SECTION 106 CONSULTATION FORK (Cultural Resources)



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SECTION 106 REVIEW FORM

Submit 1 form for group projects. Attach additional pages as necessary.

PART A – Administrative Information

NRCS Office: Date:       County(ies):     

Landowner/Cooperator(s):      

Field Office Conservationist/Project Planner:      

Is NRCS providing financial assistance for implementation of the project?

No NRCS is providing advice or technical assistance only. The undertaking is

exempted from review under Stipulation 3A of the national Programmatic Agreement.

Yes NRCS is planning to provide financial assistance.

What NRCS Program is funding the project? OTHER (Specify)      

Has the project been approved for funding? No Yes Contract Year      

Is there state or other federal funding involved with the project? No Yes

If yes, specify the additional funding source:     

PART B – Project Information

List all practices that are part of the conservation plan/proposed project. Refer to Attachment 3 of the NRCS/UTSHPO MOU to determine if the practices are subject to review. Attach additional pages as necessary.

|Practice | | |Implementation |Practice subject |

|Code |Practice Description |Acres |Date |to review? |

|      |      |      |      | |

|      |      |      |      | |

|      |      |      |      | |

|      |      |      |      | |

|      |      |      |      | |

Other project related information (equipment, construction methods, etc.):     

PART C – Area of Potential Effect (APE) The APE is the geographic area within which an undertaking may directly or indirectly cause alterations in the character or use of historic properties [36 CFR 800.16(d)].

USGS Topographic Map Name:       Map Date:     

Township:       Range:       Section(s):      

Landownership: Private State Federal Tribal

Additional information about the APE (land use history, previous natural or human caused ground disturbance, natural environmental conditions):      

Plot the APE on a 1:24,000 topographic map. Show the locations of the proposed practice(s) – not the entire farm or ranch (unless appropriate). Designate landownership. Submit map along with this form to the CRS.

PART D – Pre-field Check Information

Have any cultural resources reviews/Section 106 consultations been completed in the project area in the past? Yes No

If yes, describe:      

Is the landowner/cooperator aware of any cultural resources in the APE? Yes No

If yes, describe:      

Are there any buildings, structures or features over 50 years old in the APE? Yes No

If yes, describe:      

Are any National Register listed sites in the APE? Yes No

If yes, describe:      

Do extenuating circumstances (particularly dense, unusual, or deeply buried cultural resources or more than 4 cooperators) exist in the APE? Yes No

If yes, describe:      

PART E – Field Check Information

Has the APE been intensively surveyed for cultural resources by Trained Field Office Staff?

Yes No

If no, why was an intensive survey not completed?      

Field Check Date:       Field Check Completed By:      

% Ground Visibility:       No. of Acres Inspected for Cultural Resources:      

Results of Field Check:

Nothing Found

Site(s) Found (site documentation attached) that WILL BE avoided with a 65 foot buffer.

Site(s) Found (site documentation attached) that CAN NOT BE avoided with a 65 foot buffer.

CRS visit and/or evaluation requested

Plot the area that was inspected for cultural resources on the 1:24,000 topographic APE map.

File completed 106 form and send a copy to the Cultural Resources Specialist along with a 1:24,000 topographic map showing the location of the proposed practices, landownership, and the areas that were field checked for cultural resources. Within 30 working days of receiving the completed 106 form, the CRS will send Part F to the field office.

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SECTION 106 REVIEW FORM

PART F – Cultural Resource Specialist Use Only

Date Received:      Date of SHPO File Search:      

Results of file search:      

Determination: No Potential to Effect

No Historic Properties Affected

No Adverse Effect

Adverse Effect

Unknown - additional information needed

Recommendation: Proceed with undertaking(s) as planned

Monitor for cultural resources during construction activities

Conduct an intensive field survey of APE with trained field office staff

Cultural Resources Specialist services required.

Consultation with the SHPO. SHPO has a 30 day comment period.

Tribal consultation.

Other      

Comments:      

_________________________________________ ___________________________

CRS Signature Date

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