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UTAH
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 underStipulation 3A of the national Programmatic Agreement.
Yes NRCS isplanning 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.
PracticeCode / Practice Description / Acres / Implementation
Date / Practice subject
to review?
YESNO
YESNO
YESNO
YESNO
YESNO
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 MapName: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-fieldCheckInformation
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 Registerlisted sitesin 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.
UTAH
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:
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CRS SignatureDate
10/30/18