ITB 27-15TM - QAP.pdf

Quality Assurance Plan for

Little Back River Road Reconstruction

VDOT Project No.: U000-114-315 / UPC 109304

Federal Aid Project Numbers: STP-5A03(997)

FHWA 534 No. 35004

I. Date of Original QAP Submitted:

II. QAP Revision Date (if applicable)

III. Locality Name and Physical Address: City of Hampton

Public Works, Engineering

22 Lincoln St Hampton, Va 23669

IV. Responsible Charge Engineer: McCord Newsome

7) 727-8404 mnewsome@hampton.gov

V. Locality Project Manager Philippe Fenouil Contact Information (757) 506-6573 philippe.fenouil@hampton.gov

I.

Contact Information (757)727-6325

Cynthia Yager cayager@hampton.gov

Organizational Chart:

McCord Newsome

Responsible Charge Engineer

Contractor's Testing Firm

MBP

Quality Assurance Manager / Inspector

Independent Assurance (IA) for:

- Misc Roadway and Structure

- Soils and Aggregates

Philippe Fenouil

Locality Project Manager

Contractor QC Testing for:

- Asphalt and Asphalt Concrete

- Misc Roadway and Structure

Cynthia Yager

Locality Project Coordinator

Acceptance Testing for Soils and Aggregates

Independent Assurance (IA) for:

- Hydraulic Cement Concrete

- Asphalt and Asphalt Concrete

Acceptance Testing for Hydraulic Cement Concrete

Acceptance Testing for Asphalt and Asphalt Concrete

Terracon Testing Firm

QAP DOCUMENT

I. Mission Statement: The City of Hampton is dedicated to ensure only quality materials meeting Virginia Department of Transportation specifications and standards will be accepted and incorporated into this project as identified in the project plans and specifications. All materials shall be approved, sampled, and / or tested in conformance with contract specifications and the Locally Administered Projects Manual (LAP MANUAL). Submittal of this QAP designates a commitment by the City of Hampton to adhere to its contents as well as the LAP MANUAL. Any deviation from this Quality Assurance Plan shall not occur without a revision submittal of this QAP to the District Project Coordinator for approval.

II. The City of Hampton maintains a copy of Personnel Certifications and Licenses as required by the Contract Documents in a working file for this project. These copies are readily available to the VDOT DISTRICT Project Coordinator for review. All personnel performing materials testing will have the necessary certifications and experience /expertise required by the contract documents and the LAP Manual. The City of Hampton will not allow work to be performed by inexperience or non-certified personnel.

III. The materials testing laboratories used for this project by the City of Hampton will meet the requirements as outlined in the LAP MANUAL, Chapter 13.2 for “Qualified Laboratories”. No work shall be authorized otherwise. Independent Assurance sampling and testing will be defined within this QA Plan and is attached to this document. The Materials Notebook will be the mechanism to track independent assurance samples. All Independent Assurance Tolerances will be in accordance with the LAP MANUAL Appendix 13.2E Independent Assurance Tolerances. If IA testing is outside the specified tolerance the testing equipment for both the QC and IA testing shall be evaluated and if applicable, the calibrations checked. If either equipment is found to be out of calibration, then the equipment shall be re calibrated and the test repeated for the equipment meet calibrations standards and the equipment tolerances specified in the applicable test method, third party testing shall be used to verify the test data and an investigation will be conducted to resolve the discrepancy. The investigation and report will be documented through the NCR and AR process.

IV. Communications Channels: Once construction starts, City of Hampton will coordinate with the contractor regarding the inspection frequencies outlined in the QAP, ensuring that adequate inspections forces are available to meet the scheduled construction activities. The QA Inspector will interface daily with the Contractor and QC team. The QA Inspector’s primary point of contact on site is Cynthia Yager. The QC staff, including the technicians listed in this document, will submit all daily documentation to the QA Inspector for review and acceptance. The Project Inspector will review these documents routinely to assure they are accurate and complete. Any unacceptable work identified by the QC/QA staff will be scheduled for correction, to include additional inspections requirements.

The city of Hampton’s communications channels have been established to provide direction and Solve problems and are as follows:

V.

McCord Newsome, Represents the City of Hampton. He is the City Engineer and is the Responsible Engineer in Charge. Philippe Fenouil, Project Manager with the City of Hampton, reports to McCord Newsome. Philippe responds to design issues during construction and questions on technical aspects of the project, including design variance and/or material substitution requests. Cynthia Yager, Project Coordinator with the City of Hampton, reports to McCord Newsome.

MBP will perform the Quality Assurance and Construction Managment for the owner. They represent the City of Hampton and are responsible for quality of design, construction, project costs and deadlines. They will be monitoring and documenting of the on-site daily activities including oversight of the required field sampling, and will take on-site visual verification against reports, and will report to Cynthia Yager. They will work with Philippe Fenouil for Design issues and questions.

Terracon will perform the testing for the owner. They will verify all acceptance testing, ensures sample test results meets specifications, provides verification and oversight of activities that affect the quality of the work.

• Superintendent Name represents Contractor. He handles all field construction issues and ensures that products meet specifications. He will provide acceptance testing and contractor QC testing for material specified in the Quality Assurance Plan per the LAP Manual Appendix 13.2 pages G-2 through G-14.

Resolution Procedure: In the event of unclear contract specifications or published guidelines, the resolution procedure will be accomplished by:

MBP will call a meeting for resolution. Invited attendees will include:

a. Philippe Fenouil, Project Manager, City of Hampton

b. Cynthia Yager, Project Coordinator, City of Hampton

c. Contractor

MBP will document discussion. Once an agreement is reached, MBP will send out agreed upon resolution to all parties listed above.

VI. Progress reports as agreed upon will be provided to the VDOT District LAP Construction Project Monitor. A sample of a progress report is attached to this document for reference See attached Progress Report.

VII. The City of Hampton will keep Materials Acceptance records and test data in a project notebook and project file. This notebook and files will be readily available for inspection at all times by the VDOT DISTRICT Project Coordinator. These record shall be kept for a minimum of 3 years after project completion.

VIII. The City of Hampton agrees to the “right to inspect” by the VDOT'S District LAP Construction Project Monitor for any and all project items by the submittal of this Quality Assurance Program.

The following items shall be considered during an inspection as events that need to be hold points that must be witnessed by the DISTRICT PC and /or Engineering Consultant for the City of Hampton.

Hold Points (must notify VDOT, and work shall not proceed without VDOT):

o ADA Ramps o Asphalt placement

Witness Points (must notify VDOT, but work may proceed with or without VDOT) o Maintenance of Traffic o Traffic Signal o Concrete Placement Curb & Gutter o Flexible Planning o Pavement Markings/Striping

Type text here

IX. Non-Compliance to this QAP shall be promptly reported through the established communications process in the QAP. An example “Non- Compliance Report “and the “Recovery Plan “are attached to this document.

Attachments:

• Minimum Requirements for QA and QC

• Project item descriptions

• Progress Reports template

• Non – Compliance Report (NCR) template.

• Non- Conformance notification Log

• Audit and NCR Recovery Plan template

• Inspection logs for project items

• Lab Accreditaton.

Date

Date

Date

Submitted:

Philippe Fenouil, Locality Project Manager

Cynthia Yager, Locality Project Coordinator

Approved By:

VDOT Construction

9/25/2026

9/29/2026

9/29/26

OFFICE OF ADMINISTRATION & ENGINEERING SERVICES

(757) 727-6346 FAX (757) 727-6123

22 LINCOLN STREET, HAMPTON, VIRGINIA 23669

“Oldest Continuous English-Speaking Settlement in America – 1610”

Little Back River Road Reconstruction Project # UPC 109304

Quality Assurance Monthly Report

Period Ending:

Qam Activities This Period:

QC and QA Inspection and Testing this period:

• Approximate Quantities and testing this period.

CLEARING AND GRUBBING INSPECTION FORM

REPORT NO.: DATE OF WORK:

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

APPROVED

INTERMEDIATE

EROSION CONTROL INPLACE

CHECK CLEARING LIMITS

VERIFY AREA STAKED AND

MARKED IS IAW PLANS

CHECK FOR BURN PERMITS

IF BURNING PERMITTED

CHECK WEATHER FOR WINDS

AND DRY CONDITIONS

STUMPS LEFT IN PLACE

MAXIMUM 6” ABOVE EXISTING

GROUND SURFACE

STUMPS REMOVED IN

SHALLOW FILLS

CLEARED MATERIAL

DISPOSED OF PROPERLY

CHECK FOR DAMAGE OUTSIDE

R/W

AREA OF CLEARING

CALCULATED

DAMAGED EROSION CONTROL

ITEMS REPAIRED

TEMPORARY SEEDING WITHIN

15-DAYS (IF NECESSARY)

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL010

07/2018 Page 1of 1

BACKFILL OF STRUCTURES INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN APPROVED

BACKFILL MATERIAL APPROVED

& TESTING REQUIREMENTS

ESTABLISHED

STRUCTURES INSPECTED

PRIOR TO BACKFILL

INTERMEDIATE

PERIMETER FILLS PLACED IN 6”

LIFTS

FLOWABLE BACKFILL IN PLACE

IAW PLANS & SPECS

EACH LIFT COMPACTED AT

±20% OPTIMUM MOISTURE

EACH LIFT COMPACTED TO

MINIMUM 95% DENSITY

DENSITY TEST IAW

ESTABLISHED REQUIREMENTS

PROCTORS PERFORMED IAW

ESTABLISHED REQUIREMENTS

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE

TESTING AS REQUIRED

COMPLETION

VERIFY TESTING

DOCUMENTATION FOR

COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL020

PIPE AND DRAINAGE STRUCTURE INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

MATERIALS APPROVED AND

CERTIFICATIONS VERIFIED

QA/QC PLAN APPROVED

INTERMEDIATE

VERIFY LAYOUT

MINOR STRUCTURE EXCAVATION

CALCULATION (IF APPLICABLE)

CHECK TRENCH WITDTH/SHORING

CHECK FOUNDATION

DEWATERING

BEDDING MATERIAL (DEPTH AND SHAPING

IAW PLANS & SPECS)

VERIFY PIPE/STRUCTURE ALIGNMENT AND

GRADE

JOINING/SEALING OF PIPE

STRUCTURE INVERT

PIPE/STRUCTURE BACKFILL AND DENISTY

TESTING

WEEP HOLES

STRUCTURE TOP

COMPLETION

TL-124’S REVIEWED FOR COMPLETION AND

ACCURACY

FINAL FIELD INSPECTION PERFORMED

ADDITIONAL PIPE/STRUCTURE INFORMATION:

STRUCTURE TYPE:_______________________ PIPE SIZE:_______________________

STRUCTURE ID.: STR. #___________________ PIPE ID: STR#______________TO STR#_____________

ACTUAL INV. ELEVATION:__________________ PLAN LENGTH:___________________

FINAL DI HEIGHT:_________________________ ACTUAL LENGTH:_________________

DENSITY TESTS RECORD NO’S: _____________________________________________________

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL030

CAST-IN-PLACE STRUCTURES INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

APPROVED MATERIALS SOURCE

APPROVED MIX DESIGN

QA/QC PLAN APPROVED & TESTING

REQUIREMENTS ESTABLISHED

INTERMEDIATE

STRENGTH REQUIREMENTS IAW

PLANS & SPECS FOR PRECEDING

WORK

PROPER SUBSURFACE & BEDDING

IAW PLANS & SPECS

PROPER FORMWORK &

REINFORCING STEEL IAW PLANS &

SPECS

AREA FREE OF DEBRIS, WATER, &

MUD

2 INSPECTORS PRESENT DURING

ENTIRE PLACEMENT OF CONCRETE

PROPER TESTING METHODS

PERFORMED & RECORDED

PROPER PROTECTION & CURING

METHODS IAW PLANS & SPECS

CONTROL CYLINDERS CURED IN

SAME MANNER AS IN-PLACE

CONCRETE

VERIFY 28-DAY STRENGTH TESTS

RESULTS IAW PLANS & SPECS

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE TESTING

AS REQUIRED

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL040

EROSION & SILTATION CONTROL INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

VERIFY ALL APPLICABLE PERMITS

ARE ON FILE PER CONTRACT

DOCUMENTS

INTERMEDIATE

ARE ALL CONTROLS SHOWN ON

PLAN IN PLACE, & WITHIN

SPECIFICATIONS

DENUDED AREAS STABILIZED

DO SEEDED AREAS REQUIRE

MAINTENANCE FERTILIZER, SEED,

OR MULCH

IS SEDIMENT LEAVING SITE

PERIMETER TRAPS IN PLACE

CUT AND FILL SLOPES STABILIZED

EVIDENCE OF INCREASED OFF-SITE

EROSION SINCE BEGINNING OF JOB

CHANNELS AND OUTLETS

STABILIZED

INLETS PROTECTED FROM

SEDIMENT

WORK ONGOING IN LIVE STREAMS

THAT REQUIRES STABILIZATION

UTILITY TRENCHES BACKFILLED

AND STABILIZED

MUD ON PUBLIC ROADS

ANY CONTROLS THAT CAN BE

REMOVED

CONTROLS THAT REQUIRE REPAIR

OR CLEAN OUT

ANY DEFICIENCIES NOT

CORRECTED FROM LAST REPORT

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL050

EMBANKMENT INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN ACCEPTED

MATERIAL ACCEPTED & TESTING

REQUIREMENTS ESTABLISHED

INTERMEDIATE

VERIFY EMBANKMENT MATERIAL

BEING USED IS CONSISTENT

WITH APPROVED & TESTED

MATERIAL (CHECK FOR MUD,

MUCK, ROOT MAT, FROZEN

MATERIAL, BOULDERS.)

