Gravel Road

Blank Forms

Unless noted otherwise for specific items such as traffic counts, all policies and forms apply to both the “Dirt and Gravel” and “paved Low Volume Road” portions of the Program.

Grant Application Packet

  • Grant Application: One-page application submitted by the road-owning entity to the Conservation District. This, along with the work plan, becomes "Attachment A" to the contract between the Conservation District and the Grant recipient.

  • Work Plan: Project sketch detailing proposed work. Can be on the back of the grant application.

  • Expenditure Sheets: Two optional sheets, one for grant requested funds and one for inkind contributions, that can be attached to the grant application if needed.

  • Grant Application Packet (910 KB): Includes the four forms mentioned above. Note that these forms are fillable pdfs.

Contract

  • 2-page Contract (178 KB): Legal contract between the conservation district and the grant recipient.

  • Contract Attachments:

    • Attachment A (683 KB): Grant application and work plan (see above)
    • Attachment B (24.5 KB): General Contract Provisions - General legal provisions pertaining to the contract.
    • Attachment C (35.2 KB): Statement of Policy (incorporated into contract by reference) - State Conservation Commission Statement of Policy, incorporated into contract by reference.
    • Attachment D: QAB Standards (Visit a specific Conservation District page for QAB policies.)
    • Attachment E (75.7 KB): Schedule of Payments (see below)
    • Attachment F (145 KB): Prevailing Wage Notification Letter (see below)
    • Attachment G (20.3 KB): Prevailing Wage Certification of Compliance - (provided by contractors who are subject to prevailing wage)

  • Contract Amendment (99.8 KB): Simple amendment form that can be used to increase the funding amount or extend the completion date of an existing contract. (funding can only be increased by 20% over original contract).

  • Schedule of Payments (75.7 KB): Single page form that outlines the procedure in which funding will be distributed to a successful grant applicant. This becomes "Attachment E" to the contract between the Conservation District and the Grant recipient.

Project Completion Report

  • Project Completion Report (1.29 MB): Report used to summarize a completed project. Continues a summary of both financial information and the practices implemented on the project. It is recommended that conservation districts and grant recipients jointly complete this form as part of the final inspection.

Standard Program Forms

  • Traffic Count Validation (111 KB): Form for recording traffic counts to insure that paved Low Volume Roads have traffic counts of ≤500 vehicles per day in order to be eligible for funding.

  • Stream Crossing Evaluation (291 KB): Form used to evaluate stream crossings for potential structural replacement with Program funds.

    • Bankful Guidance (4.9 MB): A guide to determining bankfull widths for streams in Pennsylvania.

  • DSA Specification and Certification (125 KB): Driving Surface Aggregate specification and certification form. A certification form is required from the aggregate supplier with the first load of stone delivered. Please contact the Center for Dirt and Gravel Road Studies to notify them of planned DSA placements.(more DSA info here)

Example Forms

The following forms are provided only as an example. While the information is required, these particular forms are to act as a guide that the Conservation Districts can use. Note that most examples are in the Microsoft Word docx format.

  • Approved DGLVR E&S Plan (30.5 KB): The final, approved, erosion and sediment control plan to be used with the DGLVR program. This plan was coordinated with DEP’s E&S Program. This form is in Microsoft Word docx format.

  • Off ROW Consent Form (17.6 KB): Example consent form to obtain permission from a landowner to perform work and/or outlet water onto their property.

  • Project Ranking Criteria (47 KB): Example criteria for use by Conservation Districts and Quality Assurance Boards in ranking applications that are submitted.

  • QAB Designee letter (21.6 KB): Example letter that can be used by the PA Fish and Boat Commission or Natural Resource Conservation Service to appoint a designee to a county's Quality Assurance Board.

  • Project Hard File Checklist: A checklist of the items that should be included in a projects contract hard file.

  • Project Narrative: Form to describe problems being addressed along with a project summary for a given contract.

  • Project Timeline: Form to record various payment/date information for a given contract.

  • Pre Application Checklist: A checklist of the items that should be considered prior to receiving an application.

  • Pre Construction Checklist: A checklist of the items that should be considered prior to beginning construction.

  • Road Fill RFQ (36.8 KB): This optional Request for Quote allows users to specify the type or quality of material for use as road fill in projects. The RFQ is provided in an editable format and can be customized by users.

  • Stream Crossing RFP Template (43.6 KB): Editable template that CDs and Grant Recipients can use for stream crossing replacement projects. This form is in Microsoft Word docx format.

Site Assessment Forms

These forms pertain to performing a site assessment.  Although the site assessment protocol will likely be changed at some point in the future, these forms serve as a usuable guide for selecting suitable sites.  Note that while these forms are written for unpaved roads, then can be utilized for low volume roads.