BP11.R039 FSM Worksheet

NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
FIELD SCOPING MEETING WORKSHEET



TIP No.: N/A
FIELD SCOPING MEETING DATE:  May 23, 2024    

DIVISION: 11
LOCATION: On-Site

COUNTY: Wilkes
ROUTE (US / NC / SR): SR 2035

PROJECT DESCRIPTION: Replace Bridge #960236 on SR 2035 over branch Elkin River in Wilkes County

FUNCTIONAL CLASSIFICATION: Local

TIER: Sub-Regional Tier

MPO / RPO AREA: Northwest Piedmont RPO

MUNICIPALITY: N/A



ATTENDEES


NAME (PRINT)


PHONE No


E-MAIL

DIVISION CONSTRUCTION ENGINEER
     
     
     

AREA BRIDGE CONSTRUCTION ENGINEER
     
     
     

DIVISION BRIDGE PROGRAM MANAGER
     
     
     

DIVISION UTILITY COORDINATOR
     
     
     

DIVISION ENVIRONMENTAL OFFICER
     
     
     

DIVISION RIGHT OF WAY REPRESENTATIVE
     
     
     

HYDRAULICS REPRESENTATIVE
     
     
     

GEOTECHNICAL REPRESENTATIVE
     
     
     

STRUCTURE DESIGN REPRESENTATIVE
     
     
     

STEWART
     
     
     

STEWART
     
     
     

STEWART
     
     
     

SUNGATE
     
     
     

SUNGATE
     
     
     

VHB
     
     
     



DIVISION (COMPLETED BY DIVISION STAFF AND SENT WITH THE FSM LETTER)
EXISTING FEATURES

FEATURE BRIDGED:      


(BRIDGE / CULVERT) LENGTH      ’
DECK WIDTH (OUT TO OUT)      ’


WATER DEPTH:      ’
HEIGHT BED-TO-CROWN:      ’


PRIOR SURVEY DATE:      
POSTED: SV      
TTST:      


STRUCTURE TYPE:      



SPAN TYPE:      



SUFFICIENCY RATING:      



POSTED SPEED LIMIT IN PROJECT VICINITY:       (MPH / STATUTORY 55MPH)


DETOUR: OFF-SITE 
ON-SITE 
STAGE CONSTRUCTION 


IF DETOUR IS OFF-SITE, PROVIDE DESCRIPTION OF DETOUR ROUTE      



APPROXIMATE LENGTH OF DETOUR?       (MILES)



IMPROVEMENTS NEEDED TO ROAD ON DETOUR?      



IMPROVEMENTS NEEDED TO BRIDGES ON DETOUR?      



ARE BRIDGES ON DETOUR CURRENTLY PROGRAMMED ON TIP?  COMMENTS:      



ARE THERE EMS, SCHOOL , OR BUSINESS ACCESS ISSUES?  COMMENTS:      



ARE THERE ANY RAILROAD CROSSINGS ON DETOUR?  COMMENTS:      



SHOULD WORK ZONE PEDESTRIAN ACCESS BE MAINTAINED DURING CONSTRUCTION?  REASONS:      



IMPACT RATING TO UTILITIES 



OVERHEAD UTILITY LINES  IN CONFLICT 



POWER TRANSMISSION LINES  IN CONFLICT 



TELEPHONE / CABLE LINES  IN CONFLICT 



FIBER OPTIC  IN CONFLICT 



WATER  IN CONFLICT 



SEWER  IN CONFLCIT 



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 UNIT (COMPLETED BY HYDRAULICS UNIT STAFF PRIOR TO THE FSM)
WILL THIS PROJECT REQUIRE A FEMA PERMIT? 

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  COMMENTS      

WERE HYDRAULIC ALTERNATIVES BESIDES A BRIDGE CONSIDERED  COMMENTS      

POSSIBLE SPAN LAYOUT:      



GEOTECHNICAL UNIT (COMPLETED BY GEOTECHNICAL UNIT PRIOR TO THE FSM)
EXISTING FOUNDATION REPORTS?  IF SO, ATTACH.

KNOWN GEOLOGICAL FEATURES IN AREA WHICH MAY AFFECT DESIGN      

ARE PERMITS NEEDED FOR INVESTIGATIVE WORK AT SITE  COMMENTS:      

ARE THERE ANY HISTORICAL AND / OR VIBRATION SENSITIVE STRUCTURES NEAR BY  COMMENTS:      

ARE THERE ANY KNOWN LANDFILLS AND / OR GEOENVIRONMENTAL HAZARD SITES AT OR WITHIN CLOSE PROXIMITY TO THE PROJECT SITE  COMMENTS:      

DEPTH OF WEATHERED ROCK OR ROCK BELOW STREAMBED       ( FT. )

ARE ANY IMPACTS ANTCIPATED TO NATURAL SPRINGS OR ARTESIAN WELLS  COMMENTS:      

POSSIBLE FOUNDATION TYPE:      .



PD & EA AND NEU UNIT (COMPLETED BY PDEA STAFF PRIOR TO THE FSM)
TRAFFIC FORECAST (AS PREPARED BY TRANSPORTATION PLANNING BRANCH AND PROVIDED BY PDEA)

Accident History:      
-L- BASE YEAR (20   )

ANNUAL AVERAGE DAILY TRAFFIC      

% TRUCKS/DUALS      

-L- DESIGN YEAR (20   )
ANNUAL AVERAGE DAILY TRAFFIC      
 % TRUCKS/DUALS      

SHOW -Y-LINE TRAFFIC IF APPLICABLE FOR BRIDGES OVER / UNDER.

