HomeMy WebLinkAbout213 Whidby Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . . . . . .
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REQUEST
Date cg-A/-cL
Time
Received by
(phone, person)
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location of Work to be inspected ?.. I 3 u.) hid b \. /
Name of person requesting inspection T'LU I I {(\;< I
Address of person requesting inspection ftflt f8 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other t.}J/Lf-eY
INSPECTION NOTES
Inspected Date
Remarks
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RESTORATION REQUIRED
. YES
NO ~/
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
o Repaired by Permittee
o No Damage Found
Wor~rder #
~OMPlETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles l)l..O' 2..001- 2..z..0"
Public '" orks Departnlent
,"' ater Distribution Repair Report
IWork Order No: ~.:A.. 6 ~
I Crew
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CONDITION
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EMERGENCY 0 ROUTINE 0 CITIZEN COMPL~
LEAKAGE SURVEY 0 OTHER 0
~-?-7-o2- TIME. )0
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OA,M. ~.M.
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DATE REPORTED
DATE OF REPAIR.
REPAIR LOCATION
ADDRESS
TYPE OF MAIN
DEPTII OF MAIN
CLOSEST VALVE DEPlli.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVlCE TAP 0 CORP S,!"Oy-O PIPE ~URB STOP 0 FITTING 0
METER SETTER P' METER 0
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OlliER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALTCUT_FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MA1N CONDITION INTERNAL LINING TIJBERCULA TION-.MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I t.; I P.P.M.
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WATER OFF FROM
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APPARENT CAUSE OF LEAK.