National Rural Infrasti Ministry of Rural Develo ucture Development Agency ment, Government of India Format QB Version 2021.0- Part 1 x & 2 a e 5 z : tion to QM for Inspection of Ongoing/Completed Bridge Work PARI Work Information (Zo be filed-mp by PW) GENERAL: leted Work: (check any one box) Comp! a | Date of inspe —from |[ coud Name of quality monitor (QM): S- Rgjeba tered - —{[ som 2 State: Telongomo. | Pistict [pavauubwogar] Block: [shoot Por ] < Name of bridge & Location q OM. Kop pera ok Vago +e Veg, Km: Package number; | TSOWBHNIBLBOD |. Sanctioned length of the bridge.: a 3 Deviation in length of the bridge (If any).: VIIL. Reasons for deviation (ifany): Se — R Estimated cost (as cleared by GOI): Rs, 241-63, Lakh Technical sanction cost: Rs 241 63, Lakh ne & Awarded cost: ——— Rs 916-92 Lakh Loe ee hakh | 3g Expenditure: (ifwork is ongoing) a. Expenditure done: [ Rev b. Bills pending: = [ Rs, 7 Total expenditure = (ato) Re, = Completion cost: (if work is completed) Rs, SPLOVVEEEEEUVUUUUUUUUVUVUVKCVUV UY ee Scanned with CamScannerXIV. Date of award of work: (date/ month/year) at XV. Date of start of work:(date/ month year) OF XVI Stipulated date of completion:(date/ month/year) of [rot ot ||ro2! 26 ]{ ol | 223 XVI. Actual date of completion: (date/ month?” year)(in case of completed work): 2. PHYSICAL PROGRESS: (Ongoing/Completed) {f whichever not applicable): Construction programme and Physical progress (Strike of 4 Ttemofwork | Units | Quantity [Quantity ] Completed Fill in start and completion dates | Delay ia las perDPR| executed | percentage months — | ofitem | Progress | Start |Completion ( status Date Date @ @ | @® ® © © @ (8) 4 i) Layout ° Due Paola! | toler ler J “ me [eres | | reo Pretal 4 ii) Foundation oP et. }Due wletlay | volt ee we | 36] See | Ce Pac 2 Due Tah 2 it) Substructure we & a slabs | yoloter | 240 | sul [actual 3 iv) Superstructure ws . Due plow tefechul Fa Actual 1) Protection Works) “__-| — Due abst [los hk ‘Actual 1) Approaches me Due lesa [el Re is 48 etal { vii) Mandatory boards! Due tc etont 1 Soaece | | £ tea = | 3. PARTICULARS OF THE BRIDGE: ' 3.1 Type ofthe bridge (according to HEL) ar lecotng wa Submersible jon-submersible| 4 ‘according to Material) [Ree Steel ‘ Composite Pre-Stress |! 4 \ ‘ Eo T if found: 2 Type of foundation Open aa Ci ‘ File Well ‘ 39 tenaholees [eswn ol ‘ 3.4 Number of spans and spans tength tue wag ‘ ‘ : ‘ ‘ “Scanned with CamScanner3.5 Width ofthe bridge 3.6 Footpaths provided If provided, width of footpath 3.7 Formation Level (F.L.) 3.8 Highest Flood Level (MFLYOrdinary Flood Level (OFL: 3.9 Bed level (Lowest) ’ 3.10 Catchment area 3.11 Linear watenway at HFL 3.12 Design discharge pO No ™ m ty [tour om m qa is! km 60-0 m t] 61F-4S_cumec 3.13 Design velocity ‘ang ms 3.14 Foundation levels (a) Piers pi PSap [ee Pemep [es [PR pa [8R] [ps [A230] [Po | P7 m| [Ps m| [P9 ™ (b) Abutments sLAL_faxqm | [a2 [A240 (© Retums TR =] fro if 3.15 Foundation Strata SOR | boutderr 3.16 Safe Beating Capacity (SBC) 3.17. River protection works provided or not : Yes No it provided Rigid boulder apron Fexibe boulder apron 3.18 Type of Substructure @ Piers ~ Solid circular Hollow circular | Wall type pier Any other type: (b) ZAbeiiments- ~]_ Gravity type Spill through Box type Counter fort type Any other type: Seanned with CamScanner© Rew Box type Counter fort Tied returns Cantilever type Any other type: 319. Type of bearings: Elastomerie Pot PTFE Rocker & Roller Any other type: 3.20. Test report of bearings available or not : ‘Yes I No 3.21 Type of superstructure ~f__ rec [Solid slab T Beam slab Voided stab Box girder Any other type: Steel Plate girder ‘Truss frame ‘Arch bridges Cable stayed_] [_ Suspension Bailey bridges 3.22. Type of expansion joints 5 Buried Copper plate | Bituminous Strip seal {Modular Finger type Any other type: hu [Pad | 3.23. Type of wearing coat : RCC Bituminous | 3.24 Type of drainage spouts :| As aa