The National Park Service’s

National Maritime Heritage Grants

Environmental Screening Worksheet

This worksheetshould be attached to anyNEPA documentationand sent to Kelly Spradley-Kurowski, National Maritime Heritage Grant Manager, for finalreview. This worksheetshall be completed and signed by the SHPO/THPO office providing the subgrant for the project work. The Categorical Exclusion Form (if applicable) will be reviewed and signed by Kelly Spradley-Kurowski.

A. PROJECT INFORMATION

ProjectTitle: Click here to enter text.

Grant Number:Click here to enter text.

Program Area (check one from Education or Preservation):

EducationProjects☐Maritime Heritage Collections ☐Maritime Heritage Areas ☐Maritime History Programs

☐Maritime Field Programs ☐Preservation of Maritime Skills ☐Facilities Improvements ☐Maritime Resource Replicas

Preservation Projects Preservation ☐Preservation ☐Reconstruction ☐Rehabilitation ☐Restoration

Subgrant Recipient: Click here to enter text.

Project Address: Click here to enter text.

ProjectCoordinator/Director:Click here to enter text.

Property Owner (if different from Subgrant Recipient): Click here to enter text.

National Register Status (if applicable): Click here to enter text.

B. PROJECT DESCRIPTION AND LOCATION—BOTH REQUIRED[To beginthe statutory compliance file,attach to this worksheetrelevant materials such as maps, sitevisit notes,agency consultation, data, reports,categorical exclusionform (ifapplicable).]

Click here to enter text.

Background Information is attached (if applicable)☐Yes☐No

C. SECTION 106 REVIEW

Section 106 review for National Maritime Heritage Grant projects is governed by a Programmatic Agreement (PA) between the NPS, Advisory Council on Historic Preservation (ACHP), and National Council of State Historic Preservation Officers (NCSHPO), which is accessible via the NMHG website: According to the procedures specified in the PA, as part of the grant application process, the SHPO provided an opinion to the NPS as to the potential for effects to historic properties under each grant proposal in their state. Once grant recipients were determined, the NPS completed all required tribal/public notification consultation steps.

Section 106 Effects Determination: ☐No Effect ☐No Adverse Effect ☐Adverse Effect

If an Adverse Effect determination has been reached you must contact the National Park Service per the Programmatic Agreement for NMHG funding AND no CE can be taken. Additionally, review Section E, Mandatory Criteria. If your project falls into any of the listed issuesin Section E based on the above project information your project cannot claim an exclusion you must notify the National Park Service immediately to determine your next steps.For all other projects proceed with the Environmental Screening Worksheet to determine IF a categorical exclusion can be taken.

D. RESOURCE EFFECTS TOCONSIDER

Consider the context,duration andintensityof effects onresources.

Are any measurable impacts possible on the following physical, natural or cultural resources?

Yes? No? Data Needed to Determine?

  1. Geological resources – soils, bedrock, streambeds, etc.

☐Yes☐No ☐Data Needed

  1. Air quality☐Yes ☐No ☐Data Needed
  2. Soundscapes☐Yes ☐No ☐Data Needed
  3. Water quality or quantity☐Yes ☐No ☐Data Needed
  4. Streamflow characteristics☐Yes ☐No ☐Data Needed
  5. Marine or estuarine resources☐Yes ☐No ☐Data Needed
  6. Floodplains or wetlands☐Yes ☐No ☐Data Needed
  7. Land use, including occupancy, income, type of use

☐Yes ☐No ☐Data Needed

  1. Rare or unusual vegetation, old growth timber, riparian

☐Yes ☐No ☐Data Needed

  1. Species of special concern (plant/animal/state or Federal listed or proposed for listing) or habitat

☐Yes ☐No ☐Data Needed

  1. Unique ecosystems, biosphere reserves, World Heritage

☐Yes ☐No ☐Data Needed

  1. Unique or important wildlife or wildlife habitat ☐Yes ☐No ☐Data Needed
  2. Unique or important fish or fish habitat☐Yes ☐No ☐Data Needed
  3. Introduction/promotion of non-native species☐Yes ☐No ☐Data Needed
  4. Recreation resources, including supply, demand,visitation, activities, etc. ☐Yes ☐No ☐Data Needed
  5. Socioeconomics, including employment, occupation, income changes, tax base, infrastructure ☐Yes ☐No ☐Data Needed
  6. Minority and low-income populations, ethnography, size, migration patterns, etc.

