HomeMy WebLinkAbout515 E 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date J ^ -I '1- 6 l
,
Time
Received by
(phone, person)
Location of Work to be inspected -5 i )" E- )2 fJ1
Name of person requesting inspection -r fA) , J c c y'
Address of person requesting inspection , 1 (/1. <-0 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~
INSPECTION NOTES
Inspected Date
Remarks
Time By
fi -(Or' tLl~ :6. { , Pi; - .J:- U-J ~'j
1- -ecck ' . I ( fh ,( c fvcl-e C1 hd~
RESTORATION REQUIRED
/'
YES V NO
1/V
y
~
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~
~
~
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5+ ,
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
OPCC
o Other (6 j? ,. c) I L
!2s(J7 '
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE/
"
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No I,A C)-a 1
DATEREPORTED /2.-//-() 1 /'
CONDITION ENlERGENCY D ROUTINE D CITIZEN COMPLAINT V
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. I -1. ,/ ( a 1 TIME
I Crew
1/7
DA.M. DP.M.
TYPE OF MAIN
J-/<)
d.. (l C - -1-- SIZE
?
1:-
) 2-t~
REPAIR LOCATION ADDRESS
....
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
,
COMPONENT REPAIRED. /
MAIN JOINT D cm. BREAK < SPLIT BELL D LONG BREAK D
HOLE D CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FIITING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR CLAMP~SSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE illP.P.M.
WATER OFF FROM
M.TO
M.
p , 'x j;,"r ~...
!-/V~ jU6
c F (i!.-o J
~ It u+
dCJW Iv'
FROM
M.TO
M.
/A c..-f-
APPARENT CAUSE OF LEAK.