HomeMy WebLinkAbout1737 W 10th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
.....
/
REQUEST
Date-J A- ),q- OD
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)
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{-- C2.-- Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
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INSPECTION NOTES
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By
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Inspected Date
Remarks
Time
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RESTORATION REQUIRED
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YES
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NO e.,/
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Wor~der #
~OMPLETE
o INCOMPLETE
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
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City of Port Angeles
Public Works Department
Water Distribution Repair Report
~
IWork Order No , 10"<6
Reported. J~,)-/ 11-/-.lL.P
Repaired. p--/ JjJ (1)
Condition.
Source
Repair Location.
Address
Loc Description.
Component Repaired,
Main
Joint
Long. Break_
Service:
Line Valve:
Hydrant:
Other.
Repair Type: Clamp L
Tap_
Flange Nuts, Bolts
Branch
I Crew: II Y
Emergency Routine
Citizen Complaint V
Leakage Survey _ Other
/7 3/
fA.) I 0 ,pA
Cir Break /
Hole
Corp Stop_
Valve
Main Line ID#:
Split Bell _
Clamp _
Other
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Site Condition: Surface
Curb
Damage:
Dresser Other
Gravel Roadway / Asphalt Street _
Top Soil Area _ Soil Type _
Sidewalk
Cuts: Street Cut: Ft.
Sidewalk Cut. Ft.
""-1 r' C-7
Diameter' Inches of- A-
Material.
Depth of Cover- Ft.
Internal Lining:
Main Condition.
Curb Cut: Ft.
Tuberculation. NI A
External Corrosion. NI A
Special Conditions: Bedding:
Other Structures:
Samples Taken:
Water Off:
Apparent Cause of Leak:
,.
,. ,
Jomt Type
External Prot.
Minor
Localized
Severe
Extensive
Pipe Section _
From 11-1 Ii? 1 ctD
From~!I~ 100
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Coupon _!I/o IU Z uk (] F-
To ~ >6 PM I A V ~ I ,1~ ,j --e ~ f-
To~PM IL\U:s,A?.. ~ or- ~ f-
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5/19/98
Page 1
PW-902.09