Annexure-1
CHECK LIST
Guidelines for processing the proposal for laying of water supply pipeline crossing in the Existing
vents National Highways.
Ministry Circular No.RW/NH-33044/29/2015/S&R, Dated 22/11/2016
Sl. No. Item Information/ Status Remarks
Proposal for permission for laying of
water supply pipeline crossing at
1 General Information
(1)256.115 (Udumulapadu),(2)275.110
(Yenugumarri), (3)280.800
(Venglampalli) at NH44 between
Hyderabad and Bangalore
Name and Address of the Sri G.Sreenivasulu,
1.1 Executive Engineer, W.R.D., M.I.W
Applicant/Agency
Division, Kurnool.
1.2 National Highway Number NH -44
1.3 State Andhra Pradesh
1.4 Location Hyderabad and Bangalore.
1.Road Crossing @ KM256/115 60 Mts
1.5 (Chainage in km) 2.Road Crossing @ KM275/110 60 Mts
3.Road Crossing @ KM280/800 60 Mts
1.6 Length in Meters 180 Mts
1.7 Width of available ROW
(a) Left side from center line towards
increasing chainage/ km direction
(b) Right side from center line towards
increasing chainage/ km direction
1.8 Proposal to lay the pipe line
(a) Left side from center line towards 1.Road Crossing @ KM256/115
2.Road Crossing @ KM275/110
increasing chainage/km directions
3.Road Crossing @ KM280/800
(b) Right side from center line towards
increasing /km direction
1.9 Proposal to acquire land
a) left side from center line NA
b) right side from center line NA
1.10 Whether proposal is in the same side NA
where land is not to be acquired
If not, then where to lay the cable NA
Details of already laid services, if any,
1.11 NA
along the proposed route
1.12 Number of lanes (2/4/6/8 lanes) existing 4 lanes
Proposed Number of lanes (2 lane with
1.13 NA
paved shoulders/4 /6/8 lanes)
1.14 Service road existing or not NA
If yes then which side
(a) Left side from center line NA
(b) Right side from center line NA
1.15 Proposed Service Road
a) Left side from center line NA
b) Right side from center line NA
weather proposal to lay the utility is after
1.16 the service Road or between the service
road and main carriageway
Weather carrying of OFC/sewage/Gas
Pipeline has been proposed under
MS Pipe Clamping or MS and Cement
1.17 Highways & Bridges.
Concreting
If Yes, then mention the methodology
proposed for the same
Weather carrying of OFC/sewage/Gas
Pipeline has been proposed on the
1.18 parapet/any part of the bridges. NA
If Yes, then mention the methodology
proposed for the same
If crossing of the road involved
If Yes, it shall be either encased in pipes
1.19 or through structure or conduits specially Yes
built for that purpose at the expense of
the agency owning the line
a) Weather the existing drainage
structures are allowed to carry the utility No
pipeline
b) Is it on a line normal to the NH No
c) What is the distance of crossing the
utility pipelines from the existing
structures crossing shall not be too near
the existing structures on the national
highway. The minimum distance being 15
meters.
d) The casing pipe carrying the utility line N.A
shall be of steel. cast iron pr reinforced
cement concrete and have adequate
strength and be large enough to permit
ready withdrawal of carrier pipe/cable
Mention type of casing N.A
e) Ends of the casing /Conduit pipe shall
be sealed from the outside.so that it does N.A
not act as a drainage path
f) The casing/conduit pipe should as
minimum extend from drain to drain in N.A
cuts and toe of slope in fills
g) The top of the casing /conduit pipe
should be at least 1.2 meter below the
N.A
surface of the road subject to being at
least 0.3 meter below the drain inverts
mention the proposed details
h) Mention the methodology proposed
for crossing of road for the proposed
OFC/ sewage /Gas pipe line. Crossing shall
be by boring method HDD. Specially N.A
where the existing road pavement is of
cement concrete or dense bituminous
concrete type.
