ࡱ> q  Cbjbjt+t+ 4hAA;]@0`8|! F&$J^VKVK zR:Wt $| (~V"V|TR, bRzR"F&~B bRzR4γj x bR*%`*@" 1BRIDGE SITE DATA SUBMITTAL Always use the current Web version! This Document can be updated weekly! To:From:Division of Structures Design, Sacramento (HQ) (Please Submit this form & accompanying documents electronically)PROJECT MANAGER (SR):  FORMTEXT      PHONE NO.:  FORMTEXT      DESIGN BRANCH CHIEF (SR):  FORMTEXT      PHONE NO.:  FORMTEXT      PROJECT DESIGNER (TE):  FORMTEXT      PHONE NO.:  FORMTEXT      SUBJECT: BRIDGE SITE DATA SUBMITTAL Mail drop at:  HYPERLINK http://onramp/hq/ES/StructureDesign/DesignAndTechnicalServices/PI/piupload.htm http://onramp/hq/ES/StructureDesign/DesignAndTechnicalServices/PI/piupload.htmCHARGE  FORMTEXT      EA:  FORMTEXT      DISTRICT:  FORMTEXT    DATE:  FORMTEXT       District shall establish a local project directory containing the relevant files listed below on a per bridge basis (unless indicated otherwise). Please provide the name of the file in the space provided below. A code  (S) after an item indicates that Structures will provide the information. A code (B) after an item indicates that District and Structures both need to provide the information. All else, and code (D) indicates that District will provide the information. The sole purpose of this submittal is to target the needs of the Structures Designer, the Structures Specifications Engineer, the Preliminary Investigations Unit, and Structures Hydraulics.Note:This submittal will be incomplete if District does not provide the corresponding information listed below. Please click on shaded form fields to make entries or to select menu choices where applicable. (shortcut: press tab on keyboard to advance to next form field and tab+shift to go back.)Structure: FORMCHECKBOX  Bridge (Includes Box Culverts) FORMCHECKBOX  Bridge & walls FORMCHECKBOX  Wall(s) only (all types) FORMCHECKBOX  Seal Slab / Boat Section FORMCHECKBOX  Other e.g. Barrier Rail Replacement/Upgrade, Deck rehab/Overlay, Buildings, Abandonment s, approach slabs only etc. (No Foundation Plan Required or survey info - Minor Alterations to Structure) fill out first two pages only. Explain:  FORMTEXT       Always include a Cover sheet with a brief scope and history User: Read all yellow Highlighted Comment box for suggestions   HYPERLINK http://onramp/hq/ES/StructureDesign/DesignAndTechnicalServices/PI/piupload.htm http://onramp/hq/ES/StructureDesign/DesignAndTechnicalServices/PI/piupload.htmAlways Use PI Web Mail drop FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  Information ProvidedCodeFile name1.PSR/PR (Bullet Synopsis only & per project)(D) FORMTEXT      2.Include all A.P.S. s Structures Design to supply(S) FORMTEXT      3.E.I.R. (per project) Synopsis only  FORMCHECKBOX  Not Applicable(D) FORMTEXT      4.Strip Map (per project)(D) FORMTEXT      5.2-D Mapping file (per project) (photogrametric-separated from strip map)(D) FORMTEXT      6.Alignment traverse sheet(D) FORMTEXT      7.Aerial photo of site (1: 500 scale is acceptable) OPTIONAL(S) FORMTEXT      8.Bridge site plan (real world coordinates)(D) FORMTEXT      9.Profile Grade(D) FORMTEXT      10.Superelevation(D) FORMTEXT      11.Typical Section(D) FORMTEXT      12.Detour or stage construction plans  FORMCHECKBOX  Not Applicable(D) FORMTEXT      13.Highway Layouts(D) FORMTEXT      14.Utility map & Utility information sheets (DS-P58)(D) FORMTEXT      15.Lane closure charts  FORMCHECKBOX  Not Applicable(D) FORMTEXT      16.District milestone schedule (include all primary District and District Survey contacts and functional unit contacts with their responsibilities and all telephone numbers)(D) FORMTEXT      17.Archived District CAiCE files (MOST CURRENT)(D) FORMTEXT      18.Structures P.I. Survey Information sheet(D) FORMTEXT      19.Digital photos of the site if available(D) FORMTEXT      20.Always include a cover Memo with a brief scope and history(D) FORMTEXT       PLEASE COMPLETE ALL SECTIONS AND SUBSECTIONS IN ITS ENTIRETY. Please note that project will be delayed if sections are left blank! I.GENERAL INFORMATION A.Location:Bridge Name & Number: FORMTEXT      District:  FORMTEXT      County:  FORMTEXT      Route:  FORMTEXT      Post km:  FORMTEXT      This structure is located in the city of  FORMTEXT      . FORMTEXT       is the nearest city or town located  FORMTEXT       km down station of the structure. FORMTEXT       is the nearest city or town located  FORMTEXT       km up station of the structure. B.Project Description: FORMCHECKBOX  New Structure. FORMCHECKBOX  Replacement:  FORMDROPDOWN  FORMCHECKBOX  Modification: FORMCHECKBOX  Widening(Looking up station)Width: FORMTEXT       m left of centerline. FORMTEXT       m right of centerline. FORMCHECKBOX  Lengthening FORMTEXT       m beyond BB. Final Stationing :  FORMTEXT      . Explain:  FORMTEXT       FORMTEXT       m beyond EB. Final Stationing :  FORMTEXT      . Explain:  FORMTEXT       FORMCHECKBOX  Scour mitigation:Explain:  FORMTEXT      . FORMCHECKBOX  Rail replacement:Current railing type:  FORMTEXT      .Replacement type:  FORMTEXT      . Length:  FORMTEXT       m on  FORMDROPDOWN  side(s). (Looking up station) FORMCHECKBOX  Earthquake retrofit:Explain:  FORMTEXT      .  FORMCHECKBOX  Permit Load Strengthening:Explain:  FORMTEXT      . FORMCHECKBOX  Abandonment Explain:  FORMTEXT       FORMCHECKBOX  Other:  FORMTEXT      Explain:  FORMTEXT       FORMCHECKBOX  Retaining wall:  FORMCHECKBOX  Not Applicable Location:  FORMTEXT      . FORMCHECKBOX  Soundwall: FORMCHECKBOX  Not Applicable FORMCHECKBOX  Wall is on structure.  FORMCHECKBOX  Wall is off structure.  FORMCHECKBOX  Other: Explain:  FORMTEXT      .  