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Home My WebLink AboutT-MOBILE WTF @ 3519 RICHMOND DR. - PDP - 3-11 - REPORTS - CORRESPONDENCELJ NT SUBMISSION PACKET - 4.. Project Status e a, [ X ] Construction not yet commenced; b. [ ] Construction commenced. on [date] c. [ J Construction commenced on [date] completed on [date] 5. Applicant's Determination_ of Effect: a. Direct Effects (check one): FCC FORM 620 _; or, and was: Approved by'OMB 30M1039 I. [ X ] No Historic Properties in Area of Potential Effects.("APE") for direct effects; ii. ,[' ] "No effect" on Historic Properties in APE for direct effects; "No adverse effect" on Historic Properties in APE for direct effects; iv. [ ] "Adverse effect" on one or more Historic Properties in APE for direct effects. b. Visual Effects (check one): i. [ ] No Historic Properties in Area. of Potential Effects (,'APE") for visual effects; ii. [ ] "No effect" on -Historic Properties in APE for visual effects; iii. [ X ] "No.adverse effect" on Historic Properties in APE for visual effects; iv. [ ] "Adverse effect" on one or more Historic Properties in APE for visual effects. Certification and Signature I certify that all representations on this FCC Form 620 and the accompanying attachments are true, correct, and complete. Principal Investigator's Signature: 0-1- -,,_� 17 John F Hoffecker archaeologist/historian Printed Name Title 11 February 2011 Date WILLFUL FALSE SPATE4tENTS 31ADE ON THIS FORM OR ANY A'1"1AcHSIENTS ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. Code, Title 18, Section 1001) ,4YD/OR REVOCATION OF ANY STATIONLICENSE OR CONSTRUCTION PERMIT (U.S. Code, Title 47, 'Section 312(n)(1) AND/ OR FORFEITURE (U.S. Code, Title 47, Section 503). Failure to provide the. Submission Packet and complete the review process under Section 106 of the NHPA prior to beginning construction may violate Section 110(k) of the. NHPA and the Commission's rules. See Section X of the Nationwide Agreement. Applicant's Name: T-Mobile Site Name: Horsetooth Medical Project Number: 20117702 / Site Number' DN04198B FCC Form 620 January 2005 Lj NTSUBMISSION PACKET — FCC FORM 620 Approved by OMB 3060-1039 Does the Principal Investigator satisfy the Secretary, of the Interior's Professional Qualifications Standards?4 YES / NO. Areas in, which the Principal Investigator meets the Secretary of the Interior's Professional Qualification Standards: archaeology & history Other "Secretaryof the Interior qualified" staff who`worked on the Submission Packet (provide name(s) as well as well as the area(s) in which they are qualified): 3. Site Information a. Street Address of Site: 3519 Richmond Drive City or Township: Fort Collins County/ Parish: Larimer State: CO Zip Code;. 80526 b.. Nearest Cross Roads: Shields / Horsetooth c. NAD 83 Latitude/Longitude coordinates. (to tenth of a second): N 406 32'18.149"; W 105° 05'51.531" d. Proposed tower height above ground leve.l:b 60 feet; 18.3 meters e. Tower type: ❑ guyed lattice tower El:self-supporting lattice ® monopole ❑ other (briefly describe tower) The. Professional Qualification Standards are available on. the cultural resources webpage of the National Park Service, Department of the. Interior: <http;//www,cr.nps,gov/local-law/arch stnds_9.htm>. The Nationwide Agreement: requires use of Secretary -qualified; professionals for identification and evaluation of historic properties within, the APE for direct. effects, and for assessment of effects. The Nationwide Agreement. encourages, but does not require, use of Secretary -qualified professionals to identify historic properties within the APE for indirect effects. See Nationwide Agreement, §§ VI.D.1A, VI.D.1:e, VID.2 b, VI.E.5. 