☐Yes ☐No ☐Data Needed

  1. Energy resources☐Yes ☐No ☐Data Needed
  2. Other agency, or tribal, land use plans or policies☐Yes ☐No ☐Data Needed
  3. Resource, including energy, conservation potential

☐Yes ☐No ☐Data Needed

E. MANDATORY CRITERIA: If implemented,would theproposal?

  1. Have material adverse effectson public health or safety?☐Yes ☐No ☐Data Needed
  1. Have adverse effectson such unique characteristics as historic or cultural resources; park,recreation, or refugelands;wilderness areas;wild or scenic rivers; national natural landmarks; sole or principal drinking water aquifers; prime farmlands; wetlands; floodplains; or ecologically significantor critical areas,including those listed on theNational Register or Natural Landmarks? ☐Yes ☐No ☐Data Needed
  1. Havehighly controversial environmental effects?☐Yes ☐No ☐Data Needed
  1. Havehighly uncertain and potentially negative environmental effects or involve unique or unknownenvironmental risks? ☐Yes ☐No ☐Data Needed
  1. Establish a precedent forfutureaction or represent a decision in principle about future actions withpotentially significantenvironmental effects? ☐Yes ☐No ☐Data Needed
  1. Be directly related to other actionswithindividually insignificant, but cumulatively significant, environmental effects? ☐Yes ☐No ☐Data Needed
  1. Have adverse effects onpropertieslisted or eligible for listing ontheNational Register of Historic Places?

☐Yes ☐No ☐Data Needed

  1. Have adverse effects onspecies listed or proposed to be listed on the List ofEndangered or Threatened Species, or have adverse effectson designatedCritical Habitat forthese species?

☐Yes ☐No ☐Data Needed

  1. Violate a federal law, or a state, local, or tribal law or requirement imposed for the protection of the environment?

☐Yes ☐No ☐Data Needed

  1. Have a disproportionate,significantadverse effect onlowincome or minority populations (EO 12898)?

☐Yes ☐No ☐Data Needed

  1. Limitaccess to and ceremonial use of Indiansacredsites by Indian religious practitioners or adversely affect thephysical integrity of such sacred sites (EO130007)? ☐Yes ☐No ☐Data Needed
  1. Contribute to the introduction, continued existence, orspread of federally listed noxiousweeds(Federal Noxious WeedControl Act). Contribute to the introduction, continued existence, orspread of non- native invasive species or actionsthat may promote the introduction, growth or expansion of the rangeof nonnative invasive species (EO13112)? ☐Yes ☐No ☐Data Needed

***If you check “YES” to any of the above listed criteria you cannot claim a CE and must complete either an EA or EIS for your project to proceed. Please notify the National Park Service immediately to determine your next steps.

Pleaseanswer thefollowingquestions:
  1. Are the personnel preparing this worksheet familiar with the site,and/or has a site visitbeen conducted? (Attachadditional pages noting whensite visit took place, staff attending, etc.)
    2. Click here to enter text.
  1. Has consultation withall affected agenciesor tribes been completed? (Attachadditionalpages detailing the consultation, including thename, date, and summary ofcomments from other agency or tribal contacts.)
    2. Click here to enter text.

SHPO/THPO SIGNATORY

Based onthe environmental impactinformationcontained inthe statutory compliance file and inthis environmental screening worksheet, environmental documentation for the subject project is complete.

Recommended Action:Choose an item.

Approved:

SHPO/THPO ______Date Click here to enter a date.

Type Name: Click here to enter text.