VERIFY INSTALLATION

PROCEDURES ARE ADEQUATE

(COMPACTION EQUIPMENT,

BENCHING, LIFT THICKNESS)

EACH LIFT COMPACTED AT ±20%

OPTIMUM MOISTURE

EACH LIFT COMPACTED TO

MINIMUM 95% DENSITY

FINAL GRADE AND SLOPES

FORMED IAW PLANS, SPECS &

TYPICAL SECTION

EROSION & SILTATION CONTROLS

MAINTAINED & TEMP OR FINAL

SEEDING IAW PLANS & SPECS

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE

TESTING AS REQUIRED

COMPLETION

VERIFY TESTING

DOCUMENTATION FOR

COMPLETION AND ACCURACY

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL060

UNDERCUT EXCAVATION INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATOTY

AREA OF UNDERCUT REVIEWED &

DOCUMENTED

INTERMEDIATE

VERIFY WITH CONTRACTOR THE

UNSUITABLE SOIL CONDITIONS

DICTATING UNDERCUT

EXCAVATION

MONITOR & RECORD LOCATIONS,

CONDITIONS, EQUIPMENT USED &

MANPOWER HOURS FOR

UNDERCUT OPERATIONS

INSPECT, MEASURE AND RECORD

EXCAVATED AREA PRIOR TO

PLACEMENT OF APPROVED

BACKFILL MATL

BACKFILL IAW PLANS & SPECS

PROPER DENSITY TESTS

PERFORMED AND RECORDED

MEASUREMENT & PAYMENT IAW

PLANS, SPECS & CONTRACT

PROVISIONS

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL070

AGGREGATE BASE MATERIAL INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

APPROVED MATERIALS

INTERMEDIATE

EXISTING SURFACE (SUBGRADE)

PREPARED IAW PLANS & SPECS

BASE COURSE MATL MIXED IAW

APPROVED METHODS

VERIFY INSTALLATION

PROCEDURES (USE OF SPREADER

BOX, WATER TRUCK, SMOOTH

DRUM ROLLERS)

CONTROL STRIP & TEST SECTION

PERFORMED IAW PLANS & SPECS

MAXIMUM 6” LIFT THICKNESS

OBSERVED (UNLESS OTHERWISE

APPROVED)

PROPER DEPTH & DENSITY TESTS

PERFORMED AND RECORDED

PROPER COMPACTION BETWEEN

LIFTS

FINAL SURFACE PROTECTION IAW

PLANS & SPECS

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE

TESTING AS REQUIRED

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL080

CEMENT TREATED AGGREGATE INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

APPROVED MATERIALS

INTERMEDIATE

EXISTING SURFACE (SUBGRADE)

PREPARED IAW PLANS & SPECS

BASE COURSE MATL MIXED IAW

APPROVED METHODS

VERIFY INSTALLATION

PROCEDURES (USE OF SPREADER

BOX, WATER TRUCK, SMOOTH

DRUM ROLLERS)

CONTROL STRIP & TEST SECTION

PERFORMED IAW PLANS & SPECS

MAXIMUM 6” LIFT THICKNESS

OBSERVED (UNLESS OTHERWISE

APPROVED)

PROPER DEPTH & DENSITY TESTS

PERFORMED AND RECORDED

PROPER COMPACTION BETWEEN

LIFTS

FINAL SURFACE PROTECTION IAW

PLANS & SPECS

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE

TESTING AS REQUIRED

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL081

STABILIZED OPEN-GRADED MATERIAL INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

APPROVED MATERIALS

INTERMEDIATE

PROPER SURFACE CONDITIONS

OBSERVED IAW SPECS

2 INSPECTORS PRESENT DURING

ENTIRE PLACEMENT

STABILIZATION MATL

PROPORTIONING APPLIED IAW

APPROVED PLANS, SPECS &

CONTRACT PROVISIONS

TEMPERATURE REQUIREMENTS IAW

PLANS & SPECS

EQUIPMENT USED IS ADEQUATE

PROPER TESTING PROCEDURE

PERFORMED AND RECORDED

CURING PROCEDURES OBSERVED

IAW PLANS & SPECS

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL090

SOIL STABILIZATION INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED & ACCEPTED

APPROVED MATERIALS

INTERMEDIATE

PREPARATION OF EXISTING SURFACE

IAW PLANS & SPECS

MATERIAL SCARIFIED & PULVERIZED

IAW PLANS & SPECS

CEMENT & OTHER APPROVED

ADMIXTURES APPLIED IAW

APPROVED PROCEDURES (MIX-IN-

PLACE OR CENTRAL PLANT METHOD)

COMPACTION AND FINISHING

PROCEDURES PERFORMED IAW

PLANS & SPECS

CONSTRUCTION JOINTS IAW PLANS &

SPECS

DENSITY & THICKNESS TESTING

PERFORMED AND RECORDED

PROPER PROTECTION & CURING

PROCEDURES OBSERVED IAW PLANS

& SPECS

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL110

ASPHALT SURFACE TREATMENT INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS FROM APPROVED

SOURCE

EQUIPMENT PROPERLY

CALIBRATED

INTERMEDIATE

SURFACE PREPARATION IAW

PLANS & SPECS

LIQUID ASPHALT APPLICATION

RATE IAW APPROVED PLAN,

SPECS & CONTRACT

PROVISIONS

COVER MATERIAL APPLICATION

RATE IAW APPROVED PLAN,

SPECS & CONTRACT

PROVISIONS

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL110

ASPHALT CONCRETE PAVEMENT INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

ASPHALT MIX DESIGN APPROVED

INTERMEDIATE

FINAL SUBBASE INSPECTION FOR

PROPER LINE, GRADE, AND

CONFORMITY IAW PLANS, SPECS

AND CONTRACT PROVISIONS

2 INSPECTORS PRESENT DURING

ENTIRE PLACEMENT OPERATIONS

EQUIPMENT CALIBRATION

OBSERVED AND APPROVED

CONTROL STRIPS PERFORMED,

OBSERVED, TESTED AND

APPROVED

ROLLER PATTERNS PERFORMED,

OBSERVED, TESTED AND

APPROVED

TACK PLACEMENT AND

APPLICATION RATE IAW PLANS &

SPECS

PROPER MATERIAL LIFTS

OBSERVED AND APPROVED

DENSITY TESTING PERFORMED

RE-TEST WHERE COMPACTION

TESTS VARY GREATER THAN 2%

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE

TESTING AS REQUIRED

COMPLETION

VERIFY TESTING AND MATERIALS

DOCUMENTATION FOR

COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL120

HYDRAULIC CEMENT CONC. PAVEMENT INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

