HomeMy WebLinkAbout111 Whidby Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUE~
Date-J4- A 4 - () -; Time
Received by
(phone, person)
Location of Work to be inspected III l;') /1 ,: J b I
Name of person requesting inspection ~ U<-J t J c ,c
Address of person requesting inspection ) 7 +/, + f;> Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~
JI- /,/ --e '
.
INSPECTION NOTES
Inspected Date
Remarks
Time By
.lE't'r{'h 1- e ~ :z '. C - -c ,&"-+- ('1.--
01cu 1'1- to,. -u II L{ r e-l-e .4- )1('/
RESTORATION REQUIRED
YES
~.
NO~
oct Y\
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
D Asphalt D PCC 0 Other
Work Order # 3 c; J '}
~PLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
LIty 01 ~ort Angeles +t- ~ wF~ 3 <-t ~.3>
Pu blJc \V orks Departnlent
vVater Distribution Repair Report
IWork Order No
DATE REPORTED
I
1- 2g-6 ')
'Crew
"7/f'
CONDITION
HAERGENCY 0 ROUTINE 0 CITIZEN COIvIPLAlNT V
LEAKAGE SURVEY 0 OTHER 0
!t - 2. L( ~f.:> )
REP A1R LOCATION
ADDRESS
TIME 9', /1- )M OA.M. OP.M.
III &JA( d6y
DATE OF REPAIR.
TYPE OF MAIN
(jq --r
0<.. C- - .......-
SIZE
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COIvIPONENT REPAIRED. /'
MAIN JOINT 0 CIR. BREAK ~ SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLANW 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
C01'v1PONENTS OF REP AIR. CLANWO DRESSERO 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 _FT
MAIN CONDITION INTERNAL LINING TUBERCULA TJON-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ~ /1 P.P.M.
WATER OFF FROM r/ j:J l/i TO ) c. /1 '.;~.
M.TO
M.
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FROM
APP ARENT CAUSE OF LEAK.
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