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Bridge or Culvert Inventory

1. Category*: Bridge Culvert

2. Town*: __________________________________

3. Road*: __________________________________

4. TH Number: ______________________________

5. Local ID*: ________________________________

6. Location Description: _______________________

_________________________________________

7. Coordinates*: Lat/X: _______________________

Long/Y:___________________________________

8. Date of Inventory*: ________________________

9. Structure Label:___________________________

10. Severity of Erosion: Unknown[0] High[1]

~ Medium[2] ~ Low [3] None [4]

11. Year Built:________________________________

12. Is structure historic? ~ Unknown[0] ~ Yes[1]

~ No[2]

13. Owner of Structure: ~ State Highway[1]

Town Highway[3] State Park/Forest[11]

_ Local Park/Forest[12] Private[26]

Railroad[27] US Forest Service[64]

National Park Service[66] Military

Reservation[70] Unknown[80]

14. Overall Condition*: Unknown[0] Closed[1]

Urgent[2] Critical[3] Poor[4] Fair[5]

Good[6] Excellent[7]15. Structure Material*: Other[0] Concrete

Sectional[1] Concrete Poured[2]

Aluminum, cast iron[9] Steel Corrugated[10] Stone[11] Aluminum

Plastic Corrugated[13]

Pipe, Metal[15]

Tank[17] Metal-

Corrugated[12]

Plastic Smooth[14] __ Pipe, Plastic[16] undefined type[18] Mixed[97]

Steel[3] Pre-stressed

Unknown[99] Bridge Specific: concrete[5] Timber[7] Masonry & slabs[8]

16. Other[0] Arch[11]Structure Type*: _ Mixed Types[20] Unknown[99]

Culvert specific: Round[30] ~ Box[31]

Ellipse/Squashed[32] __ Drop Inlet[33] Bridge specific: Slab[1] Stringer/Multi-

Beam[2] Girder & Floorbeam[3] _ Tee

Beam[4] Box Beam[5] Frame[7] Stayed

Girder[14] Channel Beam[22]

17. Header Material: Unknown[0] Stone masonry[1] Rip-rap[2] Plastic[3] Concrete[4] Metal[5] None[6]

18. Header Condition: Unknown (0) _ Good[1] Fair[2] Poor[3]

19. Culvert Height* (Inches): ____________________

20. Culvert Width* (Inches): ____________________

21. Culvert Length* (Feet): _____________________

22. Depth of Cover (Feet): ______________________

23. Is Culvert a drop inlet or catchbasin: Unknown[0] Yes[1] No[2]

24. Does the culvert have poor alignment? Unknown[0] Yes[1] No[2]

25. Does the culvert have direct output to stream? Unknown[0] Yes[1] No[2]

26. Is the culvert perched? Unknown[0] Yes[1] No[2]

27. Does the culvert need cleaning? Unknown[0] Yes[1] No[2]

28. Feature Bridge crosses (Name): ____________

29. Width of Channel*:_______________________

30. Outside Abutment to Outside Surface Width*:

________________________________________

31. Width of Travel Lanes*: ____________________

32. Posted Weight Limit: ______________________33. Bridge to the Base of Stream Bed: ____________

34. Substructure Condition*: Good[1] Fair[2] Poor[3] Unknown[4]

35. Superstructure Condition*: Good[1] Fair[2] Poor[3] Unknown[4]

36. Deck Condition*: Good[1] Fair[2] Poor[3] Unknown[4]

37. Comment1 (ie. General):______________________________________________________________________

38. Comment2 (ie. Material & Type):_______________________________________________________________

39. Comment3 (ie. Condition):_____________________________________________________________________

40. Comment4 (ie. Construction, Erosion, In/Outflow):_________________________________________________

41. Numeric Comment: _________________________________________________________________________

16. (con't)