Guidance on using this shell:



|Transportation | |

|Project Report | |

|[Draft] Bridge Rehabilitation Report | |

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|Month 20xx | |

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|[Project Title/Description (e.g., Route______over________)] | |

|Project Identification Number (PIN): _______ | |

|[Bridge Identification Number (BIN): ________] | |

|[Village/Town/City] of________ | |

|________ County | |

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|[pic] | |

For 100% State funded projects delete the FHWA logo below.

[pic][pic]

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|Project Approval Sheet |

|Note this sheet is formatted as a table. |

|Milestones |Signatures | |Dates |

|Recommendation for, Scope and|The project cost and schedule are consistent with the Regional Capital Program. |

|Design Approval: | |

| | |      | |      |

| |Name, Regional Program Manager |Date |

| |

|B. Recommendation for Scope, |All requirements requisite to these actions and approvals have been met, the required independent quality control |

|Design, and Nonstandard |reviews separate from the functional group reviews have been accomplished, and the work is consistent with established |

|Feature Approval: |standards, policies, regulations and procedures, except as otherwise noted and explained. Meeting all requirements |

|OR |requisite to these actions and approvals includes meeting the requirements of the NYS Smart Growth Public Infrastructure|

|Recommendation for Scope and |Policy Act (SGPIPA). Recommendation for Design Approval includes verification that SGPIPA documentation requirements |

|Design Approval |are met. |

| | |

| |When the project includes justification of nonstandard features, include the following statement: The nonstandard |

| |features have been adequately justified and it is not prudent to eliminate them as part of this project. |

| |OR, |

| |Include the following when nonstandard feature justifications are not required: No nonstandard features have been |

| |identified, created, or retained. |

| | | | |      |

| |Name, |Date |

| |

|C. Public Hearing |A public hearing was not required. |

|Certification (23 USC 128): |OR, A public hearing was held on _______ pursuant to 23 USC 128. |

| |OR, A Notice of Opportunity for a Public Hearing was published in accordance with 23 CFR 771.111(h)(2)(iii). No requests|

| |to hold a public hearing were received therefore a hearing was not held. . Public hearings held in accordance with NEPA|

| |requirements and (typically) FHWA regulations found in 23 CFR 771.111 require signature for the public hearing |

| |certification. |

| | | | |      |

| | |Name, |Date |

| |

|D. Categorical Exclusion |This project qualifies as a Categorical Exclusion under the National Environmental Policy Act per the NYSDOT/FHWA |

|Determination on Behalf of |Programmatic Agreement Regarding Categorical Exclusions. |

|FHWA This certification is | |

|required when the completed | |

|FEAW indicates that NYSDOT | |

|makes the CE determination. | |

|Remove this certification | |

|when FHWA makes the CE | |

|determination and for 100% | |

|State-funded projects. | |

| | | | |      |

| | |Name, |Date |

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|D/E. Scope, Design, and |When project requires justification of nonstandard features, ensure this statement is revised Refer to Exhibit 4-2 in |

|Nonstandard Feature Approval:|PDM Chapter 4 to determine the appropriate authority or authorities for design approval and nonstandard feature |

| |approval. The required environmental determinations have been made, and the preferred alternative for this project is |

|OR |ready for final design. Nonstandard features have been appropriately justified. . |

|Scope and Design Approval |OR No nonstandard features are being retained or created. |

|Use this row for NYSDOT | |

|administered projects. | |

|For local projects remove | |

|this certification and use | |

|rows below. | |

| | | | |      |

| | |Name, | | Date |

| |

|D/E. Local Project |Nonstandard features on Non-NHS local roadways have been appropriately justified. |

|Nonstandard Feature Approval |OR No nonstandard features are being retained or created on Non-NHS local roadways. |

|Use for local projects. | |

|Include the certifications to| |

|the right as appropriate. | |

| | | | |      |

| | |Name, | |Date |

| |Only include the certification below if there is work proposed on NHS/State roadways. Nonstandard features on NHS/State |

| |roadways have been appropriately justified. |

| |OR No nonstandard features are being retained or created on NHS/State roadways. |

| | | | |      |

| | |Name, | |Date |

| |

|E/F. Local Project Scope and |The required environmental determinations have been made, and the preferred alternative for this project is ready for |

|Design Approval |final design. |

|Use for local projects. | |

| | | | |      |

| | |Name, | |Date |

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|CONTACT: Jane Doe | |

|PHONE: (XXX) XXX-XXXX | |

|PROJECT MANAGER: Jane Doe | |

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|List of Preparers |

Group Director Responsible for Production of this Bridge Rehabilitation Report: Only stamp the final report.

|__(Name)_____, PE, Regional Design Engineer, NYSDOT Region ___ | |

|OR | |

|__(Name)_____, PE, Regional Maintenance Engineer, NYSDOT Region ___ | |

|OR | |

|__(Name)_____, PE, Regional Director of Operations, NYSDOT Region ___ | |

|OR | |

|__(Name)_____, PE, Director, Design Services Bureau, NYSDOT |PLACE P.E. STAMP |

|OR | |

|__(Name)_____, PE, Principal, ___(Consultant firm name)___ | |

|Description of Work Performed: Directed the preparation of the BRR in accordance with established | |

|standards, policies, regulations and procedures, except as otherwise explained in this document. | |

| | |

| | |

Note: It is a violation of law for any person, unless they are acting under the direction of a licensed professional engineer, architect, landscape architect, or land surveyor, to alter an item in any way. If an item bearing the stamp of a licensed professional is altered, the altering engineer, architect, landscape architect, or land surveyor shall stamp the document and include the notation "altered by" followed by their signature, the date of such alteration, and a specific description of the alteration.

[For NYSDOT prepared reports, include the following section. Only include licensed professionals that are stamping work as part of the main body of the report. Only stamp the final report. Add/remove rows, as needed. Refer to PDM Appendix 7, Section 6.1 for the technical appendices that must be stamped. The professional stamp does NOT apply to the environmental portions of the report, the cost estimate, or the schedule.]

This report was prepared by the following NYSDOT staff:

|__(Name)_____, PE, ____________, NYSDOT, _____ | |

|Description of Work Performed: | |

|Prepared the _____ for the BRR in accordance with established standards, policies, regulations and | |

|procedures, except as otherwise explained in this document. | |

| | |

|OR | |

| |PLACE P.E. STAMP |

|Description of Work Performed: Directly supervised the preparation of the BRR Chapters 1 and 2 in | |

|accordance with established standards, policies, regulations and procedures, except as otherwise | |

|explained in this document. | |

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| |PLACE P.E. STAMP |

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|Table of Contents |

COVER

PROJECT APPROVAL SHEET

CHAPTER 1 - EXECUTIVE SUMMARY

1.1 Introduction 1

1.2 Purpose and Need 1

1.2.1. Where is the Project Located 1

1.2.2. Project Needs 1

1.2.3. Project Objectives/Purposes 1

1.3. Alternatives Considered/Preferred Alternative 2

1.4 Design Guidance 2

1.5 Public Involvement Plan/Stakeholders 2

1.6 MPO, Funding and Schedule 2

1.7 Environmental Classification 4

1.8 NYS Smart Growth Public Infrastructure Policy Act (SGPIPA) 5

1.9 Special Circumstances 5

CHAPTER 2 - SITE SPECIFIC MATERIAL

Report Attachments

Social, Economic and Environmental Resources Checklist (SEERC)

Federal Environmental Approvals Worksheet (FEAW) As Applicable

State Environmental Quality Review Act (SEQR) Statement

Smart Growth Screening Tool

Capital Projects Complete Streets Checklist

EXECUTIVE SUMMARY

1. Introduction

23 CFR applies if a federal action is required such as funding or a federal permit.

This report was prepared in accordance with the NYSDOT Project Development Manual, 17 NYCRR (New York Codes, Rules and Regulations) Part 15, and 23 CFR (Code of Federal Regulations) 771. Transportation needs have been identified (section 1.2), objectives established (section 1.2.3) to address the needs, and cost-effective alternatives developed (section 1.3). This project is federally funded 100% State funded.

Include a short paragraph describing the project in layman’s terms.

1 1.2 Purpose and Need

1 1.2.1 Where is the Project Located?

The proposed bridge locations are listed below: Add/delete rows as necessary

|BIN |Route Number/ |Reference Marker |Town |County |

| |Feature Crossed | | | |

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Refer to Chapter 2 for location maps.