APPROVED MIX DESIGN

INTERMEDIATE

FINAL SUBBASE INSPECTION

FOR PROPER LINE, GRADE AND

CONFORMITY IAW PLANS, SPECS

AND CONTRACT PROVISIONS

WHERE APPLICABLE, PROPER

REINFORCEMENT STEEL

PLACEMENT AND TIED IAW

PLANS & SPECS

2 INSPECTORS PRESENT

DURING ENTIRE PLACEMENT

OPERATIONS

PROPER FIELD TESTING BEING

PERFORMED AND RECORDED

JOINT CONSTRUCTION IAW

PLANS & SPECS

PROPER CURING PROCEDURES

OBSERVED

CONTROL CYLINDERS CURED IN

SAME MANNER AS IN-PLACE

CONCRETE

JOINT SEALS INSTALLED IAW

PLANS & SPECS

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE

TESTING AS REQUIRED

COMPLETION

VERIFY TESTING AND

MATERIALS DOCUMENTATION IS

COMPLETE AND ACCURATE

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL130

LOAD BEARING PILES INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED & ACCEPTED

MATERIALS APPROVED

EQUIPMENT APPROVED

INTERMEDIATE

VERIFY TYPE PILE TO BE USED IN STRUCTURE

FROM PLANS

ENSURE TESTING REQUIREMENTS OF PILING HAVE

BEEN MET. ( HEAT #’S, QA STAMPS, ETC)

VERIFY THAT DRIVING HAMMER IS APPROVED AND

REQUIRED HAMMER BLOWS FOR REFUSALS

CHECK ELEVATION OF EXCAVATION TO ENSURE

PROPER ELEVATION

CHECK PILING LOCATIONS AFTER CONTRACTOR

HAS PERFORMED LAYOUT

VERIFY LOCATIONS OF VERTICAL AND BATTERED

PILING

OBSERVE PILE DRIVING OPERATIONS TO VERIFY

BLOW COUNTS

ENSURE WELDING AT SPLICES ON STEEL PILES IS

PERFORMED BY CERTIFIED WELDER ( OBTAIN

CERTIFICATION)

VERIFY CORRECT NUMBER AND LENGTH OF

SPLICES

CALCULATE TOTAL LENGTH OF PILING DRIVEN

FROM CUTOFF ELEVATION

VERIFY CORRECT LOCATION OF PILINGS WHEN

DRIVING IS COMPLETE. COMPUTE CENTER OF

GRAVITY AS NEEDED.

COMPLETE

VERIFY TESTING AND MATERIALS

DOCUMENTATION IS COMPLETE AND ACCURATE

FINAL FIELD INSPECTION PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL140

BRIDGE H.C.C. OPERATIONS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED & ACCEPTED

OBTAIN AN APPROVED MIX DESIGN

FOR ALL CONCRETE MIXES TO BE

USED

EQUIPMENT APPROVED

INTERMEDIATE

VERIFY DIMENSIONS AND

ELEVATIONS OF FORM WORK

FORMWORK AND REINFORCEMENT

STEEL (CORRECT SIZE, TYPE, GRADE

AND PLACEMENT) IAW PLANS, SPECS

& CONTRACT PROVISIONS

SHOP DRAWINGS SUBMITTED AND

APPROVED FOR SIP METAL DECK

FORMS

CHECK DECK SCREED FOR PROPER

OPERATION AND GRADE

VERIFY WEATHER / TEMPERATURE

LIMITATION REQUIREMENTS ARE IAW

PLANS AND SPECS

ENSURE AUTHORIZATION FOR

PUMPING OF CONCRETE IS

APPROVED BY ENGINEER

VERIFY PLACEMENT SEQUENCE IAW

PLANS, SPEC, AND CONTRACT

PROVISIONS

2 INSPECTORS PRESENT DURING

ENTIRE PLACEMENT OF CONCRETE

OBSERVE PLACEMENT AND TESTING

OF CONCRETE DURING PLACEMENT

AND PERFORM INDEPENDENT

VERIFICATION TESTING AS REQUIRED

VERIFY LOCATION OF

CONSTRUCTION JOINTS ARE IAW

PLANS, SPECS, & CONTRACT

PROVISIONS

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL150

07/2018 Page 1of 2

BRIDGE H.C.C. OPERATIONS INSPECTION FORM

REPORT NO.:________________ DATE OF WORK:____________________ PAGE NO.:____2___

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

INTERMEDIATE - Continued

ENSURE PROPER BONDING AND

WATERPROOFING OF

CONSTRUCTION JOINTS

CHECK AND ENSURE REQUIREMENTS

FOR FORM REMOVAL ARE MET

ENSURE PROPER PROTECTION AND

CURING METHODS ARE USED

OBSERVE OVERDEPTH PROBES OF

DECK CONCRETE AND VERIFY

RECORDKEEPING OF SAME

CONTROL CYLINDERS CURED IN

SAME MANNER AS IN-PLACE

CONCRETE

VERIFY 28-DAY STRENGTH TESTS

RESULTS IAW PLANS & SPECS

CHECK DECK FOR IMPERFECTIONS

AND REPAIR IF NECESSARY

CHECK BRIDGE SEAT BEARING

AREAS FOR LIMITS OF TOLERANCE

COMPLETION

VERIFY TESTING DOCUMENTATION

FOR COMPLETION AND ACCURACY

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL150

07/2018 Page 2 of 2

HYDRAULIC CEMENT CONC ITEMS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED & ACCEPTED

MIX DESIGN APPROVED

INTERMEDIATE

PROPER SUBSURFACE & BEDDING

IAW PLANS & SPECS

PLACEMENT IAW PLANS & SPECS

1 INSPECTOR PRESENT DURING

ENTIRE PLACEMENT OF LESS THAN

25 CY

2 INSPECTORS PRESENT DURING

ENTIRE PLACEMENT OF GREATER

THAN 25 CY

REQUIRED ON-SITE TESTS TAKEN

AND RECORDED

PROPER CURING PRECEDURES

OBSERVED

CONTROL CYLINDERS CURED IN

SAME MANNER AS IN-PLACE

CONCRETE

PERFORM INDEPENDENT

VERIFICATION/ASSURANCE TESTING

AS REQUIRED

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL160

07/2018 Page 1 of 1

STRUCTURAL STEEL INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

AQCCEPTED

VERIFY APPROVED SHOP

DRAWINGS

MATERIALS APPROVED

INTERMEDIATE

ENSURE PROPER STORAGE

OF STRUCTURAL ITEMS ( 4”

