HomeMy WebLinkAbout409 E 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT . . . . . .
/ZC/tr-
REQUEST
Date 11- ;) q - () 3
Time 'l-' 30 f/ll'\.. Received by Ho/t/()vk
(phone, person)
Location of Work to be inspected 'I c/ q E /). T"'-
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Phone No
Permit No
Plumbing Final Sewer Excav Other lA.../q r~ .1---
Sewer Foundation Framing Chimney
INSPECTION NOTES
Inspected Date
Remarks
Time
By
RESTORA TION REQUIRED YES )( NO
'! /16' ,
'J' 3'\CT -
,... " \0'
--v~
~ J 7. T~-
r"
J J'ft("
~ --
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
~Other TDI Seel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
% COMPLETE
o INCOMPLETE
tIt-" 1-c 3
STREET SUPERINTENDENT
I
.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
/20/&
REQUEST
Date / 1- ;;..q- 0 3
Time 'l-; 30 f/ll'\.. Received by Ho/b/()ok
(phone, person)
Location of Work to be inspected 'I c/ q E /). T"'-
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 lA.../4: r~ r
Phone No
Permit No
INSPECTION NOTES
Inspected Date
Remarks
Time
By
RESTORA TION REQUIRED . . . . .. YES "X NO
,};. 11'''' ,
, 3" cT
,... ., \0'
-U~
-JS J ~ T~
\) J'ft(
~ -
SURFACE RESTORATION:
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
D Repaired by City
D Repaired by Permittee
o No Damage Found
Work Order #
~Other TDf Seel
I ~OJ t(J
o COMPLETE
D INCOMPLETE
~'T"n~~"T' C'-lln~Dlal"T'r:lunr:I\IT InATa:\
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
/zc/c;-
IWork Order No' I?--O I "
I Crew '7 f 1 11 b 7 I ~
, , I
DATE REPORTED I J. '3-.A- 03
CONDITION EMERGENCY ~ ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER D
DATE OF REPAIR. 1/- J...cj- 0:3 TIME
REPAIR LOCATION ADDRESS '10,,/ e
~:30
fir T~
DA.M. ~P.M.
TYPE OF MAIN
") '\
Cas r C/().'L SIZE. (7"-
':J -\
CLOSEST VALVE DEPTH. V" $
DEPTH OF MAIN :5 ~
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK)l1 SPLIT BELL 0 LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP 0 CORP STOP D PIPE D CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH D VALVED BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERO OTHER {'vi! c,,'C~ /~p:;.u l:.n*1d
SITE CONDITION GRA VEL D ASPHALT D SIDEWALK D CURB D
TOP SOIL AREA K SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING .A/'" A TUBERCULATION-MINOR 0 SEVERE D
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE D
CHLORINE RESIDUAL SAMPLE A/ fi P.P.M. f1.~(J(4lh.l "".'L~"",- fO"uto'< //~~$III''e
WATER OFF FROM
M.TO
M.
FROM
M. TO
M.
APPARENT CAUSE OF LEAK. q fOVt't ~ fjeHlo',-er,
I