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Total
etc.
Signature :
Name :
State Secretary :
PROFORMA - B
PRADHAN MANTRI GRAM SADAK YOJONA
PACKAGE SUMMARY
STATE : ASSAM
Total Average
Type of Proposed Cost of No. of CD Cost of
Sl. Name of Name of the Road Estimated cost per Km Rs.
Proposal length Pavement works CD Works
No. the Block cost Rs. (Lacs) (Lacs)
From To *N/U Km Rs. (Lacs) Nos. Rs. (Lacs) Const. Maint. Const. Maint.
1 Rangjuli Dhupdhara Khutabori N 0.825 82.55 5 305.21 387.76 0.00 470.01 0.00
Total 0.825 82.55 5 305.21 387.76 0.00 470.01 0.00
N-New Connectivity
Name:
Done by : Name:
Designation: Asstt. Executive Engineer, PWD
Checked by : Signature:
Name: Co-Ordinator : Signature:
Designation: Executive Engineer, PWD
STA : Name:
Scrutinized by : Signature:
Name:
Designation:
The Head of PIU
Proforma C
PRADHAN MANTRI GRAM SADAK YOJANA ( PMGSY)
CHECK LIST FOR P.I.U. & S.T.A.
( For Indvidual Road Works )
To be filled by PIU.
4. Total Length (Km) - 0.825 In Built up area - 0.00 Km In Open Area - 0.825 Km
Day 1
Day 2
Day 3
Average
ADT in the year of Traffic Count =
Growth rate adopted (%) = Base Year Traffic AADT (T) =
Design Life = Years
Number of Harvesting Seasons =
No. of Days in Each Harvesting Season (t) =
Value of (n) assumed = Cumulative ESAL =
Traffic Category =
9 Subgrade CBR ( for Different Sections ) =
Chainage
CBR %
13. Whether the Cost etimates are as per standerd data analysis and S.S.R.
Counter Signatures of
Co-ordinator STA :
To be filled by State Technical Agency
Name of the STA:
Name of Road :
15 Is the Proposed Road entered on the OMMS : Yes/ No
(Data entries to be verified by STA before Clicking the Propopsal)
16 If the Proposal is for new connectivity
Yes / No
Have you satisfied yourself that the proposed road is a part of Core Network
Is the unconnected habitation (s) part of list of unconnected Habitations as per CN-6
Yes / No
( 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 )
18 In case , Traffic is projected beyond T 4 Category are you satisfied with the reason
given by PIU Yes / No
19 In case, sub grade CBR is less than 3; has Soil Stabilisation etc. been proposed
Yes / No
( If not , specific Reasons given by PIU)
20 Is the design of the following elements as per Rural Roads Manul / Circulars of
NRRDA:
Alignment & Geometrics Yes / No
Location and type of CD works and Yes / No
Side drains Yes / No
Integration for Cross and longitudinal Drainage Yes / No
Protection Works Yes / No
21 Is the design of flexible Pavement as per IRC SP: 72- 2007 and design of Rigid
Pavement as per IRC SP:62- 2004 . Yes / No
22 Does the Estimation Conform to Standard Rate Analysis and SSR generated Yes / No
for the current Phase
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.
To be filled by P.I.U.
HPC
HPC
HPC
HPC
HPC
HPC
0.000
572.000
960.000
1244.000
2400.000
1114.000
1470.000
2310.000
H
H Habitation
HP culvert
6.45
0.94 0.96
7.95
7.500
4.050
1.875 3.750 1.875
Shoulder Shoulder
4.5% 3.5% 3.5% 4.5%
2 2
1 1 1.26
1.24
GL GL
20mm Pc & SC
75mm WBM Gr. III
75mm WBM Gr. II
150mm GSB Gr. II
300mm Subgrade
12.50
8. Base year traffic volume 2008
LCV/Mini Total
Bus/Truck Bus/Tractor Cars/
Trailor Three Two Cycle Bullock
Vans/ Cycles Non
Wheelers Wheelers Rickshaw Carts Motorizes
Jeeps Motorizes
Laden Unladen Laden Unladen
0 0
9. Growth rate adopted (%) : 6% Cumulative ESAL (N) :
10. Sub Grade CBR
Chainage 3rd to 10th km
Design CBR (%)
11. Cost Details
A. Clearing and Grubbing: Cost Rs. in lacs 0.69
B. Pavement Components
Description of the layer Thickness (mm) Cost (Rs.) in Lacs
Earthwork in Core 45.56
E/W in Subgrade & Shoulder 6.50
GSB 150mm 16.08
WBM - II 75mm 6.67
WBM - III 75mm 6.80
C. Bituminous layers :
Prime Coat 1.95
Tack Coat 0.48
Premix Carpet 20mm 6.17
Seal Coat 2.11
D. Cement Concrete Road
E. CD Works:
No. of Existing CD Works
Do you require any improvement No.
If yes, cost of improvement
No. of proposed CD Works with Classification (RCC Br. = 5 nos.) 5 Nos.
Cost of proposed CD Works 586.40 Lacs
F. Protection works Length: 232.59 m Cost: 25.53 Lacs
G. Side Drains (if provided) Length: 0.00 m Cost: 0.00 Lacs
H. Toe Wall Length: 0.00 m Cost: 0.00 Lacs
I. Road Logo, other Road Furniture Cost: 56.70 Lacs
J. Cost of Preparation of DPR etc. Length: 0.825 km Cost: 5.14 Lacs
12. Whether the road has Geometric as per Rural Roads manual (RRM)
YES
14. Whether the cost estimates are as per Standard data analysis and
YES
SSR.
