(Owner’s logo)

State of New Jersey
NEW JERSEY DEPARTMENT OF TRANSPORTATION
1035 PARKWAY AVENUE
P.O. Box 600
TRENTON, NEW JERSEY 08625-0600
(Owner’s name and address)

UNDERWATER BRIDGE EVALUATION SURVEY REPORT

STRUCTURE NO. ####-###
NJ ## OVER XX ROAD AND XX RIVER OR RAILROAD
XX BOROUGH AND/OR TOWNSHIP
XX COUNTY

MONTH DD, YYYY

                                                 

Prepared By

XXX Consultant 
101 Main Street
Trenton, New Jersey 08625-0600

TABLE OF CONTENTS	
		Page No.	
1	Structural Data	##-##	
2	Summary	##-##	
3	Conclusions and Recommendations	##-##	
4	Soundings and Photographs	##-##	
5	Field Notes	##-##	
6	Priority Repairs	##-##	

			

N.J.D.O.T. - STRUCTURAL EVALUATION AND BRIDGE MANAGEMENT
UNDERWATER BRIDGE EVALUATION SURVEY REPORT

	
STRUCTURAL DATA:	
Bridge No.:	#### - ###	Year Built:		Widened/ Rehab:		
Route No.:
	##	Length:		Width:		
Mile Point:	XXX.XX	Inspection Begin Date:	MM/DD/YYYY	
Name:	NJ ## over XX Road and XX River or Railroad	Inspection Completion Date: 	MM/DD/YYYY	

Structure Type:	
	By:		
		Date of Previous Inspection:	MM/DD/YYYY	
		By:		
WORK DONE:	(Reference a Photo)	
OVERALL BRIDGE CONDITION (ITEM B.C.13): (Indicate which Item(s) controls: B.C.01, B.C.02, B.C.03 or B.C.04)

UNDERWATER INSPECTION CONDITION (ITEM B.C.15): 

SUMMARY:
	
Number of Substructure Units in Water:	Abutments:		Piers:		
	
Type of Underwater Inspection: 		
	
Underwater Inspection Equipment Used (Item B.IE.12): 	
Substructure Elements Cleaned:  		
Water Flow Velocity: 		Soil Type:  		
Diving Mode:  		Dive Team Members: 		
Diving Hazard Analysis / Assessment / Confined Space Entry: 	
Reference Information:		

COMPONENT / MATERIAL	GENERAL REMARKS	
 ABUTMENTS
(Material)	South Abutment: 

Southwest wingwall:

Southeast wingwall:

North Abutment:

Northwest wingwall:

Northeast wingwall:

PIER
(Material) 	Center Pier:
	
PROBING/SCOUR	South and North Abutments:

Center Pier:

	
COUNTERMEASURES

FENDERS/ BULKHEADS

CONCLUSIONS & RECOMMENDATIONS:	
Provide the Underwater Inspection Condition Rating (Item B.C.15). Include a general summary of the defects, if the condition rating is 6 or less.

Provide the Channel Condition Rating (Item B.C.09) and Channel Protection Condition Rating (Item B.C.10). If applicable due to scope of services of the bridge, provide Substructure Condition Rating (Item B.C.03), Culvert Condition Rating (Item B.C.04), Superstructure Condition Rating (Item B.C.02), and Underside of Deck. Include a general summary of the defects, if the condition rating is 6 or less.

Provide comments on the Scour Condition Rating (Item B.C.11). Include a general summary of the findings of the probing performed

Provide comments on the Scour Vulnerability (Item B.AP.03) of the bridge. Reference the results from the Scour Evaluation Program, if applicable.

Indicate any significant changes since the previous underwater inspection.

Indicate any required priority repair work, and reference priority repair letter at end of report.

