historic sites survey intensive form - South Dakota State Historical ...

SOUTH DAKOTA STATE HISTORIC PRESERVATION OFFICE
HISTORIC SITES SURVEY INTENSIVE FORM
SITE INFORMATION
*SURVEY DATE: *QUARTER 1:
*SURVEYOR: *QUARTER 2:
*TOWNSHIP:
*PROPERTY ADDRESS: *RANGE:
LEGAL DESCRIPTION:
LOCATION DESCRIPTION:
*COUNTY: *SECTION:
*CITY: ACRES:
OWNER CODE 1: F S L P OWNER NAME:
OWNER CODE 2: F S L P OWNER ADDRESS:
OWNER CODE 3: F S L P OWNER CITY:
HISTORIC SIGNIFICANCE
OWNER STATE:
OWNER ZIP:
*DOE: REGISTER NAME:
QUAD NAME:
*DOE DATE: MULTIPLE PROPERTY NAME:
REASON INELIGIBLE:
SIGNIFICANCE LEVEL 1: N S L
NOMINATION STATUS: SIGNIFICANCE LEVEL 2: N S L
DATE LISTED:
REFERENCE NUMBER: CRITERIA 1: A B C D
PERIOD: CRITERIA 2: A B C D
CATEGORY: CRITERIA 3: A B C D
HISTORIC DISTRICT RATING: C or NC
SIGNIFICANCE NOTES:
* = REQUIRED FIELD
CRITERIA 4: A B C D
1

SOUTH DAKOTA STATE HISTORIC PRESERVATION OFFICE
HISTORIC SITES SURVEY INTENSIVE FORM
STRUCTURE DETAILS
SHPO ID:
*PROPERTY NAME:
OTHER NAME:
CURRENT FUNCTION: FOUNDATION:
CURRENT SUBFUNCTION: ROOF MATERIAL:
HISTORIC FUNCTION: ROOF SHAPE:
HISTORIC SUBFUNCTION: STRUCTURAL SYSTEM:
STYLE:
OCCUPIED: YES or NO TYPE:
ACCESSIBLE: YES or NO WALLS:
STORIES: SIGNIFICANT PERSON:
*DATE OF CONSTRUCTION: CULTURAL AFFILIATION:
ALTERED/MOVED NOTES:
INTERIOR NOTES:
OTHER NOTES:
*PHYSICAL NOTES:
*UTM ZONE: *RESTRICTED: Y or N
*UTM EASTING:
*UTM NORTHING:
* = REQUIRED FIELD
2

SOUTH DAKOTA STATE HISTORIC PRESERVATION OFFICE
HISTORIC SITES SURVEY INTENSIVE FORM
ARCHITECTURAL EVALUATION
PORCH TYPE:
PORCH LOCATION:
PORCH HEIGHT (ft.):
PORCH ROOF:
BAYS/TOWERS TYPE:
BAYS/TOWERS LOCATION:
WINDOW TYPE:
WINDOW LOCATIONS:
CHIMNEY TYPE:
CHIMNEY LOCATION:
DORMERS TYPE:
DORMERS LOCATION:
INTERIOR:
DOOR TYPE:
DOOR LOCATIONS:
ARCHITECTURAL DETAILS:
E = EXCELLENT; F = FAIR; G = GOOD; P = POOR
OVERALL CONDITION: E F G P ROOF CONDITION: E F G P
FOUNDATION CONDITION E F G P PORCH CONDITION: E F G P
WALL CONDITION: E F G P INTERIOR CONDITION: E F G P
WINDOW CONDITION: E F G P
* = REQUIRED FIELD
3

SOUTH DAKOTA STATE HISTORIC PRESERVATION OFFICE
HISTORIC SITES SURVEY INTENSIVE FORM
HISTORY AND CONTEXT
DATE OF AREA SETTLEMENT: DATE TOWN OR ADDITION PLATTED:
ORIGINAL OWNER:
OWNER ORIGINS:
OWNER INFO:
OTHER OWNERS:
SIGNIFICANT PERSON:
CULTURAL AFFILIATION:
BUILDER:
STATE CONTEXT TOPIC:
HISTORY NOTES:
PLANNING
PUBLIC SUPPORT: Y or N HIGH RESEARCH VALUE: Y or N
VANDALISM: Y or N ALTERATIONS: Y or N
THREAT: Y or N DETERIORATION: Y or N
SITE PROTECTED: Y or N MAINTENANCE: Y or N
STABLE: Y or N
ENVIRONMENTAL EFFECTS (weather, erosion, etc.):
* = REQUIRED FIELD
4

SOUTH DAKOTA STATE HISTORIC PRESERVATION OFFICE
HISTORIC SITES SURVEY INTENSIVE FORM
SKETCH MAP
PHOTOGRAPHS
PHOTOGRAPHER: ROLL NUMBER:
DATE OF PHOTO: PHOTO NUMBER:
CAMERA DIRECTION:
* = REQUIRED FIELD
5