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CITY OF PORT ANGELES Dc.o ~5ol-- ISOCj I
DEPARTMENT OF PUBLIC WORKS I
. . . . . . . . . INSPECTION REPORT. . . . . . . . .
REQUEST:
Date i?- - /1 - 7?
Time ?_~ PC' t1;1J
Received by A AI P y--
(phone, person)
Location of Work to be inspected I }-~. Lv ;; ~
Name of person requesting inspection #' t1 Y L E
I ? .-'P<,. d If?
Address of person requesting inspection L /2.- Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
pur ~S'C/I
INSPECTION NOTES:
I'') -11- a '?
Inspected: Date r 7
Remarks:
Time
/ ! -" v f/ -1 ~ By /( tl IV
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w~ lit J/~k?q,,/, Ct~l#~
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RESTORATION REQUIRED. . . . . (YES
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0'Asphalt
OPCC
o Other
/5//'1
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
[B1I\1COMPLETE
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/ /
17/11/;- Y-X16
STREET SUPERINTENDENT
(DATE)
Dw '1/0/'" /5t:J'
City of Port Angeles ,..-;;;
Public Works Department
Water Distribution Repair Report
'IWork Order No: I ~ tJ 9
'Crew: /(1/1" . P'CIYNf,/ . ,:7t1t
, f
Reported: / ?- / /"'/99
Repaired: ! L/ i.!lJ 7f9 '
Condition: Emergency ~. Routine
Source: Citizen Complaint ~
Leakage Survey _ Other
Address: / ? C; W;.~
Loc. Description: I 7 '1- / ~ t'j J ,'- () f Vr/ LV <f CI AI 5, E Cf7'</V ft ~
If ",..,.....,IQjVAI(
Main Line ID#:
Repair Location:
Component Repaired:
Main: Joint Cir. Break ~
Long. Break _ Hole
Split Bell_
Clamp _
Other
Service: Tap_
Line Valve: Flange Nuts, Bolts
Hydrant: Br~ch -
Other:
) Repair Type: Clamp V
Site Condition: Surface
Curb
---
~ Damage:
Corp. Stop _
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Valve
Dresser
Other
Gr~vel Roadway _ Asphalt Street ~ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft. +)( I " Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter:
Material:
Depth of Cover:
Internal Lining:
Inches 'l.
<'''-4SE if(~,v
Ft. J
,.
Joint Type:
External Prot:
~,,,,
Tuberculation: N' A v Minor
External Corrosion: N' A Localized
Special Conditions: Bedding: 6' f( ~ Vt:- L
Other Structures:
Severe
Extensive
Samples Taken: Pipe.Section _ Coupon_
Water Off: From-1_'_ TO__M
From_'_,_ TO__M
Apparent Cause of Leak: r IrE
5'ErTt..EP y C~/?c/c:e/)
5/19/98
Page 1
PW-902.09