LA-CR-1

CULTURAL RESOURCES SITE REVIEW FORM

UNITED STATES DEPARTMENT OF AGRICULTURE / NATURAL RESOURCES CONSERVATION SERVICE
SEPTEMBER 2007 / ALEXANDRIA, LOUISIANA

Use in conjunction with the Environmental Evaluation Worksheet CPA-52. To be completed for all applied conservation practices that are considered undertakings including management practices and those that involve ground disturbance. Attach to the form a Topographic Quadrangle Map with location of practices and mail, fax, or email to the Area Office/State Office.

Field Office / Parish
Planner
Program / Date of Request
Owner/Operator / Contract Number
AREA OF POTENTIAL EFFECT (APE)
Parish / Quadrangle Name
Section # / Township / Range
Previous or Current Land Use
Practice Code / Number of Undertakings / Total Estimated Area (Acres) of Disturbance (See PRS Cultural Resources Instructions in FOTG) / Practice Has the Potential to Affect Historic Properties, Including, But Not Limited to Ground Disturbing Actions (See Undertaking List in FOTG - G or PG) / Proposed Construction Date
Yes / No
410 / 2 / 0.2 acres / 5/7/07

HISTORIC PROPERTIES REVIEW

/

Yes

/

No

Is owner/operator aware of any historic structural remains, or artifacts in the APE? Required, if applicable
During the field visit, were there any concentrations of prehistoric and/or historic artifacts, shell middens, Indian mounds, foundations of buildings or other structures over 50 years’ old in the APE? (FOTG, Section II) Required
Are there any National and State Register sites listed in the APE? (FOTG, Section II) Required
Was there any information acquired from a local historian, museum, historical society, historic documents, or other source? (FOTG, Section II) If yes, document in Additional Comments/Recommendations.
Additional Comments/Recommendations:

TO BE COMPLETED AT THE AREA/STATE OFFICE

/

Yes

/

No

Archeological sites have been previously recorded within the APE of this plan. (The data has also been confirmed using the SHPO’s inventory. If No sites have been found, document in CPA-52, file this form in the conservation plan, and proceed with conservation plan.)
Comments:
Signature: / Date:
Print Name: