Information Needed for Modot RES Form

Information Needed for Modot RES Form

Information needed for MoDOT RES Form

Please fill in and e-mail.

Project Information

Stage:

Previous RES:

Job Number:

District:

Location:

County:

TIP Number:

Route/Street:

Date Desired: (Allow 30 days review period, explain if needed sooner)

District Contact:

Submit Date:

Created by:

Submitted by:

Program Year

Prelim Engineering:

Right of Way:

Construction:

Letting Date:

Request R/W Acquisition Environmental Approval:
(for protective or hardship buyouts before NEPA is completed for the entire project)t
Request Env/HP Core Team Members:

Explain the purpose of request (i.e. NEPA Classification, pre-location meeting date, preliminary plan or plans availability, is this an emergency project due to weather, scoping changes, or any other information to help in evaluating the project.

Project Description – termini (no stations)

Describe project improvements in full detail

Changes to project since last RES submittal: (e.g. has this project been “on the shelf” or dormant for 1 year or more, has an alternate been chosen, have ROW lines moved, fill slopes or road closure added or changed?) if yes, explain.

Design/Build

Alternate Technical Concept

(If Checked, explain)

Public / Private / Local Partnership

Project requires road to be closed

Bridge Rehab

Project breakout from previous or larger project

Acres – From all sources (e.g. donated from public or private entities)

Additional R/W:

Temporary Easement

Permanent Easement

No Information:

Is there a possibility that MoDOT will purchase uneconomic remnants and/or property that is in excess of what is immediately needed for the project? (If yes, identify the areas)

Land Disturbance:

Will project involve 1 acre or more of land disturbance

How many acres of tree clearing

Number of Displacements (do not include partial takes that do not displace):

Residential

Yes / No

# of residences

# of people

Commercial

Yes / No

# of businesses

# of employees

Average Daily Traffic

ADT: Construction Year

ADT: Design Year

Bicycle / Pedestrian Consideration

Were pedestrian facilities considered for this project

Yes / No

Were bicycle facilities considered for this project

Yes / No

National Flood Insurance Program (NFIP) and Hydraulic Design Data

Project is in a FEMA identified zone “subject to 100 year flooding”

If so, what zone

Project is in a FEMA defined “floodway

Project involves land purchased through FEMA Hazard Mitigation Grant Program (Flood buyout property (If checked, give details)

Known Concerns: Provide information you have about these resources that you have observed in the area.

Parkland

Wetland/404 Permit

Storm Water/Water Quality

Farmland

Threatened & Endangered Species

Hazardous Waste

Cultural Resources

District Comments