Form CS-7 "Defective Asphalt Pavement Review" - Pennsylvania

What Is Form CS-7?

This is a legal form that was released by the Pennsylvania Department of Transportation - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2021;
  • The latest edition provided by the Pennsylvania Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CS-7 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Transportation.

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Download Form CS-7 "Defective Asphalt Pavement Review" - Pennsylvania

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CS-7 (6-21)
DEFECTIVE ASPHALT PAVEMENT REVIEW
TO BE COMPLETED IN ACCORDANCE WITH POM B/9/9
www.dot.state.pa.us
ECMS# __________________ SR/SEC- COUNTY: ______________________________________ LOT# _____________
ADT: ___________________ %TRUCKS: ___________ TR-447 REF# __________________ JMF: __________________
MAT’L SUPPLIER CODE: _______________ CONTRACTOR: ________________________________________________
MIX SIZE: ______________________________ PG BINDER GRADE: __________________________________________
COURSE:
WEARING
BINDER
BASE
LEVELING
OTHER: _______________________
408 YEAR/VER./SECT: ___________ / ___________ / ___________
FIELD VIEW ITEMS:
ITEM
YES
NO
N/A
REMARKS
SEGREGATION:
_______________________________________________
FLUSHING/RUTTING:
_______________________________________________
JOINT ISSUES:
_______________________________________________
POOR RIDE QUALITY:
_______________________________________________
CRACKING, CHECKING,
_______________________________________________
OR MAT TEARS:
LOSS OF FINES/OPEN:
_______________________________________________
SEVERITY OF FAILURE:
ITEM
YES
NO
N/A
REMARKS
MIX QUALITY - LOT AVG’S
_______________________________________________
WITHIN SINGLE SAMPLE
TOLERANCES?
_______________________________________________
DENSITY - BINDER/WEARING
_______________________________________________
LOT AVERAGE ≥ 90%?
_______________________________________________
DENSITY – BASE COURSE
_______________________________________________
LOT AVERAGE ≥ 88%?
_______________________________________________
FINAL LOT DISPOSITION:
R&R
70% PAY
50% PAY
OTHER*
*requires explanation below
OVERALL DETERMINATION JUSTIFICATION REMARKS:
REVIEWED BY: _______________________________________ _____________________________________________
PRINT NAME
SIGNATURE/DATE
CS-7 (6-21)
DEFECTIVE ASPHALT PAVEMENT REVIEW
TO BE COMPLETED IN ACCORDANCE WITH POM B/9/9
www.dot.state.pa.us
ECMS# __________________ SR/SEC- COUNTY: ______________________________________ LOT# _____________
ADT: ___________________ %TRUCKS: ___________ TR-447 REF# __________________ JMF: __________________
MAT’L SUPPLIER CODE: _______________ CONTRACTOR: ________________________________________________
MIX SIZE: ______________________________ PG BINDER GRADE: __________________________________________
COURSE:
WEARING
BINDER
BASE
LEVELING
OTHER: _______________________
408 YEAR/VER./SECT: ___________ / ___________ / ___________
FIELD VIEW ITEMS:
ITEM
YES
NO
N/A
REMARKS
SEGREGATION:
_______________________________________________
FLUSHING/RUTTING:
_______________________________________________
JOINT ISSUES:
_______________________________________________
POOR RIDE QUALITY:
_______________________________________________
CRACKING, CHECKING,
_______________________________________________
OR MAT TEARS:
LOSS OF FINES/OPEN:
_______________________________________________
SEVERITY OF FAILURE:
ITEM
YES
NO
N/A
REMARKS
MIX QUALITY - LOT AVG’S
_______________________________________________
WITHIN SINGLE SAMPLE
TOLERANCES?
_______________________________________________
DENSITY - BINDER/WEARING
_______________________________________________
LOT AVERAGE ≥ 90%?
_______________________________________________
DENSITY – BASE COURSE
_______________________________________________
LOT AVERAGE ≥ 88%?
_______________________________________________
FINAL LOT DISPOSITION:
R&R
70% PAY
50% PAY
OTHER*
*requires explanation below
OVERALL DETERMINATION JUSTIFICATION REMARKS:
REVIEWED BY: _______________________________________ _____________________________________________
PRINT NAME
SIGNATURE/DATE