Damage_Survey_Report_FS253-C42_W34-C.pdf

Sheet No: 1 of 4

DSR No:

Surface Type: Aggregate Thickness: 6"

Surface Type:

Unit Unit Price

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

Cuyd $

Eligible Ineligible

Eligible Ineligible

Disaster No:

Bridge Data:

Type:

ID#:

County: Bayfield / Ashland / Sawyer

Applicant: Chequamegon-Nicolet National Forest

Photograph #:

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. 253, from MP 0 to MP 1.2 (Beginning at Lat 46°17'54.56", Long 90°48'45.12")

ADT: <200

C42/W34-FS253-C

State:

Wisconsin

Recommended By: (Name and Title)

Date:

*Attach Supplemental Sheets if necessary

Date:

Signature:

Signature:

Signature:

Date:

Submitted By: (Name and Title)

Reviewed By: (Name and Title)

DITCH RECONDITIONING

Item Description

MOBILIZATION

EMBANKMENT CONSTRUCTION

$0Subtotal Permanent Repairs (continuation sheet)

70 ROADBED RECONDITIONING

FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway

CLEANING CULVERTS IN PLACE

Proposed: Force Account Contract Total Emergency Repairs

SOIL EROSION CONTROL

AGGREGATE SURFACE COURSE

Cost

$0 $0

Cost

PLACED RIPRAP, METHOD A, CLASS 3

$0 $0 $0

COST ESTIMATE for EMERGENCY REPAIRS* Item Description

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. Repair shoulder washouts

2. Clean up clogged corrugated metal pipe culverts and recondition ditches

4. Place riprap at culvert outlet

COST ESTIMATE for PERMANENT REPAIRS* Quantity

Quantity

$0 $0 $0

$0 $0 $0 $0

$0

$0 $0 $0

Construction Engineering

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

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 12:58:02 -04'00'

Sheet No: 2 of 4

Disaster No:

Applicant: County: 0 State:

Facility Name: Mile Post:

Picture 1. Pothole location along Rte. 253

Picture 2. Pipe culvert location with inlet completely burried.

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 4

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

0 0

Rte. 253

Sheet No: 4 of 4

Roadway Roadbed

Reconditioning Embankment Aggregate

Surface Rte. MP. DSR Length (ft) Width (ft) Depth (ft) Area (sqyd) Volume (cuyd) Depth Tons Remark Betterment 253 0.01 0 0 0 Culvert 253 0.50 C42 0 0 0 Culvert 253 0.80 5 2 1.5 1 1 6 0 Pothole 253 1.00 70 3 0.5 6 8 Shoulder washout RT 253 1.00 70 3 0.5 6 8 Shoulder washout LT 253 1.20 W34 150 4 2 67 44 6 23 Shoulder washout

Totals 68 45 39

Drainage

Rte. MP. DSR Existing Size Pipe

Cleaning (ft) Ditch

Reconditioning (ft) 24" Pipe Culvert

36" Pipe Culvert

46" Pipe Culvert

Riprap, Class 3 (cuyd)

253 0.01 21" x 17" 35 20 253 0.5 C42 21" x 15" 35 20 253 1 36" x 24" 35 20 5

Totals 105 60 0 0 0 5

Remark

Outlet lost some riprap

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

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

Applicant: County: State: Inspection Date:

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

QUANTITY COMPUTATIONS