Damage_Survey_Report_FS184-W1-B.pdf
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- Attached to
- Chequamegon-Nicolet National Forest - 2016-1(4) Federal contract opportunity
- Solicitation number
- 693C73-18-B-000021
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Damage Survey Report_FS184-W1-B
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Text version
Sheet No: 1 of 5
DSR No:
Disaster No:
County: Latitude:
State: Longitude:
Facility Number: Mile Post:
Maint. Level:
Type: Traveled Way Width: 15 Surface Type: Gravel Thickness: 6" ADT:
ID#: Shoulder Width: 1 Surface Type: N/A Thickness: N/A Inspection Date:
Unit Unit Price
Proposed:
Unit Unit Price Lpsm Lpsm Lnft Ton Sqyd
Proposed:
20%
10%
100.00%
Eligible Ineligible
Eligible Ineligible
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT W1-FS184-B
(Title 23, Federal-Aid System/Federal Domain)
COST ESTIMATE for EMERGENCY REPAIRS Quantity Item Description Cost
<200
8/26/2016
Classification:Road Data:Bridge Data:
Site: 00 00' 00" W
Ashland County
Wisconsin
Applicant:
Agency:
WI2016-1-FS
$0 $0
Facility Name:
Chequamegon Nicolet National Forest
Forest Service
FR-184
$0
Description and Cause of Damage:
Severe storm on July 11, 2016 with heavy rains receiving about 8- 12 inches of precipitation during a 24-hour period, resulting in flash flooding and causing damages to the roads, bridges, and other road structures in the Forest Service.
Scope/Description of Repair:
1. Repair roadway and shoulder washouts
2. Resurface roadway with Aggregate Surface Course
FR-184
$0
$0
Total Estimated Emergency Repairs
$0 $0
MOBILIZATION
SOIL EROSION CONTROL
$0
COST ESTIMATE for PERMANENT REPAIRS Quantity Item Description Cost
ROADBED RECONDITIONING
$0
EMBANKMENT CONSTRUCTION
AGGREGATE SURFACE COURSE
$0
$0 $0
* Tribal transportation facilities and federal lands transportation facilities are at 100%. Other federally owned roads are at the sliding scale. See attached table.
Site: 00 00' 00" N
Signature: Date:
Reviewed By: (Name and Title) Signature: Date:
Submitted By: (Name and Title)
(amount from continuation sheet) $0
$0 $0
$0
Preliminary Engineering (percent of permanent repair construction)
Construction Engineering (percent of permanent repair construction)
ERFO share of Permanent Repairs (Sliding Scale) * TOTAL EMERGENCY REPAIRS and ERFO SHARE of PERMANENT
REPAIRS
$0 $0
Recommended By: FLH ERFO Coordinator Signature: Date:
$0 $0
Total Estimated Permanent Repairs - Construction Identify Betterment and provide supporting documentation and economic justification on attached sheets.
Force Account Contract
Force Account Contract
NTTFI/NFLTFI
WENDY HICIANO
Digitally signed by WENDY HICIANO DN: c=US, o=U.S. Government, ou=DOT FHWASanJuanPR, ou=FHWA FHWASanJuanPR, cn=WENDY HICIANO Date: 2016.10.28 14:06:04 -04'00'
Sheet No: 2 of 5
Disaster No:
Applicant: County: Ashland County State:
Facility Name: Mile Post:
Figure 1: Gullies formed on the shoulders of the road
Figure 2: Existing culvert. No work needed
Wisconsin
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1-FS184-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
FR-184
Chequamegon Nicolet National Forest
Sheet No: 3 of 5
Disaster No:
Applicant: County: Ashland County State:
Facility Name: Mile Post:
Figure 3: Existing culvert. No work needed
Figure 4: Washout shoulders
FR-184 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1-FS184-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
National Forest Wisconsin
Sheet No: 4 of 5
Disaster No:
Applica nt: County: Ashland
County State:
Facility Name: Mile Post:
Permanent Repair
VOLUME
Roadbed
Reconditioning Embankment Aggregate Surface Rte. WP Latitude Longitude Length (ft) Width (ft) Depth (ft) Area (sqyd) Volume
(cuft) Volume (cuyd) Depth
(in) Tons Remark
FR-184 624 46.26895 90.82926 0 0 0
Rusted bottom culvert. Not elligible
FR-184 625 46.2669 90.8194 100 2.5 0 28 0 0 3 5 Gully LT side (minor erosion) FR-184 626 46.27159 90.75665 20 0 0 0 0 0 3 0 Gully RT side (minor erosion)
FR-184
627 46.27018 90.73691 0 0 0
Potholes (Maintenance related)
FR-184 628 46.27024 90.7341 0 0 0 0 0 0 0 0 Minor erosion RT side FR-184 629 46.27028 90.73199 300 2.5 1 83 750 28 3 14 LT Side FR-184 629 46.27028 90.73199 300 6 1.5 200 2700 100 3 34 RT Side FR-184 630 46.27036 90.71741 100 2 0 22 0 0 3 4 RT Side FR-184 631 46.26889 90.71048 50 1.5 0 8 0 0 3 1 Wahout material LT side FR-184 632 46.27055 90.70055 225 1.5 0 38 0 0 3 6 LT Side
Totals 379 128 64
*Quantities are round up or down to the nearest 5
FR-184 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway DAMAGE SURVEY REPORT (Supplemental Sheet) W1-FS184-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Chequamegon Nicolet National Forest Wisconsin
Sheet No: 5 of 5
Disaster No:
Applicant: County: Ashland County State:
Facility Name: Mile Post: 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1-FS184-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Wisconsin
FR-184
National Forest
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