*Pages 1--8 from Microsoft Word - 28394.doc* Federal Communications Commission FCC 03- 125 3- 1 ATTACHMENT 3 New Tower Submission Form (Form NT, Cover Sheet, and Instructions) Instructions for New Tower Submission Form (Form NT) The Telecommunications Working Group of the Advisory Council on Historic Preservation 1 has developed this Submission Packet to assist carriers, broadcast companies, tower companies, cultural resource professionals and others involved with communications tower and antenna projects with preparation of the documentation required by the Section 106 historic preservation review process. Applicants may compare this New Tower Submission Packet (Form NT) with the Collocation Submission Packet (Form CO) (Attachment 4 to the Nationwide Agreement) to understand the similarities and differences. As explained in the Nationwide Programmatic Agreement for Review of Effects on Historic Properties for Undertakings Approved by the Federal Communications Commission (“ Nationwide Agreement”), the Applicant should submit the New Tower Submission Packet (Form NT) only: 1. Where the Undertaking is not exempt from Section 106 review under the Nationwide Programmatic Agreement for the Collocation of Wireless Antennas (“ Collocation Agreement”) or the Nationwide Agreement; and 2. Where the Applicant proposes to construct a new Tower 2 rather than collocate its antenna( s) on an existing Tower or non- Tower structure. Form NT should be completed by or on behalf of the Applicant and submitted to the State Historic Preservation Office (“ SHPO”) and/ or Tribal Historic Preservation Office (“ THPO”) prior to the construction of a new Tower that requires SHPO/ THPO review under Section 106 of the National Historic Preservation Act (“ NHPA”), the regulations of the Advisory Council on Historic Preservation (“ Council”), the Collocation Agreement, this Nationwide Agreement or any other programmatic agreement that may be applicable. Submission of a complete and accurate Form NT (with the supporting documentation requested in the Form) should be sufficient to enable the SHPO/ THPO to complete its review of the Applicant’s findings and determinations pursuant to Section VII of the Nationwide Agreement. 1 The Telecommunications Working Group (TWG), which includes representatives from industry, government, historic preservation, tribal, and other groups, was formed in 2000 by the Advisory Council on Historic Preservation to support and streamline the Section 106 process in its application to Undertakings. 2 A “Tower” is any structure built for the sole or primary purpose of supporting Commission- licensed antennas and their associated facilities. 1 Federal Communications Commission FCC 03- 125 3- 2 Although these Instructions and the attached Form NT are intended to provide guidance on the Section 106 process, they are not authoritative and, in the event of any inconsistency, or other conflict, the sources referenced above shall apply. Exclusions Neither the Form NT nor the Form CO need be submitted for any collocation where Section 106 review is not required under the Collocation Agreement, the Nationwide Agreement, or any future programmatic agreement that excludes undertakings from such review. I. Exclusions Under Nationwide Agreement Applicable to New Towers A. Section III of the Nationwide Agreement identifies a number of situations where review of a proposed undertaking under Section 106 is not necessary. B. In situations covered by Section III, Applicants should not provide a Submission Packet to the SHPO/ THPO. C. Where an undertaking is to be completed but no submission is made to the local SHPO/ THPO because of the availability of one or more exclusions, the Applicant should retain in its files documentation of the basis for each exclusion should a question arise as to the Applicant’s compliance with Section 106. Upon provision to the SHPO/ THPO of a Submission Packet (Form NT), the Applicant is deemed to have made a request for review of a finding( s), determination( s), or both for purposes of Sections VI and VII of this Nationwide Agreement and the review period specified in Section VII of this Nationwide Agreement will begin. Cover Sheet for New Tower Submission Form (Form NT) [separate page] 1. Key findings and determinations: a. [ ] No Historic Properties in APE b. [ ] “No effect” on Historic Properties in APE c. [ ] “No adverse effect” on Historic Properties in APE d. [ ] “Adverse effect” on Historic Properties in APE 2. Full name of Applicant with name, address, e- mail address, and telephone number of Applicant’s contact person( s) on this project. 3. Full name of Consultant or other representative acting on behalf of Applicant with name, address, e- mail address, and telephone number of contact person( s) on this project. Attach summary of Consultant’s qualifications. 2 Federal Communications Commission FCC 03- 125 3- 3 4. Project name and any project number( s) assigned by Applicant, Consultant, or others. 5. Project Status: a. [ ] Construction planned but not yet commenced; b. [ ] Construction commenced on [date] but not yet completed; c. [ ] Other ________. 