PEMBANGUNAN C02 REMOVAL & DHU DI SP

JATIASRI DAN KARANG BARU UNTUK

PERBAIKAN SALES GAS - SUB PAKET 1 :
JATIASRI
Document: 2122A795OO-16-CI-07-IP-001
No. Legend :
Client : PT. PERTAMINA EP
Equipment: CIVIL FOUNDATION H : Hold Point
Tag No : - W : Witness Point
Project Title
: PEMBANGUNAN C02 REMOVAL & DHU DI SP JATIASRI DAN R : Review
DAN KARANG BARU UNTUK PERBAIKAN SALES GAS- S : Surveillance
SUB PAKET 1 : JATIASRI I : Innitiate
Date : 5 APRIL 2023
Rev. :A
Page : 1 OF 1

INSPECTION & TEST PLAN (ITP) FOR CIVIL FOUNDATION

LEVEL OF INSPECTION
METHOD OF VERIFYING
NO INSPECTION ACTIVITIES ACCEPTANCE /
INSPECTION DOCUMENT SUBCON SIGN CONTRACTOR SIGN OWNER SIGN
REFERENCE

1.0. PROCEDURE/METHOD STATEMENT Review Engineering Doc Engineering Doc - - -

2.0 Material
Visual SNI15-2049-2004 Mill Certificate & Laboratory Test
- Cement I R/W H
Visual ASTM C33 Mill Certificate & Laboratory Test
- Aggregate I R/W H
Visual ASTM C94 Mill Certificate & Laboratory Test
- Water I R/W H
Visual ASTM C494 Mill Certificate & Laboratory Test
- Admixture I R/W H
- Reinforcing Steel Visual/Dimensional SNI 07 -2052-2002 QI-C.2.03 I R/W H
- Joint Filler and Sealer Visual ASTM D994 , ASTM D1751 - I R/W H
3.0 CONCRETE MIXED
- Trial Mix Test QI-C.2.01 I R/W H
- Compressive strength test Test ASTM C94 QI-C.2.04/05 I R/W H
4.0 PREPARATION WORK
- Earthwork Visual ASSHTO & ASTM QI-S.0.01, QI-S.0.02 I R/W H
- Soil compaction test Test ASTM D1557 QI-S.0.01, QI-S.0.02 I R/W H
- Lean Concrete Visual SNI 2847-2013 - I R/W H
5.0 Pilling work
- PDA Test Visual ASTM D4945 Test Report I R/W H
- Pile head of cut off elevation Dimensional/Visual AFC Drawing QI-C.1.02 I R/W H
6.0 Reinforcing Steel Work
- Cut off length Dimensional/Visual AFC Drawing QI-C-2.03 I R/W H
- Overall dimensions of stirrup Dimensional/Visual AFC Drawing QI-C-2.03 I R/W H
- Ties and spiral Dimensional/Visual AFC Drawing QI-C-2.03 I R/W H
7.0 Pile Cap
- Spacing between bars Dimensional/Visual AFC Drawing QI-C.1.02 I R/W H
8.0 Formwork
- Dimension tolerance and location tolerance Dimensional/Visual ACI 117 & ACI 347 QI-C.2.02 I R/W H
- Chamfer Dimensional/Visual AFC Drawing QI-C.2.02 I R/W H
- Embedded Item Visual AFC Drawing QI-C.2.02 I R/W H
- Anchor Bolts Visual ASTM A36 QI-C.2.02 I R/W H
- Embedded Plate Dimensional ASTM A36 QI-C.2.02 I R/W H
- Placing and Curing Visual AFC Drawing QI-C.2.02 I R/W H
- Finishes of Concrete Visual AFC Drawing QI-C.2.02 I R/W H
 SURVEY REPORT
QI - S.0.01
Doc No. : Date :
Client : Page :
Project : Elevation :
Location : Northing :
Ref. Drawing : Easting :
Ref. BM. No. : :

REMARKS :

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Date
 SURVEY DATA REPORT ( Backfill )

QI - S.0.02
Client : Doc. No. :
Project : Date :
Location : Page :
Ref. Drawing :

COORD. ACTUAL ELEVATION ACTUAL

NO POINT REMARKS
N E DESIGN / TOB ELEVATION 1 2 3 4 5 6 7 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

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Signature

Date
 PILING RECORD
QI - C.1.02
Doc. No. : Date :
Project Page :
Client Ref. Elev :
Location : Ref. Drawing :
Rig No. : Water Depth :

HAMMER DATA PILE DATA

Maker : Pile No. : Type :
Model : Pile Length :
Energy : Length Above GL : m Size :
Blow/Min : m kg Length Below GL : m
Ram Stroke : Penetration : Ground Elev : m
Final Set : mm Blow Cut Off Elev : m
S: mm/per Blow Final Tip Elev : m
DRIVING RECORD
Total Blows per Total Blows per Total Blows per Total Blows per
Cm Cm Cm Cm
Blows Cm Blows Cm Blows Cm Blows Cm

