Damage_Survey_Report_FS188-W4-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_FS188-W4-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: 22 Surface Type: Gravel Thickness: 6" ADT:
ID#: Shoulder Width: 4 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 W4-FS188-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-188
$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-188
$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 14:07:55 -04'00'
Sheet No: 2 of 5
Disaster No:
Applicant: County: Ashland County State:
Facility Name: Mile Post:
Figure 1: Washout shoulder
Figure 2: Washout shoulder
Wisconsin
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W4-FS188-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
FR-188
Chequamegon Nicolet National Forest
Sheet No: 2 of 5
Disaster No:
Applicant: County: Ashland County State:
Facility Name: Mile Post:
Figure 3: Washout road section
Figure 4: Washout road section
FR-188 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W4-FS188-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. Latitude Longitud e Length (ft) Width (ft) Depth (ft) Area (sqyd) Volume (cuft) Volume (cuyd) Depth (in) Tons Remark
FR-188 46.324 90.77735 120 3.5 0.66 47 277.2 10 3 8 Minor gully formed on both sides of the road FR-188 46.3221 90.77753 525 8 3.5 467 14700 544 0 0 Ditch on right side of the road needed FR-188 46.3215 90.7783 575 5 1 319 2875 106 6 108 Shoulder washout RT FR-188 46.3212 90.77897 10 22 3 24 660 24 6 8 Culvert damage FR-188 46.3206 90.78089 300 3 1 100 900 33 6 34 Gully on both side of the road FR-188 46.3205 90.78197 75 3 1 25 225 8 6 8 Erosion RT side FR-188 46.3206 90.78738 50 3 0.83 17 124.5 5 3 3 Gully RT side FR-188 46.3218 90.79198 250 4 1 111 1000 37 6 38 Washout RT side FR-188 46.3214 90.7934 350 3.5 0.75 136 918.75 34 6 46 RT side FR-188 46.3197 90.79914 250 2.5 1 69 625 23 6 23 Gully both sides of the road FR-188 46.3173 90.80342 200 6 1 133 1200 44 6 45 LT Side FR-188 46.3165 90.80576 75 1.5 0 13 0 0 6 4 Gully both sides of the road FR-188 46.3148 90.8074 300 3 0 100 0 0 6 34 Gully both sides of the road FR-188 46.3108 90.80878 50 2.5 0 14 0 0 6 5 RT side FR-188 46.3093 90.80891 100 3 0.58 33 175 6 6 11 RT side FR-188 46.308 90.80804 300 3 3.5 100 3150 117 6 34 RT side FR-188 46.3059 90.80903 75 2 17 0 0 3 3 LT Side
Totals 1725 994 411
*Quantities are round up or down to the nearest 5
FR-188 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway DAMAGE SURVEY REPORT (Supplemental Sheet) W4-FS188-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) W4-FS188-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Wisconsin
FR-188
National Forest
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