aerial map: Is the project site listed in the National Register of Historic Places (National Register), or in/near a designated local or National Register Historic District? The internet address for the National Register is: Yes No If Yes, identify the name of the historic property, site and/or district and the National Register document number: 3. Site photographs, maps and drawings Attach site photographs. Site photographs are required for all projects. Use the following as a checklist for photographs of your project. Attach photographs to this document or as accompanying documents in your submission. Labeled, color, ground-level photographs of the project site: Required Labeled, color photograph of each location where equipment would be attached to a building or structure: Required Labeled, color aerial photograph of the project site: Required Labeled, color aerial photographs that show the extent of ground disturbance (if applicable): Attached Labeled, color ground-level color photographs of the structure from each exterior side of the building/structure (applicable only if building/structure is more than 45 years old): Attached Are there technical drawings or site plans available? Yes No If yes, attach: Attached Appendix A has guidance on preparing photographs for EHP review Environmental documentation Is there any previously completed environmental documentation for this project at this proposed project site (e.g., Environmental Assessment, or wetland delineation, or cultural/archaeological study)? Yes No If Yes, attach documentation with this form: Attached Is there any previously completed agency coordination for this project (e.g., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)? Yes No If Yes, attach documentation with this form: Attached Was a NEPA document was prepared for this project? Yes No If Yes, what was the decision? (Check one, and please attach): Finding of No Significant Impact (FONSI) from an Environmental Assessment (EA) or Record of Decision (ROD) from an Environmental Impact Statement (EIS). Name of preparing agency:
aerial map: Is the project site listed in the National Register of Historic Places (National Register), or in/near a designated local or National Register Historic District? The internet address for the National Register is: Yes No If Yes, identify the name of the historic property, site and/or district and the National Register document number: 3. Site photographs, maps and drawings Attach site photographs. Site photographs are required for all projects. Use the following as a checklist for photographs of your project. Attach photographs to this document or as accompanying documents in your submission. Labeled, color, ground-level photographs of the project site: Required Labeled, color photograph of each location where equipment would be attached to a building or structure: Required Labeled, color aerial photograph of the project site: Required Labeled, color aerial photographs that show the extent of ground disturbance (if applicable): Attached Labeled, color ground-level color photographs of the structure from each exterior side of the building/structure (applicable only if building/structure is more than 45 years old): Attached Are there technical drawings or site plans available? Yes No If yes, attach: Attached Appendix A has guidance on preparing photographs for EHP review Environmental documentation Is there any previously completed environmental documentation for this project at this proposed project site (e.g., Environmental Assessment, or wetland delineation, or cultural/archaeological study)? Yes No If Yes, attach documentation with this form: Attached Is there any previously completed agency coordination for this project (e.g., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)? Yes No If Yes, attach documentation with this form: Attached Was a NEPA document was prepared for this project? Yes No If Yes, what was the decision? (Check one, and please attach): Finding of No Significant Impact (FONSI) from an Environmental Assessment (EA) or Record of Decision (ROD) from an Environmental Impact Statement (EIS). Name of preparing agency:
FY%202017%20Environmental%20%20Historic%20Preservation%20Screening%20Form.docx