Section 106 Review Project Summary Form




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OHIO HISTORIC PRESERVATION OFFICE:

RESOURCE PROTECTION AND REVIEW

Section 106 Review - Project Summary Form


For projects requiring a license from the Federal Communications Commission, please use FCC Forms 620 or 621. DO NOT USE THIS FORM.


SECTION 1: GENERAL PROJECT INFORMATION

Date:     


Name/Affiliation of person submitting form:     
Mailing Address:     
Phone/Fax/Email:     
All contact information provided must include the name, address and phone number of the person listed. Email addresses should also be included, if available.  Please refer to the Instructions or contact an OHPO reviewer (mailto:Section106@ohiohistory.org) if you need help completing this Form. Unless otherwise requested, we will contact the person submitting this Form with questions or comments about this project.


  1. Project Info:

1. This Form provides information about:

New Project Submittal:

YES  NO 


Additional information relating to previously submitted project:

YES  NO 


OHPO/RPR Serial Number from previous submission:

     
2. Project Name (if applicable):

     
3. Internal tracking or reference number used by Federal Agency, consultant, and/or applicant to identify this project (if applicable):

     



  1. Project Address or vicinity:

     


  1. City/Township:

     


  1. County:

     


  1. Federal Agency and Agency Contact.  If you do not know the federal agency involved in your project, please contact the party asking you to apply for Section 106 Review, not OHPO, for this information. HUD Entitlement Communities acting under delegated environmental review authority should list their own contact information.

     


  1. Type of Federal Assistance.  List all known federal sources of federal funding, approvals, and permits to avoid repeated reviews.

     


  1. State Agency and Contact Person (if applicable):

     


  1. Type of State Assistance: 

     


  1. Is this project being submitted at the direction of a state agency solely under Ohio Revised Code 149.53 or at the direction of a State Agency? Answering yes to this question means that you are sure that no federal funding, permits or approvals will be used for any part of your project, and that you are seeking comments only under ORC 149.53. 

 

YES  NO 




  1. Public Involvement- Describe how the public has been/will be informed about this project and its potential to affect historic properties. Please summarize how they will have an opportunity to provide comments about any effects to historic properties. (This step is required for all projects under 36 CFR § 800.2): 

     


  1. Please list other consulting parties that you have contacted/will contact about this project, such as Indian Tribes, Certified Local Governments, local officials, property owners, or preservation groups. (See 36 CFR § 800.2 for more information about involving other consulting parties). Please summarize how they will have an opportunity to provide comments:

     
SECTION 2: PROJECT DESCRIPTION AND AREA OF POTENTIAL EFFECTS (APE)

Provide a description of your project, its site, and geographical information. You will also describe your project’s Area of Potential Effects (APE).  Please refer to the Instructions or contact an OHPO reviewer if you need help with developing the APE or completing this form.


For challenging projects, provide as much information as possible in all sections, and then check the box in Section 5.A. to ask OHPO to offer preliminary comments or make recommendations about how to proceed with your project consultation.  This is recommended if your project involves effects to significant historic properties or if there may be challenging procedural issues related to your project.  Please note that providing information to complete all Sections will still be required and that asking OHPO for preliminary comments may tend to delay completion of the review process for some projects.
A. Does this project involve any Ground-Disturbing activity: YES  NO 

(If Yes, you must complete all of Section 2.A. If No, proceed directly to Section 2. B.)




  1. General description of width, length and depth of proposed ground disturbing activity:  

     


  1. Narrative description of previous land use and past ground disturbances, if known:

     


  1. Narrative description of current land use and conditions:

     


  1. Does the landowner know of any archaeological resources found on the property? 

YES  NO  If yes, please describe:    

     



  1. Submit the exact project site location on a USGS 7.5-minute topographic quadrangle map for all projects. Map sections, photocopies of map sections, and online versions of USGS maps are acceptable as long as the location is clearly marked. Show the project's Area of Potential Effects (APE). It should be clearly distinguished from other features shown on the map:

    1. USGS Quad Map Name:

     

    1. Township/City/Village Name:

     


  1. Provide a street-level map indicating the location of the project site; road names must be identified and legible. Your map must show the exact location of the boundaries for the project site. Show the project's Area of Potential Effects (APE). It should be clearly distinguished from other features shown on the map:




  1. Provide a verbal description of the APE, including a discussion of how the APE will include areas with the potential for direct and indirect effects from the project. Explain the steps taken to identify the project’s APE, and your justification for the specific boundaries chosen:

     

  1. Provide a detailed description of the project. This is a critical part of your submission. Your description should be prepared for a cold reader who may not be an expert in this type of project. The information provided must help support your analysis of effects to historic properties, not other types of project impacts. Do not simply include copies of environmental documents or other types of specialized project reports. If there are multiple project alternatives, you should include information about all alternatives that are still under active consideration:

     
SECTION 3:  IDENTIFICATION OF HISTORIC PROPERTIES

Describe whether there are historic properties located within your project APE. To make that determination, use information generated from your own Background Research and Field Survey.  Then choose one of the following options to report your findings. Please refer to the Instructions and/or contact an OHPO reviewer if you are unsure about how to identify historic properties for your project. 