FORMCHECKBOX  Related structures. (Culverts, Buildings, Slab Seals / Boat Section etc.): Explain:  FORMTEXT      . FORMCHECKBOX  Other: Explain:  FORMTEXT      . C.Sign structures FORMCHECKBOX  None. FORMCHECKBOX  On structure, ES  FORMDROPDOWN .* FORMCHECKBOX  Off structure, ES  FORMDROPDOWN .* FORMCHECKBOX  Both on and off structure, ES  FORMDROPDOWN .* *Located:  FORMTEXT       as shown on drawing  FORMTEXT      . Sign & post type:  FORMTEXT      . Other, explain:  FORMTEXT      . D.WeatherTemperature Record Low temperature at site:  FORMTEXT       ( FORMDROPDOWN . Record High temperature at site:  FORMTEXT       ( FORMDROPDOWN .Rainfall  FORMCHECKBOX  Not Applicable Rainfall intensity at site for 25 yr. return period and 5-min duration:  FORMTEXT       mm/hr( For deck drainage design). If none Supplied DES Designer to use 127mm/hr E.Pumping plants FORMCHECKBOX  Not required. FORMCHECKBOX  Required, information will be provided by:  FORMTEXT       on  FORMTEXT      . Historical structures (typically 75 yr. & older)  FORMCHECKBOX  Not applicable State  FORMDROPDOWN  designated bridge as a historical structure. State  FORMDROPDOWN  designated adjacent structures as historical. G.Future widening  FORMCHECKBOX  None FORMCHECKBOX  Anticipated in  FORMTEXT       years. Plan view & typical section of ultimate structure shown on the following  drawings:  FORMTEXT      . H.Future Lengthening FORMCHECKBOX  None FORMCHECKBOX  Anticipated in  FORMTEXT       years. Plan view & typical section of ultimate structure shown on the following  drawings:  FORMTEXT      . I.Is there Federal funding in this project? FORMCHECKBOX  Yes. FORMCHECKBOX  No, expected: FORMTEXT      . FORMCHECKBOX  No, none expected. J.Type K temporary rail on structure Will be included in  FORMDROPDOWN  estimate. II.Design & Construction A.Access **District PM & PE should be on this well in advance of Submittal FORMCHECKBOX  Access limitations:  FORMCHECKBOX  No Restrictions Due to :  FORMDROPDOWN . Explain:  FORMTEXT      . FORMCHECKBOX  Legal access to site is available for ES for site review & foundation drilling from  FORMTEXT        to  FORMTEXT        FORMDROPDOWN . FORMCHECKBOX  Legal access not available. ES to contact  FORMTEXT       at  FORMTEXT       before fieldwork. FORMCHECKBOX  Access to the site is restricted by environmental considerations. Contact  FORMTEXT       at  FORMTEXT       before any work is done at the site. FORMCHECKBOX  Time constraints: Explain:  FORMTEXT       B.Permits for access to site for preliminary Foundation work ** See above FORMCHECKBOX  Have been obtained and expires on  FORMTEXT      . FORMCHECKBOX  Permits have not yet been obtained but should be provided by  FORMTEXT      . FORMCHECKBOX  Not needed. Explain:  FORMTEXT      . C.Staging area: FORMCHECKBOX  Has not been identified for construction (contractor). Explain:  FORMTEXT      . FORMCHECKBOX  Has been identified for construction (contractor). Preliminary information on the location:  FORMTEXT      . D.Structure clearance calculations. (B) FORMCHECKBOX  Not required. Explain:  FORMTEXT       FORMCHECKBOX  See below:Vertical Clearance Calculations at:Eg. FORMTEXT 5.67 m  FORMDROPDOWN  of FORMTEXT "A"Line at Station FORMTEXT 2091+12.9 permanentUse supplemental form on web site for additional locations FORMTEXT       m FORMDROPDOWN  FORMTEXT      Line at Station FORMTEXT      .  FORMDROPDOWN  FORMTEXT       m FORMDROPDOWN  FORMTEXT      Line at Station FORMTEXT      .  FORMDROPDOWN  FORMTEXT       m FORMDROPDOWN  FORMTEXT      Line at Station FORMTEXT      .  FORMDROPDOWN  FORMTEXT       m FORMDROPDOWN  FORMTEXT      Line at Station FORMTEXT      .  FORMDROPDOWN UPPER ROADWAYStation: FORMTEXT      Distance  FORMDROPDOWN  of Profile Grade:  FORMTEXT       m Cross Slope: FORMTEXT       %Profile Grade Elevation:  FORMTEXT       m Corrections for Cross Slope:  FORMTEXT       mUpper Roadway Elevation =  FORMTEXT       mLOWER ROADWAYStation:  FORMTEXT      Distance  FORMDROPDOWN  of Profile Grade:  FORMTEXT       mCross Slope:Traveled Way:  FORMTEXT       %Shoulder:  FORMTEXT       %Profile Grade Elevation:  FORMTEXT       mCorrections for Cross Slope:  FORMTEXT       mLower Roadway Elevation =  FORMTEXT       mDifference between roadway elevations:  FORMTEXT       mLess required minimum clearance: -  FORMTEXT       m (Check Bridge Design Aids 10-4 to 10-5 or Highway Design Manual 309.2)Available for structure depth:  FORMTEXT       mFALSEWORK CLEARANCE Difference between roadway elevations:  FORMTEXT       m a) Less minimum falsework clearance: -  FORMTEXT       m (Check BDA 10-8 to 10-9 or HDM) b) Less falsework depth: -  FORMTEXT       m (Check BDA 10-8 & 10-9 or HDM Table 204.6)(The sum of a + b) Total falsework clearance required: -  FORMTEXT      m (Check BDA 10-6 or HDM 200-28 to 200-29) Available for structure depth:  FORMTEXT       m Minimum structure depth required:  FORMTEXT       m (Check BDA 10-25 to 10-29 or HDM 204.6) E.Construction window FORMCHECKBOX  No known constraints on construction. FORMCHECKBOX  A limited construction window exists:  FORMTEXT       FORMCHECKBOX  Environmental concerns (list periods and concerns):  FORMTEXT      . FORMCHECKBOX  Fish & Game restrictions (list period & restrictions):  FORMTEXT      . FORMCHECKBOX  Traffic (list restrictions):  FORMTEXT      . FORMCHECKBOX  Fish migration (list period):  FORMTEXT      . FORMCHECKBOX  Corps of Engineers (list restrictions & period):  FORMTEXT      . FORMCHECKBOX  Other (specify cause & period of restriction):  FORMTEXT      . F.Falsework FORMCHECKBOX  No restriction. No traffic.  FORMCHECKBOX  Not Applicable FORMCHECKBOX  Falsework not allowed over traffic. FORMCHECKBOX  Stage construction required as detailed under  Additional Data and attached plans. FORMCHECKBOX  Build above Final Elevation, lower to Final Profile (B) Explain: FORMTEXT       FORMCHECKBOX  Falsework openings (S):  FORMCHECKBOX  Must have Type K temporary railings adjacent to traffic.  FORMCHECKBOX  Must have Crash Cushions adjacent to end of railings.  FORMCHECKBOX  Guard posts are required (if work is within 7.62 m (25 ft) of centerline of RR track).  FORMCHECKBOX  Crash walls required for permanent structural elements within 7.62 m (25 ft) of centerline of RR track.  FORMCHECKBOX  Profile Grades are set to provide minimum falsework depths per Highway Design Manual:  FORMCHECKBOX  Provide  FORMTEXT      opening(s) in falsework:  FORMTEXT       m wide by  FORMTEXT       m high. Located:  FORMTEXT      .  FORMCHECKBOX  Covered pedestrian passageways to be  FORMTEXT       m wide by  FORMTEXT      m high. Located  FORMTEXT      . FORMCHECKBOX  Falsework lighting required.  FORMCHECKBOX  Not Applicable FORMCHECKBOX  Traffic is not to be interrupted between the hours of  FORMTEXT       to  FORMTEXT       on weekdays and  FORMTEXT       to  FORMTEXT       on weekdays and not at all on Saturdays, Sundays, and Holidays. Exception shall be made for erection of prefabricated girders, erection or removal of falsework or removal of portions of existing structure or other:  FORMTEXT      . FORMCHECKBOX  Lane closure charts provided. FORMCHECKBOX  Future maintenance painting could be performed without excessive interruptions or hazards to traffic. G.Railroad traffic will be carried FORMCHECKBOX  Not Applicable FORMCHECKBOX  On new alignment. DES involvement e.g. structural walls Explain:  FORMTEXT      . FORMCHECKBOX  On shoofly. DES involvement  e.g. structural walls Explain:  FORMTEXT      . FORMCHECKBOX  Through bridge construction area. H.Waterways FORMCHECKBOX  None; structure is not over water. FORMCHECKBOX  No restriction on placing Falsework or Sheet piles in existing waterway. FORMCHECKBOX  Falsework or Sheet piles cannot be present in waterway or environmentally sensitive area between the following defined dates: from  FORMTEXT       to  FORMTEXT      . I. Detour FORMCHECKBOX  None required. FORMCHECKBOX  Traffic to use existing facilities. FORMCHECKBOX  Traffic can be detoured. FORMCHECKBOX  Required. Traffic to  FORMTEXT      . FORMCHECKBOX  Stage construction required. See Additional Data. (Include proposed traffic handling and Sequence of Operations). FORMCHECKBOX  ES to review and comment. J.Storage facilities FORMCHECKBOX  No restrictions. FORMCHECKBOX  Restricted: Explain:.  FORMTEXT      . FORMCHECKBOX  On-site storage of fabricated girders is not available due to physical restrictions and hazards to traffic in the immediate vicinity of the bridge construction site. FORMCHECKBOX  Fabrication of girders or storage of material should not be allowed within  FORMTEXT       m of edge of shoulder of freeway or  FORMTEXT       m of other roads. K. Coordination  FORMCHECKBOX  Not Applicable FORMCHECKBOX  Copies of pertinent correspondence from authorities are attached. FORMCHECKBOX  Copies of pertinent correspondence from authorities are not attached.The following entities have an interest in this structure: (name/phone):State/Federal: FORMCHECKBOX  None. FORMCHECKBOX  FHWA, ( FORMTEXT       /  FORMTEXT      ) FORMCHECKBOX  Corps of Engineers, ( FORMTEXT       /  FORMTEXT      ) FORMCHECKBOX  Coast Guard; contact, ( FORMTEXT       /  FORMTEXT      ) FORMCHECKBOX  Fish & Game; contact, ( FORMTEXT       /  FORMTEXT      ) FORMCHECKBOX  State Board of Reclamation, ( FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Department of Water Resources, ( FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Other; (specify / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      )Local/Private: FORMCHECKBOX  None.  FORMCHECKBOX  Local Agency, (agency / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Railroad, ( FORMTEXT       /  FORMTEXT      ) Specify RR:  FORMTEXT      .  FORMCHECKBOX  Coastal Commission; contact, ( FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  BCDC (Bay Conservation and Development); Contact, ( FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Other; (specify / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      ) Water Related: FORMCHECKBOX  None.  FORMCHECKBOX  Water Agency, (agency / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      ) FORMCHECKBOX  Irrigation District, (district / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Drainage District, (agency / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Other; (specify / name / phone), ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      ) District Requirements:  FORMCHECKBOX  None1. FORMCHECKBOX District shall notify ES before ES proceeds with structure design. Explain in Additional Comments 2. FORMCHECKBOX District shall request Department of Fish and Game approval upon receiving notification of the design alternative chosen by ES (when applicable)3. FORMCHECKBOX District shall submit Soundwall General Plan to local authorities for approval:Local Authority:  FORMTEXT      Name: FORMTEXT      Phone: FORMTEXT       Structure Information A.Structure Approaches FORMCHECKBOX  Not Applicable FORMCHECKBOX  Needed for new construction (ES will determine the need). FORMCHECKBOX  Needed for rehabilitation, full width or specific lanes (District Pavement Rehabilitation Review Team). FORMCHECKBOX  PCC pavement will be used on road approaches. FORMCHECKBOX  AC pavement will be used on road approaches. FORMCHECKBOX  Full slope paving on approach fills recommended. PS&E by:  FORMCHECKBOX  ES  FORMCHECKBOX  District  FORMCHECKBOX  Other:  FORMTEXT      . B.Bank Protection FORMCHECKBOX  Not Applicable FORMCHECKBOX  District anticipates providing bank protection. Specify type & location:  FORMTEXT      . FORMCHECKBOX  Other:  FORMTEXT      . C.Channel Excavation FORMCHECKBOX  Not Applicable FORMCHECKBOX  District anticipates providing a channel for the conveyance of water. Provide details (side slope, typical section, Elevations, etc.) See drawing(s):  FORMTEXT      . FORMCHECKBOX  Temporary Railing required. Explain:  FORMTEXT      . D.Bridge Rail / Guard Rail FORMCHECKBOX  Not Applicable. FORMCHECKBOX  District recommends Type  FORMTEXT       as shown on enclosed drawings. Explain:  FORMTEXT      . FORMCHECKBOX  Sound wall on Barrier Type  FORMTEXT       as shown on enclosed drawings. Explain:  FORMTEXT      . FORMCHECKBOX  Structure located on super-elevation transition, possibly affecting rail profile.