U.S. Department of Transportation
Federal Highway Administration
1200 New Jersey Avenue, SE
Washington, DC 20590
202-366-4000


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Manual for Abandoned Underground Mine Inventory and Risk Assessment
Detailed Surface Deformation Site Evaluation

Ohio Department of Transportation
Abandoned Underground Mine Inventory and Risk Assessment

Detailed Surface Deformation Site Evaluation
C/R/S/ (Mile Marker): _______________________________ Field Report / Office Investigation No.__________________________
Site Description: ____________________________________________________________________________________________
__________________________________________________________________________________________________________
U.S.G.S. Topographic
Quadrangle ODOT No.:______________
O.D.N.R. Abandoned Underground
Mine Series (U.S.G.S.) Map:______________
O.D.N.R.,DGS Individual Abandoned
Underground Mine Map Index No.:______________
(If known.)
Name of Site Evaluator:________________________________________________Evaluation Date:________________
ELIMINATED SURFACE DEFORMATION SITE SCREENING
NOTE: Have site investigations and /or interviews conclusively proven that the identified mine(s) at this site is (are) not an apparent threat to the safety of the roadway? Yes_____ (SEE COMMENTS BELOW FOR BASIS OF THIS FINDING)
No______
NOTE: Checking "Yes" to this question indicates that exact location, orientation and limits of influence have been verified in the field and a determination made that collapse of the opening or the closure would not affect the roadway or roadside development.
  Criterion Criterion
Weighting
Factor
Site Condition / Rating Value Individual Criterion Rating
1)   Number of Subsidences 30 Number of Subsidence Features on Site  
2)   Recent Dewatering 21 <1 Yr.
10
1 to 3 Yrs.
9
4 to 6 Yrs.
4
7 to 9 Yrs.
2
>9 Yrs.,
Unknown,
or Dry Mine

1
 
3)   Average Daily Traffic (ADT) 15 >30K
10
20K to 30K
8
10K to 20K
6
5K to 10K
4
< 5K
2
 
4)   Classification of Roadway (NOTE: For intersecting Roads, See Implementation Manual) 12 I.R.
10
NHS Other
Than IR

7
Arterial
5
Collector
1
   
5)   Average Daily Truck Traffic (ADTT) 9 >6K
10
4K to 6K
8
2K to 4K
6
1K to 2K
4
< 1K
2
 
6)   Traffic Speed 6 >35 MPH
10
0 to 35 MPH
1
       
7)   Type of Pavement 6 Other
10
Continuously Reinforced
1
       
8)   Ratio of Unconsolidated Materials to Bedrock in the Overburden Interval 6 Ratio = 1 or > 1
10
Ratio <1
1
       
9)   Availability of Reasonable Detour Routes 6 None
10
Yes
0
       
10)   Structures in Roadway 3 Yes
10
No
0
       
11)   Minimum Overburden Thickness (Approx.) 2 < 25'
10
25' - 50'
8
50' - 100'
5
>100'
1
   
Overall (Total) Site Evaluation Rating:    
COMMENTS (Attach additional sheets if necessary):
5/15/98
Updated: 06/27/2017
Federal Highway Administration | 1200 New Jersey Avenue, SE | Washington, DC 20590 | 202-366-4000