HomeMy WebLinkAbout634 E 6th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
'. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
Date fJ -- I, )' - c 0
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)
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Permit No
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date
Remarks
Time
By
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RESTORATION REQUIRED .. YES
NO L/'"
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC / { 1 0 Other
VYo~der # - I
cY"COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
D LV - "].. 00 '1- (, 11
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: J b ( I
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Reported: q f).,5; c7J
Repaired: J:J~ Ot)
Condition.
Source:
Repair Location:
Address
Loc. Description.
Component Repaired:
'Crew'
'fIr
Emergency Routine
Citizen Complaint V
Leakage Survey _ Other
6?Y
E- tilt
Main Line ID#:
Main. Joint Cir Break
Long. Break _ Hole
Service:
Line Valve:
Hydrant:
Other:
Tap_
Flange Nuts, Bolts
Branch
Repair Type: Clamp _
Site Condition: Surface
Curb
Damage:
Cuts: Street Cut: Ft.
Split Bell _
Clamp _
Other
Corp Stop_
Pipe _
Stem
Curb Stop _
Bonnet
Valve
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Other f(-e 0/4 ~._
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Dresser
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Main Condition:
Curb Cut: Ft.
Sidewalk Cut: Ft.
rr. ( tll ~
Diameter- Inches
Material.
Depth of Cover' Ft.
Internal Lining:
Tuberculation. NI A
External Corrosion. N/A
Special Conditions: Bedding:
Other Structures.
Samples Taken:
Water Off:
Apparent Cause of Leak:
5/19/98
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Joint Type:
External Prot:
Minor
Localized
Severe
Extensive
Pipe Section _
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PW-902.09