ABOVE GROUND)

HOLES REAMED 1/8”

MAXIMUM DURING

ALIGNMENT

VERIFY PROPER STRENGTH

BOLTS USED

ENSURE PROPER TORQUE

OF BOLT TIGHTENING

SPOT CHECK WELDS,

BOLTED CONNECTIONS,

ETC. FOR COMPLIANCE

VERIFY PROPER PAINT

SYSTEM IS USED

COMPLETION

VERIFY ACCEPTANCE BY

QAM

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL170

PROTECTIVE COATINGS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

ENSURE THAT CONTRACTOR HAS

ALL REQUIRED CERTIFICATIONS

TO PERFORM PROTECTIVE

COATINGS AND COATING

REMOVAL OPERATIONS

VERIFY PE CERTIFICATIONS

REQUIREMENT FOR STRUCTURES

WITH CONTAINMENT

INTERMEDIATE

INSPECT STRUCTURAL MEMBERS

TO ENSURE PROPER REMOVAL

OF EXISTING COATINGS AS

REQUIRED

INSPECT STRUCTURAL MEMBERS

TO ENSURE PREP WORK IS

SUFFICIENT (CLEANING/REMOVAL

OF RESIDUE)

ENSURE PROPER COATING

SYSTEM AND COMPONENTS ARE

USED

VERIFY APPLICATION

LIMITATIONS (TEMPERATURE,

HUMIDITY, ETC.)

VERIFY APPLICATION

PROCEDURES IAW PLANS &

SPECS

CHECK MIL THICKNESS OF

COATING

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL180

UNDERDRAINS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPATATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

APPROVED MATERIALS

INTERMEDIATE

INSTALLED IAW PLANS, SPECS &

CURRENT STANDARDS

SLOPES CHECKED AFTER HEAVY

RAINFALL FOR SEEPAGE

CORRECTIONS TAKEN IF

NECESSARY

VERIFY UPSTREAM ENDS

RECEIVE PLUGS

CHECK GEOTEXTILE FABRIC FOR

PROPER INSTALLATION

VERIFY PROPER AGGREGATE

SIZE USED AND AGGREGATE

MATERIAL IS CLEAN & FREE OF

FOREIGN MATERIALS

OUTLET PIPES VISUALLY

CHECKED FOR CRUSHED,

CLOGGED OR DISPLACEMENT

VERIFY ENDWALL PLACEMENT

HAS CORRECT ALIGNMENT AND

IS BELOW FINAL SHOULDER

ELEVATION

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL190

GUARDRAIL INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS FROM APPROVED

SOURCE

INTERMEDIATE

GUARDRAIL INSTALLED IAW

PLANS, SPECS, CURRENT

STANDARDS, & SPECIAL

PROVISIONS

DAILY INSPECTION BY A GRIT

CERTIFIED INSPECTOR

VERIFY LON (LENGTH OF

NEED) CALCULATIONS FOR

END TREATMENTS

SPOT CHECK HEIGHT AND

ALIGNMENT

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL200

FENCING INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS FROM

APPROVED SOURCE

INTERMEDIATE

FENCE INSTALLED IAW

PLANS, SPECS,

STANDARDS & SPECIAL

PROVISIONS

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL210

RIGHT OF WAY MONUMENTS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIAL CONFORMS TO

THE SPECS

INTERMEDIATE

VERIFY LOCATION

STAKEOUT IS CORRECT

MONUMENTS PLACED IAW

PLANS OR AS DIRECTED BY

THE ENGINEER

PROPER BACKFILL

COMPACTION TO AVOID

DISPLACEMENT OF

MONUMENT

COMPLETION

FINAL FIELD INSPECTION

REVIEW PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL220

MAINTENANCE OF TRAFFIC INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

TRAFFIC CONTROLS APPROPRIATELY

DESIGNED TO MAINTAIN TRAFFIC

INTERMEDIATE

MATERIALS CONFORM TO THE SPECS

SIGNALIZATION, BARRICADES,

CHANNELIZING DEVICES, SAFETY

DEVICES & PAVEMENT MARKINGS

CONFORM TO SPECS, VIRGINIA WORK

AREA PROTECTION MANUAL & MUTCD

STANDARDS

SIGNS PLACED IAW VIRGINIA WORK

AREA PROTECTION MANUAL & MUTCD

STANDARDS

CERTIFIED FLAGGERS

CONTRACTOR PROPER MAINTENANCE

OF TRAFFIC CONTROL DEVICES

COMPLETION

FINAL FIELD INSPECTION PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL230

PAVEMENT MARKING INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS FROM

APPROVED SOURCE

INTERMEDIATE

INSTALLED IN LOCATIONS

SHOWN ON THE PLANS

INSTALLED IAW VIRGINIA

WORK AREA PROTECTION

PLAN

INSTALLED IAW

MANUFACTURER’S

RECOMMENDATIONS

CERTIFIED PAVEMENT

MARKING TECHNICIAN

PRESENT AND OBSERVING

APPLICATION

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL240

SOUND BARRIER WALLS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS

APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

SHOP DRAWING SUBMITTALS

REVIEWED AND APPROVED

INTERMEDIATE

PILE INSTALLATION IAW PLANS

& SPECS

BARRIER WALL INSTALLED IAW

PLANS, SPECS, & STANDARDS

FOR TYPE SPECIFIED

SPOT CHECK TOP FACE

ALIGNMENT IS WITHIN

DEVIATION ALLOWANCES

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL250

TOPSOIL AND SEEDING INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

INTERMEDIATE

SITE LOCATION IAW PLANS

TOPSOIL CLASSIFICATION IAW

THE PLANS & SPECS

BRUSH, ROOTS, STUMPS, LITTER

REMOVED

AREAS PROPERLY PREPARED TO

RECEIVE SEED (SLOPES ARE

COMPACTED AND GROOVED)

AREA SEEDING TIME LIMITS ARE

IAW PLANS, SPECS, CONTRACT

PROVISIONS, & VIRGINIA DCR

REQUIREMENTS

SEED MIXTURE APPLIED IAW

ROADSIDE DEVELOPMENT PLANS

(INCLUDING SEED, LIME,

FERTILIZER)

