De MINIMIS REQUEST for CONCURRENCE LETTER to OWJ

STATE AID FOR LOCAL TRANSPORTATION Rev.July 2010 De MINIMIS REQUEST FOR CONCURRENCE LETTER TO OWJ For parks, recreation areas, wildlife or waterfowl refuges Page 1 of 1

<> Date

Name of OWJ Title Agency Address

RE: SP ###-###-###, Add federal project # Name of Project and/or route name From _____ To _____ Request for Concurrence on De Minimis Impact to Park

Dear Mr. ___:

This letter is regarding the proposed impacts to the insert name of park property park property located insert description of location relative to project area , as a result of the insert brief description of the project, ie: reconstruction , bridge replacement project.

As you are aware, this project includes describe the construction aspects that will cause the impact the park, what the impacts to the park will be, and what is proposed to minimize, mitigate or enhance the park (ie: Construction of the stormwater treatment basin will require realignment of the existing paved trail. The existing trail will be replaced with a trail that is equal to, or better than, the original. Vegetation disturbed during construction will be fully restored to a condition at least as good as before the project and existing trees will be relocated to the extent possible or replaced.”)

Under Section 4(f) of the U.S. Department of Transportation Act of 1966, this park property is considered a Section 4(f) resource. A review of the project impacts and proposed construction show that the impacts to the park will be minimal and will not alter or affect the use of the park. Based on this assessment, we intend to make a determination that the impact to the park property would be de minimis.

In order to make the Section 4(f) de minimis finding, your written concurrence that this project will not adversely affect the activities, features, and attributes of the park property is necessary. To acknowledge that you have been notified of the intent to apply the Section 4(f) de minimis finding, and your agreement that the activities, features, and attributes of the park will not be adversely affected, please sign below and return the signed copy to insert FHWA name at the letterhead address. Your prompt response is appreciated.

If you have any questions, please call me at (651) 291-####.

Sincerely,

Insert FHWA name, P.E. Area Engineer

As the official with jurisdiction over insert name of the park, I hereby concur with the recommendation of the project proponents that the use and impacts associated with this project along with the identified avoidance, minimization, and mitigation measures, will not adversely affect the activities, features, and attributes that qualify the property for protection under section 4(f).

______Insert name & title of OWJ Date Insert name of agency