(ES to comment). FORMCHECKBOX  Locations of metal beam guard railing shown on site data.(ES to provide suitable connections at ends of bridge rail. Metal beam guard railing to be included in District PS&E). FORMCHECKBOX  Median barrier railing on structure. Type  FORMTEXT       is recommended. FORMCHECKBOX  Glare screen required. FORMCHECKBOX  Additional data provided. For additional information see drawing  FORMTEXT      . FORMCHECKBOX  District recommends architectural treatment(s) as shown on drawings:  FORMTEXT      . E.Sidewalk on structure FORMCHECKBOX  None required. FORMCHECKBOX  Sidewalk(s) required:  FORMCHECKBOX  Sidewalk type:  FORMTEXT      . Width:  FORMTEXT       m.  FORMCHECKBOX  Drawing with details provided. See drawing:  FORMTEXT      .  FORMCHECKBOX  Temporary sidewalks are required through construction zone.  FORMCHECKBOX  Sidewalk(s) are required to connect to existing sidewalk system. FORMCHECKBOX  Subdivision activities in the immediate area indicates that construction of a connecting system of sidewalks is imminent. FORMCHECKBOX  Overcrossing screening required on  FORMDROPDOWN . (PS&E by ES) Specify type of screen required:  FORMTEXT      . FORMCHECKBOX  Sidewalk and railing as shown (specify drawing:  FORMTEXT      ) conforms to requirements of local authorities and/or sight distance requirements. FORMCHECKBOX  A school / schools exist(s) within 1.61 km of structure.  FORMCHECKBOX  Children  FORMDROPDOWN  be using the structure routinely.  FORMCHECKBOX  Shuttle service around structure required during construction. FORMCHECKBOX  District shall provide details of non-standard sidewalk configuration. FORMCHECKBOX  Raised median on structure. See  FORMTEXT      . F.Clearances Clearances  FORMDROPDOWN  in accordance with ES Advance Planning Study dated  FORMTEXT      . (Designer has a non-standard job with special requirements)  FORMTEXT       m minimum horizontal clearance to column or abutment from right edge of pavement.  FORMTEXT       m from left edge of pavement with respect to direction of traffic.Vertical clearance of  FORMTEXT       m required over initial and ultimate traveled ways,  FORMTEXT       m over shoulders (includes)  FORMTEXT       m additional clearance required under Pedestrian or Cyclist Overcrossings. FORMCHECKBOX  Vertical clearance controls per attached calculations. Structure depths used in established grades are listed below in  Additional Data. FORMCHECKBOX  See Hydraulic Data for estimated peak High Water elevations.  FORMCHECKBOX  Match existing. FORMCHECKBOX  Columns or pier permitted in the median. FORMCHECKBOX  Railroad off-track Maintenance Road and/or future track requirements shown on Site Plan. G.Corrosion Classification  FORMCHECKBOX  NOT APPLICABLE  FORMCHECKBOX  Site is not considered corrosive. FORMCHECKBOX  Site is considered corrosive. Corrosion test sheets are attached. FORMCHECKBOX  Site is within 400 meters of ocean or tidal water. FORMCHECKBOX  Chloride concentration is  FORMTEXT       PPM. FORMCHECKBOX  Data not available at this time. Will be furnished by  FORMTEXT       on  FORMTEXT      . H.Hazardous Material at Site  FORMCHECKBOX  NOT APPLICABLE FORMCHECKBOX  Site is not considered hazardous. FORMCHECKBOX  Excavated material can be used in embankment fills. FORMCHECKBOX  Hazardous material at site is type  FORMTEXT       classification. FORMCHECKBOX  Encountered groundwater must be transported off site or filtered. Explain:  FORMTEXT      . FORMCHECKBOX  Excavated material must have special handling. Explain:  FORMTEXT      . FORMCHECKBOX  Data not available at this time. Will be furnished by  FORMTEXT       on  FORMTEXT      . I.Deck Protection/Deck Rehabilitation (B)  FORMCHECKBOX  NOT APPLICABLE The structure  FORMDROPDOWN  be exposed to de-icing salts or chemicals. Specify which:  FORMTEXT      . FORMCHECKBOX  The structure s riding surface will be exposed to chain use. FORMCHECKBOX  The Structures deck will be rehabilitated. The rehab strategy is: (Based on concurrence from Structure Maintenance)  FORMTEXT       J.Design speed  FORMCHECKBOX  NOT APPLICABLEDesign speeds shown on plans.See drawing  FORMTEXT      .Design speeds are:  FORMTEXT       (km/h).(Used in calculating centrifugal forces on curves BDS 3.10.1) K.Factors affecting sight distance FORMCHECKBOX  None. FORMCHECKBOX  Driveways/Access roads located near either end of bridge. See drawing:  FORMTEXT      . FORMCHECKBOX  Other, see  Additional Data . L.Disposal of Old Bridge FORMCHECKBOX  Not Applicable Traffic can be  FORMDROPDOWN  for bridge removal. FORMCHECKBOX  No restrictions. FORMCHECKBOX  Removal can be accomplished after construction (PS&E by ES). FORMCHECKBOX  Existing structure to remain in place for  FORMTEXT       traffic. FORMCHECKBOX  Disposition of salvageable material to be handled by ES. The following item(s) should be salvaged:  FORMTEXT      . FORMCHECKBOX  Protective cover over lower roadway is needed (PS&E by ES). M.Drainage FORMCHECKBOX  Not Applicable FORMCHECKBOX  District will provide shoulder drains on approaches near high end(s) of structure to prevent drainage crossing end(s) of structure. FORMCHECKBOX  Accumulated surface water to be carried on structure across freeway. Special sealing at structure ends and seat type abutments to be provided by ES. (This may be expensive. Should be discussed by District and Structure Designer). FORMCHECKBOX  Water from bridge deck can be removed by drop through (day light) deck drains or scuppers. FORMCHECKBOX  Other:  FORMTEXT       N.Crash Cushions on Structure  FORMCHECKBOX  Not Applicable FORMTEXT       FORMCHECKBOX  Type  FORMTEXT       and location  FORMTEXT      . FORMCHECKBOX  Details shown on drawing:  FORMTEXT      . FORMCHECKBOX  Details will be provided by  FORMTEXT      . O.Loading FORMCHECKBOX  No special construction loading. FORMCHECKBOX  Structure is on  EXTRALEGAL LOAD NETWORK Route. (PI will answer this) (Revised as of 10/00 See HQ Traffic Ops network maps).  FORMCHECKBOX  Structure is on Strategic Highway Corridor Network (STRAHNET) (PI will answer this)  FORMCHECKBOX  Structure is on state wide list of Life Line Routes (PI will answer this) FORMCHECKBOX  The Local Transportation Authority considers this a primary emergency or evacuation route. FORMCHECKBOX   FORMTEXT       Structure(s) to carry construction overloads. FORMCHECKBOX  Structure will carry railway. Specify:  FORMTEXT      . FORMCHECKBOX  Structure will carry special loads. Specify:  FORMTEXT      . P.Obstructions FORMCHECKBOX  None existing other than those stated in utility requirements. FORMCHECKBOX  Potential obstructions:  FORMTEXT       FORMCHECKBOX  Traffic. FORMCHECKBOX  Existing bridge. FORMCHECKBOX  Water flow. FORMCHECKBOX  Overhead wires. FORMCHECKBOX  Buried utilities. FORMCHECKBOX  Other:  FORMTEXT      .For marked item(s) in this section (Q), please explain the obstruction in  Additional Data And include drawing number and depths where applicable. FORMCHECKBOX  Listed below are those obstructions that are to remain in place or will be moved to locations where they could interfere with design or construction:  FORMTEXT      . Q.Retaining Walls by DES (Structures), Non Standard, (i.e. Not Found In Standard Plans Manual) FORMCHECKBOX  None needed. Explain:  FORMTEXT       FORMCHECKBOX  Needed, PS&E by:  FORMDROPDOWN .  FORMCHECKBOX  Type:  FORMDROPDOWN . Explain: FORMTEXT      . FORMCHECKBOX  Sound Wall on Retaining Wall.  FORMCHECKBOX  Sound Wall on Structure.  FORMCHECKBOX  Rail on Retaining Wall. Type: FORMTEXT       FORMCHECKBOX  Shown on District site plan. See drawing  FORMTEXT      . FORMCHECKBOX  Special design required. (Send site data to ES for evaluation) FORMCHECKBOX  Special aesthetic/architectural treatment required See drawing:  FORMTEXT      . FORMCHECKBOX  Foundation recommendations provided. See attachment  FORMTEXT      . FORMCHECKBOX  Drainage requirements:  FORMCHECKBOX  All existing drainage in conflict with the retaining walls will be removed or relocated by District during construction.  FORMCHECKBOX  All existing drainage in conflict with the retaining walls will be removed or relocated by District prior to construction.  FORMCHECKBOX  Exception to above / existing drainage to remain:  FORMTEXT      .  FORMCHECKBOX  New drainage will conflict with the retaining walls.  FORMCHECKBOX  All existing drainage in conflict with the retaining walls are as follows:  FORMTEXT      . FORMCHECKBOX  Other Details: FORMTEXT       R.Structure type recommendations FORMCHECKBOX  None, ES to recommend type. Is an aesthetic consideration to be consistent with neighboring structures ?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If Yes, then List Br. No(s): FORMTEXT       FORMCHECKBOX  Type selection to accommodate anticipated future widening. FORMCHECKBOX  Closure wall(s) required.  FORMDROPDOWN  to determine. Give Slope requirements if any.  FORMTEXT      (See XS Sheet 22-06) FORMCHECKBOX  Bin type abutment required.  FORMDROPDOWN  to determine. FORMCHECKBOX  See Additional Data for unusual or special aesthetic considerations. S.Utility Requirements  FORMCHECKBOX Not Applicable FORMCHECKBOX  All existing utilities are shown on District Site Plan (Please include all underground utilities, wingwalls, retaining walls, etc.) Title:  FORMTEXT      . Plan  FORMDROPDOWN  based on project coordinates. FORMCHECKBOX  A complete coordinate based map of all existing utilities will be provided by Specify date:  FORMTEXT      . FORMCHECKBOX  All existing utilities in conflict with the structure except as listed below will be removed or relocated by District during construction. FORMCHECKBOX  All existing utilities in conflict with the structure except as listed below will be removed or relocated by District prior to construction. FORMCHECKBOX  Existing utilities to  FORMDROPDOWN  Clearance required. Explain:  FORMTEXT       FORMCHECKBOX  Utilities already staked. FORMCHECKBOX  No utilities to be carried on structure. ES  FORMDROPDOWN  provide details for future utility openings. FORMCHECKBOX  All utilities to be carried on structure are identified & listed on the attached utility information sheet, (including all bridge lighting) DS - P58. FORMCHECKBOX  A utility information sheet, DS P58 showing all existing utilities near the structure:  FORMCHECKBOX  Is attached  FORMCHECKBOX  Will be provided by (name/ Phone/date): ( FORMTEXT       /  FORMTEXT       /  FORMTEXT      )  FORMCHECKBOX  Other:  FORMTEXT      . FORMCHECKBOX  Highway operational utilities in structure, i.e. lighting traffic signals, etc. Access frames and covers to be placed in bridge decks to be furnished by:  FORMCHECKBOX  Utility company  FORMCHECKBOX  StateThese utilities  FORMDROPDOWN  tied to survey construction lines and  FORMDROPDOWN  staked by District shortly before structure foundation work (excavation, pile driving or drilling). T.Water Line Requirements for Landscaping FORMCHECKBOX  None required. FORMCHECKBOX  Data to be furnished by District upon receipt of Bridge General Plan. FORMCHECKBOX  Water piping system should be composed of:  FORMCHECKBOX  Galvanized or ductile pipe (Mandatory for length of pipe carried through structure).  