1.2.2 Project Needs

This project is needed to preserve and prolong the service life of the structures listed in Section 1.2.1. The list of structures was generated by Regional and Main Office Structure Asset Management Teams and approved by the Deputy Chief Engineer Structures in accordance with the guidance in the NYSDOT Bridge Manual.

3. What are the Objective(s) of the Project?

The objective of this bridge project is to preserve and prolong the service life of the existing structure(s) by reducing the rate of deterioration of the identified deficient bridge elements through cost effective rehabilitation strategies.

Eliminating selected bridge element deficiencies using cost effective rehabilitation strategies will:

• Extend the structure’s service life

• Reduce the life-cycle maintenance costs

• Improve the overall condition of the structure

For bridge specific project objectives see the Bridge Rehabilitation Justification Report.Refer to Bridge Manual Appendix 19B.

1.3 Alternatives Considered/Preferred Alternative

1. The Null alternative. This alternative will result in the continued deterioration of the structures, resulting in increased maintenance and eventually requiring the structure to be closed to traffic. This alternative will not satisfy the project objective and will be removed from further consideration.

2. Bridge Replacement. This alternative will satisfy the project objectives but has been determined not to be cost effective and has been removed from further consideration. See the Bridge Rehabilitation Justification Report for the Rehabilitation vs Replacement analysis.

3. Bridge Rehabilitation. This alternative has been identified as the prudent and feasible solution that meets the project objectives.

Alternative 3, Bridge Rehabilitation has been identified as the feasible build alternative that meets the project objectives. A decision to enter Final Design will not be made until after the Environmental Determination and evaluation of the comments received from the public information meeting (if required) and the Draft Bridge Rehabilitation Report.

1.4 Design Guidance

Design Criteria are in accordance with the NYSDOT Bridge Manual Section 2 and the NYSDOT Highway Design Manual Chapter 2. Design Criteria for each site are listed in Chapter 2 of this report.

1.5 Public Involvement Plan/Stakeholders

Notifications to public officials, potential stakeholders and emergency responders and schools have been completed. Briefly describe the public involvement activities to date and attach the Public Involvement (PI) Plan; all projects require a PI Plan (PDM 2.2.6). Include how the public will be made aware of the construction activities (see PDM Appendix 2 for potential informational/PI activities).

If the project is expected to have a de minimis Section 4(f) impact finding on a park, recreation area or wildlife/waterfowl refuge, public notice and an opportunity for public review and comment must be provided per 23 CFR 771.111(h)(2)(viii) and 23 CFR 774.5(b)(2)(i). If a public meeting is planned, this may be done as part of the notice for the public meeting. If no meeting is planned, then a notice should be published in a local newspaper with deadline for acceptance of comments (concerning the Section 4(f) de minimis impact finding). For historic resources, this requirement is met by following Section 106 procedures (23 CFR 774.5(b)(1)(iii)). Additional information can be found in the Project Development Manual Appendix 2 - Public Involvement Manual.

Include a description of any major actions proposed by other governmental agencies in the same geographic area as the proposed project.

|Public Involvement Plan Schedule of Milestone Dates |

|Activity |Date Occurred/Tentative |

|Stake holder Meeting |      |

|Focus Group Meeting |      |

|Meeting with Town Reps. |      |

|Meeting with Agency (SHPO/USCG/USACE, etc.) Include if |      |

|identified as necessary and if identified as part of the | |

|public involvement process. | |

|Public Informational Meeting |      |

Refer to appendix __ for project correspondence.

1.6 Metropolitan Planning Organization (MPO), Funding & Schedule

This project will be funded with Federal/State funds. An estimate for each location is included in Chapter 2. A summary of the costs for each location is shown below.

MPO INVOLVEMENT: No Yes

TIP Name:       Identify TIP No.:       Identify

TIP AMENDMENT REQUIRED: No Yes; Needed by:      

STIP STATUS: On STIP Not on STIP

SCHEDULE AND COST: (Include possible agency review/permit time frames)

| |Route Number/ |Bridge Cost $ |Highway |

|BIN |Feature Crossed | |Cost $ |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|TOTAL |$ |$ |

PROGRAM DISPOSITION/DESIRED LETTING: Scheduled for letting in SFY 20XX:

SCHEDULE ISSUES: Public Meeting 4(f)/106 FHWA sign-off

Permits Consultant(s) for: Other – Identify e.g., utilities, endangered species (ESA)

|Schedule and Cost |

|Project Phase |Activity Duration |Estimated Cost |Fund Source |Obligation Date |

|Design V-VI |      |      |      |      |

|Construction (see below) |      |      |      |      |

|Construction Inspection |      |      |      |      |

| |      | |

|TOTAL ESTIMATED COST | | |

Estimated Construction Cost should consider including incidentals (10%), Contingency (15% or as appropriate), Field Change Order, and Mobilization (4%).

