Proforma C

PRADHAN MANTRI GRAM SADAK YOJANA ( PMGSY -II)

CHECK LIST FOR P.I.U. & S.T.A.
( For Indvidual Road Works )
To be filled by PIU.
1. Location :-

State:

District :

Block

2. Package No:3. Name of the Road:

From

To

4. Total Length (Km) -

In Built up area -

5. Catigory of upgradation proposal

Km

In Open Area -

Km

If it is category 'C' road than indiacte

Year of sanction under PMGSY

Year of completion

Yes

Design Traffic ( CVPD/ ESAL)

NO

Whether road deteriorated due non maintenance

6. Estimated Cost Rs :
Cost sharing pattern for this road

Normal Area

Special Area

Item

Total Cost in
Rs.

Average Cost per Km. Lakhs

Flexible Pavement
Rigid Pavement
Others ( CD Works, Protective works & Misc items)
Cost due to higher specification such as carriage way width,
Higher Axle load , Hard shoulders, Shifting of Utilities

Total Project Cost

MoRD Share
State Share

7. Is the road a part of DRRP

a) If Yes , Through Route/ MRL No.

or

T-

b) Names of benefitted Growth points

Name of Habitation

MRL-

Population

Overall Weightage

Total weight

c) Utility value = Total weight/ Length of road

d) Does the Proposed Road lead up to the growth centre /hub or the road is
being made partially?

Yes

e)Whether the proposed road leads to

MDR

SH

No

NH

f) Average PCI of the road to which proposed TR or MRL will be connected

g) Average PCI value of proposed road
h) If PCI of MDR / SH / NH is 3 or below , whether the State's undertaking for
simultaneouly upgrading it from State fund is avaible

Yes

No

i) Age of the proposed road

j) Cummalative maintenance expenditure in last three years( in lacs)
8. a) Whether the Proposed Road has the desired carriage way
width,Roadway width and Road Land Width (RLW )

carriage way
yes

b) Indicate the actual widths of the following for the proposed road

Roadway width

No

yes

Road land width

No

yes

In the Built Up Area (m)

-

i) Carriageway
ii) Roadway
iii) Road Land Width

Target Habitation
Name

INDEX MAP (not to scale ) : Attached saperately

Enroute Habitations Name / Chainage

H2

H2

ROAD
MDR-42
MSH-6

H1

CD1

CD2

No
In the Open Area (m)

CD3

9 Name of Road :
Cross Section details

a) Cross Section of The Existing road showing different component layers.

Item

Thickness

Item

Thickness

b) Cross Section of The Proposed road showing different component layers

(Should be as per Actual Provisions of DPR)

10

Base year traffic volume

Month & Year of Traffic Volume Count =
Motorised Traffic
Days

Cars,Jeep,
Vans,Three
Wheelers

Motorised
two
Wheelers

Light
Commercial
Vehicle

Non Motorised Traffic

Trucks
U

OL

OL

Day 1
Day 2
Day 3
Day 4
Day5
Day 6
Day 7
Average
7 day count required in case design is done with IRC 37:2001
Passenger car unit( PCU)

Traffic Details in case degisn is done as per SP IRC 72:2007

ADT in the year of Traffic Count =
Growth rate adopted (%) =
Design Life =
Years
Number of Harvesting Seasons =
No. of Days in Each Harvesting Season (t) =
Value of (n) assumed =

Base Year Traffic AADT (T) =

Cumulative ESAL =
Traffic Category =

Traffic Details in case degisn is done as per IRC 37-2001 /IRC 37 :2012
A= Intitial traffic in the year of completion of construction in terms of the number of commericial
vehicles per day
D= Lane distribution factor
F= Vehicle damage factor
n= Design life in years
r= growth rate adopted %
N= The cumulative number of standard axles to be catered for the design in terms of
msa
CVPD

11. Subgrade CBR ( for Different Sections ) =

Chainage
Design
CBR %

Cycle
Rickshawa

Animal Drawn Vechicle

Agricultural Tractors Trallers

L

Cycles

Buses
OL

SWC

Num. Tyred

12. Cost Details of upgradation proposal

A. Pavement Components
Description of layer

Thickness in mm

Quantity

Rate Rs

Cost Rs.

Earth Work - in Excavation/ Cutting

Earthwork- in Filling (Embankment)
Subgrade (if provided seperately)/ Treated subgrade
Shoulders (If not considered in the Earthwork)
Granular Sub base
Soil + Aggregate Mix
WBM Gr -I I
WBM Gr -I I I
WMM ( if designed by IRC 37)
Bituminous Layers
Prime Coat
Tack Coat
OGPC /SDBC/BC ( SDBC / BC if designed by IRC 37)
Seal Coat
BM /DBM ( if designed by IRC 37)
Surface Dressing

Total cost of Flexible pavement

Cement Concrete Road
IRC 58

IRCSP 62:2004
Design done with

GSB
WBM
Dry lean concrete( DLC)

Concrete for Pavement

Total Cost of Concrete Pavement
B: C D Works

Location - Chainage ( Similar Type of CD's may be

grouped together)

Type of CD & their Nos Total Length of Culvert

Existing CD ( requiring repair)

ii

New proposed CD ( including cpmplete replacement of

existing CDs)

Cost in Rs.( in lacs)

Total Cost of CD works in lacs

C. Protection works

Chainage
From

To

Length( m)

Cost in Rs

Average cost / m

Retaining wall
Breast wall
Toe wall
Gabbion
Pitching / turfing for slopes
Total cost of protection works

Chainage

D. Pucca Side Drains (if Provided)

From

To

Length(
m)

Cost in Rs

Average cost / m

Cost in Rs

Average cost / km

Total cost of side drains works

E. Road Logo, other Road Furniture including Road safety signs

Number
Number of Boards

Total cost of road furniture

F. Any other Provisions (Please Specify)

Total Cost of the Project (Rs)

Cost/ km
(Rs)

13. Five Year Routine Maintenance

Year
I
II
III
IV
V

To be estimated as per provision of Operation Manual

Cost in lakhs

% Cost

Cost /km

Renewal coat after 5 years

Total Maintenance Cost

Maintenance after renewal coat

I
II
III
IV
V
Total Maintenance Cost

G/ Total of maintenance
Yes

NO

Yes

No

14. Whether the road has Geometrics as per Rural Roads Manual RRM / Latest Circulars of NRRDA.

15.Whether C.D.works / Protection works are provided as per RRM / Latest Circulars of NRRDA/ Respective Codes of IRC.

16.Does the Estimation Conform to Standard Rate Analysis and SSR generated for the current Phase

17. Sources and the Lead distances of Materials are as under

Material
Source
Lead
Distance
(Km)
Earth
Murrum
(Subgrade)
Aggregate
Sand

Material

Source

Cement
Emulsion
Bitumen
Steel

Certified that information provided is true

Prepared By
(Name)

Checked By

Technical Scrutiny at STA

done by:
Counter Signatures of
Co-ordinator STA :

Vetted at
NRRDA
Yes
No

Lead Distance

Year

To be filled by State Technical Agency

Name of the STA:
Name of Road :

Yes / NO to be filled by STA in own handwriting

18

Is the Proposed Road entered on the OMMS under PMGSY II :

(Data entries to be verified by STA before Clicking the Propopsal)

19

Have you satisfied yourself that the proposed road is a part of DRRP

20

Are you satisfied with the following

Engineering Surveys
(L section, X section on A3 size paper must be verified)
Soil/ Material Investigation
( CBR, Density, LL, PI, Gradation to be verified)
Whether Traffic Surveys / count has been done by third party
Hydraulic Studies.
( Catchment for structures with more than 2 Vents to be verified from topo sheet. Location and requirement of all CD
structures to be verified from L section )

21

In case , Traffic is projected beyond T 7 Category and road designed using IRC 37 are you satisfied with
the reason given by PIU

22

In case, sub grade CBR is less than 5; has Soil Stabilisation etc. been proposed
( If not , specific Reasons given by PIU)

23

Is the design of the following elements as per Rural Roads Manul / Circulars of NRRDA:

Alignment & Geometrics

Location and type of CD works and Side drains
Integration for Cross and longitudinal Drainage
Protection Works
24

Is the design of flexible Pavement as per IRC SP: 72- 2007 and design of Rigid Pavement as per IRC SP:62- 2004 .
Is the design of flexible Pavement as per IRC 37 2001 and design of Rigid Pavement as per IRC SP:58- 1998.

25

Does the proposal have provisions for

26

Secific Remarks, if any, by STA

PMGSY Logo Sign Boards and Information Board

Km/Hm Stones
Guard Stones (where necessary )
Traffic Sign Boards (as necessary)

( Specific remarks of STA about the overall project are necessary on each DPR)

Certified that the Design and Estimation for the Proposed Road work 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 done by:

Signature
Name
Date

Co-ordinator STA:
Signature
Name
Date