MULCH APPLIED IAW PLANS &

SPECS

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL260

PLANTING INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

INTERMEDIATE

PLANTS PROPERLY

IDENTIFIED AND INSPECTED

PRIOR TO PLANTING

INSTALLATION IAW PLANS,

SPECS, & CURRENT

STANDARDS

MULCHING, STAKING &

GUYING, WRAPPINGS,

WATERING, ETC. IAW PLANS,

SPECS, & CURRENT

STANDARDS

PROPER DOCUMENTATION &

CONTRACTOR NOTIFICATION

OF ESTABLISHMENT PERIOD

BEGIN AND END DATES IS

COMPLETE

AT THE END OF THE

ESTABLISHMENT PERIOD,

DEAD & DEFECTIVE PLANTS

ARE REPLACED IAW PLANS, &

SPECS

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL270

TRAFFIC SIGNS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

SHOP DRAWING SUBMITTALS

REVIEWED AND APPROVED

INTERMEDIATE

SIGN LOCATION LAYOUT IAW

PLANS

MESSAGES & SYMBOLS ARE

CORRECT AND IAW MUTCD

STANDARDS

SIGN FOUNDATIONS AND POSTS

INSTALLED IAW APPROVED SHOP

DRAWINGS

INSTALLATION IS IAW PLANS,

SPECS, CURRENT STANDARDS,

CONTRACT PROVISIONS & MUTCD

STANDARDS

SIGN PANELS ARE FREE OF

CRACKS, GAPS, STREAKS,

WRINKLES, BLISTERS,

DISCOLORATIONS, BUCKLES,

WARPS AND HAVE A SMOOTH

SURFACE OF UNIFORM COLOR

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL280

TRAFFIC SIGNALS INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

SHOP DRAWING SUBMITTALS

REVIEWED AND APPROVED

INTERMEDIATE

ENSURE ALL FOUNDATIONS,

DEVICES, ETC. ARE

CONSTRUCTED WITHIN THE R/W

SHOWN ON THE PLANS

FOUNDATIONS AND POLES

INSTALLED IAW APPROVED SHOP

DRAWINGS

INSTALLATION IS IAW PLANS,

SPECS, CURRENT STANDARDS,

CONTRACT PROVISIONS & MUTCD

STANDARDS

VERIFY TRAFFIC LOOP

DETECTORS INSTALLED IAW

PLANS & SPECS

SYSTEM TESTING IS COMPLETE

AND ACCEPTABLE

ALL SIGNALS ARE FUNCTIONING

AS DESIGNED

COMPLETION

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL290

WATER & SEWER FACILITIES INSPECTION FORM

PROJECT NO.: CONTRACTOR:

LOCATION:

PLAN PAGE: INSPECTOR: ______________________________

ITEM

INSPECTOR

(INITIAL) DATE REMARKS

PREPARATORY

DESIGN DOCUMENTS APPROVED

QA/QC PLAN REVIEWED &

ACCEPTED

MATERIALS APPROVED

SHOP DRAWING SUBMITTALS

REVIEWED AND APPROVED

INTERMEDIATE

WATER & SEWER HORIZONTAL &

VERTICAL MINIMUM SEPARATION

REQUIREMENTS IAW PLANS &

SPECS

TRENCH EXCAVATION IAW SECT.

PIPE & FITTINGS INSPECTED FOR

CRACKS AND DEFECTS BEFORE

LOWERED INTO TRENCH

FOUNDATION APPROVED &

BEDDING MATERIAL IAW PLANS &

SPECS

BACKFILL MATERIAL APPROVED

AND INSTALLED IAW PLANS,

SPECS & CURRENT STANDARDS

VERIFY DISINFECTING, LEAK

TESTING, AND SYSTEM TESTING IS

COMPLETE AND APPROVED BY

THE QAM

COMPLETION

PROPER DOCUMENTATION IS ON

FILE WITH LOCALITY (IF

APPLICABLE)

FINAL FIELD INSPECTION

PERFORMED

REMARKS:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-CL300

Date Page No: of

Contract No:

Contractor: Hours: From: To:

Weather: Low: High: Condition:

WORK CONDITIONS: GOOD FAIR POOR UNWORKABLE

VISITORS:

Communications and instructions given to the Contractor and its QA/QC Team:

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-DAILY RPT

07/2018 Page 1 of 2

WORK IN PROGRESS:

PLAN CHANGES:

REMARKS

Submittals Received

Independent Verification tests performed:

Independent Assurance performed:

Preparatory Inspections attended:

Intermediate Inspections performed :

Final Inspections performed :

Non-conformance reports received:

Reports of corrected and pending actions to correct Non-conformance Reports

Other Comments:

SIGNED

NAME TITLE

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-DAILY RPT

INSPECTOR’S DAILY REPORT REPORT NO:

Date

Contract No:

Page No: of

Contractor:

Inspector: Hours: From: To:

Weather: Low: High: Condition:

WORK ACCOMPLISHED

TESTING ACCOMPLISHED

ITEM TESTED LOCATION:

FROM

LOCATION:

TO

QUANTITY

TESTED/LOT

RESULT SPECIFICATION

MATERIALS RECEIVED TODAY:

MATERIAL SOURCE

CAR INVOICE

OR TICKET NO. QUANTITY IDENTIFICATION

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-INSP DAILY

07/2018 Page 1 of 2

INSPECTOR’S DAILY REPORT REPORT NO:

CONTRACTOR’S EQUIPMENT & MANPOWER

EQUIPMENT MANPOWER

REMARKS

Signed Approval

Name Title Name Title

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-INSP DAILY

NONCONFORMANCE NOTIFICATION LOG Page

PROJECT: PROJECT NO:

CONTRACTOR:

Notification Spec Accepted Number Date Section Defective/Rejected Work By Date

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-NCLOG

NONCONFORMANCE REPORT

TO CONTRACTOR: NOTIFICATION NO:

PROJECT: PROJECT NO:

OWNER: TIME: AM/PM

ENGINEER: OBSERVER:

Pursuant to the GENERAL CONDITIONS of the Contract, you are hereby notified of the following noncompliance violation:

Specification Section: Paragraph:

Violation:

Contract Requirement:

Violation Detected by: Test Inspection Observation

Noncompliance Work is: Defective Rejected

Contactor’s Proposed Recommendation

Received by:

Engineer:

Date:

Authorized Representative Contractor

Title

Date

Distribution:

1. Engineer

2. Owner

3. Field File

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-NCRPT

NOTICE OF CORRECTION OF NONCONFORMANCE WORK

TO PREVIOUS NOTIFICATION NO: DATE:

PROJECT: PROJECT NO:

OWNER:

ENGINEER:

The below listed nonconformance work has been re-inspected and the results of the Contractor’s corrective actions have placed the work in compliance with the Contract Documents.

