Project Coordination Request for Historical Studies Project Project Name: <Enter Project Name> Project Description: <Enter Project Description> Control Section Job Number (CSJ): <Enter CSJ Nimber> District/County: <Enter Name of District and County> Highway: <Enter Name of Highway> Submittal Date: <Enter Date> SAT=Satisfactory Date Reviewed: <Enter Date> INC=Incomplete MIS=Missing Reviewer: <Enter Name> N/A=Not Applicable Check one box ONLY. Answers are required for questions that have no N/A box. The District completes Section 1 for submission with the necessary information required for all proposed projects. The PCR form and attached information will be reviewed by HIST staff to determine if it meets established Documentation Standards. District’s comments below should reflect known data about the project and identify any limitations that have prevented the District from providing the requested information. This form will be reviewed by ENV HIST staff and returned to the District if the information does not meet Documentation Standards. Section 1 includes the information that is minimally required to properly facilitate the review process. Please submit all relevant documentation with this PCR at one time. Section I. Information Required to Process Historic Resources Coordination and Consultation To be completed by District personnel with all appropriate documentation attached. Quality Control must be performed by District personnel. SAT INC MIS N/A A. District has provided the active CSJ (or equivalent if the project is not a construction project) against which environmental work can be charged. Comments: B. District has entered project has been entered into ECOS. Comments: C. District stated: 1. Project description (must be a short paragraph on this form describing ALL proposed work, including any sidewalks/ADA aspects). 2. Proposed actions subject to federal permitting 3. Targeted ENV clearance date Standard TxDOT Environmental Affairs Division Release Date: December 2013 Version 1 421.01.PCR Page 1 of 6 Project Coordination Request for Historical Studies Project 4. Anticipated letting date 5. “Historic-age” date (let date minus 45 years) Comments: D. District identified: 1. Additional ROW per parcel involved (estimated in acres per parcel involved) and involved parcel acreage 2. Any easements (estimated in acres per parcel involved) and involved parcel acreage Comments: E. District provided aerial maps(s) or equivalent of the project area that include: 1. Existing and proposed ROW boundaries 2. Area of Potential Effects (APE) appropriate for project type 3. Parcel boundaries for properties within the APE 4. Known historic resources 5. Major street names Comments: F. As determined in consultation with HIST, the District provided preliminary plans showing: 1. The existing ROW boundaries 2. Proposed ROW boundaries 3. Any temporary or permanent easements 4. Any ADA/SRTS improvements 5. Property parcel boundaries 6. Building footprints within the APE Comments: G. District provided typical roadway sections Comments: H. District provided proposed roadway sections Comments: Standard TxDOT Environmental Affairs Division Release Date: December 2013 Version 1 421.01.PCR Page 2 of 6 Project Coordination Request for Historical Studies Project I. District provided results of the Texas Historic Sites Atlas search, identifying NHL, NRHP, RTHL and OTHM resources located within one-quarter mile of the project area listed in a table format and identified on color aerial map(s) or equivalent. Comments: J. District provided clear identification of markers proposed to be relocated (as above) and copies of completed CHC consultation letter(s) Comments: K. For Bridge Projects or any project with historic-age bridges in the project area, the District provided: 1. The Bridge Inventory Number 2. Results of Historic Bridge Inventory search, listed in table format 3. aerial map(s) or equivalent with bridge location(s) identified 4. Copies of CHC consultation letter and results (as appropriate for project and in consultation with HIST) Comments: L. District consulted with HIST to determine if rest area(s) have been evaluated for inclusion in the NRHP. The results of the search are: 1. Listed in table format 2. Identified on aerial map(s) or equivalent Comments: N. When right of entry (ROE) is required (as determined in consultation with HIST), the District sent out ENV HIST ROE forms to affected land owners. The District provided copies of dated ROE letters (as sent). Comments: O. If applicable, the District appropriately identified: 1. Consulting Parties (as stipulated by federal and state historic preservation law) 2. Individuals, local governments and known historic preservation groups (listed with contact information) Comments: P. District provided representative and dated photographs of the project area, including: 1. Buildings/structures in the APE and those adjacent 2. Road Features (culverts, bridges, landscaping, etc. Standard TxDOT Environmental Affairs Division Release Date: December 2013 Version 1 421.01.PCR Page 3 of 6 Project Coordination Request for Historical Studies Project 3. Areas of proposed construction Comments: Additional Comments: SECTION I: District Personnel Certification I have reviewed all submitted documents for quality assessment and control. _____________________________________________________ District Personnel Name Standard TxDOT Environmental Affairs Division Release Date: December 2013 ________________________ Date Version 1 421.01.PCR Page 4 of 6 Project Coordination Request for Historical Studies Project THIS PAGE FOR ENV HIST STAFF ONLY TO COMPLETE. Section II. ENV HIST Determinations A. Project information provided is insufficient to determine level of Historic Resource Review and Consultation (see attached comments). PCR form should be resubmitted with requesting information. B. Project information provided is sufficient to recommend that a Reconnaissance Survey be performed.* ENV HIST staff will consult with the District to specify survey needs and to develop a scope of work and a timeline for receiving contract deliverables. C. Project information provided is sufficient to recommend that an Intensive Survey be performed.* ENV HIST staff will consult with the District to specify survey needs and develop a scope of work and a timeline for receiving contract deliverables. * All survey work must meet appropriate Documentation Standards. Please consult with HIST to determine if District requires assistance through an ENV Scientific Services Contract. Additional Comments: Standard TxDOT Environmental Affairs Division Release Date: December 2013 Version 1 421.01.PCR Page 5 of 6 Project Coordination Request for Historical Studies Project THIS PAGE WILL BE SIGNED AND RETURNED TO THE DISTRICT AND IS TO BE INCLUDED WITH THE DISTRICT’S SUBMISSION TO THE REC. Section III. ENV HIST Certification ENV HIST staff determined that the project information is sufficient to record Section 106/Antiquities Code of Texas actions on HIST screen in ECOS. The appropriate NEPA language was submitted to the District and recorded in ECOS. _____________________________________________________ ________________________ ENV/HIST Reviewer Name Date Revision History Effective Date Month/Year Standard TxDOT Environmental Affairs Division Release Date: December 2013 Reason for and Description of Change Version 1 421.01.PCR Page 6 of 6