BASIS OF ESTIMATE:       Indicate if estimate was prepared by lane mile, annual set aside funding capped at $X.XX M, etc.

1.7 Environmental Classification

NEPA (National Environmental Policy Act):

This project is being progressed as a NEPA Class II action (Categorical Exclusion).

Choose either:

In accordance with the Federal Highway Administration’s regulations in 23 CFR 771.117(c) this is an action which will not have significant environmental effects and does not normally require additional federal approval regarding NEPA. Specifically this action meets the description in 23 CFR 771.117(c)(#choose appropriate number from regulation) described as “regulatory description [insert description from regulation] ” and meets the constraints listed in 23 CFR 771.117(e) text only added for c(26), c(27) or c(28). This is further detailed in the Federal Environmental Approvals Worksheet (FEAW) included in Appendix X.

OR

Based on the Federal Highway Administration’s regulations, including the constraints listed in 23 CFR 771.117(e), the action is a Categorical Exclusion under 23 CFR 771.117(d). Specifically this action meets the description in 23 CFR 771.117(d)(#choose appropriate number from regulation) described as “regulatory description [insert description from regulation] ”.  Categorical Exclusions under 23 CFR 771.117(d), are actions which may be designated as a Categorical Exclusion when documentation is provided that demonstrates that significant environmental effects will not result.  To this end, information on those constraints from 23 CFR 771.117(e) that were exceeded is available, along with only include this reference if using d(13)[c(26), c(27), or c(28) that did not meet the constraints] the Federal Environmental Approvals Worksheet (FEAW), in Appendix X.

OR

If the project is 100% State funded, the typical NEPA review process is not applicable. Note that when permits are required from federal agencies or in rare cases where federal funding is used other than FHWA, information will need to be supplied to these agencies to complete their NEPA process. When this is the case use the following statement. This project is 100% State funded and the FHWA’s NEPA policies and procedures found in 23 CFR 771 do not apply.

SEQRA (State Environmental Quality Review Act):

SEQRA applies to both Federal aid projects and 100% State funded projects. Refer to 17 NYCRR Part 15.12 for SEQRA Exempt criteria and Part 15.14 for SEQRA Type II criteria. A project that does not meet the Type II criteria is classified as Non-Type II (EA).

In accordance with 17 NYCRR, Part 15, “Procedures for Implementation of State Environmental Quality Review Act”, the Department has determined that this project is a SEQR Exempt/Type II/Non-Type II Action. Additional information related to how the project meets the SEQR Exempt/Type II criteria is included in Appendix X.

The following Checklist(s) are attached:

Federal Environmental Approvals Worksheet (FEAW)

Complete and attach the Federal Environmental Approvals Worksheet for federally funded projects.

Social, Economic and Environmental Resources Checklist

Use the Social, Economic and Environmental Resources Checklist to determine if there are potential environmental issues that need to be documented in this report.

Attach for all projects except “Where and When” type projects. The checklist is not required for these projects.

Capital Projects Complete Streets Checklist

Only step one on the checklist is completed for 1R, Cyclical Pavement Marking or other maintenance project types listed in the Maintenance Project definition found in the CPCSC. For more information, refer to HDM Chapter 18, Section 18.5.1. For the checklist, refer to

1.7.1 ENVIRONMENTAL DOCUMENTATION For topics checked yes on the Social, Economic, and Environmental Resources Checklist or applicable on the FEAW in the appendix, resolution is as follows: Topics that have been checked yes on the Social, Economic and Environmental Resources Checklist should be resolved and summarized in this section (see the Instructions at the end of the checklist) and use appendices for additional documentation and correspondence. For example, Section 106 effect documentation and FHWA sign off, FHWA’s endangered species (ESA) determination, etc.

