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Initial Coordination

Meeting Data

Date / County / Council / Route
NHSYes NoSRAYes No$
Program Cost
Termini
- - -
Section Number / Township/Municipality / Project Number / Functional Classification
TIP Number / Jurisdiction of Route
Location
State Route(s) Included
Existing Cross Section:
Location / Surface
Width / Type / Roadway
Width / Shoulder Type/
Curb & Gutter Type
Average Daily Traffic:
Existing : / Projected / % Trucks:
ADT / Current Year / ADT / Projected Year
Other:
Bridge No.: / (f-f of Curb): / (f-f of Rail):
Sufficiency Rating:
Maximum Grade: / Minimum Horizontal Curve:
High Accident Location(s):
Description of Proposed Work:
Design Policy: / 3R / Rural / Urban / Bicycle Guidelines
Proposed Cross Section:
Location / Surface
Width / Type / Roadway
Width / Shoulder Type
Curb & Gutter Type
Bridge No.: / (f-f Curb): / (f-f of Rail):
Required Structural Submittals: / TSL / BLR 10210 / BCR / Other
Any proposed traffic signals ?:Yes No / Location(s):
Are signal warrants met ?: Yes No
Variances:
Item Description / Standard / Justification
Maintenance of Traffic/Detour:
Level of Environmental Significance:
Categorical Exclusion: Does the Project meet the following:
Actions which do not involve potential for extraordinary circumstances.
Actions which involve potential for extraordinary circumstances requiring concurrence from the FHWA because they involve one or more of the following:
(a) / Involve in-stream work requiring non-routine mitigation
(b) / Require an individual section 404 permit from the Corps of Engineers
(c) / Require additional right-of-way (including temporary or permanent grading easements) which involves relocation of residences or businesses or exceeds one or more of the following:
(1) / Ten acres of prime farmland
(2) / Three acres of land per mile of roadway or 10 acre total for a non-linear(spot) improvement (e.g., bridge, intersection)
(3) / Land takes from 10 property owners
(d) / Require substantial changes in access control
(e) / Substantially increase 100-year flood water surface elevations
(f) / Involve impacts on wetlands
(g) / Require preparation of a biological assessment for threatened or endangered species
(h) / Affect the characteristics that would qualify an historic or archaeological resource for inclusion on the National Register of Historic Places
(i) / Take land (permanent or temporary use) from section 106 resource, or
(j) / Take land (permanent or temporary use) from section 4(f) resource, or
(k) / Be controversial on environmental grounds or inconsistent with federal, state or local laws relating to the environment

Procedures in addition to above factors:

Environmental Class of Action Determination (ECAD)
Additional Information:
Short list of project specific items not covered above that may affect the schedule, approval or implementation of the project.
Attachments:
Functional Classification Map with project limits

Printed 10/21/2018Page 1 of 3BLR 22410 (Rev. 05/08/09)