EOEEA-CZM

THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF UNDERWATER ARCHAEOLOGICAL RESOURCES
100 Cambridge Street, Suite 900, Boston, MA 02114

NOMINATION FOR UNDERWATER ARCHAEOLOGICAL PRESERVE

In accordance with 312 CMR 2, rules and regulations established by the Board of Underwater Archaeological Resources under MGL C. 91, s. 63, as amended, the undersigned herewith makes nomination of underwater archaeological resources to be designated an underwater archaeological preserve pursuant to section 2.15(3) of those rules and regulations.

Nominator's Name(s):(Required)

(Enter first and last names of nominator[s])

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone Number (Day):(Required)

Telephone Number (Evening):

Email Address:(Required)

SITE LOCATION

Name of Site:(Required)

Nearest City or Town:(Required)

Name of Water Body:(Required)

Depth of Water (in feet):(Required)

Longitude/Latitude:(Required)

Additional Description of Location:(Required)

Dive Conditions:(Required)

(Indicate the exact location on attached NOAA nautical chart or USGS topographic map, specify technique used to fix position, and note other identifying features which define location of the site. You may also be required by the Board to complete a site file form. Use the space provided and attach sheets if necessary to complete this section. Attach additional sheets as needed at end of this form.)

Description of the Underwater Archaeological Resources:(Required)

(Include physical condition; attach images as needed at end of this form.)

A Statement of any Evidence Concerning Placement:(Required)

(Attach additional sheets as needed at end of this form.)

You May Include any Other Information you Believe May Assist the Board in Assessing Your Application:(Required)

(Attach additional sheets as needed at end of this form.)

Signature:(Required)

Type your name

Date:(Required)

Enter date of signature

Attach additional pages, photos, etc. here, if necessary. (Maximum total of all files uploaded to this form must be less than 20 MB).

Drop files here or

Max. file size: 20 MB.