Certified that information provided as true
Prepared By: Checked By : Scrutinized by :
18. In case , Traffic is projected beyond 45 CVPD; are you satisfied with the reason given
19. In case, sub grade CBR is less than 3; has Soil Stabilization etc. been proposed
20. Is the design of the following elements as per Rural Roads Manual
Alignment & Geometric Yes/No
Pavement Design Yes/No
CD works and protection measures Yes/No
Side Drains Yes/No
Integration for Cross and Longitudinal Drainage Yes/No
21. Does the estimation conform to standard rate analysis and SSR Yes/No
Certified that the design and estimation for the proposed road are based on the data and SSR provided
by Engineers. The Proposal after final correction is entered on the OMMS. The Proposal may be
considered for clearance.
Rangjuli 04
10
Total 1 0.825 5 82.55 305.21 387.76 0
0 Executive Engineer,P.W.D.(R )
Dudhnoi Rural Road Division 0
Dudhnoi 0
11
1
1
Sl. No.
2
District :
Rangjuli Name of Block
Total
3
Dhupdhara
From
Name of Habitations
Goalpara
connectd / Benifited
4
Khutabori
To
N
N
New construction
-
A
(N)/Associted
5 5A
Through Route
-
U
(A)/upgradtion (U)
5B
6
D
Facility accessed
7
0.825 0.155 0.155 0.180 0.155 0.180 Road length (km)
8
Bituminous Existing surface Type
11
13
5.37 1.01 1.01 1.17 1.01 1.17 E/W in Subgrade & Shoulder
14
SUMMARY SHEET
16
22
0.00 0.00 0.00 0.00 0.00 0.00 Boulder Pitching & Apron
26
12
FORMAT F – 2B
PRADHAN MANTRI GRAM SADAK YOJANA
ROADS PROPOSED IN PMGSY FOR RURAL CONNECTIVITY (CROSS DRAINAGE STRUCTURES)
SUMMARY SHEET
Package No. : AS-07-68
District : Goalpara
Sl. Name of Block Name of Habitations Population Existing CD Structure by Type Details of Proposed CD Structure by Type
No. Block Code Road Connected / Hume pipe Box/Arch Minor of Hume Pipe Box/Arch Minor Total cost Total cost Total Cost
Benifited Culvert /Slab Bridge/ Culvert /Slab /Major of Pavement of the
Culvert Wooden Culvert Bridge proposed from Road
Bridge CD Format (21+22)
structures F2A (in lakh)
(in lakh) (in lakh)
No Dia No Width No Length No Dia No Width No Length
1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 Rangjuli 04 Dhupdhara 1 14.70 Cost 1 1x 55.94 17.11 73.04
to Khutabori (Rs.) 14.00
Road 5593536.47
1 17.10 1 1x 62.67 16.16 78.83
16.00
6266622.88
1 19.00 1 1x 73.37 17.42 90.79
18.00
7337287.19
1 14.70 1 1x 57.56 15.93 73.50
14.00
5756188.47
1 14.00 1 1x 55.68 15.93 71.61
14.00
5567848.19
Cost
Total (Rs.) 305.21 82.55 387.76
12
FORMAT F – 1
PRADHAN MANTRI GRAM SADAK YOJANA
SUMMARY SHEET
Rangjuli 04
10
1
1
Sl. No.
2
District :
Rangjuli Name of Block
Total
3
Dhupdhara
From
Name of Habitations
connectd / Benifited Goalpara
4
Khutabori
To
N
N
New construction
-
A
(N)/Associted
5 5A
Through Route
-
U
(A)/upgradtion (U)
5B
D
Facility accessed
7
0.825 0.825 Road length (km)
8
Earthen Existing surface Type
Cost Thickness
9
Details
(Rs) (mm)
10
0.18 0.18 Clearing & grubbing
0.51 0.51
of origin ground
12
10
13
16
22
56.70 56.70
HMP, QC etc.
25
154.85 154.85
Rs. Lacs
FORMAT F – 2A
Dudhnoi Rural Road Division Goalpara Rural Road Division
Dudhnoi Goalpara
11
FORMAT F – 2B
PRADHAN MANTRI GRAM SADAK YOJANA
ROADS PROPOSED IN PMGSY FOR RURAL CONNECTIVITY (CROSS DRAINAGE STRUCTURES)
SUMMARY SHEET
Package No. : AS-07-68
District : Goalpara
Sl. Name of Block Name of Habitations Population Existing CD Structure by Type Details of Proposed CD Structure by Type
No. Block Code Road Connected / Hume pipe Box/Arch Minor of Hume Pipe Box/Arch Minor Total cost Total cost Total Cost
Benifited Culvert /Slab Bridge/ Culvert /Slab /Major of Pavement of the
Culvert Wooden Culvert Bridge proposed from Road
Bridge CD Format (21+22)
structures F2A (in lakh)
(in lakh) (in lakh)
No Dia No Width No Length No Dia No Width No Length
1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 Rangjuli 04 Dhupdhara 1 14.70 Cost 1 1x 331.14 154.85 485.99
to Khutabori (Rs.) 14.00
Road 6122572.00
1 17.10 1 1x
16.00
6811837.00
1 19.00 1 1x
18.00
7930063.00
1 14.70 1 1x
14.00
6269424.00
1 14.00 1 1x
14.00
5980438.00
Cost
Total (Rs.) 331.14 154.85 485.99
11
Asstt. Executive Engineer,P.W.D.(R ) Executive Engineer,P.W.D.(R )
Dudhnoi Rural Road Division Goalpara Rural Road Division
Dudhnoi Goalpara
12