HomeMy WebLinkAbout802 E 6th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date -:;~ ~ - -0 '(
Time I)-,en) f/V\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)
Sewer Foundation Framing Chimney ~bi~ Final
c:gu;. E 6~
~'L.fe,r ~C/IS/~? ~
J 7 rL tf /5
Phone No LJ / 7 - y<tfy 7
Permit No
Sewer Excav Other
INSPECTION NOTES
Inspected
Remarks
Date
;{ \'
(. fP1~/J;l
J3f eVIl:-
Time By
ye /Ja /I"e c! &-1/,11...... 4.".;/1 C I./',;/e t/' ~/v'~ l,.r kv,.L
I ,
RESTORATION REQUIRED
YES
Y NO
,
(rt:4IlC, S 11
I
G~
:::
Ol;)
-~~-- I
"""" \.,
"YJ' ~"cL
L38' -1
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
~sPhalt 0 PCC
Work Order #
o COMPLETE
o INCOMPLETE
D Other
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No 13~~-&-OcJ-.l
lCrew'7/7, '71;', 7;l.;;", },)3
DATE REPORTED ) - 5" -oe-(
CONDITION E1v1ERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT K
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. ~-5-oy TIME /0 'eN ~A.M. DP.M.
REP AIR LOCATION ADDRESS go;2. E 6~
TYPE OF MAIN cr SIZE .? " -
DEPTH OF MAIN :2, )"" CLOSEST VALVE DEPTII. ;,5'
COMPONENT REPAIRED.
MAIN JOINT 0 Crn.. BREAK. SPLIT BELL 0 LONG BREAK )(
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/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTIIER
COMPONENTS OF REPAIR. CLAMPK DRESSERD OTHER
SITE CONDITION GRA VEL 0 ASPHALT A: SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING ./ fi TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE .Ai' A- P.P.M. I efkt;r~j \.Jolt.",," fO~j,t,o/~ jJ/e.sfX.)/~
WATER OFF FROM
M.TO
M.
FROM
M. TO
M.
APPARENT CAUSE OF LEAK.. C/'acl::. In /J1JJ-e
, ,