i) The casing/conduit pipe shall be
installed with an even bearing throughout
its length and in such a manner as to N.A
prevent the formation of a water way
along it
Document/Drawing to be enclosed with
2 Enclosed
the proposal
Cross section showing the size of the
2.1 NA
trench for open trenching method
is it normal size of 1.2m deep X 0.3meter
NA
wide
i) should not be greater than 60cms wider
NA
than the outer diameter of the pipe
ii)located as close to the extreme edge of
the right of way as possible but not less
NA
than 15m from the centerline of the
nearest carriageway
iii)shall not be permitted to run along the
National Highways when the road
formation is situated in double cutting nor NA
shall these be laid over the existing
culverts and bridges
iv) These should be so laid that their top is
at least 0.6m below the ground level so as NA
not to obstruct drainage of the road land
Cross section showing the size of the pit
2.2 and location of Enclosed cable for HDD NA
method
Strip plan/route plan showing the
utility/Gas Pipeline Chainage Width of
ROW, distance of proposed pipeline
2.3 Enclosed
Enclosed from the edge of ROW,
important mile stone, Intersections, cross
drainage works etc.
Methodology for faying of the utility
2.4 Enclosed
pipeline
Open trenching method. May be allowed
in utility corridor only where pavement is
2.4.1
neither cement concrete nor dense
bituminous concrete type
If yes, what is the methodology of refilling Yes, MS Pipe Clamping or MS pipe and
the trench Cement Concreting encasing on pipe laying
a) The trench width should be at least
30cms. But not more than 60cms wider NA
than the outer diameter of the pipe.
b) For filling of the trench bedding shall
be to a depth of not less than 30cms.lt
shall consist of granular material free of
lumps, clods and cobbles and graded to
NA
yield a form surface without sudden
change in the bearing value. Unsuitable
soil and rock edged should be excavated
and replaced by selected material
c) The backfill shall be completed in two
stages i)side fill to the level of the top of
NA
the pipe and ii)overfill to the bottom of
the road crust
d) The side till shall consist of granular NA
material laid in 15cms layers each
consolidated by mechanical tampering
and controlled addition of moisture to
95% of the proctor density. Overfill shall
be compacted to the same density as the
material that has been removed.
Consolidation by saturation or ponding
will not be permitted
e) The road crust shall be built to the
same strength as the existing crust on
either side of the trench. Care shall be NA
taken to avoid the formation of a dip at
the trench
f) The excavation shall be protected by
flagman. Signs and barricades and red NA
lights during night hours.
g) If required a diversion shall be
constructed at the expense of agency
NA
owing the utility line.
Horizontal Directional Drilling (HDD)
2.4.2 NA
Method
Methodology for laying Pipeline through Where under Existing vents the pipe line
2.4.3 of through CD works and method of MS Pipe laying and encasing with Cement
laying Concreting.
In case where the carrying of OFC/GAS
Pipeline on the bridge becomes
inescapable.
Draft License Agreement signed by two
3 Enclosed
witnesses
The license fee estimates as per Ministry’s
guidelines issued vide Circular No:
3.1 Enclosed
RW/NH-33044/29/2015/S&R Dated
22-11-2016.
Whether Performance BG as per
Ministry's Circular No. RW/NH- Undertaking for furnishing of Performance
4
33044/29/2015/ S&R (R) Dated 22-11- BG or Demand Draft as demanded by NHAI
2016 is obtained.
Confirmation of BG has been obtained as After submission of DD/BG, the same will
4.1
per MORTH/NHAI guidelines be confirmed as per NHAI guidelines
Affidavit / Undertaking from the Applicant
5 Yes
for the following is to be furnished
Undertake for not to damage to other
utility, if damaged then to pay the losses
5.1 Yes
either to NHAI or to the concerned
agency
Undertake for Renewal of Bank
5.2 Guarantee as when asked by Yes
MORTH/NHAI
Undertake for Confirming all standard
5.3 Yes
condition of MORTH/NHAI guidelines
5.4 Undertake for Indemnity against all Yes
damages and claims clause (xxiv)
Undertake for management of traffic
5.5 movement during laying of Pipe line Enclosed
without hampering the traffic
Undertaking that If any claim is raised by
5.6 the Concessionaire/Contractor then the Enclosed
same has to be paid by the applicant
Undertaking that prior approval of the
NHAI shall be obtain before undertaking
5.7 any work / Installation / Shifting / Enclosed
Repairs / Alterations to the utility location
in the national highways RoW
Undertaking that expenditure if any
incurred by NHAI by repairing any
damage caused to the NH by laying or
5.8 Enclosed
maintenance or shifting of the utility line
will be borne by the applicant agency
owing the line.
Undertaking that text of the License deed
is as per verbatim of MORTH format
5.9 issued Vide Ministry’s Circular No: Enclosed
RW/NH-3304/29/2015/S&R(R) Dated 22-
11-2016.
Undertaking that the applicant has
obtained various safety clearances from
the representative authorities such as
Directorate of Electricity. Chief controller
of explosives. Petroleum and explosive
5.10 N.A
safety organization. Oil industry safety
directorate. State / Central pollution
control board and any other statutory
clearance as applicable before applying to
Highway administration.
If the MORTH/NHAI considers if necessary
in future to move the utility line for any
work of improvement or repairs to the
road, it will be carried out as desired by
5.11 Enclosed
the MORTH/NHAI at the coast of the
agency owing the utility line with in a
reasonable time (not exceeding 60 days)
of the intimation given
Certificate from the applicant in the
5.12
following format
i) laying of OFC/GAS pipeline will not have NA
any deleterious effects on any of the
bridge components and roadway safety
for traffic
ii)“we do under take that I/ we will
relocate service road / approach road /
utilities at my / our own cost not
withstanding the permission granted Yes Enclosed
within such time as will be stipulated by
NHAI for future six laneing / any other
development”
Who will sign the agreement on behalf of
6 Executive Engineer, MI Division, Kurnool.
OFC Agency
Power of Attorney to sign the agreement
Yes
is available or not
The Project Director will submit the
7
following certificates
Certificate that the proposal is confirming
to all standards conditions issued vide
7.1 ministers circular No: Enclosed
RW/NH/33044/29/2015/S&R Dated 22-
11-2016.
Certificate from PD in the following
7.2
format
i) “It is certified that any other location of
the OFC/Gas pipeline would be extremely
difficult and unreasonable costly and the
installation of OFC/GAS pipeline within
RoW will not adversely affect the design, NA
stability and traffic safety of the highway
nor the likely future improvement such as
widening of the carriage way, easing of
cure”
ii) For six laning
(a) Where feasibility is available “I do
certify that there will be no hindrance to
proposed six-laning based on the Enclosed
feasibility report considering proposed
structures at the said location”.
(b) In case feasibility report is not
available “I do certify that sufficient ROW
is available at site for accommodating
proposed six-laning”.
8 If NH section proposed to be taken up by NA
NHAI on BOT basis – a clause is to be
inserted in the agreement “the permitted
highway on which licensee has been
granted the right of way to lay cable /duct
has also been granted as a right of way
concessionaire under the concession
agreement for up gradation of Kolkata -
Chennai section from Km. to Km. of
NHAI no. 16 on built, operate and transfer
basis and therefore the licensee shall
honor same.
Who will supervise the work of laying of
9
pipe line
a) On behalf of Applicant Executive Engineer, MI Division, Kurnool.
b) On behalf of MORTH/NHAI
Who will ensure that the defects in road
portion after Laying of pipeline are
10
corrected and if not corrected then what
action will be taken.
a) On behalf of Applicant N.A
b) On behalf of MORTH/NHAI N.A
Who will pay the claims for damages
done/disruption in working of
11 Executive Engineer, MI Division, Kurnool.
Concessionaire if asked by the
Concessionaire?
A certificate from PD that he will enter
the proposed permission in the register of
12
records of the permissions in the
prescribed proforma (copy enclosed).
If any previous approval is accorded for
laying underground cable/gas pipeline,
13 then Photocopy of register of
records/permissions accorded (as
maintained by PD be enclosed.
Name /Designation/Signature of the Name /Designation/Signature of the
Authorized representative of the applicant concerned field authority of
NHAI/PWD/BRO
