HomeMy WebLinkAbout506 E 11th St - Engineering
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . INSPECTION REPORT . . . . . .
[) LoU -)..-0 0 1- - 180 "=J
REQUEST
Date 3 -- ~,- Co 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 Plumbing Final Sewer Excav Other bJA.:f~
/:; , J -i:, I:- /11/;
"/[;... j i J {(. x
11 fi & /3 / Phone No
Permit No
INSPECTION NOTES
Inspected Date
Remarks
Time
By
r
RESTORATION REQUIRED
YES
NO /t/~
, /fit
'K E J / +/;
I ~\
?J ,I ~ ~ 3~~ 4-j ~
j' /1"-
D ~ ~
--r
--..........
tl-I
J ~
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved o Gravel o Asphalt OPCC
~
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
~PlETE
o INCOMPLETE
I ~I . DOther
~C7
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)
CIty of })ort Angeles Dc..u. 2-<.TO 1-/807
Public \V orks Departnlent
Water Distribution Repair Report
IWork Order No: r?? 6 f
DATE REPORTED 1)_ ~ 3-0 (
CONDITION '~RGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /
LEAKAGE SURVEY 0 QTHER 0
DATE OF REPAIR. 'j - '1~ - 0 ( TIME Cf / t;,Z)
-
.,jol
I
fCrew
7/~/
1
~.OP.M.
REPAIR LOCATION
TYPE OF MAIN
ADDRESS
~.( ;f C
r!
/ lfl,
SIZE.
r! (
DEPTH OF MAIN J
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER IY-e )I~ -Ct..) ~~ pD-I- IS,r--Q
J2I' \.! ~ tjn~/ '(;r.7l./
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0 ~/f.~ c(. ,)7 'TD
TOP SOIL AREA ~OIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULA TION-MlNOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I If 3 P.P.M.
WATEROFF FROM 9 P M. TO )() ~ M.
I
/ ~ /.." 0 ';. --'1_
D tJ.+
! htr-(
FROM
M.TO
DlA
M.
[; ~-; ffl-<
~Jy r,E
APPARENT CAUSE OF LEAK.