For "Where & When” type contracts include the statement: “Sites have not been identified for this “Where & When” contract. As sites are identified, they will be screened for any environmental concerns, including necessary agency reviews and/or permits.”

|COMPARISON OF ALTERNATIVES |

|Category |Alternatives Evaluated |Alternatives Considered and Dismissed |

| |Null |Reasonable/Preferred |Alt 2 |Alt 3 |

| | |Alternative – Alt. 1 | | |

|Insert applicable environmental|None |xxx (identify unit of |xxx units |xxx units |

|topic(s) | |measurement as appropriate | | |

| | |9acres, linear feet, # of | | |

| | |sites, level of effect or | | |

| | |impact, etc) | | |

|Property impacts |None |10 acres |12.5 acres |20 acres |

| | |6 businesses |8 businesses |8 businesses |

| | |1 residence |2 residences |4 residences |

| | | | |1 relocation |

|Operation at ETC + 20 |15 min delay |4 min delay |3 min delay |1 min. delay |

|20-year Crash Costs |$21M |$2M |$2M |$1M |

|Construction Cost |None |$14M |$15M |$20M |

The above table should be modified to include the items and resources that by comparison help to differentiate the alternatives (including the null/no-build alternative) and aid in conveying the reasons for the selection of the preferred alternative. For environmental topics, this could include issues such as permanent or temporary wetland impacts as expressed in acreage; permanent or temporary stream impacts expressed in both linear feet and acreage; suitable habitat impacted for certain endangered or threatened species (amount in acreage or type -breeding, nesting, foraging etc.); number of National Register eligible or listed sites (or type of effect). All issues that have a bearing on the preferred alternative selection should be included as needed. For example, load rating could be included for a bridge project, air quality for a capacity improvement project, etc.

Proposed Mitigation: If mitigation measures are proposed for the project, briefly state what mitigation is being proposed and/or include a statement referencing the applicable section(s) in the Appendix.Refer to Appendix X for mitigation measures that are proposed for this project.

1.7.2 ANTICIPATED PERMITS/CERTIFICATIONS/COORDINATION (Briefly list any anticipated permit(s) and certification(s) as well as the status of any coordination required for the project. Refer to applicable Appendices for additional in-depth information.)

Permits

New York State Department of Environmental Conservation (NYSDEC):

• State Pollutant Discharge Elimination System (SPDES) General Permit

• Article 24- Freshwater Wetlands Permit

• Article 25 Tidal Wetland Permit

• Water Quality Certification

• Mined Land Permit

• Floodplain Variance

• Wild, Scenic, Recreational Rivers Permit

• Construction Staging Permit

• Construction Borrow Area Mining Permit

• Construction Solid Waste Disposal Permit

• Indirect Source Air Quality Permit

• Coastal Zone Erosion Permit

• Coastal Erosion Hazard Permit (Article 34)

United States Coast Guard (Reference Appendix H for the USCG Checklist)

• Section 9 Permit

Army Corps of Engineers (USACE):

• Section 404/ Section 10 Nationwide Permit # (fill in permit # and title. Some of the typical NWPs used for NYSDOT projects are; #3 – Maintenance; #13 - Bank Stabilization; #14 – Linear Transportation Projects; #23 – Approved Categorical Exclusions; #33 – Temporary Construction, Access and Dewatering; #43 – Stormwater Management Facilities.)

• Section 404/Section 10 Individual Permit

Environmental Protection Agency (EPA)

• National Pollutant Discharge Elimination System (NPDES) General Permit

Adirondack Park Agency (APA)

• APA General Permit

Others

• Local Permits

• Historic or Archaeological Impacts to National Historic Preservation Act (NHPA) Section 106 resources

• Section 1424(e) review by FHWA and EPA (sole source aquifer)

• New York State Department of State (NYSDOS)

o Coastal Zone Consistency Certification Statement

o Coastal Zone Local Waterfront Revitalization Coordination (Reference whether or not there is a Local Waterfront Revitalization Plan.)

