FORMULIR SURVEI KONDISI JALAN S.K.

J - 1
PROV : AWAL :
DIREKTORAT KOTA : BDG/KBB AKHIR :
PEMBINAAN JALAN NAMA
KOTA TGL :
SURVEYOR :
NO. ABSEN : HAL : …. dari ....
PERMUKAAN PERKERASAN
JARAK
KEKASAR RETAK AMBLAS
(m) LUBANG TAMBALAN ALUR
AN TIPE LEBAR

0-4

4-8

8 - 12

12 - 16
H

16 - 20

20 - 24

24 - 28

28 - 32
7x2

32 - 36

36 - 40

40 - 44
 PERMUKAAN PERKERASAN
JARAK
KEKASAR RETAK AMBLAS
(m) LUBANG TAMBALAN ALUR
AN TIPE LEBAR

44 - 48

48 - 52

52 - 56

56 - 60

60 - 64

64 - 68

68 - 72

72 - 76

76 - 80

80 - 84

84 - 88

88 - 92
 PERMUKAAN PERKERASAN
JARAK
KEKASAR RETAK AMBLAS
(m) LUBANG TAMBALAN ALUR
AN TIPE LEBAR

92 - 96

96 - 100

100 - 104

104 - 108

108 - 112

112 - 116

116 - 120

120 - 124

124 - 128

128 - 132

132 - 136

136 - 140
 PERMUKAAN PERKERASAN
JARAK
KEKASAR RETAK AMBLAS
(m) LUBANG TAMBALAN ALUR
AN TIPE LEBAR

140 - 144

144 - 148

148 - 152

152 - 156

156 - 160
12x1

160 - 164

164 - 168

168 - 172

172 - 176

176 - 180

180 - 184

184 - 188
 PERMUKAAN PERKERASAN
JARAK
KEKASAR RETAK AMBLAS
(m) LUBANG TAMBALAN ALUR
AN TIPE LEBAR

188 - 192

192 - 196

196 - 200

200 - 204

204 - ….

Kekasaran Permukaan : Tambalan : Alur :

- Fatty (F) - Jumlah : 2 - Panjang : ….............….. mm
- Hungry (H) - Luas : 26. m2 - Dalam : ….............….. mm
- Disintegration (D)

Lubang : Retak : Amblas :

- Jumlah : ….. - Memanjang (M) - Panjang : ...….. mm - Jumlah : …....................…..
- Luas : ….. m2 - Melintang (L) - Lebar : ...….. mm - Dalam : ….............….. mm
- Acak (A)
- Buaya (B)
 SKETSA SURVEI KONDISI JALAN S.K.J - 1
PROV : AWAL :
DIREKTORAT KOTA : BDG/KBB AKHIR :
PEMBINAAN JALAN NAMA
KOTA SURVEYOR : TGL :
NO. ABSEN :
 FORMULIR SURVEI KONDISI JALAN
PROV : AWAL :
DIREKTORAT KOTA : BDG/KBB AKHIR :
PEMBINAAN JALAN NAMA
TGL :
KOTA SURVEYOR :
NO. ABSEN : HAL :
SEBELAH KIRI SEBELAH KANAN
DRAINASE DRAINASE
JARAK TEPIAN/
PENGH JPK BAHU JPK
SALURAN KEREB SALURAN PENGHUB
UB
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
0-4
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
4-8
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
8 - 12
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
12 - 16
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA TA
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
16 - 20
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
20 - 24
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
24 - 28
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
28 - 32
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
32 - 36
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
36 - 40
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TR,M TA TA ST,M,D TA A,TT,TR,M TA A,R,B
TA ST,M,D A,TT,TR,M TA A,R,B
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
40 - 44
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
 SEBELAH KIRI SEBELAH KANAN
DRAINASE DRAINASE
JARAK TEPIAN/
PENGH JPK BAHU JPK
SALURAN KEREB SALURAN PENGHUB
UB
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
44 - 48
A,T,TR,M TA A,TR,R ST,M,D A,B A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,TR,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,TR,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
48 - 52
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
52 - 56
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
56 - 60
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
60 - 64
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
64 - 68
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,R ST,M,D A,R A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
68 - 72
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
72 - 76
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
76 - 80
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
80 - 84
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
84 - 88
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
88 - 92
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
 SEBELAH KIRI SEBELAH KANAN
DRAINASE DRAINASE
JARAK TEPIAN/
PENGH JPK BAHU JPK
SALURAN KEREB SALURAN PENGHUB
UB
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
92 - 96
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
96 - 100
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
100 - 104
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
104 - 108
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
108 - 112
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
112 - 116
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
116 - 120
A,T,TTR,TM TA TA ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
120 - 124
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
124 - 128
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
128 - 132
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
132 - 136
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
136 - 140
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
 SEBELAH KIRI SEBELAH KANAN
DRAINASE DRAINASE
JARAK TEPIAN/
PENGH JPK BAHU JPK
SALURAN KEREB SALURAN PENGHUB
UB
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
140 - 144
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
144 - 148
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
148 - 152
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
152 - 156
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
156 - 160
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
160 - 164
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
A,T,TTR,TM TA A,R,B ST,M,D TA A,TT,TR,M TA A,R,B
164 - 168

168 - 172

172 - 176

176 - 180

180 - 184

184 - 188
 SEBELAH KIRI SEBELAH KANAN
DRAINASE DRAINASE
JARAK TEPIAN/
PENGH JPK BAHU JPK
SALURAN KEREB SALURAN PENGHUB
UB

188 - 192

192 - 196

196 - 200

200 - 204

204 - ….

