CIVIL

CONTRACTOR DOCUMENT REVIEW

MECH

REVIEW
LOG DATE ELECT
IN COMM NO I&C
A APPROVED SUPPORT
B APPROVED AS NOTE CONTRACTOR
C NOT APPROVED RECORD
D INFORMATION WORKING DOCUMENT

DISTRIBUTION
APPROVAL DOES NOT RELIEVE APPROVED BY
CONTRACTOR FROM RESPONSIBLE
FOR ERROR OR DEVIATIONS FROM
CONTRACT REQUIREMENTS

( )

BY : DATE :
LOG DATE
OUT COMM NO.

0 21/02/2022 Issued For Approval PT. TEKNIKO HEC PT. PLN

Rev. DATE DESCRIPTION PRPD CHKD APPD

OWNER :
PT. PLN ( PERSERO )
Jl. Trunojoyo Blok M I/135, Kebayoran Baru Jakarta 12610
Phone : +62-21-7261875,7261122,7262234, Fax : +62-21-7221330
e-mail : webmaster@pln.co.id
Contract Agreement No. 1594.PJ/DAN.02.01/DIR/2016

PROJECT :
KALSELTENG 2 CFSPP (2 X 100MW)

PT. PLN ( PERSERO ) PUSAT MANAJEMEN PROYEK

PLN DOC NO 1 0 1 1 8 3 - 0 0 - A - 1 3 - Y Y B - 1 8 9 - 1 1 - 0 0

CONTRACTOR :
CONSORTIUM OF
PT TRUBA JAYA ENGINEERING - HYUNDAI ENGINEERING CO.,LTD. - ITOCHU CORPORATION

REV.
SUBCONT/VENDOR DOC. NO. 0

PREPARED BY 21/02/2022 TITLE

PT. TEKNIKO RANGGA INSPECTION AND TEST PLAN BACKFILLING
APPROVED BY 21/02/2022 AT ALL AREA
QA/QC Consortium TSM - WSJ
APPROVED BY CONTRACTOR DOCUMENT NO REV.
0
PT PLN IKCP0-YYB-G-05-189
 PT TEKNIKO INDONESIA
INSPECTION AND TEST PLAN BACKFILLING
AT ALL BUILDING
Subcon: TEKNIKO
ISSUIED DATE : APPROVED BY : DOC No :
21/02/2022 TITLE : INSPECTION AND TEST PLAN AT BUILDING BACKFILLING AT ALL AREA IKCP0-YYB-G-05-189
UNIT ISSUING PAGE REVISION
QAQC 1 0

