HomeMy WebLinkAbout838 W 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . .
REQUEST
Date :2 ~ q ~ () 1(
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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( '1 t11 +- 0 Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
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INSPECTION NOTES
Inspected
Remarks
Date
Time
By
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RESTORATION REQUIRED
YES
NO V~'
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--
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~
90 I lYe]:
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 pcc /3 gq Other_ :-
W?r~der # . ~~ 0 J Y
[]/COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TEl
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
'Work Order No
DATE REPORTED
17 ~:?--?-6)Y'
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I Crew
7/Y
CONDITION E1v1ERGENCY D ROUTINE D CITIZEN COMPLAINT /'
LEAKAGE SURVEY D OTHER D
TYPE OF MAIN
~ - q - 6 t.;- TI1v1E
ADDRESS ~7 '? LA-->
9n c -~ SIZE
DA.M. DP.M.
/?-M
DATE OF REPAIR.
REP AIR LOCATION
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED. ./
MAIN JOINT D CIR. BREAK ifSPLIT BELL D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP D FITTING 0
1v1ETER SETTER D 1v1ETER D
LINE VALVE FLANGE NUTS/BOL TS D STEM D BONNET 0
HYDRANT BRANCH D VAL VE D BARREL 0
OTHER.
COMPONENTS OF REPAIR. CL~RESSERO OTHER
SITE CONDITION GRAVEL D ASPHALT D SIDEWALK D CURB 0
TOP SOIL AREA D SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_IT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING
EXTERNAL CORROSION
TUBERCULATION-MINOR 0 SEVERE 0
LOCALIZED 0 EXTENSIVE D
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CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM
M.TO
M.
FROM
M. TO
M.
APP ARENT CAUSE OF LEAK.
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