternative to the proposed discharge that would be less damaging to the environment (any alternative with less aquatic resource effects, or an alternative with more aquatic resource effects that avoids other significant adverse environmental consequences?)			
2. Will the discharge cause or contribute to violations of any applicable water quality standards?			
3. Will the discharge violate any toxic effluent standards (under Section 307 of the Act)?			
4. Will the discharge jeopardize the continued existence of endangered or threatened species or their critical habitat?			
5. Will the discharge violate standards set by the Department of Commerce to protect marine sanctuaries?			
6. Will the discharge cause or contribute to significant degradation of waters of the United States?  			
7. Have all appropriate and practicable steps (Subpart H, 40 CFR 230.70) been taken to minimize the potential adverse impacts of the discharge on the aquatic ecosystem? 			

Discussion: Provide appropriate discussion here. 
9.0	General Public Interest Review (33 CFR 320.4 and RGL 84-09)
The decision whether to issue a permit will be based on an evaluation of the probable impacts, including cumulative impacts, of the proposed activity and its intended use on the public interest as stated at 33 CFR 320.4(a).  To the extent appropriate, the public interest review below also includes consideration of additional policies as described in 33 CFR 320.4(b) through (r). The benefits which reasonably may be expected to accrue from the proposal are balanced against its reasonably foreseeable detriments.
9.1	Public interest factors review
All public interest factors have been reviewed and those that are relevant to the proposal are considered and discussed in additional detail (see Table 10):

Table 10 – Public Interest Factors	
Factor	
	None	Detrimental	Neutral (mitigated)	Negligible	Beneficial	Not Applicable	
1. Conservation:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
2. Economics: enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
3. Aesthetics:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
4.  General Environmental Concerns:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
5. Wetlands:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
6.  Historic Properties:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
7.  Fish and Wildlife Values:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
8.  Flood Hazards:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
9. Floodplain Values:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
10. Land Use: enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
11. Navigation:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
12. Shoreline Erosion and Accretion: enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
13. Recreation:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
14. Water Supply and Conservation:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
15. Water Quality:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
16. Energy Needs:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
17. Safety:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
18. Food and Fiber Production:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
19. Mineral Needs:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
20. Consideration of Property Ownership:  enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							
21. Needs and Welfare of the People: enter discussion here *OR* See below for discussion. *OR* Delete this text if explanation is not warranted.							

Additional discussion of effects on factors above: N/A. *OR* describe the above factors as appropriate.

9.2	Public and private need
The relative extent of the public and private need for the proposed structure or work: 

Describe here
9.3	Resource use unresolved conflicts
If there are unresolved conflicts as to resource use, explain how the practicability of using reasonable alternative locations and methods to accomplish the objective of the proposed structure or work was considered. 

There were no unresolved conflicts identified as to resource use. *OR* provide discussion as appropriate.
9.4	Beneficial and/or detrimental effects on the public and private use
The extent and permanence of the beneficial and/or detrimental effects that the proposed work is likely to have on the public and private use to which the area is suited is described below:

Detrimental effects are expected to be minimal and temporary. *OR* minimal and permanent. *OR* more than minimal and temporary. *OR* more than minimal and permanent.

Beneficial effects are expected to be minimal and temporary. *OR* minimal and permanent. *OR* more than minimal and temporary. *OR* more than minimal and permanent.

Provide rationale here as needed to support the determinations above.
9.5	Climate Change
The proposed activities within the Corps’ federal control and responsibility likely will result in a negligible release of greenhouse gases into the atmosphere when compared to global greenhouse gas emissions.  Greenhouse gas emissions have been shown to contribute to climate change.  Aquatic resources can be sources and/or sinks of greenhouse gases.  For instance, some aquatic resources sequester carbon dioxide whereas others release methane; therefore, authorized impacts to aquatic resources can result in either an increase or decrease in atmospheric greenhouse gas.  These impacts are considered de minimis. Greenhouse gas emissions associated with the Corps federal action may also occur from the combustion of fossil fuels associated with the operation of construction equipment, increases in traffic, etc.  The Corps has no authority to regulate emissions that result from the combustion of fossil fuels.  These are subject to federal regulations under the Clean Air Act and/or the Corporate Average Fuel Economy (CAFE) Program. Greenhouse gas emissions from the Corps action have been weighed against national goals of energy independence, national security, and economic development and determined not contrary to the public interest. ADD, if determined appropriate, otherwise delete the following: The applicant voluntarily provided the Corps with an analysis of greenhouse gas emissions that they produced for other local, state, and/or federal requirements, entitled [INSERT NAME], dated [INSERT DATE].  The portions of that document pertaining to the actions within the Corps federal control and responsibility are incorporated by reference.
9.6	Consideration of cumulative impacts
Cumulative impacts are the result of the combined effects of multiple activities that occur in a particular waterbody that persist over time. Cumulative impacts can accrue to a waterbody in a number of ways. Cumulative impacts occur when there are repetitive permitted activities at a specific waterbody over time, and the resources in that waterbody are not able to fully recover between each occurrence of a permitted activity. Cumulative impacts can also occur as a result of multiple permitted activities occurring in a waterbody over time. Cumulative impacts can also be evaluated at watershed scale, by considering multiple permitted activities occurring in that watershed over time. This section of the decision document may include a discussion of activities permitted through DA authorizations that have occurred in the waterbody or watershed over time, and how the proposed activity discussed in this decision document will contribute to cumulative effects to that waterbody or watershed and whether that contribution to cumulative impacts, as evaluated against the current environmental baseline, would be determined to be “not contrary to the public interest.”  

