Stone Highway Culvert Maintenance Inspection Form printable pdf download

STONE HIGHWAY CULVERT MAINTENANCE INSPECTION FORM

(see reverse side for inspection and maintenance program instructions)

Town: ________________________________________

Date:________________________

Culvert location: Road ___________________________ over watercourse _____________________________

Nearest house/pole numbers to each side: ____________/____________

____________/____________

Nearest cross streets to either side: ____________________________

_______________________________

Box __ Arch __ Rough dimensions:

span _____________ height________________

1. Culvert Stonework Condition: satisfactory _____ not satisfactory _____

photos taken _____

describe:_____________________________________________________________________________________

____________________________________________________________________________________________

2. Waterway Obstructions: no _____ yes _____ photos taken _____ describe:__________________________

____________________________________________________________________________________________

3. Vegetation problems: no _____ yes _____ photos taken _____ describe:__________________________

____________________________________________________________________________________________

4. Roadway, Curbs, Railings: satisfactory _____ not satisfactory _____

photos taken _____

describe:_____________________________________________________________________________________

____________________________________________________________________________________________

5. Evidence of overtopping or excessive bank erosion indicating inadequate culvert size: no _____ yes _____

photos taken___describe:_______________________________________________________________________

____________________________________________________________________________________________

6. Other Conditions Noted:

____________________________________________________________________________________________

7. Note type of maintenance performed & date on reverse side

Stone Highway Culvert Maintenance Inspection Form