Checklist
for Section 4(f) Exceptions for Historic Properties
Control Section Job Number (CSJ): <Enter CSJ Number>
District/County: <Enter Name of District/County>
Property ID: <Enter Property ID>
Property Name: <Enter Name of Property>
The following checklist was developed as a tool to assist in streamlining the Section 4(f) Exception
process and to ensure that all necessary information is documented in the File of Record (ECOS).
Note: This checklist is not all-inclusive and should be modified as appropriate with ENV approval.
For each of the following steps and/or items, check the appropriate box in the columns on the left.
Check one box ONLY.
I. Section 4(f) Defining Criteria for Historic Properties
Yes
No
A. Is the property listed or eligible for the NRHP or NHL?
II. Establishing Section 4(f) Use of the Property
Yes
No
A. Does the project require a temporary use (i.e. temporary easement, construction
easement, etc.)?
III. Establishing Section 4(f) Exception Eligibility
Yes
No
A. Was it determined that the duration of use will be less than the time needed for
construction of the project and there will be no change in ownership?
B. Was it determined that the scope of the work would be minor resulting in minimal
changes to the property?
C. Was it determined that no significant features of the property would be adversely
affected?
D. Was it determined that the occupied segments of the property would be returned to
their as-found conditions or better?
E. Did the Official with Jurisdiction agree that the property was significant and that the
proposed project meets ALL conditions of items in Sections I, II and III above?
Standard
TxDOT Environmental Affairs Division
Release Date: August 2014
Version 1
815.02.CHK
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Checklist for Section 4(f) Exceptions for Historic Properties
IV. Documentation
The following MUST be attached to this checklist to ensure proper documentation of the
Section 4(f) Exception:
1. Brief project description with explanation of how the property will be used.
2. A detailed map of the Section 4(f) property including:
a. Current and proposed ROW
b. Property boundaries
c. Existing and planned facilities
3. Concurrence letter with the Official with Jurisdiction
Standard
TxDOT Environmental Affairs Division
Release Date: August 2014
Version 1
815.02.CHK
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Checklist for Section 4(f) Exceptions for Historic Properties
V. TxDOT Approval Signatures
ENV Technical Expert Reviewer Certification
I reviewed this checklist and all attached documentation and confirm that the above property and
proposed project meet the requirements of 23 CFR 774 for a Section 4(f) Exception finding.
_________________________________________
ENV Personnel Name
________________________
Date
TxDOT-ENV Section 4(f) Exception Final Approval
Based upon the above considerations, this Section 4(f) Exception satisfies the requirements
of 23 CFR 774.
_________________________________________
TxDOT-ENV, PD Director or designee
Standard
TxDOT Environmental Affairs Division
Release Date: August 2014
________________________
Date
Version 1
815.02.CHK
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Checklist for Section 4(f) Exceptions for Historic Properties
The following table shows the revision history for this document.
Revision History
Effective Date
Month, Year
August 2014
Reason for and Description of Change
Version 1 release
Standard
TxDOT Environmental Affairs Division
Release Date: August 2014
Version 1
815.02.CHK
Page 4 of 4