HomeMy WebLinkAbout3704 Old Mill Rd - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST /)
Date cg - \ q'- () I Time Received by (phone, person)
If,6' UJ F- 7815
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
9 7 () L( i> L&f q?11/ N~l.f'
-'-L-01 \ Qj r
) '111t 'is. [} Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
W..~.+-6l-
INSPECTION NOTES
Inspected Date
Remarks
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RESTORATION REQUIRED
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
D Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
~OMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty 01 IJort Angeles
Public Works Departnlent
\" ater Distribution Repair Report
!-fIE'
u~ 78 f 5
IWork Order No' 1 ~ I )
ICrew
7/Y,
DATE REPORTED
-;>
8-/6-'07
CONDITION
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT V
LEAKAGE SURVEY 0 OTHER 0
rg -- I q - 61 TIME.
ADDRESS 3 16 Lj
OA.M. OP.M.
01 cJ q1/( /'1 (
J?~
DATE OF REPAIR.
REPAlR LOCATION
TYPE OF MAIN
SIZE
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
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 NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTIiER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTIiER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULA TION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE l 2- 7 P.P.M.
WATER OFF FROM .g 11- M. TO / {) fr M.
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