HomeMy WebLinkAbout239 W 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQU~ST A~-
Date ~ - ~ V I Time
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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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1'1 t~ &- fJ Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ltj (A_f-e ~
INSPECTION NOTES
Inspected Date
Remarks
Time By
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RESTORATION REQUIRED .. YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)
CIty of Port Angeles
Public 'Vorks Departnlent
Water Distribution Repair Report
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IWork Order No.
DATE REPORTED'
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I Crew
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DATE OF REPAIR.
EMERGENCY D ROUTINE D CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER D
A -:A. ')- O( TIME. } 2... JI./&)N DA.M. ~.
,
ADDRESS 'J.. A '3 Cf W I J- f/l
2. (( f. (/ c.
_ SIZE.
CONDITION
REPAIR LOCATION
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR BREAK D SPLIT BELL. 0 LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP 0 CORP STOP 0 PIPE /' CURB STOP D FITTING 0
METER SETTER D METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH D VALVE 0 BARREL D
OTHER.
COMPONENTSOFREPAffi.
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CLAMPO DRESSERO OTHER f' f- ,t flY ( .n.e; 'C{ (1- UAJ I d n5
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ~ SOIL TYPE
CUTS. ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE j J... 7 P.P.M.
WATER OFF FROM 11- fM. TO / ,f M.
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JAJ-(
FROM
M.TO
M.
APPARENT CAUSE OF LEAK.
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