TABLE OF CONTENTS

1. TABLE OF CONTENT…..............................................................................................................
1
2. INSPECTION TEST PLAN…........................................................................................................
2
3. MATERIAL INSPECTION REPORT BACKFILL MATERIAL…....................................................... 3
4. BACKFILL INSPECTION & TEST PLAN…................................................................................... 4
5. ATTACHMENT….......................................................................................................................
5
5.1. CALIBRATION CERTIFICATE SPEEDY TESTER GAUGE
5.2. CALIBRATION CERTIFICATE DIGITAL SCALE
5.2. TRAINER CERTIFICATE
 PT TEKNIKO INDONESIA
INSPECTION AND TEST PLAN BACKFILLING
AT ALL AREA
Contract doc No : IKCP0-YYB-G-05-189 Subcon: TEKNIKO
DESCRIPTION PLTU CFSPP ( 2 x 100 MW ) PAGE : 2
PROJECT ASAM ASAM KASELTENG 2 REV : 0
Inspection Activity
Inspection
NO Item Activity Referance Document Verifying Document CONTRAC- Owner Remarks
Location SUBCON
TOR PLN
Technical Specification & Procedure
Review all technical specifications, drawing, procedures & work instructions
1.1
1.1.1 All Tech. Spec., Drawings, Proc. are latest revision
Management System Manual, Standard Operating
All tech. spec., drawing, procedures, work instruction shall be clarified, Approved General Instruction, Technical Specification & P/R R/A R/A
1.0. 1.2 Procedure, Document Contract Agreement, -
understood and implemented accordingly Procedures, drawings, etc.
Standard & Code
1.3 Finalise deviation, generate new procedure and work instruction
if required
1.4 Handover work area document W W R
Surface Preparation
2.1 Site clearance condition (Clearing, Grubbing And Stripping)
Clearing includes removal and disposal of trees and downed timber, bush, hedges, bushes
2.2 and other vegetation or organic materials; and rubbish, debris or other foreign or
objectionable materials at grade, except the removal of topsoil.
Grubbing includes removal and disposal of stumps, large roots, buried logs and other
2.3 Applicable Specification, Official Certificate & Material Inspection Subcontractor
2.0 objectionable materials to 1,000 mm below ground surface. Tech. Spec., Drawing, Proc., Gen. Instruction H W RW
Report Workshop
2.4 Measurement of existing ground profile before excavation
2.5 Routing of dewatering discharge lines
Removing of all rubbish , humus, vegetable matter and all or part of the organic topsoil in
2.6
the respective areas, which can be removed by simple excavation methods.
All materials excavated during clearing, grubbing and stripping operations shall be wasted
2.7
in disposal areas
Excavation
Excavation including construction of temporary diversion ditches, culverts, temporary
3.1
access road etc.
3.2 Coordinate and leveling must be check with refer to benchmark Tech. Spec., Drawing, , Proc., Gen. Instruction, Applicable Specification Approved Drawing, Applicable FIELD (ON
3.0 H W RW
3.3 Bottoms of all excavations must be trimmed to line and grade. Standard & Code. Specification & Report Fabrication SITE)
Protection and Support shall be arranged for minimum interference with Electrical,
3.4
mechanical, Piping etc if any.
3.5 Minimum excavation from pipelines, conduits, and the side of trench.
Fill / Backfill Material
General fill material shall be well graded, no more than 15 % passing
4.1
4.0 No. 200 screen, maximum particle size 75 mm
4.2 Type structural fill material
4.3 Optimum moisture content
4.4 Trench Fill material Sand material
Tech. Spec., Drawing, , Proc., Gen. Instruction, Applicable Specification Approved Drawing, Applicable FIELD (ON
4.5 Field Compacted around Structures H W W
Standard & Code. Specification & Report Fabrication SITE)
4.6 Field Compacted Backfill around pipe trench
4.7 Field Compacted Backfill around Fiberglass Reinforced Pipe (FRP)
4.8 Height of backfill
4.9 Maximum size of stone in the backfill material
4.10 Lab test for General backfill materials with gradations / Sieve analisys Test
4.11 Heavy Equipment compacted rolling around structure
Fill/Back Fill Test Frequency Tech. Spec., Drawing, , Proc., Gen. Instruction, Applicable Specification Approved Drawing, Applicable FIELD (ON
5,0
5.1 Bearing test interval frequency Standard & Code. Specification SITE) H W W
Documentation
6.1 Summary monitoring or Quality Inspection report activity R&A R&A
Approved Drawing ,Applicable Specification,All Quality Document
6,0 6.2 Calibration Certificate of equipment test Contract, Tech. Spec., Proc. R
as per Contract (Inspection Reports, NCR, MDR,Warranty, Punch
6.3 QAQC review of site generated document R R
List, Etc.)
6.4 Mill certificate material & manufacture certificate
Legend : P = Preparation, W = Witness, SW = Spot Witness, RW = Random Witness, R = Document Review, H = Hold Points, A=Approved
Standard and code : ASTM Mechanical Test : Destructive Test
: DIN : Non Destructive Test
: AS/NZS
 KALSELTENG 2 CFSPP (2 X 100MW)
OWNER : PT PLN (PERSERO)
CONTRACTOR :
CONSORTIUM OF
PT TRUBA JAYA ENGINEERING - HYUNDAI ENGINEERING CO.,LTD. - ITOCHU
CORPORATION

TITLE :INSPECTION AND TEST PLAN AT BUILDING BACKFILLING AT ALL AREA Subcon: TEKNIKO
Contract Doc No : IKCP0-YYB-G-05-189 PAGE : 3
INSPECTION AND TEST REPORT FOR EXCAVATION / GRADING
Sub-Cont : No. Report :

Owner : Drawing No. :

Project : Type Inspection :

Subject : Date :

Check
No Description Acceptance Criteria Remark
Acc. Rej. N/A
EXCAVATION
1.1 The work site is cleared Visual
1.2 All the grasses, weeds & roots are stripped and removed Visual
slope is not less than 1
1.3 Excavation is performed to the lines, grades and slopes vertical to 2 horizontal
1 or method statement
1.4 Excavation is kept free from water all the time Visual
1.5 Soil condition at the bottom of excavation Visual
1.6 Surface drainage and slope of excavation is safe Visual
1.7 Soil is contaminated ? (Y/N) Visual
GRADING (LEVELING & DRESSING)
2.1 Position check (Width, length shown on approved
Drawing
drawing)

