User: .us
|User: |Engineer: |
| | |
|EMA No.: |Scope of Upgrades: |
| | |
|Permit No.: | |
|County: |Engineer Phone: |
|State Route: |Engineer Email: |
|Work Limits (Segment/Offset): |Date: |
| |Included | |
|Requirement |Yes |No |NA |Comments / Remarks |
| | | | | |
|Contact District to discuss proposed upgrades | | | | |
| | | | | |
|Obtain a section number from the District | | | | |
| | | | | |
|Will multiple Users be on the roadway? | | | | |
| | | | | |
|Is cost sharing applicable? | | | | |
| | | | | |
|Maintenance or Preparatory Work | | | | |
|Coordinate Department maintenance activities | | | | |
|Coordinate User maintenance activities | | | | |
| | | | | |
|Plan Submission includes one full size (22"x34"), one half size (11"x17"), | | | | |
|and one PDF document | | | | |
| | | | | |
|Provide contacts for USER(s), Supporting Engineer, and PennDOT Approved | | | | |
|Contractors (upon selection) | | | | |
| | | | | |
|Assessment of Need for Road Upgrade | | | | |
|Coring and non-destructive testing method | | | | |
|Coring and pavement condition survey method | | | | |
|80% of remaining pavement life used in 1st 6 months | | | | |
| | | | | |
|Upgrade Design | | | | |
|Horizontal and vertical alignment defined | | | | |
|Design exception needed | | | | |
| | | | | |
|Typical Sections | | | | |
|Minimum pavement and shoulder width in accordance with Publication 23, | | | | |
|Chapter 7 | | | | |
|Identify proposed cross slope and rate of superelevation | | | | |
| | | | | |
|Approved Pavement Design | | | | |
| | | | | |
|Guide Rail | | | | |
|Identify if to remain in place, reset, replace | | | | |
| | | | | |
|Right-of-Way | | | | |
|All work within ROW | | | | |
|Additional ROW required | | | | |
|Easements required | | | | |
|Authorization to enter/waiver of claim for driveways | | | | |
|Temporary construction easement | | | | |
| | | | | |
|Upgrade Schedule/Phasing provided | | | | |
|Does project conflict with any planned PennDOT projects or maintenance | | | | |
| | | | | |
| | | | | |
|Construction Materials | | | | |
|All materials approved in Publication 35, Bulletin 15 | | | | |
| | | | | |
|Surplus Material | | | | |
|Milled material - Department or contractor property | | | | |
|Guide rail - Department or contractor property | | | | |
|Other | | | | |
| | | | | |
|Out of Season Work | | | | |
|Pavement | | | | |
|Base replacement | | | | |
| | | | | |
|Bridge | | | | |
|Current weight restrictions | | | | |
|One lane structures | | | | |
|Deadload check if overlay is proposed | | | | |
|Bridge approach reconstruction (50' length by full width) | | | | |
| | | | | |
|Vertical or horizontal clearance concerns | | | | |
|Excavation adjacent to structure | | | | |
|Backwall stability check | | | | |
| | | | | |
|Drainage | | | | |
|Cross pipes reviewed by Department and contractor | | | | |
|Replacements included or coordinated with Department | | | | |
|Underdrain needed | | | | |
|Parallel ditch cleaning required | | | | |
|New parallel pipe installation required/proposed | | | | |
|Pipe outletting at new location | | | | |
|Necessary permits | | | | |
| | | | | |
|Safety | | | | |
|Crash cluster(s) within project area (by Department) | | | | |
|Mitigation required | | | | |
|Sight distance concerns at: | | | | |
|Intersections | | | | |
|Driveways/Other locations | | | | |
|Vegetation hindering sight distance | | | | |
| | | | | |
|Utilities | | | | |
|PA One Call completed during: | | | | |
|Design | | | | |
|Construction | | | | |
|Minimum overhead Clearance maintained - 18' Min. | | | | |
| | | | | |
|Railroads | | | | |
|Railroads present | | | | |
|Coordination with railroad | | | | |
|Roadway approaches need to be reconstructed due to depth of overlay (50' | | | | |
|length for full width) | | | | |
|New grade crossing required due to a wider proposed pavement and shoulder | | | | |
|section | | | | |
|PUC Application/Coordination | | | | |
| | | | | |
|Pavement Marking and Signing | | | | |
| | | | | |
|Pavement Marking and Signing Plan included | | | | |
|Pavement markings to be installed by Department or contractor | | | | |
|Reset existing signs and coordinate with PennDOT | | | | |
|Place new signs | | | | |
| | | | | |
|Maintenance and Protection of Traffic | | | | |
|Plan provided | | | | |
|Work completed with: | | | | |
|Flagging operations | | | | |
|Temporary signals | | | | |
|Detour | | | | |
|Reset mailboxes required | | | | |
|Notify the Department in writing of any lane restrictions or detours 14 days| | | | |
|or 10 working days, whichever is greater, prior to implementation, submit | | | | |
|M-937M | | | | |
| | | | | |
|Coordination of Detours | | | | |
| | | | | |
|Posted bridges along proposed detour route | | | | |
|Notify: | | | | |
|Emergency services | | | | |
|Local municipalities | | | | |
|Businesses | | | | |
|School district | | | | |
|Property owners | | | | |
|Post office | | | | |
| | | | | |
|Erosion and Sedimentation | | | | |
|Plan required | | | | |
|Coordinated with county conservation district | | | | |
| | | | | |
|Waste Disposal / Recycling Plan provided | | | | |
| | | | | |
| | | | | |
|Environmental Issues | | | | |
|Environmental Components Matrix, M-4902EV | | | | |
( Plan Approved
Date: Reviewer:
( Plan Approved
Date: Reviewer:
Plan Comments/Pending Items:
|Date |Comments |
| | |
| | |
| | |
| | |
| | |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.