Provide underwater inspection frequency recommendation as per below:  
Underwater Inspection Condition (Item B.C.15) ≤ 3 = 24 months
Channel Condition (Item B.C.09) ≤ 3 = 24 months
Channel Protection Condition (Item B.C.10) ≤ 3 = 24 months
Scour Condition Rating (Item B.C.11) ≤ 3 = 24 months
Scour critical bridge = 24 months
Non-scour critical bridge = 48 months
Low freeboard = 24 months

DRAWINGS	

Insert Sketch

	

Photo No: UW-01	
Location:		
Description:		

Photo No: UW-02
	
Location:		
Description:		

Photo No: UW-03	
Location:		
Description:		

Photo No: UW-04
	
Location:		
Description:		

NEW JERSEY DEPARTMENT OF TRANSPORTATION
STRUCTURAL EVALUATION AND BRIDGE MANAGEMENT
FIELD NOTES
NJDOT (Owner’s name)
	
Name:	NJ ## over XX Road and XX River or Railroad	
Diver:		
Company:		
Team leader:		
NCBI:		
Company:		
Temperature:	##ºF	Weather:		

RATINGS: (Highlight or bold the applicable rating which is coded for underwater inspection condition). 	
	
N	Not applicable – Component does not exist.	
9	Excellent Condition – Isolated inherent defects.	
8	Very Good Condition – Some inherent defects.	
7	Good Condition – Some minor defects.	
6	Satisfactory Condition – Widespread minor or isolated moderate defects.	
5	Fair Condition – Some moderate defects; strength and performance of the component are not affected.	
4	Poor Condition – Widespread moderate or isolated major defects; strength and/or performance of the component is affected.	
3	Serious Condition – Major defects; strength and/or performance of the component is seriously affected.	
2	Critical Condition – Major defects; component is severely compromised.	
1	Imminent Failure Condition – Bridge is closed due to component condition. Repair/ rehabilitation may return bridge to service.	
0	Failed Condition – Bridge is closed due to component condition and is beyond corrective action. 	
	
GENERAL	
Type of Bridge:		
	
Type of Substructure:		
	
No. of Lanes:	On		Under	N/A (waterway)	
	
Number of substructure units in water:	Abutments:		Piers:		
	
Overall condition of substructure:		
	
WATERWAY:
	
Type:		Velocity:		
	
Streambed material:		

For all field note sheets, a text description must be provided for any element with a condition rating of 6 or lower. Any item with a rating of 9 through 7 shall either state “No significant defects” or state any minor defects observed. Components that are coded “N” shall state “None” or whatever other statement applies (the idea being that all rows of the field notes have associated Remarks text).

Each span MUST have its own field notes sheet. Do not combine spans into a single sheet. Likewise, you cannot lump substructure units together in a single table. Each pier and abutment require its own set of condition ratings. 

UNDERWATER DIVING INSPECTION

DECK	Item B.C.01 Deck Condition:		
	
SPAN #			
	
RATING	COMPONENT	REMARKS	
N	Wearing Surface /
Top of Deck
	Not inspected as part of underwater evaluation.	
	Underside of Deck

	
N	Median
	Not inspected as part of underwater evaluation.

N	Curbs
	Not inspected as part of underwater evaluation.

	Sidewalks /
Safetywalks
		
N	Parapets/
Balustrades
	Not inspected as part of underwater evaluation.	
N	Railings /
Fencing
	Not inspected as part of underwater evaluation.	
N	Deck Joints /
Filler Material
	Not inspected as part of underwater evaluation.	
N	Drains and
Scuppers
	Not inspected as part of underwater evaluation.	
N	Light Stands
	Not inspected as part of underwater evaluation.

	Utilities

	
	Others
		
	Additional Remarks: 		

Note: Inspection of Underside of DECK, underside of SIDEWALK/SAFETEYWALKS and UTILITIES (within superstructure) field notes are ONLY applicable when in the scope i.e. there is low freeboard.

UNDERWATER DIVING INSPECTION 

CULVERT	Item B.C.04 Culvert Condition:		
	
SPAN #			
	
RATING	COMPONENT	REMARKS	
	Roof Slab

	

	
	Side Walls/
Center Walls

	

	
	Floor Slabs

	

	
	Headwalls

	

	Wingwalls

	

	
	Others
		
	Additional Remarks: 		

UNDERWATER DIVING INSPECTION 

SUPERSTRUCTURE	Item B.C.02 Superstructure Condition:		
	
SPAN #			
	
RATING	COMPONENT	REMARKS	
	##  Girders/
Stringers/
Floorbeams/
Trusses/
P/S Beams

