Proforma C

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 SUKRANGBA

RI GAON
4. Total Length of Road (Km) - KM

5. Name of Proposed Bridge (if any)

6. Length of Proposed Bridge (Excluding Approaches) 50.27 m

7. Width of Bridge in 7.50 m (Carriage Way)

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 0 4 1

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

Total 0
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:
No

(iv) Whether the roadwork has been completed or in progress and likely date of completion: No

(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
Bridge Super Structure 58.97 1.17
Bridge Sub Structure 26.40 0.53
Foundation 148.89 2.96
Others (Protection work) 5.97 0.12
Subway+Dismantling 7.44 0.15
DPR preparation 0.42 0.01
Total 248.10 4.94
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 At Ch-4100.00M

Cross Rd.

Cross Rd.
0

12 Typical Sketch of proposed bridge showing schematic arrangement of spans

13. Typical Photographs of proposed Bridge Location.
Shown separetly
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 60.00 ton per sqm
c. Arrangement of Spans

Total Span 2 No. of Vents Clear Span of Vent

d. Critical Levels Road top level (RTL) 102.48 mtrs.

Average Ground Level(AGL) 93.82 mtrs.
Low Bed level (LBL) 93.32 mtrs.
Ordinary flood level (FL) 94.32 mtrs.
Foundation level (FL) 74.97 mtrs.
Ht. of bridge h= (RTL-NBL) 9.16 mtrs.
Ht. of bridge H=(RTL-FL) 27.50 mtrs.
e. Catchment Area
(Catchment area should be based on hydrological survey or from toposheet)
Catchment area served Not well Hect
defined
Heaviest Rainfall 1600 mm/hr.
Basis of Design Discharge Dickens formula
Waterway required 46.00 M
Waterway provided 50.00 M
f. Scour Depth (m) 5.74 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
Grade of
Description of Components Quantity Cost Rs. concrete
Dismantling
Labour for dismantling all members of the timber bridge (except piles) and stacking 49.00 41650.00
them atwork
Earth suitable places asofdirected
in excavation foundation(all members will as
of structures be perunder custody& of
drawings the
technical 603.19 68160.44
contractor
specifications,
Well Foundation till taken over
including by the
setting Department.)
out, construction scarfing
of and
shoring joining
and piles
bracing, 25cm to 30cm
removal
Providing and constructing of 1.00 41153.00
dia d andIsland
stumps other deleterious matter, dressingroadof of
sides and bottomlocation
and8back diafilling
temporary
Providing and 12 m diameter
constructing one for construction
span service towell
reachfoundation
island for mfrom onewit 25.00 56450.00
well.complete
pier location
Providing andtoas layingper of
another clause
pier
cutting 1200
location
edgeof MORTH specifications.
of mild steel weighing 40 K.G. per meter for 3.60 371167.20
Well
A. foundation
Well Curb complete as perv drawing and as per clause 1200 &1900 of MORTH I) RCC 66.26 586387.85
specifications
M -Well
B. 25 grade
steining . Case - IIII): Using
RCC concrete
M- 25 grade mixer. 726.98 5829659.65
C. Bottom Plug Concrete to beCase placed I : Using
using concrete
tremie pipe. mixer. II) 189.53 1417289.02
PCC grade
E. Top plug M-20 Case - I : Using concrete mixer. III) PCC grade M-15 31.21 187609.48
F. Well Cap Case - I : using concrete mixer. 159.17 1217788.40
I) Depth below Bed level up to 3.0m I) RCC M - 25 grade 3.00 13182.00
II) Beyond 3.0 m upto 10.0 m 7.00 44828.00
III) Additional depth beyond 10 m up to 20 m 8.00 67657.41
IV) Additional
Sinking
I) Depth of 7m depth
below external beyond
Bed level diameter
up to203.0m
mWell
up tothrogh
30 m all types of soil ( other than pneumatic 0.00
6.00 0.00
40182.00
method
II) Beyond of sinking
3.0 m upto ) complete
10.0 m as per Drawing as per MORTH Section No. 1200 . 14.00 130578.00
III) Additional depth beyond 10 m up to 20 m 18.70 230296.32
IV) Additional
Sand Filling indepth beyond 20asmper
Well complete up drawing
to 30 m and as per Technical Specification as 0.00
1010.38 0.00
1451909.26
per
0 MORTH
Supplying, Section
fitting and No. 1207
placing .
un-coated TMT bar reinforcement in foundation 0.00
43.22 0.00
3114662.76
complete asfitting
Supplying, per drawing
and placing and uncoated
technical specification
mild steel reinforcement in foundation 0.30 19912.80
(Refer
complete to quantity
as per drawing
Plain/Reinforced estimation)(TATA
Cement and
concrete, MAKE
Technical TMT REBAR)
Specifications
in Substructure as per MORTH
complete Sectionand
as per Drawing No. 166.57 1351374.86
1600
Technical Specifications
Supplying, fitting and placing TMT bar reinforcement complete in substructure 13.98 1008713.73