Coordination

• NYSDEC pursuant to the “NYSDEC/NYSDOT Memorandum of Understanding Regarding ECL Articles 15 & 24”

• Federal Highway Administration

• New York State Historic Preservation Officer (SHPO)

• US Fish and Wildlife Service

• New York Natural Heritage Program

• Adirondack Park Agency

• Municipality

Certifications

• NYS Department of Labor: Asbestos Variances

• NYSDEC Airport Air Quality Certification (Licensed Designer Specifications/Notes)

1.8 NYS Smart Growth Public Infrastructure Policy Act (SGPIPA)

To the extent practicable this project has met the relevant criteria as described in ECL § 6-0107. The Smart Growth Screening Tool was used to assess the project’s consistency and alignment with relevant Smart Growth criteria; the tool was completed by the Region’s Planning and Program Management group on insert date and reflects the current project scope. The Screening Tool shell can be found on the NYSDOT Smart Planning webpage.

1.9 Special Circumstances (public sensitivity, political commitment, relationship to other projects, relationship to local comprehensive plan, etc.) Note that for projects simple enough to be eligible to use the IPP/FDR we would not normally expect that there would be public sensitivity or political involvement. If you find those circumstances exist on your project, consider that use of the PSR/FDR or DDR may be more appropriate. Refer to Design Report Format Exhibit in the PDM. (OPTIONAL)

BRIDGE REHABILITATION PROJECT

CHAPTER 2 - SITE SPECIFIC MATERIAL FOR BIN 1234567

(INCLUDE MATERIAL FOR EACH BRIDGE)

SITE SPECIFIC MATERIAL

A. Project Information

B. Bridge Condition and Work Description

C. Design Criteria

D. Engineering Considerations

E. Environmental Consequences

F. Attachments:

LOCATION MAP

BRIDGE REHABILITATION JUSTIFICATION REPORT

CRASH ANALYSIS MEMO (AS APPROPRIATE)

NON-STANDARD FEATURE JUSTIFICATION FORMS (AS APPROPRIATE)

COST ESTIMATE

Capital projects complete streets checklist (SEE NOTE BELOW)

CONCEPTUAL PLANS (include plan and existing and proposed typical sections; add profile if the superstructure will be raised, or if vertical clearance is a concern)

Work Zone Traffic Control (WZTC) Scheme and Detour Plan

NOTE: Include a Capital Projects Complete Streets Checklist if the existing bridge shoulder width is non-standard, and a 4 ft. min. shoulder width is not being provided.

BIN 1234567 SITE SPECIFIC MATERIAL

| |

|A. PROJECT INFORMATION |

| |

|PIN and Description: |    .  .    |

| |      Description should include SH #, Route #, Locality (Village/Town/City) and County. |

|Reference Marker: |    -    -     |BIN : |      |Project Length: |      |

|Estimated Cost |Total $       M |Bridge Cost $ |Highway Cost |Funding: |      |

| | |      M |$       M | | |

|B. BRIDGE CONDITION & WORK DESCRIPTION |

|Condition Rating:       | |

|Vulnerability Ratings |Hydraulic:       |Steel:       |Concrete:       |Seismic:       |Collision:       |

|Conditions & Deficiencies: Describe conditions, deficiencies and vulnerabilities; note ratings as appropriate. Note all vulnerability ratings (above). For |

|ratings of 1 or 2 contact MO Structures Design Quality Bureau, for guidance on how to address the vulnerabilities in this project. For ratings of 3 describe, |

|under Proposed Work, the actions that will be taken to address those vulnerabilities. |

|Proposed Work: See Bridge Rehabilitation Justification Report |

| |

| |

|C. DESIGN CRITERIA |Functional Classification:       NHS:       |

| |Truck Access/Qualifying Highway:      Exist. AADT:       AADT (ETC+20):       |