FORMCHECKBOX  Plastic pipe.  U.Width/Geometric ReviewThe roadway width of the bridge  FORMDROPDOWN Headquarters Design Reviewer.Name:  FORMTEXT       Date:  FORMTEXT      .Bridge roadway widths will be  FORMTEXT       m between railings or sidewalks when viewed in the direction of  FORMDROPDOWN .See  Additional Data . V.Hydraulic Data Section FORMCHECKBOX  Not Applicable; structure not over water.Please CompleteWaterway owned by: FORMDROPDOWN    FORMTEXT      Contact Person(s) FORMTEXT      Phone #: FORMTEXT      Discharge records: FORMDROPDOWN  FORMTEXT      Rainfall records, for this site or adjacent sites  FORMDROPDOWN  FORMTEXT      High water elevations  FORMDROPDOWN  FORMTEXT      Low water elevations. FORMDROPDOWN  FORMTEXT       Please select all that applies. FORMCHECKBOX  Waterway is lined. Liner material:  FORMTEXT      . FORMCHECKBOX  Confluence, reservoir, or check dams exist on this waterway. Specify (include location):  FORMTEXT       FORMCHECKBOX  Flow Gage is located nearby (within 50 miles). Description and Location:  FORMTEXT       FORMCHECKBOX  There is an apparent scour problem or history of scour at this site. Explain:  FORMTEXT       FORMCHECKBOX  There is history of channel aggregation or degradation at this site. Describe:  FORMTEXT       FORMCHECKBOX  There are active mining operations or active gravel quarry operations on this waterway. (Briefly describe and give an approximate location):  FORMTEXT       FORMCHECKBOX  There are levees present. Location:  FORMTEXT       FORMCHECKBOX  Future levee work planned: Explain:  FORMTEXT       Minimum freeboard required:  FORMTEXT       m. FORMCHECKBOX  There is history of debris collecting at this site. Type and size:  FORMTEXT       FORMCHECKBOX  Site affected by tides (please attach a copy of current tide chart with max tidal elevations and datum). FORMCHECKBOX  A minimum vertical clearance (soffit to water surface) of  FORMTEXT       m is required to maintain adequate waterway. FORMCHECKBOX  Future Flood Control Project(s) is (are) planned.  FORMCHECKBOX  Not Applicable Agency:  FORMTEXT      . Contact Person:  FORMTEXT      . Phone:  FORMTEXT      . Brief description:  FORMTEXT      . OTHER  FORMTEXT       FORMCHECKBOX  A previous PI Report for this site exists (please attach a copy to submittal). FORMCHECKBOX  FEMA Maps and/or FEMA studies attached: Contact Name(s):  FORMTEXT      . Agency:  FORMTEXT      . Phone:  FORMTEXT      . IV.Additional Data  FORMTEXT       STATE OF CALIFORNIA . DEPARTMENT OF TRANSPORTATION Preliminary Investigations Division Engineering Service , Office of Structures Design Revised 03/03 PAGE 17 Bridge Site Submittal.doc Page  PAGE 14 of  NUMPAGES 14 REV 03/03 CSP STATE OF CALIFORNIA . DEPARTMENT OF TRANSPORTATION Preliminary Investigations Division Engineering Service Center, Office of Structures Design Revised 03/03 Bridge Site Submittal.doc Page  PAGE 1 of  NUMPAGES 14 REV 03/03 CSP PAGE \# "'Page: '#' '" Briefly explain what actions are being initiated? PAGE \# "'Page: '#' '" Hilighted box PAGE \# "'Page: '#' '" Please provide File name or indicate whether it is burned on a CD to be mailed. Is it attached to Bridge Site Submittal? PAGE \# "'Page: '#' '" District Surveys to supply. [u5] used if only one structure is submitted Optional otherwise.PAGE \# "'Page: '#' '"  PAGE \# "'Page: '#' '" If not available at this time, then comment on when they will be available in the adjacent text field ( PAGE \# "'Page: '#' '" District Surveys to supply all horizontal curve data- Lengths of curves, the angles they subtend, lengths of tangents, radii etc. PAGE \# "'Page: '#' '" If not available at this time, then comment on when they will be available in the adjacent text field ( PAGE \# "'Page: '#' '"  If not available at this time, then comment on when they will be available in the adjacent text field ( PAGE \# "'Page: '#' '" All structures and includes files from Local Agencys and Consultants as long as datum is verified by District. PAGE \# "'Page: '#' '" District Surveys to supply, however give PI the copy you are working on. PAGE \# "'Page: '#' '" Do not use old datums or As-Builts. Use what is up to date and will be used during construction phase! District Surveys should fill this out. PAGE \# "'Page: '#' '" Use readme files for direction/location PAGE \# "'Page: '#' '"  One per Structure PAGE \# "'Page: '#' '" Please complete all parts. PAGE \# "'Page: '#' '" Please enter the bridge name and number. Also indicate L/R for left and right structures. PAGE \# "'Page: '#' '" Please enter the kilo post mile. PAGE \# "'Page: '#' '" Please select one item and complete all parts. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please indicate the distance in meters from the centerline the bridge will be widened to the left. PAGE \# "'Page: '#' '" Please indicate the distance in meters from the centerline the bridge will be widened to the right. PAGE \# "'Page: '#' '" Length up or down station of: Tunnel, Box Culvert, PUC, Equestrian, Bike path, Cattle-etc. Give details! PAGE \# "'Page: '#' '" Length up or down station of: Tunnel, Box Culvert, PUC, Equestrian, Bike path, Cattle-etc. Give details! PAGE \# "'Page: '#' '" Please explain scope of job; e.g. repair work or new counter measures. PAGE \# "'Page: '#' '" Length of replacement railing. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please explain scope of work. PAGE \# "'Page: '#' '" Please explain scope of work. Please explain Structures Maintenance involvement if any. PAGE \# "'Page: '#' '" Please locate the retaining wall with reference to highway or bridge alignment with offsets and stationing. PAGE \# "'Page: '#' '" Please explain the circumstances e.g. special mitigation PAGE \# "'Page: '#' '" Please explain the scope of work for related structures. PAGE \# "'Page: '#' '" For all other projects not fitting the above categories. Please explain scope of work. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please reference structure; eg. northeast of Abutment 1. PAGE \# "'Page: '#' '" Please explain special circumstance. Non-standard design? PAGE \# "'Page: '#' '" The temperature range is critical for properly calculating the Joint movement and for the bearing pad design PAGE \# "'Page: '#' '" Please enter the record low temperature. This may affect the design. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please enter the record high temperature. This may affect the design. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" This information can be obtained from District Hydraulics PAGE \# "'Page: '#' '" This information can be obtained from District Hydraulics i.e. is ground water going to impact the design? PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Give an approximation PAGE \# "'Page: '#' '" Please specify drawing and indicate where it may be found; eg.See Drawing # 5 Attached to Bridge Site Submittal. PAGE \# "'Page: '#' '" Give an approximation PAGE \# "'Page: '#' '" Please specify drawing and indicate where it may be found; eg.See Drawing # 5 Attached to Bridge Site Submittal. PAGE \# "'Page: '#' '" Please enter the date in which Federal funding will be made become available. PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Safe and Legal access must be negotiated prior to PI investigating the site or Foundations/Geology investigating the site i.e. Guard Dogs, Angry Land Owners, and Contaminated Site Conditions will cancel your job immediately. Please select all that applies and fill out all corresponding parts.(This also includes access to both sides of a Retaining Wall or Soundwall). PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please elaborate on limitation. List all conditions/constraints is there a contact person ? PAGE \# "'Page: '#' '" Please be clear on exact times, dates and any special directions for access. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please specify the contact person for access issues. PAGE \# "'Page: '#' '" Please enter a phone number for the contact person. PAGE \# "'Page: '#' '" Please specify a contact for environmental related issues. PAGE \# "'Page: '#' '" Please specify a phone number for the contact. PAGE \# "'Page: '#' '" In other words give dates and times. PAGE \# "'Page: '#' '" Please specify who is to apply for the permit(s) and the effective dates. PAGE \# "'Page: '#' '" Is this in the process? Indicate who is to identify staging area and by what date should it be identified. PAGE \# "'Page: '#' '" Please enter the preliminary information regarding the staging area; a rough location by cross streets will work PAGE \# "'Page: '#' '" Is this a temporary or permanent case? PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Us supplemental form on web for addition critical locations. PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Drop Down menu PAGE \# "'Page: '#' '" Drop down menu. Please specify the distance left or right (Looking up station) from profile grade. PAGE \# "'Page: '#' '" Please enter the resulting elevation. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Please enter the resulting value. PAGE \# "'Page: '#' '" Please enter the dates and times of day. PAGE \# "'Page: '#' '" Please list the period in terms of dates and times of day. PAGE \# "'Page: '#' '" Please list the period in terms of dates and times of day. PAGE \# "'Page: '#' '" Please list the hours and days of the week. PAGE \# "'Page: '#' '" Please list the period in terms of days, months, or years. PAGE \# "'Page: '#' '" Please list the period in terms of days, months, or years. PAGE \# "'Page: '#' '" Please specify and list the period in terms of days, months, or years. PAGE \# "'Page: '#' '" Please select all that applies and complete corresponding parts if any. PAGE \# "'Page: '#' '" Please enter the minimum opening width. PAGE \# "'Page: '#' '" Please enter the minimum opening height. PAGE \# "'Page: '#' '" Please enter the minimum opening width. PAGE \# "'Page: '#' '" Please enter the minimum opening height. PAGE \# "'Page: '#' '" Please specify circumstance. PAGE \# "'Page: '#' '" If there are multiple limitations list/explain in Additional Data. PAGE \# "'Page: '#' '" For easy access of Construction materials PAGE \# "'Page: '#' '" Please select all that applies and complete corresponding parts. PAGE \# "'Page: '#' '" Please specify drawing and its location. Attached to Bridge Site Submittal? PAGE \# "'Page: '#' '" Please specify drawing and its location. Attached to Bridge Site Submittal? PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Typical section or drawing #? PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" This is in case we are planning future improvements or additions-e.g. PED or Bike path- Typically for a new structure PAGE \# "'Page: '#' '" This is in case we are planning future improvements or additions-e.g. PED or Bike path- Typically for a new structure PAGE \# "'Page: '#' '" Does