2.2 Depth check (Bottom of excavation) Drawing

2.3 Levelling & Dressing Visual

Accepted Rejected

* Note

Prepared & Checked By Review/Witnessed by Review/Witnessed by Approved By

Sub-Contractor/Construction QA/QC Consortium PT. PLN Pusmanrpo PT. PLN UPP Kalbagtim 4

Sign/Name/Date Sign/Name/Date Sign/Name/Date Sign/Name/Date

 KALSELTENG 2 CFSPP (2 X 100MW)
OWNER : PT PLN (PERSERO)
CONTRACTOR :
CONSORTIUM OF
PT TRUBA JAYA ENGINEERING - HYUNDAI ENGINEERING CO.,LTD. - ITOCHU
CORPORATION

TITLE :INSPECTION AND TEST PLAN AT BUILDING BACKFILLING AT ALL AREA Subcon: TEKNIKO
Contract Doc No : IKCP0-YYB-G-05-189 PAGE : 4
INSPECTION AND TEST REPORT FOR FILLING / BACKFILLING
Sub-Cont : No. Report :

Owner : Drawing No. :

Project : Type Inspection :

Subject : Date :

Check
No Description Acceptance Criteria Remark
Acc. Rej. N/A
Backfilling area is cleaned and all obstructions/ waste
1 Visual
materials removed?
Bedding
Underground Utility and Installation Refer to Interface each
2
Embedded items: Pipe, Cables etc. Pressure/Leakage dicipline
Test
No of layers required N/A

3 As per method
Maximum Thickness of each Layer
statement

- Under structure and

slab : 90%
Compaction & Compaction Test
- Under General Site :
4 80%
As per method
Compaction is done by Rammer / Compactor
statement
As per method
5 Maximum Dry Density of backfill material (MDD) statement
or ASTM D 1557
As per method
6 Optimum Moisture Content of backfill material (OMC) statement
or ASTM D 1557

Accepted Rejected

* Note

Prepared & Checked By Review/Witnessed by Review/Witnessed by Approved By

Sub-Contractor/Construction QA/QC Consortium PT. PLN Pusmanrpo PT. PLN UPP Kalbagtim 4

Sign/Name/Date Sign/Name/Date Sign/Name/Date Sign/Name/Date

 KALSELTENG 2 CFSPP (2 X 100MW)
OWNER : PT PLN (PERSERO)
CONTRACTOR :
CONSORTIUM OF
PT TRUBA JAYA ENGINEERING - HYUNDAI ENGINEERING CO.,LTD. - ITOCHU
CORPORATION

TITLE :INSPECTION AND TEST PLAN AT BUILDING BACKFILLING AT ALL AREA Subcon: TEKNIKO
Contract Doc No : IKCP0-YYB-G-05-189 PAGE : 5
INSPECTION AND TEST REPORT FOR FILLING / BACKFILLING
Sub-Cont : No. Report :

Owner : Drawing No. :

Project : Type Inspection :

Subject : Date :

Layer No.:
Ƴdry lab (gr/cc) =
Optimum Moisture Content (speedy test) =
Ƴsand (gr/cc) =

A.) BULK DENSITY

THICKNESS mm
Wt. OF WET SAMPLE FROM THE HOLE (Ws) gr
Wt. OF SAND + CYLINDER BEFORE POURING (W1) gr
Wt. OF SAND + CYLINDER AFTER POURING (W2) gr
Wt. OF SAND IN HOLE + CONE (W1 - W2) gr
Wt. OF CONE (W3) gr
Wt. OF SAND IN HOLE (Wb = W1-W2-W3) gr
RATIO (R= Ws / Wb)

BULK DENSITY OF SAMPLE (P = R x Ys) gr/cc

DRY DENSITY OF SAMPLE (Pd = P*100/(Wc+100)) gr/cc

COMPACTION = (Pd*100) / (Ƴdry lab) %

B.) MOISTURE CONTENT DETERMINATION

Wt. OF CAN + WET SOIL, (P)
T
S

Wt. OF CAN + DRY SOIL, (Q)

TE

Wt. OF WATER, (R=P-Q)

Y
D

Wt. OF CAN, (C)

E
E
P

Wt. OF DRY SAMPLE, (Md= Q-C)

S

MOISTURE CONTENT, (Ww= (W*100) / Md) %

Accepted Rejected

* Note

Prepared & Checked By Review/Witnessed by Review/Witnessed by Approved By

Sub-Contractor/Construction QA/QC Consortium PT. PLN Pusmanrpo PT. PLN UPP Kalbagtim 4

Sign/Name/Date Sign/Name/Date Sign/Name/Date Sign/Name/Date

CALIBRATION CERTIFICATE