Description of Violation:

Description of Correction:

Engineer:

Authorized Representative

Date:

Distribution:

1. Engineer

2. Owner

3. Field File

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-NCNOTICE

PUNCH LIST DATE

PAGE: OF

PROJECT: PROJECT NO:

CONTRACTOR:

INSPECTED BY:

Item Location Action Required Accepted

By Date

ALTERNATIVE PROJECT DELIVERY DIVISION FORM APD-PUNCHLIST

LAP Manual 13.2 - G-2 April 2025 Construction Administration

Acceptance/VST/IA Frequency - SOILS AND AGGREGATES Material and Test VDOT R&B Spec Test Method Acceptance (VST) IA

Soil/Embankment/Backfill – Classification, CBR, Proctor/One-Point Proctor

Special Provision, as determined by Engineer

VTM-1, VTM-7, VTM-12,

VTM-25

1/soil type during project development and 1/change in material during construction

System IA during construction

Embankment Density Test 303.04(h) VTM-10; for Nuclear use

Direct Transmission Method

For fills less than 2500 LF, one (1) test in each lift. For fills greater than 2500 LF, five (5) tests in each lift.

When tests cannot be run due to gravel, muck, rock, etc., give station and depth on report TL-124 in lieu of test, with reason. See Note 1 for reports.

System IA

Subgrade, finished (either cut or fill sections) Density Test

305.03 VTM-10; for Nuclear use

Direct Transmission Method One (1) test per 500 LF. See Note 1 for reports. System IA

Subgrade, stabilized, either in-situ or imported material other than aggregate base, subbase, or select material) Density Test by any method

306.03(f), 307.05(e)

VTM-10; for Nuclear use Direct Transmission Method

Five (5) tests per 0.5 mile per lane width. Tests shall be randomly located. See Note 1 for reports. System IA

Depth Test 306.03(g), 307.05(e) VTM-38A

One (1) test per 0.5 mile per lane width. Tests shall be randomly located. Deficient or excessive areas of depth shall be as defined in VTM-38A. See Note 1 for reports.

Tests in turning lanes, acceleration or deceleration lanes, ramps, connections, crossovers, etc., tested at discretion of Engineer.

System IA

Central Mix Aggregate Base, treated or untreated, Subbase, and Select Material Density Test by any method

305.03, 308.03, 309.05

VTM-10; for Nuclear use Backscatter Control Strip Method, set up roller pattern and control strip for each layer or lift placed.

One (1) test per 0.5 mile per lane width per layer, each test result being the average of five (5) readings. See Note 1 for reports. See Note 2 on related laboratory and plant testing of aggregate.

System IA

Depth Test 308.04, 309.05 VTM-38B

One (1) test per 0.5 mile per lane width. Maximum lot size is 2 miles for each lane width. Project divided into lots, each lot stratified, and location of each test within stratified section determined randomly. Tests in turning lanes, acceleration or deceleration lanes, ramps, connections, crossovers, etc., tested at discretion of Engineer, and shall not be taken at random, however, care shall be taken not to set up uniform patterns of tests; the tolerance for an individual test result shall be used. See Note 1 for reports.

System IA

LAP Manual 13.2 - G-3 April 2025

Shoulders Density Test by any method 305.03(a) Same as Central Mix Aggregate, alternating sides. Not required when shoulder is part of mainline pull. System IA

Depth 305.03(a) Same as Central Mix Aggregate, alternating sides. Not required when shoulder is part of mainline pull. System IA

Backfill, Pipe and Box Culverts 302.03, 303.04(g), 401.03(i)

VTM-10; for Nuclear use Direct Transmission Method

Minimum one (1) test per lift on alternating sides of structure for each 100 LF in structure length. Testing shall start after first 4-in compacted layer above bedding and continue to one (1) ft above the top of the structure.

See Note 1 for reports.

System IA

Backfill for Abutments, Gravity and Cantilever Retaining Walls

303.04(g), 401.03(i)

VTM-10; for Nuclear use Direct Transmission Method

Minimum of one (1) test per 150 CY. Tests shall be taken behind heel a distance of H+10 ft. See Note 1 for reports.

System IA

Mechanically Stabilized Earth Walls (MSE) Reinforced Zone material

303.04(g), 401.03(i)

VTM-10; for Nuclear use Direct Transmission Method

Minimum of one (1) test per 150 CY. The testing shall be conducted a minimum distance of three (3) ft away from the face of the wall, to within three (3) ft of the back edge of the zone of the reinforced fill area. See Note 1 for reports.

System IA

Backfill for Drop Inlets and Manholes 302.03, 303.04(g) VTM-10; for Nuclear use

Direct Transmission Method

Minimum one (1) test every other lift around the perimeter of each structure. To include drop inlets, junction boxes, etc. Testing shall start after first 4-in compacted layer above bedding and continue to the top of the structure. See Note 1 for reports.

System IA

Note 1. Report density tests on Forms TL-53, TL-54, TL-55, TL-124, TL-125 (Sand-Cone Method), and TL-136; report IA density and depth tests on Form TL- 105.

Note 2: CBR tests (VTM-8) are laboratory tests required for acceptance of subgrade and in some cases, aggregate Select Material, per VDOT Road and Bridge Specifications 207 and 305. A 75 to 100 lb sample of the material is typically gathered from borrow pits, borings, or plant stockpiles prior to project field work, but may also be gathered from the roadway after project field work has begun. Gradation (VTM-25) and Atterberg Limits (VTM-7) tests are also plant tests and are done on a system basis as described in Section 309 of the VDOT Materials Division MOI. Typically 4 samples of 30 to 40 lb each are collected in a stratified random sampling from each 2,000 or 4,000 ton lot of aggregate at a quarry, and one of these 4 samples is split for IA testing by the VDOT District Materials Section.

LAP Manual 13.2 - G-4 April 2025

Acceptance/VST/IA Frequency - HYDRAULIC CEMENT CONCRETE Material and Test 1 VDOT R&B Spec Test Method Acceptance (VST) IA

Structural/Miscellaneous/Pavemen t Concrete - “Wet” Tests Slump

217.08 ASTM C143 One (1) test per load (truck) per source System IA

Air Content 217.08 ASTM C231 or C173 One (1) test per load (truck) per source System IA Temperature 217.08 ASTM C1064 One (1) test per load (truck) per source System IA Unit Weight (Lightweight

Concrete only) 217.08 ASTM C138 One (1) test per load (truck) per source System IA

Structural Concrete Compressive Strength 217.08 ASTM C31 and C39 One (1) set of cylinders per load (truck) per mix design

- each set consists of three (3) 4-in by 8-in cylinders System IA with use of Qualified Laboratory

Permeability 217.08 ASTM C31, VTM- 112 One (1) set per 100 CY – per source each set consists of two (2) 4-in by 8-in cylinders

System IA with use of Qualified Laboratory

Miscellaneous Concrete Compressive Strength 217.08 ASTM C31 and C39

One (1) set per 250 CY per source, minimum 1 per day per mix design - - each set consists of three (3) 4-in by 8-in cylinders

