HomeMy WebLinkAbout1728 W 4th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
i . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:
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Date ()
OW -'351' 1- 2.143
Time
Received by
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~
(phone, person)
Location of Work to be inspected <) '7 J- i? -iJ. If -fit
Name of person requesting inspection ~ {jJ i I MY
Address of person requesting inspection Il~ '6 13 r Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other lu \e";.1"-- e/Y
INSPECTION NOTES:
Inspected: Date
Remarks:
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By
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RESTORATION REQUIRED . . . . .. YES
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NO~
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
CJ Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work~er # 21'-l3
[.VCOMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles UIA.J- aSl'l- 2/ ~3
Public Works Departnlent
"1 ater Distribution Repair Report
'work Order No: ~ } y')
ICrew:
71yr,
I
DATE REPORTED:
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CONDITION:
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
b - I~-o L TIME: ~
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DA.M. ttM.
U Y -1-4
DATE OF REPAIR:
REPAIR LOCA TI0N: ADDRESS:
TYPE OF MAIN:
SIZE:
DEPTII OF MAIN:
CLOSEST VALVE DEPTH:
COMPONENT REPAIRED:
MAIN: JOINT D CIR. BREAK D SPLIT BELL. D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE: TAP 0 CORP. STOP D PIPE 0 CURB STOP D FITTING D
METER SETTER D METER 0
LINE VALVE: FLANGE NUTS/BOL TS 0 STEM 0 BONNET D
HYDRANT: BRANCH 0 VALVE o BARREL 0
OTHER:
COMPONENTS OF REPAIR: CLAMPO DRESSERO OTIIER
SITE CONDITION: GRAVEL 0 ASPHALT D SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRIVEWAY CUT _FT.
MAIN CONDITION: INTERNAL LINING TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CI'll..ORINE RESIDUAL SAMPLE P.P.M.
WATER OFF: FROM
M.TO
M.
FROM M. TO M.
APP~CAUSEOFLE:1~~~ ~ AJo A R4K H~f-
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