Proforma C (For Long Span Brdiges only)

PRADHAN MANTRI GRAM SADAK YOJANA ( PMGSY)

CHECK LIST FOR P.I.U. & S.T.A.
( For Indvidual Bridge works with length more than15 m )
(To be filled by PIU)

1. Location :- State: District : Block :

2. Package No:-

3. Name of the Road: From To

4. Total Length of Road (Km) -

5. Name of Proposed Bridge (if any)

6. Length of Proposed Bridge (Excluding Approaches)

7. Width of Bridge in m:

8. Through Route/ Link Route Nos as per Core Network.:

(i) Is the road a part of core network : YES / NO
if Yes, Sl no. of road CN-I : Sl no. of road CN -VI :
If Yes Through Route/ Link Route No. T- or L-

(ii) Name of the benefitted Habitation (s) (to be cross Sr.N Name of Village Population
checked with CN-VI) with population
1

Total
9. Whether the Road proposal was sanctioned earlier : Yes / No

(i) If Yes, please mention the Phase, MoRD Sanction letter No and Date of sanction :
Phase : MoRD Sanction No. Date

Length Chainage : From : To:

(ii) Cost of the Road work sanctioned: Rs : Lakhs

(iii) Whether any CD/ Causeway was Sanctioned at or nearby location with the road
proposal and whether the same was constructed or not (if yes, the details thereof with
chainage:

(iv) Whether the roadwork has been completed or in progress and likely date of completion:

(v) If not, How the connectivity and movement of traffic was ensured:

(vi) Reasons for not proposing the Bridge at the time of submission of Road proposal:
10. Estimated Cost (Rs. In Lakhs) Item Total Cost (Rs in Lakhs) Cost per m
Approaches
Bridge Super
Structure
Foundation
Others
Total
MoRD Share State Share
(MoRD share and State share to be calculated as per the norms of MoRD/NRRDA)
11. INDEX MAP (not to scale ) : Attached
saperately
Enroute Habitations Name / Chainage

Name
Target Habitation
H1 H2
MDR-42
MSH-6
ROAD

Proposed Bridge Location CD3

12 Typical Sketch of proposed bridge showing schematic arrangement of spans

13. Typical Photographs of proposed Bridge Location.

PHOTO (i) At Chainage

PHOTO (ii) U/S of Bridge Site

PHOTO (iii) D/S of Bridge Site

14. Type of Proposed Bridge :

(I) Submersible Structures like Vented Causeway or Submersible Bridge
(ii) Box Culvert
(iii) Bridge With RCC Piers and Abutments

a. Type of foundation Open / Raft /Well / Pile / Any other

b. Bearing Capacity at Foundation Level

c. Arrangement of Spans
Total Span No. of Vents Clear Span of Vent

d. Critical Levels Road top level (RTL) mtrs.

Average Ground Level(AGL) mtrs.
Nala Bed level (NBL) mtrs.
Ordinary flood level (OFL) mtrs.
Foundation level (FL) mtrs.
Ht. of bridge h= (RTL-NBL) mtrs.
Ht. of bridge H=(RTL-FL) mtrs.
e. Catchment Area
(Catchment area should be based on hydrological survey or from toposheet)
Catchment area served Hect
Heaviest Rainfall mm/hr.
Basis of Design Discharge
Waterway required Sq.M
Waterway provided Sq.M
f. Scour Depth (m)
15. Cost Details Cost Rs.
A. General Costs
Cost of Preparation of DPR (Limited to 1 % of Total cost of Bridge)
B. Brdige Components
Description of Components Quantity Cost Rs. Grade of
concrete
Foundations

Abutments

Parapets

Deck Slab

Piers

Wing Walls

Wearing Course

Joints

Drainage

Bearings- Elastomeric or Roller Bearing

Earthwork (including for foundation)

C. Road Component (for approaches/ Bridge)

Granular Sub base

Soil + Aggregate Mix

WBM Gr -I I

WBM Gr -I I I/ MPM

Prime Coat

Tack Coat

OGPC / Surface Dressing

Seal Coat

D. Protection works

E. Road Logo, other Road Furniture

Total Cost of the Project (Rs)