Saluran : Ada / Tidak Ada Penghubung : Ada / Tidak Ada

Tersumbat / Tidak Tersumbat Tersumbat / Tidak Tersumbat
Teratur / Tidak Teratur
Memadai / Tidak Memadai Jalur P. Kaki : Ada / Tidak Ada
Rata / Tidak Rata
Bahu : Terlalu Tinggi / Sama Tinggi / Rusak / Baik
Terlalu Rendah / Miring /
Tidak Rata / Diperkeras / Tepian / Kereb : Ada / Tidak Ada
Tidak Diperkeras Rusak / Baik
 S.K.J - 2

…. dari ....
BELAH KANAN
TEPIAN/
BAHU
KEREB
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D TA
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
BELAH KANAN
TEPIAN/
BAHU
KEREB
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D
ST,M,D
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
BELAH KANAN
TEPIAN/
BAHU
KEREB
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,R
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D
ST,M,D
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
BELAH KANAN
TEPIAN/
BAHU
KEREB
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
ST,M,D A,B
BELAH KANAN
TEPIAN/
BAHU
KEREB

bat / Tidak Tersumbat

 HIMPUNAN TINGKATAN PRIORITAS

Angka
Angka Angka Jalur Angka
Panjang Saluran Angka Bahu Angka Total
No Nama Surveyor Nama Jalan Penghubung Pejalan Kaki Tepian/ Kereb
(m) Samping

Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka
1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 PENENTUAN ANGKA SALURAN SAMPING

Tidak
Tidak Tersumb Tidak Tidak Rata -
Panjang Ada Tersumb Teratur Memadai Total
No Nama Surveyor Nama Jalan Ada at Teratur Memadai Rata No
(m) at

Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 0 0 2 0 0 0 0 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25

No

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 PENENTUAN ANGKA PENGHUBUNG

Tidak
Ada Tidak Ada Tersumbat Total Rata - Rata
Nama Surveyor Nama Jalan Panjang (m) Tersumbat No

Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka
1
2
3
4
5
6
7
8
9
Farhan Fadhillah Jl. Sarijadi Raya 166 10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
 25

PENENTUAN ANGKA TEPIAN/KEREB

Ada Tidak Ada Rusak Baik Total Rata - Rata

Nama Surveyor Nama Jalan Panjang (m)

Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka

Farhan Fadhillah Jl. Sarijadi Raya 166

 PENENTUAN ANGKA JALUR PEJALAN KAKI

Tidak
Sama
Panjang Ada Tidak Ada Sama Rusak Baik Total Rata - Rata
Nama Surveyor Nama Jalan Tinggi
(m) Tinggi

Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka Ki Ka

Farhan Fadhillah Jl. Sarijadi Raya 166

 HIMPUNAN KONDISI PERKERASAN
Keretakan
Kekas
Tipe Kelas Ut.
Panjang Luban Tamba aran Ambla Total
No Nama Surveyor Nama Jalan Perkerasa Alur Nilai LHR Lalu- Priorit
(m) g lan Permu s Angka
n lintas as
Ukura Jumlah kaan
Tipe n Rusak
1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 lentur 1- - - - 0 2- 3 1 200-500 3 13
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 PENENTUAN ANGKA TIPE KEKASARAN PERMUKAAN

No Nama Surveyor Nama Jalan Panjang (m) F H D Total Rata - Rata

1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 - 2- 2 2
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 PENENTUAN ANGKA LUBANG - LUBANG

Panjang
No Nama Surveyor Nama Jalan < 10 % < 10 - 20 % 20 - 30 % > 30 % Total Rata - Rata
(m)

1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 - - - - - -
11
12
13
14
15
16
17
18
19
20
21
22
23
24
 25

PENENTUAN ANGKA TAMBALAN

Panjang
No Nama Surveyor Nama Jalan < 10 % < 10 - 20 % 20 - 30 % > 30 % Total Rata - Rata
(m)
1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 0- - - 0 0
11
12
13
14
15
16
17
18
19
20
21
22
23
 24
25

PENENTUAN ANGKA LEBAR RETAK

Panjang
No Nama Surveyor Nama Jalan Tidak Ada < 1 mm 1 - 2 mm > 2mm Total Rata - Rata
(m)
1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 - - - - - -
11
12
13
14
15
16
17
18
19
20
21
22
 23
24
25

PENENTUAN ANGKA TERHADAP SEVERITY RETAK

Panjang
No Nama Surveyor Nama Jalan < 10 % < 10 - 20 % 20 - 30 % > 30 % Total Rata - Rata
(m)
1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 - - - - - -
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 PENENTUAN ANGKA RETAK - RETAK

Panjang
No Nama Surveyor Nama Jalan Tidak Ada Memanjang Melintang Acak Buaya Total Rata - Rata
(m)

1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 1- - - - 1 1
11
12
13
14
15
16
17
18
19
20
21
22
23
24
 25

PENENTUAN ANGKA ALUR

Panjang
No Nama Surveyor Nama Jalan Tidak Ada 0 - 5 mm 6 - 10 mm 11 - 20 mm > 20 mm Total Rata - Rata
(m)
1
2
3
4
5
6
7
8
9
10 Farhan Fadhillah Jl. Sarijadi Raya 166 - - - - - -
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25