System IA with use of Qualified Laboratory

Permeability 217.08 ASTM C31, VTM-112 One (1) set per 250 CY per source, minimum 1 per day per mix design - – each set consists of two (2) 4-in by 8-in cylinders

System IA with use of Qualified Laboratory

Pavement Concrete Compressive Strength 217.08 ASTM C31 and C39

One (1) set per 250 CY, minimum 1 set per day and 3 sets per project - - each set consists of three (3) 4-in by 8-in cylinders

System IA with use of Qualified Laboratory

Permeability 217.08 ASTM C31, VTM-112 One (1) set per 250 CY, minimum 1 set per day and 3 sets per project, only if specified for the project – each set consists of two (2) 4-in by 8-in cylinders

System IA with use of Qualified Laboratory

Flexural Strength 316.04(f) ASTM C78 and C31 and C293

As deemed necessary by DME to determine opening to traffic; this is not an acceptance test

System IA with use of Qualified Laboratory

Thickness 316.05 VTM-26 One (1) per 0.1 mile per lane System IA Structural/Miscellaneous Self Consolidating Concrete (SCC) Slump Flow

217.11 ASTM C1611,

Procedure B One (1) test per load (truck) per source System IA

J-Ring Flow 217.11 ASTM C1621 One (1) test per load (truck) per source System IA

1. For Self Consolidating Concrete (SCC), the slump flow and J-ring flow tests replace the slump test.

For latex-modified concrete or silica fume concrete bridge deck overlays, one set of five cylinders (3 for compressive strength testing and 2 for permeability testing) will be sampled for every day of placement with a minimum of one set per bridge. Any placement over 25 CY will require an additional set of cylinders at every 25 CY.

For temperature, slump, unit weight, and air content for bridge deck concrete, all miscellaneous concrete, and all pavement concrete, if the first 3 trucks have an air content all within 1% of each other, then only every third truck thereafter need be tested.

LAP Manual 13.2 - G-5 April 2025

QC/VST/IA Frequency - ASPHALT AND ASPHALT CONCRETE (applicable to each mix type)

Material and Test

Sample Location

VDOT R&B

Specification

Test Method QC VST IA

In-place Pavement Density by Nuclear Method (Control Strip) (Asphalt Pavement)

Location - Field 315.05 VTM-76, VTM-6

(This is acceptance test) Control Strip.

Establish Roller pattern according to VTM-76. Ten stratified random sample to establish target density. Verify minimum density achieved with cores per VTM-76.

QC technician shall be certified

None

Materials representative observe and witness QC testing to assure gauge is calibrated and accurate.

Materials representative observing bulking of cores/plug and percent density calculations.

1 plug/core per 10 project control strips verified in approved lab.

IA is not required for Control Strip acceptance.

IA technician shall be certified

In-place Pavement Density by Nuclear Method and/or VDOT cores (Test Section) (Asphalt Pavement)

Location - Field

315.05; VTM-

76 VTM-6

Test Section- Lot Size:

5000 ft per Lane width.

Test stratified random samples per lot for nuclear gauge and/or five stratified random plug/cores per lot QC technician shall be

VST on 20%*QC Lots Acceptance Options:

Coring/Saw plugs method Use VTM-6 Two (2) cores/plugs per VST lot. Preferably match to QC lot which translates to one core per sub lot for two sublots [1000 ft. (300

m) (QC sub lot)].

VST technician shall be certified as Field Level II

Materials representative observe and witness QC testing to assure testing is performed properly and equipment is calibrated on a system basis: minimum once per calendar year.

IA technician shall be

LAP Manual 13.2 - G-6 April 2025

In-Place Depth Check for

SM/IM/BM

Material

Location - Mainline 315.05 None

(This is acceptance test) Two tests for 24 ft.

pavement from 0 to 1/2 mile (0 – 800m), 3 tests for pavement from 1/2 to 3/4 mile (800 – 1200 m), and 4 tests for pavement from 3/4 to one mile (1200 – 1600 m).

Maximum lot size is one mile of 24 ft. (7 m) base course.

Project divided into lots, each lot stratified, and location of each test within stratified section determined randomly.

None

In-Place Depth Check for Base Material

Location - Shoulders 315.05 None

(This is acceptance test) Same as above, alternating sides if specific plan depths specified. Depth tests not required if plans specify rate of application.

None

Asphalt Tack Applications

Location - Roadway VTM-137 None

(This is acceptance test) One tack plate test per 5000 LF (per lane)per roadway within first 500 LF.

None

Grading and Binder Content (Asphalt Pavement)

Location - Processing or mixing plant from back of truck

211.08

Eight 10-LB samples per 4000- ton lot.

Samples taken in stratified random manner.

QC technician shall be certified

Same as IA frequency, results from IA testing are used in VST statistical analysis.

VST technician shall be certified

Target two samples per lot and Maintain a twenty percent sampling rate, as a percentage of the QC samples IA technician shall be certified

Temperature Measurements

Location –

QC –

Processing or mixing plant from back of truck QA - Field

211.08

(This is acceptance test) One temperature measurement initially on first and fifth loads, of each JMF, each production day, and thereafter minimum of one per hour of production time for each JMF, by

None

Project Inspector should take and record temperature measurements of the AC at the beginning of paving operations and thereafter at a rate of not less than one measurement every hour.

Inspector may increase the frequency of temperature measurements at any time.

LAP Manual 13.2 - G-7 April 2025

Producer's APT. If any test outside of tolerance, minimum of three additional tests made in different points of the load, and four tests averaged, and average used as temperature of load or batch.

The temperature should be checked using an appropriate heat- sensing device (e.g.

probe thermometer, infrared thermometer, etc.).N/A

Field

SUPERPAVE®

volumetric Test

Location - At processing or mixing plant or from project site

211.08

One per 1000 tons of production. A minimum of one per day if at least 300 tons produced.

Field Superpave tests are obtained at the same frequency as IA testing on Grading and Binder Content

Field Superpave volumetric tests are only used for verification.

Depth of pavement

Location – AC base course, surface and intermediate courses only if depth specified on plans

315.05(c), 315.07; MOI

503.07;

VTM-32B

See VDOT Materials Division MOI Sec.503.07

See VDOT Materials Division MOI Sec. 503.07

See VDOT Materials Division MOI Sec. 503.07

LAP Manual 13.2 - G-8 April 2025

QC/VST/IA Frequency - Misc Roadway and Structure

Material Type Spec Section

Test Reference QC Testing VST IA

Clearing and Grubbing Ensure activities are confined to limits and seeded within 30 days of disturbance

VDOT Section 301 N/A Daily Weekly

Erosion and Siltation Control

Monitor for correct installation and Maintenance

VDOT Section

303.03 & Current Virginia DCR Specifications

N/A Daily After rain event

Undercut

Review area to determine need for undercut

VDOT Section

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