HomeMy WebLinkAbout916 S Lincoln St - Engineering
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
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IWork Order No:
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I Crew
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DATE REPORTED'
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CONDITION
EMERGENCY ~OUTINE 0 CITIZEN COMPLAINT r!'
LEAKAGE SURVEY 0 OTHER 0
<t-....>-t/)- TIME /1:Jo
91(;,
B1\.M. DP.M.
DATE OF REPAIR.
REPAIR LOCA TI0N
ADDRESS
51/1/ IH
LIlli ctLA/
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 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0 5" 11/7 () 1/ T P /II IJ I'! (/~ fI Pc fl f ~ e 7e fl
~
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER Cf/T IN J/f/f P.c. f71f7t 'I ~ vAlIIlNl
SITE CONDITION GRAVEL 0 ASPHAL.J.- 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ~SOIL TYPE
CUTS ASPHALTCUT_IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
Cl-ll..ORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM 1'3 () P M. TO :;:, CI f' M.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. f E fll'c
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.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
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REQUEST
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Date
Time / I : ?P /I JV1 Received by /J I t.. c..
(phone, person)
r
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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111'- L
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)i/,
LI1/Ctltlo/
Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES r
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Inspected Date r Time ;2 C' ,A By
Remarks L E /f /< I AI S I f/ 8 () III () IV /J /9 C Ie
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RESTORATION REQUIRED
YES
NO L--
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
o Repaired by City
D Repaired by Permittee
[] No Damage Found
OPCC
o Other L ~ w,,<1
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Work Order #
[9"COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)