(Girders numbered XXXX to XXXX)		
	Diaphragms /
Cross Frames

	
	Bearings
		
	Deflection and 
Vibration

	
	Others
		
	Additional Remarks:		

FATIGUE DETAILS                  	Estimated percentage of large trucks in ADT =    	#%		
	
Category	Detail Description and Location 	

N/A

	

Note: SUPERSTRUCTURE field notes are ONLY applicable when required in Scope.
UNDERWATER DIVING INSPECTION

SUPERSTRUCTURE	Item B.C.02 Superstructure Condition:		
(ARCH)	
	
SPAN #			
	
RATING	COMPONENT	REMARKS	
	Intrados of Arch
(Soffit) Arch Ribs

		
	Spandrel Columns /
Extrados

		
	Spandrel Walls

		
	Others
		
	Additional Remarks:		

Note: SUPERSTRUCTURE field notes are ONLY applicable when required in Scope.
UNDERWATER DIVING INSPECTION

SUPERSTRUCTURE	Item B.C.02 Superstructure Condition:		
(RIGID FRAME)	
	
SPAN #			
	
RATING	COMPONENT	REMARKS	
	Intrados of Frame

		
	Legs of Frame

	As per BIRM, Legs of Frame are only considered superstructure components for multi-span frames. For single-span frames, code Legs of Frame as substructure component.	
	Spandrel Walls

		
	Others
		
	Additional Remarks:		

Note: SUPERSTRUCTURE field notes are ONLY applicable when required in Scope.

 UNDERWATER DIVING INSPECTION                                                                                                       		                                                                                                		
PAINT INSPECTION  	*Environment:		

Environments:
1. Rural or Industrial, Mild exposure
2. Industrial, Severe Exposure
3A. Marine, Mild Exposure
3B. Marine, Severe Exposure
*Ref. NJDOT Design Manual Sec. 1.24.19	Date of Last Painting:		

Note: 	Code Item GA “N” if weathering steel does not require painting; however, if there are steel painted rocker bearings, or if beam ends are painted, then code “Y”. Also code “Y” when portions of encased steel members are exposed due to deterioration.

		
				
	   9			      8			    	7			

.                         .
    .
              .
                          .
         .
                   . .

                             .

                        .
                  .

													       
										
									               Notes:  	Blistered Paint areas
										      	are counted as rust
											
										     	10 = 0% Rust
	0.03%			       0.1%			0.3%		      	0 = 100% Rust
     			   		      			  		 
                6                               	         5                                     	  4		     	Use the closest rating to

										     	the actual field
                   	condition based on the
                  	average for the bridge. 
                   	Indicate any areas of 
                   	severe rusting in
                    		remarks.
                    
                   	For structures composed 
               1%                                	     3%                                    	10%			of weathering steel, this
sheet should be used to rate the effectiveness of
               3			     2			    	  1			the iron oxide coating 

											(see Appendix G from 
                                                                                                           				the state coding guide).
											For beam ends, use the 
							Q				controlling rating (paint
											or oxide coating).

             16%                                       33%                                     	  50%
                                               FIG. 1 Examples of Area Percentages

INSPECTION RATINGS (0 THROUGH 10 OR N/A)	
Fascia Beam:		Fascia Bottom Flange:		Beams Ends:		
Interior Beam:		Interior Bottom Flange:		Connections:		
            Bracing:			Substructure:		Railings/Fence:		
Bearings:		Above Deck Superstructure:		
	
Remarks 1:		
Remarks 2:   		
Note: SUPERSTRUCTURE/PAINT field notes are ONLY applicable when required in Scope.
UNDERWATER DIVING INSPECTION

TYPICAL FATIGUE DETAILS (Highlight applicable detail(s), remove sheet if none are applicable)                                            

Note: SUPERSTRUCTURE field notes are ONLY applicable when required in Scope.
UNDERWATER DIVING INSPECTION

TYPICAL FATIGUE DETAILS (Highlight applicable detail(s), remove sheet if none are applicable)                                                                                               	
13.	Field Weld Repairs - Proper welding procedures may not have been used; testing of weld by non-destructive methods was usually not done, therefore, the possibility of large flaws exists.  Check carefully on the main structural members (stringers, floorbeams, girders).

