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