F.
complete
RCC Grade
Supplying, asfitting
per Mdrawing
25 placing
and and uncoated
technical specification
mild steel reinforcement in Substructure 0.50 33721.12
(p).Height
(Refer
complete upper
to quantity
as to 5.0 m and Technical Specifications as per MORTH Section No.
estimation)
drawing
Supplying, fitting and fixing in position true to line and level elastomeric bearing 213840.00 245916.00
1600
conformingand to IRC : 83 (Pt. II) Section IX and Clause 2005concrete
of MoRTin&H Specifications
Furnishing placing reinforced / Prestressed cement superstructure 229.00 2098327.00
complete
as
Supplying, including
per drawing fittingand and all accessories
Technical
placing as per
Specifications.
TMT bar drawing andcomplete
reinforcement Technical in Specifications.
superstructure 35.20 2488112.00
RCC
completeGrade
Providing as
and Mper 25,drawing
laying cement andconcrete
technicalwearing
specification
coat M 30 grade including 28.28 414934.86
Case
(Refer - I
to
reinforcement: Using
quantity Concrete
estimation)
complete as
Construction of pre cast RCC railing of M30 Mixer
per drawing and Technical
Grade in situ Specifications
with 20 mm nominal size 107.94 242972.94
II) T-beam
(Refer
aggregate, &true
to quantityslab to estimation)
line andofgrade,
Providing and and laying a striptolerance
seal expansionof vertical
jointRCC posttonot
catering to exceed 1 in
maximum 22.50 20182.50
(a)
500 Height
center upto
to center5m spacing between vertical post not to exceed 2000 mm leaving
horizontal
Granular movement
material upto 70mm, complete as per approved drawings and standard 178.93 220439.30
(Refer
adequat to quantity
specificatons
Sandy material
Supplying, to beand
fitting, installed
fixing in byposition
the manufacturer
true to line/ and
supplier
levelorforged
their steel
authorised
roller bearing 0.00 0.00
representative
conforming
Drainage spouts e
to IRC:83 complete(Pt.-1) assection IX and clause
per approved drawings 2003and oftechnical
MoRTH specifications
specifications. 22.00 189530.00
complete
(Refer
Reinforced including
to quantity all
cementestimation) accessories
concrete Approachas per drawing
Slab andreinforcement
including Technical Specifications.
and form work 16.65 222810.30
complete as
Protection work:(B) per drawing and technical specification .
Providing and laying pitching on slopes laid over prepared filter media including 200.49 231360.54
boulder apron
Providing laid dryfilter
and laying in front
materialof toe of embankment
underneath pitchingcomplete
in slopes asas perper
drawing
drawing and and 100.24 175725.75
technical
Providing specifications
specifications.
and laying boulders on river bed for protection against scour with stone 143.43 190051.37
A. Stone/Boulder
(Qty
boulders
Boulder as laid
per statement
weighing
dry without ofwire
not less Protection
than .(work
40 kg
crates each
Qty ) complete
as per statementas perofdrawing
protection andwork
Technical
) 0.00 0.00
(Qty as per statement
specification . of Protection work )
Boulder Apron Laid in Wire Crates 0.00 0.00
Subway & Bamboo Br. 0.00
Construction of subway & Bamboo br. 0.00 702845.00
Approach
Construction of approach 0.00
DPR Preparation 0.00
Cost of DPR preparartion for br no 1/1 0.00 42000.00
Total Cost of the Project (Rs) 24809541.00

Total Cost of the Project (Rs) (In Words) Rupees One Crore Fifty Two Lakh Ninety Eight Thousand and
Fourty Nine only.
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.: YES / NO
DO.#P-17035/1/2007-Tech. 30th September, 2010.
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 Distance Material Source Lead Distance
Earth (Km) Cement Guwahati 125 Km
Murrum Emulsion Guwahati 125 Km
(Subgrade)
Aggregate Bitumen Guwahati 125 Km

Sand Steel Guwahati 125 Km

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.

DPR Prepared By DPR Checked by Checked & recommended

(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 than YES / NO
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 m.

* 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
Yes / No
Have you satisfied yourself that the road is a part of Core Network
23 Are you satisfied with the following
Engineering Surveys (L section, X sections must be verified) Yes / No
Soil/ Material Investigation Yes / No
Hydraulic Studie 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 the current Yes / No
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 Co-ordinator

Signature
done by: Signature STA:
Name Name Signature
Date Date Name
Date

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