6. Provide exact location of project. To the extent reasonably available, the location information should include the street address, longitude and latitude, and a legal description of the location. Elements of Collocation Submission Packet (Form NT) [separate page] 1. Contact Information Date: ____________________________________________________________ Name of Applicant/ Company: ________________________________________ Address of Applicant: ________________________________________________ Phone: __________________________ Fax: _____________________________ Applicant's Representative/ Consultant: __________________________________ Title: ______________________________________________________________ Address: ___________________________________________________________ Phone: __________________________ Fax: ______________________________ Email Address: ______________________________________________________ Applicant will be: New Tower Owner Carrier using New Tower Other (explain) 3 For additional information, SHPO/ THPO should contact: Applicant Applicant’s Representative Other (explain) Correspondence should be addressed to: Applicant Applicant’s Representative Other (explain) 3 PCIA suggests deleting the box for “Carrier using New Tower.” 3 Federal Communications Commission FCC 03- 125 3- 4 2. Site Information a. Site name and Identification Number: ____________________________ Identification Number above is: temporary reference number used by consultant, or permanent reference number used to identify the tower other (explain): ____________________________________________ b. Street Address of Site: _________________________________________ City: ________________________ State: ____________ Zip: ___________ County: ____________________ Township:_________________________ c. Nearest Cross Roads: ___________________ / ______________________ d. Site Universal Transverse Mercator (UTM) Coordinates or Latitude/ Longitude (if available). e. Proposed tower height:___________________________________________ f. Tower type: guyed tower monopole self- supporting other g. Type of tower lighting, if any________________________________________ h. Describe surrounding land use of leased or owned property and any access roads, utility lines, or other easements related to the site. 3. Initiating Section 106 Consultation a. State and/ or Tribal Historic Preservation – List SHPO/ THPO with jurisdiction over this project. i. Could this project potentially affect Historic Properties located on tribal lands? If so, identify tribes contacted. If not, explain how this determination was made. ii. Could this project potentially affect Historic Properties located off tribal lands to which an Indian tribe or Native Hawaiian organization attaches religious and cultural significance? If so, identify tribes contacted. If not, explain how this determination was made. 4 Federal Communications Commission FCC 03- 125 3- 5 b. Public Involvement – Because applicable rules require notice to the public of undertakings and an opportunity to comment that reflects the nature and complexity of the undertaking, describe measures taken to obtain public involvement in this project. c. Local Government – Has local government been contacted as a consulting party pursuant to Section V. A. of the Nationwide Agreement? If so, list local government agencies contacted. If not, explain why this has not occurred. d. Additional Consulting Parties – List any additional consulting parties (individuals or organizations with demonstrated interest in the project) that have been identified and any that have been contacted. 4. Identification of Historic Properties Attach continuation sheets as necessary; include key locations of all Historic Properties to maps and key descriptions of Historic Properties to photos. a. Area of Potential Effects (APE) – Describe the APE for the proposed project and how this APE was determined, see VI. B of the Nationwide Agreement. b. Previously Identified Historic Properties i. Are there any National Historic Landmarks located within the APE? If so, list the name and address of each property. ii. Are there any properties or historic districts located within the APE that are listed in the National Register of Historic Places? If so, list the name and address of each property and the source of survey information. iii. Are there any properties or historic districts located within the APE that have been determined eligible for listing in the National Register of Historic Places? If so, list the name and address of each property and the source of survey information. iv. If Applicant surveyed any previously evaluated historical sites due to the passage of time, changing perceptions of significance, or incomplete prior evaluations, identify and describe these properties. List the name and address/ vicinity of each property, the site inventory number, and the source of survey information. Contact SHPO/ THPO regarding previously surveyed archeological sites. 