HomeMy WebLinkAbout1912 W 6th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
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REQUEST (
Date 3 - '2..1- 0
/
Time
Received by
(phone, person)
Location of Work to be inspected ----1.3 t?-
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (AJ/A....,1-e-V
INSPECTION NOTES
Inspected
Remarks
Date Til1}e By
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RESTORATION REQUIRED
. YES
/
NO V
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
o Repaired by City
o Repaired by Permittee
o No Damage Found
OPCC
o Other
/'YD 1
,
Work Order #
~MPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
IDA TE)
CIty of Port Angeles
Public 'Vorks Departnlent
'Vater Distribution Repair Report
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ICrew
IWork Order No. 1 ~ c> q
DATE REPORTED' 3 - A 7 - 6 I
'71r
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. ~ - 2.. -;,- (j I TIME. lit' J 0
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SIZE.
REPAIR LOCATION ADDRESS
~A.M. DP.M.
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DEPTH OF MAIN
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5(
TYPE OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED.
MAIN JOINT 0 crn. BREAK 0 SPLIT BELL. 0 :!rONG BREAK 0 b.
HOLE 0 CLAMP 0 OTHER r;.,/ u ~ Iff J _
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 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSER~THER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ~OIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE (73 P.P.M.
WATEROFF FROM I (,. )D~. TO I 2.:~ M.
FROM
M.TO
M.
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APPARENT CAUSE OF LEAK.
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