HomeMy WebLinkAbout1502 E 5th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
. . . .
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,
REQUEST
Date I tl - 1 - f 9
Time I t)u r,/l/1
Received by /I IV P >-
(phone, person)
lC:-tJi ~ S.,~
Location of Work to be inspected ./ r <... _
Name of person requesting inspection )? c F L E
Address of person requesting inspection J 7 ~-,. '7' i5 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other /.1//1 7 e ~ L/IV ~
jl W ~ _C:;- C I
Inspected Date
Remarks frl ,/l ( /(/
CC;j(,{IEI< vi
INSPECTION NOTES
ItI-f -f9
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S~ 1-
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Time
?-;) I 51'Ct Tit
E ;((A/<J
By If tJ ;1./
Of V)"/LvE
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RESTORATION REQUIRED
YES
NO ~
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7
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fl) J ~ reSf1+A-V~
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved DGravel
o Repaired by City
o Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC
Work Order # I
g/"COMPLETE
o INCOMPLETE
o Other C -1 fA,. N
1- 7 '3
T V ~ 5"tJ / L
tYV (
P () AI E
IVLxr PAr
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
[Work Order No: I 1- 7 '3
Reported: / ~ / ? / tl f Condition:
Repaired: /0./ '1 / f 9 Source:
1
fCrew: I? ~;Y / Il AI)? /1,,- , j( I {" t7",4K~
,
Emergency~ Routine
Citizen Complaint
Leakage Survey _ Other
I r /; '} F r~
Address: j l/ r ~ ,7
Loc. Description. ;)) I 5 (; Lt T Ii () f V /) l- 1./ t. 0 ~/ .5, E c {; ~ IV E ;f
(J( S.P- i E/V/V/J'
Main Line ID#:
Repair lAK'Jltion:
Component Repaired.
Main. loint eir Break ~
Long. Break _ Hole
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.
CoIp. Stop _
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Valve
Dresser
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area ~ Soil Type _
Other
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter: Inches ')..
Material.
Depth of Cover. Ft. 'f
Internal Lining:
v
loint Type:
External Prot:
t'r....c
Tuberculation: N/A Minor _
External Corrosion: N/A Loca1ized ~
Special Conditions:~: G I< ~ 1/ e <-
Other Structures:
Severe
Extensive
Apparent Cause of Leak:
Samples Taken: Pipe Section C
- 01Ip0n-
Water Off: From I {I 1 1 1 9 q To.3 '} 0 j7 M
From / {! 1 C; 1 Y9 To'i.lLLM
PIP [
C ;:: ,LIe ICE /J
5119/98
Page Ii.
PW-902.09