5 Federal Communications Commission FCC 03- 125 3- 6 c. Field Survey Results i. Evaluate the eligibility of any potentially eligible historic districts, sites, buildings, structures, or objects that have not previously been identified that are located within the APE for the National Register of Historic Places and provide your eligibility assessment. For each property assessed, please reference Photos and Site Location Map. For identified properties, list the name and address of each property, the site inventory number, and the name of the consultant who performed the evaluation. ii. Are there any newly identified archaeological sites located within the APE? If so, evaluate their potential eligibility for the National Register of Historic Places and provide Applicant’s assessment of whether additional survey work is necessary. If Applicant has already completed an archaeological survey, please include the survey report with this checklist. For each site assessed, please reference Photos and Site Location Map. For identified properties, list the name and address of each property, the site inventory number, and the name of the consultant who performed the evaluation. iii. Describe surrounding topography including modern intrusions, existing buffering, and vegetation. Describe any previous ground disturbance. d. Determination Historic Properties Exist Within the APE. Applicant should continue to Section 5, Determination of Effect. No Historic Properties Exist Within the APE. Applicant need not complete Section 5. 5. Determination of Effect Use the Criteria of Adverse Effect and the guidelines found at Sections VI. A and VI. B. of the Nationwide Agreement as the basis for Applicant’s assessment. Check one box below and attach narrative that explains the basis for your determination. The documentation compiled through the use of this checklist should be sufficient for reviewing parties to clearly understand the basis for determinations made about potential project effects on Historic Properties. "No Historic Properties Affected” means that there are Historic Properties present within the APE, but the undertaking will have no effect on them. “No Adverse Effect” means that there are Historic Properties within the Area of Potential Effects, but that the effects of the undertaking do not meet the Criteria of 6 Federal Communications Commission FCC 03- 125 3- 7 Adverse Effect. Explain how each criterion of Adverse Effect does not apply or how the Adverse Effect is being avoided. “Adverse Effect” means that there are Historic Properties within the Area of Potential Effects, the Applicant has applied the Criteria of Adverse Effect, and found that the undertaking will have an adverse effect on one or more Historic Properties that are eligible for or listed in the National Register of Historic Places. The following questions should be answered in the narrative: 1. Which Historic Properties will be adversely affected? Explain how. 2. Has the SHPO/ THPO addressed Adverse Effects in previous communications? 3. What alternatives were considered that might avoid, minimize, or mitigate adverse effects? What conclusion was reached regarding the feasibility of each alternative? 4. How will the public be informed of developments regarding the Section 106 consultation process? 5. What mitigation options are proposed by the Applicant to resolve the adverse effect of the project? 6. Exhibits a. Photos (Number all photos and key the photos to Photo Map) i. Color photos showing view from proposed tower site in all compass directions, labeled with N/ S/ E/ W view from the tower. Photo coverage of 360 degrees is recommended. If surveyed properties are visible from the proposed tower site, include additional views from site towards Historic Properties and indicate distance between the site and each property. For all photos, label compass direction and date photos were taken. ii. Color photos of existing site conditions. Key photos to description of topography and previous ground disturbances in Field Survey section. iii. Color photos of potentially eligible Historic Properties that are reasonably available within the Area of Potential Effects. Include photos of all buildings greater than 45 years old. In urban areas where there are large numbers of buildings greater than 45 years old that do not appear to meet the National Register Criteria, Applicant may include a limited number of representative streetscape photos. However, in all cases Applicant must provide sufficient photos in urban areas to support its eligibility assessment and effect determination. 7 Federal Communications Commission FCC 03- 125 3- 8 b. Maps i. Topographic Map – 7.5- minute quad map showing location of proposed tower site. Show Area of Potential Effects. If map is copied from original, include key with name of quad and date. ii. Site Location Map – Mark location of proposed tower site and any new access roads required. Show Area of Potential Effects. Applicant must also show the location of any surveyed Historic Properties. Provide key for any symbols, colors, identifiers used. iii. Photo Map – Applicant may duplicate the Site Location Map (without the Historic Properties). Mark where all photos were taken and indicate direction of view. 8