Provide appropriate discussion here.
10.0	Mitigation 
(33 CFR 320.4(r), 33 CFR Part 332, 40 CFR 230.70-77, 40 CFR 1508.1(s))
10.1	Avoidance and minimization
Avoidance and Minimization:  When evaluating a proposal including regulated activities in waters of the United States, consideration must be given to avoiding and minimizing effects to those waters. Avoidance and minimization are described in Section 3 above.  

Describe other mitigative actions including project modifications implemented to minimize adverse project impacts?  (see 33 CFR 320.4(r)(1)(i)) 

Describe here
10.2	 Compensatory mitigation requirement  
Is compensatory mitigation required to offset environmental losses resulting from proposed unavoidable impacts to waters of the United States?  #ACTION_COMPENSATORY_MITIGATION_RQD#. Enter Yes or No if a response was not populated from ORM.

Provide rationale: Describe here
10.3	 Type and location of compensatory mitigation 
10.3.1	Mitigation bank service area 
Is the impact in the service area of an approved mitigation bank? Yes. *OR* No.

If yes, does the mitigation bank have the appropriate number and resource type of credits available? Yes. *OR* No. *OR* N/A.		
10.3.2	In-lieu fee program service area
Is the impact in the service area of an approved in-lieu fee program? Yes. *OR* No. *OR* N/A.

If yes, does the in-lieu fee program have the appropriate number and resource type of credits available?  Yes. *OR* No. *OR* N/A.
10.3.3	Compensatory mitigation
Selected compensatory mitigation type/location(s) (see Table 11):

Table 11 – Mitigation Type and Location	
Mitigation bank credits		
In-lieu fee program credits		
Permittee-responsible mitigation under a watershed approach		
Permittee-responsible mitigation, on-site and in-kind		
Permittee-responsible mitigation, off-site and/or out of kind		

10.3.4	Mitigation hierarchy
Does the selected compensatory mitigation option deviate from the order of the options presented in §332.3(b)(2)-(6)? Yes. *OR* No. *OR* N/A.

If yes, provide rationale for the deviation, including the likelihood for ecological success and sustainability, location of the compensation site relative to the impact site and their significance within the watershed, and/or the costs of the compensatory mitigation project (see 33 CFR §332.3(a)(1)):  N/A. *OR* provide rationale.
10.3.5	Watershed approach
Does the selected compensatory mitigation option follow a watershed approach? Yes. *OR* No. *OR* N/A. 

Is the impact in a watershed with a watershed plan? Yes. *OR* No.

If yes, is the compensatory mitigation consistent with the watershed plan? Yes. *OR* No.

Provide discussion here. 
10.4	 Amount of compensatory mitigation 
#MITAMOUNT#. *OR* If ORM data not entered, provide mitigation amount and type.

Rationale for required compensatory mitigation amount: 

See the attached South Pacific Division Mitigation Ratio Setting Checklist(s). Provide discussion/rationale as needed.