Total Cost of the Project (Rs) (In Words)

16. Five Year Routine Maintenance

Year Cost in lakhs % Cost
I
II
III
IV
V
Total Maintenance Cost

17. Whether the Bridge has Geometrics as per latest Circular of NRRDA.:
DO.#P-17035/1/2007-Tech. 30th September, 2010. YES / NO

18. Whether the Cost etimates are as per standerd data analysis and S.S.R.

19. Sources and the Lead distances of Materials are as under

Material Source Lead Material Source Lead Distance
Distan
ce
Earth (Km) Cement
Murrum (Subgrade) Emulsion
 Aggregate Bitumen
Sand Steel

This is to Certified that,

1. Span details of bridge tallies with DPR & data uploaded on omms.nic.in. & there is no deviation.
2. Information furnished herewith is true to the best of my knowledge.
3. Total cost of the project, State share & MoRD share worked out by PIU is justified.
4. The proposal of bridge is missing bridge proposal on sanctioned road & in the same stretch as it was sanctioend in previous phase
under PMGSY.

Checked & recommended

DPR Prepared By DPR Checked by
(Name & Sign) (Name & Sign) (Name & Sign)

Assitant Engineer Executive Engineer Suprintending Engineer

Counter Signatures of
Co-ordinator STA :
 To be filled by State Technical Agency

Name of the STA :

Name of Road :

Name of Bridge (if any) :

20. Is the proposed work is for CD/Causeway of any length or brigde with span excluding approaches less YES / NO
than 15m.
STAs need not clear such proposals

21 Is the Proposal entered on the OMMS : Yes/ No

(Data entries to be verified by STA before Clicking the Propopsal)
a. Span of Bridge on web: m. b. Span of Bridge As per DPR

* Span of bridge: C/C distance along the centre line of the bridge between inner faces of dirt walls.

c. Whether type of foundation & resting strata as per survey report justified to be safe YES / NO

d. Whether Hydraulic design is checked & found to be adequete as per site requirements YES / NO

e. Whether RCC designs are checked and found to be economical & safe. YES / NO

f. Whether the provisions made by PIU are sufficient & essentia from economy point of view. YES / NO

22 If the Proposal is for a Bridge for which Road was already Sanctioned
If Yes, Have you verified and satisfied yourself with all the items listed at Sr. No. 7, by PIU Yes / No
Have you satisfied yourself that the road is a part of Core Network Yes / No
23 Are you satisfied with the following
Engineering Surveys (L section, X sections must be verified) Yes / No
Soil/ Material Investigation Yes / No
Hydraulic Studies. Yes / No
( Catchment for structures to be verified from topo sheet. Location and requirement of structures to be
verified from L section and catchment area to be marked on Topo Sheet Copy )

24 Is the design of the following elements as per relevant I S/ IRC codes

Foundations / Abutments / Piers / Deck Slab / Wing Walls Yes / No

25 Does the Estimation Conform to Standard Rate Analysis and SoR generated for Yes / No
the current Phase for PMGSY works and a copy of SoR provided to STA

26 Does the proposal have provisions for

PMGSY Logo Sign Boards and Information Board
Yes / No
27 Whether STA and Superintendent Engineer have visited the site? If Yes, Date of Visit :

Kindly indicate whether the program of visit was informed to NRRDA for prior approval ?
28 Secific Remarks, if any, by STA
( Specific remarks of STA about the overall Bridge Project are necessary on each DPR)

29. Certificates:
Certified that the proposal of bridge is checked & found to be it is missing bridge on sanctioned road & in the same stretch as it was
sanctioend in previous phase under PMGSY.

Certified that the Design and Estimation for the Proposed bridge are based on the latest Circular of NRRDA:vide DO.letter #P-
17035/1/2007-Tech. 30th September, 2010.

Certified that the Design and Estimation for the Proposed bridge are based on the data and SSR provided by PIU Engineers . The
Proposal after final Correction is entered on the OMMS.The Propasal may be considered for clearance.

Technical Scrutiny at STA done by:

Signature Signature Co-ordinator STA:
Name Name Signature
Date Date Name
Date