the District or its stakeholders have a special request/requirement PAGE \# "'Page: '#' '" You may not know at this point, however, try to get Roadway Geology to make a determination if possible. PAGE \# "'Page: '#' '" Rail Road yards are notorious, however, you may or may not know up front-give us any suspicions you have. Lets help keep everyone safe. PAGE \# "'Page: '#' '" Please specify whether this will be done by District or by consultant. PAGE \# "'Page: '#' '" Please specify whether this will be done by District or by consultant. PAGE \# "'Page: '#' '" Drop Down Menu PAGE \# "'Page: '#' '" Any restrictions to bridge geometry or elements? PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" District PE to check with NPDES for possible water treatment. PAGE \# "'Page: '#' '" Roadway, Sidewalk etc. give details PAGE \# "'Page: '#' '" Describe what type of material or architectural treatment is desired (soundwall also if applicable). If possible, get Roadway Geology involved to determine if spread footing or a pile foundation will be needed, or to determine if a tieback, soil nail or MSE wall to be used. Explain in Other Details. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" A wall typically from soffit/belly of structure to the ground- can act as a retaining wall Adjacent to Abutment . PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '"  Closed system PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" District Hydraulics & District Maintenance should be contacted for this portion of the Bridge Site Submittal. PAGE \# "'Page: '#' '" District Hydraulics & District Maintenance should be contacted for this portion of the Bridge Site Submittal. PAGE \# "'Page: '#' '" Contact should be from District Hydraulics or someone who is knowledgeable of hydraulic conditions at this site. PAGE \# "'Page: '#' '" Discharge records refer to water discharge events recorded for the waterway. They may be seasonal or for flood control. This information is needed for substructure and waterway adequacy design. PAGE \# "'Page: '#' '" Drop down menu. PAGE \# "'Page: '#' '" Drop down menu. Documented high water events (if any) should be attached to this report to aid in designing for waterway adequacy. High water may also dictate construction method. PAGE \# "'Page: '#' '" Drop down menu. This may control foundation design and/or construction method. PAGE \# "'Page: '#' '"  E.g. pcc, ac, rip rap, sack crete. etc PAGE \# "'Page: '#' '" The location of the bridge with respect to flow controlling structures are needed to adequately design for flood and low flow conditions. PAGE \# "'Page: '#' '" Flow gages are either U.S.G.S. maintained electronic flood level gages or graduated markings on the bridge or a fiberglass rod. These gages can be used to find flow rates for that section of waterway. Gages are usually shown on U.S. Geological Survey topographical maps. PAGE \# "'Page: '#' '" Is there a history of scour at this site? If yes, at which location (bent 2, abutment 4, etc.) and how much. This information is needed to properly design the substructure system against the effects of scour. PAGE \# "'Page: '#' '" This information is needed to address potential changes in channel elevation. Significant changes in channel elevation may control foundation type. PAGE \# "'Page: '#' '" Also crucial to designing the substructure, mining may lead to lowering or raising channel elevation. This information is needed to anticipate channel ground fluctuations. PAGE \# "'Page: '#' '" The owner of the levee needs to be identified in the event that they may need to be contacted regarding encroachment, access, or similar concerns. Provide a location with reference to the bridge along the waterway; i.e. 50 m upstream or downstream of structure, on both banks, etc. PAGE \# "'Page: '#' '" Crucial to waterway adequacy, the constructing levees at both banks may increase or decrease water surface elevation or create a contraction at the bridge opening. PAGE \# "'Page: '#' '" Crucial to water overtopping the levee, minimum freeboard distance is needed to determine top of levee elevations. This value is defined as the minimum distance (from highest point of the levee to the water surface) needed for water containment. Please consult District Hydraulics for value or more information. PAGE \# "'Page: '#' '" Is there a history of debris lodging at the supports? If yes, at which location (bent 2, abutment 4, etc.) and how much. Get District maintenance involved they will be a good source of info. This information is needed to properly design the substructure system against increased scour that may result from increasing the pier/bent width. PAGE \# "'Page: '#' '" Crucial to substructure design, this information is needed to determine the proper foundation. Wet/dry cycles or the marine environment may control foundation type or design. PAGE \# "'Page: '#' '" Crucial to substructure design, this information is needed to determine the proper foundation. Wet/dry cycles or the marine environment may control foundation type or design. PAGE \# "'Page: '#' '" Crucial to waterway adequacy design and preventing Contraction Scour/pressure flow, minimum freeboard distance is needed to determine soffit and deck elevations. This value is defined as the minimum distance (from lowest point of the bridge to the water surface) needed for water flow under the structure. Please consult District Hydraulics for value or more information. PAGE \# "'Page: '#' '" This information is needed to ensure that CALTRANS work will not interfere with Flood Control projects and vice-versa. PAGE \# "'Page: '#' '" FEMA maps are flood insurance study maps. 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