HomeMy WebLinkAbout110 W 3rd St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . INSPECTION REPORT . . . . . .
REQUEST: .
Date 1),,- -I ~ -0 t
,
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.....
Time
Received by
(phone, person)
I )D W 3 y--J
location of Work to be inspected
Name of person requesting inspection 'T LU 'll (is 'j'
Address of person requesting inspection 17fh ~ G Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other lJJ (1;~
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
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By
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RESTORATION REQUIRED . . . . .. YES
//
NO V
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
~MPlETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
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'Work Order No:
DATE REPORTED:
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ICrew:
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CONDITION: EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR: J 1.. - I?- - b ( TIME: Cf ~.M. DP.M.
W 3r-j
TYPE OF MAIN:
J /6
2 .( c--5-
SIZE:
REPAIR LOCATION: ADDRESS:
3'
DEPTH OF MAIN: _
CLOSEST VALVE DEPTH:
COMPONENT REPAIRED: /'
MAIN: JOINT 0 CIR. BREAK if SPLIT BELL, 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE: TAP 0 CORP. STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVE 0 BARREL 0
OTHER:
COMPONENTS OF REPAIR: CLAMP~RESSERO OTHER
SITE CONDITION: GRAVEL 0 ASPHAj;!' 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ;:yr SOIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRIVEWAY CUT _FT.
MAIN CONDITION: INTERNAL LINING iJ IJ K ov-> Y\ TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P,M. R-ejtL,y.. e/ L:JYe.. P.?'7~/'j-Iv~ pt-e.f~(..jy~
WATER OFF: FROM M. TO M. fUll -:;1[u1- do L<.J >t
FROM
M.TO
M,
APPARENT CAUSE OF LEAK:
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