Start Splicing Joint I

Finish Joint II
Note Joint III

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 PILING SITE REPORT

QI - C.1.01
Project Total Nos : Doc. No. :
Client Cummulative : Date :
Location : Ref. Drawing : Page :

NO PILE RIG NO. NO. OF SECTION TOTAL TOP OF PILE PENETRATION TO 10 BLOW FOR HAMMER REMARKS
REF. NO. 1 2 3 4 REV. ELEV. LENGTH AGL BGL GL SET TC SIZE FINAL TIP
WELDED
(M) (M) (M) (M) (M) ELEVATION

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 COMPRESSIVE STRENGTH
TEST

QI - C.2.05
Project : Doc. No.
Client : Date
Location : Page

1. General

Placing Date / Time :

Design Compressive Strength : ( Kg/cm2) (28 days)
Concrete Class : ( MPa )
Placing Location / Purpose :

2. Test Result of Concrete

1. Fresh Concrete Test

Slump
Air Content
Fresh Concrete Temperature
Ambient Temperature
Test Cylinder Number
: ( cm )
: (%)
: ( 0C )
: ( 0C )
:

2. Compressive Strength Test

7 Day Strength 14 Day Strength 28 Day Strength

Specimen No. Test Strength Unit WT Test Strength Unit WT Test Strength Unit WT
Date (kg/cm2) (T/m3) Date (kg/cm2) (T/m3) Date (kg/cm2) (T/m3)

* Test Machine No. :

3. Test Result
Acceptable

Not Acceptable

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 POURING CONCRETE RECORD
QI - C.2.04

Project : Doc. No. :

Location : Date :

Cemen Type : …………………………………………………………..……… Page :

Specified Strength of Concrete : ………………………Kg/cm2 ( …………psi )

Delivery Time Slump Poured Total

Date Area / Block Request No. / Vol.
Order Batch Plan On Site (inch) Vol. (m3) (m3)

Remarks :

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 REINFORCING BAR INSTALLATION

QI - C.2.03
Project : Date :
Client : Page :
Location : Reference Drawing :

RESULT
NO ITEM TO CHECK DATE & SIGN REMARKS
YES N/A

1 Size/Length/Quality
2 Bending Radius / Shape
3 Spacing B/W Re-bars
4 Lap Splacing ( Length / Location )
5 Extra Length
6 Hook ( Extra Length / Shape )
7 Hoop / Stirrup ( Shape / Location / Pitch / Hook )
8 Starter Bar ( Shape / Length / Location )
9 Concrete Cover
10 Slab ( Direction / & Lower )
11 Reinforcing for Opening
12 Column / Beam ( Untorsionality )
13 Quality of Cleaning
14 Rigidity of Rebar Assembly
15 Prohibiting item (welding)
Remarks :

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 PRE-POURING CONCRETE

Test / Inspection Items

QI - C.2.02
Project Date
Client Page
Location Ref. Dwg.No.

FORMWORK REBAR

Orientation Size
Location ( Coord. ) Spacing
size Clearance
Elevation Cleanliness
Clean & Oiled
Chamfer
Bracing

EMBEDMENTS MISCELLANEOUS

Anchor Bolts ( Diameter, Length & Type ) Blockouts

Anchor Bolts ( Location & Projection ) Type of Finish
Anchor Bolts Sleeves Curing Method
Thread Protection Const. Joints
Angle Iron HOT / COLD Weather Condition
Inserts Plate Sets/Test Specimen
pipes Truck Tickets
Conduit
Ground Wire

Remarks :

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 TRIAL MIX OF CONCRETE
QI - C.2.01
Project : Date :
Client : Page :
Location :

Construction site
Construction section
Requirements
Impermeability to Water Class of concrete B 25
2
High frost resistance Required strength kg/cm
High frost and de-icing salt resistance Consistency k
Resistance against chemical attacks Slump 5 to 10 cm
Cement content kg/m 3
Fair faced concrete Water-cement ratio =
Pumpable concrete Max. size of aggregate mm
Early strength Air Content vol. - %
Concrete with low heat evolution Time for workability hours

Aggregate Type/Manufacturer/Quarry/Borrowpit
Cement manufacturing plant
Type / class of strength
Additive manufacturer
Type / Name

Grading curve No. k-value :

Govering water cement ratio W/Z Density kg/dm3 Volume dm3 / m3

Required water content, W
Required cement content, Z
Air Content
Aggregate total

Composition for 1 m3 Composition for m3

weight of Weight of
Materials weight of mpist
Percentage Volume Spec. gravity aggregate aggregate Surface moisture
aggregate
s.s.d. s.s.d.
aggregate % dm3 / m3 kg / dm3 kg / m3 kg % kg kg

Cement
Water
Weight of Fresh Concrete
Concrete admixtures
Ultra fine concrete = kg/m3 Cement = kg/m3 Aggregate < 0.25 mm kg/m3 Concrete additive = kg/m3

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