HomeMy WebLinkAbout1426 W 6th St - Engineering
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REQUEST
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS / D E7-
. . . . . . . INSPECTION REPORT. . . . . . . . . .. I
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)
Sewer Foundation Framing Chimney
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Permit No
Plumbing Final Sewer Excav Other
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INSPECTION NOTES
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By
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Inspected
Remarks
Date
Time
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RESTORATION REQUIRED
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YES t/ NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel 0 Asphalt 0 PCC 0 Other ~y;; ~ l L
Work Order # /7 { I /
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
IWork Order No'
Reported. I ').J 21/ ~ c
Repaired. I J.-./1[/ (/ ;:.'
Repair Location.
Component Repaired:
Main.
Service:
Line Valve:
Hydrant:
Other:
Repair Type:
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City of Port Angeles
Public Works Department
Water Distribution Repair Report
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Condition.
Source
Address
Loc Description.
lcrew.
7/y
Emergency Routine
Citizen Complaint ~
Leakage Survey _ Other
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Main Line ID#:
Joint Cir Break V'
Long. Break _ Hole
Tap_
Flange Nuts. Bolts
Branch
Split Bell _
Clamp _
Other
Corp Stop_
Valve
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Clamp /
Other
Site Condition: Surface
Curb
Damage:
Dresser
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft.
Sidewalk Cut: Ft.
Main Condition.
Apparent Cause of Leak:
5/19/98
Curb Cut: Ft.
r;Ld C--;:-
Diameter' Inches
Material.
Depth of Cover- Ft.
Internal Lining:
Tuberculation:
External Corrosion.
Special Conditions:
Samples Taken:
Water Off:
,-
,. .
Joint Type:
External Prot:
N/A
N/A
Bedding:
Other Structures.
Minor
Localized
Severe
Extensive
Pipe Section _ Coupon _1lJ J IU ~
From I 2-/ ~.!.-' -0? To -.L/I- M / ~ 0 U )-e
From~/.6L/~ To~
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PW-902.09