HomeMy WebLinkAbout1016 W 15th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . .
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REQUEST
Date /?- -{ ~- OD
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)
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() Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other I J.J ~
INSPECTION NOTES
Inspected
Remarks
Date
Time
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RESTORATION REQUIRED
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YES V NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel 0 Asphalt 0 PCC
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
DOther 16(:';0 I L-
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STREET SUPERINTENDENT
(DATE)
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST f f 1
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Date .. uL- 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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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other IN c::-'-...:tev
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 0 Asphalt 0 PCC
D Repaired by City
[] Repaired by Permittee
D No Damage Found
Work Order #
~MPLETE
o INCOMPLETE
o Other
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STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
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'Work Order No:
, Crew
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.
DATE REPORTED
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REPAIR LOCATION ADDRESS
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT V
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. 1 ~ - ) 1...1 - 0 ( TIME!
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~.M. DP.M.
1)1-1
TYPE OF MAIN
DEPTII OF MAIN
.J I
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED. . /'
MAIN JOINT 0 CIR. BREAK f?f SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMP~RESSERD OTHER
SITE CONDITION GRA VEL 0 ASP~ 0 SIDEWALK 0 CURB 0
TOP SOIL AREA J2f" SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
NA-
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
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CHLORINE RESIDUAL SAMPLE P.P.M. --erA ('y ~C' v)1 ...vv /~C.) . { (
WATEROFF FROM M. TO M. ;U Ll :;h vf {.fOlD ~"
FROM
M.TO
M.
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APPARENT CAUSE OF LEAK.
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City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No:
;Ir
Reported. J 1-/ VI/ ()j)
Repaired. /2- / /9 / C'D
Repair Location.
Component Repaired.
Main.
Service:
Line Valve:
Hydrant:
Other'
Repair Type:
17 s-7
Condition.
Source'
Address
Loc. Description.
Joint
Long. Break_
Tap_
Flange Nuts, Bolts
Branch
ICrew.
Emergency Routine
Citizen Complaint V
Leakage Survey _ Other
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Cir Break /
Hole
Main Line ID#:
SplIt Bell _
Clamp _ Other
Corp Stop_
Pipe _ Curb Stop _
S~m Bonn~
Barrel
Valve
Clamp /
Other
Site Condition: Surface
Curb
Damage:
Dresser
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft.
Sidewalk Cut. Ft.
Main Condition.
Apparent Cause of Leak:
5/19/98
Diameter- Inches 2, f ( C -::r:-
Material.
Depth of Cover' Ft.
Internal Lining:
Tuberculation: NI A
External Corrosion: NI A
Special Conditions: Bedding:
Other Structures.
Samples Taken:
Water Off:
Curb Cut: Ft.
"
,. ,
Joint Type.
External Prot:
Minor
LocalIZed
Severe
Extensive
Pipe Section _
Coupon --YP~
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Page 1
PW-902.09