*-Required field [1]- numeric code for website
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)