14.	Tack Welds - Check carefully on riveted members constructed in 1940’s and 1950’s as these welds were sometimes used to hold the plates together during riveting.

15.	Plug Welds - Check at bolted connections on welded structures.  These welds may have been used to fill-in incorrectly drilled holes (see sketch).

16.	Backing Bars - These welds are possibly not full penetration.  Check carefully on box girders if accessible and at butt (groove) welds made in the field.

17.	Details with 2 or 3 Intersecting Welds (Slot Welds) -   Incomplete penetration of the second and third welds is possible.

18.	Butt (Groove) Welds on Horizontal Web Stiffeners - NDT of the weld was not always required on the stiffener in the tension zone.  If the weld is not good, this will be an “E” detail or worse which can exist in a high stress area (This would be the same as or worse than typical detail 3).

19.	Detail Without Proper Welding Clearance - Poor welding can result if proper clearance for the welding rod is not maintained by the designer (such as a horizontal web stiffener placed too near the bottom flange of a girder; fillet weld at bottom of stiffener is difficult due to a lack of  clearance for the welding rod).

20.	Coped or Blocked Flanges - Check carefully when these details exist on main structural members (stringers and floorbeams).  Coped flanges are a typical detail on movable spans.

21.	Distortion (Bending) at Small Gaps - For typical details which exhibit damage due to this, see “Inspecting Steel Bridges for Fatigue Damage” (see sketches).

Note: SUPERSTRUCTURE field notes are ONLY applicable when required in Scope.
UNDERWATER DIVING INSPECTION

TYPICAL FATIGUE DETAILS (Highlight applicable detail(s), remove sheet if none are applicable)                                            

Note: SUPERSTRUCTURE field notes are ONLY applicable when required in Scope.
UNDERWATER DIVING INSPECTION

SUBSTRUCTURE	Item B.C.03 Substructure Condition:		
	
ABUTMENT			
	
RATING	COMPONENT	REMARKS	
	Breastwall

	Backwall

	Bridge Seat

	
	Wingwalls /
Retaining Walls
		
	Embankment /
Slope Protection
		
	Others / Footings
		
	Additional Remarks:		
	
ABUTMENT			
	
RATING	COMPONENT	REMARKS	
	Breastwall

	Backwall

	Bridge Seat

	Wingwalls /
Retaining Walls
		
	Embankment /
Slope Protection
		
	Others / Footings 
		
	Additional Remarks:		

UNDERWATER DIVING INSPECTION

SUBSTRUCTURE	Item B.C.03 Substructure Condition:		
	
TIMBER ABUTMENT			
	
RATING	COMPONENT	REMARKS	
	Sheeting

	Piles

	Pile Cap

	Wales

	Header

	SW Wingwall
Sheeting
		
	SW Wingwall
Piles
		
	SW Wingwall
Wales
		
	XX Wingwall                                 
Sheeting
	XX = either SE or NW as appropriate.	
	XX Wingwall Piles
		
	XX Wingwall Wales
		
	Others
		
	Additional Remarks:		

UNDERWATER DIVING INSPECTION

SUBSTRUCTURE	Item B.C.03 Substructure Condition:		
	
TIMBER ABUTMENT			
	
RATING	COMPONENT	REMARKS	
	Sheeting

	Piles

	Pile Cap

	Wales

	Header

	YY Wingwall
Sheeting
	YY = either SE or NW as appropriate.	
	YY Wingwall
Piles
		
	YY Wingwall
Wales
		
	NE Wingwall                                 
Sheeting
		
	NE Wingwall Piles
		
	NE Wingwall Wales
		
	Others
		
	Additional Remarks:		

UNDERWATER DIVING INSPECTION

SUBSTRUCTURE	Item B.C.03 Substructure Condition:		
	
PIER 			
	
RATING	COMPONENT	REMARKS	
	Columns/ 
Stem
Crashwall
		
	Pier Cap

		
	Bridge Seat

		
	Others/Fender
		
	Additional Remarks:		
	
PIER			
	
RATING	COMPONENT	REMARKS	
	Columns/ 
Stem
Crashwall
		
	Pier Cap

		
	Bridge Seat

		
	Others/Fender
		
	Additional Remarks:		