-Y- BASE YEAR (20   )
ANNUAL AVERAGE DAILY TRAFFIC      
 % TRUCKS/DUALS      

-Y- DESIGN YEAR (20   )
ANNUAL AVERAGE DAILY TRAFFIC      
 % TRUCKS/DUALS      

TRAFFIC SAFETY (AS PREPARED BY THE TRAFFIC SAFETY UNIT AND PROVIDED BY PDEA)
OPERATING SPEED:       MPH
CRASH RATE:      
WETLANDS AT SITE  COMMENTS:      

 KNOWN ENDANGERED SPECIES POPULATIONS IN AREA  COMMENTS:      

TROUT OR TVA COUNTY  COMMENTS:      

CAMA COUNTY  PRIMARY NURSERY AREA 

MORATORIA  IF YES-DURATION      

COMMENTS:      

 IS WATER FEATURE CLASSIFIED AS A WILD AND SCENIC RIVER  COMMENTS:      

WHAT IS THE WATER QUALITY CLASSIFICATION FOR THIS PROJECT:      

WILL A COAST GUARD PERMIT BE REQUIRED  COMMENTS:      

IS THE PROJECT SITE IN OR NEAR ANY OF THE FOLLOWING:

 NATIONAL FOREST 

 WILDLIFE REFUGE 

 STATE, COUNTY, OR LOCAL PARK 

 AIRPORT 

 A LAKE FOR RECREATION OR POWER GENERATION 

 WATER SUPPLY RESERVOIR 

 NUTRIENT SENSITIVE WATERS 

 PUBLIC USE BOAT RAMP 

 CEMETARIES 

WILL A FEDERAL ENERGY REGULATORY COMMISSION PERMIT BE REQUIRED 

IS THE PROJECT AREA KNOWN FOR POTENTIAL INDIAN, COLONIAL, OR OTHER ARCHAEOLOGICAL SITES



KNOWN OR POTENTIAL HISTORIC PROPERTIES IN THE AREA 

IS THE BRIDGE STRUCTURE ITSELF, OR ANY PART THEREOF, CONSIDERED HISTORIC 

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 

ANY CLARIFICATION OR COMMENTS ON ITEMS ABOVE:      




ROADWAY DESIGN UNIT (COMPLETED BY ROADWAY DESIGN UNIT PRIOR TO FSM)

ALIGNMENT: EXISTING HORIZONTAL 

 EXISTING VERTICAL 

POSSIBLE DESIGN STANDARDS      

POSSIBLE DESIGN SPEED       (MPH)

POSSIBLE DESIGN EXCEPTIONS  COMMENT      

APPROXIMATE PROJECT LENGTH      ’
NUMBER AND WIDTH OF LANES      

SHOULD THIS PROJECT HAVE CURB AND GUTTER OR SHOULDER APPROACHES  COMMENT      

TOTAL SHOULDER WIDTH      ’
PAVED SHOULDER WIDTH      ’

CLEAR ROADWAY ON STRUCTURE      

WILL EXISTING DRIVEWAYS, BUSINESS ACCESS, -Y- LINES OR RAMPS NEED TO BE RELOCATED  COMMENTS:

IS THERE ADDITIONAL RIGHT OF WAY / PERMANENT EASEMENTS / TEMPORARY EASEMENTS ANTICIPATED FOR CONSTRUCTION  COMMENT      
ARE ANY RETAINING WALLS ANTICIPATED 

IS THERE A POSSIBILITY OF RELOCATEES  IF SO, DESCRIBE      

ADDITIONAL COMMENTS:      



STRUCTURE DESIGN UNIT (COMPLETED BY THE STRUCTURE DESIGN UNIT PRIOR TO THE FSM)

POSSIBLE SUPERSTRUCTURE:

 TYPE:      

 NUMBER OF SPANS      
LENGTH OF SPANS      

WILL RAILROAD INVOLVEMENT BE REQUIRED 

WILL STRUCTURE REQUIRE DESIGN FOR VESSEL IMPACT OR FENDER SYSTEM  DESCRIPTION:      
ARE ANY RETAINING WALLS ANTICIPATED 



CONSTRUCTABILITY AND ACCESS (DISCUSSED AT THE FSM BY DIVISION BRIDGE MANAGER)

METHOD OF ACCESS:      

TOP-DOWN 

(WORK BRIDGE / CAUSEWAY) PROPOSED LOCATION RELATIVE TO EXISTING STRUCTURE: Work Bridge

PROPOSED LENGTH       (FT)
WIDTH       (FT)

MATERIAL AND EQUIPMENT ACCESS TO SITE:

TRACTOR-TRAILER ACCESS 
BARGE ACCESS 
HEAVY EQUIPMENT ACCESS 

POSTED ROADS AND POSTED BRIDGES IN VICINITY THAT MAY AFFECT ACCESS 

ARE CONSTRUCTION STAGING AREAS AVAILABLE NEAR SITE 
ANY ANTICIPATED AREAS OF TEMPORARY SHORING REQUIRED 

ADDITIONAL COMMENTS:      

ITEMS TO BE DISCUSSED / RESOLVED AT FSM BY ATTENDEES
LIST ALTERNATIVES TO BE STUDIED BY ROADWAY DESIGN:
1)
2)
3)

DESCRIBE ANY DISCUSSION REGARDING HOW THE ALTERNATIVES WERE DECIDED UPON, WHY CERTAIN ALTERANTIVES WERE REJECTED, AND IF AN ALTERNATIVE WAS SELECTED, WHY.

     

CHECK ONE

TYPE OF ENVIRONMENTAL DOCUMENT (CHECK ONE)

CATEGORICAL EXCLUSION (CE) 

MINIMUM CRITERIA DETERMINATION CHECKLIST (MCDC) 

THE OPTIMUM LET DATE FOR THIS PROJECT IS:      

ADDITIONAL COMMENTS AND/OR UNRESOLVED ISSUES TO BE ADDRESSED: