Damage_Survey_Report_FS376-W1A.pdf
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- Chequamegon-Nicolet National Forest - 2016-1(4)
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- 693C73-18-B-000021
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Damage Survey Report_FS376-W1A
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Sheet No: 1 of 8
DSR No:
N/A Surface Type: Varies Thickness: N/A
N/A Surface Type: Varies Thickness: N/A
Unit Unit Price
Unit Unit Price
LPSM $
LPSM $
LNFT $
CUYD $
CUYD $
TON $
LNFT $
15% 10%
Eligible Ineligible
Eligible Ineligible
DAMAGE SURVEY REPORT
(Title 23, Federal-Aid System/Federal Domain)
Inspection Date: 08/24/2016
Location of Damage (Route No., Name of Road and Mile Post): FR 376 -Otto Olson Road
ADT: <200
W1A W2A W3A W4A W5A W35-
FS376-H
Disaster No: WI2016-1-FS
Bridge Data:
Type:
ID#:
County: BayfieldApplicant: Chequamegon-Nicolet National Forest
Photograph #: See Attached Sheets Road Data:
Item Description Mobilization
Soil Erosion Control, Silt Fence
Traveled Way Width: Varies
Shoulder Width: Varies Description and Cause of Damage: Extensive heavy rainfall (8" - 11") in less than 24 hours on July 11, 2016 led to extensive flooding and damages to over 1,000 miles Forest Service.
Scope/Description of Repair: Perform permanent repairs to resurface or reconstruct sections of the aggregate and asphalt surface course roadway and shoulders, and recondition ditches.
State:
Wisconsin
Recommended By: (Name and Title)
Date:
*Attach Supplemental Sheets if necessary
Date:
Signature:
Signature:
Signature:
Date:
Submitted By: (Name and Title)
Classification: Maintenance Level 3
Right-of-Way
TOTAL ESTIMATED COST
(Emergency and Permanent Repairs)
Other
Cost
$0
Cost
Roadway Excavation
Subtotal Permanent Repairs (continuation sheet)
Reviewed By: (Name and Title)
Proposed: Force Account Contract Total Permanent Repairs Identify Betterment, if any, and provide justification* Preliminary Engineering
Construction Engineering
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
Ditch Reconditioning
Proposed: Force Account Contract Total Emergency Repairs
Item 15201-0000, Construction Survey and Staking
Unclassified Borrow
2589 Aggregate Surface Course
$0 $0
COST ESTIMATE for EMERGENCY REPAIRS* Item Description
COST ESTIMATE for PERMANENT REPAIRS* Quantity
Quantity
$0
RICHARD JOSEPH HODY
Eric Wright, ERFO Coordinator 1/18/2017JOHN E WRIGHT Digitally signed by JOHN E WRIGHT DN: c=US, o=U.S. Government, ou=DOT FHWASterlingVA, ou=FHWA FHWASterlingVA, cn=JOHN E WRIGHT Date: 2017.01.18 15:38:11 -05'00'
Sheet No: 2 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/A
1199Figure 2 - Typical edge of road / shoulder washout in need of excavation, backfill, ditch recondi-tioning and aggregate surface course 46.3215° N , 91.1226° W - Site 3 - W3A surface course 46.3236° N , 91.1227° W - Site 1 - W1A Figure 1 - Typical edge of road / shoulder washout in need of excavation, backfill, and aggregate
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A W5A
W35-FS376-H
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Wisconsin
FR 376 -Otto Olson Road
Chequamegon-Nicolet National Forest
Sheet No: 3 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/A
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A W5A
W35-FS376-H
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Figure 4 - Typical edge of road / shoulder washout in need of excavation, backfill, ditch recondi-tioning and aggregate surface course 46.305° N , 91.133° W - Site 7 - W35
Chequamegon-Nicolet National Forest Wisconsin
FR 376 -Otto Olson Road
Figure 3 - Typical edge of road / shoulder washout in need of excavation, backfill, ditch recondi-tioning and aggregate surface course 46.318° N , 91.122° W - Site 4 - W4A
Sheet No: 4 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/A
Chequamegon-Nicolet National Forest Wisconsin for this location site. 46.310° N , 91.133° W - Site 6 - S13
FR 376 -Otto Olson Road
Figure 6 - See Figure 5 above for information regarding this site. FS responsible to provide DSR
Figure 5 - Washout resulting in severe damage to roadway and culvert. A new 48" Ø (x 50') CSP
46.310° N , 91.133° W - Site 6 - S13 culvert replaced by Town(?). FS responsible to provide DSR for this site.
