HomeMy WebLinkAbout830 W 4th St - Engineering
CITY OF PORT Ar\lGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
.\) w - Z 001- 2/J.{Lf
REQUEST:
Date ~-/1- 02-
. . . . . ~S])
Time
Received by
(phone, person)
Location of Work to be inspected 830 w. <.f7!::
Name of person requesting inspection D.,,~ l~ +z, "":-
Address of person requesting inspection c..cr- 0 lO-,J Phone No. it ('1 -'1cfft/o.
I
Type of Inspection (circle appropriate one): Permit No.'.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Ot€~
INSPECTION NOTES:
Inspected: Date
Remarks: ,ee.i'Jcz.i /- S.er,.h-L-e..
I
Time By
{etA.. k- a. f" be7...L k. S i 'cP f d t..A..,(~+e- r"7
RESTORATION REQUIRED. . . . .. YES
NOX
'S3D LJ 4~
~ <-L..t< ~llI.,;..I. .11
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC gI Other Grc,- s S
Work Order # 2 ( L{ L(
[M"" COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
i) c.u - ~oo 1- 2.1 'fL/
IWork Order No: 'AI Lf i/
,
fCrew:
7/v
I
DATE REPORTED: t - / i- 0 L- /
CONDITION: EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REPAIR: b --- f 7--0'1- TIME: 7 All'\. DA.M. DP.M.
REPAIR LOCATI0N: ADDRESS: e?>O v.J. 'it!! ~A.
TYPE OF MAIN: ~ C --;:; SIZE:
DEPTH OF MAIN:
CLOSEST VALVE DEPTH:
COMPONENT REPAIRED:
MAIN: JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE D CLAMP D OTIIER
SERVICE: TAP 0 CORP. STOP D PIPE ~URB STOP D FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVE 0 BARREL 0
OTIIER:
COMPONENTS OF REPAIR: CLAMPO DRESSERO OTIIER
SITE CONDITION: GRAVEL D ASPHALT D SIDEWALK 0 CURB 0
TOP SOIL AREA D 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
CID...ORINE RESIDUAL SAMPLE i '5 l( P.P.M.
WATER OFF: FROM
71+-
M.TO
~Il
;J?15VSe our !/tr,
M.
FROM M. TO
M.
f3J f// jJ~ ~t/ C-
APPARENT CAUSE OF LEAK: