Damage_Survey_Report_FS207-W25_W26-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_FS207-W25 W26-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: 18 Surface Type: Gravel Thickness: 6" ADT:
ID#: Shoulder Width: 2 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 W25W26-FS207-B
(Title 23, Federal-Aid System/Federal Domain)
COST ESTIMATE for EMERGENCY REPAIRS Quantity Item Description Cost
<200
8/25/2016
Classification:Road Data:Bridge Data:
Site: 00 00' 00" W
Bayfield County
Wisconsin
Applicant:
Agency:
WI2016-1-FS
$0 $0
Facility Name:
Chequamegon Nicolet National Forest
Forest Service
FR-207
$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
W25, W26
$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 14:14:00 -04'00'
Sheet No: 2 of 5
Disaster No:
Applicant: County: Bayfield County State:
Facility Name: Mile Post:
Figure 1: Gullies formed on the middle of the road
Figure 2: Gullies formed on the middle of the road
Wisconsin
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W25W26-FS207-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
FR-207
Chequamegon Nicolet National Forest
Sheet No: 3 of 5
Disaster No:
Applicant: County: Bayfield County State:
Facility Name: Mile Post:
Figure 3: Washout shoulders
Figure 4: Accumulated material on the shoulder
FR-207 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W25W26-FS207-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-207 579 46.1494 91.17456 170 2 0 38 0 0 6 13 Shoulder washout on RT side.
FR-207 579 46.1494 91.17456 170 3 2 57 1020 38 6 19 Gully on LT side FR-207 581 46.14996 91.17246 100 1 0 11 0 0 3 2 Gully on LT side FR-207 583 46.15273 91.16063 100 2 1 22 200 7 6 8 Gully in the middle of the road FR-207 585 46.17044 91.14468 100 1 0 11 0 0 3 2 Potholes in the middel of the road FR-207 586 46.17043 91.14468 25 5 0 14 0 0 3 2 Erosion on embankment FR-207 587 46.17271 91.13511 50 5 3 28 750 28 3 5 Erosion on embankment FR-207 588 46.18564 91.12786 500 4 0 222 0 0 3 38 Ditch reconditioning needed FR-207 589 46.19064 91.1259 300 2 1 67 600 22 3 11 Reconditioning
Totals 403 73 88
*Quantities are round up or down to the nearest 5
FR-207 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway DAMAGE SURVEY REPORT (Supplemental Sheet) W25W26-FS207-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: Bayfield County State:
Facility Name: Mile Post: 0
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W25W26-FS207-B
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Wisconsin
FR-207
National Forest
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