10.5	 Permittee Responsible Mitigation 
For permittee responsible mitigation identified in 10.3.3 above, the final mitigation plan must include the items described in 33 CFR 332.4(c)(2) through (c)(14) at a level of detail commensurate with the scale and scope of the impacts.  As an alternative, the district engineer may determine that it would be more appropriate to address any of the items described in (c)(2) through (c)(14) as permit conditions, instead of components of a compensatory mitigation plan.  Presence of sufficient information related to each of these requirements in the applicant’s mitigation plan is indicated by “Yes” in Table 12.  “No” indicates absence or insufficient information in the plan, in which case, additional rationale must be provided below on how these requirements will be addressed through special conditions or why a special condition is not required:  

Table 12 – Permittee-Responsible Mitigation Plan Requirements	
Requirement	Yes	No	
Objectives			
Site selection			
Site protection instrument			
Baseline information			
Determination of credits			
Mitigation work plan			
Maintenance plan			
Performance standards			
Monitoring requirements			
Long-term management plan			
Adaptive management plan			
Financial assurances			
Other information: Provide discussion here, if necessary			

For any “No”, provide rationale on how the subject component(s) of the compensatory mitigation plan will be addressed as special conditions or why no special conditions are required: 

Provide discussion here.
11.0	Compliance with Other Laws, Policies and Requirements 
11.1	Section 7(a)(2) of the Endangered Species Act (ESA) 
Refer to Section 4.2 for description of the Corps action area for Section 7.  
11.1.1	Lead federal agency for Section 7 of the ESA
Has another federal agency been identified as the lead agency for complying with Section 7 of the ESA with the Corps designated as a cooperating agency and has that consultation been completed? Yes. *OR* No. 

If yes, identify that agency, the actions taken to document compliance with Section 7 of the ESA and whether those actions are sufficient to ensure the activity(s) requiring Department of the Army authorization is in compliance with Section 7 of the ESA: 

If yes, identify agency and provide description here.

Select appropriate conclusion: The Corps has reviewed the documentation provided by the agency and determined it is sufficient to confirm Section 7 ESA compliance for this permit authorization, and additional consultation is not necessary. *OR* Additional consultation is necessary to ensure compliance of the regulated activity with Section 7 of the ESA. 
11.1.2	Listed/proposed species and/or designated/proposed critical habitat 
Are there listed or proposed species and/or designated critical habitat or proposed critical habitat that may be present or in the vicinity of the Corps’ action area? #ESACONSULTREQUIRE#. (Answer Yes or No if ORM data was not entered) Provide supporting information on how you determined this.  If no species or habitat present, conclude with the following statement: The Corps has determined that it has fulfilled its responsibilities under Section 7(a)(2) of the ESA.

Effect determination(s), including no effect, for all known species/habitat, and basis for determination(s):  Provide determination(s) and rationale.  
11.1.3	Section 7 ESA consultation 
Consultation with either the National Marine Fisheries Service and/or the U.S. Fish and Wildlife Service was initiated and completed as required, for any determinations other than “no effect” (see the attached ORM2 Summary sheet for begin date, end date and closure method of the consultation). *OR* N/A. 

Provide additional discussion here as needed to describe consultation(s) with the Service(s).
11.2	Magnuson-Stevens Fishery Conservation and Management Act (Magnuson Stevens Act), Essential Fish Habitat (EFH)
N/A. *OR* delete green text
11.2.1	Lead federal agency for EFH provisions of the Magnuson-Stevens Act
Has another federal agency been identified as the lead agency for complying with the EFH provisions of the Magnuson-Stevens Act with the Corps designated as a cooperating agency and has that consultation been completed?  Yes. *OR* No.  

If yes, identify the agency, the actions taken to document compliance with the Magnuson Stevens Act and whether those actions are sufficient to ensure the activity(s) requiring Department of the Army authorization is in compliance the EFH provisions.

Identify agency and provide description here. 

Select appropriate conclusion: The Corps has reviewed the documentation provided by the agency and determined it is sufficient to confirm compliance for this permit authorization with the EFH provisions, and additional consultation is not necessary. *OR* Additional consultation is necessary to ensure compliance of the regulated activity with EFH provisions of the Magnuson Stevens Act.  
11.2.2	Magnuson-Stevens Act 
Did the proposed project require review under the Magnuson-Stevens Act?  #EFHCONSULTREQUIRE#. (Answer Yes or No if ORM data was not entered) 

Provide rationale here.

 The district engineer determined the proposed activity would not adversely affect EFH.
*OR*
 The district engineer determined the proposed activity may adversely affect EFH and thus requires EFH consultation with NMFS. 

EFH species or complexes
Were EFH species or complexes considered? Enter Yes or No, with discussion as needed. 

Effect determination and basis for that determination: Provide determination(s) and rationale here.
11.2.3	National Marine Fisheries Service consultation 
Consultation with the National Marine Fisheries Service was initiated and completed as required (see the attached ORM2 Summary sheet for begin date, end date and closure method of the consultation). *OR* N/A.

Enter additional discussion here as needed.  
11.3	Section 106 of the NHPA 
Refer to Section 4.3 for permit area determination.
11.3.1	Lead federal agency for Section 106 of the National Historic Preservation Act
Has another federal agency been identified as the lead federal agency for complying with Section 106 of the National Historic Preservation Act with the Corps designated as a cooperating agency and has that consultation been completed? Yes. *OR* No.

