Survey Report Cover Page

SURVEY REPORT COVER PAGE

Consultant Project No: / Agency No:
Review and Compliance No: / Cultural Records Office No:

AUTHOR(S):

REPORT TITLE (include client name, undertaking name, survey project type, and report number):

DATE OF REPORT (MO/DY/YR):

LEAD AGENCY (e.g., BLM ADMINISTRATIVE UNIT):

SURVEY ORGANIZATION/NAME:

FEDERAL PERMIT NO. (e.g. BLM CULTURAL RESOURCE USE PERMIT and EXPIRATION DATE):

BRIEF DESCRIPTION OF UNDERTAKING:

SURVEY METHODS:

____ Standard 30 Meter Transects ____ Non-Standard (Describe in body of report)

Survey Width (All Linear Inventory): ___ 100 feet (individual road or pipeline corridor)

___ 150 feet (parallel road/pipeline corridor)

___ Other (indicate width: ______feet)

COUNTY(IES):+

USGS QUAD MAPS (NAME, DATE):+

LAND OWNER:*____BLM____BuREC____FS____NPS____PRIVATE____STATE____USFWS____OTHER (Specify)

LEGAL DESCRIPTION (T/R/Sec/up to 4 qtrs and identify template corner):+

ACREAGE:

FEDERAL SURFACE / BLOCK: / LINEAR: / TOTAL: / TOTAL ACREAGE:
NON-FED SURFACE / BLOCK: / LINEAR: / TOTAL:

FILE SEARCH DATE(S):

FIELD WORK DATE(S) (MO/DY/YR):

FIELD PERSONNEL:+

SURVEY RESULTS: ____ NO CULTURAL MATERIAL ____ #ISOLATED FIND(S) ____ #SITE(S)

+ attach continuation sheets for additional data * check all that pertain

SITE SUMMARY TABLE (Field Agent Use)

Smithsonian Number
Isolated Find Number
Brief Site/isolate type
Previously recorded? (Y/N?)
Previous Eligibility
Previous SHPO Concurrence? (Y/N?)
Current Eligibility
NRHP Criteria (A,B,C, or D)
Contributing Portion? (Y/N?)
Current Project Effect?
Proposed mitigation or protection
measures
Collections? (Y/N)
Land owner
Township
Range
Section
¼’s
Comments
*User may add additional
optional attributes from this point

National Register of Historic Places eligibility: E (Eligible); NE (Not Eligible); U (Unevaluated)

Eligibility Determination: R-Listed on NRHP Register; K-Eligible by NRHP Keeper; C-Eligible-SHPO concurrence;

E-Eligible-Consultant/Agency; U-Eligibility Unknown; N-Not eligible

Effect: NO for sites with no effect; NAE for site with no adverse effects; AE for sites with adverse effect; U for Unknown

Proposed mitigation: e.g., data recovery, avoidance, fencing, sign, etc.

*ATTACH CONTINUATION SHEETS AS NEEDED/EXPAND, ADD OR DELETE INDIVIDUAL SITE COLUMNS AS NECESSARY; Please list sites in alphabetical/numeric order first and isolates after the sites.

Note: Information about the location, character, or ownership of historic properties in the report may not be disclosed to the public unless authorized by the appropriate federal agency and/or the Wyoming State Historic Preservation Office.

EXAMPLE

SITE SUMMARY TABLE (Field Agent Use)

Smithsonian Number
Isolated Find Number / 48SU1021 / 48SU2283 / 48SU4353 / 48SU4354 / AEC-01-274.IF1 / AEC-01-274.IF2
Brief Site/isolate type / Camp / Camp / Lithic/FCR Scatter / Lithic/FCR Scatter / Late Archaic Projectile Point / Tertiary Flake
Previously recorded? (Y/N?) / Y / Y / N / N / N / N
Previous Eligibility / C / U
Previous SHPO Concurrence? (Y/N?) / Y / N / N / N
Current Eligibility / C / E / NE / U
NRHP Criteria (A,B,C, or D) / D / D
Contributing Portion? (Y/N?) / Y
Current Project Effect? / NO / AE / NO / NO
Proposed mitigation or protection measures / Fencing / Data Recovery
Collections? (Y/N) / Y / Y / N / N / Y / N
Land owner / BLM Pinedale Field Office / BLM Pinedale Field Office / BLM Pinedale Field Office / BLM Pinedale Field Office / BLM Pinedale FO / BLM Pinedale Field Office
Township / T27N / T27N / T27N / T27N / T27N / T27N
Range / R1113W / R113W / R113W / R113W / R113W / R113W
Section / 15 / 22 / 22 / 22 / 15 / 22
¼’s / SWNESWSESW / NWNWNENW
NWNENWNENW / SESESESW / NENENENW / SESESWSESE / CENENW
Comments / Road rerouted to avoid site. / Cannot be avoided by project. Site is located in center of proposed well pad. / Site will be destroyed by construction of access road.
*User may add additional
optional attributes from this point

National Register of Historic Places eligibility: E (Eligible); NE (Not Eligible); U (Unevaluated)

Eligibility Determination: R-Listed on NRHP Register; K-Eligible by NRHP Keeper; C-Eligible-SHPO concurrence;

E-Eligible-Consultant/Agency; U-Eligibility Unknown; N-Not eligible

Effect: NO for sites with no effect; NAE for site with no adverse effects; AE for sites with adverse effect; U for Unknown

Proposed mitigation: e.g., data recovery, avoidance, fencing, sign, etc.

*ATTACH CONTINUATION SHEETS AS NEEDED/EXPAND, ADD OR DELETE INDIVIDUAL SITE COLUMNS AS NECESSARY; Please list sites in alphabetical/numeric order first and isolates after the sites.

Note: Information about the location, character, or ownership of historic properties in the report may not be disclosed to the public unless authorized by the appropriate federal agency and/or the Wyoming State Historic Preservation Office.