Damage_Survey_Report_FS196-C41_C19-C.pdf

Sheet No: 1 of 5

DSR No:

Surface Type: Aggregate Thickness: 6"

Surface Type:

Unit Unit Price

Unit Unit Price Lpsm $ Lpsm $ Cuyd $ Ton $ Sqyd $ Sqyd $

Eligible Ineligible

Eligible Ineligible

Construction Engineering

Proposed: Force Account Contract Total Permanent Repairs Preliminary EngineeringIdentify Betterment, if any, and provide justification*

$0 $0 $0

$0 $0 $0 $0

$0

$0

COST ESTIMATE for PERMANENT REPAIRS* Quantity

Quantity

$0 $0 $0

Traveled Way Width:

Shoulder Width:

Description and Cause of Damage:

Extremely heavy rainfall (8'-11") in less than 24 hours on July 11, 2016, led to extensive flooding and damages to over 1,000 miles of Forest Service Roads, over 3 county area of the Forest.

Scope/Description of Repair:

1. Resurface roadway with 6" of Aggregate Surface Course

2. Repair scour at roadway embankment

$0

$0 $0 $0

COST ESTIMATE for EMERGENCY REPAIRS* Item Description Cost

$0 $0

Cost

FURNISHING AND PLACING TOPSOIL, 4-INCH DEPTH

FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway

Proposed: Force Account Contract Total Emergency Repairs

SOIL EROSION CONTROL

ROLLED EROSION CONTROL PRODUCT, TYPE 2.C

$0Subtotal Permanent Repairs (continuation sheet)

Submitted By: (Name and Title)

Reviewed By: (Name and Title)

AGGREGATE SURFACE COURSE

Item Description

MOBILIZATION

EMBANKMENT CONSTRUCTION

C41/C19-FS196-C

State:

Wisconsin

Recommended By: (Name and Title)

Date:

*Attach Supplemental Sheets if necessary

Date:

Signature:

Signature:

Signature:

Date:

Road Data: Classification:

Right-of-Way

TOTAL ESTIMATED COST

(Emergency and Permanent Repairs)

Other

DAMAGE SURVEY REPORT

(Title 23, Federal-Aid System/Federal Domain)

Inspection Date: August 22-26, 2016

Location of Damage (Route No., Name of Road and Mile Post) Rte. 196, Namakagon Rd from MP 0 to MP 5.4 (Beginning at Lat 46°15'26.28", Long 90°50'45.30")

ADT: <200

Disaster No:

Bridge Data:

Type:

ID#:

County: Bayfield / Ashland / Sawyer

Applicant: Chequamegon-Nicolet National Forest

Photograph #:

KATERINA ROMAN GONZALEZ

Digitally signed by KATERINA ROMAN GONZALEZ DN: c=US, o=U.S. Government, ou=DOT FHWASterlingVA, ou=FHWA FHWASterlingVA, cn=KATERINA ROMAN GONZALEZ Date: 2016.10.11 12:50:05 -04'00'

Sheet No: 2 of 5

Disaster No:

Applicant: County: 0 State:

Facility Name: Mile Post:

Picture 1. Undermining of roadway embankment

Picture 2. Undermining of roadway embankment, shoulder view.

0 0

FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway

DAMAGE SURVEY REPORT (Supplemental Sheet) 0

(Title 23, Federal-Aid System/Federal Domain) 0

0 0

Sheet No: 3 of 5

Disaster No:

Applicant: County: 0 State:

Facility Name: Mile Post:

Picture 3. Aggregate material washout.

0 0

FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway

DAMAGE SURVEY REPORT (Supplemental Sheet) 0

(Title 23, Federal-Aid System/Federal Domain) 0

Sheet No: 4 of 5

Disaster No:

Applicant: County: 0 State:

Facility Name: Mile Post:0 0

FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway

DAMAGE SURVEY REPORT (Supplemental Sheet) 0

(Title 23, Federal-Aid System/Federal Domain) 0

Rte. 196

Sheet No: 5 of 5

Roadway

Rolled Erosion control product/Topsoil Embankment

Aggregate Surface

Rte. MP. DSR Length Width Depth Area (sqyd) Volume (cuyd) Depth Tons Remark Betterment 196 0.20 10 11 5.5 15 15 0 Scour embankment

196 5.40 200 18 0 6 135 Full width resurfacing (bridge approach)

Totals 15 15 135

Drainage

Rte. MP. DSR Existing Size Pipe

Cleaning (ft)

Removal of Pipe Culvert

(ft) 24" Pipe Culvert

36" Pipe Culvert

46" Pipe Culvert

Riprap, Class 3 (cuyd)

196 1.8 C41 196 3.7 C18 20" x 12" 196 3.9 C19

Totals 0 0 0 0 0 0

State: Inspection Date:

Location of Damage (Route No., Name of Road and Mile Post) ADT:

QUANTITY COMPUTATIONS

Remark Culvert not found

TEMPORARY REPAIR

CMP working ok

FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway DAMAGE SURVEY REPORT (Supplemental Sheet)

(Title 23, Federal-Aid System/Federal Domain) Disaster No:

Applicant: County: