HomeMy WebLinkAbout1623 Owen Ave - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . . . .
5y_B
REQUEST
Date L) -- ~ - 6 :2-
Time
Received by
(phone, person)
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Location of Work to be inspected h ,,- . \
Name of person requesting inspection .-,- U-J i I} L. h '~
Address of person requesting inspection /7 fit cflJ ~ .+ Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (j....)(i... .kl'-
INSPECTION NOTES
By
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Inspected Date
Remarks
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RESTORATION REQUIRED
YES
/'
NO ~
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC
Wo~der #
~OMPLETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
", ater Distribution Repair Report
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I Crew.
IWork Order No. ~I I) cr
DATE REPORTED 5 - ~ -- (5 2-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT J
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. )..-- g -6:2- TIME )~ /t-)!{DA.M.DP.M.
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71'1
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TYPE OF MAIN
ADDRESS
9(' ,4 C
REPAIR LOCA Tl0N
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE. TAP 0 CORP STOP 0 PIPE ~URB 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.
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COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
curs ASPHALT cur _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAYClIT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE;" I P.P.M.
WATER OFF FROM
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M.TO
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FROM
M.TO
M.
APPARENT CAUSE OF LEAK.
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