Mo DNR Sec 106 form

URS information

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Project overview

• Project Name

• Federal Agency providing funds, license, or permit

• Applicant

• Contact Person

• Applicant & Contact Person phone numbers

• Address for Response

Location of Project

• County

• Street address

• Location Description (if no street address)

• ZIP Code

• City

• GPS Coordinates and/or Address
  Address

Legal Description of Project Area

• USGS Topographic Map Quadrangle Name & Year

• Township | Range | Section

Project Description in detail.

• Project details. Indicate excavation size, whether building demolition is involved, details of proposed rehabilitation, etc.

Archaeology ( Earthmoving activities)

• Describe any ground disturbances, attach photos.

• Ground disturbance photo

  Media

• Ground disturbance photo

  Media

• Ground disturbance photo

  Media

• Will the project require fill material?

  Yes

  No

• If Yes, indicate proposed borrow areas (source of fill material) on topographic map.

• Borrow site coordinates
  Address

• Are you aware of archaeological sites on or adjacent to project area?

  Yes

  No

• If Yes, identify them on the topographic map..

• Archaeology site coordinates
  Address
• Archaeology site coordinates
  Address

Affected Structures (Rehabilitation, demolition, additions to, or construction near existing structures)

• To the best of your knowledge, is the structure(s) located in any of the following:

• An area previously surveyed for historic properties?

  Yes

  No

• If Yes, provide the name of the survey or District.

• A National Historic District?

  Yes

  No

• If Yes, provide the name of the District.

• A Local Historic District?

  Yes

  No

• If Yes, provide the name of the District.

• Use Mo DNR Section 106 Structures Form to supply the following:
  - Photographs of all structures ( see photography requirements)
  - Map and key indicating location of each photo; photos must be labeled to correspond with map key
  - Brief history of the building(s), including construction dates and building uses.

Additional Requirements

• MAP REQUIREMENTS:
  - Attach a copy of the relevant portion of the current USGS 7.5 minute topo quad (on 8.5 x 11 sheet)
  - Attach a large scale project map (if necessary).

• PHOTOGRAPHY REQUIREMENTS:
  - Clear black & white or color photographs are acceptable.
  - minimum size of 3" x 5"
  - Photos of neighboring or nearby buildings are helpful.
  - Polaroids, photocopies, photos sent by email or fax are not acceptable.
  - Photos must be labeled and keyed to one map of the area.
  Good quality photographs are important for expeditious project review.

Checklist

• Did you provide the following information?

  Select Topographic map (7.5 min quad, quad name and year noted) Thorough description (all projects) Photographs (all structures) other supporting documents, if necessary Work plans, drawings, descriptions for new construction and/or rehabilitations

  • Topographic map (7.5 min quad, quad name and year noted)
  • Thorough description (all projects)
  • Photographs (all structures)
  • other supporting documents, if necessary
  • Work plans, drawings, descriptions for new construction and/or rehabilitations