HomeMy WebLinkAbout817 E 6th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT . . . . . . . . . . .
///
REQUE~T I
Date ~)- D
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (0 ~~
INSPECTION NOTES
Inspected Date
Remarks
t-/
RESTORA TION REQUIRED . YES NO
] If
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SURFACE RESTORATION.
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC. 0 Other --rJ)?)' 0 I L-
Work Order # / 7 1 7
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public 'Vorks Departnlent
Water Distribution Repair Report
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IWork Order No:
DATE REPORTED'
17CJ7 ,
:)- 5 - 0 I
ICrew:
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REPAIR LOCATION
ADDRESS
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTIIER 0
3 -- 5""- 6 I TIME tJ' /I IJ1 ~M. DP.M.
~ I ? E (" -f~
{ -]:--. SIZE
CONDITION
DATE OF REPAIR.
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED: //
MAIN JOINT 0 CIR. BREAK rf" SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIIER
SERVICE. TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMP~SSERO OTIIER
SITE CONDITION GRA VEL 0 ASPHAI;P'15 SIDEWALK 0 CURB 0
TOP SOIL AREA ii!"" SOIL TYPE
CUTS. ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.p.M.;1/tJltl-e r-ej?V( I~C/1.l-/PZ
WATEROFF FROM r /1/11 M.TO c;,3t>/lM. 1/ f1()vJ-<'t; OU+ Jhr(
FROM
M.TO
M.
EfA..v +11
ouo.-.k-<-.
APPARENT CAUSE OF LEAK.