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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
DW ~ So 1.- I :;03
/
REQUEST:
/] a a
Date I A. - 0 -( \
Time
Received by
(phone, person)
Location of Work to be inspected bD jl
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
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" (AJ \ I C 6 f.
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( 1.t'1'1 -t-LJ Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other L...t.)' ~-V
INSPECTION NOTES:
Inspected: Date
Remarks:
Time By
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RESTORATION REQUIRED . . . . .. YES
//
NO~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
~MPLETE
o INCOMPLETE
o Other
1)03
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
0/-/$03
IzJD) I Crew: 71 V
Reported: / 2./~1 q~
Repaired: / J-ciJ a!f. .
Condition: Emergency Routine
Source: Citizen Complaint ~
Leakage Survey _ Other
Repair Location:
Address:
Loc. Description:
Z;b'2-
E:
o /
';;rc;(
Component R~aired:
Main: Joint Cir. Break L..
Long. Break _ Hole
Main Line ID#:
Split Bell _
Clamp _
Other
Service: Tap_
LIne Valve: Flange Nuts. Bolts
Hydrant: Branch
Other:
) Repair Type: Clamp ~
Site Condition: Surface
Curb
-.
~ Damage:
Cuts: Street Cut: Ft.
Corp. Stop _
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Valve
Dresser
Other .
Gr~vel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter: Inches
Material:
Depth of Cover: Ft.
Internal Lining:
1. .-< (' ~J:--
"
"'-',<c
Joint Type:
External Prot:
Tuberculation: N/ A
External Corrosion: N/ A
Special Conditions: Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Samples Taken: Pipe. Section _
Coupon Il /611/--C-
- .
Apparent Cause of Leak:
Water Off: From / J-.j 'F /1 f To /c ~M
From I J-f J ill' To II /f M
S-e Hi ~ r L r<</<z
5/19/98
Page 1
PW-902.09