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A W5A
W35-FS376-H
(Title 23, Federal-Aid System/Federal Domain) WI2016-1-FS
Sheet No: 5 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/A
Location No. / Beginning Beginning FS Number Latitude - N Longitude - W
1 - W1A 46.3236 91.1227 Photo's 1181-1190 2 - W2A 46.323 91.123 Photo's 1191-1194 3 - W3A 46.3215 91.1226 Photo's 1195-1200 4 - W4A 46.318 91.122 Photo's 1201-1207 5 - W5A 46.314 91.123 Photo's 1208-1211 6 - S13 46.310 91.133 Photo's 1213-1232 FS responsible to provide DSR 7 - W35 46.305 91.133 Photo's 1322-1329,7276
Location No. / Description of Work FS Number
1 - W1A Silt fence, roadway excavation, aggregate surface course, and ditch reconditioning 2 - W2A Silt fence, and placement of borrow material 3 - W3A Silt fence, roadway excavation, aggregate surface course, and ditch reconditioning 4 - W4A Silt fence, roadway excavation, aggregate surface course, and ditch reconditioning 5 - W5A Silt fence, aggregate surface course, and ditch reconditioning 6 - S13 FS responsible to provide DSR for this location site. Work partially completed by others (Town?)
7 - W35 Silt fence, roadway excavation, borrow material, and aggregate surface course
FR 376 -Otto Olson Road
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A
W5A W35-FS376-H
Chequamegon-Nicolet National Forest Wisconsin
Sheet No: 6 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/A
Mobilization Lump Sum Item LPSM
Item 15201-0000, Construction Survey and Staking Lump Sum Item LPSM
Soil Erosion Control, Silt Fence
Location: Length (ft) 1 - W1A 700 2 - W2A 20 3 - W3A 450 4 - W4A 640 5 - W5A 300 7 - W35 1750
Subtotal: 3860 LNFT Total: 4246 LNFT
Roadway Excavation Required at areas where EOR/Shdr erosion occurred and ONLY to grade evenly (square off). Assume 20% of Unclassified Borrow
Location: Length (ft) Width (ft) Depth (ft) CUYD Volume = (L)x(W)x(D)x(1CY/27CF)
1 - W1A 500 6 2 222 CUYD
3 - W3A 160 6 1.5 53
4 - W4A 300 6 1.5 100 (LT)
4 - W4A 200 3 1.5 33 (RT)
7 - W35 750 3 1.5 125 (LT)
7 - W35 300 5 2 111 (RT)
Subtotal: 645 CUYD Total: 142 CUYD (20% of Subtotal x 10%)
Unclassified Borrow
Location: Length (ft) Width (ft) Depth (ft) CUYD Volume = (L)x(W)x(D)x(1CY/27CF)
1 - W1A 500 6 2 222 CUYD
3 - W3A 160 6 1.5 53
4 - W4A 300 6 1.5 100 (LT)
4 - W4A 200 3 1.5 33 (RT)
7 - W35 750 3 1.5 125 (LT)
7 - W35 300 5 2 111 (RT)
Subtotal: 645 CUYD Total: 710 CUYD
Continued Next Sheet
FR 376 -Otto Olson Road
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A W5A
W35-FS376-H
Sheet No: 7 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/A
Aggregate Surface Course
Location: Length (ft) Width (ft) Area (sf) 1 - W1A 700 16 11200 3 - W3A 450 16 7200 4 - W4A 640 16 10240 5 - W5A 300 16 4800 7 - W35 1750 18 31500
Total Area: 64940 SF
Depth, D= 6 in Unit Weight= 145 lbs/cf CF Volume = Area (sf)(D)(1ft/12in) = Total Volume: 32470 CF
Weight (Ton) = Volume (cf)(Unit Weight)(1ton/2000lb) =
Subtotal: 2354 TON Total: 2589 TON
Ditch Reconditioning
Location: Length (ft) 1 - W1A 900 3 - W3A 450 4 - W4A 1200 5 - W5A 300
Subtotal: 2850 LNFT Total: 3135 LNFT
Continued Next Sheet
FR 376 -Otto Olson Road
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A W5A
W35-FS376-H
Sheet No: 8 of 8
Disaster No:
Applicant: County: Bayfield State:
Facility Name: Mile Post: N/A to N/AFR 376 -Otto Olson Road
FEDERAL HIGHWAY ADMINISTRATION, Federal Lands Highway
DAMAGE SURVEY REPORT (Supplemental Sheet) W1A W2A W3A W4A W5A
W35-FS376-H
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