UNDERWATER DIVING INSPECTION

SUBSTRUCTURE	Item B.C.03 Substructure Condition:		
	
BENT			
	
RATING	COMPONENT	REMARKS	
	Bent

	Cap

	Posts/Piles

	Foundation

	Cross Bracing

	Horizontal Bracing
		
	Longitudinal Bracing
		
	Girts

	Others
		
	Additional Remarks:		

UNDERWATER DIVING INSPECTION 

SUBSTRUCTURE	Item B.C.03 Substructure Condition:		
(ARCH/FRAME)	
	
ABUTMENT			
	
RATING	COMPONENT	REMARKS	
	Legs of Frame

	As per BIRM, Legs of Frame are only considered substructure components for single-span frames. For multi-span frames, code Legs of Frame as superstructure component.	
	Footings/
Skewbacks

	Wingwalls/
Retaining Walls

	Others
		
	Additional Remarks:		
	
ABUTMENT			
	
RATING	COMPONENT	REMARKS	
	Legs of Frame

	As per BIRM, Legs of Frame are only considered substructure components for single-span frames. For multi-span frames, code Legs of Frame as superstructure component.	
	Footings/
Skewbacks

	Wingwalls/
Retaining Walls

	Others
		
	Additional Remarks:		

UNDERWATER DIVING INSPECTION

SUBSTRUCTURE/SCOUR	Item B.C.11 Scour Condition:		
	
ABUTMENT			
	
RATING	COMPONENT	REMARKS	
		COUNTERMEASURES	
	Description
		
	Condition

		PROBING/SCOUR	
	Findings

	Changes Since Prior Inspection		
	Debris

	Repair Quantities:		

ABUTMENT			
	
RATING	COMPONENT	REMARKS	
		COUNTERMEASURES	
	Description
		
	Condition

		PROBING/SCOUR	
	Findings

	Changes Since
Prior Inspection		
	Debris

	Repair Quantities:		

UNDERWATER DIVING INSPECTION

SUBSTRUCTURE/SCOUR	Item B.C.11 Scour Condition:		
	
PIER			
	
RATING	COMPONENT	REMARKS	
		COUNTERMEASURES	
	Description
		
	Condition

		PROBING/SCOUR	
	Findings

	Changes Since Prior Inspection		
	Debris

	Repair Quantities:		

PIER			
	
RATING	COMPONENT	REMARKS	
		COUNTERMEASURES	
	Description
		
	Condition

		PROBING/SCOUR	
	Findings

	Changes Since
Prior Inspection		
	Debris

	Repair Quantities:		

UNDERWATER DIVING INSPECTION

WATERWAY/CHANNEL	Item B.C.09 Channel Condition Rating:		
	Item B.C.10 Channel Protection Rating:		
WATERWAY			Item B.AP.02 Overtopping Likelihood:		
SPAN(S)			
	
RATING	
COMPONENT
	
REMARKS	
FLOW CONDITIONS	
	Direction
		
	Magnitude
		
	Velocity
		
EMBANKMENTS	
	Upstream
		
	Downstream
		
	Channel
Countermeasures
		
CHANNEL MOVEMENT AND CHANGES	
	Horizontal
Location
		
	Cross
Section
		
	Alignment
		
	Changes Since Previous Inspection
		
	Navigation Clearances
		
	Waterway Opening
		
	Other/Debris in
Channel
		
	Repair Quantities:		

UNDERWATER DIVING INSPECTION

The following reports, files and memos are associated with this document:

PRIORITY REPAIRS:
The following Priority Letter(s) have been included for this structure:
Each Priority Letter has been submitted as a separate PDF file.

PDF Filename(s):
#######_YYYYMMDDcy##_PR#_01.pdf
####### _YYYYMMDDcy##_PR#_02.pdf

(Note: Replace ####### with Bridge Number, YYYYMMDD with Date, and ## with 2-digit Cycle Number)
(Replace # with E or 1 or 2)

For all Priority Memos, please make sure to include a photo that clearly indicates the location of each defect. Additional close-up photo(s) should follow to demonstrate the extent of the defect(s).