20140341_Field Scoping Meeting Worksheet_20111006

NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
FIELD SCOPING MEETING WORKSHEET
Design Build Process
WBS No.:P„ 5 Field Scoping Meeting Date:
Division: Location: On -site
Route (US/NC/SR): R1 5 CountyaP"�lolpl
Project Description: 0 lik # _off ;l�wh rr ,Rtu r ran SIR' 1105
Tier: 0 040 NO A4
Municipality:
Attendees
Structure No:b02 1 of 4
Name
Phone No.
E -mail
Division Bridge
Manager
Division Environmental
Officer
Hydraulics Engineer
Geotechnical
USACE
DEN R -DWQ
TPMU
TPMU
TPMU
Bridge Management
Structure No:b02 1 of 4

Existing Features
Feature Bridged: OQ;2 er(oi 040►nrh04Riu r on R Q
Ex. Bridge Clear Deck Width: ,1'P 2 (Ft.) Existing Shoulders: 6 (Ft.) grass
(Bridge 1 Culvert) Length: t4: (Ft.) Deck Width (Out To Out): (Ft.)
Water Depth: (Ft.) Height Bed -To- Crown: 0 (Ft.)
Prior Survey Date: Posted: SV t7 TTST: fi;?
Superstructure Type:, Substructure Type; 15
Span Type: ':= `;x.01 Built `55
Historic High Water (Elev. To The Existing Structure ): (Ft)
Sufficiency Rating; ± ; DP: #2 School Bussing crossings per day:
Posted Speed Limit In Project Vicinity: Statutory 55mph
Detour: Off -Site Stage Construction: On -site:
If Detour is Off -Site, Provide Description Of Detour Route: SR 1181- 1301 -1105
Approximate Length Of Detour? 7 Miles
Improvements Needed To Road(s) On Detour?
Div. Traffic Eng, Recommend Off -site detour signing?
Improvements Needed To Bridges On Detour?
Are Bridges On Detour Currently Programmed On Tip?
Are There EMS Or Business Access Issues?
Are There Any Railroad Crossings On Detour?
Should Work Zone Pedestrian Access Be Maintained During Construction?
Overhead Utility Lines
In Conflict
Power Transmission Lines
In Conflict
Telephone
In Conflict
Cable Lines
In Conflict
Fiber Optic
In Conflict
Water
In Conflict
Sewer
In Conflict
Natural Gas
In Conflict
Other
In Conflict
Based On The Past History Near This Project Site, What Is The Estimated Time Required
To Complete Utility Adjustments _ Months
Is There Any Future Utility Construction Anticipated In The Project Area
Is A FEMA Buy -Out Property Being Impacted
Hydraulics
Structure NO.$ 2 of 4

Will This Project Require FEMA Approval? (MOA } Yes - limited
Will This Project Require A State Stormwater Permit? N
Is There Unusual Scour Potential? Is Protection Needed?
Are Banks Stable? Is Protection Needed?
Does Stream Carry Appreciable Amount Of Large Debris?
Will The Placement Of Bents In The Water Be Allowed:
Note: 100 year WS is below low chord
Drop Inlets, Flumes or Funnels?
Geotechnical
Are There Any Historical And 1 Or Vibration Sensitive Structures Near By Comments:
Are There Any Known Landfills And / Or Geo- environmental Hazard Sites At Or Within
Close Proximity To The Project Site -- - - - - -- Comments:
Are Any Impacts Anticipated To Natural Springs Or Artesian Wells: Comments:
Possible Foundation Type:
Environmental
Wetlands At Site N Comments:
Known Endangered Species Populations In Area Comments: No effect
Trout County: TVA County:
CAMA County; Primary Nursery Area:
Moratoria: if Yes - Duration
Permits Required:
Water Quality Classification: 0.'..; Buffer: none - Yadkin
Will A Coast Guard Permit Be Required Drainage Basin:cl[4
Is The Project Site In Or Near Any Of The Fallowing:
National Forest No Wildlife Refuge No ;
State, County, Or Local Park No Wild And Scenic River No ;
Airport No A Lake For Recreation Of Power Generation
Water Supply Reservoir No Nutrient Sensitive Waters ;
Public Use Boat Ramp Cemeteries ;
Known Or Potential Historic Properties In The Area: Historic Archit. Survey required ;
Archaeology Survey required N.
Is The Bridge Structure Itself, Or Any Part Thereof, Considered Historic: No
Will The Project Impact A Church, Community Center, Or Other Public Facility
Is This Project On A Statewide Bicycle Route Or A Local Non - Marked Bicycle Route: No
Structure No:'1' t1* 3 of 4
H

Any Clarification Or Comments On Items Above:
Items To Be Discussed / Resolved At FSM By Attendees
Off -Site Detour ❑ Stage: ❑ New Location ❑
Type Of Environmental Document:
Low Impact Data Spreadsheet ❑ Minimum Criteria Rule /MC Checklist ❑
Other:
Superstructure Type:
Number Of Spans:
Length Of Spans:
ADT IBIR NHS: Q Tier: s. F IQ Func. Class: > � I
Bridge Min. Clear Deck width Recommended by Div.:
Per SRTG Minimum Deck Width:
Roadway lane width 'with 'shoulders
Will Railroad Involvement Be Required:
R/W by Others:DBT will be responsible for RIW acquisition and coordination of utility issues.
Permits: NCDOT will submit permits as prepared by DB Team.
Method of Clearing:
Truck Percentage:: ,_,,,, %; Reasonable Safe Speed: 25 mph based on approach
Liquidated damages: will be imposed after
CEI to be done by NCDOT or others:
Salvageable materials:
Removal of remenant abutments /piers:
Additional Comments:
Any priority in bridge construction sequencing?
Approach slab on skew or perpendicular?
Should piles be non- corrosive material?
days of closure. Amt: $ per day
Structure No:SC}?9 4 of