If yes, identify that agency, and whether the undertaking they consulted on included the Corps undertaking(s). Briefly summarize actions taken by the lead federal agency.

Identify agency and provide description here.
 
Select appropriate conclusion: The Corps has reviewed the documentation provided by the agency and determined it is sufficient to confirm Section 106 compliance for this permit authorization, and additional consultation is not necessary. *OR* Additional consultation is necessary to ensure compliance of the regulated activity with Section 106 of the NHPA.
11.3.2	Historic properties
Known historic properties present? Yes. *OR* No.

Provide discussion as appropriate. 

Effect determination and basis for that determination: Provide determination and rationale here.  
11.3.3	Consultation with the appropriate agencies, tribes and/or other parties for effect determinations
Consultation was initiated and completed with the appropriate agencies, tribes and/or other parties for any determinations other than “no potential to cause effects.” (see the attached ORM2 Summary sheet for begin date, end date and closure method of the consultation). *OR* N/A.

Provide additional discussion here as needed or delete if not needed.

11.4	Tribal Trust Responsibilities
11.4.1	Tribal government-to-government consultation
Was government-to-government consultation conducted with Federally-recognized Tribe(s)? #TTRCONSULT#. (Enter Yes or No if ORM data not entered) 	

Provide a description of any consultation(s) conducted including results and how concerns were addressed. 

Provide additional discussion here as needed or delete if not needed. 
11.4.2	Other Tribal consultation
Other Tribal consultation including any discussion of Tribal Treaty rights?

N/A. *OR* provide discussion.	
11.5	Section 401 of the Clean Water Act – Water Quality Certification (WQC)
11.5.1	Section 401 WQC requirement
Is a Section 401 WQC required, and if so, has the certification been issued or waived?  

#CWAWQCREQUIRE#.   An individual water quality certification is required and has been granted. *OR* An individual water quality certification is required and has been waived. *OR* A general WQC has been granted. *OR* A general WQC has been waived. *OR* N/A, a WQC is not required.

Provide discussion here as needed or delete. 

11.5.2	401(a)(2) Process
If the certifying authority granted an individual WQC, did the United States Environmental Protection Agency make a determination that the discharge ‘may affect’ water quality in a neighboring jurisdiction? Yes. *OR* No.

If Yes, provide an explanation of the determination of the effect on neighboring jurisdiction. 

Provide additional discussion here.

11.6	Coastal Zone Management Act (CZMA)
11.6.1	CZMA consistency concurrence
Is a CZMA consistency concurrence required, and if so, has the concurrence been issued, objected, or presumed?

N/A, a CZMA consistency concurrence is not required. *OR* An individual CZMA consistency concurrence is required and has been issued by the appropriate agency. *OR* An individual CZMA consistency concurrence is required and has not been issued, objected, or presumed to date.  A provisional permit will be issued for this activity. *OR* An individual CZMA consistency concurrence was required, and the appropriate agency did not respond to the consistency request; therefore, CZMA consistency concurrence is presumed. *OR* An individual CZMA consistency concurrence is required and was objected by the appropriate agency. *OR* A general CZMA consistency concurrence has been issued for this permit.

Provide additional discussion as needed (e.g. if CZMA is presumed waived, discuss why.)
11.7	Wild and Scenic Rivers Act
11.7.1	National Wild and Scenic River System
Is the project located in a component of the National Wild and Scenic River System, or in a river officially designated by Congress as a “study river” for possible inclusion in the system?  #WSRA#. (Enter Yes or No if ORM data was not entered)

If yes, summarize coordination and the determination on whether activity will adversely affect the Wild and Scenic River designation or study status.  Enter additional discussion here as needed.  
11.8	Effects on Corps Civil Works Projects (33 USC 408)
11.8.1	Permission requirements under Section 14 of the Rivers and Harbors Act (33 USC 408) 
Does the applicant also require permission under Section 14 of the Rivers and Harbors Act (33 USC 408) because the activity, in whole or in part, would alter, occupy, or use a Corps Civil Works project?

No, there are no federal projects in or near the vicinity of the proposal. *OR* No, the appropriate non-Regulatory office has determined that there will be no effects to federal projects that require permission from the Corps. *OR* Yes.

The proposed activity also requires authorization pursuant to Section 408 for impacts to the insert name of Corps CW project.  On insert date of Corps decision, the Corps granted *OR* denied Section 408 Permission.  

