HomeMy WebLinkAbout2128 W 6th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
Date 7.---:3 C> ~ (.; J Time
i*' 8 ~r l3~
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)
2 I J-? LJ 6-1 t1
~(~ I J Co:/
/ ((/1 i:- fl Phone No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
Permit No
(~C1 -f--<o V-
'-t '
INSPECTION NOTES
Inspected Date
Remarks
Time
By
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RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o Other
/333
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)
CIty ot IJort Angeles t-fT-€ ~ F \ ~ ~ ~
Public 'Vorks Departnlent
\" ater Distribution Repair Report
[Work Order No
CONDITION
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7~~---D}
EMERGENCY D ROUTINE D CITIZEN COMPLAlNT ~
LEAKAGE SURVEY D OTHER D
7 - '?o....--u ') TIME } 0 If yvt DA.M. DP.M.
ADDRESS ?. t ?-- ~ Lu 6-1 )1
;2 ,,( fl/ C SIZE
I Crew
7/y
DATE REPORTED
DATE OF REPAIR.
REPAIR LOCATION
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK 0 SPLIT BELL. D LONG BREAK 0
HOLE 0 CLAMP 0 OTHER ,
SERVICE TAP D CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET D
HYDRANT BRANCH 0 VAL VE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHAL T 0 SIDEWALK D CURB D
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING
EXTERNAL CORROSION
Cffi..ORlNE RESIDUAL SAMPLE I ~ (
WATER OFF FROM / 6 II- M. TO
TUBERCULA TION-MINOR 0 SEVERE 0
LOCALIZED 0 EXTENSIVE 0
P.P.M. ~
'10A' ~
II riM.
FROM M. TO M.
APPARENT CAUSE [t LEAK. [)~IH{ -e 7/ y
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