5 Include top -mounted attachments such as lightning rods. Applicant's Name: T-Mobile Site Name: Horsetooth Medical Project Number: 20117702 / Site Number: DN04198B FCC Form 620 January 2005 • NT SUBMISSION PACKET — FCC FORM 6.20 Approved by OMB 3060A039 General Instructions: NTSubmission'Packet Fill out the answers to Questions 1=5 on Form 620 and providethe requested. attachments. Attachments should be numbered and provided in the orderdescribed below. For ease of processing, provide the Applicant's Name, Applicant's Project Name, and Applicant's. Project Number in the lower right: hand corner of each page of form 620 and 6ttachments.3' 1. Applicant Information Full Legal Name of Applicant: T-Mobile: Name and Title of Contact Person: Lori Leblanc Address of Contact Person (including Zip Code): 7901 E. LoSuite 300, Denver, Colorado 80230 Phone: 303-367-7000.Fax: E-mail address: Lori.Leblanc(cDT-Mobile.com 2. Applicant's Consultant Information Full Legal'Name of Applicant's Section 106 Consulting Firm: Terracon Consultants, Inc. Name of Principal Investigator: John Hoffecker Title of Principal Investigator: Archaeologist Investigator's Address: 7876 South Niagara Way City: Centennial State: Colorado Zip Code' 80112 Phone: _(303) 220-7646 Fax: (303i 2204646 E-mail Address: ifhoffeck(a)msn.com 3 Some attachments may contain photos or maps on which this information can not be provided. Applicant's Name: TWobile Site Name: Horsetooth Medical Project Number, 20117702/Site Number: DN04198B FCC Form 620 January 2005 • Approved by OMB 3060-103.9 Estimated Time Per Response: .6 to 16 hours New Tower ("NT") Submission Packet FCC FORM 620 Introduction The NT Submission Packet is to be completed by or on behalf of Applicants to construct new antenna support structures by or for the use, of licensees of the Federal Communications Commission (°FCC'). The.Packet (including Form 620 and attachments) Is to be submitted to the. State Historic Preservation Office ("SHPO") or to the Tribal Historic Preservation Office ("THPO"), as appropriate; before any construction or other Installation activities on the site begin. Failure to provide the Submission Packet and complete the review process under Section 106 of the. National Historic Preservation Act '("NHPA" )' prior to beginning'constructlon may violate Section. 110(k) of the NHPA and the Commission's rules. The instructions below should be read in conjunction with, and not. as a substitute for, the "Nationwide Programmatic Agreement for Review of Effects on Historic Properties for Certain Undertakings Approved by the Federal Communications Commission," dated September 2004, ("Nationwide Agreement") and the relevant rules of the FCC (47 C:F.R. §§ 1.1301=1.1319) and the Advisory Council on Historic Preservation CACHP") (36 C.F.R. Part:800)? Exclusions and Scoae of Use The NT Submission: Packet should not be. submitted for undertakings that are excluded from Section 1.06 Review. The categories of new tower construction that are excluded from historic preservation review under Section 106 of the NHPA are described In Section hl of the Nationwide Agreement. Where an undertaking is to be. completed but no.submission'wiil be made to a SHPO or THPO due to the applicability of one or more. exclusions, the Applicant should retain in its files documentation of the basis for each exclusion should a question arse as to the. Applicant's compliance with Section 106. The NT Submission .Packet is to be used only for the construction of new antenna support structures. Antenna collocations that are subject to Section 106 review should be submitted using the Collocation CCO") Submission Packet (FCC Form 621): ' 16 U.S.C. § 470f 2 Section II.A.9, of the Nationwide Agreement defines a "historic property" as: °Any prehistoric or historic district, site, building, structure, or object included in,, or eligible for inclusion In, the National Register maintained by the Secretary of the Interior. This term includesartifacts, records, and remains that are related to and located. within such properties. The term.inciudes properties of traditional religious and cultural importance to an Indian tribe or Native Hawaiian Organization that meet the National Register criteria." FCC'Form 620 January M05