HomeMy WebLinkAbout730 E 6th St - Engineering
CITY OF PORT ANGELES DGu-2.SO/ -2-02G:,
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date } - '13-- D:L Time
Received by
(phone, person)
Location of Work to be inspected 7~D f:- 6-f'A
Name of person requesting inspection t ..f..? ,1 W
Address of person requesting inspection ~ t I'> - Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other W ~
INSPECTION NOTES
Inspected Date
Remarks
Time By
~('v1 R~~:~-e~r;ni'~_c'rc7f {)g~
/'
YES V NO
j IVt I
L1 b+~
"
. u
ticS I y ~q -(--b- ~
~
........ \
I
RESTORATION REQUIRED
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
D Asphalt D PCC D Other ~? :2:> J ( L
Work Order # :( b 4
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
uw - ..S"'"O I - < 0 '-CD
IWork Order No: 9-.0 A,b ICrew- 11r
DATE REPORTED /- ~) -0 :;l-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /
LEAKAGE SURVEY 0 OTHER 0
OA.M.~
REPAIR LOCA nON
ADDRESS
TYPE OF MAIN
SIZE.
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED: /
MAIN JOINT 0 CIR. BREAK VSPLIT 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 VALVED BARREL 0
OTHER.
COMPONENTS OF REPAIR CLAMP~SSERO OTHER
SITE CONDITION GRAVEL 0 ASP~D SIDEWALK 0 CURB 0
TOP SOIL AREA ti/ SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULA nON-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CJ-ll..ORINE RESIDUAL SAMPLE
P.P.M.
~ ~ t..,,}r-e- po5S'/r/-/UJ<-
f' f~S)ur-e-
5-e tf l.~_ r- ~ra Lk
M.
WATER OFF FROM
M.TO
FROM
M.TO
M.
APPARENT CAUSE OF LEAK.