SP ‘As per Design | a Scanned with CamScannera * Toading oF erent : jingle lane TRC Class “AAT loi . Aouble Inne IRC class "A" loading whieh fever produces severe stresses. IRC class Tone TRC class “70R" loading oF 1 class “A loading which double lane 1 ses. = >] ‘Any other type 3.26 Whether approaches are in cutting orin filling = Cutting | Filing | Partly cutting and filling 327, Type of pitching in approaches :[ [Boulder pitching] [ | Concrete block 4 Yes No. 28 Whether bench marks and alignment are estat & 3 Lt near the bridge site (give locations and RLs) 2] Locatio Location: RL: m Location: RL: 2; Location: RL: m Ar RCC as per Pipe railings “standard pitching Steel Collapsible pitching Any other type: QUALITY CONTROL: Location of Field Laboratory : ak petal Village Aap te Geo-tagged photograph of laboratory uploaded on: (date/ month/ year):| 24 | (rv |. tor Reason for delay in establishment of field laboratory (if'so): aS Details of contractor, executing the work: Name of contractor PAN number Mobile number: E-mail ID. cpa Rhy * aasar trot - Scanned with CamScannercontrol rewister part! eat site onsite for maintaining quality ¥. DetalcoFeontractorsenincer avaiable at ie: et Dr From ___| “Bashan rent nts es ae ae | Aapeat Aun 5s _ Mobile number is Feontracter’s | ydentity number site — Duration of posting Mobile number }— From = Employee number (Executive Engineer) Lou M.Nendra Rly rus | 348533364 _ VIL. Details of assistant engineer supervising the work and maintaining quality control register Part-I: Duration of posting at site Name of assistant 5 bs oui | Employee number | Mobile umber Fray To ove} = Abhi I$62899, AAOTUIH VII. Details of the junior engineer supervising the work: SI. no. Name of junior | Erppioyee number | Mobile number | Dustion of posting t site engineer From To IX. List of equipment available in field lab: Lt. ads Available equipment that are in working condition | Available equipment that are not in working wm condition (2) X. List of equipment not available in field lab: Scanned with CamScanner~-~~-e.~ 5. X1- Reasons put forth by PIU for non-availability of equipment in ld lt NIL. Details of calibrations of equipment done: rer Or. Ben Adys wey Restle eu Anode = XIIL Equipment, documents and drawings ready to be made available to QM before or during the inspection CTA Or. Beatty Os Rin: OM Atle - DETAILS OF MIX DESIGN(s): Sl. rr ‘Average Details of Institute/ Details of Mix No. ‘Mix Design Mix laboratory where mix | Design approving Design design was done PMGSY Authority Strength i, | Cement Concrete M20 Top Met DIT | MenCEsed -ybarbs | ee Cement Concrete M25 pee: . iii. | Cement Concrete M30 arte “ iv. | Cement Concrete M35 7 v. | Cement Concrete M40 1 Wet Mix Macadam (WMM) vii. | Dense Bituminous Macadam viii. | Semi Dense Bituminous Concrete ix. | Bituminous Concrete Scanned with CamScannerEARLIER INSPECTIONS BY NQM, SQM or SENIOR DEP?! ARTMENTAL 6. : 4 OFFICERS (SEs & CBs) AND ACTION TAKEN STATEMENT: | ingected the work): (Please indicate chronologically name ‘and designation of the officer wht : - i jon taken by PIU Due Wameand Designation) Stage of work atthe time] Major observations | Action enby of | of inspecting officer of inspection isit_ |(AWQM/SQM/CE/SE) ©. Lo @ QB) ) — = Signature of the Head of PIU.. . cl Seal of PIU Name and Designation of the Held Give”. MenabuRDABSE Reddy Mobile Number of the Head of PIU.. E-mail of the Head of PIU.. Address of the PIU... Date: zelouls ASYITSAT49... 0. ate BEM. BNE Scanned with CamScannerve Develop: Agency Government of India 0- Part ormat QB Version 2021.1 ity Mo tor (NQMYState Quality Monitor ( Report of National Qu (To be filted-np by QM) 1, GENERAL DETAILS: 1. Date of inspection: BT. OG. 202% nom |[cou___] IL, Name of Quality Monitor (QM) It QASENDAD PASCO — (check relevant box and fill code) LS 3 50M |[ Covel g seek Delangonre | District: Block: (Teka bosnager| [Breommper | Glo Gaelye