| |% Trucks: |

|Element |Standard /Reference |Existing Condition |Proposed Condition |

|Design Speed |      |      |      |

|Lane Width |      |      |      |

|Shoulder Width |      |      |      |

|Horizontal Curve Radius |      |      |      |

|Superelevation |      |      |      |

|Stopping Sight Distance (Horizontal and |      |      |      |

|Vertical) | | | |

|Maximum Grade |      |      |      |

|Cross Slope |      |      |      |

|Vertical Clearance |      |      |      |

|Design Loading Structural Capacity |      |      |      |

| |Bridge Rehabilitations | | |

| |NYSDOT Standard Specifications for Highway Bridges | | |

| |: AASHTO HS 20 Live Load | | |

| |Superstructure Replacements: NYSDOT LRFD | | |

| |Specifications AASHTO HL-93 Live Load and NYSDOT | | |

| |Design Permit Vehicle | | |

| |Substructures: NYSDOT Standard Specifications for | | |

| |Highway Bridges AASHTO HS 20 Live Load | | |

| |BM Section 2.6.2 | | |

|American with Disabilities Act (ADA) |      |      |      |

|Compliance | | | |

|The Regional Traffic Engineer has concurred with the selected design speed. |

|*Denotes non-standard feature |

| |

|D. ENGINEERING CONSIDERATIONS |

|Planned Nearby Highway Work: |      (Discuss work within the period ETC+20.) Include a statement such as: The RPPM does not anticipate capacity improvements|

| |within 20 years. |

|Utilities Affected: |      |

|Railroad Involvement: | |

|ROW Needed: |None |

|Non-Standard Features: |      (List the features here and include non-standard feature justification forms as appropriate) |

| |

| |

| |

|Crash Rate/Safety Considerations: |      (Refer to Guidance, item 2) |

|Guide Railing/Bridge Rail: |All bridge rail and guide rail transitions within the work limits will be upgraded to current standards. |

|Work Zone Traffic Control: |     If staged construction is proposed, can existing traffic volumes be accommodated on the structure? Will the planned detour|

| |route have any other construction activity on it during the season? Include the following statement: |

| |The RegionX has determined that the subject project is, is not choose one significant per 23 CFR 630.1010. |

|Miscellaneous: |      (Traffic Signals, Signs, etc.) |

|E. ENVIRONMENTAL CONSEQUENCES Discuss as appropriate See Environmental Checklist, Federal Environmental Approvals Worksheet (FEAW), and SEQR statement |

|attached to this report. |

| |

|F. SITE SPECIFIC ATTACHMENTS |

|LOCATION MAP |

|BRIDGE REHABILITATION JUSTIFICAITON REPORT |

|CRASH ANALYSIS MEMO (AS APPROPRIATE) |

|NON-STANDARD FEATURE JUSTIFICATION FORMS (AS APPROPRIATE) |

|COST ESTIMATE |

|CONCEPTUAL PLANS |

|Work Zone Traffic Control (WZTC) Scheme and Detour Plan |

Guidance on using this shell:

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GUIDANCE FOR BRIDGE REHABILITATION REPORT

Chapter 2 Site Specific Material

4/25/17

1. Section B, discuss the following:

a. Will deck replacement improve the bridge rating and/or remove a load restriction?

b. Does the deck work necessitate work on the approaches?

c. Is the bridge rail and/or approach rail being replaced?

d. Is there a safety walk? If yes, will it be eliminated or retained?

e. Confirm that the waterway (where applicable) will not be adversely impacted.

f. Hydraulics: Verify that no hydraulic concerns are overlooked and that the structure is not vulnerable to hydraulic failure. In addition, discuss and address other vulnerabilities in Section 2B.

2. Section D, Accident Rate/Safety Considerations, perform the following:

a. Check SIMS for statewide accident rate, High Accident Locations and determine if there are any identifiable patterns of accidents within the project limits; use HDM 5.3 for guidance. If there are accident patterns within the project limits, an Accident Analysis memo must be completed by Regional Traffic & Safety that concludes one of the following:

i. The accident problem is not related to the bridge, cannot be corrected by the project, and will be referred to Regional Planning for correction by a future project.

ii. There is no feasible solution to the identified accident pattern (based on B/C ratio,).

iii. Full or partial correction of the identified accident pattern can be accomplished within the project by the following actions (include the recommendations).

3. In Section D, complete Non-Standard Feature (NSF) Justification form(s) for all identified non-standard features. Discuss non-conforming features.

4. Include conceptual plans (incl. profile, if appropriate) and typical sections (existing and proposed); line drawings (not to scale) and/or marked up record plans are acceptable.

5. Bridge Manual Section 19: Requirements of Section 19 Bridge Rehabilitation Projects should be addressed, including Bridge Rehabilitation vs. Replacement Selection Guidelines (section 19.2.2) and Seismic Rehabilitation (section 19.7). Section 19.7 notes that all bridges that are scheduled for rehabilitation shall be evaluated with regard to seismic failure vulnerability.

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