HomeMy WebLinkAbout2548 W 19th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . . . . . .
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41A
REQUEST
Date S- Ii:> - (:, 7-
Time
Received by
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I 7. + It l. fJ Phone No
Permit No
(phone, person)
Location of Work to be inspected
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 l...0cli-tt-/
INSPECTION NOTES
Inspected Date
Remarks
ern e'
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RESTORATION REQUIRED
YES
NO j,-///
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
~MPLETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of IJort Angeles
Public Works Departnlent t:>c..v-"2-C.JOy.-? IlL.
Water Distribution Repair Report
IWork Order No:
DATE REPORTED
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6- 'J- - 6 1.-
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ICrew
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1
DATE OF REPAIR..
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT V'
LEAKAGE SURVEY 0 OTHER 0
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~ TIME rrli DA.M. DP.M.
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SIZE.
CONDITION
REP AIR. LOCA TI0N ADDRESS
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL. D LONG BREAK D
HOLE D CLAMP D OTIffiR
SERVICE. TAP 0 CORP STOP 0 PIPE D CURB STOP 0 FITTING D
METER SETTER ~ METER D
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH D VAL VE D BARREL D
OTHER.
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COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER vIJ-{l -/;.'1 Cl/~ (;-1/.1 r'
SITE CONDITION GRA VEL D ASPHALT D SIDEWALK D CURB D
TOP soa AREA D soa TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
,
MAIN CONDITION INTERNAL LINING TUBERCULA nON-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE I J I P.P.M.
FROM
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WATER OFF FROM
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APPARENT CAUSE OF LEAK.
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