HomeMy WebLinkAbout1836 W 4th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST: ~
Date J I-~ -6
\\l<rl1
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other LA... )~~t-ev"
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INSPECTION NOTES:
Inspected: Date
Remarks:
Time By
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RESTORATION REQUiRED...... YES L/NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
A. -ecck !?--€-!:JC!\.( Y
o Asphalt 0 PCC 0 Other Mr 56 I 'i-
Wo~6rder # j I I g7
0( COMPLETE I i-t'l--01~tv
o INCOMPLEtE__ .
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
III t1
IWork Order No:
ICrew:
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DATE REPORTED:
.I 1 \ ~1
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EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /'
LEAKAGE SURVEY 0 OTIIER 0
JI-b-C:/) TIME: /1.16
18 '} {;
c - J-- SIZE:
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tkA.M. DP.M.
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CONDITION:
DATE OF REPAIR:
REPAIR LOCATION: ADDRESS:
TYPE OF MAIN:
2 (<
jl
DEPTII OF MAIN:
CLOSEST VALVE DEPTII:
COMPONENT REPAIRED: /
MAIN: JOINT 0 CIR. BREAK V SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIIER
SERVICE: TAP 0 CORP. STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VAL VE 0 BARREL 0
OTHER:
COMPONENTS OF REP AIR: CLAMP~RESSERD OTIIER
SITE CONDITION: GRAVEL 0 ASPHALT 0 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 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE /1 ~ P.P.M ~
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WATER OFF: FROM / LflJo~. TO 2 M. / /J /6 C
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FROM
M.TO
M.
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APPARENT CAUSE OF LEAK: