This Form Was Completed by (Insert Name and Date Review Was Completed)

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/ LPA Bridge Hydraulic Analysis and TS&L Review Checklist
LPDPC is responsible for completing boxes shaded in gray prior to routing of checklist.
Local Public Agency (LPA): / LPA Responsible Charge: / PE Consultant:
State Project No.: / Project Name and Location:
State Control No.: / Date Received by NDOR:: / Structure No:

This form was completed by (insert name and date review was completed):

NDOR Local Project Division Project Coordinator : / Date:
NDOR Bridge Hydraulics Section Reviewer: / Date Received by NDOR:
Instructions for Use: This form is to be completed by NDOR Bridge Division Hydraulics and Design Sections before bridge plans are created.

This Section will be completed by the NDOR Bridge Division Hydraulics Section.

Item
# / Task Description or Questions / Completed / If No, Define
Corrective Action / Details or Information Used to Verify Content / AdditionalComments
Yes / No / N/A
1. / Has the hydraulic analysis, (including preliminary data sheet and TS&L) been performed and checked by a Professional Engineer? / Hydraulic design package
2. / Is the hydrologic data based on acceptable methods? / Hydraulic design packageBridge Hydraulics Manual* / *The manual is available on the NDOR Bridge Web Page
3. / Is the hydraulic survey data adequate to define flood conditions? / Hydraulic design package
4. / Does the existing hydraulic analysis include: input data, output data, scour data and ?graph(s) of the required information? / Hydraulic design package
Item
# / Task Description or Questions / Completed / If No, Define
Corrective Action / Details or Information Used to Verify Content / Additional Comments
Yes / No / N/A
5. / Does the proposed hydraulic analysis include: input data, output data, scour data and graph(s) of the required information? / Hydraulic design package
6. / Does the analysis include a risk assessment and an alternate hydraulic design that provides verification that the most practical design is imposed? / Hydraulic design packageBridge Hydraulics Manual*
7. / Does the final hydraulic report justify the project and identify the required permits and FEMA certificate? / Hydraulic design packageBridge Hydraulics Manual*
8. / Does the preliminary data sheet adequately communicate the bridge design requirements? / Hydraulic design packageData Sheet and/or TS&L
9. / Do the Plan & Profile sheets properly document the proposed design? / Hydraulic design packageRoadway Design Plan & Profile

This Section will be completed by the NDOR Bridge Division Design Section.

10. / Do the TS&L sheets include the preliminary data sheet information? / TS&L and Data Sheets
11. / Do the TS&L sheets include the appropriate vertical and horizontal clearances for non-hydraulic structures? / TS&L SheetsNDOR Minimum Design Standards
12. / Investigate possible conflicts between new and existing structures. Is everything acceptable? / TS&L Sheets
13. / Has the need for obtaining paint test results from the existing bridge been assessed? / TS&L Sheets
Comments:

06-15, March 2015Checklist No 06-15