Provide additional discussion here as needed or delete. 
11.9	Corps Wetland Policy (33 CFR 320.4(b))
11.9.1	Wetland Impacts
Does the project propose to impact wetlands? Yes. *OR* No.

11.9.2	Wetland impact public interest review
Based on the public interest review herein, the beneficial effects of the project outweigh the detrimental impacts of the project.
11.10	Other (as needed)
Provide discussion here as needed. 
11.11	Compliance Statement
The Corps has determined that it has fulfilled its responsibilities under the following laws, regulations, policies, and guidance:

Table 13 – Compliance with Federal Laws and Responsibilities	
Laws, Regulations, Policies, and Guidance	Yes	N/A	
Section 7(a) (2) of the ESA			
EFH provisions of the Magnuson-Stevens Act			
Section 106 of the NHPA			
Tribal Trust			
Section 401 of the CWA				
CZMA			
Wild and Scenic Rivers Act			
Section 408 - 33 USC 408			
Corps Wetland Policy (33 CFR 320.4(b))			
Other: N/A. *OR* or enter other laws, regulations, policies, and guidance identified in Section 11.10 above.			

12.0	Special Conditions
12.1	Special condition(s) requirement(s)
Are special conditions required to ensure minimal effects, ensure the authorized activity is not contrary to the public interest and/or ensure compliance of the activity with any of the laws above? Yes. *OR* No.

If no, provide rationale: Describe rationale  
12.2	Required special condition(s)
Special Condition 1:  Enter specific condition(s) *OR* format the standard special conditions you selected in ORM: 

#SPECIAL_CONDITIONS#

Rationale:  Enter rationale here.
13.0	Findings and Determinations
13.1	Section 176(c) of the Clean Air Act General Conformity Rule Review:  
The proposed permit action has been analyzed for conformity applicability pursuant to regulations implementing Section 176(c) of the Clean Air Act.  It has been determined that the activities proposed under this permit will not exceed de minimis levels of direct or indirect emissions of a criteria pollutant or its precursors and are exempted by 40 CFR Part 93.153.  Any later indirect emissions are generally not within the Corps’ continuing program responsibility and generally cannot be practicably controlled by the Corps.  For these reasons a conformity determination is not required for this permit action. 
13.2	Presidential Executive Orders (EO)
13.2.1	EO 11988, Floodplain Management
This action is not located in a floodplain. *OR* Alternatives to location within the floodplain, minimization and compensatory mitigation of the effects were considered above.
13.2.2	EO 12898, Environmental Justice
Based upon available information, the Corps has determined that portions of the proposed project within our federal control and responsibility would *OR* would not have a disproportionately high and adverse human health or environmental effect on minority populations, low income populations, and/or disadvantaged communities historically marginalized or overburdened by pollution that may be present in the vicinity of the project.

Provide appropriate discussion here, if necessary.
13.2.3	EO 13112, Invasive Species, as amended by EO 13751
There are no invasive species issues involved in this proposed project. *OR* The evaluation provided above included invasive species concerns in the analysis of impacts at the project site and associated compensatory mitigation projects. *OR* Through special conditions, which are listed in this evaluation, the permittee will be required to control the introduction and spread of exotic species. 
13.2.4	EO 13212 and EO 13302, Energy Supply and Availability
The proposal is not one that will increase the production, transmission, or conservation of energy, or strengthen pipeline safety. *OR* The review was expedited and/or other actions were taken to the extent permitted by law and regulation to accelerate completion of this energy related project while maintaining safety, public health, and environmental protections. *OR* provide discussion here.
13.3	Findings of No Significant Impact
Having reviewed the information provided by the applicant and all interested parties and an assessment of the environmental impacts, I find that this permit action will not have a significant impact on the quality of the human environment.  Therefore, an environmental impact statement will not be required.
13.4	Compliance with the Section 404(b)(1) Guidelines  
The proposed discharge complies with the Guidelines. *OR* The proposed discharge complies with the Guidelines, with the inclusion of the appropriate and practicable special conditions to minimize pollution or adverse effects to the affected ecosystem.
13.5	Public interest determination
Public interest determination:  Having reviewed and considered the information above, I find that the proposed project is not contrary to the public interest.  The permit will be issued with appropriate conditions included to ensure minimal effects, ensure the authorized activity is not contrary to the public interest and/or ensure compliance of the activity with any of the authorities identified in Section 11.

PREPARED BY:

________________________	Date:   
#PM_FULLNAME#

REVIEWED BY:		

________________________	Date:  
Enter name of appropriate level reviewer

APPROVED BY:

________________________	Date:  
Enter name of appropriate level approver