DNR PROJECT COORDINATION REQUEST FOR ROADWAY and TRANSIT PROJECTS

Wisconsin Department of Transportation (WisDOT) (rev 5/2022)

Purpose: To facilitate interagency coordination utilizing the liaison procedures under the Cooperative Agreement between WDNR and WisDOT.

Goal: Within 30 days of form receipt, the TL and REC/Project Contact should communicate regarding whether additional information is needed by the TL and the timeframe in which the WisDOT project team requested document is needed.

DNR Transportation Liaison	WisDOT Region Environmental Coordinator (Send copy of all coordination to REC)	Project Contact Click or tap here to enter text.
To: Name Phone Number Email Address	From: Name Phone Number Email Address	Name Phone Number Email Address
Design Project ID	Project Route	County & Township/Village/City
Construction Project ID	Project Termini (from FIIPS/CDR)	Section/Township/Range (if a small project, add ¼ of Section also)
Estimated Project Cost (range)	Project Name (from FIIPS/CDR)	Project on Lands of Tribal Interest? Yes No
Type of Document Requested Initial Review Letter (IRL) Final Concurrence Letter (FCL) Amendment to IRL (Attach latest IRL) Amendment to FCL (Attach latest FCL) 401 WQ Certification Other:	Document Delivery Date Information (mm/dd/yyyy) DNR Project Coordination Request Submittal: Date Initial Review Letter Requested By: Date (Provide at least 30 days lead time from DNR Project Coordination Request Submittal) Final Concurrence Letter Requested By: Date -Indicated date of Planned or Advanceable PS&E: Date
Proposed WisDOT Project Classification (Action) Preservation/Restoration, PMM 05-10-05 Resurfacing, PMM 05-10-05 Bridge Rehabilitation, PMM 05-10-05 Reconditioning, PMM 05-10-05 Pavement Replacement, PMM 05-10-05 Bridge Replacement, PMM 05-10-05 Reconstruction, PMM 05-10-05 Expansion, PMM 05-10-05 Miscellaneous, PMM 05-10-05 Preventative Maintenance Bridge Preventive, PMM 05-10-05 Other:	Proposed Work Involved Guardrail Replacement Culvert Replacement, Extensions, Liners or Cleanouts Borrow and/or Waste Site Required Channel Change/Stream Relocation Clearing and Grubbing Dredging Grading Fill Outside Toe of Slope Intersection Improvement Right of Way Acquisition Shoulder Work Storm Sewer In Water Work Other:
Storm Water Management (check all that apply) Estimated Acres of Ground Disturbance (include total acreage of all disturbed areas, plus known select sites) Under 1 acre Over 1 acre WPDES, Transportation Construction General Permit Stormwater Management Plan per TCGP 3.2 (Guidance)	Attachments
For Initial Review Letter Map of Project Limits Wetland Delineation (if available) NHI Public Portal Endangered Resources Preliminary Assessment Endangered Resource Species Surveys Preliminary Engineering Plans Other:	For Final Concurrence Letter Map of Project Limits Wetland Delineation Wetland Impact Tracking Form Special Provision Final Engineering Plans Erosion Control Plans TCGP NOI Other:

Project Narrative

Proposed Project Purpose and Need

Proposed Scope of Work (If requesting an IRL, include a summary of the Proposed Work Involved location in relation to resources that could be impacted) (If requesting an FCL, include a summary of coordination between WisDOT staff and the TL related to resources of concern identified by DNR if needed)

Proposed Bridge and Culvert Work (If bridge or culvert work is part of the Proposed Scope of Work, the following table must be completed)

No bridge or culvert work proposed

Culvert ID*	Culvert Type	Latitude	Longitude	Action
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Bridge ID	Bridge Type	Latitude	Longitude	Action
Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.

*The location and proposed action for all culverts on which work will occur should be included. The culvert ID should be included if applicable.

List of Attachments (A Project Location Map with proposed project limits and aerial map showing resources in project area must be included. Other attachments not referenced on the previous page that may expedite the IRL process include; scoping information, plan and profiles including areas highlighting proposed culvert work, site photos and HSIP application, as applicable. Other attachments not referenced on the previous page that may expedite the FCL process include; 90% plans, natural resource-related Special Provisions and hydraulic analyses, as applicable.)