Environmental Review Exemption Checklist
Requiring Minnesota Historical Society
Database Search
System Name
CRITERIA FOR EXEMPTION FROM ENVIRONMENT REVIEW
BUT REQUIRING HISTORIC DATABASE SEARCH
YES*
NO**
1. The project is limited to minor additions to existing infrastructure and
will not impact any historic properties.
2. The project is only for watermain in previously disturbed soil, typically
road right-of-way and will not impact any historic properties.
Brief description of project (only required if a statement is checked “yes”).
If historic sites/structures are found during the historic database search, explain why these
locations will not be impacted.
*If the response to any statement is “yes”, return this completed form with the Environmental
Review Cover Page to the MDH district engineer for your area along with a copy of the
Archaeological Site and Historic Structures Database Search. This database search can be
generated by contacting Thomas Cinadr with the State Historic Preservation Office (SHPO) @
thomas.cinadr@mnhs.org and asking for an “archaeological site and historic structures database
search”. SHPO will need a brief description of the project as well as the location, including
township, range, and section.
**If all responses are “no”, continue the environmental review process.
Updated 10-19-12