HomeMy WebLinkAbout1613 E 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST I~
Date 7- I -6 1- Time
p '^-' - 2.0'"0 { - 2-1 , 8
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Received by
(phone, person)
Location of Work to be inspected 1(, I J E)-f0
Name of person requesting inspection ~ \ J 1 (A f'
Address of person requesting inspection 1 { fl1 ~ r;> Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ()...J cc -+-tv-
INSPECTION NOTES
Inspected Date
Remarks
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Time By
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RESTORATION REQUIRED
/
YES_ _ NO V
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
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o Asphalt 0 PCC 0 Other ~ SM ! :>
Work Order # -:2../ -{ ~
dYCOMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public 'Vorks Departnlent
Water Distribution Repair Report
C'-^' ,.au" 1- 2.1' 8
IWork Order No. ;L' ~ <z
I Crew'
fir
DATE REPORTED'
'-7-17- 6-'2-
CONDITION
DATE OF REPAIR.
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT V
LEAKAGE SURVEY 0 OTHER 0
7 -I A -0 7- TIME. r1 \7(,
-I ("",A.M. OP.M.
ADDRESS j b /) E- S -t~
J It c ---1:-
SIZE.
1 y 2-( CLOSEST VALVE DEPTII.
REPAIR LOCATION
TYPE OF MAIN
DEPTH OF MAIN
COMPONENT REPAIRED: /
MAIN JOINT 0 CJR. BREAK tz(' SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMP~SSERO OTIIER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_FT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
,..,
CHLORINE RESIDUAL SAMPLE i / D P.P.M.
WATER OFF FROM
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FROM M. TO
M.
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APPARENT CAUSE OF LEAK.