HomeMy WebLinkAbout1802 W 5th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
Q c.v ,,1..001- (,..oB
REQUEST
Date
Time
Received by
(phone, person)
Location of Work to be inspected '> (
Name of person requesting inspection l.~.
Address of person requesting inspection
Type of Inspection (circle appropriate one)
./
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~.
~
~
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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date
Remarks '" , '
Time
By
RESTORATION REQUIRED
YES
NO \"
r'
i,"'\
no..
. -I
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
[Sl Other
D Repaired by City
D Repaired by Permittee
D No Damage Found
Work Order #
.tsJ COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
i>CA.J - 2..()O~- 11-08
IWork Order No: /' (,
I Crew'
Reported. f c /IL; / ~
Repaired. _/ r { /___
Condition.
Source
Emergency Routine
Citizen Complaint \
Leakage Survey _ Other
Repair Location.
Address I,'J
I
, .\
Loc Description.
"
Component Repaired.
Main Line IDU'
Main.
Joint
Long. Break_
Cir Break
Hole
Split Bell _
Clamp _
Other
Service:
Line Valve:
Hydrant:
Other:
Tap_
Flange Nuts, Bolts
Branch
Corp. Stop _
Pipe _
Stem
Barrel
Curb Stop X
Bonnet
Valve
Repair Type: Clamp _
Dresser
Site Condition: Surface
Curb
Damage: I." '"
Other ;V 1';., i,C '-. (! (
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area -Z- Soil Type _
Cuts: Street Cut: Ft. Curb Cut: Ft.
Main Condition. Diameter' Inches
Material
Depth of Cover' Ft.
Internal Lining:
Tuberculation. N/A
External Corrosion. N/A
Special Conditions. Bedding:
Other Structures.
Samples Taken. Pipe Section _
Sidewalk Cut: Ft.
,.
Joint Type
External Prot:
,. ,
Minor
Localized
Severe
Extensive
Coupon _
Water Off'
From _l.;J ~ ~
From ~/~/_
To ',. p., M
To~AM
----- -
Apparent Cause of Leak:
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5/19/98
Page 1
PW-902.09