FLH_Culvert_Assessment_Form_114+75_App_A-2.pdf

FLH CULVERT ASSESSMENT FORM

Notes by:__________________________ Date: _________ Project: ___________________ Measurements by:___________________ Time: _________ Site Information:

Facility Location: __________________________________Lat/Long _________________________

Milepost:_____________ Project Station: _____________ GPS Road CL Waypoint No. _________ Named waterway:_________________________________ Direction of Flow:__________________ Culvert Information:

No. of Barrels: ______ Barrel Length (approx):________________ Barrel Slope: Mild / Steep / _____________________ Skew (0 degrees = perpendicular to road): ________ Approx Cover: Upstream ___________ Downstream____________ Barrel Shape (circle one) Circular Box Elliptical Pipe Arch Arch Diameter: _______ / Span ______ x Rise _______ Pipe Material (circle one): Metal - Concrete / RCP - Corrugated Plastic - Smooth Plastic - Timber – Masonry Appurtenances (circle one):

Upstream : Projecting / Mitered / Headwall / Headwall & Wingwalls / Flared End Section / ___________________ Downstream : Projecting / Mitered / Headwall / Headwall & Wingwalls / Flared End Section / ___________________

Flowing or standing water? N / Y Depth:____(ft) Est. Flow Velocity:______(ft/s) Possible AOP/fish passage? Y / N Utilities Present (list)? Y / N____________________ Possible historic features? Y / N Open Bottom? Y / N Culvert Condition and Performance (circle / check all that apply and provide appropriate explanations below)

Category Rating Performance Problems Requiring Level 1 Action Invert deterioration Good Fair Poor Crit Unk N/A Debris/Veg Blockage > 1/3 of rise at inlet or outlet �

Joints & Seams Good Fair Poor Crit Unk N/A Sediment Blockage 1/3 to 3/4 of rise at inlet/outlet �

Corrosion / Chemical Good Fair Poor Crit Unk N/A Buoyancy or Crushing-Related Inlet Failure �

Cross-Section Deform Good Fair Poor Crit Unk N/A Poor Channel Alignment �

Cracking Good Fair Poor Crit Unk N/A Previous and/or Frequent Overtopping �

Liner / Wall Good Fair Poor Crit Unk N/A Local Outlet Scour �

Mortar and Masonry Good Fair Poor Crit Unk N/A Performance Problems Requiring Level 2 Action

Rot and Marine Borers Good Fair Poor Crit Unk N/A Embankment Piping �

Headwall/Wingwall Good Fair Poor Crit Unk N/A Channel Degradation / Headcut (circle one) �

Apron Good Fair Poor Crit Unk N/A Embankment Slope Instability �

Flared End Section Good Fair Poor Crit Unk N/A Sediment Blockage > 3/4 Rise at Inlet or Outlet �

Pipe End Good Fair Poor Crit Unk N/A Sediment Blockage > 1/3 Rise Throughout Barrel �

Scour Protection Good Fair Poor Crit Unk N/A Other Problems Requiring Level 2 Action

No Access / Ends Totally Buried / Submerged �

Aggressive Abrasion/Corrosion/Chemical (circle) �

Exposed Footing (Open-Bottom Culvert Only) �

Photos (number): ___ Inlet ___ Outlet ___ Roadway (ahead) ___ Roadway (back) ___ View downstream

___ View upstream Others: ________________________________________________________

Notes / Recommendations:

� Additional notes / Sketches on back of form A.2

Overall Rating Good Fair Poor

Critical Unknown

Performance Problems wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval wallett Oval

Bravo Environmental 6705 NE 175th St

Kenmore, Wa 98028 Tel: 425-424-9000 Fax: 425-424-9002

E-mail:

City : Port Angeles

Inspection Report / Inspection: 1 Date P/O. No. Weather Surveyor's Name Pipe Segment Reference Section No.

Certificate No. Survey Customer System Owner Date Cleaned Pre-Cleaning Sewer Category

Street Use of Sewer Upstream MH City Drainage Area Dowstream MH Loc. details Flow Control Dir. of Survey Location Code Length surveyed Section Length

Purpose of Survey Joint Length Year Laid Dia./Height Year Rehabilitated Material Tape / Media No. Lining Method

Add. Information :

5/19/2011 Dry jOEL vASEY 15 u-304-1198 No Pre-Cleaning

114+75 Port Angeles

Stormwater

57.41 ft

INLET-E

OUTLET

Upstream

57.41 ft

Maintenance Related

24 inch Corrugated Metal Pipe

1:150 Position Observation MPEG Photo

Hurricane Ridge // Page: 1

0.00 00:00:41End of Pipe / OUTLET-W

0.00 00:00:44Water Level, 5 %of cross sectional area

57.41 00:05:42End of Pipe / INLET-E

OUTLET

INLET-E

QSR QMR SPR MPR OPR SPRI MPRI OPRI

0000 0000 0 0 0 0 0 0