 

If you read the Instructions and you're still confused as to which reporting option best fits your project, or you are not sure if your project needs a survey, you may choose to skip this section, but provide as much supporting documentation as possible in all other Sections, then check the box in Section 5.A. to request preliminary comments from OHPO. After reviewing the information provided, OHPO will then offer comments as to which reporting option is best suited to document historic properties for your project.  Please note that providing information to complete this Section will still be required and that asking OHPO for preliminary comments may tend to delay completion of the review process for some projects.
Recording the Results of Background Research and Field Survey:


  1. Summary of discussions and/or consultation with OHPO about this project that demonstrates how the Agency Official and OHPO have agreed that no Field Survey was necessary for this project (typically due to extreme ground disturbance or other special circumstances).  Please attach copies of emails/correspondence that document this agreement. You must explain how the project’s potential to affect both archaeological and historic resources were considered.




  1. A table that includes the minimum information listed in the OHPO Section 106 Documentation Table (which is generally equivalent to the information found on an inventory form).  This information must be printed and mailed with the Project Summary Form.  To provide sufficient information to complete this Section, you must also include summary observations from your field survey, background research and eligibility determinations for each property that was evaluated in the project APE.




  1. OHI (Ohio Historic Inventory) or OAI (Ohio Archaeological Inventory) forms- New or updated inventory forms may be prepared using the OHI pdf form with data population capabilities, the Internet IForm, or typed on archival quality inventory forms.  To provide sufficient information to complete this Section, you must include summary observations from your field survey and background research. You must also include eligibility determinations for each property that was evaluated in the project APE



  1. A historic or archaeological survey report prepared by a qualified consultant that meets professional standards. The survey report should meet the Secretary of the Interior's Standards and Guidelines for Identification and OHPO Archaeological Guidelines. You may also include new inventory forms with your survey, or update previous inventory forms. To complete this section, your survey report must include summary observations from your field survey, background research and eligibility determinations for each property that was evaluated within the APE.




  1. Project Findings. Based on the conclusions you reached in completing Section 3, please choose one finding for your project. There are (mark one):

 Historic Properties Present in the APE:

 No Historic Properties Present in the APE:


SECTION 4: SUPPORTING DOCUMENTATION

This information must be provided for all projects. 




  1. Photographs must be keyed to a street-level map, and should be included as attachments to this application.  Please label all forms, tables and CDs with the date of your submission and project name, as identified in Section 1. You must present enough documentation to clearly show existing conditions at your project site and convey details about the buildings, structures or sites that are described in your submission. Faxed or photocopied photographs are not acceptable. See Instructions for more info about photo submissions or 36 CFR § 800.11 for federal documentation standards.

    1. Provide photos of the entire project site and take photos to/from historic properties from/towards your project site to support your determination of effect in Section 5.

    2. Provide current photos of all buildings/structures/sites described.

  2. Project plan, specifications, site drawings and any other media presentation that conveys detailed information about your project and its potential to affect historic properties.

  3. Copies or summaries of any comments provided by consulting parties or the public.

SECTION 5: DETERMINATION OF EFFECT


  1. Request Preliminary Comments. For challenging projects, provide as much information as possible in previous sections and ask OHPO to offer preliminary comments or make recommendations about how to proceed with your project consultation.  This is recommended if your project involves effects to significant historic properties, if the public has concerns about your project’s potential to affect historic properties, or if there may be challenging procedural issues related to your project. Please be aware that providing information in all Sections will still be required and that asking OHPO for preliminary comments may tend to delay completion of the review process for some projects.

1. We request preliminary comments from OHPO about this project:

YES  NO 


  1. Please specify as clearly as possible the particular issues that you would like OHPO to examine for your project (for example- help with developing an APE, addressing the concerns of consulting parties, survey methodology, etc.):

     


  1. Determination of Effect. If you believe that you have gathered enough information to conclude the Section 106 process, you may be ready to make a determination of effect and ask OHPO for concurrence, while considering public comments. Please select and mark one of the following determinations, then explain the basis for your decision on an attached sheet of paper:



 No historic properties will be affected based on 36 CFR § 800.4(d) (1). Please explain how you made this determination: 

     
 No Adverse Effect [36 CFR § 800.5(b)] on historic properties. This finding cannot be used if there are no historic properties present in your project APE. Please explain why the Criteria of Adverse Effect, [36 CFR Part 800.5(a) (1)], were found not to be applicable for your project:

     

 Adverse Effect [36 CFR § 800.5(d) (2)] on historic properties. Please explain why the criteria of adverse effect, [36 CFR Part 800.5(a) (1)], were found to be applicable to your project. You may also include an explanation of how these adverse effects might be avoided, reduced or mitigated:

     


Please print and mail completed form and supporting documentation to:

 

Ohio Historic Preservation Office 



Attn: Mark J. Epstein, Department Head

Resource Protection and Review

800 E. 17th Avenue

Columbus, OH  43211-2497


 





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